Apple Health Records are now in use at more than three-dozen leading U.S. health systems, including NYU Langone Medical Center, Partners Health Care, Penn Medicine, Geisinger, Johns Hopkins and Duke University Medical Center. It's early yet, but so far technology leaders at those brand-name hospitals are excited about what iPhone-ready access to electronic health records will accomplish for their patients.

"I think it's an important milestone," said Richard Milani, MD, chief clinical transformation officer at Ochsner Health System. "Years from now, we'll look back and see it as a milestone."

"Apple is uniquely positioned" to make big headway on patient engagement and experience where others have found only partial success, said Shez Partovi, MD, chief digital officer at Dignity Health.

Nearly three-quarters of approximately 100 Healthcare IT News readers who took our survey are similarly optimistic.

Do you think Apple will be the consumer-facing company to find patient engagement success with its Health Records product?

"There is a built-in trust/market with Apple that is different than that of a traditional healthcare organization relationship," according to one poll-taker.

"Providers are willing to give patients their data directly with just a few clicks," said another. "That hasn't been true before."

But of those who are skeptical, their reasons varied. One pointed out that the only participants in the project so far are well-known and well-funded blue chip health systems.

"So long as it’s a big-boys only solution it will never take off," said one reader. "Too many local and small clinic providers don't have the resources to even send data to a state HIE let alone a corporation like Apple. Until EHR vendors make those connections easy and cheap, I doubt success can be achieved."

Others were skeptical about the basic premise of widespread patient engagement. While one survey respondent said there is a "pent-up demand for such access and self-management of health information," noting that Apple's "user interface and approach makes the whole process potentially so easy for users," another was less optimistic that it would catch on – even though he wished it would.

"Just because the consumer has his or her medical record does not mean they are going to be engaged in their health," he said. "As a physician, I would say that the act of getting the consumer to carry their medical records with them on their phone is an undeniable DIRECT benefit to me the ED physician."

However, "making the case that carrying this information on your phone will transform the health of the patient is misinformed at best," he added. "Sleeping with a bible under your pillow every night will not make you a priest."

A more interesting question in our poll had to with how ready more garden-variety hospitals would be to deploy a similar Apple Health Records project if given the opportunity. Just over half (53.8 percent) said they'd be able to roll out something this year.

The Apple initiative is currently being piloted by 39 leading health systems. Would your organization be prepared to roll out something like this in 2018?

One respondent said lack of "time and resources" would a big hurdle to clear. Another said it wouldn't jibe well with the "substandard IT platform currently being upgraded" at his or her hospital. And another was waiting for more "evidence that it’s widely used and safe."

But one poll respondent was ready to try it, and said the benefits of making it work, which shouldn't be too hard, were self evident: 

"If you can manage the FHIR API, which is pretty simple, this is a no-brainer to do for your caregivers. Please just stop calling it patient engagement since it is caregiver information enrichment."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

In its second acquisition this year, InTouch Health, which develops enterprise telehealth technology for hospitals and health systems, announced that it has acquired Reach Health, another telemedicine platform.

The InTouch-Reach deal happened on the same day that American Well bought Avizia for its telehealth technologies that specialize in acute care services.

InTouch Health officials said the addition of Reach Health will help it broaden its footprint and enhance its ability to help its customers roll out telehealth programs across the continuum of care.

In January, InTouch also acquired TruClinic, which specializes in online direct-to-consumer care, allowing patients to consult with their physicians from their own homes.

With this new deal, the company says existing Reach Health customers will benefit from more robust support, reliability, security and compliance.

While Reach Health CEO Steve McGraw called the acquisition “a natural evolution,” InTouch Health CEO Joseph DeVivo said customers are demanding a single platform for telehealth tools to address interoperability and data management issue.

"With InTouch Health, healthcare providers have access to the complete telehealth package in any care location," DeVivo added. "Reach Health fits nicely with InTouch Health’s recent open-platform, device-agnostic strategy."

InTouch touted its experience in emergent, post-acute, ambulatory and direct-to-consumer virtual care, making for a more fully-integrated telehealth platform for its own customers and Reach Health's client base.

Reach Health has its roots at the Medical College of Georgia, which developed the telehealth technology to allow its stroke specialists to work closely with other healthcare providers to enable more timely care to patients living rural areas the state.

Since the platform was commercialized, it has broadened its scope to other states and has helped "provide life-saving treatment for some 50,000 patients," according to David Hess, MD, dean of the Medical College of Georgia and Reach Health's board chair.

Terms of the deal were not disclosed.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Long before the opioid epidemic was thought to be a public health emergency, prescription drug abuse and misuse were steadily increasing in the U.S. 

To combat this, states and hospitals have been building technological platforms to enable prescription drug monitoring programs that can the track habits of both prescribers and patients. But use of PDMPs varies by state, with some states mandating its use and others merely recommending that hospitals and medical groups opt-in. 

With the Trump administration saying it will crack down on opioid abuse, it begs the question: Could these data-heavy platforms make a dent in the crisis?

Every state but Missouri

As it stands, every state has its own PDMP, outside of Missouri -- the state has made multiple attempts and failures to implement a statewide platform. And 46 of U.S. states are part of the collaborative PMP InterConnect, an interstate group started by Appriss Health in 2011 that fosters prescription drug data sharing across state lines.

But whether PDMP use can truly impact the opioid crisis is yet to be determined. A 2017 study by University of Texas Health Science Center at San Antonio and Northwestern researchers found PDMP use effects remain mixed.

[Also: Opioid Crisis: How tech and policy are fighting the opioid epidemic]

On the one hand, researchers found an underlying link between PDMPs and a reduction of misuse and diversion. Further, many of the programs provide a detailed prescribing history of a patient over the course of the past three months.

While the use of PDMPs obviously reduces the number of opioids prescribed within a state, the researchers pointed out a number of issues that PDMPs could impact. Namely, the ‘chilling effect,’ which could deprive patients of necessary pain medications.

Further, even when opioid prescriptions were reduced, the researchers also found that it didn’t reduce overdose mortality rates in states overall.

Another recent study by Pew Charitable Trusts outlines the obvious effects of PDMP use: identifying and reducing doctor shopping, controlled substance availability and prescribing, reduced medical and drug costs related to inappropriate prescribing, and improved health outcomes for some states.

But those benefits vary by state and are also hard to determine, as it’s not possible to conduct a controlled study. And there are so many interventions going on in states right now, explained Cynthia Reilly, director of Pew Charitable Trusts Substance Use Prevention and Treatment Initiative.

“[PDMPs] have a benefit,” said Reilly. “We’ve seen nationally that there’s been a decrease of the prescribing of opioids and PDMPs are a contributor. There’s also evidence that use of PDMPs can improve prescribing decisions and decrease the abuse of opioids, and to a lesser extent that shows it improves patient outcomes.”

For example, Michigan is one of the states leading the PDMP charge. It implemented its PDMP in 2003, which was updated in recent years to address tech challenges, by transitioning to Appriss -- the platform used by most states.

“As a result of improving that software, we’ve seen an increase in the utilization of PDMP and a drop in volume of prescriptions,” said Michigan Department of Licensing and Regulatory Affairs Acting Deputy Director Kim Gaedeke.

Both prescribers and dispensers are utilizing the platform to address potential risks. And the state has seen prescription drug deaths level off, said Appriss Health President Rob Cohen.

“It’s one of the tools that is certainly central in the fight against the opioid epidemic,” said Gaedeke. “But now we’re looking to understand how do we continue to innovate and make it better?”

