Bryan Medical Center in Lincoln, Nebraska, announced that it will implement Cerner’s scheduling tool to create a centralized staffing office that better coordinates hiring and work shifts. 

The hospital’s central staffing office uses Cerner Clairvia Staff Manager and Demand Manager in a central scheduling office to save time and address a variety of scheduling issues.

Staff management IT is a common system in healthcare. Other vendors that market staff management systems include IBM Watson Health, ANM Healthcare and MedPro Healthcare Staffing, to name just three among many companies providing similar services.

[Also: Epic to integrate Nuance AI virtual assistant into EHR]

The intent of the scheduling IT at Bryan Medical Center is to align labor resources with the medical center’s strategic goals and patient needs.

Most hospitals and health systems across the country have similar goals on this score.

“Staffing is such an important part of the day-to-day functioning of the units, and to have the support of the central staffing office is beneficial,” said Angela McCown, RN, orthopedic/trauma and medical surgery oncology nurse manager at the Bryan Medical Center. “The staffing office knows the resources available throughout the organization.” 

The management tool makes it possible for Bryan’s employees to better project staffing resources. It creates and manages schedules for the medical, surgical, intensive care unit, neonatal intensive care unit, labor, delivery, emergency and nursing departments.

“It also provides a valuable tool for administrative managers to manage the complexities of patient throughput, allowing us to make adjustments in our daily staffing levels throughout the day to best meet the needs of our patients,” added Lisa Vail, chief nursing officer and vice president of patient care services. 

Prior to adding the new IT, the staffing office only scheduled nursing, but since then, leadership added 11 ancillary departments without hiring more staff. The eight staffing assistants create schedules for 34 nursing units and 11 ancillary units.

Office staff release schedules on a staggered basis to distribute the workload evenly and provides monthly reports on various staffing issues.

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

UCHealth is poised to build an innovation center in Denver designed to usher in the future of healthcare delivery.

The health system is already collaborating with more than 70 organizations on the project, and innovation hubs are taking root in many health systems across the country. 

Boston Children's Hospital has its Innovation & Digital Health Accelerator. Cleveland Clinic, of course, has Cleveland Clinic Innovations. It was launched in 2000, among the early innovators. El Camino Hospital in Mountain View, California, has theFogarty Institute for Innovation, founded in 2007.

[Also: Emory Healthcare announces new innovation hub]

What’s more, many health systems like UCHealth that have not yet created a hub of their own are at least contemplating the possibilities. Emory Healthcare, for instance,  recently announced its decision to create its own innovation hub in Atlanta.

UCHealth’s center, Catalyst Health-Tech Innovation, will convene participants from across healthcare and wellness industries to collaborate and incubate innovative ideas.

The goal: to shake up healthcare, or as they put it, “fundamentally transforming healthcare as it has been known.”

University of Colorado Hospital – or University Hospital – is part of the UCHealth System and is the principal teaching hospital for the University of Colorado School of Medicine, in Aurora.

UCHealth’s work to revamp healthcare as we know it, will begin with the development of the innovation hub where discussions with participants both inside and outside the health system, will occur. The goal: To help transform healthcare delivery of the future.

“Artificial intelligence, big data, decision support, virtual health and wearables are rapidly disrupting healthcare as we know it,” Richard Zane, MD, UCHealth chief innovation officer, said in a statement. “We are committed to being at the forefront of this change and partnering with other innovators to improve the quality, experience and safety of healthcare while helping control costs.”

“Health-tech innovation has the potential to improve medical outcomes, and healthcare is not going to be re-imagined just through established healthcare organizations or startups – we have to do it together,” added Mike Biselli, health-tech entrepreneur and co-founder of Catalyst HTI, which is partnering with UCHealth on the innovation center. “Our industry integrator concept allows UCHealth to be plugged in at the point of innovation by physically housing a healthcare innovation ecosystem in a single location – allowing entrepreneurs, technologists and clinicians to collaborate through the entire process of innovation.”

UCHealth plans to build “hospital room of the future” in the innovation lab – a space to test equipment and devices and a space to create a new type of clinical setting.

