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Articles on this Page
- 08/14/18--13:51: _Apple is developing...
- 08/15/18--10:17: _Geisinger, Merck co...
- 08/16/18--11:09: _HRSA to give $125 m...
- 08/17/18--06:43: _Digital transformat...
- 08/17/18--07:12: _HIMSS19: New focuse...
- 08/20/18--11:17: _Vets group sues Tru...
- 08/23/18--09:16: _Relentless focus on...
- 08/24/18--09:54: _VA Cerner EHR Proje...
- 08/27/18--09:55: _Poll: Should the VA...
- 08/28/18--11:55: _Epic, Cerner, Allsc...
- 08/29/18--09:47: _Harris Healthcare a...
- 08/29/18--12:41: _GAO to review DoD C...
- 09/19/18--11:00: _How to Protect EHRs...
- 10/16/18--10:00: _HIMSS Media Insight...
- 08/30/18--09:59: _Judy Faulkner touts...
- 08/30/18--11:03: _Patient safety dema...
- 08/31/18--11:57: _Nationwide prescrip...
- 09/05/18--06:25: _VA leadership woes:...
- 09/06/18--12:11: _IT investment neede...
- 09/06/18--13:24: _VA CIO nominee pled...
- 08/14/18--13:51: Apple is developing custom health information tracking chips
- 08/15/18--10:17: Geisinger, Merck co-launch new FHIR-enabled patient apps
- 08/17/18--06:43: Digital transformation is changing IT consulting, Black Book says
- 08/23/18--09:16: Relentless focus on innovation wins Ochsner a HIMSS Davies Award
- 08/24/18--09:54: VA Cerner EHR Project CHIO Genevieve Morris resigns
- 08/27/18--09:55: Poll: Should the VA put Cerner EHR plans on hold?
- 08/29/18--12:41: GAO to review DoD Cerner EHR implementation status
- 09/19/18--11:00: How to Protect EHRs at Scale and With Crypto-Agility
- 10/16/18--10:00: HIMSS Media Insights on Technology Disruption in Healthcare
- 08/31/18--11:57: Nationwide prescription safety alert system proposed by House bill
- 09/05/18--06:25: VA leadership woes: Readers nearly deadlocked on EHR project path
- 09/06/18--13:24: VA CIO nominee pledges to fix cybersecurity, EHR modernization
Apple is looking to hire engineers to develop a custom chip for more sophisticated health information tracking and applications, according to a CNBC report.
CNBC said it got the information from a job posting from Apple’s Health Sensing hardware team. The July 10 job summary is for sensor ASIC architects to design, develop and launch next generation sensor technologies to enable interaction with users and the environment.
Developing its own chip would also be a way for Apple to protect its intellectual property, the report said, and the custom sensor would be expected to measure information from the body.
While Apple iPhones and Watch already have health-monitoring features, such as heart rate detection capabilities, the current pinnacle of optical sensing technology would be a chip for continuous blood sugar monitoring.
Apple and rivals including Alphabet, Amazon and Microsoft are all building technologies that have the potential to transform the delivery of care.
Amazon’s recent collaboration with Berkshire Hathaway and JPMorgan Chase to form an as-yet unidentified healthcare venture, for instance, is being closely watched as a major disruptor.
Alphabet, IBM, Google, Microsoft Oracle and Salesforce just this week announced that they are undertaking the interoperability of electronic health records.
And Alphabet invested $375 million in Oscar Health, with which the insurer plans to get into the Medicare Advantage business.
Over the last five years, healthcare funding among the 10 largest IT companies in the United States has increased from $277 million to $2.7 billion, according to Business Insider.
Geisinger and Merck have collaborated on a pair of new web-based applications, designed to make it easier to incorporate patient data into health systems' electronic health records for better care coordination, treatment and outcomes.
One app, called Family Caregiver, enables two-way communications between patients and their care teams. The other, known as MedTrue, draws together medication data from different sources to help patients with reconciliation and adherence, creating a meds list that's vetted by both patient and provider.
Both apps, which use SMART on FHIR specifications to incorporate data from disparate EHRs, are accessible to patients and also embed their information within providers' EHR workflows, bringing patient-reported data to the point of care. Both were also tested in clinical settings at Geisinger.
"Providing these tools for patients and family caregivers – tested within our own system – enables patients to be more active in healthcare decisions and could increase the likelihood that patients will adhere to their treatment plans and lead healthier lives," said Geisinger Chief Scientific Officer David Ledbetter.
The Family Caregiver application enables a calendar to meld medical and personal appointments for better care coordination, and offers a patient-managed medication scheduler based on daily activities. It gives patients information on their health care team members (specific roles, contact numbers) and offers a journal-like feature to jot notes and create narrative dialogue for patient encounters.
The app, which was first piloted for oncology but is designed to work for other areas requiring complex care coordination, "enables our team to create a more personalized experience with each patient during a very difficult time," said Rajiv Panikkar, MD, chair of the Geisinger Cancer Institute.
It can help with "planning treatment appointments around important personal upcoming events and answer medical questions that the patient or caregiver may otherwise forget to ask during a scheduled appointment," he said.
The MedTrue app, meanwhile, includes medication fill data from a prescription data aggregator irrespective of care setting. It uses a web-based interface for patient-reported verification, changes and adherence data, making that info accessible at home or at the health system. Caregivers can see the data within the EHR, gaining visibility into the patient's own validated meds list and help with medication nonadherence, which is a major hurdle to better population health.