Data challenges

While some states have made good progress, it’s not a nationwide trend. There is still a lot of work to be done, explained Reilly. Part of that is due to regulations that vary by state, such as how long that data can be stored, among others.

“In an ideal world we would want the information from a PDMP right in a prescriber workflow,” said Reilly.

To David Kilgo, director of systems implementation at Wolters Kluwer Clinical Effectiveness, that’s the biggest challenge: the difficulty of integrating PDMP into the prescriber’s workflow.

“In many instances, the prescriber must leave the screens in an EHR, log into the state website, search for the patient name, possibly making several selections due to the variation of names, and then return to the EHR to complete the work,” said Kilgo.

Part of that is due to software models, which were built at different times, explained Reilly. Trying to integrate that data has been a massive undertaking.

That’s partially due to “the lack of a unique patient identifier that can tie records across multiple pharmacies within a state,” along with the “lack of data availability across state boundaries,” said Kilgo.

“Imagine, for example, a clinician whose practice is near a state border,” he continued. “Their state regulation may mandate validation of the prescription history of a patient, but only in the state where the clinician is based.”

As a result, the data received about a patient’s ‘in-state’ activity, may only be a small portion of the relevant patient activity, Kilgo explained. “The very nature of a retrospective submission versus a real-time submission can cause a delay that reduces the effectiveness of the process.”

Not only that, but once in the PDMP system, the data often looks like a laundry list, explained Reilly. It makes it difficult to efficiently detect a prescribing issue or any overlapping data.

Adding to that issue is a lack of data standardization, explained Gaedeke. While most states are sharing data, it’s not always efficient given the lack of standards around state processes and requirements.

Currently, Michigan is attempting to tackle this issue, by what Gaedeke hopes will be a standardized collection of data and the ability to make data available in real-time.

“I think the key is that PDMP administrators need to collectively identify what kind of standard to agree upon - so sharing data becomes more seamless,” said Gaedeke. “We’re sharing today, but certainly we can improve on that process, especially if states agree on standards and protocols.”

The way forward

PDMPs were initially instated to ensure appropriate prescribing and to avoid patients being given too many opioids. But it’s time the platform improves to make better use of the data to improve patient outcomes.

“I think the evolution of PDMPs and continued evolution is going to increasingly impact the opioid epidemic,” said Cohen.

The next step, perhaps, would be to leverage that data to address opioid deaths, enable treatment through PDMPs and pour more data into the platform to gain more insights, explained Cohen.

States are already making those efforts to determine next steps, including determining innovative solutions, utilizing data-driven analytics and “to hopefully guide potential policy decisions,” Reilly explained. “They’re also looking into whether we’re really making a dent [in the crisis] and whether we’re seeing providers using the data.”

PDMPs would be more effective if the platform could actually better inform prescribers and identify patients at risk or those using dangerous combinations or high quantities of opioids.

“The point of a PDMP isn’t just to turn them away,” said Reilly. “The point, in an ideal world, would be to have a dialogue with a patient. Maybe their pain isn’t being properly managed, for example. We’ve also seen that prescribers will use the information to talk to patients about substance use disorder.”

Too often PDMPs are looked at as a tool to impede access, but Reilly explained that those data and platform challenges stand in the way of prescribers having the time to make those crucial decisions.

To Gaedeke, machine learning and predictive analytics could be the key to making PDMP data more actionable. The tools could not just look at morbidity trends or frequency of patients receiving an opioid prescription, but to predict outcomes.

“The goal would be to use those technologies to pull that data in so you can have better predictive modeling,” said Gaedeke. “The prescriber could see all of that data in terms of potential overdose death, and the like.”

As usage increases, it could hopefully alert the prescriber that there’s something going on with a patient, said Gaedeke. And if the patient continues down that path and the provider doesn’t intervene, it will lead to death.

“The more we can predict that, the more effective PDMPs will be,” she added. “That’s the ultimate goal. The challenge becomes, how do you pull in all of the other data assets that could be helpful when trying to transform PDMPs to help us with the predictive modeling?”

PDMPs have “such a wealth of information to inform prescribing, so how do we make sure more people are getting that information and using it?” Reilly asked. That data can be helpful to determine hot spots of overprescribing and can help with more law enforcement engagements, along with helping patients get into treatment programs.

It’s not enough for states to mandate the use, as obviously “if you require the use of PDMPs, prescribers are going to do it,” said Reilly. The real questions are whether they’re using it well and if not, how do regulators make that happen?

PDMP use is “not just checking a box or jumping through hoops, it goes back to the idea of finding out what information is more informative to the prescriber and the best way to display it,” said Reilly. “And then, focus on getting it into the workflow and move toward e-prescribing.

Kilgo agreed that these improvements would be more helpful if more states adopted e-prescribing mandates.

For example, since New York adopted its e-prescribing mandate in 2016, the state has reduced doctor shopping incidents by more than 98 percent.

“From a fraud prevention perspective, speeding up the adoption of electronic prescribing of controlled substances across all states will minimize the opportunity for unscrupulous actors to falsify or forge documents,” said Kilgo. “It also creates a gate for opportunistic prescribers to pass through before establishing a practice that targets those seeking opioid products because of a substance use disorder.”

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

Mayo Clinic is on the cusp of one of the biggest and most expensive EHR go-lives in history. 

When the health system replaces Cerner and GE software with Epic’s electronic health record on May 5, at its Rochester, Minnesota,  headquarters, the go-live will be the most critical piece of a massive technology project dating back to 2013. But it won’t the last: Launches in Arizona and Florida are scheduled for October 2018. 

Cost of the total project, which includes several pieces in addition to the EHR: $1.5 billion

[Also: Mayo Clinic's Epic EHR go-live: A look at major milestones leading up to big switch]

Aside from the U.S. Department of Defense’s estimated $4.3 billion contract to modernize its proprietary EHR and swap in Cerner, and the Department of Veterans Affairs currently paused plan to also deploy Cerner, projected to be in the range of $10 billion, and Partners HealthCare’s well-known $1.2 billion Epic project, Mayo’s undertaking puts it firmly in rarified EHR air. 

Healthcare IT News asked Mayo Clinic CIO Christopher Ross what it takes to manage a technology project of this scope, discuss the challenges and potential pitfalls and explain why he feels what Mayo has learned in the past and from other organizations inside and outside healthcare.

Q: What is the trick to managing a software rollout this important?

A: Managing a project of this scope requires a lot of hard work and discipline applying lessons learned from other organizations and previous Mayo Clinic implementations. We’ve completed comprehensive planning and extensive preparation with a single-minded focus on our core mission: Putting the needs of patients first. This version of Epic was built to meet the specific needs of Mayo patients and staff. Several thousand staff from across Mayo Clinic have contributed to this project in a myriad of roles. Organizations sometimes wait to address user experience and optimization efforts after a system implementation is complete. We’ve seen the pros and cons of that. Mayo Clinic tried something a little unusual by conducting usability studies beforeimplementation to improve the way the system is built. We will continue to focus on user experience long after the project is complete.

Q: Size of the project aside, what unique challenges does Mayo Clinic face with this rollout?

A: The project is highly complex due to the number of specialties and subspecialties involved. We have spoken with several organizations that implemented the Epic system in recent years. They have shared lessons learned and best practices. Outside firms are also advising on best practices and providing risk assessments. Many processes are in place to anticipate, track and address project risks. Moreover, we are not only focused on building and delivering a converged technical solution. We are also invested in the people side of change to support them in adopting, utilizing, and becoming proficient in the Epic system. This is being accomplished through a comprehensive change management strategy.

