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- 05/08/18--10:47: _DoD IG finds massiv...
- 05/08/18--14:01: _Disruptive innovati...
- 05/09/18--06:40: _SAP, Cerner team up...
- 05/09/18--09:57: _Senate passes bill ...
- 05/09/18--10:22: _House passes bills ...
- 05/09/18--13:36: _Cerner scores two n...
- 05/09/18--11:55: _How the VA's Lighth...
- 05/10/18--07:18: _VA gives final EHR ...
- 05/10/18--11:10: _NewYork-Presbyteria...
- 05/10/18--14:09: _From HITECH to open...
- 05/10/18--14:18: _How Cleveland Clini...
- 05/11/18--07:08: _HLTH takeaways for ...
- 05/11/18--10:21: _Indiana psychiatric...
- 05/11/18--12:59: _Apple Health Record...
- 05/14/18--06:11: _Next-gen analytics:...
- 05/14/18--08:44: _Precision medicine:...
- 05/14/18--11:07: _DoD responds to rep...
- 05/15/18--06:32: _Cerner has almost d...
- 05/15/18--11:32: _Sequoia Project res...
- 05/15/18--12:54: _First IT-savvy med ...
- 05/08/18--14:01: Disruptive innovation: Inside athenahealth's developer lab
- 05/09/18--06:40: SAP, Cerner team up to develop next-gen EHR for European hospitals
- 05/09/18--13:36: Cerner scores two new Millennium EHR contracts
- 05/10/18--14:09: From HITECH to open APIs: How healthcare is becoming more connected
- 05/10/18--14:18: How Cleveland Clinic is leveraging APIs to advance interoperability
- 05/11/18--07:08: HLTH takeaways for hospital CIOs and IT pros
- 05/14/18--06:11: Next-gen analytics: Here's what's coming in the future
- 05/15/18--12:54: First IT-savvy med students graduate under pioneering AMA program
The electronic health record and security systems at the Defense Health Agency and some Navy and Air Force hospitals and clinics are riddled with serious vulnerabilities, according to a recent U.S. Department of Defense Office of Inspector General report.
OIG identified the issues at the Naval Hospital Camp Pendleton, San Diego Naval Medical Center, NSNS Mercy, 436th Medical Group and Wright-Patterson Medical Center. These vulnerabilities ranged from password configurations to meet DOD requirements to user access based on assigned duties.
In fact, OIG officials said DHA, Navy and Air Force may have violated HIPAA with their lax security protocols, which could result in millions of dollars in fines.
"Specifically, DHA, Navy and Air Force officials did not consistently implement technical, physical and administrative protocols to protect Department of Defense EHR systems, modified EHR systems and Service-specific systems from unauthorized access and disclosure," the report read.
"As a result, ineffective administrative, technical, and physical security protocols, resulting in HIPAA violations, could cost Military Treatment Facilities up to $1.5 million in penalties each year," the report said.
What's more troubling is that officials said when network administrators at the audited sites discovered vulnerabilities, they often failed to address them. In June, for example, the Dover Clinic performed a scan that revealed 342 of the 1,430 vulnerabilities found in May.
Reasons for failing to implement proper security measures varied by site and flaw, including a lack of guidance or resources, vendor limitations, and system incompatibility.
To address these flaws, OIG made several recommendations, including configuring the DoD EHR systems and other DHA systems that handle patient data to automatically lock after 15 minutes of inactivity.
OIG also recommended that the Surgeons General for the Departments of the Navy and Air Force, in coordination with the Navy Bureau of Medicine and Surgery and the Air Force Medical Service, coordinate efforts to assess whether the issues found in the report are systemic or specific to the audited locations.
Officials also asked those leaders to develop and implement an oversight plan to make sure those sites enforce the use of common access card and configure passwords to meet DoD requirements. Further, CIOs need to draft an action plan to outline steps to mitigate vulnerabilities in a timely fashion.
The DHA director agreed that DHA could potentially lock systems automatically after a period of inactivity, however, they "did not provide assurance that the DHA would configure its systems that process, store, and transmit PHI to lock automatically after 15 minutes of inactivity."
The Navy Executive Director at the Navy Bureau of Medicine and Surgery agreed with all recommendations for the Navy Bureau of Medicine and Surgery and the Naval Hospital Camp Pendleton. But the other sites have unsolved issues that require additional comments.
DHA is not the only federal agency to be chastised for its security protocols. The Department of Veterans Affairs has been on the Government Accountability Office's and Inspector General's high-risk list for more than three years, despite efforts to improve its status.
SAP and Cerner have joined forces to create a new electronic health record platform for hospitals outside the U.S.
“We decided to create next-gen clinical EHR systems jointly for the rest of the world,” said Werner Eberhardt, MD, Global Head of SAP Health during an interview ahead of the announcement at the HLTH conference in Las Vegas.
Wait. With arguably too many EHRs already on the market, why build a new one for the rest of the world instead of just selling Cerner’s existing tools in Europe?
The regulatory environment is different. Take GDPR, for instance. The General Data Privacy Regulation that kicks in on May 25, is a big challenge for hospitals that Eberhardt said will accelerate the switch to cloud services.
It also doesn’t hurt that InterSystems and Epic have the most customers in Europe, according to KLAS, which ranked Cerner third on the continent, at least as of 2016 when it last conducted the research.
And the degree of digitalization among hospitals around the world is lagging behind the U.S. because meaningful use created a massive opportunity for vendors here that resulted in expensive products, Eberhardt said, adding that they are frequently prohibitively pricey in markets outside the U.S.
“The vast majority of hospitals in Europe cannot afford to buy Cerner or Epic at scale,” Eberhardt added. “That’s why we are making this a cloud solution.”
Basing it on the cloud model also enables the companies to use technologies including machine learning, internet of things and analytics to play a role in the hospital of the future.
“We are enabling the intelligent hospital by combining patient experience, outcomes, data-driven innovations, empowered workforce capabilities,” Eberhardt said.
SAP and Cerner will also handle privacy and security as well as regulatory changes by updating the code in local datacenters rather than customers having to do that on-premise.
