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    3 Levers to Drive Organizational Change

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    “In order to improve the country's health service to a better level, the Ministry of Health is committed to ensuring that the electronic medical record system (EMR) can be realised within three years at 145 hospitals nationwide,” said Malaysian Health Minister Datuk Seri Dr Dzulkefly Ahmad.

    He spoke to the media after the Luncheon Talk at Menara Razak, Universiti Teknologi Malaysia (UTM) on 8 November 2018. Dr Dzulkefly added that 20 percent of the hospitals in Malaysia already have the EMR system in place, including Selayang Hospital and Ampang Hospital in Selangor but it is still not fully operational.

    “We want to follow the best examples, such as in Turkey that have end-to-end solutions, good hospital information, and efficient track and trace for medicines that they have zero counterfeit (medicines).”

    In a recent interview with HIMSS TV at the HIMSS Eurasia Conference in Istanbul, Dr Dzulkefly said, “It is important to me that I do not solve the problems (of healthcare) in piecemeal manner but approach them methodologically. Until you as someone who is providing the leadership knows exactly what it takes to realise further infrastructure that needs to be there and of course together with infrastructure realising what change you would need to undertake and how your human resources can adapt to it by way of change management…then finally you would understand how the whole system would work.”

    As the newly appointed Health Minister of Malaysia since May 2018, Dr Dzulkefly also said that it is important the leadership must have the grasp and understanding of hospital infrastructure as well as clinical outcomes – otherwise there will lots of government spending with no tangible improvements and problems will still be solved in a piecemeal manner.

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    Transforming healthcare in Saudi Arabia

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    The data-driven healthcare era is here, and healthcare organizations that successfully leverage the power of their data will have a competitive edge. Therefore, it is critical that investments in infrastructure and data management solutions both unlock the power of data in the near term and lay the IT foundation for a data-driven future.

    Is your infrastructure strategy setting you up for success, or holding you back?

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    Becoming Data-Driven: Is Your Infrastructure Strategy Holding You Back?

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    The U.S. Department of Health and Human Services, through ONC and CMS, has released its draft strategy on reducing regulatory and ease-of-use burdens in electronic health records.

    While EHRs have countless benefits, physicians have made clear their long-simmering frustration with the layers of documentation and regulatory requirements they have to meet – which adversely impacts the time they have to interact with patients. The 21s Century Cures Act, therefore, required HHS to examine the issue and develop a strategy to respond to it.

    WHY IT MATTERS
    Because so much documentation is now required in healthcare and because EHRs make it so easy to enter more data through templates, checkboxes and copy and pasting, many systems are experiencing note bloat.Many care providers say they're often spending more time entering data into the EHR than they are practicing medicine.

    Additionally, the profusion of unnecessary notes make it much more difficult to find relevant patient information.

    This draft strategy acknowledges that while the amount of information at physician fingertips is greater than it ever has been, work still needs to be done to improve EHR design and to reduce the time and reporting requirements for data entry. It lays out "three overarching goals designed to reduce clinician burden," as ONC and CMS noted in a Nov. 28 blog post:

    • Reduce the effort and time required to record health information in EHRs for clinicians;
    • Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations; and
    • Improve the functionality and intuitiveness (ease of use) of EHRs.

    "Electronic health records have several advantages over paper-based records, from improving continuity of care during a natural disaster to enabling more reliable prescribing," said Dr. Andrew Gettinger of ONC and Dr. Kate Goodrich, of CMS in the co-written post. "While EHRs can also improve care delivery, quality, and outcomes, many clinicians have told us, and their members of Congress, that EHRs can make it difficult to provide effective patient care."

    THE LARGER TREND
    Despite their required use and the promise that they will modernize healthcare, many EHRs are still struggling to be more functional and intuitive. Hospitals and health systems that implement them well can cut costs and improve care– as long as they do so with physician input.

    Because of the distractions they can present in the form of poor information design or pop-up alerts, electronic systems can actually become more burdensome than the traditional pen and paper method of record-keeping. If these encumbrances aren’t properly addressed, they can even lead to safety risks for patients.

