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    Turkey’s efforts to digitize healthcare

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    A big appointment scheduling contract between the U.S. Department of Veterans Affairs and Epic that's been up in the air in recent years may soon be resolved – and may go instead to rival Cerner, which is overseeing the VA's larger electronic health record modernization project.

    WHY IT MATTERS
    The Medical Appointment Scheduling System, based on Epic's Cadence software, has already gone live, reportedly under budget, at a VA facility in Ohio.

    But Cerner's contract wins at the VA have changed the calculus for how the project might expand and move forward – and which company will maintain the scheduling platform.

    THE LARGER TREND
    The five-year $624 million MASS contract was first awarded to Epic and Lockheed Martin in 2015– two years before Cerner had scored the massive $10 billion no-bid deal for a new EHR at the VA.

    In 2016, the contract was put on hold while the VA experimented to see if the project could be accomplished with some of its own homegrown VistA software, but by 2017 the agency announced it would move forward with Epic for the scheduling technology.

    But even then there were doubts about the future trajectory of the deal, given the size and scope of Cerner's other commitments at the VA, and in 2018 the department hinted that it might scrap the deal.

    ON THE RECORD
    In a letter to VA officials earlier this month, Rep. Jim Banks, R-Indiana, chairman of the House VA Subcommittee on Technology Modernization, called on the department to make a decision on the MASS project soon – and outlined the questions he wants answered to ensure the choice is an informed one.

    "Without a doubt, scheduling is one of the most archaic VistA modules," he wrote. "These scheduling inefficiencies and a serious lack of internal controls created the environment resulting in the veteran wait list crisis."

    Banks noted the apparent success of the MASS pilot in Columbus, Ohio, but also acknowledged "that VA’s preference is to implement the Cerner Millennium scheduling package, because it has either already been purchased or a commitment has been made to purchase it."

    He also said it was "extremely frustrating" that earlier VA leaders had awarded MASS contract to Epic but "stopped and started it repeatedly." Had the Cadence implementation been allowed to roll out unimpeded, "it could have been nearly complete by now," said Banks.

    Still, he said, he was "encouraged that VA will soon decide on a final course of action." But as VA weighs whether to go with Cerner instead, Banks offered a list of questions he wanted answered beforehand:

    • Whichever vendor was chosen, how would their system "increase efficiency, reduce wait times, and make better use of health care resources?"
    • "How much does the Cerner Millennium scheduling package cost? If it is not severable from a larger software package, how was that determined, and how much does that software package cost?"
    • How would decoupling the MASS system from the rest of the VA EHR deal affect the total cost estimate and and timeline?
    • "How much would it cost to deploy the Cadence scheduling system according to the accelerated timeline contemplated for the Cerner Millennium scheduling package, instead of the original timeline and notional scope of work in the MASS contract?"
    • "Would there be meaningful schedule differences in an accelerated Cerner scheduling implementation compared to an accelerated Epic scheduling implementation?"
    • And has VA "considered publishing scheduling resources in conjunction" with the FHIR API initiative it launched earlier this year?

    "Regardless of the decision, I encourage you to retain Epic Cadence in Columbus, Ohio over the medium term," Banks added. "Time and money have already been invested to implement it, and by all accounts it is functioning well."

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

    Healthcare IT News is a publication of HIMSS Media. 


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    2018 was quite a year in healthcare and technology. Tech titans Amazon, IBM, Google, Microsoft, Oracle and Salesforce all banded together to take on the interoperability challenge, Apple made serious inroads with hospitals, while stalwart EHR vendors offered a glimpse of what customers can expect in forthcoming incarnations of their software.

    We saw loads of innovation and emerging technology. Artificial intelligence and machine learning gained a greater presence, and we conducted research to find out how hospitals are proceeding with AI now. And we saw blockchain use cases starting to take shape.

    Then there were the downsides – notably that data breaches kept occurring with regularity and, despite some milestone interoperability advancements, it became even clearer just how thorny of a problem data sharing really is.

    If the state of health IT in 2018 could be summarized in one phrase, it might be this: "Accelerating beyond the EMR," as Blain Newton, executive vice president of HIMSS Analytics, a Healthcare IT News sister company, explained.

    Now, as the New Year approaches, here’s a look back at 2018’s most important stories as chosen based on both reader interest and our editors' picks.

    1. The 12 healthcare issues that will define 2018

    Yes, this one was technically posted in mid-December, but we counted it because it was about 2018. From AI to patient experience, with a helping of social determinants, government policy, IoT and more, PwC’s list is a perennial reader favorite. 

