When Karen DeSalvo, MD, became the fifth National Coordinator for Health IT in January 2014, she took charge of ONC at a critical time for the industry, as four years of momentum spurred by meaningful use started to pay exciting dividends – but also sowed frustrations as many healthcare providers struggled with burdensome federal requirements.

She also had some big shoes to fill. Her two immediate predecessors,  David Blumenthal, MD, and Farzad Mostashari, MD, had helped conceive and implement Stage 1 and Stage 2, respectively, of the transformative EHR incentive programs – setting the stage for widespread uptake of basic IT systems, then dramatically raising expectations about how hospitals and practices should put them to work.

But DeSalvo was the right person for the job, at the right time. Her public health bona fides – honed in her hometown of New Orleans, first in the wake of Hurricane Katrina as Vice Dean Community Affairs and Health Policy at Tulane University and later as New Orleans Health Commissioner – made her the ideal national coordinator for a period that saw the building blocks of basic EHRs mature into interoperable networks focused on improved population health.

As DeSalvo steps down from ONC to finally devote her full energies to the Assistant Secretary for Health role at HHS – the one she first took on during the Ebola crisis of 2014 – we look back at our coverage of her over the years.

Public health restored in New Orleans
Before she joined ONC, way back in February 2013 – as the health IT industry prepared to head to the Big Easy for HIMSS13 – we spoke to DeSalvo, then the city's health commissioner, about how technology infrastructure was a critical to the rebuilding process after Katrina.

"We say down here that New Orleans is a preeminent laboratory for innovation and change, and it has been since we lifted ourselves up after Hurricane Katrina," DeSalvo told Healthcare IT News nearly a year before she took the reins at ONC.

Specifically, she pointed to the advancements – HIE, patient engagement – enabled by the ONC-funded Crescent City Beacon Community. "We've been engaging with powerful work to change the way we deliver care and work with each other," said DeSalvo. "The Beacon Program is a national layer underneath that to make sure that we can advance the culture change and the data opportunities to improve the health of everybody."

(Incidentally, a citywide water crisis in New Orleans the next month meant DeSalvo had to cancel her presentation at HIMSS13 as she prioritized the public health emergency.)

HHS appoints new ONC chief
Then-HHS Secretary Kathleen Sebelius lauded DeSalvo's commitment to technology (her experience in rebuilding New Orleans' public health infrastructure post-Katrina) and population health (her leadership of the Louisiana Health Care Quality Forum) as she named DeSalvo the first woman to serve as ONC chief in December 2013.

"DeSalvo has advocated increasing the use of health information technology to improve access to care, the quality of care and overall population health outcomes – including efforts post-Katrina to redesign the health system with HIT as a foundational element," said Sebelius. "DeSalvo’s hands-on experience with health delivery system reform and HIT and its potential to improve healthcare and public health will be invaluable assets to the Office of the National Coordinator and the Department."

DeSalvo: Interoperability 'top priority'
In February 2014, soon after starting work at ONC, DeSalvo announced her plan to put technology to work effectuating better care for larger patient populations at lower cost. ONC would be focused on five goals as it kicked off its second decade, she said:

1. Increase end user adoption of health IT
2. Establish standards so the various technologies can speak to each other
3. Provide the right incentives for the market to drive this advancement
4. Make sure personal health information remains private and secure
5. Provide governance and structure for health IT

ONC chiefs compare notes on past decade
At HIMSS14 in Orlando, DeSalvo joined her ONC predecessors onstage to discuss the high points and low points of a momentous 10 years.

"I don't have a low point yet," DeSalvo – just seven weeks on the job – said with a laugh. But she added that the high point happened at her first HIT Policy committee meeting. "I got very excited about that because this is a community of vendors, purchasers, providers, policy folks, who really want to get it right."

ONC restructures, charts a new course
About six months after taking office, DeSalvo unveiled her plan for a reshaped ONC, one more able to capitalize on the IT advancements made over the past decade. Key focus areas would be interoperability standards, care transformation, quality and safety, patient engagement and privacy and security.

"As we pivot to a new decade, these few strategic organizational changes allow us to better align the agency to meet the needs of the future," she said. "This functional realignment will improve the overall effectiveness and efficiency of ONC by combining similar functions, elevating critical priority functions, and providing a flatter and more accountable reporting structure."

Wither ONC?
Despite the promise of what was increasingly looking to be a pivotal moment for healthcare technology, there were big challenges in 2014. Meaningful use attestation numbers were starting to stall, as some providers buckled under onerous Stage 2 requirements. And ONC itself was having some challenges of its own. Some on Capitol Hill were starting to question the long-term mission of ONC, asking pointed questions about its regulatory powers for IT and medical devices. One proposed Senate budget cut its budget by 20 percent.

Meanwhile, the agency it was seeing the beginnings what would eventually become a significant brain drain, with the departures of Chief Privacy Officer Joy Pritts and Office of Consumer eHealth Director Lygeia Ricciardi. Soon, the stepping-down of Chief Scientist Doug Fridsma, MD; Deputy National Coordinator Jacob Reider, MD, and Chief Nursing Officer Judy Murphy, RN, would add to the sense that ONC was losing the prestige it enjoyed earlier in the decade.

However choppy the waters, DeSalvo stood at the helm of the ship.

DeSalvo drafted to tackle Ebola
But in October of that year, the national coordinator found her attention diverted, as DeSalvo was called upon by HHS Secretary Sylvia Mathews Burwell to bring her public health expertise to the fight against Ebola.

In being tapped as acting Assistant Secretary for Health, DeSalvo was charged with joining HHS Ebola response team and working directly with Burwell on "pressing public health issues," according to HHS.

Some private sector groups, such as the American Medical Association, worried that a "leadership gap" might slow interoperability and MU initiatives. But ONC Chief Operating Officer Lisa Lewis stepped up to serve as acting national coordinator while DeSalvo managed duties at both HHS and ONC, continuing to "work on high-level policy issues" related to health IT while the agency continued to follow her policy direction.

