President Donald Trump nominated James Paul Gfrerer as Department of Veterans Affairs assistant secretary for information and technology late Friday.

Currently, Gfrerer serves as an executive director with Ernst and Young, with a focus on cybersecurity. Prior to EY, he served in the Marine Corps for more than 20 years and was a Department of Defense Detailee to the Department of State.

Gfrerer led the program’s interagency portfolios in cybersecurity and counterterrorism for three years.

According to the organizational chart, Gfrerer would also serve as Chief Information Officer. If confirmed, it would give the agency its first permanent CIO since Laverne Council stepped down in March 2017.

Acting CIO Scott Blackburn stepped down in April 2018, and former Trump campaigner Camilo Sandoval has filled the role in the interim. Sandoval has been surrounded by negative reports, including that he conspired to have former VA Secretary David Shulkin, MD, fired.

The VA recently launched its Office of Electronic Health Record Modernization led by Deputy National Coordinator Genevieve Morris. Morris will work closely with the VA CIO on the $16 billion Cerner EHR project to replace the agency’s legacy EHR.

Last week, Robert Wilkie was confirmed as the new VA Secretary and will be sworn in on Monday. Wilkie said the EHR project will be a top priority of his office, which is expected to go-live by 2020 in the Pacific Northwest.

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

The U.S. Department of Health and Human Services Office of Inspector General fined eClinicalWorks $132,550 for failing to report patient safety issues with its EHR to regulators in a specific timeframe, violating the agreement with the Department of Justice.

The fine comes just over one year after it settled with the DOJ for $155 million for claims eCW falsified its EHR certification standards. As part of that settlement, eCW signed a corporate integrity agreement with OIG, mandating the vendor notify regulators of reportable event notifications in a timely manner.

According to the agreement, reportable events include issues that impact patient safety or “any identified instance of actual or suspected patient harm related to the EHR software.” And if one of these adverse events leads to death, injury or hospital readmission, eCW has 48 hours to report the event to OIG. 

As that one year mark approached multiple eClinicalWorks clients said the vendor, in their experience, was not adequately complying with the Corporate Integrity Agreement. Failure to comply with the May 2017 agreement comes with a $2,500 stipulated penalty, which begins to “accrue on the day after the date the obligation became due for each day eCW fails to establish and effectively implement” any of the obligations.

As part of the CIA, eCW is also required to describe appropriate actions taken to resolve reportable events, along with the methods to prevent it from recurring. The agreement is in effect for five years. 

Based on the DOJ allegation, eCW caused providers who used the software to unknowingly submit false claims to Medicare and Medicaid EHR incentive program, as the platform didn’t meet Meaningful Use certification requirements.

“We have consistently sought to [report events] in a complete and timely manner to comply with the CIA, including by reporting such events to customers on our portal,” eCW spokesperson Bhakti Shah said. “The OIG determined that certain reports were not timely provided to it and assessed this penalty. We have paid the penalty and enhanced our processes to ensure timely reporting going forward.”

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

Virginia Governor Ralph Northam today announced the launch of the Virginia Emergency Department Care Coordination Program. The single, statewide network connects all hospital emergency departments in the commonwealth, enabling real-time communication and collaboration among healthcare providers, health plans, and clinical and care management personnel for patients receiving services in emergency departments.

Virginia is the first state in the nation to connect all of its emergency departments in this way, according to the governor. The program also integrates the state's prescription drug monitoring program and its advance healthcare directive registry.

"The Emergency Department Care Coordination Program is an important step forward in making sure all people in Virginia receive the best care possible," Governor Northam said. "Secure technology to access a patient's critical medical information can provide physicians with vital information to increase effective and efficient care, avoid duplicative tests, and save valuable time."

Near real-time, up-to-date information in an emergency department can assist healthcare providers in so many ways, from treating patients with chronic disease to knowing what medications to avoid prescribing to a patient with allergies, added Virginia Secretary of Health and Human Resources Daniel Carey, MD. 

"When you have the right care and the right information in the right setting, you are able to make the best decision for the individual patient," Carey said.

Bruce Lo, MD, medical director of the department of emergency medicine at Sentara Norfolk General Hospital, president of the Virginia College of Emergency Physicians, and professor and assistant program director at Eastern Virginia Medical School, explained the challenge and the solution. Lo has been live on the new system for a month.

"While it was possible to look up previous emergency department visits within a physician's own health system, it was very difficult to know when a patient visited another emergency department outside of the health system or in another part of the state," Lo explained. "Collective Medical Technologies' EDie platform now allows for a visual cue already on our EHR dashboard to see if the patient is flagged as a 'high utilizer' – with no extra clicks needed."

Before, unless the patient divulged having been to another emergency department outside the health system, physicians didn't have that information readily available, he added.

A physician clicks the EDie icon on their EHR dashboard and a summary report displays a patient's previous emergency department visits and admissions and the patient's diagnosis and care coordination plan for care after the emergency visit. Within a special EHR link, the physician can access information about certain emergency department visits across Virginia that use the same EHR.

"I had a middle-aged patient present with abdominal pain, representing a 'Crohn's flare,' what he described as severe," Lo recalled. "He did not come forward with information that he had 10 other emergency department visits from other health systems within the past several months prior to coming to my emergency department; he had only one visit within my health system during the past several months."

On review of outside records, Lo found that the patient had four CT scans done of the abdomen within this timeframe for the same complaint, the most recent being several days prior. This made it easy to forgo a CT scan during this visit when this information was available – and Lo reiterated the plan that was given to him for his follow-up visit, which had already been arranged.

"And best of all, no narcotic prescriptions were given," he added.

In 2017, the Virginia General Assembly established the Emergency Department Care Coordination Program within the Virginia Department of Health. This effort has involved extensive collaboration between health systems, health plans, physicians, the health department, the Department of Medical Assistance Services, and the Department of Health Professions, Carey said.