    2. The biggest health data breaches of 2018

    That’s right, this article collection contains nearly 50 infosec incidents: hackers, of course, as well as ransomware, illegal snooping around medical data, phishing, data leaks, misconfigured databases and more. All of the above kept happening over and over again in 2018 and probably will in 2019 too. Should it happen to you, here’s the right way to handle a data breach.

    3. Apple lined up 39 hospitals to use its Health Records

    That was back in March, folks, and the number is by now hiking up toward 150, according to Apple’s list of hospitals that support health records on the iPhone. 

    4. White House Senior Advisor Jared Kushner made a surprise speech at HIMSS18

    Kushner took the stage just before CMS Administrator Seema Verma to reveal the federal government’s new plan to address interoperability with artificial intelligence and machine learning. “The president is determined to make interoperability a reality for all Americans,” Kushner said, adding that the initiative will involve overhauling meaningful use and expanding Blue Button and the MyHealthEData program. 

    5. Epic Systems founder and CEO Judy Faulkner shared some advice for Women in Health IT

    “Be a builder,” Faulkner began, urging others to ignore the glass ceiling as she did and, instead, use the fact that they are women to their advantage. “Are you a missionary?” she asked. “Or are you a mercenary?” 

    6. Another surprise: the biggest tech companies actually came together to tackle interoperability

    At a White House hackathon for Blue Button 2.0, top executives of each company’s healthcare divisions pledged to use FHIR, open APIs and cloud technologies to improve information sharing.

    The lack of further detail about how they will accomplish the goal left some Healthcare IT News readers skeptical about the prospects, so it will be interesting to see what 2019 brings on that front. 

    7. Amazon got into the precision medicine game with Accenture and Merck

    The trio aligned to develop a cloud-based analytics platform to enable collaboration across life sciences that will lead to faster drug development work and more apps and tools to help patients. 

    8. EHR vendors gave us a glimpse at what comes next

    Here’s a taste: automation, analytics, artificial intelligence, telemedicine, genomics and more. eClinicalWorks even said it’s next version will be akin to a Bloomberg terminal, only for doctors and clinicians.

    The coverage was part of of our next-gen series looking at what to expect from more than 20 technologies shaping the future of health IT

    9. 3 charts show why interoperability is still such a mess 

    The average health system has 16 different EMRs across its facilities, 75 percent have 10 or more and only 2 percent have gotten down to two platforms. 



    10. Mayo Clinic CIO Christopher Ross on breaking the $1 billion barrier with EHR and IT modernization work

    Ross explained how Mayo managed a project so big in scope, discussed the challenges and obstacle to avoid, and outlined reasons why his health system focused on experience and optimization from the get-go. “The project is highly complex due to the number of specialties and subspecialties involved,” Ross said. “We are not only focused on building and delivering a converged technical solution, we are also invested in the people side of change to support them in adopting, utilizing, and becoming proficient in the Epic system. This is being accomplished through a comprehensive change management strategy.”

    Bring on 2019! 

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

    Healthcare IT News is a HIMSS Media publication. 


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    It starts with a great idea that inspires an innovative health application.

    An exceptional team gathers to deliver that application energized by the passionate belief that they can make a difference and achieve success for patients and providers everywhere. Until they realize their application and their success are being held back by inadequate legacy integration solutions, especially for electronic health records.

    Fortunately, there’s a proven way forward that can liberate applications and companies to create innovative approaches for patients through application programming interfaces (APIs). APIs have transformed the rest of the digital economy and are doing the same for health IT.

    Properly designed API-based EMR integration provides significant advantages:

    1. One Deployment – Multiple Connections. APIs can be plug-and-play across different EMRs resulting in a single, consistent solution across multiple connections. Application design, deployment and maintenance are greatly simplified and accelerated by this approach.
    2. Agility. Because APIs serve up a rich data set from the beginning and can add new capabilities quickly, they are perfect for agile development. Application design and enhancement proceed rapidly. The impact on customer satisfaction, product management and the sales cycle is profound.
    3. Better Applications – Enhanced User Experience. API’s provide robust, real-time, bi-directional data exchange. Applications can read and write more data without delays. This results in applications that seamlessly integrate into clinical workflow, are more interactive and perform better.
    4. Built for the Enterprise. APIs are solid, dependable and scalable. They can deploy in a variety of environments and can scale to meet the needs of today’s demanding enterprise solutions.
    5. More secure. Encrypted data flowing over secure networks passes through, but is not saved by, an API. This eliminates duplicate data stores - a tempting target for hackers.