“One of the key differentiators is that we do not pull all the data together, we know many organizations have restrictions with respect to where the data can sit,” Eberhardt said. “Data can stay local even within a specific provider organization. We have local datacenters globally.”
The SAP-Cerner platform is independent of infrastructure so it can run on Amazon Web Services, Google, Microsoft Azure or others, though it will run on SAP’s cloud to start with.
SAP and Cerner will launch the first beta customers later this year and the EHR will be generally available in 2019. Cerner, of course, will continue to offer Millennium in the U.S.
“If this all goes well,” Eberhardt said, “who know knows where this might take us next?”
A bipartisan bill cleared the U.S. Senate on Tuesday, which gives the Centers for Medicare and Medicaid Services the authority to offer incentives for behavioral health providers who implement electronic health records.
The legislation now heads to the House where it will be reconciled with similar legislation.
The Improving Access to Behavioral Health Information Technology Act is meant to offer funds to providers who were left out of the original $38 billion EHR Incentive Program, with the aim of helping them coordinate care for patients with addiction and mental illness.
Psychologists, community mental health centers and psychiatric hospitals were not part of the meaningful use program, but the bill– first introduced in August 2017 by Senators Sheldon Whitehouse, D-Rhode Island, and Rob Portman, R-Ohio – wants to give CMS the ability to disburse incentive payments to those and other behavioral health providers.
"It’s critical that we have the ability to communicate issues easily and effectively, particularly with primary care providers, and this bill goes a long way towards leveling the playing field and making sure those suffering from mental health issues are not treated differently than anyone else," said Mary Marran, president and chief operating officer at Providence, R.I.-based Butler Hospital, a psychiatric and substance abuse facility, in a statement supplied by Whitehouse's office.
The legislation, cosponsored by Senators Bill Cassidy, R-Louisiana, and Debbie Stabenow, D-Michigan, calls for CMS to first set up a demonstration pilot that would give incentives to behavioral healthcare providers for adopting and using EHRs.
The bill now heads to the House, where Reps. Lynn Jenkins, R-Kansas, and Doris Matsui, D-California, introduced companion legislation this past summer that would authorize a demo project to give clinical psychologists, social workers and mental health and substance use treatment facilities money for EHR uptake.
"Electronic records help doctors and other providers make better decisions about their patients’ care," said Senator Whitehouse in a statement. "Americans who receive substance abuse and mental health treatment should benefit from that technology, too. This bill would test the use of electronic health records by mental health providers to care for patients who too often are left behind."
Portman added that the "common-sense bill" would "help bring our behavioral health system in line with physician healthcare by enabling the same incentives for substance use and behavioral health providers that other medical professionals have received."
The House Committee on Veterans Affairs passed two pieces of legislation on Tuesday that would both provide congressional oversight for the agency's plans to replace its legacy VistA EHR with Cerner and bolster data sharing between the VA and community care providers.
The Veterans' EHR Modernization Oversight Act (H.R. 4245) would support the VA's transition to a Cerner EHR, which the committee called "one of the largest contracts and projects in VA's history." The bill gives oversight to the project, including tools to ensure the project remains on track.
The agency is in the final stages of negotiations with Cerner, which VA Acting Secretary Robert Wilkie said is planned for the "near-term." The contract has been on hold for months, first for interoperability concerns, but now due to a leadership shake-up at the agency.
Once the contract is finally signed, the bill requires the VA to "provide Congress with the project's key planning and implementation documents, in addition to copies of the contracts, to indicate the effort's progress and how the money is being spent.
The agency also will need to notify Congress of any significant increases in costs, schedule delays, or any loss or breach of veteran data.
The House Appropriations Committee approved Fiscal Year 2019 funding for the agency on Tuesday, which includes $1.2 billion in funding to get the project off the ground. The projected cost for the replacement has seen estimates as high as $16 billion over the course of a decade.
The other legislation with health IT implications, VA MISSION Act (H.R. 5674), passed on Tuesday, includes three pieces of legislation from both the House and the Senate.
Introduced this past week, the bill would streamline and consolidate the agency's community care programs while creating a process to improve data sharing between the VA and community care providers. It would also make permanent the Choice Program, which would have run out of funds in June.
Specifically, the bill gives the VA authority to "share medical record information with non-department entities for the purpose of providing healthcare to patients."
It also requires the VA create a process to ensure private sector doctors caring for veterans have access to relevant patient data, including all prescribing history. It also mandates private sector doctors provide the agency with all relevant patient data for all services provided.
The agency will need to establish a timeframe and format to facilitate this sharing. The hope is to curtail opioid abuse.
"VA would be responsible for the recording of those prescriptions in the EHR and enable other monitoring of the prescription as outlined in the Opioid Safety Initiative," the committee wrote.
The VA also will need to participate in a national network of state-run prescription drug monitoring programs and mandates that any licensed healthcare provider could use this system to send and receive prescribing data.
"Under this authority, licensed healthcare providers or delegates would be required to query the network in accordance with applicable VA regulations and policies, and no state would be authorized to restrict the access of licensed healthcare providers or delegates from accessing that state's prescription drug monitoring programs," according to the bill.
Telemedicine also gets a boost with the passage of the MISSION Act, which gives legislative authority to VA providers to practice across state lines with a telehealth platform.
Capital Region Medical Center, which is part of University of Missouri Health Care, will implement integrated electronic health record and revenue cycle management technology from Cerner, the company announced this week.
Cerner provides CRMC access to the Tiger Institute for Health Innovation's integrated platform and solutions.
"As a result of the successes we’ve seen in patient care while working with Cerner, we look forward to seeing improved health outcomes for patients at CRMC and MU Health Care," said MU Health Care CEO Jonathan Curtright, in a statement.
Cerner and MU work closely together as part of the Tiger Institute for Health Innovation, which they co-founded in 2009 with the goal of driving healthcare innovation for Missourians. The Tiger Institute and Cerner ITWorks manage the EHR and IT operations for MU Health Care. Cerner is extending this agreement to CRMC.
It means that Cerner will assume day-to-day management of CRMC’s IT operations and staff, which Cerner officials expect will optimize resources and boost efficiencies.