Q: What have you learned from earlier rollouts?

A: After the first successful implementation at Mayo Clinic Health System in Wisconsin, we modified the staffing, support and training to further enhance the success of the second implementation at Mayo Clinic Health System in Minnesota.  Both implementations have gone well, and the second was better than the first. We expect to see improvements in our third and fourth rollouts. We’re already seeing the benefits: We’re able to consult with colleagues about patient care more efficiently, offer answers more quickly and ultimately, spend more time with our patients.

Q: How many people does Mayo have dedicated to the Rochester implementation?

A: The core project team includes about 460 members, but thousands of staff have been involved in the project across Mayo Clinic. Approximately 26,000 Rochester staff will go through training.

Q: Will this rollout be harder or easier than the previous work at Mayo Clinic Health System in Wisconsin, and why – or why not?

A: This will be the most complex implementation due to the number of specialties and subspecialties involved. The Rochester implementation will be about four times larger than either health system implementation.

 Q: How does the $1.5 billion cost break down – the EHR system, preparation, staff training, implementation? 

A: Mayo Clinic has embarked on a major technology modernization program across the enterprise, and we estimate our investments over multiple years for many purposes, not the EHR alone, will be about $1.5 billion. Only a portion of this goes toward the electronic health record and revenue cycle replacement, and only part of that will go to Epic since much of the work is being done by Mayo Clinic staff. Other technology investments are to advance patient care, to upgrade the data network and improve information security.

Q: What worries you the most about a project of this size?

A: The complexity and scope of the project.

Q: What gives you confidence?

A: I have great confidence in our excellent clinical and technical staff and the superb support we are receiving from the Epic team. Our previous experience and the preparations we have made position us well for a successful implementation. I’m also confident because this program is strongly physician-led, and is based on a pre-existing eight-year effort to converge and standardize our clinical practice. Our group practice patient care has been integrated from the very beginning and we have been a leader in the use of electronic tools. This is one of the largest projects in Mayo Clinic history and is quite complex in scope and size. However, Mayo Clinic has extensive experience in implementing large-scale systems and we already have completed successful implementations in Mayo Clinic Health System. As we have worked with various vendors and built systems at our sites, we’ve learned from each other and shared that knowledge to bring us to where we are today. We are well positioned to implement a unified system that will meet our patients’ needs and Mayo Clinic’s needs now and into the future. 

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

American Well launched new telehealth technology on Tuesday dubbed AW11 at the American Telemedicine Association Annual Conference and Expo. 

The new version comes one day after American Well announced its acquisition of Avizia, with plans to broaden its offerings in the acute care space, with new software workflows for some 40 clinical specialties, including telestroke and tele-behavioral health.

Now, with the release of AW11, American Well said it's making another move for hospitals to offer remote consults, with a redesigned user interface, and more telemedicine capabilities designed for inpatient settings.

Most notably, the new software offers a direct embed option to integrate telehealth visits directly into hospitals' electronic health records, enabling physicians to continue their clinical documenting without disrupting their workflow.

The new app has a more appealing and intuitive visual design, according to American Well, and offers automated enrollment help providers more easily use the technology. It also offers what the company calls a "global home" feature gives physicians a way to see patients from across different practices, exchanging services system to system. 

"Telehealth is expanding rapidly by way of consumer adoption," said American Well CEO Roy Schoenberg, MD. "As a result, there's a heightened sense of urgency to tighten the integration into provider workflows, as the two are so deeply intertwined.”

Schoenberg said that, as telehealth continues its evolution "from an urgent care consumer app to an ecosystem where clinical services are distributed digitally, deep assimilation into the provider day-to-day reality, supporting systems and practicing lifestyle becomes pivotal for adoption and growth."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Health executives know about Amazon, Apple, Google, IBM and Microsoft making moves into the healthcare industry but there are far more Fortune 50 companies that already have a foot in the space. 

Translation: Healthcare is even more ripe for disruption than it presently appears. And that means it’s time to act fast or face irrelevancy. 

Here’s a look at what hospital IT shops should be doing now to prepare for the future. 

Strange healthcare bedfellows

New research from PwC found the U.S. health industry is undergoing “seismic change” generated by a collision of forces, such as the shift from volume to value, rising consumerism and the decentralization of care. 

“The last six months have seen an explosion in unusual deals with the potential to reshape the US health ecosystem,” PwC authors wrote. 

[Also: Why the Amazon, Berkshire and JPMorgan plans should inspire hospital IT shops to act fast]

PwC, in fact, found that 84 percent of Fortune 50 companies already have a play in healthcare, and that’s up from 76 percent in 2013. 

Consumerism, also on the rise, is posing a threat to old business models. PwC noted that while 17 percent of doctors used an EHR and 11 percent of people in the U.S. had a smartphone in 2008, those statistics have risen to 87 percent and 79 percent, respectively. That essentially opens the doors for technology firms to step in and deliver what consumers want more effectively, not to mention faster, than traditional healthcare entities. 

Amazon, JPMorgan Chase and Berkshire Hathaway aligning to focus on improving health insurance for their own employees is one example. CVS Health buying Aetna is another. 

[Also: Follow the money: Where Gartner, IDC and HIMSS Analytics say hospitals will invest the most in 2018]

To the question of whether Amazon can succeed in healthcare, 27 percent of respondents to new Venrock research said, “they just might pull this thing off.” Forty-eight percent, however, answered with “it’s gonna be a long haul,” and 25 percent believe the companies “have no idea what they’re getting into.” 

Venrock’s research also found that 51 percent of participants said Amazon will have the biggest impact on healthcare in 2018, followed by Apple at 26 percent, Google at 18 percent then a sharp drop to IBM at 3 percent and Microsoft at 2 percent. 

“This shifting terrain is creating uneven opportunities in the new health economy and will likely drive players new and established to reconsider their business models and strike the sorts of deals announced in the past six months,” PwC authors wrote. “Some will be driven to seek returns in new markets as their core revenues shrink. Others will find success creating value for other players, including consumers. Still, others will thrive by building infrastructure for the emerging virtual health system.” 

PwC recommends: Fluency and focus 

PwC was careful to point out that it could take a while and it’s wise to know that some of the moves that appear to be substantive today will fail, others will be transformed, while some will succeed. 

With little doubt that disruption is coming, what can health executives do to prepare for the future regardless of what it might look like? 

The consultancy cited Jeff Arnold, Chairman and CEO of Sharecare, a digital Sharecare CEO Jeff Arnold in saying that it’s time to become fluent in three languages: healthcare and technology, of course, but also and perhaps surprisingly media. Simply put: hospitals are going to have communicate with existing and prospective consumers in new ways. 

PwC, for its part, also recommended three key areas to focus on in the short- and long-term as patient experience, broadening the workforce, and price. 

Patient experience: That consumer expectations are changing as they embrace retail clinics for certain care events and increasingly anticipate that hospitals will operate on modern technologies is well known, if not as widely acted upon, at this point. “Companies that invest in a deep data-driven understanding of their customers will be able to develop tailored products and services,” PwC wrote. Newcomers the firm described as “vertical integrators, technology invaders and health retailers all have a leg up on many established health players in understanding consumers and tailoring experiences for them.” 

