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- 09/19/16--09:55: _McLeod Health taps ...
- 09/20/16--09:34: _NYU Lutheran launch...
- 09/20/16--10:44: _New ONC chief Vinde...
- 09/21/16--07:21: _athenahealth debuts...
- 09/21/16--09:48: _Surescripts gives E...
- 09/23/16--04:03: _Health IT execs hav...
- 09/23/16--08:42: _See what top EHR ve...
- 09/23/16--08:50: _Chan Zuckerberg Ini...
- 09/23/16--10:05: _HHS aims to grow be...
- 09/26/16--04:08: _Interoperability: R...
- 09/26/16--06:37: _Obama kicks off Nat...
- 09/27/16--08:35: _HHS privacy and sec...
- 09/27/16--10:43: _ONC offers help nav...
- 09/29/16--10:12: _Direct messaging: N...
- 09/29/16--13:12: _CMS gives $347 mill...
- 09/29/16--13:29: _Congress approves $...
- 09/30/16--08:23: _Ransomware spreadin...
- 09/30/16--13:02: _Hawaii Pacific Heal...
- 10/03/16--03:33: _Are EHRs getting be...
- 10/03/16--03:34: _Comparison chart: H...
- 09/19/16--09:55: McLeod Health taps Cerner for EHR, RCM, population health tools
- 09/20/16--09:34: NYU Lutheran launches Epic EHR, implements Imprivata patient ID
- 09/21/16--07:21: athenahealth debuts data-driven athenaInsight hub
- 09/23/16--04:03: Health IT execs have a new favorite dirty word
- 09/23/16--08:42: See what top EHR vendors contributed to 2016 presidential campaigns
- 09/26/16--04:08: Interoperability: Ripe for disruption?
- Update EHR guidance to address implementation of NIST's Cybersecurity Framework controls;
- Update technical assistance for healthcare organizations;
- Revise the enforcement program to include following up with investigated entities;
- Establish performance measures;
- Create procedures to share audit and investigation results with HIPAA.
- 09/29/16--10:12: Direct messaging: Not just for meaningful use anymore
- Carolinas Healthcare System
- Dignity Health
- Healthcare Association of New York State
- The Health Research and Educational Trust of the American Hospital Association
- Health Research and Educational Trust of New Jersey
- Health Services Advisory Group
- The Hospital and Healthsystem Association of Pennsylvania
- Iowa Healthcare Collaborative
- Michigan Health & Hospital Association Health Foundation
- Minnesota Hospital Association
- Ohio Children's Hospitals' Solutions for Patient Safety
- Ohio Hospital Association
- Premier, Inc.
- Vizient, Inc.
- Washington State Hospital Association
- 09/30/16--13:02: Hawaii Pacific Health lands HIMSS Enterprise Davies Award
- It implemented a computer-directed insulin dosing system, development of EHR order sets for insulin dosing and wireless glucometer integration, which significantly reduced the hospital stay for diabetic patients.
- The length of stay for all sepsis patients was reduced by about two days and saved 275 over two years, through the development of a series of order sets and alerts that used best practice algorithms.
- The creation of a data warehouse, integration of ancillary technology to its EHR functionality to drive metrics, engage patients and improved population health management, significantly improved ambulatory patient outcomes and generated $6 million in revenue.
- 10/03/16--03:34: Comparison chart: How readers rated their EHR in 2016 vs. 2015
McLeod Health, an integrated delivery system, will transition its seven acute care hospitals and 90 ambulatory facilities from the Invision financial and Soarian clinical platforms to a suite of integrated Cerner technologies.
McLeod’s 650 physicians ad 1,600 nurses serve more than a million people across 15 counties in South Carolina.
McLeod will employ Cerner’s Millennium Revenue Cycle, integrated with the Cerner Millennium EHR to boost both clinical and financial workflow. The health system will also roll out HeatheIntent, Cerner’s population health management platform.
[Pop Health Forum 2016: What speakers said and panelists debated at the event]
Among the advantages McLeod is expected to reap, according to Cerner, is a streamlined billing process and better clinical documentation to help improve reimbursements and limit claims errors.
Patients will receive a single bill and record, direct access to clinical results and visibility into their financial liability.
“We will provide our physicians with sophisticated tools to develop a more holistic view of each individual’s health history by incorporating financial and community information with the clinical record,” McLeod Health CIO Jenean Blackmon said in a statement.
McLeod, in turn, will use that record to identify gaps in care and analyze population- and enterprise-level data through the use of registries, scorecards and enterprise data warehouse.
Helpful advice for planning to purchase a population health platform:
Brooklyn, N.Y.-based NYU Lutheran has launched Epic's electronic health record, consolidating the clinical systems at the health system's 22 inpatient and outpatient care settings, the health system announced Monday.
The platform integrates with NYU Lutheran Medical Center, NYU Lutheran Family Health Centers and affiliated faculty group practice offices in the NYU Langone Health System. Officials say the goal is better patient-provider communication, improved access to medical records and for patients to share medical history with providers.
The Epic integration links the health system with the larger health information exchange network Healthix and uses a sophisticated analysis and reporting platform to improve patient and provider experience, according to officials.
The health system has also implemented Epic's MyChart personal health record and messaging portal, as well as Imprivata's PatientSecure, a biometric palm-scanning technology that can identify patients at registration.
"Digitizing health records has become a national imperative in order to modernize healthcare for patients and consumers," said Robert I. Grossman, MD, NYU Langone's CEO in a statement. "This enormous undertaking is a key component of our commitment to provider our patients in Brooklyn the world-class care that is a hallmark of the NYU Langone health system."
Planning and development took more than a year, with the health system's IT, clinical and administrative departments analyzed the existing EHR systems and created workflows tailored to the patient population.
The Epic rollout is the largest clinical go-live in the NYU Langone health system to date, officials said. Funding was provided partly by a $29.2-million grant from New York State Delivery System Reform Incentive Payment program.
"The integration of NYU Lutheran and these electronic health record innovations have created an efficient, safe and convenient way we can communicate and deliver healthcare," Bret J. Rudy, MD, hospital executive director and senior vice president at NYU Langone said in a statement.
"We created a seamless way to collect information that respects patients' time as well as their confidentiality," he added. "The end result is improved patient satisfaction and reduced costs. This is an exciting new chapter in how patients experience healthcare at NYU Lutheran."
