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Articles on this Page
- 08/28/13--08:29: _Imaging Portals: Dr...
- 12/03/13--10:13: _EHR Insider's Guide...
- 12/03/13--10:19: _EHR Replacement: Do...
- 12/03/13--10:25: _Make ICD-10 Easier:...
- 07/26/17--10:00: _HIPAA-Attested Clou...
- 08/14/17--10:32: _Amazon could seek p...
- 08/14/17--12:34: _Using both Direct a...
- 08/15/17--07:22: _MIT Medical picks C...
- 08/17/17--12:02: _The next big thing ...
- 08/18/17--08:50: _Doctors loathe thei...
- 12/03/13--10:13: EHR Insider's Guide: The Secrets of Optimizing your EHR
- 12/03/13--10:19: EHR Replacement: Do It Right - An eBook Guide to EHR Replacement
- 12/03/13--10:25: Make ICD-10 Easier: Get Answers, Get Ready, Get Going
- 08/14/17--12:34: Using both Direct and FHIR standards could improve data exchange
- 08/15/17--07:22: MIT Medical picks Cerner for EHR, population health
- 08/18/17--08:50: Doctors loathe their EHRs, right? Not these physicians
Want to reduce costs and increase flexibility and agility by running healthcare workloads in the Cloud? Oracle successfully concluded another series of HIPAA attestations for Platform as a Service (PaaS) and Infrastructure as a Service (IaaS) Cloud Services, adding to existing HIPAA-attested Software as a Service (SaaS) Cloud Services. We also recently achieved SOC1 and 2 attestations for PaaS and IaaS Cloud Services. We will discuss the results of the latest 3rd party attestations, healthcare use cases relevant for Oracle Cloud, and successful customer illustrations.
Amazon appears to have put its plans to join the healthcare market on the fast track.
On the heels of creating a stealth team to focus on opportunities in the healthcare IT market, the e-commerce giant, now could be positioning itself to take the leap into pharma.
Investment banking firm Goldman Sachs is out with a new report indicating some preparations on the part of Amazon to seek a pharmacy partner as an initial step, reported first by CNBC.
The Goldman Sachs report compiled by five analysts, suggests that Amazon could move its way into healthcare by first partnering with a pharmacy benefits manager, which is a third-party administrator of prescription drug programs.
The move might open up new opportunities for Amazon to cross-sell, according to the report.
In recent weeks, both Amazon and Apple have indicated a more than passing interest in a healthcare play, with explorations including EHRs and telemedicine. To date, the reports are based on unnamed sources.
Another scenario put forth by Goldman Sachs considers Amazon’s potential to speed up the drug delivery process – and home delivery. It would not be unlike what Amazon did with books – and the other products available on its website. Also, Amazon could build its own online pharmacy.
The ecommerce giant also has other pathways to the healthcare industry. It could move its Echo/Alexa into the clinical realm and build or buy telemedicine and remote patient monitoring technology, Goldman Sachs notes.
“There are really large companies in the tech world that are driving really significant growth,” David Solomon, president and co-chief operating officer of Goldman Sachs, notes in a video on the investment bank’s website.
Amazon grew 27 percent on $130 billion in revenue in 2016, Solomon said.
One-fifth of the S&P 500 constituents referenced Amazon on quarterly earnings calls in the past 90 days, according to investment research company Seeking Alpha, which added: “The scope and scale of the companies and industries referencing Amazon show the tremendous competitive reach of the e-commerce giant.”
As HL7's FHIR standard continues to catch on across healthcare, there are ways it can be leveraged to work in tandem with the Direct protocol for better information exchange, a new report from DirectTrust shows.
Hospitals and medical practices could make progress in their interoperability initiatives by availing themselves of both approaches, according to the report, coauthored by DirectTrust CEO David Kibbe, MD, members of the DirectTrust Policy Committee and FHIR architect Grahame Grieve of HL7.
The two approaches are different, but offer synergies that bear exploration. FHIR is a standards framework created by HL7; Direct is an exchange network for easy and exchange of personal health information between providers and between provider and patients.
The white paper, "Direct, DirectTrust, and FHIR: A Value Proposition," explores different ways FHIR's web APIs can complement the Direct standard for more seamlessly exchanging healthcare data.
