The emerging protocol known as FHIR has been most closely associated with interoperability so far. The acronym, after all, stands for Fast Healthcare Interoperability Resources. But if the standard succeeds in its mission of enabling widespread data exchange, FHIR might soon have a higher calling to serve as a foundation for population health management.

"FHIR is a better-designed Lego," said Doug Dietzman, executive director of Great Lakes Health Connect, a self-sustaining health information exchange in Grand Rapids, Michigan. "I'm looking forward to having it in my toolbox."

Feds back FHIR, big-time

There is certainly no lack of public support for FHIR right about now. National coordinator Karen DeSalvo, MD, started the fire at HIMSS16 by launching a $625,000 triptych of developer challenges. One focuses on patient-facing apps, the second on software geared toward providers and for the third ONC is hoping the funding and recognition inspire someone to create what essentially would be an app store for housing these FHIR-based apps and making them available for download.

[Also: See our big gallery of HIMSS16 photos]

DeSalvo described the developer challenges as an opportunity for the federal government to engage private sector entrepreneurs in building technologies that make more effective use of health data for patient-centric care.

"It's time for us to see some digital dividends," DeSalvo said, "to really make that data sing."

That's going to require much more than these developer challenges. In fact, DeSalvo's announcement came just days after ONC unveiled the Interoperability Proving Ground, which the director of ONC's office of standards and technology, Steve Posnack, called a "Match.com for FHIR."

As of March 10, there are currently 61 projects in the Interoperability Proving Ground. While those are not limited to FHIR, the idea is to build a central hub that connects the community of people working on interoperability projects to share lessons learned, best practices and, indeed, to prove the progress already being made.

The MITRE Corp., meanwhile, also used the occasion HIMSS16 to post an open source tool, a web UI called Crucible. Available at ProjectCrucible.org, it enables developers to run 228 test suites comprising some 2,000 tests of the FHIR specification. Entrants are classified as API, resources or administrative, displayed in a graphical map to pinpoint bugs and, ultimately, given a pass or fail grade. 

[Also: Poll: Which health IT trends dominated the conversation at HIMSS16?]

MITRE lead systems engineer Andre Quina cut to the chase: "Having a standard alone isn't enough to achieve interoperability," he said. "Ambiguities in the standard can be disastrous."

Nascent progress en route to population health

Among the early success stories of FHIR in action is the work Duke School of Medicine is doing with FHIR and Apple's HealthKit to integrate standards-based apps such that it can, in the words of Duke's director of mobile technology strategy Ricky Bloomfield, MD, "liberate electronic health records data."

Another perhaps less-covered initial FHIR success is the rheumatology app that Geisinger Health System's innovation unit xG Health Solutions built with FHIR to communicate between Epic and Cerner EHRs basically straight out-of-the-box.

Duke and Geisinger's work offers a glimpse into the much larger potential FHIR holds. 

Indeed, at Great Lakes Health Connect, Dietzman is already thinking about the big picture — as is Corey Waller, MD, medical director at the Spectrum Center for Integrative Medicine, which participates in the Great Lakes HIE.

Hurdles ahead 

Dietzman and Waller acknowledged that FHIR alone won't get the nation to ubiquitous population health management, of course. No single technology or specification existing today can manage that.

Many in the industry, rather, maintain that technology is not the hardest obstacle. Healthcare organizations haven't received strong guidance from the government, Waller said, while Dietzman added that issues such as informed consent and compliance with federal mandates are also inhibiting information exchange.

[Also: Duke liberates Epic EHR data with Apple HealthKit and FHIR]

That said, what FHIR at least has the promise of enabling is something akin to a reliable pathway into data about patient populations.

Waller said he can envision looking at patient records relative to a particular geography to know in which neighborhood to set up, say, an addiction clinic. And that's just one example.

"I can only imagine what we'll be able to do when we have that data," Waller said. "I know I have the keys to a healthier community. I just can't use that data effectively yet."

Twitter: @SullyHIT

This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

John Glaser, whose health IT career spans more than 30 years, will head population health and global strategy for Cerner starting April 1.

The company announced Glaser's appointment just before the 2016 Annual HIMSS Conference and Exhibition, which took place in Las Vegas this past week. There, Glaser signed copies of his new book, "Glaser on Health Care IT: Perspectives from the Decade that Defined Health Care Information Technology."