The program is directed by the health department, which contracts with ConnectVirginia to operate the Emergency Department Care Coordination Program. Collective Medical Technologies is the technology vendor.

Next steps include the participation of the State Employee Health Plan and all non-ERISA commercial and Medicare health plans operating in the Commonwealth by June 30, 2019.

Additionally, the Emergency Department Care Coordination Program will expand to include other downstream providers, including primary care physicians, case managers, nursing homes, CSBs, private behavioral health providers and Federally Qualified Health Centers, who will have the ability to use the technology to receive alerts and contribute to patients' care guidelines.

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

In recent years, state and regional health information exchanges – the ones that have managed to survive the depletion of federal HITECH incentive dollars, at least – have been forced to adapt to a changing landscape by enlisting new partners, shifting their focus, offering value-add service and, sometimes, fundamentally rethinking their technological infrastructure.

The job of an HIE, after all, is to serve its payer and provider members by delivering data they need to enable better care within their own organizations and better health across region-wide populations.

There's no shortage of different approaches to making that work and, as a recent case study from vendor Leap Orbit shows, some of them more advanced than others.

"The most basic HIEs at least offer a Direct secure messaging service and a clinical record portal. A large number also offer encounter alerts, public health registry reporting, quality reporting support, and some form of reporting or analytics. The more evolved HIEs are also offering complex services to support prescription drug monitoring, population health, predictive risk modeling, and a score of other detailed use cases,” the case study found. “Most importantly, these organizations are also thinking about how to make their data more usable, visible, and available to wider audiences and stakeholder groups."

One example is Columbia, Maryland-based CRISP – it stands for Chesapeake Regional Information System for our Patients – a regional HIE serving Maryland, West Virginia and Washington, D.C. With help from Leap Orbit, it recently transitioned, over several years, to an API-based infrastructure.

The shift has enabled the HIE, which supports providers at Johns Hopkins Medicine, MedStar Health, Adventist Healthcare and others, to more easily transmit data for "a host of new innovative use cases," according to the vendor.

[Also: What's next for health information exchanges?]

These include in-context alerts, which enable delivery of prescription drug monitoring program data, overdose alerts, public health alerts, provider and care management attribution and more, directly into electronic health record workflow.

"Critical information from the CRISP HIE is now being directly embedded into the EHRs of thirty-seven out of the forty-seven hospitals across the state of Maryland, with the last ten still under development," according to the report. (Healthcare IT News has previously reported on Leap Orbit's RxOrbit technology, which delivers PDMP directly into clinical workflows.)

Another use case is the CCDA Federator, which compiles clinical documents from a range of sources including other members of the HIE and also from national networks such as Carequality. Discrete data APIs, meanwhile, enables providers to query the HIE for specific data such as medications and attribution.

"The evolution to API-based interoperability has so far been a win for all of CRISP’s stakeholders," according to Leap Orbit. "Physicians are receiving vital information to help better inform decision-making at the point of care. Patients are receiving better care with the hope of it ultimately improving their overall health status. The state is realizing Medicare cost-savings with targeted information fostering more efficient coordination of resources."

Even better, unlike many struggling state and regional HIEs across the country, CRISP is "now experiencing an exponential increase in utilization volume." With APIs enabling easy integration of data into physicians' EHR workflows, the doctors are "increasingly realizing the value and becoming reliant on this data on a daily basis."

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

Earnings and cash flow were each up triple digits for athenahealth in the second quarter of fiscal year 2018, and revenue was on the upswing too as the company looks to chart a course through a tumultuous period marked by a hostile takeover bid and the resignation of its founding CEO.

The cloud-based EHR and practice management vendor adopted a new revenue recognition standard at the start of the year and will implement it fully starting in Q1 2019. Accordingly, athenahealth posted 7 percent growth in Q2, with total revenue of $323.3 million. (Revenue prior to the impact of the new standard was $331.9 million, compared to $301.1 million in the same period in 2017, an increase of more than 10 percent, according to the company.)

Net income from continuing operations, meanwhile, was up nearly 265 percent, year over year, and adjusted earnings per share up almost 112 percent.

"We achieved double digit top-line growth on a comparable basis and significantly improved profitability and operating cash flow year-over-year," said athenahealth Chief Financial Officer Marc Levine. "We remain focused on executing against our product and technology initiatives, improving the customer experience, and delivering on our financial commitments."

Year over year, the cloud-based IT company also saw double-digit network growth for its ambulatory technology (athenaCollector, athenaClinicals, athenaCommunicator) and triple-digit growth for its athenaOne platform for hospitals.

"Any company that undergoes the type of changes we're making at athenahealth experiences a certain degree of uncertainty," said athenahealth Executive Chairman Jeffrey Immelt on Monday's earnings call. "However, the overwhelming sentiment with our employees and clients has been one of optimism and confidence about the strength of athenahealth and where we're headed."

Immelt also noted that the company has yet to decide on a strategy for how or whether to find a buyer, amid ongoing pressure from Elliott Management.

"The board and I believe there's significant value embedded in the company, notwithstanding the positive actions that have been taken to enhance growth and profitability," said Immelt. “We're fully engaged in a thorough evaluation of strategic alternatives to enhance shareholder value."

He added that there's no definitive timeline for the completion of that process, but "we're moving with purpose as we consider a number of options, including a sale, merger or other transaction involving the company as well as continuing as an independent company."

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

David Einhorn of investment firm Greenlight Capital said this week that Elliott Management, which earlier this year bought some 9 percent of athenahealth and publicly said it wants to acquire the company, actually has a different end in mind. 

Einhorn added that athenahealth, long held as an example of cutting-edge cloud-based vendor in the EHR space, is not really a SaaS company. 

The comments come during the same week that athenahealth announced its revenue is up 10 percent and earnings tripled in a call with investors. 

“This quarter, an activist forced out the CEO and convinced the company to put itself up for sale,” Einhorn wrote in a letter outlining some of the reasons Greenlight had a difficult quarter. 