    ON THE RECORD
    "Information technology has automated processes in every industry except health care, where the introduction of EHRs resulted in additional burden on clinicians," said Dr. Don Rucker, national coordinator for health information technology, in a statement, calling for public input on the draft plan. "Health IT tools need to be intuitive and functional so that clinicians can focus on their patients and not documentation."

    "With the significant growth in EHRs comes frustration caused, in many cases, by regulatory and administrative requirements stacked on top of one another," added HHS Secretary Alex Azar. "Addressing the challenge of health IT burden and making EHRs useful for patients and providers, as the solutions in this draft report aim to do, will help pave the way for value-based transformation."

    Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media.
    Twitter: @BenzoHarris.


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    Last week, Calvary Mater Newcastle Hospital in New South Wales (NSW), Australia became the 17th Intensive Care Unit (ICU) across the state to replace paper charting with Electronic Record for Intensive Care (eRIC), which digitally integrates patient data from bedside monitors, ventilators and other specialised equipment every minute. With this latest go live, more than a third of NSW’s 44 ICU hospitals are onboard the eRIC clinical information system.

    The electronic Record for Intensive Care (eRIC) is an electronic clinical information system within an Intensive Care Unit (ICU) that integrates patient data every minute from multiple systems, to improve patient safety and provide better clinical decision-making.

    “eRIC will cut manual documentation work, which is very time consuming,” said Kelly Duff, Clinical Nurse Educator and Change Manager at Calvary Mater. “With eRIC, we expect that documentation and compliance will improve, resulting in fewer mistakes relating to these.”

    Calvary Mater Newcastle is the major cancer care centre for the Hunter New England Local Health District, delivering more than 320,000 occasions of outpatient services and in excess of 16,000 inpatient treatments per year.

    In October 2016, Port Macquarie Base Hospital (PMBH) was selected as the first ICU in NSW to deploy eRIC. Subsequently, there were eight hospital deployments of eRIC in 2017 and this year, there were nine hospital deployments, including the latest deployment by Calvary Mater Newcastle Hospital. Including Calvary Mater’s ICU, 345 beds in 17 health facilities across nine Local Health Districts (LHDs) have been enabled with eRIC as part of the ongoing digital transformation of NSW Health.

    Deployments of eRIC will continue in 2019, starting with Gosford Hospital and Wyong Hospital in Central Coast LHD. eRIC will also be introduced next year in the ICUs of St Vincent’s Private Hospital within South Eastern Sydney LHD, Broken Hill Base Hospital in Far West LHD and Nepean Hospital in Nepean Blue Mountains LHD.


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    The U.S. Department of Health and Human Services has announced the winners of a new challenge to develop software for identifying and reporting safety and usability issues in EHRs in a way that doesn’t disrupt clinical workflow.

    The winning tools aim to make it easy to report IT issues within the healthcare workflow: giving feedback to developers and guiding the formation of best practices. The hope is to targeting usability challenges before they become major problems.

    Three winners were announced:

    • The James Madison Advisory Group came in first, with a hotkey that allows a clinician to document an issue without leaving their EHR and which simplifies the process of reporting issues.
    • Pegwin, in second place, developed an intuitive reporting system that allows a user to document an issue “in as few as three clicks.”
    • Jared Schwartz and team came in third with a Google Chrome plugin which integrates with common IT ticketing platforms, making it easy to work into existing systems. The winners received $45,000, $25,000, and $10,000 respectively.

    WHY IT MATTERS
    Like any software, EHRs sometimes have flaws or malfunctions. An already busy clinician who is trying to manage a full patient load, perform diagnostic work and enter data usually doesn’t have time to document and report safety or usability issues to his or her IT department.

    Finding a way to work tools into the care workflow that allow practitioners to capture and share potential safety and usage concerns results in greater efficiency without disrupting a clinical workflow.