The benefits of a broader workforce: PwC predicted that emerging business models will include knowledge worker coding, writing artificial intelligence tools, running data analytics and prototyping new technologies to advance patient experience. The firm added that 39 percent of providers are already investing in AI, machine learning and analytics. “Yet few established companies have the in-house capabilities to develop and implement these tools, so they should acquire these skills or partner to gain access to them,” the authors wrote. “And they should be prepared to pay for them — the rest of the global economy is seeking these capabilities, too.”

Money matters: “Price is the next frontier,” PwC wrote. Since potential disruptors are better-positioned to tackle costs through scale and a grip on the healthcare value chain than hospitals, healthcare organizations must focus on pricing or risk losing patients. “Consumers, employers and the federal government are seeking relief on price and likely will reward companies able to significantly cut them without downgrading quality.”  

Today, there are plenty of indications that change is barreling its way into healthcare. The aforementioned unorthodox partnerships, new models of care, even new ways of providing care based on value rather than volume and using telehealth tools to treat patient outside the hospital are among those.

Ultimately, that means the time has come for hospitals, those dreading change particularly, to drive new business models, strike bold not-yet-considered partnerships akin to those that have manifested in the last six months — and innovate to shape the future that is coming. 

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

It's a big week for Epic implementations in the Upper Midwest. The world-class Mayo Clinic is ready to go live with its newly-minted system on May 5, after more than three years of work. And today comes news that sprawling Trinity Health, based in Livonia, Michigan, has selected Epic to build out its own enterprise-wide electronic health record and revenue cycle management system.

It's a process the Catholic health system expects will take four years to implement across its 94 hospitals and 109 continuing care locations. The expected cost of the deal was not disclosed.

Trinity officials said the integrated Epic platform will allow the health system to improve experiences for patients and clinicians across the board.

"People deserve customized and convenient healthcare experiences, including simple access to a complete health and billing record," said Mike Slubowski, president and chief operating officer of Trinity Health.

"At the same time, physicians and clinicians need tools that make it easier to practice medicine," he said. "We look forward to implementing a single, enterprise solution enabling us to deliver excellent, people-centered care."

It's the same appetite for a seamless and enterprise-wide system, across all locations and functionalities, that Mayo Clinic CIO Christopher Ross said was a factor in its choice of Epic back in 2015. That health system had been "steadily working toward a convergence of its practice" for several years, he said at the time, and best-of-breed would no longer suffice for achieving those goals.

At Trinity Health, the plan is to leverage Epic as a fully-integrated system for a single, comprehensive health record for every patient.

Trinity tapped Epic on the strength of the different products offered on that single, unified platform, officials said – not just enterprise EHR and revenue cycle, which will eventually go live at all of its hospitals, ambulatory centers, physician offices and continuing care programs, used by some 100,000 employee – but also online scheduling, e-visits and  online bill pay.

"We are confident a single platform will enable new levels of innovation, consumer focus, clinical and business integration and efficiency to help us build our people-centered health system," said Slubowski. "It will also help align people, process and technology to create a culture in which people-centered care becomes the standard way we care for the communities we serve."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Efforts to break down inefficiencies between providers and payers has put healthcare IT organizations on the front lines.

In so-called “payvider” models, health systems may establish their own health plan or partner closely with an existing payer. In either case, the objective is to bridge information silos, streamlining processes and coordinating care with the ultimate goal of improving health outcomes at reduced cost.

“It’s a great a great opportunity to work together, rather than independently,” said Pam Jodock, senior director of health business solutions at HIMSS. “The level of partnership we’re seeing evolve, especially as it relates to downside risk, creates a win-win for both organizations. It helps the provider organization make immediate course corrections when appropriate, and it also helps the payer in managing [its] costs and improve [its] relationships with providers.”

While the “payvider” concept has been around for decades, reforms to Medicare and the Affordable Care Act (ACA), both of which incentivize and penalize providers around health outcomes, get most of the credit for the switch from fee for service to pay for value. However, Jodock and others say new consumer expectations are playing an equally important role.

“As a consumer, you don’t want to be necessarily forced to use one [provider] or another,” said Alan Hughes, president of the global healthcare and life sciences practice at NTT Data Services. Consumers who can bank from their smartphones increasingly expect the same fluidity and choice when it comes to medical treatment. “Empowered consumers” are behind the quest to integrate healthcare data and processes, he said.

Another force is what Michael Parkerson, an industry leader and former chief strategy officer for Blue Cross Blue Shield North Carolina, called the “affordability crisis.” “It’s driving the need to identify and eliminate inefficiency,” he said.

Data, insight, action

Achieving the “payvider” business model obviously requires bridging many information silos. But an even more important step comes earlier: simplifying existing processes.

“Sometimes we digitize before making a process efficient,” said Parkerson, adding that healthcare is “data-rich but insight poor and activation absent.” The good news, he said, is that vast opportunities now exist for taking existing data, such as a patient’s digital records (claims, clinical results, financial status, consumer activities and lifestyle habits), analyze them and provide insights to clinicians at the right moment. Similarly, other systems could activate the patient’s networks, be they other healthcare professionals or friends and family.

Reduce variation

For Hughes, a disciple of the 6 Sigma process improvement methodology, another IT problem is the profusion of “solutions to any given business process.” This is one place healthcare IT organizations can start preparing for the “payvider” revolution because excessive variation drives costs, he said. He expects industry consolidation will help with this. “Over time, you’ll see rationalization with a smaller set of technologies from a processing perspective and somewhat more standardization than we see today,” he said.

But gaps remain, particularly on the financial side. “In those situations where there is financial reward or penalties associated with contracts, [you’d] need to determine what portion of risk to assign to each of the providers touching that patient in that episode of care,” Jodock said, citing Medicare. “But we do not have the technology or processes in place to follow and record those activities.”

All three experts were optimistic that infrastructure changes, such as the adoption of the public cloud as well as the use of advanced analytics and AI, will help address current inefficiencies inside and between clinical and financial networks.

Cultural issues

Yet all three are equally convinced that the biggest impediment to the “payvider” movement isn’t technology per se.

“The technology challenges can generally be worked through,” Jodock said. The bigger challenge is a cultural one — the long-standing adversarial relationship between healthcare providers and insurance companies. “Even if you have the technology to support the business functions as being proposed, you need both parties to be able to trust one another ... that the data they’re sharing [are] accurate, the data they’re sharing [are] going to be used appropriately, and not used against them … etc.”

Jodock’s advice? Find one person in each organization who wants to build the relationship and act as ambassador. She also stresses the need for transparency. “Talk about the problems you want to solve and be honest about what you can bring as a solution,” she said, adding, “Don’t make promises you can’t keep.”

NTT Data’s Hughes agrees. “I don’t believe this is a technology issue; it’s a business philosophy issue,” he said. While providers and payers desire seamless solutions, he said they first need openness and common goals and a plan for sharing in the rewards of keeping people healthy.

Top priorities for payvider convergence

How do IT leaders ensure that their organization is prepared for the payvider convergence? The top priorities should encompass:

• Collaborate with your peers to ensure there is a clear strategy and measurable objectives for your organization’s efforts to either stand up a health plan or work more closely with payers.
• Don’t tackle technical solutions until there are clear business objectives and requirements from your stakeholders.
• A robust data governance model is essential to realizing the benefits of the payvider convergence, especially when it comes to identifying which source of data will be considered the “source of truth” between EHR data, claims data and other third-party sources of information.