[Also: See our big gallery of HIMSS16 photos]

Glaser, senior vice president and member of the executive cabinet for Cerner, will assume the new title of senior vice president of population health and global strategy at the company – a fitting position, it seems, for a man who views healthcare IT as inextricably connected to patient care.

Before joining Cerner, Glaser was the longtime vice president and chief information officer at Partners HealthCare. He had been with the Boston healthcare system for 22 years.

Glaser then made the move from the provider side to the vendor side in 2010, when he took the helm of Siemens' global healthcare IT business, which 4,500 employees, multiple health information system brands, a global services arm and Siemens's Information Systems Center.

[Also: Glaser reflects on decade of health IT]

In February 2015, Cerner acquired Siemens for $1.3 billion. That's when Glaser joined Cerner as a senior vice president and member of the company's executive cabinet.

"What hooked me early on was that it all came back to patient care," Glaser writes in his book – a compilation of columns he has written over many years. "There are few things more fundamental to being a human being than taking care of those who are sick, disabled or dying."

Among his many affiliations Glaser was president of HIMSS. Also, he was the founding chairman of the College of Healthcare Information Management Executives, known as CHIME.

[Also: Glaser to advise ONC chief on HITECH]

He has served on the boards of the eHealth Initiative, the National Alliance for Health Information Technology and the American Medical Informatics Association. He also served as senior advisor to the Office of the National Coordinator for Health IT.

Glaser is on the faculty of the Wharton School at the University of Pennsylvania, the Medical University of South Carolina and the Harvard School of Public Health.

Twitter: @HealthITNews

This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.

Healthcare providers operating in New York state take note: Beginning March 27, physicians will be required to digitally transmit all prescriptions. 

Doctors can use either certified e-prescribing technology or electronic health records to perform the task, but those who continue to scribble on script pads will be penalized through fines or, potentially, prison. 

[Also: eRx of controlled substances now legal in 50 states]

The change comes about due to 2012 legislation known as the Internet System for Tracking Over-Prescribing Act, or I-STOP, which requires electronic prescription of drugs classified as Schedule II, III, IV and V by the federal Drug Enforcement Agency.

While I-STOP's initial goal was to curb opioid abuse, this e-prescribing mandate is wider. 

By the end of March, "it will be mandatory for practitioners, excluding veterinarians, to issue electronic prescriptions for controlled and non-controlled substances," according to the New York State Department of Health.

Beyond the obvious problem of drug abuse, this larger goal for e-Rx is to improve patient safety generally by removing sloppy handwriting, and the chance for missed or inaccurate information, from the prescription process, New York Attorney General Eric T. Schneiderman told the New York Times.

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"Paper prescriptions had become a form of criminal currency that could be traded even more easily than the drugs themselves," Schneiderman said. "By moving to a system of e-prescribing, we can curb the incidence of these criminal acts and also reduce errors resulting from misinterpretation of handwriting on good-faith prescriptions."

The the DEA's regulations for EPCS are voluminous and detailed and their regulation process is intense, Cerner senior strategist Matt Moore told Healthcare IT News in 2013, not long after I-STOP was first passed.

But even then the EHR vendor, with help from security companies such as Imprivata, was working to make the process easier for its clients, perhaps predicting that this would become the norm in more states moving forward.

EPCS is "something a lot of our clients are interested in," Moore said. "Depending on who you ask, 20 percent of all prescriptions are for controlled substances."

Twitter: @MikeMiliardHITN

More than 30 healthcare provider organizations have banded together to urge the Centers for Medicare and Medicaid Services to adopt a 90-day reporting period for meaningful use measures in 2016, rather than full-year reporting as CMS has proposed.

Providers proved successful when they rallied for 90-day reporting for 2015.

[Also: Meaningful use will still be part of MIPS reimbursement]

In a March 15 letter to CMS Acting Administrator Andy Slavitt, the groups said the changes CMS made in the Modified Stage 2 final rule for 2015 provided welcomed relief to the provider community.

As they see it, full-year reporting in 2016 would demand complex system changes: "For many providers, these system changes will impact their ability to comply with the full-year reporting period," they wrote.

CHIME, which represents more than 1,800 healthcare chief information officers, is leading the call for 90-day reporting.