The Office of the National Coordinator for Health IT has seen its influence and agenda-setting power evolve somewhat over the past decade, but one thing is clear, said its newest chief, Vindell Washington, MD: The agency has helped bring the industry to "a place that is, quite frankly, astounding."
Consider healthcare organizations' adoption of information technology, "the fact that we're looking at well over nine out of 10 – 97 or 98 percent – of hospitals being digitized, and three-quarters of physicians offices being digitized," said Washington, responding to reporters' questions during a media availability on September 19.
"If you look at where people thought we would be when those programs started and ONC was sort of getting its sea legs, people have been astounded by that," he said. "When we have our sessions with foreign delegations, that's one of the questions: 'How did you get to this level of adoption?'"
[What to expect: National Health IT Week 2016 kicks off on Monday]
Now that adoption has reached such a critical mass, "it's time to pivot toward information sharing," said Washington.
Of course, interoperability has been a priority at ONC for some time – before Washington's predecessor, Karen DeSalvo, MD, made it a strategic imperative, before her forerunner, Farzad Mostashari, MD, made data exchange a centerpiece of Stage 2 meaningful use.
But now, Washington seemed to be saying, there was little excuse for further foot-dragging on robust and widespread information exchange.
ONCs approach to interoperability is three-pronged, he said, starting with the encouragement (and sometimes requirement) of nationally-recognized standards and the development, with CMS, of new approaches to the ways care is reimbursed, such as meaningful use.
But "perhaps the most important is working toward cultural changes in the sharing of information," said Washington. "We've done lots of work in that area with the Office for Civil Rights, making sure patients know their information can be exchanged and available when and where they need it for their care."
ONC generally applauds the advancements made by groups such as the CommonWell Health Alliance, the Sequoia Project's Carequality collaborative, Surescripts, and others, he added: "There may be different ways to exchange, and different structures around exchange based on the actual use case."
But "we're also particularly focused on making sure there's a level playing field, that folks are not left out," said Washington. "There's an opportunity to do more. There's more to be done."
Having most recently served as chief medical information officer at Baton Rouge, Louisiana-based Franciscan Missionaries of Our Lady Health System, Washington seen firsthand the value of having data from other health systems easily available in the patient record.
"When I was a provider – as recently as January – one of the things I valued the most about being digitized was the support I got from my electronic medical record in helping me avoid error," he said. "But also the information I could get at my fingertips to help me deliver better care."
The new ONC leader touched on several topics during his call with reporters, from patient identification ("there's some great work that's being done in the private sector – CHIME comes to mind– but it's an area that certainly needs some attention and focus"); privacy and security ("it's a human issue, not just a technical problem"); and the potential for emerging innovations such as blockchain ("we were all relatively surprised in the number and quality of papers" that were submitted in response to ONC's recent blockchain challenge).
But one matter on which he held forth at length was clinical documentation, spurred by discussion of the report earlier this month from the Annals of Internal Medicine, which found that for every hour a physicians spends face-to-face with patients, on average, he or she spends two more documenting the encounters in the EHR.
Beyond the essential note-taking needed to deliver and track quality care, of course, a significant volume of clinical quality measures and other data must be relayed to the government for meaningful use and beyond.
"When is enough enough?" Washington asked rhetorically. "One of the things that strikes me is that it is so different in different sectors of the healthcare environment."
To start, he defended information technology's role in helping create documentation efficiencies: "I (know) providers who implemented their systems, have great patient encounter times and go home on time or even a little bit earlier than they did."
On the other hand, he said, he knows others "are spending time at home documenting – time they'd rather spend with their families.
It's "a mixed picture," Washington admitted. "When the picture is so diverse we're probably still in an evolutionary phase when it comes to the usability of (electronic) records."
He emphasized that he himself, as a clinician, has struggled with the line between quality measurement and actual quality. "It's not an easy scenario. And it's often multifactorial. Asthma might have to do with whether someone lives in a polluted town, rather than whether they've taken their steroids or use their inhaler. In those instances, we operate in a slightly imprecise environment while we try to reach these goals of measurement."
But Washington promised that ONC has thought hard about both "the amount of documentation that's required to provide care, and to signal to others that you're providing care." And he said the agency will continue to push "toward that world where technology enhances the activity rather than putting a burden or pressure on it."
athenahealth unveiled what CEO Jonathan Bush called a “daily news hub” dubbed athenaInsight. Its aim: To report on American healthcare.
The company said it will mine the activity and trends of more than 80,000 healthcare providers and 81 million de-identified patients on the athenahealth network.
It’s something the cloud-based health IT company has done regularly over the years, employing its athenaInsight platform to use EHR data to track flu cases across the country, putting it to work on determining the effects of the Affordable Care Act, and even stepping in for the CDC to monitor disease while government workers were furloughed in 2013.
As Bush described it, athenaInsight provides an unparalleled view into the habits of high-performing health systems, drivers of effective physician leadership and engagement, and trends tied to public health, such as Zika, opioids and the flu virus.
“Healthcare suffers from a critical lack of cross-continuum information and knowledge sharing,” Bush said in a statement. “With athenaInsight, we’re working to address this by putting our network to work.”
Initially, the hub will focus on the opioid crisis across the country. The vendor is collaborating with the Centers for Disease Control to launch the Guideline for Prescribing Opioids for Chronic Pain, an interactive, patient-specific tool designed to be used in 90 seconds at the point-of-care.
Since its launch this spring, this has become the most-viewed guideline in Epocrates, athenahealth’s mobile medical reference app.
Also, in partnership with various specialty societies, athenahealth is identifying and alerting patients with opioid-related health risks and their providers across its network using evidence-based clinical guidelines.
Helpful advice for planning to purchase a population health platform:
Surescripts' announced that several electronic health record vendors, including Epic, eClinicalWorks, Greenway, NextGen and Aprima are now offering its National Record Locator Service to their clients. The NRLS enables providers to see where patients have received care and to retrieve clinical records irrespective of geography.
The nationwide health information network, in fact, just started offering free access to the record locator – which launched this year with data on 140 million patients and more than 2 billion interactions – to EHR vendors until 2019, another example of private-sector collaborations meant to improve information sharing among providers across the U.S.