While Einhorn did not mention specific names, Elliott was vocal in early May when it issued a $6.5 takeover bid of athenahealth and suggested it could take the publicly-traded company private. Former GE CEO Jeffrey Immelt, who now serves as athenahealth’s executive chairman, has said multiple times that the board is considering options that include either a sale or continuing to operate as an independent organization. 

“Notably, the activist indicated that it would be willing to pay $160 a share and possibly much more pending due diligence,” Einhorn wrote. “Our take is that the activist has little interest in actually buying the company, but hopes someone else does.”

That might be a welcome thought to health IT professionals. In June, Healthcare IT News polled readers: Should athenahealth accept activist investor Elliott Management's $6.5 billion takeover bid? 

Nearly 75 of the 201 respondents answered in the negative, saying athenahealth should not sell -- and quite a few had choice words aimed at Elliott. 

In the meantime, however, existing athenahealth clients and other practices and ambulatory facilities considering switching electronic health records vendors are left wondering what the future holds for the company and how that impacts their own purchasing decisions in a market that analyst firms are saying is on the verge of consolidation. 

“The risk is that the other buyers realize athenahealth is not a SaaS company, but rather a business process outsourcer in a mature market that already cut costs to the bone last year in response to the activist,” Einhorn wrote. “The prospective buyers might also waver should they conclude that many of the best employees were personally loyal to the now deposed CEO.” 

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

CommonWell Health Alliance and Carequality on Thursday kicked off live health information sharing between CommonWell members and healthcare organizations that have adopted the Carequality Interoperability Framework. 

That means hospitals that participate in either organization can now share Continuity of Care Documents with any other member, regardless of which EHR platform each is running. 

“This currently limited production use is the beginning of a broader effort to increase health IT connectivity nationwide by enabling CommonWell subscribers to engage in health data exchange through directed queries with Carequality-enabled providers, and vice versa,” Sequoia Project Marketing Director Dawn Van Dyke wrote on the Carequality website. The Sequoia Project oversees Carequality. 

[Also: Why interoperability guru Micky Tripathi says this is a signature moment] 

CommonWell Executive Director Jitin Asnaani wrote on its site that it has met all Carequality requirements to move this capability into production. The organizations said that already early members of CommonWell shared 4,000 documents with Carequality-enabled physicians. 

Asnaani pointed to EHR vendors Cerner and Greenway, in fact, as examples of participants that already have providers live on the connection and explained that means CommonWell and Carequality can benchmark and validate the health information exchange. 

“This is not to say that there isn’t still work to be done, but we have made significant strides over the past few months,” Asnaani added. “We are still on track to make this Generally Available to our members, and in turn, their participating providers and health care systems, by the end of summer.”  

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

As consumer at-home genetic tests become more popular, patients are increasingly interested in how their inherited health impacts their future wellness. At the same time, some hospitals are exploring ways to incorporate genetic information into the delivery of healthcare.

NorthShore University HealthSystem's "advanced primary care" model is designed so a patient's genetic and family history are seamlessly factored into the standard diagnostic assessments performed by primary care physicians.

This means, for instance, that blood pressure and cholesterol are measured and recorded in the electronic health record, and genetic information is gathered from both patient-shared data and associated genetic testing.

The information gathered through a patient's advanced primary care visit is saved to the EHR so pertinent details – whether a high risk for cancer based on genetic mutation or an inherited sensitivity to select medications – are flagged to providers throughout that person's lifetime.

"Advanced primary care includes all aspects of a traditional primary care visit but also incorporates a more detailed assessment of a patient's genetic history."

John Mark Revis, MD, NorthShore University HealthSystem

This individualized approach offers the physician customized information that directly informs clinical recommendations and preventative measures that will best address that patient's unique needs throughout the continuum of their care, officials said. It also helps patients with diseases such as breast cancer and prostate cancer use their genetic testing information to help family members navigate their own healthcare plan.

"Advanced primary care includes all aspects of a traditional primary care visit – for example, overall health assessment, blood pressure, weight checks, etc. – but also incorporates a more detailed assessment of a patient's genetic history," said John Mark Revis, MD, a primary care physician at NorthShore University HealthSystem. "We do this through our Genetic and Wellness Assessment questionnaire that is filled out either online ahead of the visit or at the time of the visit."

Based on responses, the patient may be eligible for a referral to one of NorthShore's personalized medicine clinics or be recommended to have lab tests performed to learn more about how changes in their DNA might affect their health, he explained. This information would then be used to create a customized care and treatment plan that is based on unique genetic characteristics and health history, he added.

Integration of genomic data into the Epic EHR is an ongoing process. For data generated by in-house testing – for example, the organization's pharmacogenomics test and tumor genomic data – the data is integrated as discrete variables for which clinical decision support tools and care pathways can be built, said Peter Hulick, MD, head of the division of medical genetics at NorthShore University HealthSystem.

For testing that is conducted externally, NorthShore has integrated the ordering process to electronically send relevant patient health information and insurance information to its lab partners.

The report is returned as a scanned document in a standard fashion; the goal is to ultimately have the information returned as discrete elements just like the in-house data. This requires more health IT build since NorthShore has to interface with the external lab.

Revis offered one recent example of advanced primary care at work: "A patient did not know her biological family health history because she was adopted, so she completed the Genetic and Wellness Assessment questionnaire," he explained.

"Based on her results, she decided to do the healthy gene panel test, which analyzes a large number of genes that are well-established indicators of a significantly increased risk of developing certain conditions, including hereditary cancers, cardiovascular conditions and other disorders," he said.

The genes tested are all related to inherited conditions that, if detected early, have effective medical interventions and preventive measures. Her primary care physician ordered the test and found that she has a pathogenic variant in the PMS2 gene, which results in Lynch syndrome, the second most common hereditary cancer condition after BRCA1/2.