[Also: Healthcare industry cheers meaningful use modifications]

"Healthcare providers are firmly committed to using information technology to transform the delivery system," CHIME Board Chair Marc Probst, CIO at Intermountain Healthcare, and CHIME President and CEO Russell Branzell, said in a joint statement. "Changes made to the meaningful use program last year provided welcomed relief from burdensome regulatory requirements.”

"Providers now are awaiting further changes to the program spurred by the Medicare Access and CHIP Reauthorization Act of 2015. However, the current regulatory scheme still calls for a 365-day reporting period. Until the final MACRA rules are issued, providers will be greatly challenged to meet the reporting requirements,” they said.

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"Maintaining 365-day reporting period also will force providers to pull resources away from using health IT to innovate care processes and workflows. Additionally, it will limit the amount of time providers and vendors could spend on improving interoperability and information exchange."

Organizations supporting the change are:

American Academy of Dermatology Association
American Academy of Family Physicians
American Academy of Neurology
American Academy of Ophthalmology
American Association of Clinical Endocrinologists
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Cardiology
American College of Mohs Surgery
American College of Physicians
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Society for Dermatologic Surgery
American Society for Gastrointestinal Endoscopy
American Society of Nuclear Cardiology
American Society of Plastic Surgeons
American Urological Association
America’s Essential Hospitals
Association of Medical Directors of Information Systems
Cardiology Advocacy Alliance
Coalition of State Rheumatology Organizations
College of Healthcare Information Management Executives
Congress of Neurological Surgeons
Federation of American Hospitals
Heart Rhythm Society
Infectious Diseases Society of America
Medical Group Management Association
National Association of Spine Specialists
National Rural Health Association
Oncology Nursing Society
Premier healthcare alliance
Society for Cardiovascular Angiography and Interventions
United Surgical Partners International

Twitter: @Bernie_HITN

Primary care doctors now lose more than an hour a day to sorting through approximately 77 electronic health record notifications, researchers at Baylor University found.

“Information overload is of concern because new types of notifications and ‘FYI’ (for your information) messages can be easily created in the EHR (vs in a paper-based system),” the researchers wrote in the Journal of the American Medical Association  Internal Medicine.     

Making the workload harder to endure, reading and processing these messages is uncompensated in an environment of reduced reimbursements for office-based care, according to the study.

[Also: Epic to develop Apple Watch app, 'Limerick,' a test results notifier]

Physicians are receiving these increasing amounts of notifications in EHR-based inboxes such as Epic’s In-Basket and General Electric Centricity’s Documents. The messages include test results, responses to referrals, requests for medication refills, and messages from physicians and other healthcare professionals.

The system is crying out for change the researchers wrote. “Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed.”

What’s more, optimistic predictions that EHRs would improve patient care through better doctor-patient communications have not ubiquitously materialized.

“Unfortunately, we are far from this promise and now also grapple with the unintended consequences of EHRs,” Joseph Ross, MD wrote in an editorial accompanying the research. 

In fact, electronic “paperwork” has burdened doctors and reduced the time for patient care.

Ross advocated that inbox notification capabilities be periodically reviewed to be sure EHRs are working in the best interests of patient care and not creating an unnecessary burden on physicians.

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In addition, doctors should be reimbursed for time spent reviewing EHR notifications.

“Although many of these notifications are in the service of patients,” Ross wrote, “we need to be sure that physicians’ reimbursement, particularly for primary care physicians, is taking into account the full time needed to manage patients’ care.” 

Twitter: @HealthITNews

Medsphere Systems Corp., whose OpenVista electronic health record is based on the architecture of the Department of Veterans Affairs' VistA EHR, has released a mobile version of the technology called Mobile OpenVista Enterprise, or MOVE.

With secure and real-time access to patient data wherever a clinician has Wi-Fi or cellular coverage, officials say MOVE – which includes Medsphere's NoteAssist patient documentation system – allows physicians and nurses to review medication orders and record patient information on the go.

[Also: OpenVista EHR maker Medsphere merges with MBS/Net]

"Without doubt, healthcare IT is moving toward mobility and enhanced, streamlined processes," said Medsphere President and CEO Irv Lichtenwald in a statement. "Medsphere is excited about moving OpenVista in that same direction."

On March 17, Medsphere also announced an expansion of it products and services since its recent mergers with Phoenix Health Systems and MBS/Net. Phoenix Health continues to integrate its infrastructure support and application management skills with Medsphere's offerings. Meanwhile, MBS/Net's technology, such as physician practice management system and ambulatory EHR, are being integrated with OpenVista, officials said.