"The FHIR community’s current focus is 'perimeter interoperability' – that is, exchange of data outside the institution, either with patients/consumer directly, or between institutions," according to the report. "In the USA, most of the focus around FHIR has been consumer to business (C2B) rather than business to business (B2B). This focus is because institutions have their internal integrations and some external exchanges already in place, whereas C2B is where immediate value can be extracted and may lead to a marketplace for apps."
Meanwhile, "the primary use of the Direct protocol is for exchanging data between clinicians and support staff in institutions," the authors said. "Today, as a result of the meaningful use Program, Direct is commonly used to carry C-CDA formatted data between many institutions using version R2.1 of the C-CDA. There were over 98 million such exchanges via Direct in the DirectTrust network during 2016, and approximately 150 million transactions are expected in 2017."
Despite those very different origins and uses, however, there's big potential for harnessing the two specs together, especially across the DirectTrust network, which expect to host 150 million transitions in 2017.
"There is a perceived conflict between the current use and growth of Direct and the future use of FHIR," according to the study, "even though Direct is content agnostic, and FHIR as a resource is transport agnostic."
There are challenges to making the two standards work together – but also, potentially, big advantages.
There are two primary avenues through which Direct/DirectTrust and FHIR could work well together, the study shows. 1) FHIR resources can be pushed in Direct Messages; 2) DirectTrust framework and certificates can support FHIR’s RESTful API
The first approach could be most in cases where "each exchange information flow is unidirectional, and a Direct- based trust network like that of DirectTrust exists between the source and destination (i.e. the source knows how to deliver to the destination). Where these conditions exist, using Direct to send messages saves implementers from recreating the same distribution management system, such as certificate and policy frameworks and trust agreements."
The second strategy holds promise in that "existing work in the FHIR eco-system does not deal with establishing trust between systems," according to the white paper. "To authenticate system-to-system communication, some trust framework will be needed – either point to point agreement about certificates and other security tokens, or some mediated trust community will need to provide a framework in which these are managed. The DirectTrust community could serve this role – this would enable the 100,000+ existing DirectTrust enabled institutions and 1.5 million identity proofed addressess at those institutions to allow connections between each other without the need for point-to-point agreements."
Much more work remains to be done, and the report emphasizes the need for the DirectTrust and the FHIR communities find ways to build engagement to iron out how the technical specifications can better relate to each other and explore the implications for real-world use cases.
"Collaboration is key to getting the best out of standards," said Kibbe. "We should take every opportunity to combine the strengths of different interoperability standards, so that they enrich and support each other," said Kibbe. "No single standard, either for transport, or for content, or for trust in identity, can do everything that is needed by providers and patients wanting to securely share and exchange health information using various tools and technologies," he added.
"The existing work in the FHIR ecosystem does not standardize all aspects of establishing trust between systems,” said Grieve. "While FHIR offers SMART-on-FHIR as a way to delegate authorization, underlying trust frameworks are needed to provide a framework in which these are managed. Working with DirectTrust could potentially save the FHIR community from the costs of building a new trust framework by using one already proven to scale high identity assurance."
MIT Medical will install a Cerner Millennium EHR as well as the company’s integrated financial and population health management technology, the provider announced Tuesday.
MIT Medical is an ambulatory care center that serves more than 25,000 members of MIT, including students, faculty, employees, retirees and families. It operates two locations in Massachusetts – in Cambridge and Lexington.
The technology will help care providers, frontline staff and the business office improve efficiency, which will in turn boost care, said Cecilia Stuopis, MD, medical director at MIT Medical.
The system will also connect electronically to other healthcare institutions, Shelagh Joyce MIT Medical’s director of information services, said in a statement. Moreover, the Cerner platform makes it possible for MIT Medical to store data on one integrated database.
“One of the most compelling things about Cerner is that their own clinicians use the software they develop,” said Joyce. “It’s very unique to find a technology provider with that kind of front-line healthcare experience.”
Part of the technology package at MIT Medical includes a patient portal to connect patients with the hospital and physician practices.
MIT Medical also plans to launch video visits for some types of care.
Cerner President Zane Burke said the technology will not only support MIT Medical’s clinical processes and make patient health management easier, but it will also help clinicians provide value-based care.