"We are committed to working with all vendors to accelerate the adoption of record locator and exchange, while adding valuable new services to make meaningful health information available to providers," said Tom Skelton, Chief Executive Officer for Surescripts, in a statement.
Surescripts partners with some of these vendors as part of the Carequality Interoperability Framework, which just this past month announced that eClinicalWorks, Epic, NextGen and others were leveraging common technical specifications to share data among 200 hospitals and 3,000 clinics.
With this new initiative, providers whose EHRs include Surescripts' NRLS will be able to see where their patients have care over time, across locations and among different IT systems, enabling more comprehensive health management.
"Our customers have already seen increases in record location using Surescripts NRLS," said Carl Dvorak, president of Epic. "A free NRLS could be a game changer to expand and accelerate vendor-neutral search – a big win for patient care nationwide and providers preparing for the reality of the post-reform environment."
"We’re very pleased to see that the Carequality Framework is able to advance the work of services like the Surescripts NRLS and to aid in its adoption by so many participants," added Dave Cassel, director of Carequality, which is an initiative of the Sequoia Project. "A big part of our mission is providing the ecosystem in which different services can flourish, all doing their part to ensure that critical health information is securely available, whenever and wherever needed."
When eClinicalWorks rechristened its flagship electronic health record software as the cloud-based 10e, CEO Girish Navani said something curious: “I don’t want to call it an electronic health record anymore.”
Executives at other EHR makers are striking a similar tone recently as well, nominally disassociating their products from the three-letter acronym as if it were a dirty word.
Navani’s reasoning is simply that the core eClinicalWorks EHR is only about 5 percent of what the 10e iteration actually does.
[What to expect: National Health IT Week 2016 kicks off on Monday]
Jonathan Bush, CEO of athenahealth, explained that his company is not an EHR vendor, either, because it offers more, including revenue cycle management, patient communications and care coordination services in the cloud.
Bush also took aim at the federal government’s meaningful use EHR reimbursement incentive program.
“They are driving organizations into [EHR] products.” And while Bush said the idea is “adorable and cute,” he also insisted that it is a mistake.
“Even if Ed McMahon gave you an EHR, your problems would not be solved. That did happen except his name was Barack Obama, and no one believes their problems have been solved,” Bush said.
Cerner President Zane Burke took a different tack in saying he does not actually mind being called an EHR company – while also acknowledging that EHRs will be relegated to heavy transactional systems in the future rather than the central piece of care delivery they are often positioned as today.
“The strategy layer has to be played at a different game,” Burke said. “Fundamentally Cerner will become a population health company. You’ve got to have access to information whether it’s in an EMR or in claims data or PDF data or a national database to help physicians make better decisions at the point of care. You can only do that by having all available information out there. And you’re just not able to do that within the confines of an EHR.”
Whether other vendor executives will start to consider EHR a dirty word as they broaden their technology horizons remains to be seen.
At this point, however, it should be clear that EHRs alone as they exist today will not suffice as healthcare providers move toward population health, precision medicine, chronic care management, accountable care and value-based reimbursement.
Healthcare IT News Editor-at-Large Bernie Monegain and Managing Editor Bill Siwicki contributed to this report.
Helpful advice for planning to purchase a population health platform:
With America deep into the presidential race now is a good time to check into the campaign contributions to Democratic Presidential Candidate Hillary Clinton and REpublican nominee Donald Trump.
Some EHR makers were even ‘feeling the Bern,’ and in certain cases made bigger contributions to Bernie Sanders than either Clinton or Trump.
These statistics come from OpenSecrets.org, a website that keeps track of campaign contributions and encourages others to distribute and cite the material.
Allscripts contributed a total of $13,516 with $12,064 going to candidates and $1,302 to political parties. The vendor’s top contribution – $4,498 – went to Bernie Sanders, while Hillary Clinton received $3,304.
Athenahealth contributions totaled $148,882. Of that, the biggest share – $97,119 – went to Right to Rise USA, a PAC created to support Jeb Bush, who dropped out of the running. The presidential candidate receiving the most money from athenahealth, however, was Bernie Sanders with $13,586, followed by Hillary Clinton $12,102. Jeb Bush, athenhealth CEO Jonathan Bush’s uncle, received $2,700 directly.
Of Cerner’s total $212,220 contributions, $139,820 went to candidates. The biggest contribution went to Rep. Kevin Yoder, R-Kansas, 3rd District, who collected $26,200. Next was a $12,318 contribution to Clinton while Bernie Sanders received nearly as much with $11,583. The company also contributed $35,0000 to National Republican Congressional Committee.
Epic’s total contributions were $37,349. The lion’s share – $22,730 – went to Sanders and Clinton took in $5,128. Trump, for his part, received $205 and the rest was divided among Congressional and other presidential candidates.
McKesson contributed more than any of its rivals: $921,295. Within that, it earmarked $27,655 for Clinton’s campaign, while the rest went to a wide range of House and Senate members and $8,967 went to Sanders.
Sanders, Clinton, Trump and the Super PACs
According to OpenSecrets.org, Sanders had raised $229, 050,714 before he endorsed Clinton on July 12 and left the race. Clinton has raised $516,791,763 to date and Trump has garnered $205,860,765. Super PACs, meanwhile, have raised some $526 million to date.
The Chan Zuckerberg Initiative, led by Facebook founder Mark Zuckerberg and his wife, Priscilla Chan, MD, will invest $3 billion over the next 10 years in an effort to prevent, manage or cure all diseases, Chan announced Wednesday at an event in San Francisco.
While the initiative has already made investments in education and charter schools, this project marks its first major investment in science.
Chan Zuckerberg Science will be funded by the initiative started in December by Zuckerberg and Chan. It will bring together scientists and engineers from various disciplines to build new tools for the scientific community, Chan said.
"We believe the future we want for our children is possible," she said. "We set a goal: Can we cure all diseases in our children’s lifetime? That doesn’t mean that no one will ever get sick. But it does mean that our children and their children should get sick a lot less."
"We should be able to detect and treat or at least manage it as an ongoing condition," she added. "Mark and I believe this is possible within our children’s lifetime."