Twitter: @MikeMiliardHITN

Physicians are embracing electronic prescribing more rapidly than ever before, according to new data from Surescripts – especially in New York.

In the Empire State, more than 48,000 providers have embraced digital prescriptions as a way to avoid fraud and abuse of prescription drugs – and a way to avoid fines. The deadline for complying with the state’s Internet System for Tracking Over Prescribing, or I-STOP, mandate for digital prescribing is March 27.

[See also: NY e-prescribing law takes effect March 27, doctors now face fines for pen-and-paper.]

Since March 1, the number of New York providers adopting electronic prescribing of controlled substances increased 28 percent, Surescripts reports. New York Is ahead of other states in e-prescribing adoption with 47 percent uptake, compared with numbers nationwide at just 8 percent.

“The industry has made remarkable progress in adopting this critical technology that can have a direct and immediate impact on improving patient care and saving lives,” commented Surescripts CEO Tom Skelton, in a news release.

Skelton pointed out that pharmacy adoption of the technology is nearly universal, with 95 percent of pharmacies in New York ready to prescribe controlled substances electronically.

In 2013, more than two million Americans abused prescription painkillers such as hydrocodone, oxycodone and methadone, according to Surescripts. Drug diversion is a significant concern when it comes to controlled substances, officials say, with between three and nine percent of diverted drugs for abuse tied to fraud or forgery of paper prescriptions.

The times are changing – not only in how care is delivered but, equally as important, in the ways hospitals, doctors and healthcare workers will be paid.

"The regulatory landscape is getting tougher," said Caleb Anderson, who heads up the ambulatory reimbursement business for Cerner. The market for revenue cycle management is poised to grow big time – and practices and technologies are bound to change as well. "I don’t see it slowing down by any means between now and 2019."

That’s because in 2019 the Medicare Access and CHIP Reauthorization Act will create a fundamental shift in physician reimbursement. And MACRA is poised to arrive against the backdrop of health systems getting larger via consolidation, acquiring physician practices and other partnerships.

[Also: Revenue cycle pros share insights into the future of healthcare finance]

As the health system itself changes, the revenue cycle, too, is likely to evolve.

"The fundamental business model of billing services is going to get different in the next several years as you move to a capitated payment or a risk model," Anderson said.

As that shift happens, Anderson envisions a lot of hospital executives wanting to shift some of that risk to companies for revenue cycle management tools and practices, such as Cerner, athenahealth, eClinicalWorks, NextGen and Conifer, to name a few.

At Cerner, for instance, that business is called BOS – Business Office Services – not RCM. But regardless of what it’s called, it’s about revenue and how to reap all that is owed the provider.

Instead of an RCM service provider contracting with clients for a percentage of net receipts – which today is anywhere from 4 to 6 percent of the amount collected – a new model of reimbursement is likely to emerge with capitated payment.

Anderson said that one potential option is to have a vendor run the patient call center, submit claims, handle denials, and essentially take care of everything up to the point where the customer determines it’s time to turn a patient over to collections.

And there’s a perhaps less-frequently discussed upside to outsourcing revenue cycle management:

"We may be in an era where we’re helping to manage gaps in care in order to avoid that patient having an intervention or an encounter in order to maximize reimbursement," Anderson said. "I think there are a lot of things that are going to play out in the next decade to grow the RCM business model and probably fundamentally change how it’s sold in the market – what RCM means."

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

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Mergers and acquisitions are often conducted with the aim of saving hospitals significant amounts of money by consolidating clinical and IT systems and processes to achieve economies of scale — but new research from PwC finds that such deals are rarely successful in that regard.

"Bigger companies are not yet able to convert their size into operating efficiencies," the authors wrote in the report.

Instead of having an integrated organization, PwC said, the merged health systems are often still run as individual hospitals. And that starts with top executives.

"A CEO of a hospital owns his or her own kingdom," said Anil Kaul, a PwC principal and one of the report authors. "They think of other hospitals as competitors, even if they're part of the same system."

[Also: Cerner's point man on revenue cycle talks outsourcing options in a risk-based world]

For the study, the authors analyzed 5,600 individual facilities and 525 health systems using data from Centers for Medicare and Medicaid Services. They didn't give information on specific systems, but focused on the statistics, they said.

