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    Pine Rest Christian Mental Health Services in Grand Rapids, Michigan, went live with its Epic electronic health record system this past week.

    Pine Rest, one of the largest behavioral healthcare providers in the country, is the first free-standing behavioral health system worldwide to implement the Epic EHR, officials said

    "Behavioral health is an essential component of any integrated and collaborative community of care," said Pine Rest president and CEO Mark Eastburg said in a statement, noting that the health system "aims to partner with local and national healthcare systems to provide a network of support and care coordination that "exceeds anything previously experienced."

    As Pine Rest officials put it, now that Epic is in place, the organization has begun to set a new standard for patient care in a behavioral health setting. Features of the new platform allow the provider easier coordination of care, both within its continuum of services as well as in partnership with other healthcare providers in the area, officials say.

    For instance, with Epic Care Everywhere, Pine Rest can receive critical health information from other healthcare systems in real-time during an admission, screening or visit.

    Pine Rest has nearly 50,000 patients. Its executive leaders anticipate a return on their $18 million EHR investment but did not disclose how much.

    [Also: Michigan-based psychiatric hospital picks Epic for EHR, data sharing]

    "The community's health and well-being improves when providers can easily communicate and coordinate care," said Eastburg. "Because other major healthcare systems in West Michigan are either on or moving toward Epic as their 'common language,' I'm convinced that our entire community will benefit."

    He added that a key consideration when planning the Epic go-live was "remaining accessible to those in need of care. Many come to us in a time of crisis, and we are extremely pleased to have successfully achieved the goal of meeting those needs with open doors."

    Provider efficiency has already been improved by the transition to the new EHR, Eastburg explained. Tools such as Epic's Smart Templates and NoteWriter functionality makes it possible for providers to document care as it occurs, which makes it easier to manage their workflow more effectively.

    Louis Nykamp, MD, Pine Rest's chief medical information officer, noted that Pine Rest physicians and clinicians are in full support of the change to Epic.

    Pine Rest shares patients with many of the regional hospitals that currently use Epic. They include Metro Health – University of Michigan Health, Spectrum Health, Bronson, Sparrow Health and Lakeland Health.

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

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    Short Headline: 
    Michigan behavioral health provider goes live on Epic EHR
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    Michigan behavioral health provider goes live on Epic EHR, seeking better care coordination
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    Leaders at Pine Rest Christian Mental Health Services, touted as the first free-standing behavioral health system to implement Epic, anticipate ROI through better patient quality and efficiency.
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    Cerner will pay $4.5 million to settle a class action lawsuit that had spent three years in court, after employees charged that it had improperly avoided paying overtime wages.

    U.S. District Judge Fernando J. Gaitan, Jr., of the United States District Court for the Western District of Missouri, approved the settlement – which Cerner had first agreed to back in April – earlier this month.

    Cerner, which denies any wrongdoing but wants to avoid the expense and disruption of ongoing litigation, had asked that the terms of the settlement agreement be kept under seal.

    The case, Speer et al v. Cerner Corporation, was first filed back in 2014, alleging that the company was in violation of the Fair Labor Standards Act – with plaintiffs Fred Speer and Mike McGuirk saying that Cerner used "an unlawful company-wide payroll processing system," according to the lawsuit.

    With that system, "defendant allegedly (1) paid its nonexempt employees’ overtime wages a full pay period late; and (2) systematically miscalculated overtime wages by failing to include all remuneration into nonexempt employees’ regular rate of pay," according to the suit.

    "Additionally, plaintiff alleges that defendant unlawfully paid plaintiffs and hundreds of other non-exempt employees using the 'fluctuating workweek' method of pay, even though those individuals were not paid a fixed salary because they received varying amounts of pay to perform other job functions such as on-call work."

    Cerner asked that the case be dismissed because: "(1) named plaintiffs had not filed written consents to join the litigation at the time of filing the motion; (2) the statute of limitations bars named plaintiffs’ two-year FLSA claims; (3) the classes plaintiffs seek to certify are overbroad and the policies identified by plaintiffs do not violate the FLSA; (4) the Court should apply a heightened standard of proof rather than the typical lenient standard; and (5) plaintiffs have not demonstrated that other potential class members have an interest in proceeding with a collective action."

    Cerner employees are classified into three separate groups, according to the case: salaried exempt; hourly non-exempt and salaried non-exempt. As of February 2015, it employed salary nonexempt employees in more than 120 different business units across 18 states nationwide, with hourly non-exempt employees working in more than 200 business units in 32 states.

    Speer and McGuirk worked as service center analysts, salary non-exempt roles, at Cerner's Columbia, Missouri-based ITWorks division.

    Epic also faced overtime allegations

    This is the second recent major labor law case involving the top two electronic health record vendors. On May 21, the U.S. Supreme Court handed down its decision in Epic Systems Corporation v. Lewis, which asked whether the National Labor Relations Act allowed for collective redress in arbitration situations.

    This case also centered around overtime pay and employment status classification: A technical writer at Epic has filed the lawsuit, alleging that it violated the Fair Labor Standards Act and Wisconsin state law by failing to compensate him and other similar employees for overtime.

    In its 5-4 decision on Epic v. Lewis, the Supreme Court ruled that companies can require labor and wage disputes to be hashed out individually, and not allow workers to collectively bring class action lawsuits against their employers.

     

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

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    Cerner to pay $4.5M to settle class-action lawsuit
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    Cerner to pay $4.5M to settle class-action overtime suit
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    The lawsuit, litigation for which had lasted for more than three years, alleged that the EHR developer had misclassified certain employees to keep from paying them overtime.
    HOT @HIMSS: 

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    Physician burnout is an increasingly common issue in healthcare, and there are a lot of factors that can contribute to it. Long hours, paperwork and the burden of administrative tasks all play a part. But electronic medical records can also contribute to burnout, largely because each system is different. With disparate electronic health record systems comes an added hardship for physicians, affecting their work -- and their reimbursement.

    Compounding the issue is that many physicians are no longer limited to just one facility. Many handle rounds at multiple hospitals and/or practices, and if each has its own EMR system that doesn't necessarily communicate with the others, it can be a growing headache.

    [Also: Patient experience management platform saves solo practitioner from burnout]

    Niki Buchanan, general manager of population health management at Philips Health, said the lack of interoperability is taking a toll.

    "What a physician might have in their physician care practice might be Athena, or an EMR customized to their workflow or a public-type vendor. When they go in to do rounding, it's usually an Epic or a Cerner, a large system. They have to deal with three or more EMR systems depending on how they're caring for their patients. If there is no standardization … then imagine the challenge of only having a few minutes for the patients and having to provide a full realm of care for them."

    Indeed, physician burnout has become an increasingly widespread problem in healthcare. Earlier this year, a  Medscape National Report on Physician Burnout and Depression found that nearly two-thirds of U.S. physicians report feeling burned-out, depressed or both, with one in three admitting that their feelings of depression have an impact on how they relate to patients and colleagues.