On the population health management front, Cerner’s HealtheIntent platform aggregates and normalizes data from various sources in near real-time, providing clinicians data they need to identify locate gaps in care.
HealtheIntent is also engineered to engage patients beyond the hospital setting and help providers manage outcomes, to improve the overall health of the community. The technology creates a single, comprehensive view of an individual’s experiences.
As Amazon's Alexa makes "herself" comfortable in more and more homes, she and similar artificial intelligence technologies could soon be having an impact on hospitals.
AI-based virtual assistants are evolving quickly, and more and more effort is being put into making them emotionally intelligent – able to pick up on subtle cues in speech, inflection or gesture to assess a person's mood and feelings.
The ways that could impact wellness and healthcare are intriguing. By reading into vocal tone, AI platforms could perhaps detect depression, or potentially even underlying chronic conditions such as heart disease.
For example, a Tel Aviv-based startup called Beyond Verbal is working on analytics tools that could work with Alexa et al. to gain insight into behavioral and vocal patterns.
"In the not so far future, our aim is to add vocal biomarker analysis to our feature set enabling virtual private assistants to analyze your voice for specific health conditions," said the company's CEO Yuval Mor in June.
In the nearer term, hospitals looking to realize the benefits of AI and EI need to think hard about where and how they'll deploy the technology as it continues to mature, said Anthony Chambers, director in the life sciences practice at Chicago-based consultancy West Monroe Partners.
The use cases for AI in healthcare are many and varied. Voice-enabled virtual assistants can help clinicians access notes or let surgeons see safety checklists. They can help with staff handle coding and transcription chores. Smart deployments of the technology hold the potential for big gains in hospital efficiency.
"Hospitals have realized they're sitting on mounds of data," said Chambers. "The past few years, they've been starting to take the next steps with narrative science, natural language generation and other machine learning technologies to give them a competitive advantage. We're seeing our clients make a lot of progress on identifying and predicting where efficiencies could be found in the patient care journey."
Lots of hospitals are now using AI and machine learning to "predict where issues are: where they can the get higher throughput, where they can see more efficiency in their care management," he said. "They can measure in real-time how they're doing, how can they gauge capacity, where is the slack in the system."
But in the years ahead it may be patients themselves who could be spending the most time with the AI platforms – and that's where emotional intelligence begins to take on more importance.
"What gets really fascinating – we have yet to see it, but we're seeing discussions of it – is potential uses around the quality of care," said Chambers. "That remains an untapped potential where the promise of emotional intelligence, in combination with AI, could play out."
Hospitals and pharmaceutical companies are starting to explore how the platforms could help clinical trial management, for example: "We already know of one client that is doing a proof of concept to support clinical trials, at the intersection point between provider and pharma," he said.
Natural language processing tools could help with gathering data and predicting outcomes, "giving almost real-time feedback to the physician and the drug company at the same time," said Chambers.
That's especially useful given how stress clinical trials can be on the patient. Offering a less intrusive way to communicate results to both provider and drug company could be a boon.
"If we could use an interactive bot, where the patient then has a point of conversation via smartphone or something, that could be a game changer because of the challenge of clinical trials being so stressful on the population, and the expense of running the trials," he said.
Chambers said he's also seeing more and more providers starting to "dip their toes into automating the bookends of the patient journey" – intake and discharge.
"Being able to potentially monitor the intake with a human in the room, but also an Alexa-type unit listening to the conversation and also hearing the stress or anger or fear in a patient's voice, that may throw up real-time prompts that the human can then put forward," he said. "That use case has been kicked around, a way to support the intake process.
"Think about facial expressions, gestures, pace and tenor of speech," he added. "If you factor those pieces into what a chatbot or robot or other interaction point with a human, that becomes an indicator or piece of data that artificial intelligence and big data algorithms could use to assess outcomes."
As hospitals increasingly look to forward-leaning implementations such as these, there are some important questions CIOs and other IT professionals should be keeping in mind, said Chambers.
For those organizations looking to use AI and EI to help with customer experience or quality of care efforts, "I think the first question hospitals or clinicians are going to have to decide is how will it support that care journey," he said.
Will it displace human interaction, or just augment it? And if it does displace it, where is it going to support the patient, and how are you going to use that communication?