    "Improving the safety of health IT remains an important priority," said Dr. Andy Gettinger, ONC chief clinical officer. "We believe that making it easier for end users to report will help in that goal."

    THE LARGER TREND
    EHRs have the potential to be the first point of data capture in a new landscape of precision care. First, though, they need to win over physicians who see them as cumbersome and byzantine replacements to the old pen and paper methods.

    Some healthcare systems are focusing on identifying those problems and addressing them to enhance the value of their EHR systems. Practitioners are experiencing EHR burnout – something ONC has also recently been working to help combat– where poor usability or other IT safety concerns can have a detrimental impact on effective patient care.

    ON THE RECORD
    "Helping reduce the burden of health IT continues to be a key area of focus at the Office of the National Coordinator for Health Information Technology, and we anticipate the winning submissions to the Easy EHR Issue Reporting Challenge will help with those efforts," said ONC chief Dr. Don Rucker.

    Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media.
    Twitter: @BenzoHarris.


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    EPR development: One unique journey
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    A recent article from China Daily stated that IT investment in the country’s hospital system will reach 65.7 billion yuan ($9.47 billion) in 2022, surging 53.5 percent from 2017 and boosting the digitalisation of the Chinese medical system, based on a forecast report by Analysys. The Beijing-based research consultancy’s report also noted that the Hospital Information System has almost achieved full coverage in China’s tertiary hospitals, which is the largest in the country’s three-tier system.

    Coverage in primary and secondary hospitals, the lowest two tiers, is currently at 80 percent.

    Statistics from the Chinese Hospital Association indicated that in 2017, hardware investment accounted for 44 percent of total hospital digitalisation investment, while spending on software and services represented 56 percent. Chen Qiaoshan, a medical analyst at Analysys said that software and services as the core of hospital digitalisation will a have higher growth potential than compared to hardware.

    From 2017 to 2018, 17.43 percent of the country’s hospitals greatly expanded their investment in hospital digitisation, and 29.78 percent slightly increased their investment, showing that in the future, the overall investment into hospital digitisation will continue to rise, according to the same report by Analysys.

    Based on the latest statistics from HIMSS Analytics, China has 36 EMRAM Stage 6 validated hospitals and 10 EMRAM Stage 7 validated hospitals. EMRAM is the acronym for Electronic Medical Record Adoption Model by HIMSS Analytics, which incorporates methodology and algorithms to automatically score hospitals around the world relative to their Electronic Medical Records (EMR) capabilities. This eight-stage (0-7) model measures the adoption and utilisation of electronic medical record (EMR) functions and Stage 7 represents a remarkable achievement in which paper charts are no longer used.

    Huangshi General Hospital in Hubei province and Children’s Hospital of Shanghai are two such hospitals to achieve EMRAM Stage 7 validation in the first quarter of 2018.

    In the same China Daily article, Qu Jing, another medical analyst at Analysys, said, “Although most hospitals attach great importance to information gathering, they do not have a clear development strategy. Statistics from the Chinese Hospital Association showed that while 97.25 percent of China’s hospitals have a specialised information and technology department, 56.29 percent of them lack thorough digitalization development planning.”

    Qu also added that hospitals lack regional connectivity, which is important for the development of hospital information platforms, with only 49 percent having a regional information platform.


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    In surveys Massachusetts General Physicians Organization conducted of its physicians, the healthcare organization found that 46 percent exhibited some degree of burnout. When asked what contributed to that burnout, they blamed the administrative burden added to the work of patient care.

    THE PROBLEM

    Chief among those administrative burdens was documenting in the electronic health record. Many physicians were spending two hours or more after each clinical session documenting in the EHR.

    As a result, they were missing family events and staying up late at night typing clinical notes. And in the office, they were too burdened to add new patients to their panels or focus on improving care and outcomes of their existing patients.

    In short, they were losing the joy of practicing medicine, and Massachusetts General Physicians Organization needed a way to relieve the burden of documenting ambulatory clinical encounters, said Dr. David Y. Ting, chief medical information officer and a practicing physician at the organization.