Obama nominates DeSalvo for HHS post
By May of 2015, DeSalvo was looking at an official promotion, formally nominated by President Obama to the post of Assistant Secretary for Health – a role requiring Senate confirmation.

That still hasn't happened (chalk it up to politics), but at least now she'll be able to devote her full energies to the task, rather than juggling her ONC duties, as she has now for nearly two years.

DeSalvo at HIMSS15: 'True interoperability, not just exchange'
In her keynote April 16 at HIMSS15 in Chicago, DeSalvo put out the call that the wider health industry must start to "focus beyond adoption" of health IT to create an interoperable, learning health system "upon the strong foundation we all have built."

Since meaningful use, we've come a long way, she said. It's been "such an incredible accomplishment for just five years."

But now it's time to push further: "I do know it's hard work," said DeSalvo. It requires "personal and organizational commitment." It demands "changes to workflow and changes to culture."

The true benefits of health IT can only be realized when we're able to "digitize care experience across the care continuum," she added, calling for a nationwide healthcare ecosystem that thrives on "true interoperability, not just exchange."

ONC releases final Federal Health IT Strategic Plan 2015-2020
Emblematic of the pivotal era in which she led ONC, one of the cornerstones of DeSalvo's tenure was this document, which sets the agency's goals for the rest of this decade.

It represents an "action plan for federal partners, as they work to expedite high-quality, accurate, secure, and relevant electronic health information for stakeholders across the nation," said DeSalvo. Drawing on recommendations from the Health IT Policy Committee, along with input from some 35 other federal partners and hundreds of public comments, it has four key goals:

1. Advance person-centered health and self-management
2. Transform healthcare delivery and community health
3. Foster research, scientific knowledge and innovation
4. Enhance the United States health IT infrastructure

ONC reveals final interoperability roadmap
As she said when she took office, nationwide interoperability was a "top priority" of DeSalvo's time at ONC. We're still not quite there. But this landmark document was one of her signature achievements, describing a path forward for this hugely complex and transformational task.

Its goals are big: giving consumers the ability to access and share their health data at will; stopping intentional or inadvertent information blocking by providers and vendors; adopting federally-recognized national interoperability standards. Moreover, it sets benchmarks to reach these goals, over the next three, six and 10 years.

"Data needs to be free," said DeSalvo. "If we're going to change the care model we need an information model to support it."

Twitter: @MikeMiliardHITN
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Carequality announced on Tuesday that several major EHR vendors are using its Interoperability Framework to exchange data with electronic health records of their direct competitors. Officials also said that more than 200 hospitals and 3,000 clinics are now live on Carequality.

“It’s not a trial, it’s not a pilot. We’re up and running – it’s operational and it works,” said Dave Cassel who heads the public-private collaborative under the Sequoia Project umbrella. “Physicians and clinicians are actively getting records under the Carequality framework.”

Hospitals using EHR software or cloud services from athenahealth, eClinicalWorks, Epic, HIETexas, NextGen and Surescripts are among those. Cerner, however, is a member of Carequality that has not yet adopted the Carequality Interoperability Framework. 

First published in December of 2015, the framework includes technical specifications, governance processes and legal and policy requirements to enable health information exchange between health systems and data sharing networks.  

“If you accept the policy — and Epic accepts the policy — then we just exchange,” said Eric Helsher, Epic’s vice president of client success. “We don’t have to negotiate between one another. What Carequality will do is take meaningful exchange that’s happening today and make it widespread.”

Precision medicine: Analytics, data science and EHRs in the new age

Prior to the Carequality Interoperability Framework every time a provider wanted to exchange information with another health system, it first would have to negotiate an agreement to do so, Helsher said.

The framework eliminates complex negotiations between providers, Helsher said. Carequality has taken care of that with an agreement worked out, ready for members to accept. The agreement enables a single connection to the whole Carequality network, so any organization that joins will be connected to everybody else in the framework.

Cassel added that Epic, for instance, has turned on the connectivity for 50 of its client organizations, sparking others to come on board.

Athenahealth is having a similar impact, he said, as the Boston-based health IT company moves to connect the larger physician practices it serves.

“There will be much more to come in terms of numbers and volume and real impact being felt by a large percentage of people around the country,” Cassel said. “But before any of that can happen, somebody needs to go first. Somebody needs to actually turn it on. The first exchanges need to occur. And that’s where we’re at right now.”

Whereas athenahealth, eClinicalWorks, Epic and NextGen are the initial vendors involved, other participants include Coordinated Care Oklahoma, Surescripts and HIETexas, as well as providers including Sutter Health and SSM Health in the St. Louis area.

Other EHR vendors, notably Cerner, are Carequality members that have yet to implement the framework.  

“I think ultimately the value will be very clear and everyone will want to join,” Cassel said. “We’ve talked a lot about the promise for some time now, and it’s no longer just a promise. It’s real. It’s happening right now. It will only continue to grow from here.”

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

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Researchers at the University of Maryland posted a new tool to help health officials and departments more effectively harness electronic health records, other IT and data during disease epidemics.

Dubbed the Public Health Information Technology Maturity Index, the offering can be used to assess information technology, benchmark against peers, set specific goals and to foster continuous improvement, according to Kenyon Crowley, deputy director of the Center for Health Information and Decision Systems (CHIDS) in the University of Maryland Robert H. Smith School of Business

To that end, the index can help officials know how well their technology performs at gathering relevant and urgent information, including the source of infection, where it happened and under what circumstances, who an infected patient has contacted to build as complete a picture of the incident as possible. 

Precision medicine: Analytics, data science and EHRs in the new age

The PHIT Maturity Index includes four technology categories: community infrastructure, human capital and resources, scale and scope of IT use, and quality.