CRMC will transition to Cerner Millennium, a platform designed to support an individual’s care across the continuum – from the doctor’s office to the hospital and other venues of care – with consistent patient engagement.
The Cerner Millennium system will provide CRMC staff with a digital record of their patients’ health history, rendering a more complete, near real-time view of an individual’s health. Also, through the new online, integrated patient portal, patients will be able to securely message doctors, schedule appointments and access their health history across both CRMC and MU Health Care.
Maine critical access hospital also chooses Cerner
Mayo Regional Hospital in Dover-Foxcroft, Maine, has also chosen to deploy the Cerner Millennium EHR, seeking an integrated clinical and revenue cycle platform across its acute and ambulatory facilities.
"At Mayo, we focus the knowledge, skills and resources of our doctors and staff to forge a strong and integrated community health system that serves the people of our region," said CEO Marie Vienneau, noted in a statement.
Vienneau said the hospital went to Cerner because of the vendor’s experience in supporting community healthcare organizations.
As a critical access hospital in rural Maine, Mayo’s move to a single integrated EHR will facilitate the exchange of health information with other healthcare systems and providers in the state to create a more seamless patient experience," said Zane Burke, president of Cerner.
"Through our solutions, a patient’s critical health and financial information will be in one place and will support Mayo in their effort to provide a better approach toward improving the health and well-being of their community."
The hospital will also deploy Cerner’s revenue cycle management technology, which provides clinical and financial data in one patient record.
The U.S. Department of Veterans Affairs will make its decision about whether it will sign a contract with Cerner to replace its VistA EHR on May 28, Jon Rychalski, VA assistant secretary for management and chief financial officer told the Senate Committee on Appropriations on Wednesday.
It’s been almost a year since former VA Secretary David Shulkin, MD made the announcement that the VA would replace its legacy EHR with Cerner, to align its system with the Department of Defense. The deal has been delayed for both interoperability concerns, and then due to Shulkin’s firing in March.
Currently, DoD official Robert Wilkie has been the agency’s acting secretary in the interim. Rychalski told the committee that Wilkie “came in cold” to the position.
And while “he knew what was going on with DoD,” Rychalski said Wilkie didn’t know “enough about the VA and felt he needed to do due diligence to make sure that he was comfortable in making a decision of this magnitude.”
The result was further delay in contract negotiations between the two parties. Rychalski explained that the initial interoperability concerns were evaluated by MITRE in January, which “was probably worthwhile because they came up with about 50 recommendations” that will be added to the contract.
Cerner took a financial hit due to the delays, but officials still expect the contract to go through within the year. The VA asked for $782 million to jumpstart the EHR project for Fiscal Year 2018 and requested $1.2 billion for Fiscal Year 2019.
Estimated totals for the project range from $10 billion to $16 billion over the course of 10 years. Buried in the request was language that outlined the new EHR will be identical to the DoD’s system, which is currently in an assessment stage.
But some senators aren’t convinced the delays were due to Wilkie’s lack of knowledge about the project, but rather a “leadership vacuum,” said Sen. Brian Schatz, D-Hawaii.
Schatz also took issue with the fact that the agency hasn’t spent the original request of $782 million -- but then requested another $1.2 billion for the project.
“It makes little sense to give the VA more money for the EHR system so that it can sit in an account, while this all gets sorted out,” Schatz said. “No amount of money from Congress can fix the leadership issues at VA.”
Schatz noted the agency’s acting CIO Scott Blackburn resigned last month, but his departure was just the latest in the ongoing turmoil at the agency. In fact, Wilkie’s position as acting secretary is being called “unlawful” by two veterans’ groups, which have sued to stop any decision Wilkie makes in the role.
Every minute after blood flow is even partially cut off from the brain, 1.9 million brain cells die due to lack of oxygen. So every second counts when it comes to treating someone who is suffering a stroke.
NewYork-Presbyterian Hospital has a whole unit dedicated to slashing the time it takes to successfully treat a stroke patient. It's called the Mobile Stroke Treatment Unit, and as of this week, NewYork-Presbyterian, in collaboration with Weill Cornell Medicine, Columbia University Irving Medical Center and the Fire Department of New York, is expanding its fleet of Mobile Stroke Treatment Units to Queens and Brooklyn.
With a donation by the W.P. Carey Foundation, this makes NewYork-Presbyterian the first health system in the country to operate three of these advanced units.
Late last year, the MSTU implemented a telemedicine component for patient care, where a stroke physician now communicates with the registered nurse on the MSTU via video conferencing to evaluate patients and order CT scans.
With telemedicine, one physician can virtually evaluate patients with acute stroke that are far from the base station with high-fidelity audio/video and in real time. The result of switching over to this model has improved treatment times for patients.
Since launching telemedicine initiative on November 27, 2017, the NewYork-Presbyterian MSTU has transported and treated 29 patients using a telemedicine model of care. This includes 18 patients diagnosed with ischemic stroke, two patients diagnosed with intracerebral hemorrhage, and 9 patients diagnosed with other diseases.
Intravenous tPA, a clot-busting drug, has been administered five times without any complications. The median MSTU arrival to tPA treatment time has been 31 minutes for these patients.
"Telemedicine networks bring convenience of care and cost savings to MSTU programs as they expand throughout the country," said Michael Lerario, MD, medical director of the Mobile Stroke Treatment Unit at NewYork-Presbyterian Hospital.
"The more MSTUs in operation within a single network, the larger this benefit, as one neurologist can oversee the clinical care on multiple ambulances," he explained. "The benefit of telemedicine MSTU networks are well-known and have been published in prominent medical journals."
The onboard clinical team for the NewYork-Presbyterian MSTU consists of a specially trained registered nurse, two REMAC-certified paramedics, and a CT technician. A vascular neurologist communicates with the onboard crew via a remote audiovisual connection. Using telemedicine, the vascular neurologist oversees the stroke assessment and clinical care being performed on the MSTU.
The neurologist is responsible for ensuring the accuracy of the stroke examination, confirming the diagnosis of stroke, and ordering the administration of advanced stroke care medications, not typically carried on an Advanced Life Support ambulance.
