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ONC to Congress: EHR adoption is widespread, but health IT progress is still stifled

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Despite the fact that 96 percent of hospitals and 78 percent of physician practices have adopted certified health IT — too many hurdles still stand in the way of progress, according to ONC’s “Annual Update on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information”—the agency’s annual report to Congress mandated under the HITECH Act.

The report found that:

  • Despite HIPAA, patients still lack the ability to access health data and that makes it harder to manage their health and shop around for medical care
  • Providers also lack access to patient data at the point of care, particularly true when patients see multiple doctors
  • And payers often lack access to clinical data about populations of covered individuals

WHY IT MATTERS

Today’s certified health IT products lack secure access and sharing of data — like that found in other industries — the kind of capabilities needed to allow for greater innovation, the report says. ONC is eager to see seamless data flow, to accelerate progress.

THE BIGGER TREND

ONC has known that interoperability has been the sticking point for years and thus changed its focus from meaningful use of EHRs to a greater emphasis on data sharing. The average hospital has 16 electronic medical record platforms across various facilities, which helps to explain some of the difficulty. Some are even still using faxes to exchange information, a December ONC report said.

One potential solution is opening up, however. A December report issued by KLAS says more healthcare organizations should join the newly launched CommonWell-Carequality network. Many EHR and health IT vendors have eliminated obstacles to participation in the data-sharing network, going so far as to make it plug-and-play. But, what’s holding them back is governance and organizations themselves 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 the 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."

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. 


Australia’s My Health Record system sees rise in data breaches

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The agency’s Annual Report 2017–18 identified that “42 data breaches (in 28 notifications) were reported to the Office of the Australian Information Commissioner (OAIC)… concerning potential data security or integrity breaches”, but with “no purposeful or malicious attacks compromising the integrity or security of the My Health Record system”.

Of the 42 instances, one breach resulted from unauthorised access to a My Health Record as a result of an incorrect parental authorised representative being assigned to a child.

Two breaches resulted from suspected fraud against the Medicare program, where the incorrect records appeared in the My Health Record of the affected individual and were viewed without authority by the individual undertaking the suspected fraudulent activity.

The ADHA report also identified that 17 breaches were a result of data integrity activity initiated by the Department of Human Services to “identify intertwined Medicare records (that is, where a single Medicare record has been used interchangeably between two or more individuals)”.
The remaining 22 breaches were from suspected fraud against the Medicare program involving unauthorised Medicare claims being submitted, and the incorrect records appearing in the My Health Record of the affected customers.

An ADHA spokesperson confirmed that in all instances, the Department of Human Services took action to correct the affected My Health Records.
“Errors of this type occur due to either alleged fraudulent Medicare claims or manual human processing errors, as was the case for the breaches reported during the 2017-2018 financial year. There has been no reported unauthorised viewing of any individual’s health information from a notifiable data breach,” the spokesperson said.

“In each case, the affected individuals have been contacted and the OAIC has examined the circumstances of the breach and no unauthorised breach has been determined.”

The ADHA spokesperson added that there are more than 6.3 million people with a My Health Record, but in the six years of its operations, there have been “no reported unauthorised views of a person’s health information”.

“When a person’s health information is stored in different places – hospitals, doctors’ offices, filing cabinets, computers – they don’t know who is accessing it or when. In a My Health Record, every access is listed in a person’s record access history. A person can be notified by text message about who is accessing their record or restrict access to all or parts of their record,” the spokesperson said.

On 26 November 2018, the Federal Parliament passed legislation to strengthen privacy protections in My Health Records Act 2012 without debate or division.
 
The new legislation means that Australians can opt in or opt out of My Health Record at any time in their lives. Records will be created for every Australian who wants one after 31 January and after then, they have a choice to delete their record permanently at any time.

“At the time of writing, almost one quarter of all Australians have registered for a My Health Record. That figure is expected to change dramatically with the transition to an opt out system early in the 2018–19 financial year,” ADHA CEO Tim Kelsey said in the report.

“Once this resource becomes almost ubiquitous across the Australian health system, clinical workflows and consumer behaviours will gradually and irrevocably change to take advantage of its many benefits.

“For many people the benefits of digital health will be realised gradually, as health and medical data gradually accumulates to form a comprehensive medical history,” Kelsey said.

This article first appeared on Healthcare IT News Australia.

How HCA Healthcare is using clinical analytics for opioid stewardship

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HCA Healthcare's Physician Services Group offers oversight for some 5,700 physicians and advanced practice providers, and embraces an approach to communication and collaboration that's "deeply collaborative," said Barbara Coughlin, RN, vice president of quality at HCA.

One specific area where the health system has been making big headway in that regard has been an all-hands-on-deck response to the opioid crisis.

"The opioid abuse epidemic has ravaged communities across our nation, claiming the lives of more than 115 Americans every day," said Coughlin.

"Across the PSG organization, we recognize that there is a real opportunity to make a meaningful difference, and doing that requires data, partnership, and a commitment to making these efforts a priority," she explained. "We have been very intentional with how to mitigate the effects of the epidemic our nation faces."

At HIMSS19, Coughlin and her colleague Carol White, ambulatory EHR medication management pharmacist at HCA, will show how the health system has been making use of its data to ensure its providers are thinking critically about the way they prescribe controlled substances.

Their session will explain how HCA Healthcare and the PSG is leveraging its technology infrastructure to help physicians stay compliant with regulations while also delivering better and safer care to complex patient populations.

They'll show how they define key performance indicators of effective pain management programs, tap into data analytics and reporting to keep tabs on how providers are prescribing and  gain insight into specific EHR workflows to learn how physicians make decisions about pain management therapy.

In early 2013, the PSG "developed, in partnership with our physicians and providers, controlled substance guidelines that outline best practices around controlled substance prescribing," Coughlin explained. "Included in these recommendations is monitoring of state prescription drug monitoring programs, implementing controlled substance agreements with patients, and random drug screens, if necessary."

When that work began, "much of our initial activities were manual," she said. But by the next year, HCE began working more closely with IT staff and EHR leadership to "identify and develop ways to aggregate prescribing metric data and make it available to our providers."