    PROPOSAL

    The organization already had a relationship with vendor IKS Health, which had demonstrated success in allowing physicians to delegate and centralize clinical tasks – in that case, transferring medications from the legacy EHR to the current Epic system.

    Building on the vendor's clinical delegation abilities, Massachusetts General Physicians Organization engaged IKS Health to implement its virtual scribe technology, dubbed Scribble. Scribble provides a hybrid technical-human system where a physician uses a secure device to obtain an encrypted audio recording of the patient encounter, with the patient's consent.

    The recording is accessed by an IKS Health physician partner, who then synthesizes a complete, concise clinical note in the EHR, ready for the Mass Gen physician to review, edit if necessary, and sign. In addition, IKS Health coders review the documentation and provide billing and coding guidance.

    "The workflow releases our physicians to focus on – and even enjoy – the patient-doctor interaction, rather than fret over how they would document complicated histories and detailed exams," Ting said. "And in contrast to live-scribe solutions that require placing an additional person in the exam room, the Scribble solution suffers neither from the need to expand the size of exam rooms nor the hassle of managing and scheduling hundreds of additional staff with the accompanied high rates of turnover."

    MARKETPLACE

    There are many scribe technology vendors on the market. These vendors include iScribeMD, Physicians Angels, Scribe America, Scribe Healthcare Technologies, Scribe Technology Solutions and Skywriter MD.

    MEETING THE CHALLENGE

    Currently, around 200 physicians at Massachusetts General Physicians Organization use Scribble, representing about 90 percent of the primary care team and about 10 percent of the total clinical team.

    "We rolled Scribble out to our primary care and medicine-pediatrics teams first, with the notion of gaining experience with a general specialty that could then be applied across other specialties, where our current focus lies," Ting explained. "We also chose primary care because they were among the most burned-out of our physicians."

    "Patients note that our doctors are more attentive to them, and less distracted by the computer in the exam room."

    Dr. David Y. Ting, Massachusetts General Physicians Organization

    The organization began by attaching omnidirectional microphones to exam room workstations and worked with information systems to vet and add the Scribble recorder to the hospital's suite of clinical applications.

    Eventually, it worked with IKS Health to develop and transition to an Android app that is deployed on inexpensive single-purpose tablets, encrypted and managed by the organization's enterprise mobility management service. The switch to a mobility solution has meant that Scribble is now available anywhere doctors go.

    "For implementation, we standardized the patient consent and clinical workflows, and created training videos and in-person training sessions to ensure our physicians and staff were fully versed in how to integrate this new approach into office workflow and culture," Ting said.

    "We also worked with our business transformation team to create a standard implementation timeline that gives our physicians several weeks to gradually transition from traditional documentation and coding to a fully scribed model," he added.

    Integration with the Epic EHR was a light lift, Ting explained, as the organization's hospital already had security templates for inpatient and ambulatory scribes, and IKS Health's physician partners enter their data directly into approved coded and free-text fields in the EHR. Scribble is EHR agnostic: the physicians organization has partner organizations on different platforms that also use Scribble.

    Click on page 2 below to read how physicians are saving time, seeing more patients, and more.

    RESULTS

    "We began with the desire to reduce physician burden and return them to the joy of practice of medicine, as well as the experience of better work-life balance," Ting said. "The Scribble program has helped us achieve those goals. One third of our physicians indicate saving one hour of time per clinical session; another third saved between 1 to 2 hours; and nearly another third saved more than two hours per session."

    And what are the physicians doing with that extra time? Twenty-five percent state they are seeing more patients and have opened their panels to more new patients. More than half state they are spending more time creating work-life balance. And most note they spend more time thinking about and attending to the needs of their patients.

    "Patients have been pleased with the improved patient-doctor relationship," Ting said. "They note that our doctors are more attentive to them, and less distracted by the computer in the exam room. One patient noted, 'I really like Dr. X, but now for the first time I can see his eyes instead of the top of his head.'"