"We know from prior work that about 70 percent of our medication lists are inaccurate, and these inaccuracies can lead to medical errors," said Mike Evans, Geisinger's chief pharmacy officer. "The MedTrue application provides an interface that seeks to clean up medication lists, so patients and providers can be on the same page regarding medication use and better care decisions can be made."
The Health Resources and Services Administration is awarding $125 million in grants to 1,352 community health centers nationwide, seeking to bolster their technology infrastructure and ability to offer high-quality and affordable, primary care.
The new funding is aimed specifically at several different areas, officials said: advancing the use of health IT, broadening access to comprehensive care, addressing health disparities, improving patient-centered care, boosting quality and outcomes and driving cost-efficiencies for comprehensive care delivery.
"Community health centers provide coordinated, comprehensive, and patient-centered care to millions of Americans," said HHS Deputy Secretary Eric Hargan in a statement. "They have a track record of delivering quality care at significantly lower cost, and are vital partners in our movement toward a health system that delivers quality, affordable, value-based health care for all Americans."
In 2017, about one in 12 U.S. residents – more than 27 million people – relied on a HRSA-supported health center for affordable, accessible primary care, officials noted. Those percentages increased significantly for certain demographics: one in three people living in poverty; one in five rural residents; one in nine children 17 years or younger.
Patients at community health centers – 1,400 health centers operating more than 11,000 sites nationwide – also include more than 355,000 U.S. veterans.
"Nearly all HRSA-funded health centers demonstrated improvement in one or more clinical quality measures from the year prior, and these funds will support health centers' work to improve the quality of care they deliver every day in their communities around the country," said HRSA Administrator George Sigounas.
The digital transformation underway in healthcare is not only altering the tech landscape but also the nature of consulting services and arrangements that hospitals are inking with outside firms.
It’s no secret that rapidly changing technology means consulting firms have to evolve as well. Healthcare IT News this summer reported on the next-generation of consulting, wherein top firms revealed how they working in the post-EHR era to move beyond prediction and keep pace with consumerism, to cite two examples.
Add IT optimization to that mix. Black Book on Thursday released a report finding that optimization is the top technology priority of hospital executives CEOs, CFOs and COOs as well as CIOs.
To that end, nearly two-thirds of survey participants indicated plans to seek advisors to optimize their current EHR and revenue cycle management systems, Black Book said.
Another 46 percent plan to access experts in software training and implementation in 2019.
The most substantial portion of management consultant engagement expenditures, 64 percent or about $29 billion, involve the implementation of software, information systems, systems integration and optimization, and support for the growing number of industry mergers and acquisitions, according to Black Book’s client satisfaction survey.
Respondents said the three current market drivers of healthcare consulting at their organizations are a lack of highly skilled IT professionals, adoption of cloud technology and increased industry digitalization.
Here’s the rub: that wide range of digital projects is also changing how hospital IT shops engage with consultants
Eighty-four percent of respondents report they will be seeking multiple-sourced consultants to work on engagements and projects together. Options include single shop consultants, single freelancers, group purchasing organizations, HIT vendors, networks of freelancers, boutique advisory firms -- as well as major consultancies.
“There is an accelerating trend away from one large consulting group retained to execute a substantial project for a health system client wherein 2019 we will see more arrangements where healthcare clients press multiple consultants and advisory firms to collaborate on project engagements,” said Doug Brown, founder of Black Book.
Big Data & Healthcare Analytics Forum
The Boston forum to focus on effective pop health management, AI and precision medicine Oct. 22-23.
HIMSS is debuting a new set of communities ahead of, during and after the HIMSS19 Global Conference.
Called HIMSS Circles, they’re an opportunity for like-minded people to convene at the conference, get to know each other and learn together what will be of most interest, according to HIMSS Vice President Karen Malone.
For its first year, the HIMSS Circles program will include nine distinct communities: non-IT C-suite executives, IT executives (CIO, CTO), clinical IT executives (CCIO, CMIO, CNIO), security executives, investors, entrepreneurs, physicians, nurses, and researchers or scientific specialists focusing on life sciences.
“The experience we’re creating for these groups will help them navigate the conference and identify what’s important,” Malone said. “We’re taking the initiative and saying ‘you might want to participate in this session with other nurses,’ for example.”
The HIMSS Circles communities will begin in the fall, with webinars for each group and the HIMSS19 Global Conference will feature an on-site welcoming activity, identified relevant education sessions, tours of specific exhibit areas, HIMSS executive thought leadership briefings and custom activities.
The HIMSS Investor Circle, for example, includes exhibition, professional development and networking events.
The exhibit portion including the Innovation Live Showcase, Innovation Pavilions, start-up booth, a Developers Lab and the Innovators Genius Bar.
When it comes to professional development, HIMSS Investor Circle participants will have access to Venture Connect pitch competitions, Reverse Pitch Competitions and Market Debut Sessions.
And the networking events also include orientation, an investor reception and the investor lounge so Circle members have a private place to conduct business.
“Circles are an opportunity to be engaged with the community and services, such as HIMSSTV, year-round,” Malone added. “We’re starting with nine stakeholder groups this year and hopefully we’ll be expanding it for HIMSS20.”