"Without the prompting of the Genetic and Wellness Assessment questionnaire, the patient and physician might not have been aware that such genomic screening was available, and now the patient can be screened more frequently for colon cancer, as well as other Lynch syndrome related cancers, following well-established guidelines by the National Comprehensive Cancer Network," Revis said.

"We have a Genetic and Wellness Assessment questionnaire completion rate of about 75 percent with more than 95,000 encounters thus far."

Peter Hulick, MD, NorthShore University HealthSystem

NorthShore has built an analytics dashboard to help follow the advanced primary care process in order to identify areas of improvement, whether it is from an operational standpoint or a patient and physician education standpoint.

"We have a Genetic and Wellness Assessment questionnaire completion rate of about 75 percent with more than 95,000 encounters thus far," Hulick said. "With this dashboard, we can drill down by site, practice location/specialty and best practice alerts, and analyze follow-through on lab tests ordered and referrals."

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

Allscripts' revenue was up 23 percent and earnings up 142 percent for the second quarter of 2018. Cerner's revenues were up 6 percent, but earnings were down by the same number.

Two of the largest publicly-traded health IT vendors have some very different priorities for 2018 and beyond, as Allscripts focuses expanding its scope offerings to an array of different clients and partners, while Cerner knuckles down for the ongoing rollout of the Defense Department's MHS Genesis and the looming VA modernization project.

On its earnings call, Allscripts President Rick conceded that the company was a "bit disappointed" with the quarter's booking of $278 million," and said long sales cycles and timing uncertainty could lead to more "quarter-to-quarter volatility" ahead – but he expected some but said its remains "very confident in our pipeline of opportunities."

[EHR interoperability: We’re closing in on a signature moment]

Allscripts CEO Paul Black pointed to double-digit revenue growth and the fact that Q2 earnings per share were "the highest they've ever been" under the current management team.

The executives said they're prioritizing innovation on a number of different fronts, from precision medicine (the company is "just scratching the surface" of what its 2bPrecise platform can do for its EHR clients, said Poulton) to interoperability: the Allscripts Open API platform just crossed the 4 billion data share milestone, Black noted.

"Today more than 8,000 registered developers have accounts on Allscripts Developer portal," he added. "This vibrant community of entrepreneurs and their collective innovation creates a key competitive advantage for Allscripts."

He noted the company's continuing track record of strategic investments, such as its acquisition this spring of patient communication platform HealthGrid, which helps position Allscripts for the era of consumerism, and its addition of Netsmart, with aims toward post-acute care.

In addition, growth of its payer and life sciences business, analytics offerings for "driving additional value from our pharmaceutical clients," and ongoing R&D spending in general, are meant to continue to Allscripts' evolution for a diversifying healthcare space, said Black.

Cerner sees 'broad industry impact' from DoD, VA deals

Cerner, meanwhile, enjoyed a "solid Q2, with all key metrics coming in at or above our expected results," said Chief Financial Officer Marc Naughton. Bookings were up 9 percent over the same period 2017, "largely due to the initial task orders for the Veterans Affairs contract that was announced in May," he said.

Indeed, now that the deal is officially signed, sealed and delivered, the VA promises to take up much of the company's bandwidth in the years ahead. Cerner President Zane Burke offered updates on that initiative, as well as the ongoing rollout at the Defense Department.

With regard to MHS Genesis, "we remain on track to begin the next wave of implementations later this year," said Burke, noting that DoD upped the contract ceiling for MHS Genesis by $1.2 billion to include the Coast Guard and other expanded scope.

As for the VA, "we believe there is great potential for a broad industry impact," Burke added. "At the core of this project, Cerner will enable seamless care through a single system that links both veteran populations totaling more than 18 million people, while also delivering national interoperability to the commercial market."

Both of those projects will also help Cerner boost its efforts across the board in population health, open platforms and telehealth, he said, "all of which have relevance to our commercial client base."

Burke also offered some further insight into the intriguing value-based care partnership it launched with Lumeris this past month, which will see the launch of an "EHR-agnostic" technology, called Maestro Advantage, to help health systems manage Medicare Advantage plans and other risk-based reimbursement models.

"It will provide connectivity across the provider health plan and consumer, and will be designed to improve outcomes and lower costs by embedding actual insights into the provider workflow," he said. "It will include a unique accountable care clinical model that supports a health system's development of a high-performing integrated delivery network and shared savings with providers through value-based incentive alignment."

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

The Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services are working together to realize a shared vision for a health ecosystem that sees the free flow of information between patient, provider and payer, CMS Administrator Seema Verma said Monday during the ONC's Interoperability Forum in Washington, D.C.

Verma set a goal for digital health information to replace the current use of fax machines in physician offices to send patient information.

To this end, CMS is seeking developers, and already has an estimated 600, interested in building consumer-friendly applications for Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust.

"If I could challenge developers on a mission, it's to help make doctors' offices a fax free zone by 2020," Verma said to applause. 

CMS is kicking off its inaugural Blue Button 2.0 Developer Conference on August 13. 

Blue Button API has data for 53 million beneficiaries in Medicare Parts A, B and D.

"As head of CMS, one of my main missions is to break down barriers to interoperability," Verma said.

While we live in an age of wonder at technological advancements such as fitness apps and precision medicine tailored to an individual's genetic code, health information technology remains far behind all of the major industries, Verma said.

Healthcare remains in a 1990s time warp, she said.

Instead of making work easier for physician, electronic health records are contributing to their burnout, Verma said. Physicians are still recording their notes on paper.

Too often patients are told their data can't be shared with another provider. But systems refused to share data because of the fear the patient will be poached, Verma said.

"We can keep data secure, while making it available to patients," she said.

To avoid payment reductions, physicians and hospitals will have to give patients electronic access to their health records.

Verma said she's also called on insurers to release their claims data so that health information is no longer locked in siloed systems.