That ability to see and learn from the physicians' prescribing patterns is "powerful," said Coughlin. "We evaluate this data on a routine basis to help ensure we are within appropriate national benchmarks and to continually identify opportunities to improve."

"Having this data available for our providers was a turning point," added White. "It made the data transparent and actionable. This has been a big win for our prescribers and, more important, for our patients. And, it allows our providers to have robust conversations with patients regarding the care that we ultimately want to deliver."

Coughlin and White's presentation, "A Quality and Analytics-Based Approach to the Opioid Epidemic," is scheduled for Wednesday, February 13, from 8:30-9:30 a.m. in room W303A.

HIMSS19 Preview

An inside look at the innovation, education, technology, networking and key events at the HIMSS19 global conference in Orlando.

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

Healthcare IT News is a publication of HIMSS Media.

NHS Chair Lord Prior talks challenges, opportunities of digital health tech

ONC releases Interoperability Standards Advisory Reference 2019

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The Office of the National Coordinator for Health IT (ONC) has issued its latest report on interoperability standards, following the close of comments last October 1. ONC officials said they received 74 comments on the ISA this year, resulting in nearly 400 individual recommendations for revisions.

The 2019 Interoperability Standards Advisory Reference Edition (ISA), which includes recommendations from the federal Health IT Advisory Committee and changes made due to the comments from stakeholders, contains new standards and updated characteristics and calls for more efforts to make e-prescribing easier. It also encourages a more prolific patient record exchange between patients and their many care providers. The ISA is updated throughout the year for substantive and structural changes, based on ongoing dialogue, discussion, and feedback from stakeholders, ONC says.

 

The ISA represents ONC’s “current assessment of the heath IT standards landscape,” and ONC officials note it is for informational purposes only. “It is non-binding and does not create nor confer any rights or obligations for or on any person or entity,” ONC said.

 

WHY IT MATTERS

ONC listened. “Since the 2018 comment period on the Interoperability Standards Advisory (ISA) closed on October 1, we combed through all your comments and made improvements based on your suggestions, write Steven Posnack, Chris Muir and Brett Andriesen in a Jan. 14 blog.

The latest changes to the reference manual itself include RSS feed functionality to allow users to track revisions to the ISA in real-time; shifting structure from lettered sub-sections to a simple alphabetized list; and revised titles to many of the interoperability needs, to reflect their uses and align with overall ISA best practices.

ONC also added more granular updates on added standards, updated characteristics, and additional information about interoperability needs.

THE BIGGER TREND

The Interoperability Standards Advisory (ISA) process is traditionally how ONC coordinates the identification, assessment, and public awareness of interoperability standards and implementation specifications, encouraging all stakeholders — clinical and research — to use them. ONC also encourages pilot testing of the standards.

Starting with the 2017 ISA, the ISA’s focus expanded to more explicitly include public health and health research interoperability. The ISA is not exhaustive, ONC says, but it is expected to be incrementally updated to include a broader range of health IT interoperability needs.

To provide the industry with a single, public list of the standards and implementation specifications that can best be used to address specific clinical health information interoperability needs. Currently, the ISA is focused on interoperability for sharing information between entities and not on intra-organizational uses. 

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. 

How AdventHealth leverages real-time data to boost outcomes

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Quality improvement is no longer just a nice-to-have. It's a critical must-do for any health system that hopes to survive in the era of value-based care. But opinions vary widely on the best way to manage data for better outcomes.

Robert Altemose, RN, clinical operations analytics director at Altamonte Springs, Florida-based AdventHealth (which until this past August was known as Adventist Health System) explains, doing so retrospectively isn't effective – true quality improvement has to be done proactively and in real time.

At HIMSS19, in a presentation with his colleague, Judi Reed, senior manager of clinical operations analytics and user experience at AdventHealth, Altemose will show how his team has helped the health system make the leap from retrospective to real-time analytics, nudging its clinical staff toward higher-quality care as it's delivered.

They'll show how AdventHealth got buy-in from top leadership and the clinicians in the trenches, combined new technologies with its existing IT infrastructure and designed efficient and effective dashboards to bring analytics to the bedside.

First things first: "Leadership engagement is key to the deployment and effective use of real-time analytics," said Altemose. "Without analytics of this kind being driven from the top down there is no impetus for the front-line users to engage."

In addition, for those clinical end-users, "it is best for processes to be as standardized and as well defined as possible prior to building a real time analytics platform," he explained. "However, it is not a prerequisite for success. Real-time analytics, when properly built, tend to quickly identify where a process breaks down or has not been followed."

But the "most important aspect of successfully leveraging real-time analytics is metric selection," said Altemose. "When deciding on what to include there isn't much value in exposing metrics that cannot inspire action."

At AdventHealth, for example, "I handpicked metrics that allow clinicians to take action before there is a negative impact to the patient and left anything that was classified as 'good to know' on the cutting room floor," he explained.

And what should be the bigger emphasis in projects such as these? People or technology?

"Neither can function independently," said Altemose. "The staff needs to be engaged in using the tool for the organization to realize the value the application can provide. However, if the application is difficult to use, requires a lot of work to find the actionable items, or is filled with metrics that don't drive change then there can be no improvements. Both must work in concert to maximize the value the tool can bring."

Indeed, buy-in from docs and nurses is non-negotiable for effective real-time analytics, which "cannot be successful without clinician involvement," he said. "Feedback from the end users and process owners throughout the design, and building phases is an absolute must. Continuing to listen following go-live is also necessary for continued success."

That said, however, there is a also "a significant risk of analysis paralysis," Altemose warned. "A strong, politically savvy, application owner is necessary to ensure that only the content with the greatest opportunity for having the most impact is included."

At AdventHealth, the clinical ROI of real-time data is already showing itself.

"This application has impacted CLABSI scores, CAUTI scores, as well as flu vaccine and pneumo vaccine compliance rates," said Altemose. "These are all metrics that impact a hospitals CMS Star rating and we have seen improvements in our star ratings as well."