Zika, Ebola and SARS demonstrate the need for “seamless data integration across hospitals, primary care, and public health delivery locations,” said Ritu Agarwal, chair of information systems at the Smith School. “And of course all of this has to occur while simultaneously maintaining the privacy of pertinent patient data.”

Working with a team of UMD researchers, Agarwal spent two years analyzing an EHR implementation among Montgomery County, Maryland health systems and primary care practice.

 “We uncovered a host of barriers and obstacles to effective use of information, including the complexity and usability of the software, the inability of the software to support certain unique public health reporting needs, the learning curve for public health workers, and the lack of standards for effective data exchange,” Agarwal said. “All of this does not bode well, either for crisis response or for proactive crisis anticipation.” 

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On Tuesday, the U.S. Federal Trade Commission approved a final order with EHR vendor Practice Fusion that will consent to a 20-year privacy practice order, stemming from its highly-publicized privacy scandal.

The settlement was first announced in June, and after a 30-day comment period, the final order was unanimously approved, 3-0.

Practice Fusion was charged with soliciting reviews from patients and posting them online - without concealing personal identification information. According to the FTC, the patients in question were unaware their information would be disseminated online.

Precision medicine: Analytics, data science and EHRs in the new age

The FTC charged that although there was a privacy policy online, from 2012-2013 Practice Fusion didn’t warn patients their reviews would be publically available.

"Practice Fusion’s actions led consumers to share incredibly sensitive health information without realizing it would be made public," Jessica Rich, director of the FTC’s Bureau of Consumer Protection, said in a statement. "Companies that collect personal health information must be clear about how they will use it – especially before posting such information publicly on the Internet."

Under the final agreement, Practice Fusion is prohibited from misrepresenting the extent of its use of any patient information, including the data it makes publicly available and the vendor cannot post any personal identifiable information of its patients online without the explicit consent of the patient.

Further, Practice Fusion is prohibited from commercially exploiting or publicizing review information - which was the cornerstone of the scandal. The FTC will be allowed access to company records and use any means to make sure Practice Fusion remains compliant.

Practice fusion will be liable for civil penalties up to $40,000 per violation of the final order, according to FTC Secretary Donald S. Clark.

“As is the case with all Commission orders, Commission staff will closely monitor Practice Fusion’s conduct to determine whether any violations occur,” Clark continued in a statement. “In light of these considerations, the Commission has determined that the public interest would best be served by issuing the Decision and Order in the above-titled proceeding in final form without any modifications.”

The FTC’s order spans 20 years and, as such, terminates on August 15, 2036.

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

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Leidos, which along with Cerner and Accenture, last year won a $9 billion contract to provide the Department of Defense with a new electronic health record at DoD facilities worldwide, has recently positioned itself gain even more healthcare business.

On August 16, Leidos closed on a $50 billion merger with Lockheed Martin's Information Systems and Global Solutions business. It paid Lockheed $1.8 billion in cash and gave Lockheed shareholders 50.5 percent of Leidos shares, worth $3.2 billion in Leidos stock.

Analysts noted the Lockheed IT acquisition brings Leidos new government customers such as the U.D. Departments, Homeland Security, FAA, DISA and the Social Security Administration.

Nick Wakeman, in his blog covering Washington D.C. technology, writes that Lockheed had been building its health IT business with acquisitions such as Systems Made Simple.

"So that should complement the extensive health IT related work Leidos does," he writes.

[Also: Leidos scores new military medical contract]

Indeed, Leidos CEO Roger Krane, speaking on an investor conference call on August 15 indicated one of its established clients, the Cleveland Clinic, might open doors for additional business in Abu Dhabi.

Cleveland Clinic operates a multi-specialty, 4.4 million square foot hospital in Abu Dhabi. The hospital on Al Maryah Island in Abu Dhabi opened in May 2015.

The merger, Krane said, provides the scale that makes pursuing new business in markets like Abu Dhabi doable.

"With this move, we are now big enough that we can open a field office in Abu Dhabi," Krone said on the investor call.

With the merger Leidos added three new members to the board, one with deep ties to healthcare: Surya Mohapatra, former CEO and chairman of Quest Diagnostics, who has held senior leadership positions in the healthcare industry for more than 30 years.

Susan Stalnecker, former vice president and treasurer of DuPont, and Gregory Dahlberg, former senior vice president for Lockheed Martin's Washington operations, also joined.

Post-merger Leidos is a 33,000-employee government services business with about $10 billion in annual sales, larger than any of its competitors, such as Booz Allen Hamilton, CACI International, SAIC and CSRA.

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Industry experts and the federal government are divided on the best way to assess the state of the nation’s health IT interoperability.

The Office for the National Coordinator for Health IT, for instance, has proposed using CIO surveys to gauge the status of interoperability among and between healthcare organizations.

To that end, ONC posted a Request for Information (RFI) on how to best assess interoperability that closed last month — just not before drawing some sharp comments from across the industry.

Better measures
In his response to the RFI, Gary Dickinson, director of healthcare standards at CentriHealth, said the CIO surveys won’t give a true picture of interoperability.

Dickinson, who is also co-chair of HL7’s EHR workgroup, suggested that ONC let the software tell the story, instead. EHRs aren’t currently programmed to audit how well data is transferred between EHRs or what takes place in that process.

Precision medicine: Analytics, data science and EHRs in the new age

Dickinson speculated that health IT vendors aren’t likely to want to include this type of programming in their products, either, because it will shine a light on where interoperability is falling short.

Another problem Dickinson pointed to is that the MACRA definition of interoperability is based on an aging IEEE statement from 1990 “and that definition was never intended to describe the interoperability of health data records nor interoperation of EHR or HIT systems.”

IEEE’s definition: “The ability of two or more systems or components to exchange information and to use the information that has been exchanged.”

Because ONC in using that IEEE definition of interoperability, Dickinson said, the agency is not measuring the right things. A lot of data is lost as it is translated, and this isn’t measured in most surveys.