Interoperability imagines a world in which medical decisions are fully informed by medical history; health history follows consumers wherever they go; third parties can leverage EHRs; data is used not only to treat, but to prevent illnesses; and researchers are using the information to develop cures.

Verma first unveiled new interoperability efforts at HIMSS18 in March, when she and Jared Kushner, director of The White House Office of American Innovation, promoted interoperability and the MyHealthEData initiative.

It's about driving a new era of digital health, Verma said, liberating data to put patients in charge of their healthcare.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

A grand total of 475 healthcare facilities earned HIMSS Analytics EMRAM Stage 6 in July, while another three achieved Stage 7.

It’s worth noting that individual health systems commonly validate multiple, if not numerous, sites as was the case with Northeast Medical Group, Southcoast Physicians Group, and Yale Medicine in July, according to HIMSS Analytics.

[HIMSS Analytics now offers a free version of its Logic Analyze News weekly newsletter: Subscribe]

All three of this month’s Stage 7 winners are located in Massachusetts: Bolton Primary Care in Bolton, William McLaughlin, MD Gynecology in Auburn, and Worcester Cardiology in Worcester.

HIMSS Analytics pulled the updates for this article from its Logic Health IT Market Intelligence Platform.

Maidstone and Tunbridge Wells NHS Trust’s board has approved a full business case that will see the organization deploy Allscripts' Sunrise EPR. 

A recent KLAS Research report looking at the 2017 global EPR market share noted that the UK was one of Allscripts’ primary EPR markets outside of the United States -- while HIMSS Analytics created two maps that demonstrate how Allscripts acquisition of McKesson’s health IT business expanded the vendor’s footprint west of the Mississippi in the U.S. 

The NHS trust, which comprises two major hospitals and a cancer service, deployed the Allscripts Patient Administration System last October. 

“Now it will roll out the Sunrise clinical suite in a phased deployment,” Allscripts President Rick Poulton said during a recent call with investors that the implementation, expected to last around 14 months, according to the trust's most recent board papers, will initially focus on order communications and test results, clinical documentation, patient tracking and vital signs. 

“My ambition for the trust is to deliver outstanding staff and patient experience. Sunrise will support that by giving clinicians the information they need to deliver excellent patient care.

“At the same time, investment in digital solutions will give us the data we need to respond to the demand and financial pressures we are facing,” said in a statement Chief Executive Miles Scott.

“In general, UK customers have been fairly pleased with Allscripts, leading to the vendor’s rapid expansion in previous years,” KLAS researchers said.

The KLAS report also points out that the company has "lagged significantly behind Epic, InterSystems, and Cerner in recent years, in terms of both new wins and provider perceptions of the Allscripts solution."

This article originally appeared on Healthcare IT News sister site The British Journal of Healthcare Computing. 

Georgia-based Piedmont Athens Regional Medical Center has gone live with its new Epic electronic health record, following a year and a half of prep work that including the training some 5,000 clinicians and hospital staffers for the switch.

The hospital enlisted the help of 130 volunteers from other Piedmont hospitals who were familiar with Epic's ins and outs, to provide "at-the-elbow support" for Piedmont Athens Regional, officials said.

In addition to the obvious appeal of an integrated patient record across the health system, the hospital said it was drawn to the Epic MyChart portal, enabling patients at Piedmont Athens Regional to gain secure access to their own health data, book appointments, refill prescriptions and more.  

More than half of all Georgia residents currently or will soon have a record in Epic when all planned installs are complete, Piedmont Athens officials noted, enabling better care coordination and reducing duplication.

"Doctors will now be able to pull up a patient’s medical history quickly and know about current medications, allergies and other essential patient information," said Charles Peck, MD, president and chief executive officer of Piedmont Athens Regional. "Providers will have access to a patient’s full story, whether they were seen here at Piedmont Athens Regional, another Piedmont location, or even at other providers in Georgia or across the country, regardless of which system they use."

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

Apple's clinical and health informatics lead, Ricky Bloomfield, MD, said on Wednesday that health IT is at a unique period in time.

"We have the convergence of the technology required, with the regulatory pieces in the 21st Century Cures Act and Promoting Interoperability and the ecosystem of platforms and phones that can run apps," Bloomfield said.

Speaking at the at Office of the National Coordinator for Health IT's Interoperability Forum, Bloomfield pointed to the FHIR standard in particular, which Apple is using with its Health Records app to enable patients to control who can access their data.

[Also: EHR interoperability: We're closing in on a signature moment]

"If any of you have an iPhone in your pocket running the latest version of iOS you likely already have a FHIR app on it," Bloomfield said. "That's a real FHIR app."

Apple used the HL7 Argonaut Implementation Guide for its Health Records apps, which the company launched in January of 2018 in partnership with a dozen hospitals. In the time since, more providers have joined, including nine earlier this month, bringing the total to 78, according to Apple's website.

Bloomfield also gave a glimpse of how the upcoming iOS 12, due this fall, will enable developers to ask users for permission to access their data – and, if granted, once that data is released to developers they will treat it in accordance with their own privacy policy.

"For the first time, developers can create apps with data from multiple EHRs, across multiple health systems," Bloomfield said. "There are still a lot of data types that need to be liberated, and many more health systems that need to get on board with APIs."  

But as companies such as Apple and EHR makers including Epic, Cerner and athenahealth use the Argonaut Implementation Guide, it will make it easier for others who wish to build on or adopt the specification.

"I am tremendously optimistic about the state of the HIT ecosystem today," said Bloomfield.   

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com

Millions of patient records were potentially left vulnerable to attack by more than 20 vulnerabilities discovered by cybersecurity researchers from Project Insecurity.

The widely used open source EHR management platform is used across the world by thousands of providers and small healthcare organizations for lab integration, CMS reporting, scheduling and storing records. Up until OpenEMR addressed the issues, the platform had 18 severe vulnerabilities.

As a result, Project Insecurity held its report until OpenEMR was able to address the findings.