$600 million of the funding will go toward Biohub, an independent research facility. It will connect the University of California San Francisco, UC Berkley and Stanford University, with the goal of developing tools to measure and treat all diseases.
The project will concentrate on heart disease, infectious diseases, neurological disease and cancer. According to Zuckerberg, the project’s roadmap includes: uniting scientists and engineers; building tools and technology; and increasing science funding.
Part of the project’s focus is to build a cell atlas, which will document the locations and properties of all cell types. Initiative representatives explained the project will also focus on the incorporation of software engineering into databases and the development of engineered human stem cells.
Chan Zuckerberg Science will be led by Cori Bargmann, a neuroscientist from the Rockefeller University.
The U.S. spends 50 times more on treating sick people than curing diseases. "We can do better than that," Zuckerberg said. To accomplish this, there needs to be a shift towards long-term thinking for research, coupled with more funding.
"It’s going to take years before the first tools are built and years after that before the first diseases are treated," Zuckerberg said. "We have to be patient."
Mental health and substance abuse programs across the country will share $44.5 million for training programs aimed at increasing the number of mental health providers and substance abuse counselors.
The Health Resources and Services Administration and the Substance Abuse and Mental Health Services Administration are funding 144 new and continuing grants through the Behavioral Health Workforce Education and Training program.
The Department of Health and Human Services unveiled the initiative, which supports clinical internships and field placements, on Sept. 23.
More than $7.9 million will support 34 new grantees and an additional $36.6 million will fund 110 current grantees.
In announcing the effort, HHS Secretary Sylvia M. Burwell noted the grants are an important step toward creating an educational pipeline for future behavioral health providers.
"The program emphasizes integrating behavioral health, primary care, violence awareness and prevention, and the involvement of families in the prevention and treatment of mental and substance use disorders," HRSA Acting Administrator Jim Macrae, said in a statement.
In 2015, 55 million adult Americans had a mental or substance use disorder, yet fewer than 39 percent of those affected got treatment, according to SAMHSA Principal Deputy Administrator Kana Enomoto.
See the complete list of fiscal year 2016 grant recipients here.
Interoperability as it stands now is a point in time. But what the healthcare industry really needs is a continuous ability to exchange health data among providers.
Mario Hyland, founder and senior vice president of Aegis.net, explained what that means: A hospital using one vendor’s electronic health record might be able to exchange data with another hospital running a different vendor’s EHR platform today – until one or both of those hospitals upgrade to a new version of the software, that is.
After that, there is no guarantee that they can swap records and, instead, all likelihood they'll have an interface problem.
Call it a newfangled government-funded planned-obsolescence upgrade cycle. EHR vendors can sell software that hospitals use to earn meaningful use reimbursement incentives despite widespread usability issues and then those vendors can essentially turn right around and sell upgrades or entirely new EHRs to customers needing a product that qualifies as actual modern software. The circle loops onward.
Such a low interoperability bar does not make for rapid progress. The existing scenario, however, does ripen the entire interoperability realm for disruption.
“We’re at the cusp of interoperability challenges. We’re not almost there, we’re not halfway,” Hyland said. “We don’t even know what we don’t know.”
Network effect? Not soon enough
There is a general consensus that the industry is headed toward a scenario wherein enough hospitals and networks are effectively sharing data with competitors that even the stubborn holdouts will have to cooperate or risk losing patients, falling behind in care services they can deliver, lacking data for population health and value-based payments. That will trigger an inevitable tipping point, the argument goes, after which any providers that want to survive will have to make themselves and their data interoperable.
That network effect may very well happen at some future point. In the meantime, however, there are more pressing challenges.
The chief obstacle is existing provider-vendor business models and the lack of any carrot for sharing or stick for not sharing,” said Brian Murphy, an analyst for HIE Strategies and Technologies at Chilmark Research. “Any carrots or sticks have only been nibbled around the edges so far.”
Interoperability won’t reach the mainstream without widely agreed upon and indeed deployed semantic, data model and data definition standards, according to Mike Restuccia, CIO of Penn Medicine.
“Until then, as evidenced by the rapid migration of health systems and providers toward integrated solutions such as Epic, Cerner and Allscripts interoperability will continue to lag in adoption and under-deliver in meeting expectations,” Restuccia added.
In the here and now, though, hospitals are getting impatient by the reluctance of others to share data without a committed financial incentive or reimbursement, said Doug Brown, managing partner of Black Book Research.
“The catalyst is the benefit hospitals, systems, commercial payers and payviders will gain from the exchange of data,” Brown added.
The coming disruption
Building on that, Mariann Yeager envisions multiple tipping points on the road in front of healthcare providers. Yeager is CEO of the non-profit Sequoia Project, which oversees the eHealth Exchange and Carequality public-private data sharing collaborative.
The first point, Yeager said, is the availability and implementation of software that is technically capable of interoperability and then, on top of that, would follow sufficient forward momentum among hospitals sharing data. A third would be those business drivers Chilmark’s Murphy mentioned.
None will happen overnight.
“At the current pace and process of which interoperability is being pushed forward, when 35 to 40 percent of all visits result in an interoperability request – as we get to that tipping point more interoperability will be broken than solved,” Aegis’ Hyland said. “We’re going to see interoperability challenges start to skyrocket in a number of ways.”
Among those challenges will likely be a digital divide of the provider sorts, said Jane Sarasohn-Kahn, a health economist who meets with rural hospitals around the country lately and found that their top concern is internet connectivity.
“I can see a potential digital divide between those who join and those who may lose market share and never recover,” she said. “Without mandate or incentive, most rural providers will find it tough.”
At the same time, patients are growing fed up. They don’t want to carry around paper records, drives or discs from one appointment to the next.
The overarching question, then: When will hospitals, networks and technology providers finally catch on and bring interoperability out of the abstract and into the concrete?
“It starts with CMIOs talking to CIOs,” Hyland explained “and saying they need software to be higher-quality than what exists today.”
Helpful advice for planning to purchase a population health platform:
As National Health IT Week 2016 gets under way, President Barack Obama issued this statement on Sept. 26:
"I send greetings to all those marking National Health IT Week.
"When clinicians, researchers, individuals, and families have access to the tools, information, and resources they need, everyone can lead safer and healthier lives. During National Health IT Week, we recommit ourselves to improving the health of our citizenry using the breakthrough technologies of our time and reaching for the next frontier of innovation.