Attendees can opt-in when they register for the HIMSS19 Global Conference and anyone who did not do so can go back in and edit their registration to join a Circle.
Veterans’ advocacy group VoteVets and Democracy Forward filed a lawsuit against the U.S. Department of Veterans Affairs on Friday, to stop the influence of three friends of President Donald Trump from further influencing decisions at the agency.
Filed in a Washington, D.C. federal court, the lawsuit asks the court to block the trio dubbed “shadow rulers” from weighing in on decisions, policies and personnel changes. The men in question, Ike Perlmutter, Bruce Moskowitz, MD, and Marc Sherman, are members of the so-called “Mar-A-Lago Council.”
A ProPublica report released this month found the trio has “influenced, shaped and dictated” agency choices, including a delay of the EHR modernization contract with Cerner and the removal of former VA Secretary David Shulkin, MD.
“They have done so without being subjected to transparency requirements, conflict-of-interest screens and other accountability rules required of public servants,” according to the lawsuit. “They have none — no government experience, no U.S. military experience.”
“Rather, each simply shares a financial relationship with Trump as a dues-paying member of the Mar-A-Lago Club, a private golf and social club in Palm Beach, Florida, owned by the Trump Organization,” the lawsuit continued.
Citing the Federal Advisory Committee Act, government agencies must be transparent when permitting “public participation when the executive branch establishes or uses non-federal bodies for the purpose of seeking advice and generating policy,” according to the suit.
The lawsuit outlines several meetings that failed to observe the procedures outlined by FACA, including documentation, transcripts of meetings and the like. As a result, the VA and the trio have violated the law, the groups argued.
Led by Rep. Nancy Pelosi, D-California, and Rep. Tim Walz, D-Minnesota, the group requested Wilkie provide unredacted copies of any and all documents, records and correspondence between the trio and any current or former VA employees by Aug. 31.
On Friday, Sens. Tammy Duckworth, D-Illinois, and Maggie Hassan, D-New Hampshire, joined the call to investigate the potential legal and ethics violations by VA officials.
The pair asked the VA Office of Inspector General to determine whether agency officials inappropriately shared sensitive data with the trio, as they had “no legitimate need for the information, resulting in the delay of contract awards and costing the federal government additional money,” Duckworth wrote.
Duckworth, who served 23 years in the Reserve Forces, also asked OIG to investigate whether the trio had financial interests in the companies or whether they were competitors, to determine whether VA officials misused taxpayer funds and if senior Trump appointees violated the Federal Records Act by using personal emails for VA policy decisions.
Further, Duckworth asked OIG to see if former acting VA Chief of Staff Peter O’Rourke violated federal civil service protections “by communicating with non-governmental individuals regarding several VA civil servants and a contractor assigned to a VA project.”
Duckworth wrote to VA Secretary Robert Wilkie soon after the ProPublica report to urge him to cease involvement with the Mar-A-Lago trio and to replace several VA appointees that have caused “significant dysfunction” at the agency.
“VA leaders should be focused on reserving taxpayer dollars for veteran care and making decisions that benefit veterans, not on pleasing unelected and unconfirmed political advisors,” Duckworth wrote. “Any undue and unethical influence by these types of advisors on VA leaders should be subject to continued and careful scrutiny.”
Currently, Wilkie is forging ahead with the Cerner contract, working to get the new EHR fully functional in the Pacific Northwest by 2020 in alignment with the Department of Defense’s EHR rollout. The VA did not respond to a request for comment.
Ochsner Health System has won a 2018 HIMSS Davies Enterprise Award, honored for the accomplishments of its innovationOchsner group, or Team iO, and its broader efforts to improve patient safety and population health.
The workgroup within Ochsner, the large academic medical center based near New Orleans, has developed several specialized digital technologies that integrate with its electronic health record to improve its approach to treating high blood pressure and diabetes and monitoring maternity patients.
Ochsner has also innovated its use of the EHR to combat the opioid epidemic and boosted its population health management efforts by finding and closing gaps in care.
The 30-hospital health system has been a longtime leader in tech-enabled innovation. Whether it's deploying artificial intelligence from Epic and Microsoft to help spot and prevent potential adverse events, or pioneering precision medicine techniques, Ochsner is at the forefront of new advances in quality and safety.
"Ochsner’s unique application of integrating digital medicine and remote home monitoring into patient care has generated significant improvements in population health while improving patient satisfaction," said Jonathan French, senior director of quality and value-based care at HIMSS, in a statement.
French pointed to the health system's use of predictive analytics to spot patients at high risk of opioid addiction and connect them with alternative pain management models as just one area where it's driving innovation in care delivery.
Another area of marked improvement is pop health: Ochsner's team advanced its value-based care initiative by focusing intently on care coordination and chronic disease management, resolving nearly 50,000 gaps in care.
"Ochsner leverages information and technology as a mechanism to enable significantly improved care outcomes for their patients," said French. (You can read case studies spotlighting the health system's initiatives here.)
Innovation team develops specialized EHR add-ons
The health system's Team iO was also cited by HIMSS for a trio of innovative data capture tools it created to help improve its approach to managing chronic conditions and delivering obstetrical care.