Included in the list of bugs: A flaw that would easily let anyone bypass the patient portal authentication by navigating to the registration page and changing the URL to access the desired page. The researchers provided a list of all portal directory pages that would open to the hacker, including patient profiles.

The researchers also discovered multiple instances of SQL injection, which can be leveraged to view data from a targeted database or to perform other tasks like performing database functions. There also were many security issues that could have led to remote code execution and others that could have disclosed data.

OpenEMR’s management system also was open to compromise by hackers through unrestricted upload errors, unauthenticated information disclosure and unauthenticated administrative actions, among others.

All vulnerabilities required no automated scanning or source code analysis tools. The researchers found them by just manually reviewing the source code and modifying requests. If found by a hacker, they could access patient records, compromised databases and sensitive system data, and elevate privileges, upload files and more.

Researchers set up a test lab to examine the platform, as OpenEMR was warned of system flaws by Risk Based Security in November 2017. That report found a configuration vulnerability that could expose a system to complete compromise.

Patches have been released to cloud customers and users. OpenEMR released an update to resolve these issues on Aug. 7.

Given the severity of the target on the healthcare sector, this disclosure is more than alarming. Platform vulnerabilities and failed patches are giving hackers an even easier way to get into private data. Patch management and monitoring are crucial to shore up these flaws.

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

In a brief mention contained in its Form 10-Q, filed with the U.S. Securities & Exchange Commission, publicly-traded Community Health Systems revealed that it is facing a "civil investigative demand" related to its "adoption of electronic health records technology and the meaningful use program."

There were few details in the note, contained on page 78 of the 86-page filing, but the EHR investigation, first reported by Fierce Healthcare, was listed fourth among other topics for which CHS, the largest for-profit acute care hospital chain is "responding to subpoenas and administrative demands" – including "short-term Medicaid eligibility determinations processed by third party vendors at one of our Pennsylvania hospitals" and "an inquiry regarding computer servers running the Windows 2003 operating system."

[See also: Microsoft sues Community Health Systems for alleged copyright infringement]

It wasn't clear from the filing which federal agency would be looking into the meaningful use participation of Tennessee-based CHS, although the incentive program (which has since evolved into the Promoting Interoperability initiative) was administered by the Centers for Medicare & Medicaid Services. 

In its 10-Q, the hospital network noted that it occasionally fields "inquiries or subpoenas from state regulators, state Medicaid Fraud Control units, fiscal intermediaries, the Centers for Medicare and Medicaid Services, the Department of Justice and other government entities regarding various Medicare and Medicaid issues."

A request for comment from Community Health Systems was not immediately returned.

A civil investigative demand has been described as an "increasingly aggressive investigative tool" that the government can use to investigate complaints related to the False Claims Act.

As one health law firm explains, a CID offers wider latitude for federal probes of civil complaints, compared with other tools used to investigate potential fraud or overbilling.

"Unlike other investigatory tools (such as grand jury subpoenas), a federal agency does not have to appear in court and prove its case for issuing a civil investigative demand," according to Oberheiden & McMurrey. "To the contrary, authorities such as the U.S. Department of Justice have broad authority to issue civil investigative demands on their own accord."

False Claims Act claims can be expensive. In 2017, of course, eClinicalWorks agreed to pay  $155 million to settle FCA allegations related to meaningful use certification of its EHR technology. 

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

The Centers for Medicare and Medicaid Services late Thursday proposed overhauling the Accountable Care Organization program in a number of ways related to EHRs and risk-based payment models. 

On the technology front, and as part of the Administration’s broader MyHealthEData initiative, the new proposed rule would advance interoperability and give patients more control of their medical data by instituting criteria regarding the number of clinicians using certified technology in lieu of quality metrics, the agency said. 

The new rule would also reimburse Next Generation ACOs for telemedicine services, including dermatology and ophthalmology, in addition to virtual visits conducted in so-called non-rural geographical areas, CMS said. 

And as part of the Administration’s Meaningful Measures initiative to reduce burden, the proposal aims to streamline the measures that ACOs are required to report. 

To bolster beneficiary engagement, CMS proposed allowing certain ACOs under performance-based risk to provide incentive payments to patients for taking steps to achieve good health.

Also, CMS proposed to require that beneficiaries receive a notification at their first primary care visit of a performance year informing them that they are in an ACO and explaining what that means for their care.  

The Accountable Care Organization program has “not lived up to the accountability part of its name,” CMS Administrator Seema Verma said during a call late Thursday. 

Instead, the Medicare Shared Savings Program has shown increases in net spending for CMS and taxpayers.

The majority of the 649 Medicare ACOs, 561 are in a Medicare Shared Savings Program. The majority of these – 460 of the 561, or 82 percent – are not taking on risk for increases in costs.

CMS projected that proposal would save Medicare $2.2 billion over 10 years.

Among the ways it will achieve that is by putting limits on the amount of time an ACO can remain in upside-only risk from six years to two years.

Under the current program, ACOs can remain in an upside risk arrangement for six years, getting 50 percent of the savings. This has created a perverse incentive not to take on downside risk, said CMS Administrator Seema Verma. 

Under Thursday’s proposal, ACOs in the two years of an upside risk arrangement would get 25 percent, rather than 50 percent, of the savings.

In addition, the proposal would authorize termination of ACOs with multiple years of poor financial performance.An estimated 107 ACOs are expected to drop out of the program, according to CMS.

An estimated 10.5 million beneficiaries in fee-for-service Medicare, out of 38 million beneficiaries, are in a shared savings ACO.

“Medicare cannot afford to support programs with weak incentives that do not deliver value,” Verma said by statement. “ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up, and this has to change.”

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

A team of House and Senate Democrats launched an investigation into cronyism at the Department of Veterans Affairs after a ProPublica report found that three friends of President Donald Trump are influencing policy and personnel decisions at the agency.