    One doctor's experience is fairly typical of the results the provider organization has seen from Scribble, Ting explained.

    "Before virtual scribes, she used to spend about 3-4 hours a day writing her clinic notes," he said. "Now, she reports that her notetaking time has decreased to 30 minutes or less. With the saved time, she has been able to launch a group visit program to encourage healthy lifestyles and educate patients."

    Her program has already seen results, with one of her patients losing 40 pounds in six months. This doctor never would have been able to implement the new program before the scribe technology, Ting said.

    ADVICE FOR OTHERS

    "We see Scribble as a component of a larger suite of solutions, which we call the Kitty Hawk portfolio, that look at the problem of physician burnout and administrative burden as a holistic one that requires a multi-pronged approach," Ting explained. "In other words, Scribble is not a panacea, but it is a large and critical part of addressing the whole problem."

    Be prepared to discover that relieving the documentation burden will reveal opportunities for one's physicians and practices to address other longstanding issues, such as coding improvement and automation, scheduling optimization, medication management, data abstraction, decision support, and so on, Ting added.

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


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    More of the healthcare world is going digital and the race for maximum patient engagement continues. As the systems involved increase in complexity and importance, healthcare execs are saying that quality tech support will be one of the most important factors in staying competitive in 2019.

    A new Black Book research paper shows that eighty percent of clinicians report being "impeded" by inadequate tech support, and that most help desks are falling short of the needs of healthcare systems.

    The IT support landscape is expected to undergo massive changes as healthcare organizations react to the opportunities – and challenges – that increased support offerings present. Among the findings from the new report:

    • Technologies such as AI are expected to help pick up the slack for support organizations using deep learning to create robust virtual agents that can help support teams scale up or down services without changing their workforce numbers.
    • The Internet of Things requuires better monitoring and management – needs that are not being fully met currently.
    • The emergence of ever more ways to connect (cloud, mobile, or social) means more security risks. With greater access comes a corresponding need for support to help safeguard data and systems.

    WHY IT MATTERS
    Patient satisfaction is increasingly tied to ease of use of online systems like portals and personal health records. Black Book's survey finds that quality tech support has a major impact on client loyalty. Healthcare organizations are finding the need to transition their tech support from purely internal to an external, customer-facing role as well.

    As the complexity of the systems and providers involved increase, having proper support for both internal and external users will be a major step that allows healthcare organizations to sidestep roadblocks on the path towards having a greater digital presence.

    "The increasing complexity of healthcare technology has made it even harder for an in-house help desk team, especially in small and medium sized communities to have sufficient expertise to meet all of an organizations' tech support needs," said Doug Brown, managing partner of Black Book Research.

    THE LARGER TREND
    Eighty-three percent of hospital decision makers polled by Black Book say they prefer that their electronic health record vendor deliver direct, comprehensive tech support, rather than delegating the responsibility to third parties or the health system itself.

    As similar majority of providers employing third-party IT support are "significantly dissatisfied" with the experience, the report shows, and often have to use one vendor for their help desk services, another for their upgrade services and more.

    "Vendors scoring highest among the four comprehensive levels of technical support are Cerner, Allscripts and MEDITECH," Black Book notes. "The majority eighty-four percent of tech support for Epic clients were attributed to third party outsourcers, consultants, and independent tech support firms working in Epic Systems client facilities."

    Those companies and their contractors must recognize that operational and patient experience needs are two of the most critical priorities for forward progress in the healthcare provider space, the report shows. Privacy and security concerns remain ever-present. Even the roles of top IT execs in healthcare are changing rapidly.

    Digital transformation is taking the industry by storm and meeting consumer expectations is an area most healthcare systems still struggle with. All of these factors point to the necessity of a robust and responsive tech support team that can help practitioners navigate internal tech issues as well as patients and outside clients resolve their usability concerns.