PwC found that for individual facilities, larger hospitals do have a lower cost per encounter than smaller hospitals. When it comes to health systems with multiple facilities, however, the report found no relationship between size and cost.

Two hospitals within a 10-mile radius of each other, for instance, are often serving the same population, splitting the number of surgeries rather than pooling their resources, said report author and PwC director K.R. Prabha.

Also, when health systems look at saving money, they generally start with administration and the supply chain, they said. A centralized human resources, finance and IT department are obvious choices, Kaul said. As are revenue cycle and service line management when appropriate for specialties.

Yet the real savings could come from the clinical side, as that's where the majority of money is spent, Prabha said.

[Running list: Health IT mergers and acquisitions.]

"Eighty-five percent of the spend is on the clinical part of it," she said. "What we found was physicians that did more pre-procedure work got shorter stays in the hospital (after the procedure).”

The authors also said that patients should have a similar experience in every facility of a single health system. 

"When you look at the reason for the merger, it's less about reducing cost and more of a land grab for market share to get more negotiating leverage with the insurance company," Kaul said. "Some acquisitions are not about reducing costs, they're more about filling the portfolio."

Kaul, Prabha and Suman Katragadda, a PwC director, co-authored the report "Size should matter: Five ways to help healthcare systems realize the benefits of scale."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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Massachusetts General Hospital and Philips are embarking on a clinical analytical study to gauge the effectiveness of digital alternatives for pathology work.

The project will assess Philips’ IntelliSite digital pathology whole slide imaging technology to determine IntelliSite’s effectiveness in detecting disease.

“With rising healthcare costs, we have a public responsibility to work effectively,” Jochen K. Lennerz, MD, principal investigator of the study and an Assistant in Pathology at Mass General’s Center for Integrated Diagnostics, said in a statement. “Through the genomic revolution we have started to learn how to manage big data. Now there is a pressing need to gain access to and increase flexibility in how pathologists manage the massive amounts of imaging data we procure every day.”

If digital whole slide imaging gets cleared for diagnostic use, it would replace the analog process widely practiced today and enable pathologists to switch to a digital system for their routine work.

Pathologists play a critical role in the detection and diagnosis of a wide variety of diseases, including cancer.

[Also: Mount Sinai to digitize glass slides]

Here’s how the analog process works today, according to Philips executives: Most tissue-based diagnoses are rendered through analysis performed on a microscope using sections on glass slides. Once interpreted by a pathologist, they inform the final treatment pathway that has a significant impact on the patient and their families. In the process, providers often have to ship the glass slide samples for expert consults, running the risk for lost or damaged specimens and communication delays.

Philips general manager of digital pathology solutions Russell Granzow added that digitizing pathology can streamline workflows to improve efficiencies that can, in turn, be scaled internally to reduce costs.

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

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Clinical decision support is designed to deliver the most relevant patient data to the physician at the time it is most needed – namely, when a critical choice about care has to be made. It is not a new concept and the healthcare industry certainly has the technology available to make it work at an optimal level.

Still, there is room for improvement on both the provider and vendor ends, say specialists in the CDS field.

"The traditional definition of CDS is what you can do within the electronic health record to support better decisions, but across the industry the state of decision-making is really bad," said Dale Sanders, senior vice president of Salt Lake City, Utah-based Health Catalyst.

"You have spots of innovation in some areas, but as an industry CDS at the EHR level is really bad. On a scale of one to 10, I'd give it a three or four. But there is great movement around improving it, so we're optimistic."

The keys to optimizing clinical decision support are three levels that Sanders calls the "three p's – population, protocol and patient." Each level has its own self-contained purpose, but together they coalesce into an effective program.

"When you're making decisions and putting data in front of patients, they are as important to CDS as doctor is – both parties have to be involved," Sanders said. "The decisions you make about clinical care and strategy at the population level is a different skill set, different strategy and different method than at the patient level.

"The next level down is the protocol level, where you narrow the number of patients affected," he added. "Within the population, it is about developing specifics for clinical protocols of a certain type – the temporal dimension of decision making, measured in months and weeks. The final tip is delivering to the personalized level for the patient."

In grading the industry based on his "Three Ps" benchmark, Sanders says efforts at the protocol and population levels get "passing grades" due to increased emphasis on making them better. However, he imposes "a failing grade" at the patient level due to "a lack of vision, priority and leadership" around the topic.