Led by Sen. Nancy Pelosi, D-California, and Rep. Tim Walz, D-Minnesota, the Democrats blasted the influence of a group sometimes known as the “Mar-a-Lago” trio. The three men are “not accountable to veterans or taxpayers, and none of whom have served in the U.S. military or government.”

Yet these men are helping shape crucial decisions without Senate confirmation or a presidential nomination, explained Walz in a statement.

According to the report, Ike Perlmutter, Marvel Entertainment CEO, Bruce Moskowitz, an internal medicine specialist, and Marc Sherman, an attorney, are the “shadow rulers of the VA.” They speak with VA officials on a daily basis despite having no healthcare experience or VA connection.

The trio reportedly has reviewed a wide range of policy and personnel decisions, “prodded the VA to start new programs” and required VA leadership to meet with the group with travel paid for by taxpayers. Those who disagreed with the group lost their jobs or were passed over for promotions.

The report also claimed the group profited from their influence. While the men have repeatedly denied these claims, according to a statement from Rep. Tim Walz, D-Minnesota, “reports and actions taken by these individuals and VA leaders appear to contradict this statement.”

Indeed, ousted VA Secretary David Shulkin, MD, alluded to the trio in his New York Times Op-Ed after he was fired by Trump in March, blasting those in and outside the agency for “putting their personal agendas in front of the well-being of our veterans.”

In fact, a Politico report from the spring said it was Moskowitz that held up the Cerner contract, as he’d used the platform and didn’t like it. The trio reportedly pressured Shulkin to perform further vetting and not sign the contract.

Current VA Secretary Robert Wilkie has only been in the position for a few weeks and said he won’t privatize the VA and will fight against it. Wilkie signed the Cerner contract in June, nearly a year after Shulkin announced the plan to switch EHRs.

Walz requested Wilkie provide unredacted copies of any and all documents, records and correspondence including text messages between the trio and any current or former VA employees including Shulkin and former acting VA Secretary Peter O’Rourke.

Wilkie was given an August 31 deadline to provide the documentation, which will also include any and all travel of VA employees to Mar-A-Lago in Florida where the meetings reportedly took place.

“Veterans and military families were shocked and outraged to hear that the VA is being run by three Trump cronies with no U.S. military experience and whose only qualification seem to be that they are dues-paying members of Mar-a-Lago,” Pelosi said in a statement.

“The poisonous Trump culture of corruption, cronyism and incompetence is finally coming to light at VA, threatening the health and futures of millions of veterans, caregivers and their families,” she added. “The VA is an indispensable and cherished guardian of our veterans’ healthcare and benefits, not a second branch of Mar-a-Lago.”

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

It contains some of the most remote areas on earth and communities of people suffering from diseases that have no place in a developed nation, but despite colossal challenges, the Northern Territory is on track to deliver its digital health record on time and on budget.

As the $259 million five-year project approaches its halfway mark, it is readying to reach a population distributed throughout more than 1.35 million square kilometers and significantly improve care outcomes, according to Chris Hosking, Deputy Chief Executive with the Northern Territory Government's Department of Corporate and Information Services.

With InterSystems TrakCare being implemented at every point of care across public health facilities – including six hospitals, 54 remote health centers and all community-based health services – Hosking said the sickest Territorians stand to benefit most from what is a transformation.

"It's such a bloody overused word but I think this really will be transformational for the Northern Territory and really enhance our ability to deliver care in real time to people, as much as possible, close to their homelands," Hosking told Healthcare IT News Australia.

The Core Clinical Systems Renewal Program will see the delivery of a single integrated patient administration and clinical information system, and despite transient patients, complex cases and cultural naming practices it will provide "one patient/one record" for the 250,000 people in the NT.

"All our reputations are on the line here but we are committed to delivering it on time, on budget and within scope."

Ranging from the outback to the tropical north, over 43 percent of the population live in remote or very remote areas of the vast territory, including in more than 600 communities and remote outstations.

Indigenous people make up a third of the Northern Territory's population, with a rate of avoidable hospitalizations four times the Australian average. In 2016 the median age at death for NT residents was 67.6 years, 14.4 years fewer than the national average.

Added to that is an aging population and the highest premature death rates in Australia.

For many reasons, this is a project with ambitious goals.

"The complexity is in the fact that we're trying to implement a single digital health record across the entire spectrum of care, which is everything from Royal Darwin hospital, which is a large teaching hospital in Darwin affiliated with Flinders Uni, and does all the things that you'd expect in a major, acute centre to do," Hosking said.

"[Then] down to the smallest primary care clinics in the bush that might only have a couple of nurses in a very remote location, servicing a really small community of a couple of hundred people many miles from anywhere, and generally with very poor access to services and basic infrastructure.

"Right across that whole spectrum, we're trying to implement this one solution with every clinician, no matter where they are when they treat a patient, and they'll touch that one patient record in real time, all the time."

Hosking said the current legacy systems – despite being "just about held together with sticky tape" – position the territory well for the new implementation.

"We have acute primary and community service by different systems, and we have another one in the acute space, so we're going from four systems down to one, which in itself is pretty complicated, but we've already got that whole of jurisdiction take up. And being a small jurisdiction, it probably gives us the agility to do this, it would just be too hard in somewhere like New South Wales or Queensland."

But in the territory, the stakes are higher.

The NT has the highest burden of disease among all jurisdictions in Australia – 5.7 per cent of the population suffers diabetes, about 60 percent of Indigenous males and almost 50 percent of Indigenous women are smokers, and the highest rate of renal failure in the world could see the need for dialysis treatments in clinics rise by 70 per cent by 2022.

Hosking, who spoke at the InterSystems event at last week's HIC18, said two years into the largest technology endeavor the NT Government has ever embarked on, the project was on track.

"We're where we need to be in terms of timeframe and budget and all those other things that you get measured on, and I'm really confident we'll deliver it within that five years."

Tech projects haven't always been so seamless in the territory.