"Risk models were constructed to assist in providing guideline-based care driven by data captured through digital links to patients," HIMSS explains. "Dashboards highlighting key data and risk elements were created for pharmacists and health coaches to augment care interventions, including guideline-driven medication treatment, as well as lifestyle and behavioral changes."
Patients get monthly report on their progress through their online portal, and can see changes in their risk profile and get tips on self-care. Ochsner providers, meanwhile, can see progress summaries for any patient enrolled in the program.
Earlier this year, Richard Milani, MD, Ochsner's chief clinical transformation officer and medical director of Team iO, spoke to Healthcare IT News about the huge value of patient generated data– as long as its properly curated in a way that's useful for clinicians.
"It's incumbent upon us to design algorithms to be able to curate the information to be able to make responses without it all being on the human," said Milani. "That's what information services should be doing: saying, 'OK, there's a ton of data coming in, we're going to figure out, before it even gets to the doctor, that these are the three data points you need to look at, and don't even worry about this other 450.'"
"We're collecting all of that stuff. From home, and everything else on a regular basis. It's not a problem. Storing the information, curating the information, doing stuff with it, is not that hard. But if all we're going to do on the IS side is say, 'OK, here's your connection,' just telling the doctor to sift through this pile of sand to find the one particle you need, that's not very fair."
The results of Team iO's initiatives have been promising for Ochsner. Its Hypertension Digital Medicine application has helped control blood pressure in 71 percent of previously uncontrolled patients within just 90. Its Connected MOM app has helped effect a 30 percent reduction in the number of in-person routine obstetrical visits. And its Diabetes Digital Medicine tool helped achieve a 1 percent drop in in hemoglobin A1c levels in enrolled patients while also enabling improved adherence with eye exams and screenings.
"With the explosion of digital applications and an increasing value in health information technology, it is critical that traditional health systems become more innovative in how and where care is delivered while still creating a connection with their patients," said Warner Thomas, President and CEO, Ochsner Health System. "We are proud of the work our physicians and staff accomplish on a daily basis so that we can fulfill our mission to change and save lives of our patients."
Genevieve Morris, chief health information officer of the U.S. Department of Veterans Affairs’ Office of Electronic Health Record Modernization stepped down from her role this morning, just one month after moving into the position, a VA spokesperson confirmed to Healthcare IT News.
Morris was on detail from the Department of Health and Human Services. Her intended plans have not been announced.
In her resignation email to both departments, obtained by Politico, Morris cited VA leadership as the reason for her departure: “Over the last few weeks, it has become clear to me that VA’s leadership intends to take the EHR modernization effort in a different direction than we were headed.”
John Windom will take over as acting CHIO for OEHRM. Windom is a recently retired Navy captain, who help led the Department of Defense EHR modernization project and the VA negotiations with Cerner over the last year.
The departure is just the latest executive departure for the agency. In fact, the OEHRM Chief Medical Officer Ash Zenooz, MD announced her resignation on Tuesday, which will go into effect Sept. 4. The staffing shakeups, however, began even earlier.
President Donald Trump fired Former VA Secretary David Shulkin, MD in March. His departure was followed by longtime acting CIO Scott Blackburn in April and the retirement of VA Deputy Secretary Thomas Bowman in May.
Trump nominated EY cyber executive James Paul Gfrerer as the agency’s CIO in July.
Morris’ email brings to light continued concerns about VA leadership and the influence of what’s been dubbed the ‘Mar-A-Lago Council.’ The three friends of Trump have been influencing policies, decisions and personnel changes at the agency.
Veterans’ advocacy group VoteVets and Democracy Forward sued the Trump administration on Aug. 20 to put an end to it.
But with a projected March 2020 go-live for the new Cerner EHR in the Pacific Northwest, these staffing changes are more than concerning. Congress has aired those concerns in several committee meetings, but VA officials have stressed the project will follow the DoD rollout.
In response, the House formed a committee in July to ensure the VA Cerner EHR modernization stays on track.
Genevieve Morris, the U.S. Department of Veterans Affairs EHR modernization project CHIO, resigned from her leadership position on Friday, just a little more than a month on the job. Morris’ departure is just the latest staffing shake-up to plague the agency, which includes the lack of a permanent CIO.
In her departure letter, Morris said leadership is taking the project in a different direction than planned. Given EHRs are arguably the most complicated tech implementations an organization can take on and VA is one of the most complex health systems in the country, we thought we’d ask our readers their thoughts on the matter.
The electronic health record market has largely settled on a few major players in the U.S., even if it's still somewhat in flux. But a very different set of circumstances in Europe has led to some competitive jousting from a variety of vendors.
"Europe has one of the most dynamic and competitive EMR markets in the world, with active tenders in nearly every region," according to a new report from KLAS. "Amid this activity, multi-regional vendors are becoming more prevalent, forcing regional solutions to redefine themselves in order to stay relevant."
The study tracked market share and gathered performance feedback from more than 100 interviews with IT decision-makers from providers in a dozen European countries.
"Epic has grown rapidly in market share, (especially among larger academic and regional organizations in the Netherlands and Scandinavia) while hitting timelines and maintaining strong customer relationships," said to KLAS researchers, who did note that some customers say Epic’s approach "can feel somewhat US-centric."
Cerner has found success, primarily in the UK, by innovating its functionality, according to the report. And Allscripts’ recent implementations "have progressed quickly and successfully."