“It might not even be in a hospital – it could be in your own home,” UCHealth CIO Steve Hess added. 

By experimenting with virtual health options, wearable monitors and the electronic health record, healthcare organizations might be able to transform a patient’s bedroom into a space where medicine is delivered in a novel way that is both convenient and comforting to the patient while also lowering costs, he mused.

UCHealth is already partnering with more than a dozen innovative companies, and together, products have been developed to improve the efficiency of operating rooms, boost the accuracy of medication prescribing, inject the latest research and protocols into the electronic medical record, and to utilize wearable devices to constantly monitor the vital signs of patients, and many more innovations are in development.

“We are now in the dawn of a new era of medicine, one in which the electronic medical record and artificial intelligence work hand in hand with medical providers to support and inform clinical decisions,” Hess added.

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

Sepsis is the leading cause of death in U.S. hospitals: 62 percent of people hospitalized with sepsis are re-hospitalized within 30 days, and as many as 80 percent of sepsis deaths could be prevented with rapid diagnosis and treatment, according to the Sepsis Alliance.

Halifax Health, the Florida-based health system, is fighting back against sepsis with a combination of its electronic health record, cloud-based clinical decision support and mobile communication devices Here’s how the systems are working together to improve patient safety.

About 250 data points per patient are sent from its Meditech EHR to the Wolters Kluwer Point Of Care Advisor cloud-based decision support platform. The decision tree engine in the cloud can predict sepsis based on data and trends.

[Also: With EHR-based sepsis detection, Epic and Cerner have different approaches]

When sepsis is predicted, an alert is triggered and sent to a patient's caregiver and hospital sepsis care team members via Vocera hands-free communications badges or smartphone apps. The alert goes through an integration engine to the communications system via APIs.

"When we started, we only sent the predictive alerts to the patient’s care team and our sepsis care team, then we added an acknowledge feature," said Tom Stafford, vice president and CIO at Halifax Health.

"Soon after that, we decided to convert the alert to be prescriptive," he added. "Now, when caregivers acknowledge a sepsis alert on their badges or smartphone apps, the system tells them their next steps over their mobile devices. If the steps are complex, the system refers them to the Point of Care Advisor system."

The power of the three integrated systems hit close to home recently. One of Halifax’s IT team members was hospitalized. The integrated system predicted sepsis in the staffer and alerted the applicable clinical team members. They followed the recommended actions from the system and were able to successfully treat their fellow employee for sepsis.

Stafford offers some wisdom for peers considering similar approaches to warding off sepsis.

"You need to have a physician champion that understands what you are trying to accomplish technically," he said. "You also need to have team members who are very knowledgeable in APIs and who can work with development teams at external companies, like our vendor partners."

And before a healthcare organization can innovate, it needs a stable workforce and infrastructure, Stafford added. "To innovate, you must also have time to do so," he said. "Lack of resources and stability in staff and infrastructure will prevent innovation."

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

After 20 years operating with a Meditech EHR, the Countess of Chester Hospital NHS Foundation Trust – the national health service in England – is turning to Cerner with a 15-year agreement to employ Cerner Millennium, when Meditech’s contract expires in November 2019.

The Trust noted the agreement with Cerner is part of its “commitment to providing safe, kind and effective care in the digital era.”

Cerner leads the worldwide EHR market, with Epic taking the second spot, Allscripts in third and GE Healthcare at fourth. For 2017, Cerner earned 17.3 percent market share, while Epic has 8.8 percent. 

[Also: Cerner has almost double EHR global market share of closest rival Epic, Kalorama says]

The Cerner Millennium EPR system is currently used by 22 NHS trusts in England. The latest organization to deploy the system, West Middlesex Hospital, went live in May.

The nomenclature in England is slightly different than in the U.S. Instead of “Electronic Health Record” or “EHR,” in England, it’s called EPR. The “P” is for patient -- an approach somewhat similar to vendors such as Epic, Cerner, athenahealth and eClinicalWorks taking a more comprehensive approach in loosely saying EHRs are becoming CHRs. 