"Over the past 8 years, my Administration and Congress have invested billions of dollars to encourage the adoption of electronic health records, with partners in the public and private sectors playing a major role. Electronic health records allow physicians, pharmacists, patients, and emergency personnel to access information quickly and securely – enhancing collaboration, improving decision-making, reducing the risk of errors, and putting individuals at the center of their care. Because of our collective efforts, 97 percent of our Nation's hospitals and three-quarters of doctors are using electronic records to care for their patients.
⇒ What to expect: National Health IT Week 2016 kicks off on Monday
⇒ National Health IT Week 2016: A CIO reflects on 5 key technology advancements
"Last year, I launched the Precision Medicine Initiative, a bold research effort to accelerate innovation and prepare us for a new era of medicine – all enabled by digital data. Precision medicine will help match the latest treatments to individual needs, reducing health disparities and bringing America closer to curing diseases like cancer and diabetes and overcoming epidemics such as opioid misuse. We have also worked to clarify an individual’s legal right to access their health information and transmit it where they choose – whether it’s to a family member or to their smartphone. These efforts help advance our Administration’s goal of fostering the seamless and secure flow of electronic health information when and where it is needed most.
"Though there is more to be done to realize a healthcare system that fits each of our needs, I am confident that if we continue working together, we can build a future of greater health and prosperity for coming generations."
The Department of Health and Human Services' guidance on security and privacy requirements for protected health information and HIPAA compliance fails to meet federal guidelines, according to a U.S. Government Accountability Office report released Monday.
Further, the HHS guidance neglects to cover all elements from the National Institute of Standards and Technology's Cybersecurity Framework, according to GAO, which noted that, as a result, electronic health record data is left vulnerable.
Healthcare organizations struggle with data security, GAO said, which is problematic, given that HIPAA requires them to routinely evaluate technical and non-technical privacy controls.
And although HHS requires risk assessments and risk response development, it doesn't address the ways organizations should customize these key security control implementations, according to the report.
"HHS has primary responsibility for setting standards for protecting electronic health information and for enforcing compliance with these standards," according to the GAO report. "Without more comprehensive guidance, covered entities may not be adequately protecting electronic health information from compromise."
In response, GAO explained HHS officials responded, "They intended their guidance to be minimally prescriptive to allow flexible implementation by a wide variety of cover entities."
While HHS has a compliance oversight program for privacy and security, it often didn't completely verify that regulations were implemented and also failed to help organizations correct its security practices, the report explained.
"For some of its investigations it provided technical assistance that was not pertinent to identified problems, and in other cases it didn't always follow-up to ensure agreed-upon corrective actions were taken once investigative cases were closed," the authors said.
To address and improve these issues, GAO made five recommendations to HHS:
HHS agreed to comply with three out of five of the recommendations, according to the report. It didn't agree or disagree with the others.
The Office of the National Coordinator for Health IT has put out new guidance for choosing EHRs and understanding the fine print of vendor contracts.
The EHR contract guide – subtitle: Selecting Wisely, Negotiating Terms, and Understanding the Fine Print – aims to help providers that are purchasing new systems better understand the intricacies of contract language and negotiate good terms with their vendors.
The guide points toward key rights and vendor obligations that providers can stipulate in their EHR contracts, and also advises about terms to avoid. It also covers patient safety and security risks, data integrity, downtime and other scenarios that can arise after go-live. It seeks to arm providers with the knowledge necessary to enable constructive relationships with vendors handle disagreements with vendors.
"Purchasing processes and contracts have an important role in ensuring information can move freely and securely across all the devices and IT systems used in patient care," said Ed Cantwell, executive director of the Center for Medical Interoperability. "This guide can help foster the dialogue between buyers and sellers to achieve that shared goal."
ONC's accompanying Health IT Playbook, meanwhile, is a web-based tool that offers clinicians guidance on specific usage topics as they put EHRs to work. It highlights best practices and success stories for system implementation; gives advice for workflow, usability and other optimization challenges, and offers guidance on HIPAA, data exchange, quality reporting and more.
"It is great to see ONC stepping up and creating the Health IT Playbook," said Steven Waldren, MD, director of American Academy of Family Physicians' Alliance for eHealth Innovation. "They have engaged family physicians to offer input during the development and we are excited to see it has launched.
"Physicians can find it difficult to keep up to date on the changing requirements for and breadth of information on health IT," he added. "The simple structure and the interactive tools provided in the Playbook will be an asset to family physicians and their practices as they continue their journey of selecting, implementing, optimizing, and switching EHRs."
Helpful advice for planning to purchase a population health platform:
While Direct messaging has had a circuitous path into health information exchange, Nemours is already using the protocol to meet the 10 percent threshold for sending electronic summary care records when transitioning patients to other care settings under meaningful use.
Nemours has Direct messaging integrated with its EHR and also contracts with a separate HISP – health information services provider – which senior manager of strategic process implementation Alex Koster likened to "a telecom company for Direct messaging," during a National Health IT Week webinar on Wednesday.
In Nemours' case, the HISP is Surescripts, but others include DataMotion MedAllies, Medicity, Orion, RelayHealth and many more.
"Once we have that in place, it allows us to generate Direct secure messaging addresses for all the physicians, nurse practitioners and others in our system," Koster added. "And also to create, if we wanted departmental address, such as an endocrinology address or a hospital-level address as well."
That function, he said, is embedded in Nemours' EMR, and routes messages as part of the system's communication and ordering workflows.
"As a large subspecialty and specialty pediatric system we receive many more messages than we send," Koster pointed out. "We have been receiving messages from a variety of different sources, and we've identified message types that come into our system using the Direct messaging framework."
1. Inpatient and ED discharge notifications. "We are the primary care physician of record, and one of our patients goes to a hospital that's not ours. If they have updated their provider directory, they know when they discharge that patient to send us information about the hospital stay via a CCD," he said."
2. Referrals from primary care sites. "Most of them have explored Direct messaging through their local EHRs. They select Nemours – whether it's just our generic address or the address of one of our doctors – from their directories. And they're able to send us referrals directly, using this mechanism."
3. Post-visit notes to PCPs from specialists who come from other health systems. "And also from retail clinics such as CVS," Koster added. "When one of our patients goes to a CVS, they send us a post-visit note via Direct and that goes into our system."