But other players are also making their presence known – notably InterSystems.
“From 2012–2017, more European hospitals (including both public and private hospitals) came under contract with InterSystems than with any other vendor," KLAS reports. "This growth expanded the already-large InterSystems customer base.”
That said, there have been growing pains, and that fast expansion has led to "missed implementation timelines, slow delivery of promised functionality, and a lack of localized functionality" for country-specific editions of its TrakCare system.
Meanwhile, some smaller vendors are also holding their own.
"Better than any other regional solution measured, ChipSoft has kept pace with the multiregional vendors in development, technology, and customer satisfaction," said KLAS, referring to the Amsterdam-based health IT developer.
However, DXC Technology and Medasys, which is based in France, are "falling behind in support and development," according to the report.
DXC's Lorenzo platform, which had been rolled out as part of the UK's since-abandoned National Programme for IT, has "performance and usability challenges, and delivery of promised functionality has lagged," KLAS notes.
And Medasys broadened its product offerings, but "as resources have shifted, support has declined, leading to a large backlog of tickets."
The report also looks at Agfa HealthCare and Cambio, whose EHRs are "slower in development, though customers are more positive about their overall experience."
Harris Healthcare acquired Iatric Systems for an undisclosed sum. Boxford, Massachusetts-based Iatric, which specializes in integration tools to help hospitals optimize electronic health records and other IT infrastructure, will operate as an independent business unit of Harris, officials said.
Iatric develops a wide range of technology for medical device connectivity, security, interoperability and other areas of EHR optimization. Its President and Chief Operating Officer Frank Fortner, who has been with the company for 20 years, was named executive vice president for Iatric Systems.
Iatric recently partnered with device makers like Hospira to promote more secure connectivity between smart infusion pumps and EHRs, using its Accelero Connect software. And its FlexButton application enables single sign-on, helping clinicians avoid multiple re-authentications when accessing third-party data in the EHR.
"The acquisition of Iatric Systems represents a natural extension of our offerings in the healthcare information technology segment," said Harris Healthcare President Jerry Canada, Jr.
The size and scale of Harris, Fortner added, will offer the Iatric business unit new and resources to help support its customers. It helps position Iatric Systems "for continued and long-term success in line with our 28-year history of providing innovative healthcare IT solutions to hospitals."
In an amendment tucked into the Senate appropriations bill passed on Aug. 23, the Government Accountability Office will be required to conduct its own review of the Department of Defense MHS Genesis rollout.
The DoD has been in a planned holding pattern for several months while it addresses technical concerns at its four test sites in the Pacific Northwest. Several reports have outlined serious concerns about the platform, with one government assessment deeming parts of the platform operationally unsuitable.
Sen. Patty Murray, D-Washington, questioned the DoD’s current process in April, outlining the “significant morale impact” the project has had on the practitioners in her state and that the EHR may be “putting patient lives at risk.”
DoD officials have consistently stressed that the assessment stage was planned and that there’s an obvious learning curve to the rollout. But the mandated GAO audit will once again put the Cerner EHR under a microscope.
According the amendment, GAO will be looking for what actions DoD has taken to improve the platform since the initial report and whether the system is meeting the healthcare demands at those pilot sites. GAO will also look into any anticipated delays and EHR performance.
Officials will also determine any underlying issues that could impact future deployments and whether the agency will be able to meet its timeline to deploy the new EHR worldwide by 2022.
The results of the report could be telling, as the Department of Veterans Affairs intends to rollout its own Cerner EHR to model the platform at DoD -- under the same timeline. VA predicts that its test sites will go live in 2020.
The amendment was passed in the Senate appropriations bill for the DoD and Department of Health and Human Services and the Labor and Education department. The legislation will still need to be reconciled with the House bill, but if passed, GAO will need to report on the DoD platform within six months.
Patients willingly share Personal Health Information (PHI) living in Electronic Health Records (EHRs) with trusted healthcare providers, yet how reliable are the controls in place to ensure continual privacy? When data is physically and digitally shared across so many networks, what protection scenarios must be considered? The answer, any and all. Cyber criminals are becoming more inventive every day, demanding action from healthcare networks to move at pace with their adversaries.
While budget and staffing continue to be named as the biggest issues in the healthcare IT, what steps can be taken to ensure security and overall trust to deliver the best patient care? The solution is to either increase budget/personnel or people or invest in agile automation.
Janet King and Leonard D’Avolio, Assistant Professor at Brigham and Women’s and Harvard Medical School, will convene to discuss the results of a recent HIMSS Media survey, which polled healthcare providers on their outlook for the future of healthcare IT, with a focus on disruptive technologies.
Epic is working to take interoperability global, CEO Judy Faulkner told more than 10,000 attendees at the company's annual Users Group Meeting.
"You've eliminated the silos from within your organization," said Faulkner, speaking at Epic's headquarters in Verona, Wisconsin, according to the Madison Capital Times. "Now it's time to eliminate the silos from outside."
Faulkner was referring to Epic's One Virtual System Worldwide initiative, which it launched early this year. The initiative enables "clinicians across all organizations using Epic" to more easily gather, share and interact with health data no matter the location and presents it in a unified view.
"We’re taking interoperability from being able to 'view more' to being able to 'do more,'” said Dave Fuhrmann, Epic's vice president of interoperability, when the project was first announced.