Additionally, the CT imaging performed on the MSTU is transmitted to the NewYork-Presbyterian picture archiving and communication system so the neurologist can interpret the scans and rule out intracranial hemorrhage prior to the nurse administering the clot busting drug, tPA.
The MSTU program currently has five vascular neurologists participating in the telemedicine network who were recruited from Weill Cornell Medicine, Columbia University Irving Medical Center, NewYork-Presbyterian Queens and NewYork-Presbyterian Brooklyn Methodist Hospital.
NewYork-Presbyterian uses Cisco Jabber for telemedicine capabilities on all of its Mobile Stroke Treatment Units. The ambulance is outfitted with microphones and speakers for audio transmission. The neurologist uses a Logitech headset to communicate with the patient and crew.
Additionally, an adjustable camera that offers high-definition imaging is mounted on the ceiling of the MSTU, directly above the patient. This allows the remote neurologists to see the patient and crew during their examination and clinical treatment. The neurologist's workstation is located in their hospital office and includes a desktop computer, dual monitors, as well as a webcam device.
Using their keyboard, the neurologists can remotely control the onboard camera to tilt or zoom in on the patient. Mounted on the wall of the MSTU is a monitor that allows the patients to see and speak directly to their treating doctor.
Neurologists are able to log into the Allscripts electronic health record from their office workstation so they can enter orders and document the clinical encounter. All documentation in Allscripts can be viewed on the MSTU and throughout the receiving NewYork-Presbyterian affiliated hospital prior to patient delivery to the Emergency Department.
Lerario walks through an actual acute ischemic stroke patient example of the MSTU telemedicine in action.
"The MSTU team rushed to treat a 48-year-old man who was working in Central Park, who developed acute onset right-sided weakness, facial droop, dizziness and difficulty speaking," Lerario recalled. "The patient had told his work partner that he 'didn't feel well' and 911 was called and the MSTU was dispatched. The patient was loaded onto the MSTU and our neurologist, via telemedicine, was able to examine the patient and quickly diagnose a clinical stroke."
A head CT scan was ordered and interpreted by the remote neurologist, and it was determined safe to administer intravenous tPA, the clot busting drug for stroke, to the patient. This occured within 74 minutes of the onset of stroke symptoms. After tPA, the patient was transported and admitted to NewYork-Presbyterian Hospital for observation and further treatment. The patient returned to his baseline and was discharged home.
"Response time is a critical factor in stroke recovery and the Mobile Stroke Treatment Units now have the capacity to help even more patients," said Matthew E. Fink, MD, who oversees the MSTU program and is neurologist-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. "We are bringing the emergency room directly to a patient suffering a stroke. This is a game changer in advanced stroke care."
Hospitals, and doctors specifically, need more tech tools, not fewer. The shift to platforms and networks-of-networks is essentially unstoppable, geographical pockets of interoperability might be what the industry actually needs, and there’s a new type of healthcare supply chain emerging. Well, that, and you’ll be able to download next-generation EHRs from Apple’s App Store.
That’s what I walked away from the inaugural HLTH (pronunciation for the uninitiated: health) conference this week in Las Vegas with. Of course, I went into the event with an eye on what it all means for hospital IT departments.
“I have said many times that I do think this internet thing will be a big deal in healthcare at some point,” joked Jonathan Bush, athenahealth CEO. “But I also think this physician thing will be a big deal, too.”
Both are so important, indeed, that Lumeris CEO Michael Long said a new type of supply chain is emerging in healthcare and it’s not about getting enough drugs or latex gloves just in time.
“We’re talking about a supply chain for the delivery of care,” Long said. “What powers this supply chain will be a re-imagined doctor-patient relationship.”
That’s a big break from the paternalistic care driven by resources immediately available to physicians — and data previously inaccessible to doctors will be the rocket fuel powering easy-to-use tools that change behavior for patients and caregivers alike to maximize the effectiveness of both prevention and treatments.
“The digital foundation we finally have in healthcare, coupled with high-performance computing capabilities and the surge of data, means we can do something with that information,” said Bryce Olson, Intel’s Global Director of Health and Life Sciences.
Plumbing: Platforms and networks
We’re not quite there yet, realistically, on a widespread basis. But innovators are building platforms, technological infrastructure and connective tissue to reach that point.
Redox, born of Epic employees with implementation, strategy and interoperability expertise, released on Tuesday what CEO Luke Bonney called a FHIR profile called R^FHIR. R^FHIR enables developers to use FHIR to exchange data across Redox’s network of some 250 hospitals.
“FHIR is a highly-extensible spec,” Bonney said. “We think this is the one developers will have the most confidence in over time.”
Read more Innovation Pulse columns from Healthcare IT News.
Redox’s overarching goal is to build connective tissue so web developers don’t have to — a novel idea neither entirely different from, nor mutually exclusive to, athenahealth’s ongoing effort to create microservices.
Athenahealth chief Bush said that the next version of its cloud-based EHR will be available in the Apple App Store. Called Epocrates Connect, the new app is slated for availability in September, and while the current version of Epocrates is already in the App Store, Epocrates Connect is a piece of what Bush described as transitioning to a platform that ultimately enables developers, both internal and non-athena innovators, to build on its underlying infrastructure.
“Developers on the athena platform won’t need patient database, log-in, security, capacity, hosting, production systems,” Bush explained. “All that will be provided, they won’t have to manage the data — all they have to do is manage their own product.”
To date, the biggest problem is that doctors lack interoperability and many of the tools make them work more slowly and simultaneously know less.
Athenahealth’s is taking a layered approach beginning with infrastructure, on top of which resides compute, then data, applications and the services that clinicians interact with.
“The idea that we should have fewer tools is such a bad idea. There is not some finite number of tools you can download just so the data will work together,” Bush said. “This is not a new problem, it's been solved a hundred times. Why not here yet?”
Up next: Three-way intersections
One could be forgiven for buying into the bold vision that so much data and infrastructure constitutes a nationwide if not a global capacity for any doctor, given appropriate permissions, to view, download and transmit the health data of any patient in front of them.