Altemose and Reed's presentation, "Using Real-Time Analytics to Improve Patient Clinical Outcomes," is scheduled for Wednesday, February 13, from 4-5 p.m. in room W206A.

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

Healthcare IT News is a publication of HIMSS Media.

Pew: Here's what APIs need to succeed for healthcare

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Application programming interfaces are all the rage in healthcare and just about every other industry undergoing digital transformation. And with the release of Health Level 7’s Fast Health Interoperability Resources 4 earlier this month, the excitement around open APIs, FHIR and data interoperability just kicked into a higher gear.

“Increasing the use of APIs could represent a dramatic shift in how health data is accessed, extracted, and utilized to improve patient care. APIs can help get patients their data, support information exchange among healthcare facilities, and enable enhanced clinical decision support tool,” said Ben Moscovitch, project director of health information technology at Pew Charitable Trusts.

Indeed, the 21st Century Cures Act gives the Office of the National Coordinator for Health IT the opportunity to advance standards around open API, FHIR included, and to encourage vocabularies and code sets for clinical concepts, Moscovitch added, while the private sector has been making strides of its own.

Consider the Argonaut Project, CommonWell Health Alliance and Carequality, which last year reached an interoperability milestone of sorts when the organizations made their connectivity live nationwide such that healthcare facilities that belong to either can now bilaterally exchange CCDs with any other participating member.

Yet, obstacles remain. The industry continues awaiting information blocking rules from ONC, for instance, and the agency is working on draft regulations outlining requirements for APIs that are expected to ease the exchange of health data.

“ONC should not miss this opportunity to advance the effective use of APIs, such as by ensuring that more data are exchanged, appropriate standards are used, and longitudinal data are made available, among many other steps,” Moscovitch said.

Finalizing the rules is one thing, of course. Hospitals, health systems, payers and other entities still have to put them to use.

“For APIs to reach their full potential,” Moscovitch said, “industry and government should ensure that APIs can access more patient information, and work to begin breaking down other barriers that hamper them being able to effectively share data.”

Moscovitch, along with Jeffrey Smith, vice president of public policy at the American Medical Informatics Association, will offer more insights at HIMSS19 during a session titled “Unlocking EHRs: How APIs usher in a new data change era.” It’s scheduled for Wednesday, Feb 13, from 1:00-2:00 p.m. in room W303A.

HIMSS19 Preview

An inside look at the innovation, education, technology, networking and key events at the HIMSS19 global conference in Orlando.

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

Healthcare IT News is a HIMSS Media publication. 

Sponsored: Alleviating the global problem of physician burnout

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Machine learning will help EHRs fulfill precision medicine's promise

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Electronic health records are very good at being repositories for valuable patient data. But they need help when it comes to putting that data to work for more innovative care delivery. The ever-expanding volume and variety of clinical and social-determinant factors will require more advanced technologies to be optimally harnessed for precision medicine.

Enter AI and machine learning, which "will play a growing role in healthcare, under two main categories – generating knowledge and processing data," said Auckland, New Zealand-based Kevin Ross, who will speak next month at HIMSS19.

Ross is general manager at Precision Driven Health, launched as a partnership between Orion Health (where he is director of research) and government agencies and academic organizations in New Zealand to explore and promote precision medicine. He sees machine learning as a key enabler in the years ahead as health systems look to unlock the data and in their EHRs and put it to work for more personalized care.

"Health records have been electronic – and therefore accessible for analysis – for a relatively short period of time, but we are now seeing huge volumes of data being generated from different sources," he explains. "We've had insufficient computational power to process the volume of data in a genome, let alone a microbiome, etc. until fairly recently."

The advent of AI and machine learning opens new avenues for healthcare wisdom to be accrued. Medical research has traditionally come through "targeted studies on narrow subsets of the population," he said, "now we can analyze over large populations in relative real time, because the data is being collected digitally. New knowledge will come about by applying machine learning to these increased data sets to uncover patterns that are occurring today without being noticed."

In Orlando, Ross will explain how he and other researchers are making the most of some unique aspects of New Zealand's healthcare landscape – connected electronic healthcare data across the population, leading-edge research organizations – to enable the development of new technologies and data strategies for precision medicine.

"New Zealand has some unique benefits, including a long history of digital health records with well managed health ID numbers, so it is a lot easier to link different data sets together," he explains. Add to that :

  • Linked data between social services (health, education, justice, welfare, tax) available for research purposes;
  • A single payer system whereby the incentive of patient, provider, and system are typically well aligned (e.g. early intervention benefits all)
  • Willing collaboration between commercial and public provider organizations as well as between clinical and data science researchers
  • A unique ethnic diversity (74 percent European, 15 percent Maori, 12 percent Asian, 7 percent Pacific Islander – including those identifying multiple)
  • A strong data science research community
  • A population relatively comfortable with technology and with broad access

All that, plus the fact that New Zealand has a smallish population (fewer than 5 million people) means that "research is more likely to be population wide rather than highly specialized," said Ross.

From that remote corner of the globe to other health systems worldwide, he sees a big future ahead for AI-enabled EHRs – enabling a fast evolution for precision medicine.

"Machine learning can be used to aid intensive tasks such as processing large data sets for genomics, image processing or network analysis, as well as finding anomalies – such as for diagnosis or fraud detection – and identifying cohorts," he said. "There are interesting applications in maintaining records such as matching data from different systems, inferring missing data elements."

And as the evolutions continue apace, what should health systems who have already begun AI implementations be doing to ensure they're making best use of machine learning in their workflows?

"Design systems with a view to interoperability and data sharing," said Ross. "Use standards, build tagging into systems. And make it easy for patients to control the use and sharing of their data, and see the benefits from it."

In addition, he advised health systems to make the most of all the data they have on hand: "Even 'dirty' data can have incredible predictive value," he said. "Don't wait for perfect data to start using it."

Ross' presentation, "Machine Learning Over Our Growing Electronic Health Records," is scheduled for Wednesday, February 13, from 2:30-3:30 p.m. in room W308A.

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

Healthcare IT News is a publication of HIMSS Media.

Queensland Ambulance Service launches digital system for medical emergencies

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Queensland Ambulance Service (QAS) has rolled out a digital system that aims to give paramedics greater access to a patient’s vital medical information in an emergency.