This spring, for example, UNC Health announced it was using the "Happy Together" component of One Virtual System Worldwide to pull in EHR data from other health systems to create a more comprehensive narrative view of its patients – improving care for diabetes patients.
As is often the knock against the company, the focus on exchange across Epic customers is not quite the same as true interoperability. But Epic said the initiative does include "organizations that use other EHRs."
It certainly represents an Epic-esque approach to the idea of more widespread data sharing. Given the scope of Epic's customer footprint, with nearly two-thirds of U.S. patients and increasingly more in Europe, it's on a scale that could credibly live-up to the project's bold name.
In some ways, the One Virtual System Worldwide concept is similar to Epic's ideas for "comprehensive health records" – CHRs, not EHRs– that incorporate more and bigger data. It's a branding of sorts, that reflects the new scope of tech-enabled 21st Century healthcare but also highlights Epic's own outsized ability to shape the conversation – even if some healthcare professionals take issue with that branding.
In Verona, Faulkner told the customers assembled in Epic's 11,000-seat Deep Space Auditorium that the possibilities enabled by the shared network of One Virtual System Worldwide were huge.
By connecting its customers across the globe and making data more seamlessly available and actionable within their and others' clinical workflows, Faulkner said Epic could help a wide range of organizations improve care for their patients and collaborate on medical advances that could have a global impact.
"Together, we can find answers to many puzzling questions, and prevent many diseases," said Faulkner, according to the Cap Times.
Pew Charitable Trusts says not enough attention is being paid to electronic health record usability from a safety point of view. And given that federal certification requirements don't address two key safety factors, it's offering EHR developers and provider organizations a toolset to help boost patient protections.
For all the benefits that EHRs bring, variations in their design, customization and use can "lead to inefficiencies or workflow challenges and can fail to prevent – or even contribute to – patient harm," according to a new study from Pew.
On the flip side, proper EHR optimization can be a boon to patient safety. The challenge is that proper assessment and testing of how the systems are actually used in the wild can be hard to do.
Yes, ONC has exacting certification requirements for health IT, including provisions that say vendors have to conduct usability testing and bring clinical end users into their design and development process.
But the testing rules "fall short in two ways when it comes to assessing whether the use of products contributes to patient harm," according to Pew's Project Director for Health Information Technology Ben Moscovitch.
First, federal testing criteria focus on vendors' development and design but "do not address circumstances in which customized changes are made to an EHR as part of the implementation process or after the system goes live," he explained. "The second key challenge is the absence of requirements and guidance on how to test clinician interaction with the EHR for safety issues."
But use of such clinical test cases, with scenarios that mimic real-world clinical workflows and patient conditions, can be hugely valuable in detecting design or customization quirks that might have an adverse impact on safety.
As part of its new report, Pew, in partnership with MedStar Health's National Center for Human Factors in Healthcare and the American Medical Association, has made available a group of model test cases and list of best practices to help providers make safety assessments of their own post-install EHRs, and spot any "usability-related risks to patients throughout the life cycle of these products."
Earlier this summer, we highlighted human factors research from Pew, MedStar and AMA, where researchers examined how EHRs were used at four health systems: two that use Cerner and two that use Epic.
They tracked how emergency physicians at each location handled six specific scenarios, collecting keystroke, mouse click and video data.
"There was wide variability in task completion time, clicks and error rates," according to the report. "For certain tasks, there were an average of a nine-fold difference in time and eight-fold difference in clicks."
To better help hospitals and health systems ensure their EHRs are deployed and configured for optimal usability and safety, the new Pew report outlines scenarios and advice to help providers get a handle on how its clinical staff are putting the IT to work.
"The sample scenarios in the report provide thorough tests covering seven types of usability issues that clinicians may face, including unclear settings, data entry obstacles, and confusing system alerts," said Moscovitch. "Each scenario was designed so that both health IT vendors and purchasers of EHR products can conduct realistic, safety-focused usability tests. The scenarios can be used directly by vendors or providers and can help build additional tests."
He emphasized that successful scenarios should "include expected users of the system with varying levels of computer expertise; represent realistic clinical care processes; be shaped around a clinically oriented goal; contain clear, quantitative measures of success and failure; and include known risk areas and challenging processes, such as ordering that a patient’s drug dose be tapered."
The hope, Moscovitch said, is that more EHR vendors adopt such test cases and incorporate them not just in design and development, but also in subsequent iterations as the technology matures.
He added that the test scenario criteria included in the Pew report "can serve as a potential standard for the EHR accrediting bodies and a resource for developers" – and ideally would eventually be incorporated into future updates to ONC's own certification requirements.
Health systems, meanwhile, "can use the test criteria and sample cases to evaluate the usability and safety of their product during the implementation phase, after changes are made, and to inform customization decisions," said Moscovitch. "Organizations can immediately leverage the example test cases to quickly evaluate system safety to identify challenges and prevent harm."
A House bill introduced on Aug. 30 would create a nationwide Prescription Safety Alert System, designed to better protect patients at risk of opioid overuse.
If passed, the Analyzing and Leveraging Existing Rx Transactions (ALERT) Act would mandate the Department of Health and Human Services to work with the private sector on a system that can analyze data from payers and pharmacists to protect patients from opioid abuse.