Perhaps that shouldn’t be the prize and what the healthcare system needs, instead, is more regional areas of interoperability that enable such data sharing in the places patients are most likely to present than, say, a New Yorker suddenly needing care in San Diego.
Either way, there’s little disputing that health information interoperability is a thorny and longstanding problem and even the move to value-based care and risk-based contracting won’t make the situation much better because hospitals still want to keep their patients.
What is needed most right now is people with experience and understanding in healthcare, technology and user experience, said Krishna Yeshwant, MD, General Partner of GV, formerly known as Google Ventures.
“We need the people who can translate those different worlds. Two is really hard, but three, I don’t think we’ve seen that in healthcare,” Yeshwant said. “The most interesting things happen at intersections.”
The Indiana Family and Social Services Administration, FSSA, announced plans to roll out integrated EHR and revenue cycle management software across six state-run inpatient psychiatric facilities.
FSSA is the third customer this week to sign-on with Cerner in a month that has seen several interesting EHR moves, from Mayo Clinic’s massive Epic implementation to Veterans Affairs Department CFO telling Congress the agency would decide by May 28 whether to sign a multi-billion dollar contract with Cerner to replace its proprietary VistA electronic health record.
Trinity Health in Pontiac, Michigan, meanwhile, revealed plans to embark on a similar integrated EHR and revenue cycle management platform path as FSSA, only it opted for Epic technologies.
At FSSA, Cerner’s IT platform is expected to make it easier for doctors, nurses and staff to streamline operations, boost patient care and improve mental health facilities across Indiana.
Kevin Moore, director of Indiana Division of Mental Health and Addiction, said the software will help FSSA connect and improve Indiana’s network of state psychiatric hospitals, and also connect with other mental health providers in the state,
The Cerner Millennium healthcare IT platform also will provide clinicians with a single digital record of their patients’ health history, including clinical and financial data.
FSSA intends to unify its facilities with one integrated system for sharing patient health data among facilities, Moore noted, including the NeuroDiagnostic Institute, that is under construction and expected to open in 2019.
While May is shaping up to be another busy month, EHR go-live wise, April saw some interesting moves as well, including the State Department’s RFI for its own EHR, the Coast Guard forging a unique deal to tap into Defense Department’s Cerner platform as well as a handful of other hospitals saying they plan to deploy a new electronic health record, too.
Many players in the healthcare industry are closely watching how Apple Health Records are performing in this rapidly changing market.
A major shift in what makes up a record of patient care is already underway. EHR vendors are working to transform EHRs into CHRs – Comprehensive Health Records. Couple that with their plans to integrate machine learning and artificial intelligence into their offerings, and you have the stuff of market disruption.
So where exactly will Apple fit in? An early look at the 39 hospitals already using Apple Health Record offers a glimpse of what’s to come.
Apple Health Records real impact
Apple Health Records has the potential to impact millions of patients given the iPhone’s broad customer base, research firm KLAS noted in its May 2018 report.
Early participants say Apple Health Records has both short-term benefits and long-term potential to impact how provider organizations interact with patients and how patients manage their health.
Sixty-seven percent of early participants indicated Apple Health Records would empower patients. On the topic of interoperability, 58 percent indicated it would help solve the elusive issue. Fifty percent indicated it would speed innovation and change. Thirty-three percent figured it would facilitate consumer app development; and 25 percent indicated it would open up healthcare to outside vendors.
Health Records is expected to help solve the difficult and long-standing challenge of interoperability by allowing iPhone users to store their health records on a device that is already part of their lives.
Seventy-five percent of respondents to the KLAS survey plans to harness Apple Health Records to give patients access to their data, and 50 percent said it was to use as an additional option in the current patient engagement strategy. Only 17 percent said it was to be an active participant.
EHRs are bound for change (if not glory)
None of this is to say Apple’s road ahead will be easy. Even well-funded giants such as Google and Microsoft have stumbled when they ventured into the healthcare realm, so expect both Apple and the hospitals using its Health Records to face their own challenges.
To that end, Respondents to the KLAS inquiry said that non-healthcare vendors understand patients in a different way and that out-of-the-box research and development from these vendors could motivate and direct patients better than the methods that have been in play so far.
All told, though, 92 percent of the respondents think Apple Health Records will have a positive impact within 12 months. How that will translate to the broader EHR market remains to be seen -- but it’s worth noting that Apple Health Records work with existing EHRs from athenahealth, Cerner and Epic at the hospitals that are already using it. It’s not a direct competitor, yet.
The healthcare analytics market is booming and will be worth close to $54 billion worldwide by 2025, according to a March 2018 report from Grand View Research.
Given the need to achieve the Triple Aim, along with the rise of precision medicine and the move toward value-based care, data analytics have never been more important to healthcare provider organizations.
As the technology continues to grow and mature, here's the pressing question for healthcare and IT leaders: How will analytics tools evolve – and what should they expect to come next?
We asked experts from across the industry about major shifts on the horizon. Here's what they said healthcare decision-makers should be tracking now.
We're getting closer to a 360-degree view
Healthcare providers have long sought the elusive 360-degree view of the patient, and soon the healthcare industry will get it, said Brandon Purcell, a senior analyst at Forrester Research who specializes in analytics.
"Because analytical models and artificial intelligence are only as good as the data used to teach them, healthcare providers will make significant investments in the creation of foundational data assets that link patient data from disparate sources," Purcell said. "The completeness and quality of this 'single source of truth' will be the key to differentiation for healthcare providers, enabling them to provide proactive care, personalize services and reduce operational costs."
Purcell also said that unstructured information will become more commonly used.
"Text, image, audio and video data have long been analyzed in a vacuum, typically by a human being," Purcell explained. "Solutions like Watson Health that are able to diagnose results from medical images are just the start of a trend in healthcare toward using deep learning to analyze unstructured data."
Technology now allows for conversations with patients – whether in person or on the phone – along with text from emails and SMS messages and all types of image and video data now can be analyzed by neural networks. The results of this analysis: structured data points that can be added into the holistic view of the patient.
"Healthcare providers should look to adopt solutions that have been trained in their specific use case and offer the ability to further customize models through the process of 'transfer learning,'" Purcell added.