    Legacy approaches create a backlog of projects and frustration due to the slow pace of moving through the “integration project queue.”  Sales teams and health system integration staff dread the topic. They know integration is essential and that legacy solutions are costly and time consuming.

    APIs eliminate the consequences of the dreaded integration project queue. Initial deployment and on-going maintenance can be automated resulting in a rapid process with minimal impact on busy integration teams.

    API-based EMR integration is a game changer. Developers benefit from robust, bi-directional, EMR-agnostic integration that rapidly deploys and can quickly evolve. Sales teams close more deals faster because their applications are superior and integration conversations go from being painful to being a key selling point and advantage. 

    Health systems and other customers benefit by getting from vision to execution faster and at substantially lower cost. Everyone benefits from applications that work better because of seamless data exchange and integration into clinical workflows.

    APIs truly liberate applications and digital health companies while helping health systems unleash greater value from their EMR. Viva la revolución!

    Joining the revolution of API-driven integration is easier than innovators may think. Learn more at SansoroHealth.com.


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    What docs want from EHR vendors in 2019
    A little listening and responsiveness could go a long way to help cure alert fatigue and physician burnout in the year ahead.

    Software solutions that purport to be innovative are flooding the healthcare world, but often become more of a problem than the ones they set out to solve.

    A recent CNBC report detailed how entrepreneurs, engineers and developers need to pair with physicians to gain better insight into the type of problems they aim to solve.

    For example, it points to Epic sending engineers to open heart surgeries as an illustration of the standard medical software developers should aspire toward.

    Many vendors don’t have that degree of connection to the practitioner, however – and the result is alert fatigue, hours spent on data entry, and a general malaise towards software solutions that are supposed to help, but really just mean more work and another clunky interface.

    WHAT'S AHEAD
    Recognizing this, the American Medical Association has recently paired with technology developers and clinicians to develop the Digital Health Implementation Book, which helps physicians better adopt health technology in their practices – and suggests what vendors can do to make their products more useful and user-friendly.

    Since practices vary and one piece of software can be used in different ways depending on the provider, developers need to be responsive to requests for information and support.

    Additionally, AMA recommends that developers need to listen to physician feedback and focus on hearing how doctors actually use their software so that they can continuously improve their solutions.

    THE TREND SO FAR
    Physicians trying to cope with technology frustrations are hardly a new phenomenon for 2018. Burnout is a major problem that many developers and healthcare systems are exerting a tremendous amount of effort to fix.

    Similarly, others in the healthcare space are seeing how responsivity and feedback-gathering can lead to better care for patients.

    It follows, then, that this technique works backwards for developers. Spending more time with actual physicians and watching them at work will help vendors make products that will fit into a physician workflow – not just be added on top of it.

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


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    It's an all too common occurrence for clinical decision support alerts to misfire or otherwise malfunction. And that's a common frustration for clinicians. New research in the Journal of the American Medical Informatics Association shows how data scientists at Partners HealthCare are making use of provider feedback to spotlight and fix CDS errors.

    WHY IT MATTERS
    Rule-based alerts in the electronic health record could help notify physicians of risks such as adverse drug interactions or nudge them to add relevant information to the EHR.

    But such alerts can also malfunction, break, or might be triggered for the wrong reasons or patient populations. That could cause alert fatigue or pose safety risks.

    The variety and types of these misfires can vary widely - as can clinicians' responses to inaccurate CDS alerts.

    "In prior work, we developed a taxonomy of CDS alert malfunctions based on 68 cases of alert malfunctions collected from healthcare institutions in the United States," wrote Partners HealthCare researchers in JAMIA.

    They also researched the ways in which those errors were found.

    "Although the most common discovery method in the sample was user reports via traditional channels such as the help desk, safety reports, and contacting CDS maintenance personnel, five malfunctions were discovered by reading free-text override reasons written by providers when overriding alerts," they said.

    "These malfunctions were discovered at our own institution, by chance, when a student researcher was reviewing alert overrides and noticed that some comments seemed to express strong frustration and disagreement with the alerts," researchers explained.

    The researchers pointed to several instances where clinicians made note of the inaccuracies - often using colorful and indignant language:

    • "BPA misfiring: no potassium on file, but there was a K done!"
    • "Inappropriate warning as K is 4.3"
    • "He is on beta blocker!"
    • "You are stupid"
    • "This is an inappropriate rec"
    • "cyclosporine is eye drops!"

    The Partners researchers noted that such comments "were helpful for determining why the rules were broken, and helped us fix the rules."

    It's a resource that more hospitals should take advantage of to help them pinpoint where inaccuracies are occurring in their EHRs, they said.