The SafeMate emergency medical information program is under trial for Medibank customers with chronic illnesses that are living in Queensland. Patients must be enrolled under Medibank’s CareComplete chronic disease management service.

The SafeMate program houses a patient’s medical and personal information that they enter online. QAS personnel can then access this data by scanning a QR code on a patient's SafeMate card using iPads.

“This is crucial information that a patient wants the paramedic to know in a medical emergency,” Queensland Government Minister for Ambulance Services Steven Miles said.

“Paramedics will use their operational iPads to tap the patient’s SafeMate card or device, and the medical information will appear on the screen. It eliminates the time it would normally take a paramedic to ask the patient a range of questions in order to obtain their medical history and other pertinent details.”

This gives paramedics access to important information, such as details on allergies and medical history, letting them identify best courses of treatment earlier and improving patient outcomes.

It also aims to reduce paramedic and patient stress, time-consuming hospital visits and costs in the health system, in addition to improving ambulance efficiencies.

Prior to December 1 last year, paramedics were unable to access these records as the organisation was not in the Australian Health Practitioner Regulation Agency (AHPRA) regulated health profession registry.  

The digital system is a testament to Queensland’s ongoing digitisation journey, with the launch of a digital hospital program to improve the state’s healthcare and patient outcomes. 

In December last year, through findings from a report tabled by the Queensland Audit Office (QAO), Miles outlined the benefits of the digital hospital program in Queensland.

He said that as a result of the digital hospital program, Queenslanders face improved health service delivery and patient outcomes, including a reduction in unplanned readmission rates, faster access of clinical information by medical staff and more legible patient records.

“Digital hospitals are making Queensland hospitals safer than ever before. Doctors and nurses have told me when I’ve visited hospitals that the digital system helps them do their jobs and helps patients,” Miles said.

Ambulance Victoria has also ramped up its digitisation strategy, with the organisation most recently announcing that it will soon deploy a predictive analytics platform for its paramedics to access real-time information, enhancing and accelerating its decision making as the need for emergency services grows.

This article first appeared on Healthcare IT News Australia.

How HIEs can enable public health reporting when EHRs fall short

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Healthcare’s Holy Grail of widespread information sharing holds considerable promise as well as daunting challenges and public health reporting is among the places it is playing out.

"Interoperability can automate routine reporting processes that can alleviate burden on providers while improving data gathering processes for public health organizations," said Brian Dixon, a research scientist at Regenstrief Institute.

But Dixon explained that hospitals and public health face a number of obstacles today.

For starters, local health departments have yet to implement the infrastructure necessary to receive digital reports. "They rely on paper and require help from a larger health system or health information exchange network," Dixon said.

Also, providers at times do not completely understand all of the diseases they should be reporting to public health departments. And others simply presume that someone else is responsible for reporting for them – or, in certain cases, Dixon said the people and resources to complete that reporting do not always exist.

It doesn’t help either that state laws about reporting conditions and criteria vary, which Dixon added make harmonization a necessity.

What’s more, few EHR platforms are currently capable of facilitating data transfer to public health departments.

That's where health information exchanges can come in. Dixon pointed to three key ways HIEs can facilitate information sharing to overcome the obstacles outlined above.

First, HIE networks can harmonize reporting requirements to help providers better understand what they should alert health departments about and what they do not need to. "Regional HIE networks are well positioned to harmonize regional laws that might vary," Dixon said.  

Second, HIE networks can harmonize messages and data.

This includes health information residing in otherwise disparate EHR systems as well as standards for submitting information to public health authorities. Dixon pointed for example to the ability translate certain lab test names to LOINC codes to enable reporting into the Centers for Disease Control and Prevention.  

And third, HIE networks can help with interfaces for connecting various EHR systems to public health infrastructure.

"The regional HIE entities know their health system landscape and can navigate the key players, engage public health organizations in dialogue with health system leadership, and can develop interfaces that connect the health system players together," Dixon said.  

Dixon will address these obstacles and opportunities during a HIMSS19 session, “Enhanced Public Health Reporting Using an HIE Network,” is scheduled for Wednesday, February 13, from 1:00-2:00 p.m. in room W230A.

HIMSS19 Preview

An inside look at the innovation, education, technology, networking and key events at the HIMSS19 global conference in Orlando.

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

Healthcare IT News is a HIMSS Media publication. 

HL7 gives a glimpse of FHIR 5

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Health Level 7 International on Monday offered a peek at its roadmap for Fast Healthcare Interoperability Resources, aka FHIR 5.

WHY IT MATTERS
FHIR is widely viewed as holding great promise for enabling health data sharing among vendors, providers, payers, government, health information exchanges and other entities. 

THE LARGER TREND
HL7 earlier this month posted the eagerly awaited FHIR 4 iteration— which is the first version of the interoperability specification to be normative.

That was seen as a milestone for EHR and other software vendors, as well as startups and innovative hospitals looking to implement FHIR can now plan future versions including and beyond FHIR 5 being backward compatible with FHIR 4. 

Several electronic health record vendors, in fact, run developer programs in which third party innovators can use FHIR and open APIs to build on their platforms. Among the needs for such programs to thrive is a single version of FHIR and broader support for the spec.

What’s more, the biggest software companies in the world continue homing in on healthcare. Amazon, Google, IBM, Microsoft, Oracle and Salesforce, in fact, came together during a White House hackathon over the summit in a pledge to eradicate interoperability barriers that was noticeably short on details other than to say cloud, FHIR, and the Argonaut Project will somehow be involved.

WHAT FHIR 5 WILL BRING
FHIR Product Director Grahame Grieve explained on the HL7 blog that FHIR 5 will build on FHR 4 with more content formally becoming normative, enhanced publishing implementation guides, additional content in new domains, improved support for apps that use more than one version of FHIR, multi-language support, federated servers and "new facilities for migrating data to and from v2 messages and CDA documents."