“It is our duty to provide safe, kind and effective care for the people of West Cheshire and shifting our processes from analog to digital is a huge part of that, NHS chief executive of Countess of Chester Hospital Tony Chambers said in a statement. “The NHS operates at the forefront of science clinically but so much of the technology being used to support that is outdated.”

The upgrade will help the facility to become a “Model Hospital.” To that end, the Countess of Chester Hospital is designated a “Fast Follower” of Wirral University Teaching Hospital, which has been using Cerner since 2010.

The trust plans to integrate the new EPR with its Co-ordination Centre, a technology program implemented in 2017, which is designed to improve logistical processes and use patient flow technology designed to help reduce the time people spend in the hospital, by improving bed management.

Some 4,000 sensors installed throughout the trust help provide a real-time picture of the hospital, providing the location of tagged equipment and picking up data from badges and electronic wristbands. Information is then sent to a coordination center, which acts like an air traffic control room.

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

The American Medical Association is taking aim at dangerous drug shortages and the need for better EHR education for physicians with two new policies that could change manufacturer infrastructure and medical education.

First, a newly adopted policy has declared drug shortages an urgent public health crisis, as many of the drugs currently in dangerously short supply are everyday commodities needed for patient care in all medical settings such as sterile intravenous products containing saline or other fluids. 

Shortages of these basic products and their containers significantly ramped up following the devastation wrought by Hurricane Maria in Puerto Rico, where most of the bags used in the U.S. are made.

The AMA said it would push the Department of Health and Human Services and the Department of Homeland Security to treat drug shortages as a national security initiative resulting in the designation of drug manufacturing sites as”critical infrastructure with vital importance to the nation’s public health.

However, that effort must be a shared one with both government and industry. One hurdle the AMA effort faces is manufacturer reluctance to share production locations for drugs and other medical products, despite the fact that any information shared with Health and Human Services and Homeland Security would be protected by law from public disclosure and used only in the context of preparedness planning and response.

“To facilitate industry and government collaboration in preparing for disasters and determining contingency plans to mitigate drug shortages, the AMA calls for greater manufacturer transparency regarding production location and problems that may lead to a drug shortage. Given the uncertainty regarding these sites as alternative sources for drugs in short supply, the AMA also calls for more information on the quality of outsourcing compounding facilities,” the organization said in a statement.

Second, it’s no secret that electronic health records systems have become an integral part of physician functions in most provider settings, and that under MACRA and value-based reimbursement, they are becoming even more crucial in documenting the quality of care delivered as well as other reportable measures that will influence physician reimbursement. However, the AMA said it is becoming clear that medical students and residents are suffering from a lack of training in medical school and residency programs when it comes to the often-lamented systems. The AMA adopted a new policy at its annual meeting that it hopes will ensure medical students get quality clinical documentation experience using EHRs. 

[Also: First IT-savvy med students graduate under pioneering AMA program]

“There is a clear need for medical students to have access to - and learn how to properly use -  EHRs well before they enter practice. That’s why, even as we continue to work to improve EHR usability for all physicians and physicians-in-training, we’ve been working over the last five years with medical schools across the country to ensure our future physicians are 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 healthcare is delivered nationwide,”  said AMA Board Member and medical student Karthik V. Sarma.

According to the AMA’s new policy report, there are concerns about the effects of the EHR on relationships with patients, as students and residents might be more engaged with the chart and computer than with the patient. There is also concern about students and potentially poor role modeling from faculty and care teams on proper use and best practices for EHRs.

“The AMA’s new policy encourages medical schools and residency programs to design clinical documentation and EHR training that provides evaluative feedback regarding the value and effectiveness of the training, and that can be evaluated and demonstrated as useful in clinical practice,” the AMA said.

The policy also pushes medical schools and residency programs to provide faculty with additional EHR professional development resources to make sure they are setting the appropriate example of EHR use during physician/patient interactions.