    Clinicians "sometimes provide information in override comments or other text fields in the EHR that seem to be communicating information to someone else but in fact are not sent to the implied recipient and are never acted upon.

    "Override reasons are an example of this kind of text field," they added. "Although intended for audit purposes, override reasons are typically not intended for communication of clinical information or issues with the CDS itself. Nonetheless, users sometimes provide meaningful information in their override reasons."

    THE LARGER TREND
    CDS software can be a valuable tool to help providers make more informed medication, imaging and lab orders.

    In addition to improving quality and safety, it can also save money, as we showed recently in a case study looking at Saint Luke's Health System.

    But it needs to be configured properly and embraced by clinicians to prove its worth. Paying attention to physician feedback is one way to ensure it's working optimally.

    ON THE RECORD
    "Override comments are a rich data source for finding alerts that are broken or could be improved," said Partners researchers. "If possible, we recommend monitoring all override comments on a regular basis."

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

    Healthcare IT News is a publication of HIMSS Media.


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    Most maternity providers in England are making a "good start" in adopting digital technologies, according to a new report by NHS Digital.

    Published in November this year, the analysis looked at the progress made by all 135 providers, and the investment being made in software, equipment and infrastructure.

    The digital maturity assessment (DMA) found great variation across the country, with some trusts scoring zero (the lowest level) on some sections and others 100 (the highest level), although only a minority had “very low digital maturity”.

    “We now want to see greater collaboration across the NHS so those maternity services not using digital can be helped along the journey,” said Juliet Bauer, NHS England chief digital officer.

    The overall national average score was 51, and findings indicated that areas of high and low digital maturity were distributed across England. The highest scoring section was governance, which scored 77, while the lowest one was remote and assistive care, scoring 23.

    “It would appear the maternity providers are often doing well on the same elements but are also encountering challenges in the same areas. This allows a great opportunity for the national teams and networks to focus on solving those common issues,” the report reads.

    At the time the analysis was completed, NHS Digital identified 20 suppliers providing maternity systems to trusts across England, and “close to a quarter” of providers said they were considering re-procuring their IT system in the next 12 months.

    The DMA was commissioned after a national review outlined the potential role that technology could play in transforming England’s maternity services. It included more than 200 questions prepared by clinicians, spanning the acute and community setting, and responses were converted into scores to allow them to carry out comparative analysis and calculate an overall score.

    “The Maternity DMA is a ‘self-assessment’– this means that it is mainly based on the opinions of those who complete it, rather than pure fact. As a result of this, there may be inaccuracies or inconsistencies compared with what actually happens," according to the analysis.

    Digital midwife Julia Gudgeon, clinical advisor for the Digital Maternity Programme at NHS Digital, and one of the report’s authors, said:

    “We have listened to clinicians working in the field and women themselves, both of whom are key to developing the use of digital tools to improve the experience of service users. This insight helps us to understand what to do and what not to do.

    “Our hope is that the findings of this report will inspire further collaboration so that women, technology and maternity services can work together to provide better health, better care and better value."

    Twitter: @1Leontina
    Contact the author: lpostelnicu@himss.org


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  • 01/02/19--08:47: HL7 releases FHIR 4
  • Health Level Seven announced on Wednesday that a new version of its interoperability specification is now available.

    WHY IT MATTERS

    Many in the healthcare industry have been eagerly awaiting the fourth iteration of FHIR 4 because future changes will now be backward compatible.

    "Applications that implement the normative parts of R4 no longer risk being non-conformant to the standard," said FHIR Product Director Grahame Grieve on the FHIR blog.

    Grieve also noted that in addition of the base platform several key piece of FHIR are also now normative, including the RESTful API, the XML and JSON formats, the terminology layer, the conformance framework as well as Patient and Observation resources.

    THE BIGGER TREND

    FHIR and open APIs are widely considered to be critical to making health data more interoperable. The Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT have both said as much. When Apple launched its Health Records a year ago, it incorporated FHIR – and nearly 150 hospitals have signed on to support the tool.

    At the same time, EHR makers such as Allscripts, athenahealth, Cerner, eClinicalWorks, Epic and Meditech have developer programs that use FHIR and open APIs to enable third-parties to write software that uses their electronic health record platforms. (The 21st Century Cures Act requires certified EHRs to have open APIs.)

    Some of those developers have been calling for a single version of FHIR and while R4 does not solve that entirely, it is a step in the right direction.