ON THE RECORD
"The community will continue to develop the adjunct specifications to FHIR – SMART App Launch, CDS Hooks, FHIRCast, CQL, Bulk Data specification, and others – that build out a complete API-based ecosystem for the exchange of healthcare data," Grieve wrote. "HL7 will also continue to collaborate with our many partners across industry, government, and academic communities to support the overall development of data exchange and health process improvement."

Grieve said HL7’s normal development cycle is about 20 months, so FHIR 5 could be ready in 2020 — but he also added that the organization will survey its members to see if they would prefer waiting longer to ease the convergence to a single version.

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

Healthcare IT News is a HIMSS Media publication. 

Starting digital transformation? Focus on the cultural changes

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With the implementation of electronic health records and other healthcare information systems, there has been explosive growth in the amount of data captured by provider organizations.

Just as these provider organizations must prudently manage their talent pools, financial resources and medical assets to fully extract value from data, the organizations must manage data as a strategic asset, said Dr. Ferdinand Velasco, senior vice president and chief health information officer at Texas Health Resources, a faith-based health system based in Arlington that was awarded the HIMSS Enterprise Davies Award for Excellence in 2013 and has achieved Stage 7 on the HIMSS EMR Adoption Model.

"This involves implementing sound enterprise data management, advancing data analytics maturity and promoting a data-driven culture," said Velasco. "While much of the clinical informatics and business intelligence domains have focused on the technical aspects of data management and analytics, we feel that there hasn't been enough focus on the cultural changes associated with digital business transformation."

The importance of the cultural changes associated with digital business transformation has to do with two industry trends, according to Velasco: the emergence of Big Data in healthcare and the transformation of the healthcare delivery model.

"While both topics have received considerable coverage in the media, they're not usually discussed in tandem, as two trends that complement each other," he explained. "Consider what has been occurring in other industries such as retail, entertainment and transportation. In each of these, Big Data has been exploited by new entrants to disrupt the ecosystem and displace legacy firms that previously dominated the marketplace."

Companies such as Amazon and Uber that didn't even exist until the digital age are now formidable players. An advantage these "digital natives" have over established firms is that they're equipped, both technically and culturally, to effectively harness data in near real time, transforming it into actionable insights, and to make agile, data-driven decisions. In contrast, analog companies are characterized by decision making that tends to be laborious and informed by incomplete or old data, Dr. Velasco contended.

"The same phenomenon is happening in healthcare," he said. "We are seeing new entrants as well as established healthcare organizations that are seeking to reinvent themselves into nimble, data-driven organizations. As with other industries, healthcare also has experienced a massive growth in data, not just from clinical workflows and financial transactions but from the consumer side, as well."

In addition to the data captured from EHRs and billing systems, healthcare organizations need to cope with data from technologies such as genetic testing and wearable devices. Through efforts to improve population health, there is a greater appreciation for social determinants of health such as housing, transportation and physical activity. These also represent novel data subject areas for healthcare organizations.

"Layered on top of the Big Data phenomenon is the relentless push toward healthcare reform, driven by employers and payers," said Velasco. "In addition to the usual competition between providers, these organizations are under intense pressure to bend the cost curve. Successfully exploiting data as an asset isn't just going to provide these systems with a competitive advantage, it will be essential for survival."

The first step in promoting a data-driven culture is to promote data literacy, said Velasco.

"This may seem rather basic, but the reality is that many healthcare people have catching up to do in terms of getting educated on some fundamental principles of data management and analytics," he explained. "It's important that they take the time to understand the environment, that is, the source systems and workflows for data capture."

This is essential to developing an appreciation of the strengths and limitations of the data being analyzed, he added. They need to be savvy about performance measurement and which analytical methods to use for which applications – successful organizations invest in providing their workforce the education necessary to develop this literacy, he said.

"The second point I would make is that data-literate healthcare professionals are genuinely curious about the data," he said. "They don't just passively consume information presented to them. They actively question the reliability of data, challenge the conclusions being advanced, and discern what are the significant insights to be gleaned from the analysis."

This ties in to the importance of effective communication.

"Unfortunately, there is sometimes a tendency to get bogged down with complex statistical methods and fancy graphs, which risks losing sight of the main objective," said. Velasco. "Data-driven businesses are adept at telling stories using data and not letting the data get in the way of the message."

Finally, leveraging data as an asset means being action-oriented, he explained. This means focusing on data analytics that matter, that drive decision-making and enable process improvement, he said.

"This requires alignment with the organization's strategic priorities and key initiatives," he said. "You know you've been successful when the CEO quotes a data point or cites a trend in explaining the rationale behind a major decision for the company."

"CIOs have a key role in promoting a data-driven culture," said Velasco. "Just as they've been essential in influencing physicians and clinical staff to adopt electronic health records and other digital tools, CIOs and their teams will be pivotal in leading the cultural transformation of the workforce needed to embrace data as a strategic asset. A logical place to start is within their own IT department."

Velasco will share more insights at HIMSS19 in a session titled, "Data As an Asset: A Pragmatic Framework for Health Analytics." It's scheduled for Thursday, February 14, from 4-5 p.m. in room W308A.

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Allscripts CEO: Consumerism, machine learning to be key in 2019

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Health IT giant Allscripts Healthcare Solutions will have a massive footprint on the HIMSS19 exhibit floor. It will be showcasing its popular electronic health record system and other related technologies.

And the company will be focusing discussions with HIMSS19 attendees on two trends it says are key in 2019: consumers demanding better healthcare and technology experiences and machine learning gleaning more insights from patient data.

From patient to consumer

The transition from patient to consumer has progressed, said Allscripts CEO Paul M. Black.

"People are taking more ownership of their healthcare, and they expect user-friendly technologies to help them do so," he said. "The solutions that deliver what consumers want are the ones that will be successful."

New entrants to the marketplace – such as IBM, Google and Amazon – will be focused on the patient experience, he said. They will be focused on making it much easier for the consumer to manage wellness and engage with providers.

"As consumers, we are looking for solutions as mobile as we are," Black explained. "We're looking for technology to make it easy for us be active in our own care before, during and after visits. For example, our FollowMyHealth consumer/patient platform expanded capabilities in 2018 to enable real-time SMS messages and alerts. Consumers no longer need to log into the portal; providers can reach them on the go and simplify activity."