Dickinson said that an obvious starting point would appear to be measuring what data didn’t transmit because it had nowhere to go, and what data was successfully translated to transmit but lost elements along the way.

Measuring can get messy
Taylor Davis, executive vice president of analysis and strategy at KLAS Research, said that tuning EHRs to track interoperability would not be easy, and he bases this opinion on more than 20,000 interviews KLAS has conducted on interoperability with healthcare providers over the past few years; 500 of those took place this year.

“Measuring interoperability is messy to do,” Davis said, though he conceded that the type of auditing Dickinson suggested is possible.

“Our current research highlights that the market is incredibly immature,” Davis said. “We’re learning some common ways to send some things, but we’re still so far away.”

KLAS, in fact, formed an interoperability advisory team of providers and EHR vendors last year to create measurement standards for interoperability and plans to publish these standards in September, according to Davis.

Bigger than meaningful use
Healthcare IT News owner HIMSS and the Personal Connected Health Alliance (PCHA) commented together on ONC’s RFI that the office should consider collecting interoperability data from sources beyond those in the meaningful use program, including the data shared between patients and providers via Blue Button or Direct Messaging. Using “multiple, discrete interoperability measures” would provide “a broader, more holistic, long-term picture of the data exchange,” in addition to establishing a baseline for further study, the organizations said. 

[Also: athenahealth's Jonathan Bush slams meaningful use as 'incredibly dark hubris']

The DirectTrust collaborative non-profit that promotes interoperable health information exchange via the Direct message protocol, meanwhile, asked why ONC isn’t including faxes in the measurements for interoperability. Faxes are the baseline old technologies to be replaced by secure electronic exchange  – relied on perhaps by the tens of millions every day.  DirectTrust CEO David C. Kibbe suggested that it could be important to measure the quantity of faxes and their rate of replacement as a way of monitoring the progress on interoperability.

Kibbe also said the surveys ONC suggests using to measure interoperability will be a “blunt instrument,” because they don’t measure how useful the exchanged information is to providers and patients.

What clinicians actually need
Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), ONC has the job of reporting to Congress on the status of interoperability and needs to conduct appropriate research to do so.

Dickinson said he has had multiple conversations with ONC about this situation.

“We really have to get ONC out of the quantitative mode and into the qualitative mode,” Dickinson said.

How hard would it be for EHRs to have software added that could analyze interoperability in the way Dickinson suggested?

Whereas Davis said it could get tricky, Dickinson doesn’t anticipate that programming future EHRs to audit interoperability would be prohibitively expensive.

And one could argue that for EHR vendors who do it well, the capability could give them a competitive advantage.

“Clinicians want the full context of the data,” Dickinson said. “These things can be done, but nobody has requested that they be required.” 

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As cybercriminals continue to assault the healthcare industry, most health executives are elevating data security as a business priority, according to the 2016 HIMSS Cybersecurity Survey, released Tuesday.

Eighty-five percent of the report's 150 surveyed IT security leaders are increasing cybersecurity awareness, motivated by potential phishing attacks (80 percent of acute care providers, 65 percent non-acute); viruses or malware (68 percent acute, 65 percent non-acute); and risk assessment results (64 percent acute, 77 percent non-acute).

But there are serious barriers inhibiting better cybersecurity practices. About 71 percent of non-acute care and 50 percent of acute care respondents pointed to a lack of financial resources, while about 60 percent of respondents pointed to a lack of cybersecurity personnel.

"Cybersecurity attacks have the potential to yield disastrous results for healthcare providers and society as a whole," said Rod Piechowski, HIMSS' senior director, health information systems, in a statement. "It's imperative healthcare providers acknowledge the need to address cybersecurity concerns and act accordingly."

[Commentary: Healthcare providers must spend more on cybersecurity readiness]

Medical identify theft was reported as the source of healthcare attacks by about 75 percent of respondents; 69 percent feared these potential attacks will stem from ransomware and 61 percent are concerned about persistent threats and phishing attacks.

Despite these worries, 75 percent of respondents said they feel ready to detect and protect against brute force attacks. Further, respondents said they're ready for known software vulnerabilities (74 percent) and negligent insider attacks (73 percent).

While the report suggests providers are addressing cybersecurity concerns, "more progress needs to be made so that providers can truly stay ahead of the threats," Piechowski added. Some of the areas requiring attention: vulnerabilities in email, mobile devices and the internet of things.

To address these issues and provide support to the healthcare industry, on October 25 HIMSS will open the Cybersecurity Hub at the HIMSS Innovation Center in Cleveland. The in-person resource will educate visitors on important requirements and help healthcare leaders prepare for and protect against cyber threats.

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

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Use of electronic health records has come a long way in the past decade. But so has the ubiquity and maturity of many technologies. A new report in the Journal of the American Medical Association, in fact, argued that EHRs need to play catch-up to make the most of other data management advances.

As tech-savvy strategies for diagnosis, monitoring and treatment have become commonplace, EHRs aren't always able to capitalize on the ways they can help improve care, wrote the authors, Donna M. Zulman, MD, Nigam H. Shah and Abraham Verghese, MD, all of the Stanford University School of Medicine.

"The EHR has many virtues: It supports arduous and time-intensive tasks such as order entry and medical history review, and most systems routinely alert clinicians if they prescribe medication combinations that might cause harm," they noted. "But the evolution of EHRs has not kept pace with technology widely used to track, synthesize, and visualize information in many other domains of modern life. 

Precision medicine: Analytics, data science and EHRs in the new age

"While clinicians can calculate a patient’s likelihood of future myocardial infarction, risk of osteoporotic fracture, and odds of developing certain cancers, most systems do not integrate these tools in a way that supports tailored treatment decisions based on an individual’s unique characteristics," they added.