    ON THE RECORD

    "R4 is the culmination of 18 months of extensive work to finalize the base parts of the specification, and incorporate changes and enhancement requests received from implementation partners across the world," said Grieve. "R4 is the culmination of 18 months of extensive work to finalize the base parts of the specification, and incorporate changes and enhancement requests received from implementation partners across the world."

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


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    Medsphere Systems, a provider of the electronic health record CareVue and RCM Cloud, announced today that it has acquired HealthLine Solutions for its hospital supply chain inventory applications.

    HealthLine’s applications, which use bar coding and RFID technology for automated tracking, are also capable of providing support for interventional medicine and surgery, the companies said in a joint statement.

    WHY IT MATTERS

    Purchasing, receiving and inventory supply are challenging in healthcare because they are maintained in multiple locations, such as nursing stations, operating rooms and specialty departments.

    Medsphere said that HealthLine’s applications will enhance the revenue cycle management cloud component of its CareVue EHR solution.

    The acquisition is yet another sign that healthcare is moving to make IT a one-stop shop with platforms that can meet clinical, revenue cycle and inventory management needs.

    Medsphere’s cloud options, both for EHRs through CareVue Cloud and its RCM Cloud solution, are designed to help organizations that want to move away from onsite data centers.

    THE BIGGER TREND

    Supply chain expenses are slated to be the number one healthcare cost by next year, especially as hospital margins continue to shrink, said John Kupice, CEO of H-Source, an online marketplace for hospital groups to buy and sell medical supplies.

    In our sister publication, Healthcare Finance News, Kupice said hospitals that want to move beyond merely surviving, to thriving, must learn to manage supply chain effectively. But this won’t be easy, because it will first take a cultural shift.

    Supply chain is viewed today as a transactional model — and it must move to be seen more as a strategic priority. Like most cultural shifts, to accomplish this, system-wide buy-in will be required.

    ON THE RECORD

    “With the addition of supply chain management functionality, the CareVue solution overall, and the RCM component specifically, offer a combination of comprehensive and affordable functionality,” said Medsphere CEO Irv Lichtenwald.


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    As the quantities of personal health data go from being measured in gigabytes to terabytes, a precision medicine action plan from the California Office of Planning and Research looks at the state of data sharing in the Golden State – and concludes the it can lead great advances in healthcare if it can get data sharing and standards right.

    OPR commissioned the study, which looks at ways to advance precision medicine across both California and the larger U.S.

    Health data exists in traditional forms such as electronic health records, lab results and clinical trials, of course – but also now comes in a variety patient-generated flavors from devices such as FitBits and via "passive" collection from smartphone and environmental sensors.

    The report finds that there is "tremendous potential to use all of the data as input for algorithms and AI allowing for more real-time understanding and intervention," as long as there is a more concentrated effort across the state and the nation to develop common formats, metadata and ways to share the data.

    Additionally, the shifting from siloed data to cloud storage and processing opens up greater possibilities for sharing data across a wide range of stakeholders and researchers. Advances in machine learning can leverage these newly-available troves of data to help clinicians arrive at new insights about individual and population health.

    WHY IT MATTERS
    Health data is growing in size rapidly and researchers are only uncovering the tip of the iceberg of what they can glean from it.

    The report noted that in one experiment "deep learning methods accurately predicted multiple medical events, including in-hospital mortality and 30-day unplanned readmission," and that it is critical to be on the forefront of developing new tools and systems to analyze the information available.

    Researchers are finding that the social determinants of health, environmental factors that are not specifically health-related but which directly influence a person or population's health outcomes, are incredibly important in developing precision healthcare approaches for patients.

    While many determinants are captured in one way or another, there are no consistent standards for the data. Making SDOH data more readily available to health professionals through a common standard would allow practitioners to develop greater precision health approaches.

    THE LARGER TREND
    The value of massive datasets and the insights artificial intelligence can bring are already being recognized. Across Europe there is already a nascent framework for sharing anonymized data to allow machine learning to help researchers.

    Greater insight driven by data sharing is critical to population health management, an industry that is expected to near $7 billion by 2022. Factors like AI-assisted research and greater collection of social determinant information can greatly help clinicians target both high- and low-risk populations for preventable and predictable health incidents with better data sharing and processing power.

    Health data is accumulating at a brisk pace and shows no signs of slowing down. As large states like California begin to suggest common frameworks for sharing and researching this data, they are influencing a national conversation on how best to make patient data available securely, safely, and privately. These efforts are mirrored around the world, and are the harbinger of a new age in precision health.

    ON THE RECORD
    "We believe that much better integration of various data sources is possible (including the social, economic, and environmental data) and beneficial, and can be activated through state leadership," the authors of the action plan wrote on Dec. 26 in a letter to outgoing California Gov. Jerry Brown.