    Physician burnout can hurt the bottom line. Research has shown, for instance, a consistent relationship between higher levels of physician burnout and lower levels of patient safety and quality of care.

    The evolution of the patchwork EHR landscape has been complex, and Buchanan traces the genesis back to meaningful use.

    "There were some positive intentions when meaningful use started," she said. "The HITECH Act was a good thing that happened for healthcare, but it didn't bring with it all of the standardization you should have in place. So for years and years, when the dollars were flowing into health systems to have them implement an EHR, the systems all had different business goals and things they were good at."

    The overall intent, said Buchanan, was to be episodic in nature, documenting the care a given physician was going to provide or recommend that day. But without any standardized rules for how that documentation should be done, every EHR interpreted the meaningful use rules differently.

    Eventual consolidation, a step on the road to true interoperability, may be the key. While Buchanan doesn't think consolidation would necessarily be great for physicians looking for a variety of payment models, it is starting to force the competitors to work together to find the right ways to get the right data in front of clinicians. 

    While true interoperability has yet to be attained, there are technologies out there, including Philips' own, that can allow disparate systems to communicate with one another -- alleviating the pressure on physicians and allowing them to refocus on their core mission of patient care.

    "We have capabilities now … to take some of the data we bring into our system and send that data back into the EMR so it can be recognized at the fingertips of the providers," said Buchanan. "We don't want them to have another system to work in. It's our obligation that if we're going to take the data and put it in a separate place, we have to serve it back up to them at the point of care."

    The good news, this year in particular, is that CPT codes are being brought into the billing codes discussion, allowing them to demonstrate remote patient monitoring.

    "If we can get CPT codes aligned into the system, that will certainly help," said Buchanan. "Until we can start reimbursing clinicians, it's very hard for them to change their clinical workflow and their model if there's nothing for them on the other side."

    Twitter: @JELagasse
    Email the writer: jeff.lagasse@himssmedia.com

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    Disparate EHR systems contribute to physician burnout
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    How disparate EHR systems, lack of interoperability contribute to physician stress, burnout
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    The evolution of the patchwork EHR landscape has been complex, and one expert traces the problem back to meaningful use.
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    Making the case for investing in identity and access management
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    Making the case for investing in identity and access management
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    Kimberly Carrosino, senior director of identity and access management at Providence Health and Services, says hiring a partner to manage identities within healthcare systems can reduce costs, improve compliance and automate certain workflows.

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    In another partnership that will allow its clinicians make more informed treatment decisions while also helping a major vendor improve its implantable devices, Mercy is working with Johnson & Johnson – making its real-world data platform available to help the device developer track its products' performance.

    Johnson & Johnson Medical Devices Companies is embarking on a research partnership with Mercy to leverage its data platform – similar to an agreement the St. Louis health system struck this past year with Medtronic, where Mercy mines its Epic EHR for data to track the failure rate of implantable cardiac devices.

    [Also: Next-gen medical devices: Security, AI, rethinking design for patient experience]

    "We began this project to make sure the devices Mercy uses work for patients," said Joseph Drozda, MD, Mercy's director of outcomes research, in a statement. "With more than 8,000 new medical devices entering the market each year, it's critical that we find better ways to evaluate their performance."

    Johnson & Johnson will tap the health system's data infrastructure offer insights into its devices' performance and help inform its regulatory decision making. The data will also help Mercy improve outcomes for its own patients.

    Drozda, a longtime leader in developing unique device IDs for cardiac implantables notes that the Food and Drug Administration has encouraged manufacturers to make better use of the troves of real-world device data at health systems such as Mercy.

    "Not only does Mercy have diverse data, we have the data platform, quality, scale and sophisticated data scientists to turn this data into meaningful information," he said.

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

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    Mercy shares EHR data with Johnson & Johnson to help improve its medical devices
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    Mercy shares EHR data with Johnson & Johnson to help improve its medical devices
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    It's the second such collaboration, using real-world clinical data to track device performance, following the health system's 2017 agreement with Medtronic.
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    Mubadala Healthcare, based in Abu Dhabi, has implemented an integrated electronic health record from Cerner.

    The latest rollout adds to Cerner's lead in the worldwide electronic health record market, with Epic in the second spot, Allscripts in third and GE Healthcare now among the top four companies, according to recent research into global EHR market share.

    Mubadala Healthcare's Healthpoint facility, a 45-bed, integrated hospital in Abu Dhabi, is among the first in the Middle East to upgrade its health information systems.

    "Our patients will benefit from a seamless experience that starts with their arrival at the check-in desk," said Jose Lopez, CEO of Healthpoint Abu Dhabi, in a statement. "The new software will help us access the right information at the right time and supports our physicians in making the appropriate decisions for our patients."

    For the overall global market in 2017, Cerner earned 17.3 percent of the market share, while Epic trailed at 8.8 percent, according to Kalorama Information. Allscripts rose to 6.1 percent.

    Mubadala Healthcare executives have named the Cerner Millennium integrated clinical information system, called "Sehati" – Arabic for "My Health."

    The new technology will support Healthpoint, National Reference Laboratory, Wooridul Spine Center, Cleveland Clinic Abu Dhabi's Anatomic Pathology Lab and other remote sites. The EHR documents patient care across the healthcare from the doctor's office, the hospital and also outpatient clinics.

    With the EHR, clinicians can document care, order medications, submit treatment orders and access near real-time to patient details when needed.

    "This collaboration is a strategic fit to Cerner's long-term presence in the Middle East region and United Arab Emirates," said Michael Schelper, general manager, UAE & Kuwait, Cerner Middle East and Africa, in a statement.

    In 2017, Healthpoint achieved Stage 6 of the HIMSS Analytics Electronic Medical Record Adoption Model. The award was presented to the hospital during the EMRAM Awards Ceremony at the 2017 annual HIMSS UAE eHealth Week in Dubai.

    "With these new enhancements, the hospital looks forward to achieving HIMSS Stage 7 soon," Lopez added. "By collaborating with Cerner, Healthpoint aims to achieve the UAE Vision 2021 of providing patients with a world-class healthcare system and stimulate the overall development of the sector in the UAE."

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

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    UAE-based Mubadala Healthcare launches Cerner
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    UAE-based Mubadala Healthcare launches Cerner integrated information system
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    Healthpoint, the hospital in Abu Dhabi, hopes the new technology will help it advance from Stage 6 to Stage 7 on the HIMSS Analytics EMR Adoption Model.
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    Cleveland Clinic announced Monday that its patients can now access their personal health data on their iPhones with the Health Records feature.

    That, together with Cleveland Clinic's version of the Epic MyChart app, offers patients more comprehensive mobile access to their own health data and a way to manage appointments, message their physicians and more, officials said.

    "Access to one's own medical records is a crucial part of the digital transformation taking place in healthcare today, and enhances our relationship with our patients," Peter Rasmussen, MD, a neurosurgeon and medical director of digital health at Cleveland Clinic, said in a statement.

    "Our goal is to make that access as easy, convenient and useful as possible, placing patients firmly in the center of their own health data."