4. Immunization notifications from organizations such as Walgreen's. "Those are coming int our EMR via Direct.
5. Medication renewal reminders from groups such as ExpressScripts
6. Medication adherence notices. "I won't say we've gotten many of these, but where there has been some discussion between patients and a pharmacy on a medication regimen; we've gotten a clinical note, via Direct, where a patient has admitted they haven't followed up with the fact that they've discontinued their medication regimen."
7. Drug substitution notices.
8. Some patient generated messages. "One of the requirements for functionality with patient portals is that they have to have the capability for the patient to transmit using this avenue as well," Koster said. "We have had patients who are relocating from other areas of the country and are coming under our care, sending us their own care summaries."
Nemours analyzes which doctors are transitioning patients to specialists or other facilities, for example.
"We then reach out to those organizations to see how we can enable this electronic transmission, so they have easy access through our communication workflow, our ordering workflow, to select that common referral partner and that (continuity of care document) will go out electronically,” Koster said.
What’s more, Koster added that staff at Nemours has been "making sure, as we've been working with different primary care sites, to capture the Direct address for the physicians or practices, in a way that will be readily available."
That way, when a patient is discharged from a Nemours hospitals and is managed by a referring physician for whom a Direct address is noted, "they will automatically get a discharge summary," he said. "That is also happening from our urgent care."
How Direct got where it is today
When it was first unveiled as a new vehicle for health information exchange back in 2011, Direct messaging was described as "a classic, fantastic, soon-to-be-legendary example of how the public and private sectors can come together in a collaborative, entrepreneurial explosion of mojo to improve and advance healthcare in America."
The secure, scalable, email-like messaging system was touted by one of its architects as "the first technology that could really kill the fax in healthcare."
More than five years later, the hype has abated a bit. Direct messaging has spread somewhat as reliable and cost-effective way for physicians, clinicians and even patients to exchange data, but it still hasn't quite caught on to the extent some – not least government agencies like ONC, which initially convened the who's-who of private-sector IT vendors to helped develop its specs – had hoped.
As David Kibbe, MD, CEO of Direct Trust, which accredits and supports its protocols, told Healthcare IT News in 2015: Direct's use has grown, but it has also, at times, felt like "an uphill struggle."
According to HIMSS' 2015 Direct Messaging Survey, Direct is broadly available and substantially put to work for certain use cases. But many respondents reported difficulties incorporating the messaging with theirs EHRs – while also citing cost, workflow integration challenges and a lack of other Direct-enabled providers as barriers to wider use.
But Direct offers a familiar and intuitive way to exchange information about admissions, discharges and transfers; enables easy consultations between physicians and other clinical staff; offers new avenues for patient communication and much more.
It's also, not insignificantly, a key way to comply with the health information exchange requirements of Stage 2 meaningful use.
More than meaningful use compliance
While Nemours has achieved success in complying with meaningful use, Koster has additional future plans for the protocol.
"If organizations take the stance that this is really all about checking a meaningful use box, it might limit the imagination or creativity that could be applied enhancing their patient experience," said Koster.
Koster recommended taking an approach that technology and tools can be applied to make a better patient experience as well as improving treatment and outcomes.
"We're very much interested in seeing how we can streamline and remove paper from our workflows," he said. "That's part of the reason why we will actually accept referrals that come in via Direct – rather than saying, 'No, send us Direct so we can meet meaningful use, but also fax it to us.' We're trying to eliminate that duplication. I'm not going to say it's been smooth, or perfect, but it's working most of the time and when it doesn't work we're able to follow up and figure out why."
Helpful advice for planning to purchase a population health platform:
The Centers for Medicare and Medicaid Services awarded $347 million to 16 national, regional or state hospital associations, quality improvement organizations and health systems to continue efforts in reducing hospital-acquired conditions and readmissions in the Medicare program.
"We have made significant progress in keeping patients safe – an estimated 2.1 million fewer patients harmed, 87,000 lives saved, and nearly $20 billion in cost-savings from 2010 to 2014 – and we are focused on accelerating improvement efforts," Patrick Conway, MD, CMS acting principal deputy administrator and chief medical officer, said in a statement in announcing the funding.
The 16 organizations receiving contracts in the Hospital Improvement and Innovation Networks:
CMS officials also announced up to $5 million to two awardees over the next three years to leverage primary and specialist care transformation work and learning that will catalyze the adoption of alternative payment models on a large scale.
Initial awards went to: Virginia Cardiac Services Quality Initiative ($670,673) and American Psychological Association ($723,600).
On Wednesday, Congress approved $1.1 billion in funding to combat the Zika virus in a short-term spending bill. In doing so, it's sidestepped a government shutdown.
The House voted 342-85 and the Senate voted 72-26 to pass the legislation, which will fund the government through December 9 and provide time to work out the long-term spending goals for 2017, The New York Times reported. President Obama supports the bill and is set to sign it into law by Friday.
The spending bill was held up for months due to a debate for financing improvements to the lead-tainted water supply in Flint, Michigan. Congress has been under pressure from the White House and other government organizations to pass the law. Vice President Joe Biden told Congress on September 8: "Do your job."
The bill no longer includes restrictions to Planned Parenthood clinics, which hindered past negotiations, The New York Times said. The bill also includes funding for military housing, infrastructure and services.
Further, the bill passed despite objections from both conservatives and Democrats. The agreement is contingent upon a water projects bill, which would authorize $170 million in spending to areas where the president has declared emergencies - like Flint.
"A continuing resolution is a last resort," Rep. Harold Rogers (R) Kentucky and House Appropriations Committee chair said, according to the Times. "But at this point, it's what we must do to fulfill our congressional responsibility to keep the lights on in the government."
2016 has been the year of ransomware in healthcare and beyond, and cybercriminals are continually modifying their techniques to improve the effectiveness of their attacks.
A prime of example of this is the two-year old ransomware Virlock. While the virus has been around for a few years, the most recent strain is able to spread through cloud storage and collaboration applications, according to Netskope researchers.
This means users can inadvertently spread Virlock across an organization's network with a "fan-out" effect, the researchers added. In doing so, Virlock spreads via cloud sync, cloud storage and collaboration applications.