    ON THE RECORD
    "As technology becomes more profoundly entrenched into every turn of the healthcare consumer journey, vendors are also beginning to realize that the traditional internally-focused support organization may be best suited to help their provider clients successfully shift their focus to consumers," said Brown. "Given the enormous level of competition found in virtually all areas of the healthcare delivery industry, this edge can drive the success or failure of your system."

    Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media.
    Twitter: @BenzoHarris.


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    What's holding back widespread interoperability? The latest KLAS report says it's governance and organizations dragging their feet on participating in new national interoperability frameworks, such as the CommonWell-Carequality link.

    "Even Epic and athenahealth customers report diminished value from their connection when local exchange partners opt not to connect to the national networks," according to a new KLAS report on interoperability. "Until other vendors take an opt-out approach, you as an organization will have to be proactive in promoting local connections to these networks to ensure high value from your connection."

    WHY IT MATTERS
    Since the last KLAS report on interoperability was published in March 2018, hospitals and physician groups have been taking critical steps forward in sharing data via national networks, KLAS finds. What have been the most notable steps? KLAS cites:

    • The CommonWell-Carequality link;
    • MEDITECH's initial connection to CommonWell; and
    • Carequality's adoption among NextGen Healthcare customers.

    KLAS says that as of now, all of the most prevalent EHR vendors except Allscripts and MEDHOST are connected to the national framework provided by CommonWell-Carequality – "putting the ability to exchange patient records within the reach of most acute care or clinic-based provider organizations, regardless of size or financial situation."

    THE LARGER TREND
    Vendors are at very different stages of supporting provider organizations in the national framework effort, KLAS says. All the major vendors have made commitments to support the CommonWell-Carequality link, because healthcare providers are demanding it, and it is such a low-cost option for them.

    Many vendors have eliminated obstacles on the path to participation, with all of them but Virence offering connections to the link for their customers at no cost. In addition, all but Cerner have made participation in the network plug-and-play.

    KLAS notes that Epic's and athenahealth's approach to facilitating participation, via an opt-out option, while removing governance barriers, "shows that regardless of customer size, vendors can facilitate widespread adoption if they choose."

    The latest findings by KLAS show a huge leap over a year ago, when Carequality, reported participation at about 50 percent, with more than 1,000 hospitals, 25,000 clinics, and 580,000 healthcare providers connected.  According to Dave Cassel, vice president of Carequality, the organization was born out of industry demand, shaped by industry and government collaboration and it will ultimately succeed through industry support and participation.

    This summer, we reported that EHR interoperability was closing in on a signature moment with the advance of the CommonWell-Carequality link, comparing it to the cusp of a breakthrough akin to AT&T customers being able to pick up their phones and call Verizon subscribers. The CommonWell-Carequality link is changing the current thinking about the future of FHIR and open APIs, and laying the foundation for really using data in a meaningful way.

    ON THE RECORD
    "With CommonWell and Carequality linked, the biggest technical obstacle to widespread patient-record sharing has been removed," says the KLAS researchers in the December 2018 Interoperability Report.

    Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology. 
    Twitter: @Diana_Manos
    Email the writer: dnewsprovider@gmail.com


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    Three winners and one honorable mention have been announced in the Office of the National Coordinator for Health IT'’s Certified Health IT Product List Data Challenge. The competitors were tasked to find ways for users of the Certified Health IT Product List to make better use of the granular data it keeps on every technology product that has been approved by ONC.

    The winners include:

    • ResearchAE. First place winners ResearchAE took their background in developing health IT dataset search engines to map out many of the different realms of data CHPL contains, enabling users to analyze how ONC certified health IT is being used and by whom. The prize was $20,000
    • Shiro Labs. Shiro Labs claimed runner-up for an application enabling providers to cross-analyze their Medicare Quality Payment Program and CHPL data, helping them see how they are meeting their reporting requirements. The prize was $10,000.
    • Darena Solutions. Darena Solutions also won runner-up for CheckEHR, a program that lets users view which certified criteria different certified health IT modules meet, allowing them to better reach goals like patient engagement or care coordination. The prize was $10,000.
    • Tom Nguyen. Nguyen won an honorable mention for a Google Chrome extension that helps users more easily navigate the CHPL listings.