The system would flag patients at risk of overuse based on prescription history. Pharmacists would get the data right in the workflow, including capturing transactions from across state lines and any unsuccessful opioid fill attempts.
The idea is to stop fraudulent transactions before prescriptions are filled and empower providers to identify patients at-risk of misuse.
“By giving pharmacists, insurance companies, and programs like Medicare a new tool to understand the data they already have, we can help prevent further harm,” said Rep. Tom MacArthur, R-New Jersey, in a statement.
The system would also alert the pharmacist to patients who may be doctor-shopping, said MacArthur. “Instead of filling that unnecessary prescription, pharmacists will have an extra tool to detect and prevent these dangers.”
Health IT NOW applauded the legislation.
Currently, providers rely heavily on prescription drug monitoring programs to flag suspicious opioid transactions, but there are significant blind spots in that process, explained Joel White, executive director of HITN's Opioid Safety Alliance.
Right now, every state besides Missouri has a PDMP in place. And 46 states are part of the PMP InterConnect: an interstate group started by Appriss Health in 2011 that fosters prescription drug data sharing across state lines. But there’s still a long way to go to determine just how effective PDMPs are in impacting the opioid crisis.
Industry leaders say part of the issue is with data: Some states are making progress, but it’s not nationwide. Many have pointed to a lack of unified regulations around the platform. The new legislation may provide a solution.
Many factors limit PDMP effectiveness, including a lack of real-time data and a lack of prescriptions from across state lines -- and the platform doesn’t include fill attempts, White said. The proposed legislation would give providers the ability to stop opioid abuse with real-time data and “prevent undue delays in access for those with a legitimate need.”
Since March, the U.S. Department of Veterans Affairs has seen a lot of leadership turnover: 40 senior staffers by the Democrats count in May. The agency lost two more in late summer, with the departure of its EHR project office Chief Medical Officer and Chief Health Informatics Officer.
As the VA just began its EHR modernization project, we asked our readers whether the office should pause the project while it waits for experienced IT leadership. But the near-700 responses were far from clear: 55 percent said to pause, 45 percent said no to stopping the current progress.
Should the VA put its EHR project on hold until it has permanent IT leadership in place?
What’s interesting is that despite those close responses, the majority (63 percent) said they were concerned with the project’s current trajectory. And a glimpse at the poll responses provided one clear result: No one can agree on what to do, what’s right for the VA or whether Cerner was the right choice.
Those in favor of the project highlighted the need for the VA to work with Cerner, the Department of Defense and industry leaders to get the project right.
“There is a culture of using VistA that will need to change. It would be helpful to have the same DoD transition team work directly with VA to assist in the switch over to Cerner,” said one respondent. “The VA needs to get their act together.”
Are you concerned about the project’s current trajectory?
“They need to move forward and start tailoring the EHR to their patient and provider needs,” said another.
Another reader had strong words for everyone involved: “I work for a hospital system in the process of changing all of our EHRs over to a new system. Of course, it's not easy. Change is never easy. There are just too many cooks in the kitchen. Just get over it already like the rest of us 99-percenters have to do, and do what needs to be done.”
Others were unsure of the right path forward, some citing the need for an external investigation and even more saying the VA needs to quickly hire both a CHIO and a chief information officer.
Those against the current path were a bit more direct, revisiting the argument that began when former VA Secretary David Shulkin, MD first proposed the need to replace the legacy VistA system. Those respondents called for Epic -- and for the agency to keep its current platform.
“Revisit the EHR Acquisition at this time - put [the project] on hold,” said one reader. “Create conditions for successful EHR implementation: Do not move forward until these criteria are in evidence.”
“The process is relying too heavily on DoD implementation, which has some serious problems and is still paused,” said another respondent. “VA is driving this without enough Veterans Health Administration input. It’s not an IT project: It’s a healthcare transformation project.”
The reader comments echo similar sentiments from a letter sent by 11 lawmakers to the agency, blasting the modernization progress and the leadership shakeups. The group went as far as to call the lack of leadership ‘malign neglect.’
In fact, a recent letter to VA Secretary Robert Wilkie from Rep. Jim Banks, R-Indiana, said he’s greatly concerned “about the deteriorating and rudderless leadership” at the VA EHR project office and requested Wilkie fill those leadership holes.
Without its CHIO and CMO, Banks said, “at most half of the program’s leadership positions are occupied, and its rank-and-file positions are only sparsely filled, primarily with detailees… It would be a tragedy for the program to be undermined by personality conflicts and bureaucratic power struggles before it even begins in earnest.”
Banks also noted he wasn’t even able to meet with the CHIO and CMO before they resigned.
Congress is also concerned that the VA is attempting to rollout the same platform as the DoD, given the long list of challenges that have plagued that project. The DoD rollout is still on hold, and if a recent amendment to the Senate appropriations bill is passed, the Government Accountability Office will review the project.
But not everyone is concerned with the leadership troubles. An AMVETS spokesperson told Healthcare IT News in a statement: “I don’t necessarily see the turnover in IT leadership as worrisome.”
Instead, the leadership changes indicate that the EHR project is moving forward without “meddling outside interests,” the spokesperson added. “When [Wilkie] left the Pentagon to head the VA, Sec. Mattis specifically asked him to ensure the VA EHR modernization was done right, and we believe he's going to see to it that it is.”