When approaching consumerism, healthcare CIOs should simplify their efforts by focusing on a unified platform that integrates all outreach technologies, he said.

Customized services

"In addition, healthcare organizations need to implement solutions that customize services for each patient, recognizing their specific needs," said Black. "Outreach methods such as e-mails, text messages, social media posts and automated voice responses can assist in the delivery of reminders, check-ins and post-care summaries, resulting in better outcomes and lower costs."

Beyond consumerism in healthcare, another trend Black eyes in 2019 is machine learning expanding its ability to gain key insights from health data.

"As we shift to value-based care, the industry must be able to draw insights from ever-increasing amounts of information," he said. "EHRs should be smart enough to deliver the right information at the right time, customized for the user. Machine learning helps deliver real-time insights to the clinician at the point of care, which improves both the clinician and patient experience."

"People are taking more ownership of their healthcare, and they expect user-friendly technologies to help them do so."

Paul M. Black, Allscripts Healthcare Solutions

Machine-learning capabilities within Allscripts' new EHR, Avenel, learn treatment patterns for each clinician, Black explained.

"It pre-populates information based on these patterns and delivers preference reminders," he said. "The technology is monitoring usage trends and identifying opportunities for more efficiency by user, organization and location.

Honing algorithms with analytics

"And through Allscripts Analytics, we're also honing algorithms on our 'data lake' of more than 50 million de-identified patient records," he added. "We're gleaning insights and will bring them to bear on some of healthcare's most difficult challenges, such as chronic care management and the opioid crisis. Stakeholders across the industry must work together to make the most of the opportunity."

Black's advice to healthcare CIOs looking to succeed with machine learning is to make insights easily available within the technology so that clinicians can actually use them.

"In addition, building trust with your clinicians is critical," he concluded. "Sharing how and why these technologies curate knowledge to automate and improve function will help build trust within your organization."

Allscripts will be in Booth 3501.

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

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eClinicalWorks looking to ease physician burnout with trio of tools at HIMSS19

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eClinicalWorks this year is concentrating its efforts, and cloud-based services, on reducing the burden EHRs put on clinicians.

“The epidemic of physician burnout continues to threaten the quality of healthcare,” Girish Navani, CEO of eClinicalWorks said.

To that end, the EHR maker is demonstrating tools, Navani said, “that will help providers save time by eliminating clicks and increasing efficiency and accuracy at the point of care.”

Specifically, those are Prizma, a health information search engine eCW unveiled at its user group in late 2018, the eClinicalWorks virtual scribe, and Eva, an embedded virtual assistant it demonstrated an initial version of last year at HIMSS18 in Las Vegas.

In the year since, eCW has continued winning new customers amid allegations of holding clients’ data hostage and not complying with the Corporate Integrity Agreement provision in its $155 million May 2017 False Claims Settlement with the United States Department of Justice, and being hit with a comparatively minor fine from the Office of Inspector General regarding patient safety risk.  

Navani also gave a taste of what the vendor has in store post-HIMSS19.

“The eClinicalWorks cloud-centric EHR already includes an Electronic Medical Record, Electronic Dental Record, and behavioral health services record,” Navani said. “In 2019, our Acute Care platform will be a primary focus; creating a unified platform across all care settings.”

Branching into acute care settings also means the company is working to advance interoperability efforts. Navani pointed to collaborations with Carequality Interoperability Framework, the CommonWell Health Alliance, the Centers for Medicare and Medicaid Services Blue Button 2.0 API as ways it is enhancing access to health data for physicians and, in turn, patients.

Navani said the eCW will also be focusing its attention on making healthcare more accessible and improving user experience by enhancing patient engagement integration directly through its EHR via healow TeleVisits, and by tapping into FHIR cloud services to enable third-party developers to build patient- and provider-centric apps.

“Today’s complex healthcare systems are increasingly focused on interoperability and integration, promoting more effective transmission and integration of patient data,” Navani said. “We will remain focused on developing integrations and tools for better quality healthcare among systems to help providers streamline patient data and improve health outcomes.”

eClinicalWorks will be in booth 149.

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Kelly Cronin leaves ONC after 15 years

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After 15 years at the Office of the National Coordinator for Health IT, Kelly Cronin, director of interoperability for health care transformation and the first ONC employee, will be transferring to another federal position, the agency said.

Cronin will step into the deputy administrator role at the Administration for Community Living (ACL), according to an internal ONC memo Thursday.

"We are excited for Kelly to have this new opportunity," National Coordinator Dr. Donald Rucker wrote, thanking Cronin for her services. "She will not be far from us on the 6th and 7th floors."

WHY IT MATTERS

Cronin helped establish the initial start-up team and foundational programs at ONC and went on to lead the State Health Information Exchange program, the Beacon Community Program and the Office of Care Transformation.

THE BIGGER TREND

Collaborating with many outside stakeholders and CMS on health IT enabled value-based payment models, Cronin "provided impactful technical assistance to states that facilitated their own approaches to health IT enabled payment reform," Rucker said. "Her leadership and deep knowledge of health IT and healthcare writ large has been instrumental in ONC's success over the years."

Cronin will leave big shoes to fill, as her departure comes on the heels of ONC’s latest report, calling for renewed efforts to advance interoperability. Even though 96 percent of hospitals and 78 percent of physician practices have adopted certified health IT — too many hurdles still stand in the way of progress, according to ONC’s "Annual Update on the Adoption of a Nationwide System for the Electronic Use and Exchange of Health Information" — the agency’s annual report to Congress mandated under the HITECH Act.

The report found that despite HIPAA, patients still lack the ability to access health data and that makes it harder to manage their health and shop around for medical care and providers also lack access to patient data at the point of care.

ON THE RECORD

"[Kelly] has served this organization well through all of its stages, but most importantly she has served the American people with excellence and will be greatly missed," Rucker added. "Please join me in wishing Kelly the very best."

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

Cerner offers voluntary layoffs to unspecified number of employees

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Kansas City-based Cerner has offered some of its employees a "voluntary departure" offer, according to the Kansas City Business Journal.