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

Many eyes are watching the likes of Amazon, Apple, Google, Microsoft and other tech stalwarts for some kind of signal about their healthcare intentions. While some moves are already out in the open, such as Apple Health Records and Amazon Web Services expressing interest in longitudinal health records and analytics, the companies also have patents that potentially foretell the future. 

As of Jan. 23, Amazon-owned 7,096 U.S. patents, according to the United States Patent and Trademark Office.

In addition, Amazon Technologies, Inc., had filed and published 870 patent applications in the U.S. as of Jan. 23, and Amazon.com, Inc., had filed and published 16 patent applications.

Amazon has been granted patents for thousands of inventions spanning one-click buying, drones, virtual-reality mirrors and Alexa, the company’s AI–powered voice assistant.

Google, for instance, – with 186 patents – focused mostly on investments for DeepMind, its artificial intelligence technology, and also on Verily, its healthcare and disease research entity among its 186 patents, according to the new Kalorama report.

Apple filed 54 patents to turn its iPhone into a medical device that can monitor biometric data such as blood pressure and body fat levels and to develop algorithms to predict abnormal heart rates.Microsoft filed 73 patents based on expanding its AI capabilities and developing monitoring devices for chronic diseases.

Such innovations have encouraged biopharma, medtech and providers to partner with these tech giants to boost digital healthcare, Kalorama noted. 

Although Amazon has not officially announced details, industry rumblings indicate that e-commerce and cloud giant has been working with a secret project team known as 1492 that is exploring platforms for EHR data, health apps and telemedicine. The 1492 team is also reportedly working on extracting data from EMRs to make it more useful to healthcare providers and adding to its existing Amazon products such as Amazon Echo and the Dash Wand to fold into the healthcare setting. 

Microsoft, meanwhile, has a number of projects that are impacting – or will impact – the digital health arena including: Microsoft Genomics, Microsoft Azure Security and Compliance Blueprint. The tech giant is also expanding Microsoft's Intelligent Network and plans to create an AI-focused network in cardiology.

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

I'm not always a fan of assigning a score, on the fabled scale of one to 10, to assess the maturity or readiness of a particular sector of a particular industry.

But sometimes, as it was at the HIMSS Big Data and Healthcare Analytics Forum in San Francisco this past week, getting those who work in the trenches to hang a specific number on it can be illustrative.

At the conference, I moderated a panel featuring four healthcare professionals whose heterogeneous approaches to the management and use of healthcare data together offered an interesting snapshot of how U.S. healthcare is doing with its IT-enabled analytics initiatives.

The panelists' answers to the following question were surprisingly unanimous: "On a scale of 1 to 10, where is healthcare on its journey to being an advanced user of data and analytics to improve care, control costs, and create operational efficiencies?"

Across the board, each expert assessed healthcare's readiness at a "3" or lower.

"Two," said Douglas Nowak, executive director enterprise data and analytics at Sanford Health. "Maybe two-and-three-quarters."

Each expert was of the broad consensus that the technology now exists to store, scrub, streamline, share and scrutinize the mountains of data that have been amassed since EHRs became basic and ubiquitous utilities these past 10 years or so.

But they also agreed that cultural factors related to information governance and basic data literacy were big impediments to truly taking advantage of it all. Too often, even the smartest and most well-trained clinicians don't know the right questions to ask to get the most from their data.

For all the progress made over the past decade – and let's pat ourselves on the back that we've has come a long way in a short time, especially when compared with the paper-based system that existed as recently at the late 2000s – most healthcare organizations are still far behind other industries when it comes to capitalizing on the treasure trove of data that exists.

As Cleveland Clinic Chief Information Officer Ed Marx noted in his keynote (showing a chart from The International Institute for Analytics that ranked the various industries in their ability to harness data) healthcare providers ranked last – lagging health insurers, utilities, groceries, manufacturing, pharma and medical devices, and, of course, financial services.

To make up that ground, a lot has to happen, both with our clinical and financial data and those across healthcare who put it to work, said Marx, pointing to a future where "data is readily available, understood and expected" and "discussions are interactive and supported by data discovery and intuitive visualizations."