"We had several major IT projects some years back that didn't go so well, and I think every jurisdiction's had a few of those. You don't have to walk too far to find an IT project that got itself into strife," Hosking said.

Following some troubled implementations including a tech project that the then Deputy Chief Minister David Tollner described as a "diabolical mess", a parliamentary inquiry in 2014 into the NT's management of IT projects led to the tightening of governance.

As a result, according to the straight-talking Hosking, this project is rightly being held to a tough yardstick.

"Because we did have several projects that didn't go so well, including one which was a $70 million asset management project that had to be set aside, there's very little appetite for things going wrong. So I guess we're measured against that yardstick of things that haven't gone so well in the past, so the governance and the scrutiny that is applied to the project is very rigorous."

As the rollout ramps up, InterSystems, which has partnered with a local IT supplier, is recruiting tech professionals who are prepared to relocate to the NT.

Building up the territory's capacity in clinical system expertise is another intention of a venture that will leave behind a lasting legacy.

"InterSystems have got a whole bunch of obligations on them in their contract, which it appears they're living up to," Hosking said. "They're doing a bloody good job of it, and we want to see that survive the project. The project will finish but we see that as continuing to grow, enhancing the skills base in the Northern Territory."

This article first appeared in Healthcare IT News Australia.

The Centers for Medicare and Medicaid Services on Monday held its first White House hackathon. The topic: Blue Button 2.0.

Ahead of the event, I spoke with two technologists, one from CMS and one from the United States Digital Service (which worked with the agency to develop the Blue Button API). 

Mark Scrimshire is CMS Blue Button Innovator and a developer evangelist. Kelly Taylor is a product manager at the United States Digital Service. They discussed the momentum that CMS has picked up recently in the developer sandbox, the ideal example of what Verily is doing with the API and what they hope other developers do with the tools moving forward.

Q: The White House hackathon is about Blue Button 2.0 – where is Blue Button now?

Scrimshire: When (CMS Administrator) Seema Verma announced the sandbox at HIMSS18 we thought we’d get 20-30 people but we came away with more than 200 developers registered – and it’s still growing. We didn’t try to create something unique to CMS. The resource was meant to be friendly and familiar to the payer industry and, in fact, there are four or five payers that have taken it and are using to do things like send data to analytics vendors. We deliver the API, documentation, implementation guide, sample apps, code samples, there’s a support forum on Google.

Taylor: It’s four months old and now we have more than 700 developers in the sandbox, apps in production. That tells states and Medicare Advantage plans that this is totally doable and there’s product market fit, developers want this.

"The challenge is always getting the data – so the big opportunity is CMS setting an example for the rest of the industry."

Mark Scrimshire, CMS Blue Button Innovator

Q: What are some of the most successful apps using the API today?

Taylor: The research projects so far – Google Verily’s Project Baseline is a perfect example. Research participants contribute all sorts of health data, it’s very in-depth, they can connect their Medicare data as one piece of the longitudinal puzzle. It’s the exact use case we envisioned when we set out to do this. A lot of startups are working on PHR apps, payers and EHR companies are in the sandbox experimenting with the API so they can understand what it looks like. From pop health to research projects, to people thinking about doing things with Amazon Echo, to health systems to stealth startups, it’s been fun to see the interest in this.

Scrimshire: Consumer-directed exchange is part of the wider application happening with Blue Button. Using the OAUTH 2.0 protocol allows a patient to authorize an app or service without giving away a password, and FHIR makes it easier for developers to find the data because it’s in JSON format so they can use standards to carry out their work. 

"The larger our developer ecosystem, the better for everyone, the more diversity we have, the more people asking hard questions, the stronger the product becomes."

Kelly Taylor, U.S. Digital Service

Q: With the recent push to attract more developers, what are you hoping they achieve? 

Scrimshire: Because my interest has been on patient empowerment for years, I’m engaging in conversations with payers and asking what is the relationship you want to have with your members in this interoperable world? Should you be finding preventative services members are eligible for? Should payers be publishing to their members the results of benefit or eligibility checks for services the member is after? Another thing that would be great to see is a single Medicaid implementation of Blue Button and not 50 different Medicaid implementations. 

Taylor: As a Blue Button product manager for the last year, I want to see more developers get their apps into production. I’m looking to better understand their blocks, friction and collect ideas for the roadmap.

Q: What’s one thing about Blue Button that developers might not know but should really be aware of?

Scrimshire: The Blue Button API is in a unique position because only a small fraction of care is happening in the doctor’s office or hospital, lots of care is delivered at home or in the community. Because a patient is enacting their HIPAA right of access, Blue Button is the only API that would enable a covered entity to share data with a community or faith-based organization that may be active in the community. If a hospital made available the FHIR information using Blue Button methodology a patient could share lab tests with the community organization that helps take care of them at home. Those organizations don’t necessarily have funding or infrastructure to become a Business Associate or covered entity. With Blue Button, they don’t have to become a covered entity. I’m trying to get this idea out there to get innovators and entrepreneurs to think about how to make healthcare better. Putting the patient in control makes sense.

Q: Last question: What’s next?

Taylor: One of the things I noticed is that there’s a community of early adopters and thought leaders around FHIR that understand the direction of everything and are driving the industry forward, and then there’s a massive gap and then everybody else in healthcare. So the idea is bringing healthcare decision makers, software engineers closer to understanding the FHIR data format and why that’s important. The larger our developer ecosystem, the better for everyone, the more diversity we have, the more people asking hard questions, the stronger the product becomes.

Scrimshire: I just want to see it really grow and flourish, ultimately it’s about seeing those apps in the hands of people, whether it’s working with Alexa or doing cool stuff with smartphones. We’re really just scratching the surface of what’s possible. The challenge is always getting the data – so the big opportunity is CMS setting an example for the rest of the industry. The more that causes other organizations to make this API available with relevant information for their members, the better in empowering consumers to manage their own health. 

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com