"We're offering eligible associates a voluntary departure with financial and health-related benefits, providing individuals the chance to pursue other desired career opportunities," a Cerner spokesperson told the KCBJ, which reports that Cerner didn't disclose the terms of eligibility for the layoffs.

In 2016, Cerner conducted a similar round of layoffs, which cost the company $36 million in buyouts.

WHY IT MATTERS
A Cerner spokeswoman told Politico that this round of "voluntary departure" offers might require further "additional adjustments" that will be explored going forward.

The health IT giant has more than 24,000 employees, developing technology and support services for more than 27,500 contracted healthcare organization worldwide in more than 35 countries. It reports a cumulative R&D investment of more than $6.6 billion.

According to Cerner's Oct. 25 earnings call, the company generated $1.34 billion in revenue in the third quarter of 2018, a 5 percent increase from the prior third quarter.

On that call, Marc Naughton, Cerner's chief financial officer, said all of the company's key metrics were "within guidance ranges." He did note, however, that revenue was at the lower-end of the company's guidance "primarily due to lower than expected software and technology resale." Naughton said this would be "largely offset by reduced expenses."

Naughton said Cerner's third quarter "lower level of software" would be expected to also impact fourth quarter, leaving the company's fourth quarter earnings outlook "below consensus estimates." But Cerner's full-year outlook was expected to remain within the company's full-year guidance range, he said.

Cerner will hold its 2018 Q4 earnings call on Feb. 5.

THE LARGER TREND
This past May, after a year-long delay over interoperability concerns and staffing shake-ups, Cerner made it official with the Department of Veterans Affairs for a $10 billion contract to overhaul the agency's legacy VistA EHR over a 10-year period to Cerner's system. In 2015, Cerner contracted with the Department of Defense for a $9 billion overhaul of that agency's VistA system.

A Cerner source told Politico this week that the recent employee buyout won't have any impact on Cerner's VA or DoD EHR implementations.

The House Committee on Veterans Affairs will be watching to make sure. This past July, the committee approved the creation of the Subcommittee on Technology Modernization, to provide oversight of the VA's EHR modernization project with Cerner.

"As the department embarks on the nation's largest EHR overhaul, it is critical that we ensure veterans and taxpayers are protected throughout the transition," said House VA Committee Chairman Rep. Phil Roe, R-Tennessee, at that time. "Congress has a duty to conduct rigorous oversight every step of the way."

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

The Importance of Manual Abstraction During EHR Migration

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State and regional HIEs: 'Don't count us out just yet!'

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Once upon a time, not too long ago, state and regional health information exchanges were really where it was at when it came to interoperability in the U.S. Earlier this decade, the betting was on those HIEs across the country to help build the infrastructure and use cases for nationwide data exchange.

That's why programs such as ONC's State HIE Cooperative Agreement Program disbursed $548 million to 56 awardees in 2010 to help them "develop and advance resources" for interoperability and, eventually, become self-sustainable. As we all know, many of them did just that – but many of them did not.

"That money came and went," said John Kansky, president and CEO of Indiana Health Information Exchange, one of the HIEs that is still standing and self-sufficient. "Some of it was put to good use some of it wasn't.

"But the reality is that as you look across the nation there are some states and regions with very good, very strong, very valuable health information exchanges, and there are some regions that have none," he added. "Some regions have an HIE that still struggles to kind of find its value proposition – and therein lies, I think, the problem when you look from a national perch."

But there is hope – and huge potential – for the HIEs still operating in the U.S. At HIMSS19 next month, Kansky, alongside Indiana Health Information Exchange COO Keith Kelley, will offer a presentation whose title paraphrases Mark Twain: "Said the HIE: 'Reports of Our Death Are Greatly Exaggerated.'"

In recent years, a new nationwide model for interoperability and exchange has emerged and gained momentum, of course, this one largely driven by electronic health record vendors. Groups such as CommonWell Health Alliance and Carequality have built out membership, infrastructure and user base, gaining ground nationwide.

As they have, some in the industry may now give less thought to more traditional HIEs than they used to, said Kansky, or may criticize them for complexity and expense, failure to evolve with the times or develop more robust and sustainable business models.

Some of those criticisms may have merit, depending on the specific state or regional exchange being discussed, he admits. But the larger picture is more complex. In their HIMSS19 presentation, Kansky and Kelley will take a historical look at HIEs – describing why some failed and others have flourished. But they'll also look to the future – highlighting the enduring value such exchanges can bring to the table, especially as they work in concert with other vendor-driven interoperability efforts.

"I want to be clear about our talk: It is not a couple of HIE guys getting on the stage and whining that no one appreciates us," said Kansky. "Because half of our message is to the other HIEs – saying there is great opportunity for HIEs to deliver value if we adapt."

More traditional HIE networks have a role to play in the current interoperability landscape, he said, and many will continue to evolve and demonstrate value for providers, payers and and vendors who partner with them – to say nothing of the patients who benefit from them.

Kansky recently offered some further thoughts on that topic with Healthcare IT News.

On the existing data exchange landscape in 2019:
"Many HIEs are still going strong and making great progress – even on the national level, which they are not known for, since HIEs are thought of as regional or state things. But despite making progress they're a little bit forgotten or under represented in the national conversation about interoperability."

On how HIEs and vendor-driven networks need to work together:
"If you look at interoperability nationally, it's hard to say, 'HIEs can be a solution,' because it's too easy to point to this state here or that region there where its HIE is weak or nonexistent. And so you go, 'Oh well, then they can't be the national solution because there's gaps.'

"But it's too easy for people to say, 'Well, this other thing isn't tied to any region or state, this EHR vendor-driven thing – EHR vendors are everywhere, right? Or what about Direct? People use Direct everywhere!' But when you start digging down into the practicality of any one of those solutions achieving national interoperability, you don't get very far.

"The HIE story is messier. But the reality is that most of healthcare is local. And that and that if you are interoperable local, or interoperable in a region, you're providing a heck of a lot more value than if you're a tiny bit interoperable, nationally.