With this strategy in place, healthcare organizations will be able to not only manage this transformative and disruptive convergence but thrive in this new healthcare ecosystem.

Blockchain holds big potential for overcoming issues of trust and ironing out technology wrinkles in the sharing of clinical and financial data in healthcare. While that is becoming increasingly widely discussed, it’s also true that the distributed digital ledger technology is still somewhat shrouded in mystery and has that futuristic feel about it. 

There’s little questioning the road ahead will be long but new evidence is emerging that perhaps practicable uses of blockchain are closer than many health IT and security professionals currently think. 

Blockchain: healthcare to benefit from financial services early work

New research from Deloitte and Chilmark offer a real-world look at what’s happening in blockchain today. 

“Blockchain is gaining traction, but critics who question the scalability, security, and sustainability of the technology remain,” Deloitte begins its report, Blockchain and Cybersecurity. Let’s Discuss. “Deloitte member firms across the globe are continuing to collaborate to build blockchain capabilities to develop world class solutions and services for clients.”

In its new report, Blockchain: Opportunities and Challenges in Healthcare, Chilmark Research analysts said there are various way the technology can help ease friction between stakeholders and enable new approaches to data privacy, quality and timeliness.

Specifically, researchers are intrigued by the technology's inherent ability to offer integrated, decentralized database capabilities, allowing for data exchange without the need for third-party mediation.

[Also: 'Mad Libs' for blockchain: Fill in the blanks now to avoid mistakes before it's too late]

The opportunity for more granular identity management, immutability and proof of provenance are other appealing features that could help improve data quality and security, they said. The groundwork is already being laid for blockchain advances in other industries, and now healthcare should capitalize on some of the headway that's been made.

"Healthcare will benefit from the early work in finance and leverage blockchain applications in finance and supply chains and a few applications based on identity management," report author Jody Ranck said in a statement.

Deloitte noted that the interest among financial services and technology firms is so strong that in 2016 alone they collectively invested more than $1 billion and said an exponential increase is expected during the next five years. 

Blockchain market-ready apps are here but challenges remain 

Chilmark listed some of the companies already making inroads with blockchain in healthcare: Accenture, Change Healthcare, Deloitte Rubix, Factom, Hyperledger, MedRec, PokitDok, Simply Vital Health, SolveCare and T Systems.

Many of those have applications that are market-ready for 2018 but for all the quick advances that seem to be happening with blockchain so far – beyond the hype and over-promises, of which there's also plenty – Chilmark said healthcare should be prepared to ride out the technology's ongoing evolution.  

There will be challenges along the way, but Chilmark said a way forward exists to where blockchain becomes much more foundational to IT systems than many might expect at this point.

And especially working in tandem with other fast-evolving technologies – artificial intelligence, cloud computing – blockchain could well enable fundamental changes in how the industry manages data for care delivery and claims processing. Chilmark also noted that claims adjudication, care coordination, patient engagement and supply-chain are areas ripe for disruption by distributed ledger-based approaches. 

"We need to view blockchain almost as an infrastructural transformation," Ranck said. 

Deloitte echoed that sentiment.

“Blockchain’s evolution has been compared to the early rising of the internet with comments and arguments of the technology’s potential to disrupt multiple industries including healthcare, public sector, energy, manufacturing and particularly financial services, where it is predicted to be the beating heart and the ultimate provider of a new industry fabric.” 

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

The ongoing uncertainty about the status of Cerner's EHR contract with the U.S. Department of Veterans Affairs is beginning to have an impact on the company's balance sheet. 

Cerner executives discussed its first quarter 2018 numbers on a conference call on Wednesday. The vendor's bookings were $1.4 billion – up 12 percent compared to the same period in 2017. Revenue increased too, but not as much as analysts had hoped: $1.3 billion, up just 3 percent from the previous Q1.

The company's first quarter operating cash flow was $409.0 million. Net earnings for Q1 2018 were down, slightly: $160.0 million, compared with $173.2 million in 2017. Adjusted Net Earnings were $193.9 million, compared with $197.8 million in 2017.

"Our mixed results and revised outlook reflect the delay of a large contract and a less predictable end market," said Cerner President Zane Burke. "However, we remain optimistic about our long-term growth opportunities due to our strong market position and portfolio of solutions and tech-enabled services that align with the pressures healthcare stakeholders are facing."

The controversial dismissal of former VA Secretary David Shulkin, MD, in March has thrown the no-bid EHR modernization contract he'd awarded to Cerner into doubt.

There's money there to at least get the project – expected to exceed $16 billion – off the ground. The House Appropriations Committee on Military Construction in April voted to earmark some $1.2 billion for the EHR for fiscal year 2019 and (without mentioning Cerner by name) said VA must adopt the system that's being rolled out by the Department of Defense.

But ongoing disarray at the VA – most notably the withdrawal this past week of Ronny Jackson, MD, President Trump's pick to lead the massive agency – has left the impression that the status of Cerner's contract won't be clarified any time soon.

And earlier this week, Politico reported that Bruce Moskowitz, MD, a Florida physician who sometimes socializes at Trump's Mar-a-Lago resort, had bent the ear of one of Trump's outside advisors on veterans issues, Ike Perlmutter, to say he wasn't a fan of Cerner technology from his experience with it at two nearby Tenet Healthcare facilities. Sources told Politico that VA’s Office of Information and Technology investigated the Cerner systems Moskowitz uses at the two hospitals and discovered the software to be out of date.

While the delay of the VA contract is "disappointing, we continue to believe we have broad support from key stakeholders and initial funding for the project was approved as a separate line item in the budget," said Cerner's Chief Financial Officer Marc Naughton.

Burke added that Cerner continues to be in touch with Capitol Hill, the White House, VA and others. Despite the fact that VA leadership is serving on an interim basis, and there's no clear timeline for when a new secretary might be confirmed, "all of those factions are all seemingly moving ahead."

The line item in the House's budget "is a critical item as we move forward that gives us the confidence in that side," said Burke. "But obviously, it's been very challenging for us to predict the actual completion of that contract."

As Cerner waits for the issues impeding the contract finalization to be sorted out – the hope is for a resolution during the second half of this year, officials said on the earnings call – executives are keeping an eye on the larger goal.

"We believe the VA's going to happen," said Naughton. "We're going to be absolutely prepared to deliver on that when it does."

The holdup, he emphasized, "does not change in any manner the magnitude or importance of the overall opportunity. We will be ready to deliver when it signs."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Change Healthcare has unveiled a new version of its Acuity Revenue Cycle Analytics that will enable users to track and gather data across the revenue cycle continuum. 

Change’s move to boost revenue cycle solution comes at a time when such products are in high demand, as hospitals strive to grab every dollar and either maintain or grow margins and footprints.

Healthcare organizations are poised to spend more than $90 billion worldwide by 2022, an outlook spike from about $51 billion in 2017, according to a recent Research and Markets report. So it’s not surprising that startups such as Recondo and Payformance introduced new rev cycle tools earlier this year while bigger players such as Cognizant bought Bolder Healthcare Solutions to round out its RCM portfolio earlier this year. 

[Also: Trinity Health chooses Epic for integrated EHR, revenue cycle management]

Hospitals use such tools to optimize collections, cut insurance claims denials, expedite the explanation of benefits and improve the quality of information sent to patients.The report said Factors reimbursement cuts, EHR mandates, governmental push to boost the adoption of RCM solutions and revenue loss thanks to billing errors are some of the drivers in the upward moving market. loss of revenue due to billing errors, and process improvements in healthcare organizations.