Longitudinal records are a foundation
Healthcare is an industry rich with data, yet many provider organizations continue to focus on single vertical views of that information – for example, analyzing outcomes at just one site of service or thinking about data in terms of individual care encounters.
Instead, health systems must look to analytics technology to provide a holistic view of the patient experience over time and across all sites and episodes of care, said Garri Garrison, RN, vice president of performance management at 3M Health Information Systems, which develops analytics and other healthcare technologies.
"These analytics tools exist today, but their success depends on the creation of the longitudinal record," Garrison said. "This is the next step in the evolution of analytics technology. To take advantage of new analytic tools, healthcare organizations must have access to patient-centric records that encompass the full spectrum of clinical care."
By applying advanced analytics to aggregated data from across all visits, episodes of care and patient populations – and evaluating it against key performance measures – organizations can identify inefficiencies and uncover interdependencies between sites of care and between caregivers that may be causing poor outcomes or high costs, she said.
"With advancements in machine learning and artificial intelligence, we'll see a transition from descriptive analytics to predictive analytics," she added. "Integrating machine learning or AI with risk stratification methodologies will create a new set of analytic tools that support real-time interventions in care delivery."
Robust analytic capabilities will also advance performance measurement, providing meaningful information that can be used to promote real and sustainable improvements in healthcare quality and cost – especially as analytic tools incorporate social determinants of health to provide a more complete understanding of patient populations, Garrison said.
Emerging technologies beget more data
Jennifer Esposito, worldwide general manager for health and life sciences at Intel, points to some technological shifts that will affect analytics that healthcare CIOs need to understand.
"We are starting to see convergence in High Performance Compute, or HPC, and AI workloads," Esposito explained. "As data sets get larger and more complex, the lines between scientific computing and analytics are blurring. HPC clusters are well-suited to the increasingly parallel nature employed by AI-enabled analytics. An HPC approach to analytics drives additional architectural considerations such as high-bandwidth interconnect fabric between CPU nodes and the use of parallel file storage systems."
On another technological front, healthcare provider organizations will need to be planning for how analytics strategies change as the world becomes connected by 5G, she said. The move to deliver more care outside of the hospital is a trend seen worldwide, and 5G is going to open amazing opportunities to deliver new services and reimagine how patients are engaged, she added – adding even more information that can be analyzed.
"Examples of this could be immersive real-time virtual reality rehabilitation sessions in the home, virtual visits augmented by complex sensor data or field robotics controlled by centralized specialists," she explained. "Clearly, it will still be some time before 5G becomes a widely used platform. But it is coming, and it has the potential to generate orders of magnitude more data than what is being generated today."
Lesson learned: Data governance matters
In the end, it is important to remember that the first step to driving forward an analytic strategy is to identify potential sources of data and information available to an organization. Data acquisition is a laborious effort within healthcare due to its system designs, but necessary to have a complete picture of care and the opportunity to improve performance.
"We have been on this journey for approximately 18 months and have connected a few hundred data sources – EHRs, billing files, claims – all while knowing we have just begun to scratch the surface," said Derek Novak, division vice president and COO at Iowa's Mercy Accountable Care Organization. "However, we already are starting to see benefits of this work as we have created a uniform dataset that incorporates all aspects of patient, payer and provider information."
One mistake the ACO made early on was to jump right into analytics – only to later discover that the quality and consistency of the data was problematic.
"Pushing bad data out to executives and providers ultimately leads to a lack of trust and a lot of wasted energy for the organization," Novak said. "Having an analytics platform partner to work through the process to ensure a correct aggregation of data and ensure quality data is a crucial step in the process."
Novak said that providers looking to the future and getting into analytics should select a platform from a vendor that is willing and able to work with their data sources and has the ability to grow with their needs.
The platform should be able to work with all types of systems and users," he said. "It can't be yet another closed-off system with no access. Your analysts and other applications need to be able to access the data so you can actually scale for your organization."
For Mercy, the work enabled it to incorporate data across six regional chapters, spread out in over 400 locations and 3,500 providers. It afforded Mercy the ability to scale to 18 value-based arrangements and 310,000 members.
"While we didn't start with this number of lives when we started our engagement, over time as our needs grew, we needed to be sure that our data platform had the ability to grow with us under an economically sustainable model," Novak said.
The big (data) takeaway
As analytics products continue advancing from descriptive to predictive and, in turn, to prescriptive functionality, hospitals will have more tools – including but not limited to technologies such as artificial intelligence, high performance computing and 5G – to more effectively use as much data as they can to establish longitudinal records with a 360-degree view of the patient.
That will mean connectivity to literally hundreds of data sources, including EHR, text, imaging, audio, billing and claims, just to name a few.
And yes, that will require sizable financial investments and heavy lifting to make sure the technology infrastructure is in place. But the opportunities for return on investment, through new revenue and cost-savings, are significant too.
While precision medicine continues picking up momentum it’s going to change many aspects of healthcare, notably shared decision making in the doctor-patient relationship, confidentiality and data privacy.
Managing those is going to require a human touch. If physicians and caregivers just focus on genetics and genomics without taking into account who the patients are as people to better understand their activity and behavior then they will be missing a big part of what drives an individual’s health.
“We want to make sure that precision medicine continues to be human medicine – person-centered – as in treating the whole person,” said Paul Ford, a clinical ethicist and Director of the Center for Bioethics at the Cleveland Clinic Foundation. “We want to make sure people feel respected. In some ways, making things personalized – tailors it, makes them feel less like a whole mass.”
That might sound simple enough, but it’s not, because humans are not always perfect at making decisions.
Ford, who describes his work as helping people make decisions they won’t regret later, said that most of us need guidance when picking healthcare options, particularly for gauging probabilities and thinking rationally.
He recounted how people reacted after the Sept. 11 attacks on the Twin in New York City in 2001 to illustrate the point. Over the next two years, so many people chose not to fly, but to drive instead that traffic fatalities “showed an incredible spike,” Ford said. “The safe thing for you to do if you’re traveling is to get on a plane. It’s pretty safe if you look at the numbers. Yet so many people fear flying more than driving.”