    Synced together and updated in tandem, the MyChart and Health Records apps will let iPhone users access their personal health information – allergies, conditions, immunizations, labs, medications, procedures, vitals – and organize it alongside health data from other providers.

    They'll also be view upcoming and past appointments, physician notes and details about hospital admissions. They can schedule appointments, request medication renewals and preventive care procedures and message their providers as well.

    The apps will enable patients to "track important health factors, such as weight or cholesterol or blood sugar, to determine their own personal trends over time," added Amy Merlino, MD, Cleveland Clinic's chief medical information officer. "They are able to easily see a combined view of their information from multiple health systems, as well as have the ability to share their healthcare history with other providers."

    Cleveland Clinic was not among the initial 39 health systems to first launch the Apple Health Records service, but it's little surprise that the innovation leader has been quick to embrace the technology. The health system has a long history of developing apps for its patients, and it has made patient engagement and experience a centerpiece of its mission.

    As Adrienne Boissy, Cleveland Clinic's chief experience officer explained at HIMSS18, it's long past time for healthcare to catch up to patients whose expectations of access and convenience have been shaped by consumer technology.

    "The Amazons and Apples of the world have mastered service, and they are coming for us," said Boissy.

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

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    Cleveland Clinic puts EHR data onto iPhone
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    Cleveland Clinic puts EHR data onto iPhone with Apple Health Records
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    In combination with the Epic MyChart app, patients can now access lab results, meds, vitals and more.
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    While the FHIR specification continues gaining momentum, early success stories are happening among hospitals around the country. 

    Health Sciences South Carolina, for instance, built a FHIR-based clinical data repository infrastructure to create an inter-institutional culture of collaboration for learning from clinical practice, and empowering action through access to data while advancing evidence.

    "Our goal was to create the infrastructure for collaborative quality improvement across health systems and for technology-enabled communities of practice that advance healthcare collaboratively," said Jeff Jacobs, a data architect at Health Sciences South Carolina. "The specific problem that we were trying to address is the lack of a standard data model across institutions to support collaborative work."

    [Also: Next-gen interoperability: AI, blockchain, FHIR and open source analytics]

    FHIR, which stands for Fast Healthcare Interoperability Resources, is an emerging standard from HL7 that allows open access to clinical data without the requirement of proprietary or licensed programming infrastructure.

    "We chose FHIR because of its potential use in supporting 'write once/run everywhere' apps to drive projects," said Leslie Lenert, MD, vice president and chief medical officer at Health Sciences South Carolina. "It allows us to tackle interoperability projects one resource at a time."

    This architecture moves the organization from an information-at-rest model to one of information-in-motion, added Kenneth Deans, president and CEO of Health Sciences South Carolina.

    In this architecture, each facility is able to have a dedicated repository of clinical data which is populated in real time based on feeds from various hospital EHR systems. Hospital data is normalized into FHIR Patient, Encounter, Condition, Observation and other resources. This data infrastructure is then combined with an enterprise master patient index to provide standardized research data reporting, and to enable SMART on FHIR based apps with a longitudinal view of data across institutions.

    The repository is a mirror of the content of health systems' EHRs and other information systems that allows Health Sciences to create clinical and research programs that offer value for its members based on technology from Simpatico Intelligent Systems and Oracle. 

    "It provides an interactive data store in FHIR format that members can use for FHIR app development and to support patient access to their health data," Lenert explained.

    "The feature of the FHIR repository that is most compelling to us is its support of FHIR subscriptions," Lenert added, "both for enriching the data of our members from external sources – such as mortality data and social determinants data – and its use in transforming that data into multiple different formats for collaborations; for example, Observational Health Data Sciences and Informatics for analytics and National Patient-Centered Clinical Research Network for research."

    Broadly, the FHIR repository helps Health Sciences preserve the independence of multi-institutional data while simultaneously supporting the ability to link across institutions, Deans added.

    Working with the FHIR repository is an enterprise master patient index from Oracle. The eMPI generates a unique, cross-system patient identifier for research and quality studies that allows easy linkage of data across sites. This identifier is integrated into member data repositories via the FHIR subscription mechanism. In addition to linkages of records, there are potential applications for collaborative maintenance of patient contact information across the network.

    Bringing everything together, Health Sciences is just getting started. One of the prototype FHIR apps that Health Sciences created is a notification system for admissions to hospitals or emergency departments. Health Sciences also created an app that can present merged records across health systems.

    An app might support collaborative work on avoidance of opiate dependence after surgery or diabetes management, Deans explained. A single app, in this framework, scan span multiple institutions, reducing costs and making advanced projects more feasible and easier to disseminate.

    "Future apps will be more sophisticated and use the SMART on FHIR approach for EHR integration," Deans said. "Apps would support areas for collaborative quality improvement in technology-enhanced communities of practice. The idea is that a group of our members would work together to create an app and share experience on deployment and optimization in the community of practice."

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

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    Health Sciences South Carolina lights up a FHIR-based clinical data repository
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    Health Sciences South Carolina lights up a FHIR-based clinical data repository
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    Tech initiative enables hospitals across the Carolinas to build apps that merge patient records.
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    Lucile Packard Children's Hospital Stanford initiated various safety interventions for medication administration. Moving from a daily medication cart fill – once every 24 hours – to multiple fills per day – every 2 to 3 hours – and implementing a barcode verification system for all medication dispensing has resulted in a 21 percent decrease in missed doses, a 66 percent reduction in wasted doses and one of the lowest medication error rates according to incident reporting in the Solutions for Patient Safety Collaborative.

    "Medication errors in hospitals can occur at any point during the medication use process and may result from the actions of physicians, pharmacists, pharmacy technicians, nurses, other hospital personnel or even the patient," said Melanie Chan, assistant director of pharmacy services at Lucile Packard Children's Hospital Stanford. "In California, hospital pharmacies are required by law to have a 'Medication Error Reduction Plan' that must be reviewed and updated annually, and technology implementation must be part of the plan.”

    Safely providing medications in a children's hospital environment presents a number of unique challenges not seen in adult hospitals. Doses are primarily weight-based and medication formulations must be manipulated to provide patient-specific doses. An error in the medication use process has the potential for a catastrophic event when a child is involved.

    At Lucile Packard Children's Hospital Stanford, the prevention of medication errors has been a primary focus for more than 30 years.

    "Most systems were manual as we waited for the development of technology solutions including software, hardware and automation," Chan said. "Most error prevention strategies had focused on the development and implementation of an electronic health record. However, the entire medication use process needed to be addressed, which includes compounding and dispensing processes within the pharmacy."

    Improving patient safety

    The primary goal was to improve patient safety and the quality of care. A secondary goal was to eliminate waste by utilizing LEAN principles, standardizing the work processes and workload leveling. The primary drivers included ensuring that for every dose administered to a patient, it would be the correct drug, the correct dose to the correct patient at the correct time, and decreasing waste and improving workflow efficiency to ensure complete documentation.