In introducing its new technology, Change said revenue cycle managers often struggle to optimize processes because they can’t analyze the flow of revenue through every phase of the cycle, denying them the ability to pinpoint challenges. As such, the new program enables providers to access data no matter where it lives in the revenue cycle. Change added a customizable dashboard that facilitates viewing rev cycle performance data, be it historical, near real-time within or across facilities. 

“Provider revenue cycle managers get near real-time information and can set customer performance alerts without involving IT resources,” Change said.

The program also connects to the Change Healthcare database, which contains billions of healthcare financial transactions including eligibility, authorization, estimation, claims and remittance data supporting root-cause analysis.

Finally, the technology provides a broader view of the revenue cycle continuum which can allow providers to pinpoint trouble areas and helps providers understand how estimated patient charges compare to actual adjudicated insurance benefits to gauge the accuracy of patient responsibility estimates up front.

“With visibility into eligibility, estimation, pre-authorization, and medical necessity, as well as the relationships between processes that span departments and systems, revenue cycle managers now can make decisions to better manage consumer experiences, promote accurate and timely payment from patients and payers, and improve patient access team management,” the company said.

Other vendors have out with tools that are specialized toward a specific niche of healthcare revenue cycle operations. Payformance Solutions, heeding the much-heralded shift from volume to value-based care, designed and unveiled a cloud- service to connect hospitals and insurance companies in that transition.  It includes technical tools for designing, evaluating, building, measuring and negotiating value-based reimbursement requirements that the company said would enable providers and payers to also align their financial goals with improved patient outcomes.

Recondo Technology has unveiled plans for a new revenue cycle management tool that harnesses artificial intelligence and Epic's electronic health record to cut denials and boost POS collections.

The Recondo automated RCM platform for Epic capabilities include: patient demographic verification, real-time eligibility and authorization, benefits normalization alerts management for denial risk reduction, and it and features Recondo's ReconBot technology for authorization initiation and follow-up.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

The Food and Drug administration is looking for its own, large-scale EHR system to track the safety of regulated products and drug adverse reactions.

According to the RFI, the EHR would support a critical project of the FDA’s Bioinformatics and Biostatistics, which will research the safety and surveillance of regulated products through the FDA’s adverse event reporting systems. 

FDA has requested $100 million in FY2019 for an EHR initiative to evaluate the safety of regulated products. 

[Also: New EHR go-lives, RFIs and other interesting moves so far in April]

The pilot study will work on the FDA Adverse Events Reporting System (FAERS) Center for Drug Evaluation and Research (CDER) database. Researchers will analyze data with a data mining and data visualization method, developed and evaluated by the EHR system.

Researchers will take not only FDA data but also leverage data from the Department of Veterans Affairs, specifically looking at drug-induced cardiovascular abnormalities after drug exposure. The project will use topic modeling to identify hidden adverse events and “significant safety signals from the FAERS, Vigibase and the VA EHR databases.”

The FDA also is hoping to identify the relationships between the use of multiple drugs and repeat adverse events using data mining.

Part of the contract will include the development of the VA cardio-related database, which will be developed using the VA Health System’s Informatics and Computing Infrastructure database.

The database will need to contain a drug dictionary and patients receiving drugs included in the study, among other elements. It also will be able to identify patients who developed cardiovascular issues after drug exposure.

Further, it would select a medication-matched controlled population of those patients who received the same medication but didn’t develop any cardiovascular abnormalities.

Currently, while the data for these patients exist, it is located on various platforms, including VistA.

However, the FDA’s data project may need to move this data in the future, as the VA still is planning on signing its EHR modernization contract with Cerner despite numerous delays due to both interoperability and the lack of a permanent VA Secretary.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

EHR vendor Allscripts has made an agreement to purchase patient communication app maker HealthGrid for $60 million in cash, with an additional $50 million in earn-out payments based on HealthGrid achieving certain revenue targets over the next three years, according to a recently registered SEC filing. The merger of the two companies is expected to close sometime during Q2 2018.

“The growing adoption of value-based care, combined with the modest level of usage of patient portals across the industry, has made it critical to take a new approach to patient engagement solution design,” Richard Poulton, president of Allscripts, said during the company’s Q1 earnings call yesterday when announcing the acquisition. “We expect to tightly integrate the Health Grid capabilities into our FollowMyHealth platform, adding functionality that would enable providers to reach 100 percent of their patient populations by leveraging existing patient contact information rather than requiring patients to sign up for the portal.”

HealthGrid is a mobile app platform that delivers care and education materials traditionally distributed from practices to patients via paper. For example, an electronic discharge document provided when a patient walks out the door could include appointment reminders, educational videos, or even updates for parents on where their child is within the hospital at a given time, HealthGrid CEO Ed Martinez explained to MobiHealthNews back in March.

“Keep the patient engaged and keep them in the center of the discussion,” Martinez said at the time. “If you do that, margins go up, satisfaction goes up, compliance goes up because the patient is more aware of what they have to do.”

Allscripts hasn’t shied away from M&A opportunities lately. In October the company announced the acquisition of McKesson's Enterprise Information Solutions business, which Poulton said was progressing well during the earnings call. A few months later, Allscripts also announced an agreement to acquire another EHR, Practice Fusion, and according to Poulton is currently in the process of integrating it with the payer and life science business unit. On the other hand, Allscripts also closed on a divestment agreement with Hyland Software that unloaded its OneContent offering and returned $260 million.

Poulton said that the company’s leadership is happy with its recent moves across the EHR market, and was optimistic about what its most recent acquisition will be bringing to the table.

“Patient engagement is a top-of-mind challenge for CEOs and leaders of healthcare provider organizations of all sizes,” Poulton said during the call. “Once integrated with FollowMyHealth, we believe the platform will have the broadest reach of pre-encounter, during encounter, and post-encounter patient engagement opportunities in the entire industry. Since most of our EHR clients use FollowMyHealth today, we see a meaningful opportunity to grow with this expanded offering.”

Allscripts’ quarterly report also included strong gains for the company, including a 24 percent increase in GAAP revenue and $304 million in bookings (up from $286 million during the same time last year).

Healthcare IT News previously reported on a KLAS study that showed "speech recognition proving its worth," with findings that nine out of 10 hospitals had plans to expand their deployment of front-end voice tools. Four years later, that potential may be stalling somewhat.

Clinician resistance was cited as a big hurdle to voice recognition technology making the most of its usefulness in that 2014 KLAS report. Now, in a new study, the research agency sees other limiting factors at work in U.S. hospitals, with speech tools failing to improve the usability of electronic health records to the degree many think they should.

"Front-end speech recognition tools have long held the promise of increasing EMR usability for physicians and helping to decrease costs," write Boyd Stewart and Alexander McIntosh in the report. "In reality, a lack of widespread adoption has hampered healthcare organizations’ ability to fully realize an impact."

That said, for those who hospitals who embrace the tools and deploy them in a holistic way, there are big gains to be had, even if physician satisfaction isn't always one of them. KLAS took a look at customers of Dolbey, M*Modal and Nuance who had fully deployed speech technology, asking them for input about what they've gained from using front-end tools with their IT systems.

The promise of voice technology, when properly deployed, is to improve physicians' user experience and smooth their EHR workflows. Of the providers surveyed by KLAS, nearly all said the tech has "had an impact on overall physician satisfaction, yet when pressed for details, most point to satisfaction with the speech tools themselves and not specifically to impact on physician job fulfillment or burnout."