It won't be easy, of course, and it will require continued "investment in technical and human resources," he said.

That said, we're closer than we may think. And certainly closer than we were just a few years ago.

"The best in healthcare are competing with the best in other industries in terms of analytics," said Lee Pierce, chief data officer at Sirius Computer Solutions. "There’s a lot going on here."

At the HIMSS Big Data forum, many of those stories were told. And taken together, the anecdotal experiences of some of the country's leading-edge health systems suggests that advances in data literacy and smart analytics initiatives could be creating a gravitational pull that might drag the rest of healthcare along with it.

St. Charles Health System, for instance, is harnessing a small staff to develop in-house predictive models, using it’s own data, customized to solve their specific clinical and operational challenges, according to Michael Johnson, a data scientist at the hospital. 

The Academy for Population Health Innovation at University of North Carolina is building a next-generation analytics infrastructure to drive innovation and gains in its population health management programs, said Michael Dulin, MD, APHI Director. 

And the Staten Island Performing Provider System is using real-time data to drive improvements on its unique quality measures and closing the gap with more traditional healthcare providers, said CIO Anyi Chen. 

All told, those case studies and others showed that, in multiple very different settings, heartening progress is being made. And that healthcare – despite its slowness compared with other industries – may be on the cusp of some big transformations for the better.

They suggested that, with the IT infrastructure now in place and wider awareness about the value of data on the rise, providers can (and probably will) make up a lot of ground in a short time.

"We are achieving value,” Pierce of Sirius said. “We’re just not as good at telling and sharing those stories."

The next HIMSS Big Data and Healthcare Analytics Forum is scheduled for October 22-23 in Boston. Register here. 

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

I'm not always a fan of assigning a score, on the fabled scale of one to 10, to assess the maturity or readiness of a particular sector of a particular industry.

But sometimes, as it was at the HIMSS Big Data and Healthcare Analytics Forum in San Francisco this past week, getting those who work in the trenches to hang a specific number on it can be illustrative.

At the conference, I moderated a panel featuring four healthcare professionals whose heterogeneous approaches to the management and use of healthcare data together offered an interesting snapshot of how U.S. healthcare is doing with its IT-enabled analytics initiatives.

The panelists' answers to the following question were surprisingly unanimous: "On a scale of 1 to 10, where is healthcare on its journey to being an advanced user of data and analytics to improve care, control costs, and create operational efficiencies?"

Across the board, each expert assessed healthcare's readiness at a "3" or lower.

"Two," said Douglas Nowak, executive director enterprise data and analytics at Sanford Health. "Maybe two-and-three-quarters."

Each expert was of the broad consensus that the technology now exists to store, scrub, streamline, share and scrutinize the mountains of data that have been amassed since EHRs became basic and ubiquitous utilities these past 10 years or so.

But they also agreed that cultural factors related to information governance and basic data literacy were big impediments to truly taking advantage of it all. Too often, even the smartest and most well-trained clinicians don't know the right questions to ask to get the most from their data.

For all the progress made over the past decade – and let's pat ourselves on the back that we've has come a long way in a short time, especially when compared with the paper-based system that existed as recently at the late 2000s – most healthcare organizations are still far behind other industries when it comes to capitalizing on the treasure trove of data that exists.

As Cleveland Clinic Chief Information Officer Ed Marx noted in his keynote (showing a chart from The International Institute for Analytics that ranked the various industries in their ability to harness data) healthcare providers ranked last – lagging health insurers, utilities, groceries, manufacturing, pharma and medical devices, and, of course, financial services.

To make up that ground, a lot has to happen, both with our clinical and financial data and those across healthcare who put it to work, said Marx, pointing to a future where "data is readily available, understood and expected" and "discussions are interactive and supported by data discovery and intuitive visualizations."

It won't be easy, of course, and it will require continued "investment in technical and human resources," he said.

That said, we're closer than we may think. And certainly closer than we were just a few years ago.

"The best in healthcare are competing with the best in other industries in terms of analytics," said Lee Pierce, chief data officer at Sirius Computer Solutions. "There’s a lot going on here."