    "We recommend exploring the feasibility of a California Patient Record that gives all Californians the ability to access their complete health record, with the ability to contribute their ability to contribute their own data and share their record with any provider or researcher. We also recommend protections for patients when they do share that data."

    In addition, researchers suggested starting with a pilot project that "integrates the various components needed for precision medicine (e.g., technology tools, data integration and sharing, research and clinical partnership, patient-centered care) within a defined population.

    "Piloting a precision medicine model of care for a high-needs population would serve the dual purposes of not only understanding precision medicine’s impact on patient outcomes, but also whether precision medicine can be a cost-effective model and reduce health disparities," they explained.

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


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    The Senate confirmed James Gfrerer, a former marine and cybersecurity executive at Ernst & Young, to head the agency’s IT department — a position that has been without a permanent leader for the past two years.

    WHY IT MATTERS

    The assignment comes as the VA is in the throes of a $10 billion, 10-year overhaul from VistA to Cerner’s EHR — arguably the largest health IT undertaking in history.

    Gfrerer’s predecessor, Scott Blackburn, resigned as interim CIO last May, after four years of leadership on a wide range of technology projects. President Donald Trump temporarily filled the position with Camilo Sandoval, former data operations director for his campaign.

    Gfrerer will have his hands full, as the VA officially signed with Cerner on the EHR modernization project last May, after nearly a year of speculation that it would.  The Cerner EHR at the VA will be similar to the one currently in the pilot phase at the Department of Defense, and both agencies said last May they will work together to learn what can be gleaned from the new implementation.

    VA officials expect pilot sites for the Cerner implementation to go live in the Pacific Northwest by 2020.

    The VA – in the public spotlight in the past for VistA’s interoperability failures -- will be adding mental health to the new Cerner EHR capabilities. The new EHR will allow for seamless data sharing between community providers and the agency, the VA said last spring.

    THE BIGGER TREND

    During his senate confirmation hearing Sept. 6, Gfrerer pledged to fix cybersecurity at the VA and advocated maintaining VistA during the 10-year process to implement the new Cerner EHR.

    "I've read the OIG report on [VistA’s] material weakness. It's a sustained pattern of unpreparedness,” Gfrerer told the Senate committee last fall. “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." 

    Nonetheless, Gferer will be charged with seeing the Cerner implementation through in the future. 

    Sen. Jon Tester, D-Montana said at the Senate confirmation hearing that the new implementation of the Cerner EHR, “…is really going to make or break the VA going forward.”

    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.

    In October, we reported that Cerner named Accenture, Leidos and AbleVets among the vendors that will support the project throughout the projected 10-year timeframe. “This is the beginning of a long transformational journey,” Travis Dalton, president of Cerner Government Services, said in a statement. “We’ll continue to seek and bring the best talent available to the VA.”

    The transition to the Cerner platform has all eyes on it, no less those of Congress, who have been monitoring the project from the start – urging the VA to use the Interagency Program Office for a single point of governance. 

    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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    Secondary care providers in England are expected to be “fully digitised” by 2024, according to the 10-year NHS plan released today.

    NHS leaders were asked to develop the blueprint following an announcement in the summer of 2018 that the NHS would receive increased funding of £20.5bn per year in real terms by 2023/24, which applies to NHS England’s budget and not the overall health budget.

    The new plan outlines a series of “practical priorities” to ensure that digital services become a “mainstream” part of the NHS, and the new secondary care digitisation “milestone” covers “clinical and operational processes across all settings, locations and departments".

    It includes a focus on ensuring that clinicians can access and interact with patient records and care plans “wherever they are”, protecting patients’ privacy and putting them in control of their records, while encouraging a “world leading health IT industry in England with a supportive environment for software developers and innovators”. 

    Technology standards will be mandated and enforced, as mentioned in the digital, data and technology strategy published by the Department of Health and Social Care towards the end of last year, to ensure that “data is interoperable and accessible”, and the plan also pledges investment in expanding the NHS Digital Academy programme and increasing the training of health and care staff in digital capabilities.

    Improvements to require "staged action"

    The NHS App will offer a “standard online way” for people to access services, with an open environment to be created for developers to “build enhancements”, and patients with long-term conditions will reportedly be able to access their Summary Care Record through the app by 2020.

    Separately, it is expected that 100,000 women will be able to digitally access their maternity records in 2019/20, with plans for the coverage to be extended to the whole country by 2023/24, while a new wave of Global Digital Exemplars (GDEs) is also reportedly on the way, along with seven other Fast Followers. 