In the past, Virlock was seen as a novel ransomware as it borrowed from a wide range of threat techniques, according to Lysa Myers, security researcher at ESET, an IT security company. However, at the moment, the virus is not that prevalent.
"Malware authors often try to get crafty with adding and subtracting functionality to see if it helps make them more money," Myers said. "Parasitic infectors naturally cause a lot of unintentional corruption of infected files, as malware writers aren't generally known for their excellent quality assurance testing skills."
"So even if (an organization) did pay, they might be left with a larger-than-average number of gummed up files," she added. "As this has been in development for a few years, it would seem the author is rather committed to giving this technique their best shot. Time will tell if this becomes more effective."
Virlock works by first infecting all of a user's files, Netskope researchers said. The new 'infector files' include data synced with the cloud collaboration application, which then spreads to the cloud folder and infects the stored files.
In doing so, other users who click on the files in the shared folder, inadvertently execute the Virlock-infected files and the rest of the files on their machines become encrypted, researchers said.
The virus asks for a Bitcoin payment to unencrypt the machine, but, it appears as an FBI anti-piracy warning. Users must pay the 'first-time offender fee,' which cybercriminals user to scare victims into paying the ransom.
To prevent infection, Myers said organizations should treat Virlock like other ransomware. All software must be updated regularly. Anti-malware should be used and frequently updated, while IT leaders should routinely scan files, removable media and cloud drives. Further, organizations need to enable showing hidden-file extensions, which will filter emails with double-file extensions.
"In general, non-brute force decryptors do not exist, or have not yet been developed, so it's important to use security software to protect against all known strains, and to the largest degree possible, those yet unknown," Myers said.
One of the largest healthcare providers in Hawaii, Hawaii Pacific Health, was named a 2016 HIMSS Enterprise Davies Award recipient, making it the only the second two-time winner of the award since the inception of the program.
Hawaii Pacific operates four medical centers and 70 outpatient clinics across the state, while integrating women’s health, pediatric care, cardiovascular services, cancer care and bone and joint services initiatives.
Established in 1994, the HIMSS Nicholas E. Davies Award of Excellence recognizes outstanding achievement in organizations leveraging health information technology to improve patient outcomes and achieve a return on investment.
Hawaii Pacific demonstrated its health IT successes in three ways:
"As a two-time Davies Award winner, HPH clearly exemplifies how collaborative teamwork, effective planning and use of health IT, and modified clinical process changes when warranted, can result in sustainable improvements in patient outcomes," Janis Curtis, chair of the HIMSS Davies Enterprise Award Committee, said in a statement.
"Substantially improving patient outcomes through health IT is only possible with a special kind of teamwork and trust between physicians, clinical staff and administration," Steve Robertson, executive vice president, chief information officer of Hawaii Pacific Health said in a statement. "To win this honor a second time in five years is humbling, but it does validate how powerful these partnerships are in transforming patient care and creating a healthier Hawaii."
In the year since we unveiled the results of Healthcare IT News' inaugural EHR Satisfaction Survey, the nature and perception of electronic health records has changed. So too has much of what the providers who use EHRs and the vendors who make them think is important.
But many of the complaints about the systems remain the same. For instance, just like in the first survey, one of the most common pieces of anecdotal feedback was a variation of the following sentiment: "Too many clicks!"
Once again, we sought those of our readers who manage EHRs every day to tell us how they really feel. We reached out to CIOs, CTOs, VPs of IT, CMIOs, CNIOs, CSOs and more – in addition to directors of radiology, lab services, cardiology, oncology, pathology and other clinical chiefs.
We sent the survey to professionals at hospitals, health systems, academic medical centers, ambulatory care facilities, group practices, long-term care facilities, the Department of Defense, the VA and others provider sites.
Then we asked them to weigh in on an array of features: interoperability with clinical systems and medical devices, interface and design, quality of installation support, quality of ongoing support services, security features, and user experience.
The 340 who responded did not hold back when assessing the strengths and weaknesses of their systems. They cheered good UX design and robust security settings, but they jeered at intrusive alerts and elusive interoperability.
[Comparison chart: How readers rated their EHR in 2016 vs. 2015]
After tallying the vendors that had a critical mass of reviews, that left the same nine companies as in 2015: Allscripts, Cerner, eClinicalWorks, Epic, GE Healthcare, NextGen, McKesson, MEDITECH and Siemens. The difference this year was the order in which they were ranked.
Except, that is, for the number one spot: Once again, Epic was voted the all-around best EHR – not just in overall satisfaction (with a score of 7.7 out of 10), but in every category our readers rated. Cerner was a close second in the overall scoring, with GE Healthcare ranked third. Allscripts, eClincialWorks, MEDITECH, Siemens, McKesson and NextGen rounded out the list.
Here's what readers said about each.
Click on the buttons below to read what readers said about their vendors and view the scores.
Overall Satisfaction: 7.7
It's become an infamous (if hotly disputed) knock against Epic that it doesn't play well with others. And it was not an uncommon refrain in our survey: "More interoperability, interface capabilities with other systems," pleaded one user. "Cooperate with other EHR vendors and medical device vendors for integration," another humbly suggested. "It would be nice if it were possible to have exchange data from 3rd party EHRs be incorporated as structured data," wrote a third. Design and UX was another complaint. One manager said a "recent upgrade has been challenging as visual appearance has changed and end users have complained." Another hoped for a "more intuitive GUI." Still, one respondent called the user interface "reasonably inviting" and another said simply: "Nice colors." Meanwhile, Epic drew high marks for its versatility ("There is more than one way to accomplish just about everything in Epic"), its "reliability" and - proving that opinions can vary widely and sometimes contradictorily - its interoperability. "It provides the highest level of satisfaction with our providers who use multiple EMRs," wrote one poll-taker. "Most hospitals in our geographic area are currently on the product or switching to it making interoperability real and functional with minimal effort.”