Ford called this non-rational, noting that it is normal, but following our instincts can also be wrong.
“As we think about precision medicine for an individual, we often are talking about knowing information about a group,” Ford added. “Your genetics tell me both something about you and tell me something about your family, and about your extended family.”
"If we don’t characterize data well, it can have serious public health and financial issues"
Paul Ford, Cleveland Clinic Foundation
In applying precision medicine, in fact, Ford advocated for gathering a good history of behavior and activity to including that in clinical decision making as having a solid history of the patient includes more than just the facts residing in an EHR or medical chart.
“A history is actually a story that enlightens you about behavior, attitudes, goals, that isn’t captured through the EMR,” Ford said.
As is the case when collecting any kind of data, building that patient history also creates the need for safeguarding it, including HIPAA-covered protected health information and personally identifiable information.
Confidentiality and privacy -- classic issues in ethics -- are entirely different in today’s world with growing mountains of genomics and genetic data than they have been thus far -- and there is great power to make predictions in that information as well as pitfalls to avoid before it’s too late.
“If we don’t characterize data well, it can have serious public health and financial issues,” Ford said. “We have to continue to apply new technology and push it forward.”
Ford will be speaking at the HIMSS Precision Medicine Summit, May 17, in Washington, D.C.
HIMSS Precision Medicine Summit
Accelerating precision medicine to the point of care is focus of summit in Washington, D.C. May 17-18.
The Department of Defense, along with EHR vendor Cerner and contractor Leidos, held a call with reporters late Friday in response to a report finding that MHS Genesis implementation is not effective and slamming the massive modernization work’s survivability as well as recommending DoD delay the project.
MHS Genesis “is not operationally suitable because of poor system usability, insufficient training and help desk support,” according to the Initial Operational Test and Evaluation.
What’s more, Robert Behler, the Director of Operational Test and Evaluation, recommended in the IOT&E report that DoD “delay further fielding until the Joint Interoperability Test Command completes the IOT&E and the Program Management Office corrects any outstanding deficiencies.”
Behler pointed to a lack of workplace functionality needed to document and manage patient care as examples, and noted that clinicians using MHS Genesis only completed 56 percent of the 197 tasks used to measure performance.
“Poorly designed user roles and workflows resulted in an increase in the time required for healthcare providers to complete daily tasks,” according to the report.
In some instances, EHR issues caused providers to work overtime or see fewer patients. In other cases, users actually questioned that accuracy of the data exchanged between external systems and MHS Genesis — which could have put patient lives at risk.
“Users generated 22 high severity incident reports that the testers attributed to inoperability, including interoperability of medical and peripheral devices,” according to the report. Users ranked usability at 37 out of 100 on the system usability scale.
“Survivability is undetermined because cybersecurity testing is ongoing,” Behler added.
When asked directly about the IOT&E report, Stacy Cummings, DoD’s Program Executive Officer for the Defense Healthcare Management Systems, agreed with the recommendation to refine workflow roles and views and added that DoD needs to elevate its training strategy moving forward.
Cummings also said the Pentagon worked with HIMSS Analytics to conduct an independent measure of the progress and effectiveness of MHS Genesis.
HIMSS Analytics, in fact, scored DoD inpatient and outpatient EHRs at 2 out of 7 prior to implementing Cerner and at Stage 5 on the Electronic Medical Record Adoption Model scale post-implementation.
DoD officials have repeatedly insisted that the agency will meet its timelines — though the IOT&E report makes it appear that completing MHS Genesis on time will be a difficult task.
Indeed, the project has already experienced a two-month delay so Cerner and DoD officials could evaluate the initial pilot test sites and Behler wrote in the letter that officials postponed the IOT&E report at the fourth pilot site “to remediate significant problems at the first three sites.”
What emerges from that fourth IOT&E report, due later this year, could be very telling about how realistic the timeline is, or not.
Last month Washington Senator Patty Murray (D) called out the DoD for a backlog of issues including inaccurate prescriptions, misdirected referrals, long wait times to solve known problems, technical issues opening the program and others that she said raise “serious concerns about putting patient lives at risk.”
Even still, DoD officials said the agency will meet its implementation deadlines.
Vice Admiral Raquel Bono, Director of Defense Health Agency, said the DoD is on track to deploy a modern electronic health record to replace the patchwork of expensive legacy systems that will serve 9.4 million beneficiaries.
Cummings explained that “we are planning on beginning our next set of deployments in 2019,” and still aiming for full deployment in 2022.
“We have a unique no-fail mission, which requires a tremendous amount of flexibility. Deploying the latest technology is extremely important to us,” Bono said. “MHS genesis is extremely important and it’s important to get MHS Genesis right.”
“In the competition for large healthcare systems, it's the top four EHR companies mainly participating with some exceptions,” Mary Anne Crandall, a senior analyst at Kalorama Information, wrote in the firm’s annual report on the state of EHRs.
For 2017, Cerner earned 17.3 percent market share, while Epic has 8.8 percent.
Allscripts, thanks to mergers and acquisitions of Misys and Eclipsys, rose to 6.1 percent.
That’s when looking at the overall global market. When homing in on the physician office space, however, Crandall said Epic is in the lead and Meditech is also in play.
"In the physician office arena, competition is fierce,” said Crandall. It’s not just the big four like it is among larger customers. Instead, athenahealth, eClinicalWorks, NextGen and NueMD are all vying for clients. “There are a lot of competitors.”
As it did last year, Kalorama pointed out that no one company has a majority share of the market as of 2017. One notable change from Kalorama’s report about 2016 is that McKesson was then in the second spot behind Cerner and ahead of Epic and Allscripts.
There are other ways to slice and dice the EHR market. Just last month, KLAS researchers found that both Cerner and Epic showed what KLAS called “market energy,” based on how many deals a vendor is likely to land in the immediate future.
KLAS found Epic in the lead with 393 potential customer wins, while Cerner has 304. Athenahealth is at 129, with Meditech close behind with at 125. Allscripts, meanwhile, could score as many as 72, GE Healthcare has 61 potential customers, while eClinicalWorks is looking at 45, Merge/IBM at 39; and Philips has 33 prospects.