    “The continued roll-out of GDE blueprints to more Fast Followers will ensure the NHS achieves maximum value by reducing duplication and sharing systems between organisations where possible based on open standards and interoperability. Central funding will be made available to trusts (subject to an upper limit) to help them meet mandated standards and technical requirements,” it is added.

    In a speech today marking the publication of the plan at Alder Hey Children’s Hospital in Liverpool, NHS England chief executive Simon Stevens said some improvements would require "staged action over the next 10 years", while others would "happen quite quickly". 

    "The ability to share and access high quality data driven insights - led by patients - is key to improving patient care in the NHS," said Dan Vahdat, CEO and founder of UK health tech company Medopad. "Helping patients understand their own conditions and sharing ongoing updates with their clinicians can enable clinical teams to drive earlier interventions and ultimately, use that data to predict issues before they arise."

    Commenting on the publication of the long-term plan, Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges, added:

    “It’s good to have a plan which sets a clear direction for the NHS and tackles many of the issues the Academy has long been saying need to be addressed if we are to improve patient care. Our challenge now is to make sure it’s properly implemented and in this regard we, that is everyone who works in the NHS and patients who use the service, must all play our part if we are to make it a success.”

    Editor's note, 7 January 2019: This article has been updated to include a statement from Dan Vahdat, CEO and founder of Medopad.

    Twitter: @1Leontina
    Contact the author: lpostelnicu@himss.org


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    Medical device integration and analytics vendor Excel Medical, a company that markets technologies designed to eradicate unexpected deaths in hospitals, announced its solution for Epic.

    Excel said the offering delivers physiological data, including waveforms, vitals and clinical alarms, into Epic’s workflows across Hyperspace, Canto, Haiku and Rover applications.

    WHY IT MATTERS

    Today’s clinicians are overburdened with time demands and are looking for real-time patient data via their EHRs. But the process hasn’t been fully streamlined, causing clinician burnout not to mention unexpected deaths in U.S. hospitals.

    Excel said the new tool is designed to ease that burden by using a single platform to support patient monitors, medical devices, alarm management, digital cardiac monitor documentation, and real-time physiological surveillance.

    Last May, we reported that Excel Medical debuted Wave, an FDA-cleared patient surveillance and predictive algorithm platform that's now available in Epic's App Orchard.

    "Being in App Orchard is not only a game changer for Excel, but more important, it opens the doors to improved patient surveillance for clinical care teams," said Mary Baum, chief strategy officer at Excel Medical.

    The platform is available through the vendor's AlarmView and TeleTrend apps in the app store, which opened in 2017. Both apps enable hospital information systems to make predictive analytics an actionable process, according to Excel Medical.

    ON THE RECORD

    “We all are aware of the clinical limitations of traditional MDI: it simply provides a vital sign into a flowsheet,” said Lance Burton, president of Excel Medical, in a statement. “This misses the majority of the patient’s clinical picture and impedes workflows. By delivering clinical content across Epic’s suite of applications, Excel Medical supports clinical decision making.” 

    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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    New electronic health record rollouts are infamously fraught with risk. At best, a they can cause workflow disruption, confusion among clinical staff and other minor inefficiencies. At worst, they can necessitate a temporary return to paper records, cost millions in remedial IT projects – or cause serious sentinel events.

    As John Rekart, chief of quality management and informatics at the California Department of Corrections and Rehabilitation points out, "anywhere from 30 to 80 percent of EHR implementations over the past two decades failed and went back to paper."

    Health systems have gotten much better at it in recent years, but challenges related to new workflows, spotty training and poor preparation continue to put go-lives at risk.

    Analytics can help. Rekhart's experience – he was configuration architect for the mental health system at CDCR, and oversaw testing and implementation of systems at 35 institutions across California, including design and rollout of the EHR at a 1,700-bed correctional hospital – shows how smart use of data can target help toward those who might be struggling with the new systems.

    In his role at CDCR Mental Health, Rekart leveraged data and analytics to boost the chances for a successful rollout. The insights derived from how clinical end-users were interacting with the new Cerner EHR led to successful implementations at all 35 locations, he said.

    At HIMSS19, he'll share insights into the value of such data for improving go-live success rates, how quality management tools can boost training results for EHR rollouts, and show some of the metrics and KPIs used by CDCR to build a data-driven implementation customized for its own particular needs.

    "Basically I used some quality management techniques of monitoring and feedback to really help the project along," said Rekart. "Our users go through 40 hours of training," he added. "Our trainers go through 80. And they have to pass a knowledge check to certified."