    WHY IT MATTERS
    The CHPL contains a massive amount of very granular data which has only recently been made available in a structured and actionable way. Providers already have to abide by a wide range of standards and regulations, so having easier access to the CHPL data and finding ways to make more efficient use of it will help enable organizations to better use their health IT.

    THE LARGER TREND
    As the healthcare technology marketplace evolves, new to health IT start to take bigger roles in the space, providers will continue to roll out new IT services to meet those demands and remain competitive. Being able to make intelligent searches of CHPL data means providers can chart a more informed course though the array of technology options available.

    ON THE RECORD
    "This challenge shows that there is more to the CHPL data than meets the eye. It is great to the see the creativity and ingenuity each participant put into their submissions," said Steve Posnack, executive director, office of technology, ONC.

    Benjamin Harris is a Maine-based freelance writer and and former new media producer for HIMSS Media.
    Twitter: @BenzoHarris.


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    Memorial Hermann Health System reduced its fall rate to one of the lowest in the nation in 2016 -- using clinical decision support (CDS) and for that was honored with a HIMSS Davies Award of Excellence

    The Davies recognizes outstanding achievement of organizations that have utilized health information technology to substantially improve patient outcomes and value.

    To achieve such success, a team at Memorial Hermann used the AGS Beers Criteria, a resource that helps physicians find potential medication-related dangers that often lead to geriatric patient falls. Memorial Hermann started using CDS oversight with the support of a Beers Criteria workgroup led by physicians, pharmacists, medical informatics professionals and an acute care medical informatics committee, according to HIMSS.

    Memorial Hermann used CDS in the form of order sentences and alerts to limit the ordering of medications for the elderly patient population. The EHR’s ability to add filters for age and conditions, in addition to dose range checking alerts, improved the automation and reliability of the CDS alerts.

    WHY IT MATTERS

    “Every second of every day in the U.S., an older adult falls, making falls the number one cause of injuries and deaths from injury among older Americans,” according to the Centers for Disease Control and Prevention (CDC). In 2014, CDC reported some 29 million falls by older Americans, resulting in seven million injuries at an estimated $31 billion in Medicare costs.

    Falls are a growing public health issue, particularly with the surging Baby Boomer population, says the National Council on Aging (NCOA).

    “Older adult falls are increasing and, sadly, often herald the end of independence,” said former CDC Director Tom Frieden. “Healthcare providers can make fall prevention a routine part of care in their practice, and older adults can take steps to protect themselves.”

    THE LARGER TREND

    More and more providers are using advanced predictive analytics to reduce falls. The 420-bed El Camino Hospital in California dramatically lowered its hospital fall rates, as we reported last April. “It seemed like a lot of the efforts we tried were not getting us to where we wanted to be,” said chief nursing officer Cheryl Reinking, who helped spearhead the effort to transform the organization’s fall prevention program. The effort involved going beyond traditional “predictive analytics” into what Reinking called action-focused insights that allow providers to immediately respond and impact patient safety.

    We also reported about a blueprint for fall prevention that can also be applied to heart attacks and other patient conditions, using telehealth and predictive analytics applied to population health data.

    Physician and clinical informatics fellow Andrew Muth, MD, has developed a fall prevention program that uses predictive analytics to identify veterans who are at risk of falling. Some factors that can lead to a higher risk of falling include taking strong medication for pain, narcotics like benzodiazepine or antipsychotics, which can cause you to be a little shakier and more likely to fall.

    ON THE RECORD

    HIMSS senior director of quality and value-based care Jonathan French: “Memorial Hermann Health System significantly decreased the overall rate of unnecessary, high-risk medication orders, and are now leading the nation with the least amount of patient falls.”

    Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology. 
    Twitter: @Diana_Manos
    Email the writer: dnewsprovider@gmail.com 

    Healthcare IT News is a HIMSS Media publication. 