    "Prior to the implementation of technology, the systems were primarily manual, which presented challenges in creating standard work," Chan said. "They relied on a manual checking system and lacked the ability to collect data for workload analytics. A core principle of the medication safety plan is that technology implementation should be included. The implementation of information technology as a tool in the pharmacy compounding and dispensing processes had the potential to mitigate the risk of serious medication errors in pediatrics."

    Adding medication cart fill check-ins

    One of the major shifts was from a daily medication cart fill to multiple fills per day. A review of incident reports identified errors in dosing including lost or missing doses, as well as inefficiencies in the system that resulted in medication waste.

    "With the every 24-hour fill, the doses could be prepared anytime between 24 to 36 hours prior to when the dose was administered," Chan explained. "Each patient's 24-hour supply of medication was delivered daily at 3:30 p.m. Depending on the complexity of the patient, a single medication bin may contain 40 or more doses per day per patient."

    [Also: The next big thing in pharmacy supply chain: Blockchain]

    As doses were discontinued, modified or if the patient was discharged, doses may remain in the medication bin until picked up the next day. Discontinued doses remaining in the patient's medication bin could contribute to potential dosing errors or waste of unused or discontinued medications. Overall, the 24-hour fill system contributed to difficulties in flexibility and capacity issues.

    "The goal of the conversion was to redesign the system to separate medications in the medications bins to those needed for the current two-to-three hour interval, the following two-to-three hour interval, to prepare and deliver medications every two-to-three hours around the clock," Chan explained. "As medication orders are modified or discontinued, the previous doses would be removed from the medication bin by the pharmacy within two-to-three hours, thus decreasing the risk of a wrong dose being administered."

    Implementing barcode verification for medication dispensing

    Another big change was the implementation of a barcode verification system for all medication dispensing. The American Academy of Pediatrics policy statement of Prevention of Medication Errors in the Pediatric Inpatient Setting states that medications should be dispensed in a unit-dose, ready to administer whenever possible. Pharmacy is one of the very few professions in healthcare in which a commercially available product is repackaged and relabeled.

    "With high volume and a manual system, there is greater risk that errors may go undetected," Chan said. "Errors during pharmacy preparation of parenteral products and admixtures have been frequently reported to the Institute of Safe Medication Practice Error Reporting Program, and studies have shown that compounding error rates for manually compounded complex IV solutions were significantly higher than those preparations that were at least partially automated."

    A challenge in pediatric pharmacy is that the preparation requires the fractioning of a product for patient-specific doses. This requires extensive documentation, calculations and processes to ensure that the dose is accurate, and meets all regulatory requirements.

    "Although technology can greatly facilitate the medication safety process, it is critical to understand how individuals interface and perceive the technology. "

    Melanie Chan, Lucile Packard Children's Hospital Stanford

    In addition, the Drug Supply Chain Security Act, which was enacted in 2013 by Congress, outlines steps to identify and trace certain prescription drugs as distributed in the United States with the goal to protect the consumer.

    "The goal to include barcode validating of the dispensed products was to error-proof the medication preparation process, improve regulatory compliance and documentation, and standardize workflow," Chan said. 

    The hospital became an early adopter of a pharmacy workflow manager, Baxter's DoseEdge, which integrated barcode enabled verification of the source container into the preparation process. The technology also enabled the hospital to create a standard work process with detailed preparation instructions, digital image capture, remote verification of the compounded product by pharmacists and the archiving of all of the documentation of the preparation process, which is readily retrievable in the event of an investigation or recall.

    With the successful implementation of barcode validation for the sterile product dispenses, Lucile Packard Children's Hospital Stanford decided to move forward with implementing barcode validation for the nonsterile product dispenses.

    As many medications are not commercially available in a liquid formulation, this required the pharmacy to compound oral suspensions/liquids. The previous system as a standalone system did not integrate with the patient's record and did not include barcode validation of the source container.

    "The decision was made to adapt and implement Epic's dispense prep and check for the barcode validation of pharmacy dispensed non-sterile products," Chan explained. "Epic's compounding and repackaging module was also customized to create formulation records, which includes barcode validation of the ingredients used to compound oral solutions and suspensions, and create a lot-specific barcode for each lot number that is used to link to the patient-specific doses."

    Additional value derived from the implementation of Dose Edge and Epic included the ability to prioritize and sort doses, traceability to the patient level, electronic signature and event capture, and the ability to run analytics on workload and workflow, Chan added.

    All of these efforts resulted in the aforementioned 21 percent decrease in missed doses, 66 percent reduction in wasted doses, and one of the lowest medication error rates according to incident reporting in the Solutions for Patient Safety Collaborative.

    "Although technology can greatly facilitate the medication safety process, it is critical to understand how individuals interface and perceive the technology," Chan advised. "Adoption and acceptance of the technology is crucial to the success. In addition, there must be the understanding that although technology is a powerful tool, it cannot replace the critical thinking of individuals with a constant vigil focusing on the safety of each patient."

    The technology implemented in the pharmacy at Lucile Packard Children's Hospital Stanford helped to drive standardization and remove variability in the work processes, which resulted in consistent quality and reproducible medication products. The technology implemented also provided a wealth of data and analytics that allowed the hospital to proactively anticipate potential risks and address them before they became an issue.

    "Data analysis also provided valuable information to support decision making, validate process changes and productivity measures," Chan explained. "A continuing review of the types of errors, error rates and near-miss errors, along with data from the systems, allows a proactive approach to medication error prevention."

    With regard to the hospital achieving one of the lowest medication error rates according to incident reporting in the Solutions for Patient Safety collaborative, this was a significant achievement.

    The reduction of errors from adverse drug events is one of their focuses of the 11 preventable pediatric hospital-acquired conditions. Adverse drug event rates (per 1,000 patient days) are reported to the collaborative and benchmarked against the network hospital rates. Lucile Packard Children's Hospital Stanford has had zero reportable adverse drug events for the past 11 consecutive months, substantially below the collaborative ADE rate of 0.012 ADEs per 1,000 patient days.

    The hospital was awarded the HIMSS Enterprise Nicholas E. Davies Award of Excellence for these initiatives.

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

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    It has seen a 21 percent decrease in missed doses, a 66 percent reduction in wasted doses and zero reportable adverse events in the past 11 months.
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    EHR and related IT installations continued last month as did the number of hospitals that achieved Stage 7 on the HIMSS Analytics Electronic Medical Record Maturity Model.  

    Epic and Cerner both landed notable contracts in June.  

    Crisp Regional Health Services in Cordele, Georgia, for instance, deployed Cerner Millenium at the hospital as well as half-d-dozen practices and two sub-acute facilities, according to the HIMSS Analytics Logic Health IT Market Intelligence Platform.   

    HIMSS Analytics also said that Spokane, Washington-based MultiCare Deaconess Hospital is now live with Epic’s EMR and 18 other tools, while North Mississippi Health Services in Tupelo signed a contracted to use Epic for ambulatory EMR and practice management.

    Cerner and Epic also faced legal charges relating to overtime pay for employees; Cerner settled its case for $4.5 million as June wound down.