    That test is administered via the CDCR's intranet, he added, enabling easy access to the test data. "That was one of the ways we monitored. We used that data, and if they failed, we required people to retrain."

    But a more granular approach to the test score data enabled staff to make use of one its best assets – those "super users" who truly get the new EHR system and can help their peers and colleagues do the same.

    "We wanted this test to divide people into three piles," Rekart explained. "We wanted to use floor questions that almost everyone should get. And ceiling questions that almost nobody can get.

    "If you can't answer the floor questions, you've identified people who need retraining. Then the people in the middle are competent users. And the people who answer the really hard questions are probably going to be your super users."

    Using that analytics-based approach to implementation has "worked out really well," he said. It's enabled CDCR staff, with help those superusers, to home in on the people who might need the most help and optimally allocate assistance to where needed.

    "We used data to look at where people were in the process, then used focused and targeted interventions to get them going in the right direction: 'Looks like you're struggling with this, you need to focus on this,'" said Rekart. "After go-live we had a bunch of data flags that look at certain workflow variants, and we could see patterns and notice people who were veering from the workflow."

    The numbers speak for themselves. "We had a 25 percent reduction in sentinel events, post implementation," he said. "Usually there's an increase."

    While CDCR had "spent a lot of money on this," that money wasn't spent it on extra staff, he added. "I didn't have 30 people for this, I had three. You're basically testing people from a distance. We're government, we needed to bootstrap. But use of the data helped us be very successful in that regard."

    John Rekart's session, "Analytics-Based EHRs Implementation: Improved Outcomes," is scheduled for Thursday, February 14, from 11:30 a.m. to 12:30 p.m. in room W308A.

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

    Healthcare IT News is a publication of HIMSS Media.


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    Meritus Health, based in Hagerstown, Maryland, has gone live with its new Epic electronic health record – implemented and hosted via a collaboration with partnership with Mercy Technology Services, the IT arm of the 45-hospital St. Louis-based Mercy.

    WHY IT MATTERS
    Meritus, which has direct a software license with Epic, wanted more capabilities from the technology that might have been out of reach for a similarly-sized small health system, according to Mercy.

    So with help from MTS, it opted to implement Mercy's advanced version of the Epic system, gaining faster access to a more robust and higher-performing EHR while maintaining autonomy over the system for its own purposes.

    "Adopting a new EHR can be a costly, time-consuming process for any healthcare system," said Tom Chan, chief financial officer for Meritus Health, in a statement. "Thanks to our partnership with MTS, Meritus was able to implement one of the most sophisticated versions of Epic in use today, reducing the time to install from 18 months to just over a year and helping us experience savings along the way."

    Mercy's model of Epic, developed over the past decade for its own use and that of MTS clients,   offers many specialty modules, mobile capabilities, clinical decision support functionality and population health management tools.

    Meritus, whose CEO Joseph Ross retired abruptly this past month, had first announced its plans to implement Epic in July 2017 after a reported 18 months of planning, with an expected cost of $100 million. At the time, Ross said clinicians at the health system, whose flagship Meritus Medical Center has 243 beds, "particularly preferred Epic."

    THE LARGER TREND
    Mercy's 900-employee technology staff has repeatedly been voted one of Healthcare IT News' Best Hospital IT Departments.

    "We've been growing really fast so there's a lot of acquisition work going on, as far as bringing other healthcare organizations into our infrastructure, converting them to some of our Epic systems," Mercy Chief Information Officer Gil Hoffman told HITN in 2017. "That's been a lot of work. We're also a little bit unique from the standpoint that Mercy sells its IT services to other providers: We have commercialized our IT, and that has taken a lot of work, bringing some other health systems not only into our Epic services but our hosting services as well."

    Similarly, earlier this year Mercy consolidated its imaging platform, distilling several legacy PACS and VNA systems into a single hosted technology, and commercialized it through MTS as a secure software-as-a-service model aimed a small- and midsize hospitals.

    ON THE RECORD
    "As we started this journey with MTS, we knew we wanted to maintain a degree of autonomy," said Meritus Health's chief transformation officer Carrie Adams. "This process helped us retain the ability to make decisions about the direction of our EHR so we can build and grow a system that meets the needs of our clinicians as well as our patients."

    Hoffman added: "Meritus is really a model for how a smaller health system can best implement a new EHR on their own terms. By taking advantage of MTS’ experience, a decade of Epic design and award-winning build, they’ve been able to catapult their capabilities, while managing their risk and controlling their costs."

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

    Healthcare IT News is a publication of HIMSS Media.


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