Looking ahead to 2018, Kalorama’s Crandall said the firm expects Epic to continue gathering market share and adding to its ambulatory customer base.
Allscripts, meanwhile, bought McKesson's EHR technology in 2017, part of the Enterprise Information Solutions business unit that includes the Paragon EHR system. Kalorama said that will enable Allscripts to offer a stronger hospital offering, especially among smaller providers and health systems.
What’s in store for athenahealth is unclear. Activist investor Elliott Management, which owns 9 percent of athenahealth’s stock, sent a $6.5 billion takeover bid last week, which athenahealth’s board is currently reviewing.
Cerner, for its part, has gotten a revenue boost from its modernization contract with the U.S. Department of Defense and is awaiting a final decision about whether Veterans Affairs will sign a contract to modernize its EHR with Cerner as well. VA CFO Jon Rychalski told the Senate Committee on Appropriations that the VA will make that decision by May 28.
Kalorama explained that it determines market share by looking at revenue for EHR and EMR platforms, Computerized Physician Order Entry systems as well as consulting, installation, training and servicing.
The Sequoia Project announced plans to implement a new corporate structure this summer that will emphasize its role as a convener for nationwide interoperability initiatives, leading to two distinct subsidiaries: eHealth Exchange and Carequality.
Together, the eHealth Exchange, which traces its roots back more than a decade to ONC's old Nationwide Health Information Network, and Carequality, which was launched by Sequoia as an interoperability framework in late 2015, with EHR vendors such as Epic, eClinicalWorks and athenahealth signing on to its principles soon after, serve distinct but complementary roles in advancing information exchange in the U.S.
Sequoia Project's new approach aims to ensure that both projects have the governance and management resources they need.
The restructuring was "driven by the significant growth and progress of the eHealth Exchange and Carequality," said Mariann Yeager, CEO of The Sequoia Project (which also this week announced its expansion plans for the PULSE exchange platform for disaster response).
She said the plan was to maintain the operational efficiencies for each initiative, "while expanding Sequoia's focus on incubating new interoperability opportunities and overcoming impediments to health information exchange."
As part of the new organizational arrangement, eHealth Exchange will become both a member of Carequality and an implementer of its standards – helping expand its presence to other networks that participate in Carequality.
"For the last nine years, the eHealth Exchange has been the principal way the public and private sector share health information," said Jay Nakashima, eHealth Exchange's new vice president, in a statement. "I'm honored to take the helm at this critical stage of the network's evolution as we develop new services and features, beginning with operating as a separate legal entity and becoming a Carequality implementer."
The eHealth Exchange network – used by more than 15 EHR vendors, nearly five dozen HIEs and in place at 75 percent of U.S. hospitals – enables the secure sharing of records for more than 120 million patients. The Centers for Medicaid and Medicare Services, Department of Defense, Department of Veteran Affairs and Social Security Administration also use it to exchange data with private sector organizations.
Carequality's framework enables some 600,000 physicians nationwide to exchange health data. Sequoia Project officials say that when eHealth Exchange completes the Carequality application process, each eHealth Exchange participant will be able to use Carequality connectivity to share information with similarly-connected health systems.
"Carequality's success as the leading national-level trusted exchange framework is predicated on our commitment to fairness and transparency," said Dave Cassel, vice president of Carequality, in a statement. "By reorganizing the eHealth Exchange and Carequality into separate legal entities, we further ensure unbiased, equitable treatment for the eHealth Exchange alongside every other implementer subject to Carequality oversight."
The first graduating classes from some of the 32 medical schools to participate in the American Medical Association's pioneering curriculum modernization initiative are now ready to take their tech savvy to hospitals and practices nationwide.
Medical students from NYU, Indiana University, East Carolina University, Oregon Health and Science University and Penn State graduate this month as part of AMA's Accelerating Change in Medical Education Consortium.
ACME was launched back in 2013 with the goal of helping "close gaps in readiness for practice," said Susan Skochelak, MD, group vice president of medical education at AMA, aiming to educate students in the information technology, techniques and value-based philosophies that have come to define healthcare in the 21st Century.
At the time, a recent poll had shown that only 64 percent of medical school programs even allowed students to get hands-on experience with electronic health records.
"When you talk to people who are hiring in the major health systems or you talk to graduates, what they'll say is they really are not prepared. They don't know how to manage panels of patients; they don't fully even necessarily know what to do with an EHR," Skochelak told Healthcare IT News at the time.
Mayo Medical School, UC Davis School of Medicine and The Warren Alpert Medical School of Brown University were among the first organizations to sign on to the initiative. Two years later, AMA added 20 new medical schools to ACME, tripling its size.
This past year AMA partnered with the Regenstrief Institute and Indiana University School of Medicine to launch an EHR training program for med students: the EHR Clinical Learning Platform, billed as the first of its kind, uses actual data from patients at Indianapolis-based Eskenazi Health, enabling students to more realistically care for virtual patients as they familiarize themselves with EHR workflows.
Not learning how to document in the EHR during university training "comparable to a physician graduating from medical school without learning how to properly use a stethoscope," said Skochelak.
Beyond the teaching EHR system, other innovations from the consortium include competency-based programs, curricula allowing students to be totally immersed within the health care system from day one of medical school, training in physician leadership, education in team care skills, and curricula aimed at achieving health equity and increasing diversity in the physician workforce.
Through the ACME Consortium, AMA also developed what it calls the Health Systems Science textbook, aimed at helping students think about care delivery in terms of quality improvement, patient safety, accountable population health management, social determinants of health and beyond. The textbook is currently being used in 14 medical schools across the country.
Now, five years since it was first dreamed up, the first of those students are graduating from some of the ACME Consortium's 32 schools, which have developed innovative curricula using $12.5 million in grants from AMA.
All told, some 19,000 medical students are studying under the technology-intensive programs, and will eventually care for 33 million patients nationwide.
"These future physicians will be better equipped to provide care in a practice environment of rapid progress, new technology and changing expectations both from government and society —directly impacting the way health care is delivered nationwide," said AMA CEO James Madara, MD.