At the HIMSS Big Data forum, many of those stories were told. And taken together, the anecdotal experiences of some of the country's leading-edge health systems suggests that advances in data literacy and smart analytics initiatives could be creating a gravitational pull that might drag the rest of healthcare along with it.

St. Charles Health System, for instance, is harnessing a small staff to develop in-house predictive models, using it’s own data, customized to solve their specific clinical and operational challenges, according to Michael Johnson, a data scientist at the hospital. 

The Academy for Population Health Innovation at University of North Carolina is building a next-generation analytics infrastructure to drive innovation and gains in its population health management programs, said Michael Dulin, MD, APHI Director. 

And the Staten Island Performing Provider System is using real-time data to drive improvements on its unique quality measures and closing the gap with more traditional healthcare providers, said CIO Anyi Chen. 

All told, those case studies and others showed that, in multiple very different settings, heartening progress is being made. And that healthcare – despite its slowness compared with other industries – may be on the cusp of some big transformations for the better.

They suggested that, with the IT infrastructure now in place and wider awareness about the value of data on the rise, providers can (and probably will) make up a lot of ground in a short time.

"We are achieving value,” Pierce of Sirius said. “We’re just not as good at telling and sharing those stories."

The next HIMSS Big Data and Healthcare Analytics Forum is scheduled for October 22-23 in Boston. Register here. 

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

BOSTON — Beth Israel Deaconess Medical Center and Lahey Health, along with three other hospitals, are currently in the midst of a mega-merger to bring the organizations under one umbrella. But as with most providers, they’re operating with a wide range of EHR vendors and versions.

There are three instances of Epic, three different versions of Meditech, athenahealth and Cerner, and the assumption is that we’ll rip and replace these versions and put in one monolith EHR, explained John Halamka, MD, Beth Israel Deaconess CIO at HL7’s DevDays on Tuesday.

[Also: Next-gen data management: From FHIR APIs to AI to genomics, tech is changing fast]

“That might be true if I had $2 or $3 billion,” or if I had the nerve to uproot the current EHR workflows, said Halamka. “But I don’t want to do that. So instead, what we’ve said is FHIR. Why don’t we just create a suite of apps, device neutral, then enable providers to have the appropriate workflow and experience, regardless of the transaction in the EHR.”

“This will enable me for the next five years or so to keep the EHRs in place and give people a unified experience,” he added.

But while the use of FHIR will allow the organization to save costs and fuel interoperability, there are still a few challenges in the U.S. to making full use of it, explained Halamka. “People think FHIR does more than it does at the moment. The trajectory is excellent, but we need to temper expectations.”

One of those issues is the lack of a patient wide matching system, where people are assigned a unique identifier. Halamka doesn’t think the industry can expect any changes in that under the current administration, nor any “major change in national identification habits.”

“We need to see some kind of service to track patient identity -- demographics alone aren’t sufficient,” said Halamka. Instead, a service could break down patients by their first name, a relative’s name and other things that can help us figure out who you are.

“We’ve created ways of saving that data and taking it place-to-place, but we’ve never had a way to get there,” he continued. “We told doctors they had to drive, but we didn’t build any roads. And we’re going to hold them accountable if they don’t get there.”

Another issue is that data sharing policies vary by state. So, for example, New Hampshire has different policies for the type of data that can be shared and its purpose, which differs from neighboring Massachusetts, he explained. “How are you supposed to coordinate care?”

While FHIR improves these issues, there are still 50 different states and six territories, “so 56 different policies,” said Halamka. “As we move from fee-for-service we have an imperative to improve care quality. But today, we can’t survive in a risk-based environment unless we share data.”

The quality and source of data also prove problematic, as the industry lacks standards, he explained. Consider consumer data, what should providers do with that data and how should it be interpreted?

“I think, the answer is that we need metadata, around the data, and we hope, maybe as a society we develop rules,” Halamka said. For example, FitBit is allowed to have a variable heart rate, but with a pacemaker, it’s not allowed.