    IT initiatives were not limited to EHRs, of course. HIMSS Analytics said that Henry Mayo Newhall Memorial Hospitals deployed the da Vinci robotic surgery device at its Valencia, California, unit, while Tallahassee Memorial HealthCare installed Voalte for secure messaging and Capital Region Medical Center, based in Jefferson City, Missouri, closed a deal with Infor Healthcare for data warehousing and mining, supply chain management and financial technologies.

    The federal Government Accountability Office published a report finding that Veterans Affairs plunked down $3 billion from 2015 to 2017 to keep its proprietary VistA EHR—so it’s no surprise that VA Secretary nominee Robert Wilkie said that the Cerner EHR project would be one of his top priorities.

    Phoenix Children’s tuned its EHR to be disease-specific, which almost entirely eliminated the need for transcription because it can now capture 99 percent of clinician notes in a structured format.

    Pine Rest Christian Mental Health Services, meanwhile, said it is the first such free-standing behavioral health system to implement Epic. 

    Cloud-based EHR and practice management vendor athenahealth, when it comes right down to it, got the most attention as its founder and chief Jonathan Bush stepped down during the first week of June amid allegations of misconduct. So we asked Healthcare IT News readers what they think: Should athenahealth’s board accept the $6.5 billion takeover bid from activist investor Elliott Management?

    Nearly 75 percent answered in the negative with some of the anonymous commenters describing Elliott as “horrendous” and “focused on immediate profits rather than long-term growth,” and that a hedge fund company is not “the best choice to drive the innovation that will be necessary to change healthcare.”

    Walmart made a brow-raising move when it filed a patent related to EHRs, blockchain and wearables that appears as if it would protect a method for accessing electronic health record data via the distributed ledger technology.

    And Apple posted an API developers can use to build apps that access EHR data to help patients more effectively manage their care.

    A number of hospitals in North Carolina were also busy in June achieving Stage 7 of the HIMSS Analytics Outpatient-EMRAM. Those include: the Center for Nutrition & Diabetes, Eskra Plastic Surgery, Laurel Park Women's Imaging, Nash Wound Care Center, QuickMed Urgent Care, Wayne Health Family Medicine, Wayne Urological Associates and the Wound Healing & Hyperbaric Center.

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    Cerner is partnering with Lumeris, a health plan and managed services vendor, with a decade-long agreement, including an ownership stake where the companies will help health systems tackle inefficiencies to prepare for value-based reimbursement.

    An early centerpiece of the new partnership is a jointly-developed new technology, Maestro Advantage, aimed at value-based payment arrangements like Medicare Advantage and provider-sponsored health plans.

    The new platform combines tech from the two companies, aiming to help health systems improve lengthy claims processing and reimbursement cycles, clear obstacles to sharing data and records and generally improve quality of care and patient outcomes.

    John Doerr, chairman of Kleiner Perkins and a Lumeris board member, said that by capitalizing on the companies' core competencies, Maestro Advantage aims to ensure patients "receive enhanced access to primary care and a level of service that was previously only delivered via expensive concierge medicine programs."

    The platform will focus on bringing more valuable data into clinical workflows to help providers make more efficient use of their existing investments and processes, officials said. It will help health systems manage owned- and affiliated-provider relationships, irrespective of what electronic health record they use.

    "By using data to reduce or eliminate unnecessary costs and ineffective transitions of care, providing doctors and their patients a more complete view of their medical history and a health plan that consistently receives high quality scores from CMS, this collaboration with Lumeris aligns well with our mission and illustrates the potential of Cerner technology to positively impact healthcare economics and outcomes in deeper, more impactful ways than before," said Cerner CEO Brent Shafer in a statement.

    As part of the partnership, Cerner will make a $266 million investment in Lumeris' parent company, Essence Group Holdings Corporation, to expand the companies' outreach. The goal is to help those organizations make better use of the technology to assess risk more accurately and develop smarter interventions for patients enrolled value-focused health plans.

    Another aspect of the new strategic relationship will see Lumeris implementing Cerner's HealtheIntent population health technology.

    Earlier this year, the company announced that it would be expanding that analytics platform's capabilities through another partnership, with Salesforce Health Cloud. The goal is to help patients more easily "participate in their physician’s decision-making and engage in their own health," Cerner President Zane Burke explained. “We have digitized EHRs and are now aggregating and enriching this data for clinical and engagement insights through applied intelligence.”

    With this new deal, executives from Cerner and Lumeris will work together on strategy, business development, client delivery and innovation for Maestro Advantage. Together the companies will choose specific health systems they think are best-positioned to put the platform to work, officials said – notably large organizations aiming for multi-year growth.

    The first implementations of Maestro Advantage could start as soon as this year, with more rollouts in 2019.

    "The United States healthcare system's transition to value-based care has been impeded by disjointed technology, cumbersome processes, misaligned incentives and inadequate management of clinical and financial outcomes," said Doerr. "Maestro Advantage lowers the barriers to data transparency and sharing and empowers physicians and health systems."

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    Missouri-based Cass Regional Medical Center is currently recovering from a ransomware attack that struck its communication system and shut its staff out of its Meditech electronic health record system on Monday.

    Hackers hit the health system around 11 a.m. Monday, and officials opted to turn off the EHR to prevent unauthorized access. Officials said there appears to be no evidence that patient data was breached.

    Currently, recovery efforts are about 50 percent complete, officials said in the most recent update. Cass Regional did not immediately respond to a request for comment.

    [Also: The biggest healthcare data breaches of 2018 (so far)]

    The health system is working with an outside forensics firm to decrypt affected systems and files. The EHR remains offline as they continue to investigate whether patient data was compromised. Officials expect the EHR to be brought back online within 72 hours.

    Patient care is able to continue as Cass Regional prepared an incident response protocol that was launched just 30 minutes after the ransomware attack was discovered.

    Care managers met to develop plans to continue care during the attack, but trauma and stroke patients were diverted to ensure the best care for those patients. Care diversion is still continuing for these patients as a precautionary measure. But despite the attack, inpatient, outpatient, emergency and primary care services continue.

    Patients are leaving positive comments on the health system’s social media site regarding its response effort.

    “I am extremely proud of our staff for the manner in which they have rallied to make sure we can still take the very best care of our patients,” Chris Lang, Cass Regional CEO, said in a statement. “It has not been easy, but their dedication and can-do attitude is inspiring.”

    “We deeply appreciate the patience and support that our community has shown during this challenging time,” Lang said. “We look forward to resuming normal operations and continuing our mission to meet the healthcare needs of area residents.”

    This story is developing and will be updated as more information becomes available.

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    The House Committee on Veterans Affairs approved the creation of the Subcommittee on Technology Modernization on Thursday, which will provide oversight of the VA’s EHR modernization project with Cerner.

    “As the department embarks on the nation’s largest EHR overhaul, it is critical that we ensure veterans and taxpayers are protected throughout the transition,” said House VA Committee Chairman Rep. Phil Roe, R-Tennessee, in a statement. “Congress has a duty to conduct rigorous oversight every step of the way.”