Analytics tools have made great leaps in recent years too, the authors pointed out, with providers able to deploy complex algorithms to spot patients at risk for hospitalization or readmission. But most IT systems still have a hard time marshaling data to deliver personalized medicine.

"Existing EHRs also have yet to seize one of the greatest opportunities of comprehensive record systems – learning from what happened to similar patients and summarizing that experience for the treating physician and the patient,” they wrote.

The report also faults current systems for note bloat, overpopulation with cut-and-paste clinical information, alert fatigue and poor user experience. "Advances in personal computing and the entertainment industry suggest immense possibilities for more thoughtful and valuable ways of depicting information,” the report said.

But the authors argue that the "most important shortcoming of the EHR is the absence of social and behavioral factors fundamental to a patient’s treatment response and health outcomes."

With consumers wired up to wellness trackers and other gadgets like never before, and able to connect with their providers via now-commonplace patient portals, "it should be possible to collect from individuals key information about their environment and unique stressors — at home or in the workplace — in the medical record," they wrote.

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Janet Campbell is a software developer and vice president of patient engagement at Epic Systems.

In that role, she is focused on patient portals and engagement features but also on home health and telemedicine. That means working closely with the usability team as well as the standards and interoperability experts.

Campbell and other Epic developers — notably Sumit Rana, Epic’s senior vice president of R&D — work with clinicians toward the end goal of being to enable doctors and nurses to interact with patients in a way Campbell described as focused and friction-free.

Programmers doing fieldwork
“Anything and everything we now develop, whether it’s for a doctor, scheduler, caregiver, we’re always thinking how would a patient be a consumer of this information, and how would you think about that end-to-end thing,” said Rana, who in his early days at the company led the development of Epic’s MyChart patient portal.

Rana recounted working at a client health system in Chicago back in 2001-2002, when he had first started at Epic, and spending four nights in the ICU observing workflow.

“Until then I sort of knew what people wanted us to do,” Rana said. “I knew the features we wanted; I knew the technical components. But I did not get ICU – what it means to be in an ICU.”

[Also: athenahealth CEO Jonathan Bush says 'Allscripts and Epic were dead in the water before meaningful use']

Rana had to be there to understand what the care providers needed to effect the best care for patients, what their workflows were, how they went about their work.

As a result of these early on-site observations, in fact, Epic formalized the program requiring every developer to spend a minimum of four days and up to 18 days testing their applications in the field.

As Rana sees it, fieldwork helps Epic developers understand not only the technical and functional pieces, but it also enables them to view their technology through the eyes of providers and patients. Real-world users, in other words.

“I think what it teaches programmers is to care,” Rana said. “Because when you see someone struggling with something, it really bothers you, and you want to come back and say, ‘How would I do this so it functionally is doing what the user expected – how do I make it more intuitive?’”

Shadowing clinicians and appealing to patients
Under Epic’s program of developers spending time in the field, they follow clinicians as they work, listen to how they speak with one another and to patients, and gain a better sense of the types of reports caregivers write.

“It helps you get the lingo,” Campbell said. “There’s some stuff you can learn from a textbook, but a lot of what you can learn is by observing activities such as the corner cases, and what happens when everything doesn’t go according to plan, and how can you tell if everything doesn’t go according to plan? How can you recover from it?”

Campbell, who has worked on applications for cardiology and also with a team developing obstetrics technology, tries to see herself as a medical student, and reads a lot of medical textbooks. It doesn’t replace the shadowing, instead it augments her understanding of what’s needed.

“If anything, when you’re designing for a patient you have to be even more focused on usability,” Campbell said. “Because we’re talking about a wider spectrum of users, we absolutely need to understand their goals and objectives because that’s where usability comes from.”

Rana added that the core expectation of developers is they have to understand the domain – and not only understand it in the context of what users expect the software to do. “That’s sort of an obvious given thing,” Rana said. “You have to understand what their life is like.”

[Inside Epic: Judy Faulkner refutes rivals' claims about Epic EHR being closed] 

And then there is the ongoing challenge that every technology company faces of figuring out exactly what users want and delivering that. Then doing it again. To help on that score, Epic employss more than  20 physicians, nurses, and pharmacists to help design the software, and the conpany also takes input from customers through dedicated focus groups, steering boards, and hands-on usability labs.

Rana pointed out that patients’ expectations today – and those of clinicians, too – are sculpted by their experience at the Apple store, JC Penny and travel websites as well as technologies they use everyday outside of work.

“Patients expect that experience,” Rana said. “So that’s part of what we’re focused on as well.”

To that end, Rana and colleagues at Epic sometimes don T-shirts displaying the slogan: “My code saves lives.”

'Health IT is hard'
Healthcare IT is probably one of the toughest industries for programmers, Campbell and Rana said.

“There are so many different variables that can go wrong. There are these societal pressures,” Campbell said.  

Campbell acknowledged that she could have a simpler job developing software at a less-demanding company or a sector with softer consequences when mistakes are made than the price paid for medical errors.

"If I wanted to have an easy job, you know,” Campbell said, “I could go be a software developer at Facebook.” 

Enterprise imaging strategies are key priorities for healthcare leaders and many organizations are well on their way to implementing them; however, interoperability roadblocks remain a challenge, a new survey has found.

Further, while IT executives have an understanding of what needs to be done, they also recognize that unattainable image data can negatively impact patient care, according to the survey from medical image exchange technology vendor lifeIMAGE and commissioned by the College of Healthcare Information Management Executives.

The survey of 100 CHIME members revealed

– Imaging, once under the tight control of radiology, has evolved into a core responsibility for an organization’s IT staff, with 86 percent of surveyed CIOs reporting that IT owns enterprise imaging either exclusively or as a shared initiative with radiology departments.

– More than 58 percent of facilities have implemented an enterprise imaging strategy to help manage, store and exchange medical image data. And nearly half of respondents agree that a successful enterprise image strategy is a shared responsibility.