“But please recognize, all of the underlying data you work with will have its flaws,” he continued. “Consider the source of data. There needs to be a solution to this mismatch problem because you can’t update everyone simultaneously. We need to accept the fact we’re going to have a lot of variation.”

And change won’t come from policymakers. “The government used to drive the agenda -- but I really think the private sector economy is where the action is … the change is going to come from you.”

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

The Agency for Healthcare Research and Quality has awarded MedStar Health a contract to develop and test new technology that can gather patient-reported outcome data and put it to use.

The 18-month contract, which was given through AHRQ's Accelerating Change and Transformation in Organizations and Networks, or ACTION III, will support researchers as they seek new ways to collect patient data and incorporate it into electronic health records.

MedStar Health Research Institute will be focusing on two specific standards-based applications, designed to work with EHRs to gather patient-reported data for and make it available to clinicians and researchers.

[Also: 'Bring your own data' is the next trend in healthcare]

Usability and unique functional requirements will be key considerations as the apps are pilot-tested and evaluated in 10 different primary and specialty care practices across MedStar Health, each with its own characteristics, according to MedStar officials.

With smartphones and health trackers now commonplace, more and more patients are amassing data – quality of life, ongoing symptoms, daily activities – that can help guide clinicians in their care and treatment. 

As Penn Medicine CIO Mike Restuccia noted in a Healthcare IT News blog post earlier this year, "patient monitoring systems, wearables (and) patient reported outcomes … transmit large streams of data."

Many vendors, he wrote "indicate the technology component can be easily addressed. Simply sign up to procure large amounts of data storage, either through their on-premise or cloud offering, and you have solved your problem. Unfortunately, it’s never that easy."

[Also: Next-gen analytics: Here's what's coming in the future]

At MedStar, the new apps will be assessed on how well they're able to collect such data and then integrate it within the EHR so it can be put to work for clinical decision support, quality improvement initiatives and more.

"Ensuring that patients have a way to report on outcomes that are meaningful to them is critical to the delivery of safe and effective care," said Neil Weissman, MD, chief scientific officer for MedStar Health and president of MedStar Health Research Institute, in a statement. "The ongoing collaboration through the ACTION III network will help to advance the health of patients beyond our care sites and community."

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

A few years ago, Boston Children's Hospital developed an application it calls Quality & Charge Capture to collect quality improvement-related data directly from clinicians overseeing care by linking it to something that each clinician is responsible for completing for every patient encounter: submitting charge information for professional billing.

The QCC application has been a major success in a complex academic environment spanning both inpatient and ambulatory care to facilitate collection and utilization of quality improvement data directly from clinicians.

"We currently have 77 active quality surveys across 26 clinical specialties," said Daniel Nigrin, MD, senior vice president and CIO at Boston Children's Hospital and assistant professor of pediatrics at Harvard Medical School. "In 2017, more than 80,000 surveys were triggered and almost 800,000 charges were captured using QCC."

Since the program was designed by and for clinicians, Nigrin said they have been enthusiastic to work with the tools to minimize their investment of time, collect only information they find relevant, and harness functionality to do so efficiently.

"In an era in which medical professionals are inundated with documentation and compliance requirements that are often considered inefficient nuisances, they find QCC refreshing," said Nigrin. "The ability to collect real-time data for clinical quality analysis and improvement has been very powerful in our environment of continuous quality improvement initiatives."

One app, two problems

The QCC application grew out of two seemingly unrelated problems in a fashion in which one system could solve both issues.

"The first problem was professional charge capture," Nigrin explained. "Prior to QCC, most of our physician charges were captured using a variety of paper charge tickets and a series of different vendor systems, which subsequently required manual entry into our billing systems. We felt that charge capture performed directly by clinicians would generate more timely and accurate data collection."

But standard, out-of-the-box descriptors for CPT codes from the American Medical Association and ICD codes from the World Health Organization are often neither clinician-friendly nor specific to the conditions treated and procedures performed in the quaternary pediatric institution, Nigrin said.