    The five-member committee will be led by Rep. Jim Banks, R-Indiana, with Rep. Conor Lamb, D-Pennsylvania, as ranking member. Reps. Jack Bergman, R-Michigan, Mike Coffman, R-Colorado, and Scott Peters, D-California, round out the group.

    “Service members and veterans deserve a seamless, lifetime medical record and an EHR system that supports the highest quality care,” Banks said in a statement. “The goal is worthy, and the strategy incorporates years of recommendations by technical experts... However, I have no illusions about the challenge confronting VA in this monumental undertaking.”

    The VA signed the EHR contract with Cerner to replace its legacy VistA EHR in May and is projected to cost about $16 billion over the next 10 years. Officials said the first go-lives will happen in the Pacific Northwest and be fully functional by 2020.

    Congress has been concerned with both the price tag and the agency’s plans to share the same EHR as the Department of Defense, given the staggering challenges facing that rollout.

    The VA is still waiting for a permanent VA Secretary to lead the project after David Shulkin, MD, was fired by President Donald Trump in March. Trump’s first nominee, Ronny Jackson, MD, withdrew from consideration due to workplace controversies.

    DoD’s Robert Wilkie is currently awaiting a full Senate vote to officially head the agency, which he temporarily ran as acting secretary after Shukin’s departure. He overwhelmingly won the committee vote on Wednesday, and the full Senate confirmation vote is expected later this summer.

    “Wilkie has the expertise and the positive attitude to take on challenges that lie ahead, and he will prove indispensable in helping transform the VA,” Sen. Johnny Isakson, R-Georgia, said in a statement. “Today’s committee vote signals the broad, bipartisan support that I hope we can look forward to in his confirmation by the full Senate.”

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    Natural language processing is a useful technology that's become so commonplace in recent years it's almost hard to remember how miraculous it once seemed.

    Hospitals are leveraging NLP to innovate clinician interactions with their electronic health records, of course. But they're also using it to advance population health analytics projects, create more effective imaging workflows and help manage value-based reimbursement and risk-sharing programs.

    As the technology evolves, there's no shortage of use cases for NLP, which is fast becoming an essential tool to help health systems manage the vast stores of unstructured data they've amassed. NLP, in fact, is now sufficiently evolved to help hospitals automate and augment clinician workflows, enabling an array of valuable cases that don't depend on structured data.

    "We are rapidly approaching the limits of the potential insights to be gleaned from basic computable data available today, and the time has come for the industry to shift its focus to unlocking the data heretofore trapped in unstructured clinical notes," said Brian Edwards, an Associate Analyst at Chilmark Research. 

    While NLP technology is still largely put to work for front-end clinical documentation and back-end coding for claims submissions, Chilmark identified a dozen other areas where it's being innovated at hospitals nationwide in a new report

    These include everything from mainstays such as speech recognition and clinical documentation improvement, of course, as well as data mining and computer-assisted coding. 

    The study also found emerging use cases (clinical trial matching, prior authorization, decision support, risk adjustment and hierarchical condition categories) and leading-edge applications such as ambient virtual scribes, population surveillance and computational phenotyping and biomarker discovery and more.

    Using an ambient virtual scribe to help clinicians

    What's an ambient virtual scribe? Edwards explains: "Existing speech recognition applications are ill-equipped to address the clinical documentation burden that providers have been forced to impose on clinicians. Human scribes at the point of care can effectively prevent documentation fatigue, but they are a costly solution and can make it more difficult to take advantage of CDS rules.” 

    What clinicians really need is more akin to Amazon Alexa or Google Assistant, to name two examples. 

    "Microsoft and Google have both recently partnered with providers to pursue exactly this application. It’s fair to assume Amazon and IBM aren’t far behind. Nuance and M*Modal are also shifting their existing products in this direction, while many EHR companies are either partnering with startups or beginning to develop their own solutions in-house,” Edwards added.  eClinicalWorks, Epic and athenahealth have all announced that they are developing ambient virtual assistants."

    Interestingly, Edwards noted that such an application is "probably the most active use case from a startup perspective, with nearly a dozen serious players." 

    Chilmark found a raft of vendors in addition to the aforementioned moving in a similar direction, including 3M, Artificial Intelligence in Medicine (an Inspirata Company), Clinithink, Digital Reasoning, Health Catalyst, Health Fidelity, Linguamatics, Optum, and SyTrue.

    Those are not the only ones, either. athenahealth, for instance, partnered this past year with Boston-based NoteSwift for its new Samantha technology (it stands for Semi-AutonoMous Adaptive Note Transcription Heuristic Algorithm), an AI-powered clinical documentation tool.

    Available in athena's online marketplace, the tool can interpret the physician's narrative  – whether dictated or typed – and uses AI to parse the information, detect structured data, assign the necessary ICD-10, SNOMED or CPT codes, prepares orders and electronic prescriptions for physician sign-off.

    "The market for NLP in healthcare is expanding from a handful of mainstay legacy applications originally aimed at documentation and claims submission to a much broader set of more interactive text and speech use cases, particularly in support of population health management and precision medicine," Edwards wrote in the Chilmark report. "NLP’s ability to allow users to converse more fluidly with their HIT systems, and to search and abstract from ever-larger stores of unstructured data helps, healthcare providers accomplish more at less cost with higher accuracy."

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    The U.S. Department of Veterans Affairs established a new Office of Electronic Health Record Modernization, which will be led by Genevieve Morris, Department of Health and Human Services principal deputy national coordinator.

    Morris and the OEHRM will work closely with the agency’s Under Secretary of Health and CIO to manage the massive transition from the legacy proprietary VistA EHR to Cerner.

    OEHRM is focused exclusively focused on the EHR modernization project that officials estimate will be fully functional in the Pacific Northwest by 2020. The $16 billion project is designed to give the VA the same Cerner EHR platform currently being deployed at the Department of Defense.

    “We are working hard to configure and design a system focused on quality, safety and patient outcomes, which will allow health IT innovations within one VA facility to be used across the entire VA healthcare system,” said Morris in a statement.

    During a VA House Committee meeting in June, Acting VA Secretary Peter O’Rourke called Morris a “perfectly qualified” candidate for the project. 

    On Thursday, the VA House Committee on Veterans Affairs launched an oversight committee of its own, to ensure veterans and taxpayers are protected throughout the transition. Congress has been increasingly concerned about the cost and the ability to pull off such a large undertaking, given the struggles of the DoD Cerner project and past failures to work together.

    The VA is still awaiting permanent leadership, after the departure of David Shulkin, MD in March. DoD’s Robert Wilkie’s full confirmation vote is set for the end of summer and is expected to be confirmed.

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    The "historic changes" announced late yesterday by the Centers for Medicare & Medicaid Services, promising big adjustments to its policies around the Physician Fee Schedule and the Quality Payment Program, already have the healthcare industry talking.

    CMS says it wants to incentivize the use of and access to virtual care and telehealth, to ease the quality reporting burden on physicians by focusing on the most important and impactful measures.