"I guess that's what concerns me about the direction that the conversation nationwide is going in: We've oversimplified. We're placing our bets on these national approaches and we've forgotten about the regional HIEs because in some places they look a little dead – hence the title of our presentation. But in other places they're the workhorses of interoperability today and, you can make the case, for decades."

On the different ways interoperability can be defined:
"The EHR vendor-driven approaches, if you think about it, are trying to achieve one thing: There's the doctor using their software, or a nurse, who needs information about the patient in front of them who's from somewhere else.

"Is that national interoperability? If I can get a piece of data about a patient that came from somewhere else into my EHR, am I done? I don't think so. Isn't it a lot more complicated than that? What about notifying people about clinical events? What about population health? What about community health records? What about electronic delivery of clinical results? Aren't all those use cases part of what we need to declare ourselves interoperable as a healthcare system?"

On whether an HIE should be thought of like a public utility:
"Yes, and a darn useful utility that keeps chugging along. There have been some big success stories related to the California wildfires, or recent hurricanes in the southeast where the HIEs came in pretty handy. That's another log on the pile for the value they bring."

On how to maximize that value and build it out on a wider scale:
"With regard to the EHR vendors, it maybe seems like I'm trying to detract from their interoperability efforts. That's not at all what I mean.

"Because if I'm talking to a bunch of other HIEs, I would say: 'Well, wait a second we're supposed to be making the nation interoperable, right? And the problem we had 10 years ago was that there weren't a enough clinicians using electronic health records, right? And then we complained five years ago that those EHRs that they were starting to use weren't good at exchanging data and didn't have good interoperability capabilities, right? Well now they do. So that's an asset not a problem, right?'

"The fact that the EHRs are more ubiquitous and the fact that they have better interoperability capabilities – Commonwell, Carequality. Care Everywhere, Outside Record Viewer – those are all assets in the equation of making the nation more interoperable.

"But what's often forgotten is that if you go looking for the people that have the last mile wired and/or have the data available – and in some cases have it in normalized, curated repositories, ready to be exchanged – it's the HIEs.

"So if I'm going to argue that those EHR capabilities are assets, then the vendors should be willing to acknowledge that the HIEs are assets too."

On how the vendor-led approach evolved the way it did:
"I don't think it's necessarily just profit-motivated or not being cooperative. I empathize and I occasionally lecture my HIE peers: If you're an EHR vendor that has to be able to do business in 50 states and six territories, and there are, you know, 10 states that don't have an HIE worth a darn, how do you come up with a solution that works in all your markets? So to an extent they designed their solutions around there not being an HIE there.

"What I wish they were better at is adapting to a circumstance where, 'Hey in this market, there is a great HIE! So let's have more than one approach, let's take advantage of the assets that exist in the markets where we do business. They need to be adaptable, just like the HIEs need to be adaptable.'"

On whether the two approaches will eventually cohere into real nationwide interoperability:
"We are closer to that. And that's why I like to say we're doing this the American way. The American way is 13 different people trying 13 different things all at the same time. And then chaos and the free market economy ensues. And the next thing you know, we've figured out something that is overly complicated, but works.

"Just look at the American healthcare system. Or the American transportation system or the American telecommunications system. It's all really complicated but it works.

"Some people from other industries, talking to people who are trying to achieve healthcare interoperability, they like to throw in our face the example of the financial system: 'Why can't it just be like I got my ATM, I go anywhere in the country or the world, and I can get money?'

"It's like, do you have any idea how complicated the system that makes that possible and how many different networks and standards are involved and how many decades it took for that to be the case? People just assume it's simple. It's not. We're just grossly oversimplifying the solution for healthcare interoperability."

Kansky and Kelley's presentation, "Said the HIE: 'Reports of Our Death Are Greatly Exaggerated,'" is scheduled for Thursday, February 14, from 2:30-3:30 p.m. in room W311A.

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Pew tells ONC that it's time to emphasize safety in pediatric EHR usability efforts

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ONC needs to incorporate safety into the usability of EHR reporting and prioritize safety in new certification requirements for EHRs used in pediatric care, according to Ben Moscovitch, project director of health information technology for the Pew Charitable Trusts, in a Jan. 28 comment letter to Donald Rucker, MD, National Coordinator for Health IT.

Pew’s response follows ONC’s request for comments on its Nov. 28 draft report, “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs,” which proposes making EHRs easier for clinicians to use while at the same time easier to meet regulatory requirements.

The ONC proposal was mandated under the 21st Century Cures Act.

WHY IT MATTERS

In the report, ONC highlights two key challenges with EHRs, namely, poor system usability and ineffective data exchange.

“These same challenges can also introduce patient safety problems and hinder the coordination of care,” wrote Ben Moscovitch, project director of health information technology for the Pew Charitable Trusts. “ONC, through several policies under development, can take steps to address these challenges.”

The Pew Charitable Trusts, a non-profit research and policy organization, has a number of initiatives focused on improving the quality and safety of patient care. The organization also works on facilitating the development of new medical products and reducing costs. Last April, Pew released a report on how to make EHRs easier and safer to use.

THE LARGER TREND

Moscovitch pointed out that usability challenges can arise from the implementation, customization, layout, use, and maintenance of an EHR system.

“These same factors can also contribute to medical errors — such as patients receiving the wrong dose of a drug,” he noted.

Moscovitch explained there are two provisions in the Cures Act that ONC could use to ease EHR burdens on clinicians and improve safety.

One: develop a reporting program to collect data on a variety of EHR-related functions, including system usability. “Given the intersection of usability and medical errors, ONC should ensure that some of these usability-related criteria focus on safety,” Moscovitch added.

Two: issue regulations that establish a voluntary certification program for EHRs used in the care of children. EHRs designed for use with adults can overlook differences in the care of children — such as growth patterns — and introduce the opportunity for error, he says.

In the report, ONC said APIs can be used to improve interoperability, but Moscovitch said, “only if the interfaces are effectively implemented.” 

ON THE RECORD

“Forthcoming regulations from ONC on EHRs used in the care of children and the development of a new reporting program offer opportunities to enhance usability — which would simultaneously reduce burden and improve safety,” Moscovitch added. 

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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