But those who implemented the technology most robustly enterprise-wide said they discovered that voice tools help in other other areas, such as cost savings and productivity. Among the vendors profiled, KLAS offered several insights from the hospitals it polled.

Dolbey has "done well at establishing high-value relationships with their clients for some time," but some customers craved further innovations from their voice recognition offerings. "About a quarter of current customers are at risk of moving to other vendors who, while not as strong in relationships, offer more cutting-edge technology that is better able to meet evolving needs," according to the report.

KLAS noted that M*Modal’s cloud-based Fluency Direct technology is scalable for larger institutions, contrary to popular opinion. It reported that several hospitals, some with as many as 3,000 beds are currently using M*Modal, and most were very satisfied. "Current users feel that, in addition to good support, the product itself is easy to use, integrates well with other systems, and gives organizations the functionality they desire out of a front-end speech tool," researchers wrote.

Meanwhile, Nuance’s Dragon Medical One tool "is seen as a leap in improvement over the previous Network Edition," according to KLAS, which showed that across all metrics the new version of the technology more well-liked than the previous one. "Technology factors including ease of use, functionality, and overall product quality are all highlighted by high adopters as advantages of the new platform," according to the report.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

The Sequoia Project is developing a nationwide deployment plan for Patient Unified Lookup System for Emergencies, a disaster response platform for health information access that was launched this past year in California.

First launched during the 2017 California wildfires, the PULSE platform makes critical patient data available during disasters, when patients may need to be treated by providers that don't have knowledge of their health history and may not have access to traditional electronic health records or health information exchange systems.

[Also: Carequality's interoperability framework now exchanging 2.5 million documents monthly]

The system currently lets healthcare professionals, registered and authenticated through California's Emergency System for Advance Registration of Volunteer Health Professionals system, retrieve data on evacuees from statewide HIEs, hospital systems and other sources using national standards.

The PULSE approach was first conceived by the Office of the National Coordinator for Health IT and Office of the Assistant Secretary for Preparedness and Response following experiences in Hurricanes Katrina and Sandy– natural disasters where physicians and nurses arrived at shelters to offer care, but their credentials couldn't be confirmed and they couldn't the evacuees’ data.

In California during the wildfires, the platform helped many area health systems to offer better care to those who were displaced. Now, the aim is to take the system nationwide.

Sequoia Project will also launch a PULSE advisory council to build on those early successes and help guide efforts to bring the platform to other states. It will focus on governance and policies for a national-level platform that enables more robust data sharing among healthcare volunteers and community providers.

"Disasters and other events are unpredictable and disruptive and place unique demands on public health, private sector healthcare, first responders and other key resources," said Mariann Yeager, CEO of The Sequoia Project, in a statement. "People need seamless healthcare, whether for emergency care or just uninterrupted prescription access, when they are displaced by a disaster."

The new advisory comprises experts from federal and state government, emergency response organizations, HIEs and providers. Its membership includes representatives from ONC, CMS, HHS, California Association of Health Information Exchanges, California Emergency Medical Services Authority, Dignity Health; Audacious Inquiry and Texas e-Health Alliance.

"PULSE is a public-private collaborative effort focused on ensuring our cities, counties and states are ready for when the next disaster strikes," said Yeager. "Disasters and other serious events are inevitable, but how we handle them improves daily, and this effort will help communities take an important step forward toward more effective disaster response."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Activist investor Elliott Management is pressing athenahealth CEO Jonathan Bush to sell the cloud-based EHR company he co-founded in 1997. Shares of athenahealth jumped more than 23 percent on the news.

Bush, who is in the midst of retooling the company, said in a statement Monday that the board of directors would "carefully review the proposal to determine the course of action that it believes is in the best interest" of the company and shareholders.

To date, athenahealth has managed to fend off the circling New York hedge fund, which is headed by Paul Singer.

This latest offer, to pay $160 in cash per share, comes on the heels of first quarter results that appeared to provide a slight boost for the company – although Bush acknowledged during the first quarter 2018 call with investors that there was still more "remodeling work" to do.

"The case for going private is compelling and cannot be ignored," Jesse Cohn, a partner and senior portfolio manager at Elliott, wrote to the athenahealth board, adding that the company "has not worked for many years, is not working today and will not work in the future."

He said that, as a public company, athenahealth "has not made the changes necessary to enable it to grow as it should and to create the kind of value its shareholders deserve."

Elliott Associates took the first step toward acquiring athenahealth in May 2017 when it purchased 9.2 percent of its stock, which at the time triggered a 12 percent jump in stock price.

In an effort to ward off a takeover, Bush began to restructure in October 2017. The company cut 9 percent of its workforce, closed some offices and sold the company jet.

In February 2018, athenahealth appointed former GE chairman and CEO Jeff Immelt as chairman of its board of directors.

In April 2018, Bush announced an overhaul of the company's structure, with new standalone micro-services.The company debuted Epocrates Connect, a mobile app in March at HIMSS18. The system uses machine learning and language processing to give providers information and help coordinating patient care.

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

LifeArts Integrated Health Center in Plattsmouth, Nebraska, implemented a patient experience management platform this past year. The technology is designed to be used across any in-office or personal device, offering a consistent and intuitive digital waiting room experience between patients and the practice.

The practice quickly realized results: Its caregiver is seeing two to three more patients per day while its administrative staff are saving nearly 20 hours a week on administrative tasks, including saving 15-20 minutes of time per patient and reducing new client blocks from one hour to 35 to 40 minutes.

Further, the tool has "made it easy for patients to view and pay their own balances and save their payment preferences, resulting in a substantial increase in patient collections for 2017,” said Julie Howard, FNP, a chiropractor and family nurse practitioner at LifeArts, describing the Breeze platform from vendor CareCloud. The practice also uses CareCloud's electronic health record and practice management systems.

“My accountant even commented on the difference in our bottom line – we boosted our billings by more than 27 percent compared to a year ago," said Howard.

The icing on the cake for Howard is that now she has her weekends off and evenings free. She has time to be with her family and have the work-life balance that she so desperately wanted.

“I love what I’m doing again and can finally be the provider that I’ve always wanted to be – and that starts with being able to put my patients first,” she said.

This all started a couple of years ago when Howard was so frustrated with the inefficiencies of managing the operations and paperwork associated with her practice that she was considering a job elsewhere and closing her practice altogether.

As a solo practitioner, she was working 12 hours a day, seven days a week, and was burned out.

“Beyond the long hours, I knew there was a better way to connect with my patients and make the experience easier and more efficient for them, too, so we sought a new system for managing our practice,” Howard explained.

She decided she did not want to have the kind of office where patients had to wait hours before they could see her. Having outdated check-in and check-out procedures meant restricting scheduling significantly to account for the time needed for administrative work around a patient’s appointment.

“While I could see three to four chiropractic patients in a 15-minute time slot, it took our receptionist at least twice as long to check them in and even longer to check them out,” she said. “This limited the amount of patients that we could schedule during the day. And prior to CareCloud, we collected payment during check-out and often times patients would walk out before paying us.”

With the new patient experience platform, patients check in much more quickly, they see their account balances, and often pay before Howard is even aware they are present, she said. The process is simple and quick, and the practice is seeing more patients in the same amount of time without having to sacrifice the quality of care that they receive, she added.

The new practice management, EHR and patient experience management systems ticked off all the boxes for LifeArts, offering multi-specialty support with the backing of a strong support team, Howard said.