    It also wants to spur better information sharing among healthcare providers, regardless of what electronic health record vendor they happen to use.

    Part of the way it plans to do this: making changes to the MIPS "Promoting Interoperability" performance category to better encourage interoperability and patient access, and aligning it with a similar program for hospitals.

    "CMS notes that these proposals will modernize Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services no matter where they live," HIMSS said. 

    Soon after the announcement on Thursday, the Office of the National Coordinator for Health IT immediately put its support behind the CMS proposed rule, with ONC chief Don Rucker, MD, noting that Physician Fee Schedule changes would be a "historic shift in the documentation requirements associated with clinician office-based evaluation and management visits for Medicare," helping reduce administrative burdens and allowing physicians to spend more time with their patients."

    Rucker also said the new rules would encourage "more efficient, effective use of electronic health records in clinicians’ offices, improving the workflows needed to support patient-centered care instead of a focus on meeting billing documentation requirements."

    And he said the new proposal would "help shift the nation’s electronic documentation away from overly long, form-driven, hard-to-read documents written primarily to satisfy billing requirements to what it was originally intended for – providing high- quality care to patients."

    Premier, MGMA, AMGA weigh in

    Other industry groups also liked that the new rules would help ease physician busywork. Premier, for instance, praised CMS' efforts to "alleviate unproductive clinician burden," especially a streamlining of the Medicare Shared Savings Program reporting measures to "focus more on patient outcomes and satisfaction."

    The provisions for EHRs and data exchange were also a hit with Premier, said Senior Vice President of Public Affairs Blair Childs.

    As a longtime advocate for interoperability standards, Premier "strongly support proposals that support electronic health record interoperability and patient access to health information, as well as alignment with other interoperability requirements for hospitals," he said. "With this provision, we will take another step forward in our efforts to unlock healthcare data, optimize HIT investments and improve the quality of care across settings."

    But other organizations weren't so bullish on the new proposals. The Medical Group Management Association, for instance, said it was "disappointed" that CMS would continue with full-year MIPS quality reporting, rather than the 90-days reporting that had been asked for by many.

    "Reducing the reporting burden would allow more physicians to participate in MIPS and focus the program on rewarding quality care rather than quality reporting," said Anders Gilberg, MGMA's senior vice president of government affairs. "Requiring medical groups to submit excessive amounts of data to the government has little impact on the quality of care delivered to Medicare beneficiaries."

    Moreover, he took issue with the fact that the rules would require physicians to "deploy costly EHR upgrades for 2019 and takes further steps toward implementing burdensome appropriate use criteria. At first glance, the rule doesn’t meet MGMA’s definition of administrative simplification."

    Meanwhile, the American Medical Group Association said it too was disappointed by the proposed rules' high MIPS exclusion threshold and called them a "missed opportunity" to encourage value-based reimbursement.

    "AMGA members will continue to work to provide superior quality care to their patients," said Jerry Penso, MD, president and CEO of AMGA. "We are concerned that CMS has again opted not to recognize the efforts of high-performing AMGA members. As we enter the program’s third year, it is time for CMS to honor congressional intent and use MIPS to create value for Medicare."

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    Clinical decision support technology is becoming more popular among healthcare provider organizations to blend large volumes of information and ensure that the key details do not escape the attention of the care team. The fast rise of artificial intelligence and machine learning in clinical decision support tools has generated excitement over the potential for providers to revolutionize diagnostics, including in the areas of pathology, radiology and imaging.

    Clinical decision support technology experts offer a variety of opinions on where the tools are headed and how healthcare provider organizations should prepare for tomorrow’s tools —and the next generation of technologies will be tasked with providing greater guidance and sound advice in new ways.

    Artificial intelligence

    Hospital clinical and IT leaders should expect a steady adoption of artificial intelligence-driven analytic tools, first in teaching hospitals and academic medical centers, said Douglas Brown, president and managing partner at Black Book Research, a healthcare technology and services research firm.

    These tools will transform the skill levels of human clinicians, diagnostic decision-making, prescription drug support, integrate clinical decision support into EHR workflows, clinical goals and priorities, and trust in the accuracy and reliability of the underlying data, Brown added.

    "Clinical decision support must be sustained with as much reliable information as possible."

    Douglas Brown, Black Book Research

    “Lackluster clinical decision support systems of the past 20 years will be replaced by service-oriented architecture and interfaces, reduced risk, better analytics, reduced alert fatigue, and the development of open standards to ensure compatibility with as many systems as possible,” Brown said. “Clinical decision support must be sustained with as much reliable information as possible.”

    That will no doubt include health data gathered from the electronic health record, customers, health plans, medical equipment and wearable devices.

    Black Book’s research found that 77 percent of hospitals fear that weak early clinical decision support system implementations have challenged the clinical judgment of medical professionals. What’s more, 86 percent of respondents who use new systems said the tech is highly scalable, which enables hospitals to determine if existing data sets are sufficient to support new algorithms designed to extract actionable insights from financial, clinical, operational and customer-driven sources.

    Beyond alert fatigue: making better use of health data

    Some experts think about the evolution of clinical decision support technology in terms of what needs to be done in the short-term, mid-term and long-term. Some things can be done right now, while others will take a bit longer to implement.

    “Clinical decision support to date has often been a by-product of the requirements of meaningful use, and has met with varying degrees of success,” said Richard Loomis, MD, CIO, clinical solutions, at Elsevier, a health IT vendor that specializes in clinical decision support technology. “There is alert fatigue, and a limitation around how much alert content can be made available. There also is a high cost and effort – often borne by health systems and hospitals – to build out and deliver this content, and more importantly to keep it current. In many instances, this content is built out but then not enough thought is given to how to keep it up to date.”

    As healthcare moves into the next phase of clinical decision support, it’s time to integrate content, Loomis said. In the near-term, healthcare needs to consolidate clinical decision support to help all members of the care team – physicians, nurses, respiratory therapists, allied health professionals, care managers, everyone who’s taking care of the patient, he added.

    “We must move beyond alerts to provide comprehensive content in the clinical workflow to drive each intended clinical action,” he said. “This would cover inpatient, ambulatory, post-acute care, and even home care – and ultimately result in better decision making and a reduction in the unintended variability of care. We can still do a better job of ensuring the five ‘rights’ of clinical decision support: the right information, to the right person, in the right intervention format, through the right channel, at the right time in the workflow.”

    Next, healthcare has to harmonize content, Loomis said. Healthcare must begin thinking about patients, and start to deliver directly to them the same content it gives to providers, but in a patient-oriented way, he suggested.

    “By aligning care team clinical decision support with patient-facing clinical decision support, we will drive patient engagement with their care in a way that aligns to the overall plan of care,” he said. “In many cases, feedback captured from a patient, such as blood glucose measurements by a diabetic patient, would drive not only the patient pathway but also inform the provider pathway.”

    Looking at clinical decision support in the long term, healthcare must begin to take the data generated by providers, learn from that data, then use it in a virtual feedback loop to better inform pathway content, Loomis said.