"Thus, we sought to facilitate clinician-chosen descriptions with many-to-one descriptor-to-code mapping," said Nigrin. "We used a commercial vendor for part of this work, but also built upon it with additional Boston Children's-specific terminologies, as we found that some of our very unique patients and their care needs were not captured by the code sets nor the vendor."

The second problem it addressed was capture of quality/outcomes data elements at the time of service – for specific populations of patients chosen by age, gender, specialty, diagnosis, procedure or other parameters. Like most organizations, quality improvement efforts often occurred retrospectively, conducted by individuals not involved in the care of the patient, and usually using only information stored in the EHR.

"Since clinicians would now be performing charge capture electronically, survey questions could be triggered by the chosen combination of codes and patient demographics, allowing collection of patient-specific quality improvement data while fresh in the clinician's mind, and that might be difficult or impossible to extract from the medical record at a later time," said Nigrin.

How QCC works

After completing a clinical encounter, a physician can access QCC from a desktop icon, an intranet homepage menu or directly from within the Cerner EHR. If entering from the icon or menu choice, they can find the patient of interest in a list patients scheduled that day, a "pending charges" list, or by searching name or medical record number.

If they enter QCC from the Cerner PowerChart embedded tab, QCC loads the patient whose clinical record is currently open. The clinician name and place of service are pre-populated. If appropriate, a choice of encounters will be presented. The physician will enter the procedural or evaluation and management descriptions and codes by search, by choosing from specialty-specific "favorites" menus, and/or selection from previously used diagnoses and services.

They are presented with diagnoses previously used by clinicians in their specialty as well as those chronic conditions chosen by other specialists,  which can be used to populate the patient's problem list in PowerChart.

"If any of the entered data triggers a quality survey, they respond to those questions most typically by choosing from multiple choice radio buttons," Nigrin explained. "The user interface is clean and elegant but robust, allowing all data entry activity to occur from a single screen.  By design, we aim to have the quality surveys take seconds and not minutes to complete. The transaction is completed by clicking a Sign button attesting to their entry."

If a mid-level provider or trainee initiates data entry, the attending provider will be presented with this pre-populated information that can be edited or amended prior to the transaction being completed by clicking an attestation, he added.

"It should be mentioned that creation and maintenance of the quality surveys is managed by clinical departments themselves, and not by IT," said Nigrin. "We created a survey editing tool that allows for streamlined, easy development of the quality surveys that clinicians respond to by the responsible quality improvement experts within the clinical areas themselves."

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

Medicalchain, a London-based startup that develops blockchain technology for storing electronic health records, announced this week that it is has signed a working agreement with the Mayo Clinic to explore different distributed ledger initiatives at the health system.

The company says its blockchain platform can securely store health records, describing it as a single source of truth that can easily and securely be accessed, updated and shared.

With Mayo Clinic, the startup plans to explore the potential a variety of different blockchain EHR projects and other distributed ledger services, officials said.

"Mayo Clinic will provide healthcare and health IT expertise, while Medicalchain will provide our knowledge of blockchain and crypto," said Medicalchain CEO Abdullah Albeyatti, MD, in a statement. "Together we will work on several use cases for blockchain-based electronic health records. There's a lot of opportunity out there, and we feel this working agreement will be of benefit to all healthcare stakeholders."

Medicalchain makes the case that the same innovations that make blockchain a good fit for the financial industry – speed, affordability, the integrity of an immutable ledger – make it useful for hospitals and health systems looking to bolster security, fix data fragmentation and improve engagement by offering patients easier access to view and share their health data.

In a blog post this past week, Eric Funk, MD, an emergency medicine residency at Mayo Clinic, pointed to another potential healthcare use case for blockchain: medical education.

"Using blockchains to improve education is the logical next step," Funk wrote. "It has traditionally been very difficult for clinical educators to get credit for their work, especially compared to their peers who focus primarily on research output.

"Recording this information in the blockchain will easily allow educators to track their impact as their students ultimately become educators themselves, and pass along their knowledge to each subsequent class of students," Funk added. "It will also allow for easy tracking of the most utilized and most effective learning modules."

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