– More than 50 percent of respondents indicated that inefficient imaging practices could lead to delays in diagnosis and care, unnecessarily repeating studies, and patients potentially going elsewhere for care.

– The overall interoperability outlook is bleak: While 86 percent of CIOs note improving care coordination is a driver for interoperability, more than half of the organizations surveyed cannot yet move imaging data between systems and applications. Other drivers of interoperability include reducing redundant testing for value-based care (71 percent), improving physician satisfaction (63 percent) and reducing patient exposure to radiation (42 percent). 46 percent said the biggest challenge is integrating imaging technology systems with an electronic health record.

– One-third of surveyed CIO respondents indicated their facility might be losing revenue because of image data interoperability challenges. Several respondents cited value-based contracts that do not reimburse for duplicate exams.

“It was telling to learn that the majority of CIOs surveyed say meeting interoperability at their facilities remains a challenge,” said Matthew Michela, CEO and president of lifeIMAGE. “Healthcare IT executives have an understanding of what needs to be done, because they’re seeing how unattainable image data can negatively impact patient care, but they haven’t yet solved the technical issues surrounding image interoperability.”

Tech giant Apple appears to be taking a giant step further into healthcare with the purchase of startup Gliimpse, a personal health data company launched three years ago.

It’s the fifth consumer health venture for Anil Sethi, founder and CEO of Gliimpse. The company’s website is no longer accessible.

Financial terms of the deal were not disclosed.

Sethi describes himself in a speaker’s summary for the Stanford Medicine MedicineX 2016 conference as an investor, mHealth lecturer and mentor to StartX, UCSF, Cancer Commons.

Others describe him as a serial entrepreneur, getting his start as a systems engineer at Apple in the late 1980s, according to Fast Company, which was first to report the news and noted that the acquisition occurred earlier this year, but Apple had not announced it.

Sethi has 30 years of health tech background.

Sethi’s past exits from IPOs include Dakota, a billing company acquired by WebMD, and Sequoia, an EHR clinical data extraction comapny acquired by Citrix.

Sethi hinted at where he was going with the Gliimpse platform on the MedicineX site.

“EHRs restrict and still silo the lifesaving data individuals need to create a longitudinal health summary that brings the greatest benefit to their lives," Sethi wrote in the description of his presentation for MedicineX. “It’s time to invite the patient to be at the center of their data so the collective narrative of the Empowered Patient can be heard once and for all – moving from a focus on pills and procedures to being prescriptive and predictive in their care.”

Apple has indicated a keen interest in healthcare, for example, with its HealthKit app — which helps users monitor personal health and fitness data.

Apple also has teamed up with hospitals and doctors to build a research-tracking app for common diseases like Parkinson’s and breast cancer.

[See also:Johns Hopkins tests EpiWatch app on Apple Watch to track seizures and Cedars-Sinai deploys HomeHero's Apple CareKit app for care transitions.]

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

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Joy M. Grosser, a 20-year health IT veteran, will take the CIO post at University Hospitals’ 18-hospital network in Ohio, effective September 12.

After an extensive nationwide search, University Hospitals’ executives announced their pick to succeed Sue Schade, who has filled the position as interim CIO. Schade is moving to Rhode Island, where she will be closer to her family on the East Coast.

In her new role, Grosser, who most recently served as vice president at UnityPoint Health in West Des Moines, Iowa, will lead major initiatives to optimize information technology performance at every level of the UH Hospitals health system.

Before UnityPoint, Grosser was CIO at UC Urvine for eight years, from 2000 to 2008.

On her LinkedIn page, in addition to extensive IT experience in large healthcare systems, Grosser highlights strategic planning and integration experience for major organizational initiatives among her strengths.

UH officials said Grosser would work closely with administrative and clinical leaders to implement strategies that enhance the UH experience for patients, physicians and employees.

She will report to Michael A. Szubski, University Hospitals’ chief financial officer.

“We look forward to welcoming Joy to Northeast Ohio," Szubski said. “Her impressive accomplishments and collaborative leadership style will advance our mission and help us achieve our information technology improvement goals.”

[See also: CHIME: Is a happy CIO a better CIO?.]

At the core of the $4 billion UH health system is University Hospitals Case Medical Center, the primary affiliate of Case Western Reserve University School of Medicine.

As for Schade, she and her husband have sold their house in Ann Arbor, Michigan, and moved to the Providence, Rhode Island, area.

[See also: Sue Schade leaves University of Michigan, heads to Cleveland for interim CIO role ]

“We now live near some beautiful New England beaches and less than an hour from all four of our grandchildren – all part of the master plan,” she wrote on August 19 in her blog, where she muses on a range of work/life issues.

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

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The Office of the National Coordinator for Health IT has made the new draft 2017 Interoperability Standards Advisory available for stakeholder feedback.

The ISA is meant as a catalog to help the industry keep tabs on the long list of standards and implementation specifications available to help meet interoperability requirements. The draft 2017 advisory features updates and improvements derived largely from public comments and the work of the Health IT Standards Committee.

Among the biggest changes between the proposed 2017 ISA and the 2016 version, according to ONC: a transition from being a stand-alone document toward an interactive online tool; links to projects listed in ONC’s Interoperability Proving Ground, showing use of an ISA-listed standard or implementation spec that can demonstrate ongoing implementations; improved clarity around of the pairing of standards for observations (so-called "questions") and standards for observation values ("answers").

[Also: ONC's Steve Posnack: New Interoperability Proving Ground 'like Match.com for FHIR']

The agency also discontinued use of the label "best available" as a concept for the ISA, as recommended by the Health IT Standards Committee, according to the draft document. The aim, it says, is to respond to previous public feedback that stakeholders might see certain standards and specifications as "best" - notwithstanding known limitations or low adoption levels.

Instead, ISA should serve as a way to "identify" standards and specifications and "should be as inclusive as possible in order to increase public awareness about a standard or implementation specification’s applicability to an interoperability need," according to the draft document.