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    "At its core, technology would seem to be the antithesis of humanity," said Dr. Chris Derienzo, chief quality officer at Asheville, North Carolina-based Mission Health System. "It doesn't feel, it doesn't think and it can't see the humanity of the person in front of it," he explained."

    Ask physicians how the feel about electronic health records, or read Atul Gawande's recent New Yorker feature, "Why Doctors Hate Their Computers," and it's apparent that most healthcare professionals' relationship with technology is ambivalent at best.

    "It's tempting to say there's no way we can build or leverage technology in order to restore some humanity to the practice of medicine," said Derienzo. "But I think that's fundamentally a wrong assumption."

    At HIMSS19 in Orlando, in one of the new TED Talk-style SPARK Sessions, titled "Humanity and Technology in Medicine: Antithetic or Symbiotic?" Derienzo will explain why.

    The reason technology seems to pull us away from people, rather than bring us together, mostly boils down to "how we've designed it and what we've designed," Derienzo said. But rethinking both of those, IT could be repositioned in a way where it enhances, rather than detracts, from the clinician and patient experience.

    With funny personal anecdotes and real-life case studies, he'll show how technology, properly deployed, can restore joy to healthcare – helping burnt-out physicians better engage person to person, enabling them to practice at the top of their license and use their skills to solve complex challenges

    "If we focus on the right types of technology, and we build it right, then we can actually use it to empower people to do more of the things that only people can do in healthcare," said Derienzo.

    How technology is designed, and what it's used for, plays a big role in how well it is liked by its end-users. Consider tech that's intentionally created connect people, such as telemedicine. "We see much more positive reaction to it."

    EHRs, on the other hand, were not designed with joy in mind. They were developed under certain conditions, with necessary check-the-box functionalities related to regulatory compliance and billing capture.

    And they were "based on a world where we took what we did on paper then did the same thing on computers," said Derienzo. They effectively ignored a lot of the human factor elements for how to design a way to document and record care electronically."

    But EHRs are only one challenge, he said. "Our monitors are another. How we use algorithms is another very important one."

    Derienzo predicts that "our electronic documentation will evolve drastically over the next few years as we move away from this built environment and toward a world where human factors matter a whole lot more."

    In the meantime, he sees one technology doing a lot to return humanity to healthcare. One that may seem ironic, to say the least, given the trepidations many have about its potential to disrupt and displace: artificial intelligence.

    "AI stands positioned to be one of the core technological advances that allows us to return humanity to healthcare," he said.

    For example, he explained, "we've built a machine learning model at Mission Health and we've now gotten it fully up and running. Its purpose is to help risk-stratify patient who are case managers need to focus on. To serve them, not only by a ranked-ordered list but a concept as to why our model thinks they may be at a high risk of being readmitted."

    That's a fairly AI application, "but its purpose is to pull out things that people don't have to be doing so now my care manager team can spend less time wondering who to focus on and more time actually focusing on people," said Derienzo.

    Ditto with radiology, he said: "I don't think that reading a thousand normal chest X-rays brings radiologist a ton of joy. But doing the really complex work – is it this, is it that? – is what they enjoy. How do we bring the expertise and brains of these terrific musculoskeletal and neuroradiologists tp the things we actually need them to be doing? That is how something like AI can actually empower humans.

    The practice of medicine is an ancient art, and one that's long depended on the power of human interaction, he explained.

    "At one point that was all we had – other than leeches and bloodletting, all we had was the ability to interact with our patients one on one and be human with them," said Derienzo.

    "We've vastly improved our ability to care since then, but in some ways we've lost an appreciate for that aspect of a clinician patient relationship," he explained. "My fervent hope is that once we get this right, we'll actually be returning, somewhat, to a place where it's that person to person relationship that's the most valuable part of our day."

    Chris Derienzo's HIMSS19 SPARK session, "Humanity and Technology in Medicine: Antithetic or Symbiotic?" is scheduled for Tuesday, February 12, from 3-3:30 p.m. in room W300.


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