    “Our thinking about the long-term evolution of clinical decision support is in sync with the Institute of Medicine’s ‘The Learning Healthcare System’ report,” Loomis explained. “We need to create a cycle where we provide decision support, generate evidence, understand what does and doesn’t work for the providers and patients, and respond accordingly to continuously and iteratively drive better care delivery.”

    AI across the continuum 

    Healthcare is approaching an inflection point toward advanced clinical decision support tools, and in the future physicians will have more visually dynamic and interactive pathways that move beyond decision support to true evidence-based decision making more deeply embedded in the clinical workflow, said Diana Nole, CEO of Wolters Kluwer Health, a health IT vendor that markets clinical decision support technology.

    “Further, patient care is not one-size-fits-all and physicians will be able to access decision-making resources with personalized and patient-specific care recommendations,” Nole said. “To optimize clinical effectiveness, healthcare organizations can leverage more advanced tools that focus on helping patients with the highest risk/highest benefit conditions.”

    "To optimize clinical effectiveness, healthcare organizations can leverage more advanced tools that focus on helping patients with the highest risk/highest benefit conditions."

    Diana Nole, Wolters Kluwer Health

    And artificial intelligence will play an exciting role in the future of clinical decision support technology, she added. Physicians, pharmacists, nurses and other care providers across the continuum of care will be able to tap AI as a resource with the potential to analyze patient data in the EHR to inform and support clinical decision making, she said.

    From the provider perspective, Sabiha Raoof, MD, chief medical officer and patient safety officer at Jamaica Hospital Medical Center and Flushing Hospital Medical Center, knows what she wants tech vendors to deliver in the future.

    “I would like to see clinical decision support tools assist radiologists in improving appropriateness of follow-up recommendations for incidental findings,” Raoof said. “Clinical decision support for radiologists will help improve adherence to guidelines for follow-up of these incidental findings. It will help reduce the variability in follow-up recommendations and reduce unnecessary imaging studies. Having these guidelines available at the point of care is critical.”

    Next-gen technology

    What tech is shaping the future of healthcare IT?

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    Medical transcription tools have long been legacy products but as vendors inject modern technologies, notably automation and voice recognition, new data suggests that hospitals are going to deploy more of these products and services amid broader digital transformation work.

    Medical transcription is the process by which doctors and healthcare professionals process health records, which are then converted into a readable format from voice and text. Such data is used largely by healthcare organizations and electronic health record initiatives.  

    Two research reports suggest that hospitals will deploy more medical transcription tools from companies including Acusis, Nuance, MModal, iMedX, Precyse, Scribe Healthcare, Superior Global Solutions, Transcend Services and TransTech Medical Solution, among others. 

    [Special Report: AI voice assistants making an impact in healthcare]

    Research firm Technavio published a report last month projecting that hospitals globally will spend more than 72 billion by 2020, representing 6 percent compound annual growth rate. 

    Technavio pointed to voice recognition technologies as a big driver of hospital plans while 

    An analysis Radiant Insights published earlier this year added that key factors driving hospitals adopting transcription tools are reliability, portability and cost-effectiveness. 

    Growing adoption of automatic transcribing technologies, in fact, is expected to replace various analog devices in near future, according to Radiant. Other factors attributing to the growth of the market are the rise in the value of skilled professionals and an increase in the outsourcing of medical transcription services. On top of that, increases in the number of transcribers, coupled with years of training to learn various methodologies and terminologies, is expected to boost overall market demand in near future.

    More hospitals are also outsourcing medical transcription services to third-parties, which the analysis expects to double. The medical transcription industry is considered one of the most vibrant segments in the healthcare management sector, since it is affected dramatically by evolving technologies.

    Most medical transcription devices consist of built-in speech recognition and memory storage systems. Medical transcription is performed with the help of different techniques adopted by healthcare professional or in-house transcriptionists, factors that are predicted to drive market demand over the next few years.

    That’s not to say there won’t be challenges. Concerns persist about partial medical transcription services and accuracy, which has been hampering the overall quality of medical transcripts and over the past few years.

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    Premier Management Company manages accountable care organizations. Two of its ACOs are leveraging clinical, financial and operational health IT to meet key performance and quality measures under the Medicare Shared Savings Program and the Medicare Access and CHIP Reauthorization Act.

    That's impressive, given that some of its physician practices were still using paper charts and had failed to meet meaningful use requirements

    According to the company (not to be confused with the Premier healthcare alliance), the adoption of electronic health records by those practices is helping them manage information more efficiently, better monitor their patient populations and make more informed decisions for patient care. It's also helped streamline reporting for the 33 metrics they must report on as Medicare ACOs.

    Despite early successes, in fact, CEO Anwar Kazi said there were areas it needed to improve upon.

    "While the Premier ACOs had been successful in generating Medicare shared savings every year since 2014, in 2015, some of the Premier physicians did not meet the minimum threshold in performance when attesting for meaningful use because they were still using paper charts and had fallen out of attestation for not having an EHR," Kazi said.

    Looking toward the requirements for MACRA, Premier knew that penalties for these doctors would grow if changes were not made.

    Premier also struggled with too many lab vendors across its network, which was driving up costs and the ability for clinicians to receive data quickly. Additionally, the data frequency for Medicare claims patients from CMS claims to ACOs is every three months, which added to the challenges.

    "We not only felt that this was too long to wait for the ACO physicians to take action on the information being provided, but when physicians did gather the data they needed, they'd have to capture it from a manual chart audit or study printouts of spreadsheets from old claims data and then try and aggregate the data sources to have a complete picture," Kazi explained. "We needed to manage information faster, to better monitor the patient population, and to make more informed decisions for patient care."

    So Premier turned to a technology from Quest Diagnostics called Quest Quanum. Other IT and services vendors that work with ACOs include Aledade, Caravan Health, Conifer Health, Evolent, McKesson and Optum.

    "Central to our goals was improving upon our quality scores," Kazi said. "We have 33 metrics to report as a Medicare ACO. The tools make that easier. In 2017, we implemented Quanum EHR, Practice Management, and Revenue Cycle Management systems, along with Quanum Interactive Insights, and an enhanced results data set to supplement claims information.

    "Of the 12 physicians who had not been meeting meaningful use, because they were still using paper charts, nine already have shifted to the EHR," Kazi said. "One doctor in Highland Village, Texas, a member of the ACO, switched from paper to the EHR and she appreciates the fact that the lab results populate into the EHR – cutting down on staff time because instead of having to print out the labs and file them in paper charts for review, everything is already in the EHR."

    For prescriptions and refills, there are no longer any callbacks from the pharmacy, Kazi added. And finally, since that practice has implemented RCM, its collection rate is much higher and it has fewer denials, Kazi said.

    "Premier is looking forward to seeing what kind of savings it will achieve for the 2017 reporting year," Kazi said. "In the meantime, building on our continued success, we have plans to expand and grow beyond MSSP with new commercial contracts, Medicare Advantage contracts, and commercial ACO products with other payers."

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

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