Other patient experience systems on the market include offerings from AdvancedMD, Medfusion, Q-nomy, SE Healthcare and more.

Staff enjoys the Breeze patient experience system. For instance, the receptionist has more free time now to take some of the daily tasks off Howard’s desk, such as taking ownership of patient billing and collections. The receptionist also is able to schedule and reschedule patients much more efficiently, allowing the practice to have better flow of patients through the office, she added.

“My assistant is able to see the schedule at a glance and that helps us plan ahead for the various visit types and specialty services that we offer,” Howard said. “We no longer have to click on each patient in the schedule to see why they are scheduled. We are able to be more prepared for their visits. She is also able to chart more quickly and efficiently, freeing her up to take care of the other tasks that she is responsible for at our office.”

Breeze easily connects with CareCloud’s practice management and EHR systems and instantly populates intake information to the patient chart. Many patients like to check in on their phones, and with Breeze, they check in from their phone in the morning for their afternoon appointment, so Howard knows it won’t be a no-show. In the last year, appointment no-shows for LifeArts have decreased by 66 percent to less than 1 percent of all appointments, Howard said.

“In addition to intake and check in, our patients now have the ability to check and pay their balances from their phones,” Howard explained. “Patients receive emails right away and are able to pay online or set up auto-draws from their accounts. Patients don’t get blindsided by balances they didn’t know they had if the practice got behind on sending out statements.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

More than three-quarters of the hospitals surveyed for a new HIMSS Analytics study said that denials are the biggest challenge they face with revenue cycle management.

One reason for that could be their use of multiple IT systems that don't mesh well together with various systems looking at numbers in different ways, the report, commissioned from HIMSS Analytics by Dimensional Insight, a developer of analytics and business intelligence technology, suggested.

Seventy-six percent of hospitals – ranging in bed-size from 50 to 500 –  said denials were the biggest challenge they faced with RCM – far more than revenue integrity (36 percent), patient pay (34 percent), collections (29 percent) and capturing ICD codes (27 percent).

Of those having the most trouble with denials, 72.5 percent of respondents polled by HIMSS Analytics were using their electronic health record alongside three or more other RCM systems to manage their revenue cycle.

As for data integrity – another big hurdle to getting paid – hospitals said lack of interoperability, and the fact that some systems are too siloed (67 percent each) were problems for their RCM strategies.

When it came to gathering necessary data from disparate sources for reimbursement, nearly everyone said it was either moderately (65 percent) or extremely (33 percent) challenging. Similar numbers said that the way revenue cycle data is collected is either a moderate (59 percent) or big (38 percent) issue for their organizations.

The report also found that one big hurdle to hospitals trying to make better use of analytics to automate revenue cycle processes might be the use of too many disparate systems for their revenue cycle.

Indeed, 41 percent of hospitals said they used their EHR with two or more other vendors for RCM -- some 16 percent are using two or more RCM vendors with no EMR. And more than one-third of respondents said that less than 25 percent of their revenue cycle process is automated with analytics.

The upshot, according to HIMSS Analytics, was that, without full interoperability, data have to be normalized to drive improvements in the revenue cycle process. That can be a tall order.

But, according to the report, data standardization for RCM is ripe for innovation.

"Just like we have seen with clinical solutions at health systems, one of the big challenges that exist for advanced analytics on the financial side is that there are also many different solutions involved in revenue cycle management," said Bryan Fiekers, senior director, research services at HIMSS Analytics.

"If we can create those seamless integrations across RCM solutions," he added, "we have a greater opportunity to drive automated analytics which will improve efficiency that results in the identification of billing errors and the reduction of AR days, etc."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Excel Medical, which markets technologies designed to eradicate unexpected deaths in hospitals, has debuted Wave, an FDA-cleared patient surveillance and predictive algorithm platform that's now available in Epic's App Orchard.

The platform is available through the vendor's AlarmView and TeleTrend apps in the app store, which opened in 2017. Both apps enable hospital information systems to make predictive analytics an actionable process, according to Excel Medical.

"Being in App Orchard is not only a game changer for Excel – by integrating our predictive analytics into Epic– but more important, it opens the doors to improved patient surveillance for clinical care teams," said Mary Baum, chief strategy officer at Excel Medical. "Wave, via TeleTrend and AlarmView, brings 95 percent positive predictive value into the early detection of at-risk patient deterioration."

More information on the subject is documented in a professional journal article titled "Integrated Monitoring and Analysis for Early Warning of Patient Deterioration," in the British Journal of Anaesthesia.

The Wave patient surveillance and predictive algorithm platform received FDA clearance in January 2018. Excel Medical has been working to maximize its impact through new relationships, organizational augmentation, and a renewed dedication to the company's mission to eliminate unexpected deaths in hospitals, the company said.

This goal has now moved to "accessible" by tapping into Epic's open, standards-based interoperability platform, and at the same time, by leveraging the widespread data generating infrastructure – BedMasterEx and BedComm solutions – that Excel already has installed at many hospitals, the vendor said.

"To be effective at predicting patient deterioration and catastrophic events, it is vital that we have close working relationships with all of our hospital EMR partners," said Lance Burton, president of Excel Medical. "In working with Epic, we have been very pleased with their responsiveness and the simplicity of the resulting user interface."

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

Change Healthcare will work with Adobe and Microsoft on a new platform that will aggregate patient data for a more seamless and user-friendly patient experience.

The three companies will leverage Change's Intelligent Healthcare Network, Adobe Experience Cloud and Microsoft Azure to create a platform that can securely "aggregate and activate" various types of consumer information from several sources: electronic health records, registration systems, scheduling software, billing applications and others.

The goal is to help hospitals and practices gain a competitive advantage by offering a better online experience to their patients, officials said.

Providers can deploy the technology as part of their revenue cycle and patient relationship management projects, enabling them coordinate and personalize patient engagement campaigns, manage educational content and gain insights from consumer behavior.

Speaking at the HIMSS Patient Engagement and Experience Summit earlier this year, Adrienne Boissy, chief experience officer at Cleveland Clinic, said good patient experience demands more than just on-time doctors' appointments and accessible patient portals.

It's about "putting information in the hands of patients that matters most to them," she said.

And increasingly, traditionally consumer-facing companies are compelling healthcare providers to up their game with regard to patient experience offerings "The Amazons and Apples of the world have mastered service, and they are coming for us," said Boissy.

"This unique collaboration is all about helping our customers put the consumer first," said Change Healthcare CEO Neil de Crescenzo in a statement.

"Bolting transactional features onto portals can't provide the frictionless, end-to-end experience consumers want," he explained. "That ideal can be met only when providers can infuse and orchestrate intelligence into touch-points across healthcare's administrative, clinical and financial continuum."

Change Healthcare has been busy so far this year. Earlier this month, it expanded its revenue cycle analytics platform. In January, it launched what is says is the first enterprise-scale blockchain network for healthcare.

This new partnership brings together Adobe's consumer-facing expertise, Microsoft's secure and scalable cloud technology and Change's experience helping manage healthcare data and AI-enhanced workflows.

The aim is to "help providers keep patients connected with care and wellness solutions throughout their healthcare journey," said de Crescenzo.

"Patients today expect the same seamless, personalized experiences with healthcare providers they already know from other consumer brands," added Matt Thompson, Adobe's executive vice president of worldwide field operations.

Twitter: @MikeMiliardHITN
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