In an Aug. 22 blog post, Steven Posnack, director of ONC's Office of Standards and Technology, said ISA a key component of the agency's ongoing implementation of the Nationwide Interoperability Roadmap and is essential to the commitment signed at HIMSS16 earlier this year by some of the industry's largest vendors, providers and stakeholder groups to adopt "federally recognized, national interoperability standards, policies, guidance and practices" for healthcare data.

[Also: Burwell: EHR giants Epic, Cerner, Meditech among those taking pledge to standardize health IT]

"By providing the industry with a single, public list of the standards and implementation specifications that can be consistently used to fulfill specific clinical interoperability needs, we hope to spur more seamless and secure flow of information across the health system," Posnack said. "The input and feedback we have received from across the health IT spectrum on earlier ISA versions has helped us continue to shape the ISA into an effective resource and guide for all who are engaged in interoperability work.

"The draft 2017 ISA also represents the first phase of ONC’s effort to transition the ISA to an interactive online platform, starting with the publication of this draft as an online version," he added. "Additional interactive functionality will be built throughout this year. Our goal is to shift the ISA experience from a static, PDF to an interactive, wiki-style product that stakeholders can more fully engage with and shape."

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

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MaineHealth has tapped a veteran chief information officer from a Long Island, N.Y., healthcare system to lead its organization’s information technology efforts.

Dunn is senior vice president and CIO at Catholic Health Services of Long Island in Melville, N.Y.

Dunn will begin her work at MaineHealth this fall. She succeeds Andrew Crowder, who left MaineHealth in January to join San Diego-based Scripps Health as CIO and corporate senior vice president.

[Also: CIO Andy Crowder brings Epic savvy to Scripps Health]

In her role at MaineHealth, Dunn will be responsible for IT operations across the system of nine member hospitals and other healthcare providers serving southern, western and central Maine, as well as Carroll County, N.H.

Jeffrey Sanders, executive vice president and chief operating officer at Maine Medical Center highlighted Dunn’s experience.

"In Marcy we get someone with a wealth of healthcare IT experience, including with the specific platforms we are rolling out across our system," he said.

That experience stood out as a big plus, but even more critical, Sanders said, is Dunn’s collaborative style and track record of leading change.

"She has the intangibles so important to leading change and building teams of talented professionals," he said.

Dunn began her career on the front lines of the healthcare information world as a billing center manager in Albany, N.Y. Over a career spanning more than 30 years, she stepped into roles with increasing responsibility. She joined Catholic Health Services in 2001as director of applications. Starting in 2004, she served as senior vice president and CIO.

During her time as Catholic Health Services' CIO, Dunn oversaw an extensive upgrade of the organization’s information systems, including implementation of the Epic EHR, which MaineHealth is rolling out across its system.

"The opportunity to lead a team that is transforming healthcare in Maine is very exciting to me," said Dunn, in a statement. "MaineHealth is considered a forward-thinking organization, deeply committed to improving the lives of the people and communities it serves. This is a chance to make a difference in a very special place."

Fourteen Texas Health Resources locations have been revalidated at EMRAM Stage 7, the highest level that can be achieved on the HIMSS Analytics EMR Adoption Model.

The model, adopted in 2005, is a methodology for evaluating the progress and impact of electronic medical record systems for hospitals in the HIMSS Analytics Logic platform.

Novant Health in March became the first to revalidate its HIMSS Stage 7 Award  for EHR use.

“Texas Health has made great progress over the past three years,” HIMSS Analytics Global Vice President John Daniels said in a statement. “They have successfully implemented smart pumps across all 14 hospitals, they use advanced analytics to convert acuity and census data into optimized nurse staffing levels, and have placed emergency department tracking monitors in the lab that help optimize operations and staffing. “

[Also: Buyers Guide: What to look for when picking a population health platform]

Daniels noted that the initiatives were made possible by Texas Health’s innovative use of its IT investments.

Texas Health’s senior vice president and CIO Joey Sudomir traces the start of the continuing quest to improve back 10 years when the system implemented iEHR at Texas Health. Texas Health is an Epic shop.

“We take great pride in our ability to effectively insert the EHR into clinical activity as a way to enhance our clinicians’ ability to deliver quality patient care, rather than impede it,” Sudomir said.

Chief Nursing Officer Raymond Kelly added that Texas Health is also using performance improvement activities to find new and innovative ways of tapping technologies for patient safety and, ultimately, better clinical outcomes.

“We find real value in the power of our EHR to improve patient care and quality, through efficiencies in process including: medical device integration; barcode scanning of medications and specimens; clinical decision support rules and alerts; and access to information through robust dashboards,” Kelly said.

Texas Health and other EMRAM hospitals will be recognized at the 2017 HIMSS Annual Conference & Exhibition on Feb. 19-23, 2017, at the Orange County Convention Center in Orlando, Fla.

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

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Atlanta-based Emory Healthcare and Stratus Healthcare, an affiliation of 21 Georgia hospitals, have struck a new partnership to develop a clinically integrated network and strengthen access to specialty care, Emory announced.

The affiliation will initially focus on four keys areas, including collaboration on the development of integrated care systems and an information technology infrastructure. The affiliation is also expected to streamline access to Emory's quaternary and specialized tertiary services, as well as expedite access to the Emory Clinic's single and multi-specialty clinics. Emory and Stratus physicians will also establish medical record connectivity to ensure coordination of care. 

[Buyers Guide: What to look for when picking a population health platform]

In addition, the partners plan to take advantage of clinical consultation and treatment services through telemedicine technology, as well as Continuing Medical Education programming.

Formed in 2013, Stratus Healthcare currently consists of 21 hospitals and approximately 1,500 physicians.

Emory Healthcare is a nonprofit, charitable, academic healthcare system consisting of six hospitals, multiple provider locations and more than 2,000 faculty, employed and network physicians in about 70 specialties.