"Because you really are changing the paradigm, potentially, of how you're going to interact with the patient," said Chambers. "Where on the patient journey do you see a need?"
Assuming those questions are ironed out and the implementation is complete, there another important thing to consider, he said: "What are you going to do with that data? It's patient-level data, it's real-time. Does that get then folded into an electronic health record? Do you tag it with social media? Does claims data use it? How does it get integrated?
The issue of privacy alone "is a little daunting," said Chambers. "How do you manage a patient's emotional quotient? I don't know. These are problems we're grappling with. But hospitals and healthcare companies have an opportunity to lead in this space."
EHR dissatisfaction is rampant. Doctors complain about too many clicks and unusable interfaces, to name just two common gripes. Health IT pros and clinicians hear and read about these problems a lot. But the other side of the story -- physicians who say the EHR makes them better doctors -- is less-often told.
“Yes, I love the EHR I use,” said James Legan, MD.
Legan, an internal medicine physician in Great Falls, Montana, who credits the EHR for helping him to practice medicine more effectively, is not alone. Medical Group Management Association CEO Halee Fischer-Wright, MD, while perhaps less exuberant than Legan, said EHRs have considerable promise in the practice of medicine. And then there’s Jeffrey Cleveland, MD, a pediatrician at Carolinas HealthCare System.
Cleveland even went so far as to say that implementing Cerner had an immediate and positive impact on his ability to care for patients.
“I was a better doctor overnight,” Cleveland said. “Absolutely. There’s no question in my mind. I was a better doctor in March 2008 than I was in February of 2008 – because I instantly had data.”
Jeffrey Cleveland, MD, a pediatrician at Carolinas HealthCare System
How EHR love came to Carolinas
When Cleveland started practicing medicine in 1994 at Charlotte Pediatrics Clinic in Matthews, North Carolina, there was no EHR system, and there wouldn’t be one for another 14 years.
The clinic is part of the sprawling Carolinas HealthCare System, which today operates 900 care locations in North Carolina and South Carolina.
The work of getting the health system’s Cerner EHR up and running started in 2008. Cleveland was part of the informatics team that helped launch the EHR in ambulatory clinics first, and later in acute care facilities.
Since then, he has become a champion of EHRs, working to help other physicians get the most out of the technology. Perhaps it’s payback of sorts for what, by his own account, the EHR has done for him – and his patients.
Cleveland paints a typical scenario he encounters.
He sees children who’ve been in the newborn intensive care nursery for two months – because they were born prematurely at 26-week gestation. They’ve been discharged on Monday, and he’s seeing them on Wednesday.
“I’ve got a two-month hospital stay that I can actually go back and look at,” Cleveland said. “All the problems are neatly categorized in a problem list. All the meds are in front of me. All the procedures are right there tabulated in one place, That’s a goldmine.”
These days, after having the EHR in place for a decade, the efforts at Carolinas HealthCare are all about optimization, better integration of tools in clinician workflow.
“One of the things I love about our EMR,” Cleveland said, “is that in the decade since we started using it, a lot of the vendors have come up with a mobile solution.”
Cleveland uses Cerner’s Power Chart Touch. It’s a mobile version of the electronic health record, which is available on Cleveland’s phone or on his iPad, and it helps him to be more productive and better engages his patients, he said.
A screensnap of Amazing Charts EHR interface.
EHRs a boon to patients, too
EHRs are not just popular among doctors at large tech-savvy hospitals.
In Montana, for instance, when Legan transitioned to the cloud-based Amazing Charts EHR and later added CRM from Updox, “it got even better,” he said. He now counts e-prescribing and e-faxing as vital.
Legan added that the technology enables quick coding after each patient visit. It’s easy to provide and easy to read. It’s much more effective than trying to find the information on the old paper superbill.
“I couldn’t do any of this,” he said “if I had not transitioned from paper to EHR-CRM.”
But the biggest benefit is the ability to display the patient’s record on a large screen, which Legan pointed out is an effective way to engage and coach patients at the point of care.
“Clinicians, who have figured out how to use their EHRs to build strong relationships and leverage data from their systems that intelligently inform their decision making, are role modeling the highest and best use of EHRs in a clinical setting," MGMA’s Fischer-Wright said. “Physicians who love their EHRs are those who have worked hard to make their EHRs work for them.”