Overall Satisfaction: 7.1
"Not enough consistency in the ordering system," wrote one frustrated clinician of the Cerner EHR. A nurse, meanwhile, weighed in that the system was "not user friendly," specifically with regard to how it's set up for RNs to perform functions for docs, such as "placing alarms for nursing because providers 'can't be expected to remember' things like expiring restraints and/or medications." And while one provider said Cerner's implementation support "should be better prepared to advise pros and cons of design decisions in the short and the long term," they did quite like the "ability to customize the view and add buttons for features that I use" – a BMI calculator, for example. Another noted that, although it's a "very complex EHR, there are several features I like." Among them? "The PowerNotes for the ED FirstNet product, message center that mimics an email server where providers can sign their orders and documents, and the CDS program for medication safety." Another respondent simply applauded a "more complete integration of the patient record than we had in our previous system."
Overall Satisfaction: 6.8
GE may have announced the phase-out of its Centricity Enterprise for hospitals in 2015, but its large practice-focused Centricity EMR product is still going strong – and getting some good reviews from our readers. Complaints about the product ran the gamut: One user wanted quicker "application response," another wished it was "easier to maintain." Indeed, a third wrote that "installing upgrades and service packs requires the client to be installed by an administrator on each of 150 workstations. There has to be a better way!" Still, others had high praise. "Good functionality and I've always gotten good response to my service requests," said one manager. An end user appreciated the "inclusiveness and thought put into workflow." And one respondent said the system functions at a "best of its class" level.
Overall Satisfaction: 6.4
One review complained that the software was "too complex" for clinical end users, with "too many different ways to do the same task." It added that "some of the new modules are immature, not complete." Another said it was "very hard to maintain/enhance the software using our internal IT resources," and that "upgrades of software involve significant downtime." The EHR is "too 'busy,' not easy on the eye," said a third, adding: "Too many clicks." On the other hand, some reviewers very much liked the UX and usability. "Extremely customizable, and able to add automation as we wish," enthused one respondent. Another touted the "dynamic customization capabilities that allow us to tailor the look and workflow to meet the physicians' needs and preferences." A third liked the fact that "all parts of the chart (are) accessible from one screen," and said documentation is "very uniform and simple."
Overall Satisfaction: 6.1
Ongoing support was a big complaint for one eClinicalWorks client. Technicians have "remote (access) into your computer to fix problem which ties up the computer," they wrote, noting he "was on the phone with customer support over two hours with them remote to my computer and still did not fix the problem." He said he could only recommend the EHR for "standalone clinic (with) a full-time IT staff to deal with the multiple problems." Meanwhile, this same person applauded the fact that eCW offers an integrated system with practice management and EHR in one – and, even better, "it's easy to navigate." They called it a "well-written application that fills needs you didn't know you had, from the front staff to the providers."
Overall Satisfaction: 6.0
One MEDITECH client suggested the company consider an "increase ease of use and efficiency" for the the EHR system. Another called the UI "outdated" while another wished for improvements in mobility and "better clinical decision support." One manager of an EHR at a long-term care provider had qualms about that product's efficacy, especially as LTC grows in importance to the care continuum: "Would like to see software that is more adapting to this healthcare setting," he wrote, saying the product looked to be "primarily for acute setting" with an LTC label on it. On the positive side, users liked the fact that "all patient data readily available in a single source" and it's "easy to write custom reports to pull data based on specific needs." "The interoperability between applications and ease of transitioning between them is excellent," wrote one. "It is incredibly reliable. We have less downtime than any other system in the market," wrote another. The MEDITECH system is also reportedly "difficult to hack," wrote a third, adding to its security bona fides.
Overall Satisfaction: 5.4
"The system should be more interactive," was the feedback from one Siemens customer. "Too many clicks before getting what you need." Another hoped for better "testing by development prior to release of upgrades." Wrote a third: "Clunky use. Has no flow to it. Their own interfaces are highly patched between two modules and it still needs workarounds." In the plus column, various Healthcare IT News readers liked Siemens' "customizability," "data density," "accessibility" and "maturing clinical workflows.
Overall Satisfaction: 5.1
"Functionality and service" left something to be desired for one McKesson client. One offered a laundry list of complaints: "database, interface, usability, integration, instability, daily downtime, customer support." Another complained the EHR's "system of using doctor-generated templates for entering information during patient visits is inefficient, slow, antiquated and does not utilize the capabilities of computers," while still another said the system is "not meeting (the) needs of (a) complex, multi-hospital system." On the other hand, there were some bright spots: "Well integrated with ICD10," said one respondent. Another liked "consistency between applications (general look and feel)" and said it was "easy to learn basic functionality." A third applauded McKesson's "safety mechanisms, alerts and overall care guidance."
Overall Satisfaction: 4.4
Atop the list of one NextGen user: Lack of "interoperability between different EHR systems." The EHR "does not communicate with many other systems," they wrote, "therefore, staff are forced to do manual data entry at times or duplicate work." Another echoed the point: "Better HIE connectivity with other vendors." Reconsidered workflow configuration and reduced number of necessary clicks were cited by numerous survey respondents. But some managers had come to appreciate NextGen's strengths. One applauded flexibility, "specialty content" and the fact that the "vendor provides client education on regulatory changes." (More than one appreciated the company's webinar guidance on constant CMS changes.) Said another: "It took four years to fully understand it, but it is a good hefty application. It's like an EMR in a T-Rex body."
Read more of our EHR coverage
⇒ Comparison chart: How readers rated their EHR in 2016 vs. 2015
⇒ 2015 Healthcare IT News EHR satisfaction survey
⇒ Health IT executives have a new favorite dirty word
⇒ EHR interoperability: Ripe for disruption?
When Healthcare IT News conducted the second annual EHR Satisfaction Survey, we found a noteworthy change since the first year’s results: Readers rate their EHRs higher today than they did twelve months ago.
Allscripts, Cerner, Epic, GE Healthcare, MEDITECH, McKesson and Siemens all garnered a higher ranking in 2016 than they did in 2015 — while eClinicalWorks and NextGen dipped in satisfaction rates.
[Main article: See the 2016 Healthcare IT News EHR Satisfaction Survey results]
The overall findings are based on 340 responses from a range of healthcare professionals including clinicians, executives and IT pros at hospitals, health systems, ambulatory care and other facilities.
Participants rated their EHRs based on interoperability, interface, security, user experience and support services.
Read more of our EHR coverage
⇒ 2015 Healthcare IT News EHR satisfaction survey
⇒ Health IT executives have a new favorite dirty word
⇒ EHR interoperability: Ripe for disruption?