“This collaborative will assist hospitals, health systems and physicians across the region in working together for the development of consistent best medical practices," said Sen. Dean Burke, R-Maryland, chairman of Stratus Healthcare and chief medical officer for Memorial Hospital and Manor in Bainbridge, Georgia. "Shared services will be designed to lower costs while improving value for patients, physicians, providers and payers."

Just over a year ago, in June 2015, the WellStar Health System backed out of a planned merger with Emory Healthcare after talks broke down between the two major Atlanta hospital systems. Though WellStar didn't give a clear answer as to why the discussions fell apart, the health system said it planned on "exploring and launching new opportunities that will drive future growth and stability throughout the state of Georgia."

Had they merged, the combined system would have been one of the largest nonprofits in the state.

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Thomas Barnett will take the CIO post at the University of Rochester Medical Center, the organization revealed.

When he assumes the chief information officer role on Oct. 10, 2016, Barnett will succeed the recently retired CIO Jerry Powell and report to CEO Mark Taubman, MD.

Barnett currently serves as vice president of the NorthShore University HealthSystem in Evanston, Illinois, a network that encompasses four hospitals, 70 clinics, and an 850-member physician practice.

At NorthShore University, Barnett led the planning and deployment of initiatives such as electronic health record and revenue cycle systems, enterprise data warehousing, meaningful use initiatives, IT security, mobile app and telemedicine strategy.

[Buyers Guide: A close look at 8 population health platforms]

He also drove IT participation in key population health efforts, including the development of advanced analytic platforms for ambulatory and inpatient reporting, as well as predictive modeling for patient risk registries, care gap analyses, and risk-based contract management.

They are all essential capabilities that UR Medicine will require as it advances its own population health strategy, UR Medicine officials added.

While at NorthShore, Barnett was appointed to lead the system’s Digital Health Initiative, through which he collaborated with EPIC’s product development team for MyChart, Cadence, Ambulatory, and Healthy Planet products.

Barnett is known for forward-thinking strategy as well as measured, effective project management, officials said. Prior to his tenure at NorthShore, Barnett spent seven years at Detroit’s Henry Ford Health System as Executive Director of Information Technology before being promoted to Vice President in 2012. At Henry Ford, he was responsible for the system’s Epic implementation, including the migration of an acquired hospital, as well as oversight of the network’s legacy applications portfolio.

“We were especially impressed with his proven experience with Epic, our EHR vendor,” Taubman said. “And his track record of maximizing information for clinical research.”

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In a letter sent to acting CMS Administrator Andy Slavitt on Sept. 1, HIMSS reiterated its desire to see a less prescriptive EHR Incentive Program that works best for providers. Key to making that happen: the quick finalization of a 90-day meaningful use reporting period for 2016.

To keep a focus on the key issues – interoperability and data sharing – that simplified 90-day reporting for eligible professionals, eligible hospitals and critical access hospitals is essential to maintaining meaningful use's flexibility, said HIMSS, responding to CMS' July 14 proposed rule for its Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs.

By the same token, HIMSS Board Chair Michael Zaroukian, MD, and CEO H. Stephen Lieber expressed support for a one-time hardship exception from CMS' 2018 payment adjustment for those EPs who are new participants in the EHR Incentive Program in 2017, as well as those practices transitioning next year to the Merit-Based Incentive Payment System outlined in MACRA.

With so much recent regulatory activity, the letter expressed concern that "changes made to the EHR Incentive Program for 2016 will not be finalized before the start of the year's final possible 90-day reporting period and will create more confusion for providers."

[Buyers Guide: A close look at 8 population health platforms]

Because 90-day reporting was for 2015 meaningful use wasn't finalized until after the start of the final period, "many providers were not able to take advantage of the additional flexibilities" – instead, they were forced to rely on hardship exceptions, Zaroukian and Leiber pointed out.

"In order to avoid a repeat in 2016, it is vital that the 90-day reporting period for 2016 be finalized as soon as possible," they wrote. "If the promulgation of this Final Rule is similarly delayed, CMS must be prepared to provide the flexibility for hardship exceptions as was done in 2015."

In addition, HIMSS recommended that CMS further align the reporting requirements for the Medicare and Medicaid EHR Incentive Programs with those of MIPS, to help reduce the need for multiple reports from IT systems.

"Such a change will assist the program simplification CMS is seeking to achieve. One benefit of the MIPS performance category weighted structure is that it relieves providers of the burden of meeting a 3 variety of high measure thresholds that may not add value to their individual practice," wrote Zaroukian and Lieber. "Eliminating measures and adjusting thresholds is a good start toward what should be a much more cohesive convergence between the hospital EHR Incentive Program and the quality and Advancing Care Information components of MIPS in the future."

Twitter: @MikeMiliardHITN
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The U.S. Department of Defense said it is pushing back its giant $4.3 billion EHR modernization project with Cerner at least a few months.

"During the testing of the system, we identified the need for more time before initial deployment to ensure we are providing the best possible user experience to our beneficiaries and health care providers,” DoD Program Executive Officer Stacy Cummings said in a statement. “We collaborated closely with our vendor, the Leidos Partnership for Defense Health, to make the best overall decision for the successful deployment of MHS Genesis.”

[Also: A look inside Epic's EHR design and usability teams]

The Pentagon awarded the contract to Cerner, Leidos and Henry Schlein in the summer of 2015 and named the project MHS Genesis in April of 2016.

DoD had been scheduled to begin implementing the EHR December 6, starting in Washington state with a pilot at a naval hospital.

"We have a responsibility to our customers to ensure that all required test procedures and processes are completed in an orderly manner,” Cummings said. 

Cerner spokesperson Marlene Bentley added that the additional configuration and testing will help the technology perform at "an optimal level when scaled across MHS facilities."  

The Defense Department said that it will release more specifics about the delay within 30 days. 

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

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