Hospital chief medical information officers are almost unanimous in recognizing the patient safety improvements that have been brought about by better medication management processes, according to a new poll from their U.S. trade group, the Association of Medical Directors of Information Systems.
The results come amid the ongoing opioid epidemic in America. Technology vendors are trying to help in the battle. IT-savvy hospitals such as Intermountain, which has tweaked its Cerner EHR to reduce such prescriptions in the first place, and Ochsner, which has integrated an opioid monitoring tool into its Epic system, are taking matters into their own hands. More and more states, meanwhile, are passing e-prescribing laws and standing up prescription drug monitoring programs.
Even with all that going on, there is a lot that can be done to further boost hospital safety initiatives, said AMDIS members, and that depends largely on bigger and better investments in health IT systems for inpatient settings.
Nearly all of the physician informaticists surveyed, in a poll sponsored by e-prescribing and med management developer DrFirst, agreed that patient safety issues are less likely to occur today, as compared to five years ago.
In large part, that's due to better medication administration processes enabled by technology. Some 82 percent of the CMIOs polled say such initiatives have led to fewer adverse drug events, for instance.
That said, many still thought there was big room for improvement in medication management processes, and saw broader tech deployments to be a way to further safeguard their patents. Only half of the AMDIS members polled said they were satisfied their hospitals' processes, and 12 percent said they were dissatisfied.
The CMIOs pointed to gaps such as incomplete patient medication histories (80 percent) and misaligned medication reconciliation and care transition cycles that lead to misinformed decisions by care teams (75 percent), according to DrFirst.
The AMDIS survey also noted several other areas where bolstered technology infrastructure could improve medication safety surveillance.
For instance, 91 percent of CMIOs said one of their biggest challenges was a lack of visibility into their patients' medication adherence: Pharmacies know when a prescription has been filled, but hospitals are often left in the dark.
And 85 percent of the clinical informaticists polled pointed to the fact that patients aren't often active participants in the med rec process as a big culprit when when it comes to spotty medication history at their hospitals, suggesting a bigger role for more integrated patient engagement technologies.
Meanwhile, large majorities of CMIOs pointed to challenges with interdepartmental workflow variations, and challenges with process buy-in, compliance and ownership as issues that could adversely impact safety.
Nearly all of the AMDIS members surveyed said a holistic focus on the entire medication management process was key to building on safety improvements. At the same time, they said reducing order entry and data validation burdens for pharmacy and clinical staff will enhance patient safety and process efficiencies, according to DrFirst.
"While the industry has clearly made significant strides to improve medication management processes, CMIOs remain troubled by a number of gaps that compromise patient safety and quality outcomes," said the company's president, G. Cameron Deemer, in a statement.
Opioid risks top concern
The survey also found a lot of concern among informaticists specifically related to opioid related monitoring gaps. Nearly two-thirds (65 percent) of CMIOs called for more tightly integrated clinician workflows to enable better coordinating the entire medication management process – including electronic prescribing of controlled substances and access to state prescription drug monitoring programs.
While PDMPs have their limitations, being able to better discern patients opioid histories and EPCS data could help stem the spread of addiction and avoid harmful drug combinations.
And almost half (41 percent) of AMDIS members said they had concerns about hospitals' opioid readiness, given the difficulty to get discern so-called drug shoppers from patients with genuine pain management needs. As we noted earlier this week, several technology vendors are exploring, from different angles, the potential of blockchain to help solve that challenge.
Improving communication at the Department of Veterans Affairs as it transitions onto modern technology platforms would be a top priority for President Donald Trump’s nominee for the VA Chief Information Officer, James Gfrerer. He testified before the Senate VA committee on Wednesday.
Gfrerer also plans to put an end to the cybersecurity vulnerabilities that have put the VA on the Office of Inspector General’s high-risk list for the last three years. Gfrerer comes from the risk and security practice of Ernst and Young.
"I've read the OIG report on material weakness. It's a sustained pattern of unpreparedness,” Gfrerer told the committee. “As someone who has their personal health information in the VA system, and even if it was Lance Corporal Gfrerer, I would be pretty hot under the collar if there were continued material weaknesses and insecurity."
Not only that, but Gfrerer would advocated for maintaining the agency’s legacy VistA EHR -- which is “absolutely essential,” while it transitions to the new Cerner platform. Officials expect the implementation project will take 10 years, with the pilot sites going live in the Pacific Northwest by 2020.
The plan to roll out the same platform as the Department of Defense was a top concern for Sen. Jon Tester, D-Montana, who said “this is really going to make or break the VA going forward.” But Gfrerer directed Tester to the new Office of Electronic Health Record Modernization, already making progress.
OEHRM reports directly to the VA Deputy Secretary and has support from the Office of Technology. Both will ensure the network infrastructure and other technology resources are “up to par” to support the EHR implementation.
Gfrerer told the committee he’ll keep officials accountable to the projected milestones for the project, using a “scorecard” method to monitor the progress of the EHR project and other IT work.
“There’s a huge change management component so clinicians will have to go through a substantial, rigorous process to conform their workflows to the IT systems,” Gfrerer said.
Most recently, OEHRM Chief Health Informatics Officer Genevieve Morris stepped down from her leadership role, citing leadership taking the project in a different direction than originally plan. Surprisingly, the committee did not ask Gfrerer about Morris during the hearing.