Extracting actionable data
The machinery is in place for deploying CDS, but the industry has faced various obstacles in getting it up to speed, says Foad Dabiri, chief technology officer at San Francisco-based WANDA. Principally, he says, the challenge has been with extracting actionable information from the various system silos.

"It is getting actionable information – what you can collect and record," Dabiri said. "The question is, what information is the physician looking for and how can it be seen?"

Having instant access to actionable data is paramount when making decisions to keep chronic disease patients from costly hospital readmissions, he said. Diagnosing the symptoms of a homebound patient with congestive heart failure, for instance, requires enough granular information so that the physician can determine if an episode such as fluid retention can be handled with a remote intervention or if the situation is more urgent in nature.

"A patient can show signs of something wrong, but that is very different than a tangible outcome," he said. "What we do is combine various symptoms and vital signs, and through analysis correlate the historical value and combine it into a single decision."

Technology has advanced to the point where CDS should be readily utilized, but Dabiri maintains that many provider organizations are still overly reliant on proprietary legacy systems that prevent mobile access.

"The industry recognizes the need to upgrade – providers need to move from an in-network system to a cloud-based system," he said. "That would provide more scalability, reliability and access to electronic records."

Seeking 'knowledge'
For physicians contemplating implementing a CDS system in their practices, there are some considerations they need to make, such as determining what type of CDS is most suitable as well as adhering to HITECH Act requirements.

Allan Ridings, senior risk management and patient safety specialist with the Cooperative of American Physicians concedes that there have been "trust issues" with CDS in the physician community, which is why the sector is not as proficient in its utilization as it should be. Moreover, he says EHRs evolved in a backwards fashion, starting with the claims and financial data and moving to clinical diagnostics instead of the other way around.

In looking at CDS systems, physicians will find two kinds – a knowledge-based system and a data mining system. It is essential they know the difference, Ridings said.

A knowledge-based system obtains patient data from a result engine and "reveals all discoveries based upon the data being enquired upon," he said. "This type of system is also known as ITTT –'if this-then that' and could be used for determining drug interactions."

Data mining is based on algorithms, artificial intelligence and machine learning from previous entries. "They might be used to examine a patient's medical history in conjunction with reliable clinical research," Ridings said.

Whichever system they decide upon, physicians need to make reducing risk and maximizing patient safety their highest priority, he said.

Replacing the 'gut'
As a physician himself, David Delaney, MD, chief medical officer for the SAP Public Services and Health Care Industries team in Newtown Square, Pennsylvania, understands the traditional medical process of "using your gut, intuition and experience" in decision making. And while some old-school docs might still prefer that method, Delaney realizes the tremendous clinical advantages of CDS.

"The ability to leverage organizational knowledge to bring better decisions has been lacking in the industry," he said. "The data also includes claims and financial data that are needed to understand the 'value' in value-based care. I believe we are ready to pivot into an era where if there is information available that can impact a decision, it must be brought to bear."

CityMD, a New York City urgent care provider, has launched the 10e cloud platform from eClinicalWorks, connecting the electronic health records of its 52 campuses and about 300 providers.

The platform will maintain care coordination and critical data access at the point of care and automate processes among practice locations, helping lower costs, officials say.

The EHR incorporates eClinicalWorks patient engagement and population health tools, enabling better preventative care. Since implementation, CityMD says patient experience has improved from registration to after the patient leaves the campus.

[Also: eClinicalWorks makes big move into acute care EHRs, signs Tidelands Health]

"Our organization is rapidly expanding, requiring a partner that is an innovative leader that will scale with us," CityMD CEO Richard Park, MD, said in a statement. "eClinicalWorks provides enhanced care coordination and patient-centric tools, along with helping us stay nimble."

Launched this past October, the HTML5-based 10e platform also allows data feeds from patients' health and wellness trackers and enables integrated telehealth visits from within the EHR.

"Our intuitive technology and integrated patient engagement tools aid clinics and health networks in delivering quality care efficiently," said eClinicalWorks CEO Girish Navani in a statement. "We're excited to partner with CityMD."

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

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Ransomware attacks are growing in severity and sophistication. Two newly-discovered strains, Samsam and Maktub Locker, are prime examples of what healthcare organizations can expect in the near-future.

The ransomware Samsam gains access to an organization's network by exploiting vulnerabilities in JBoss servers, such as a missing patch, and spreads to all machines connected to the network.

Maktub Locker, for its part, enters through spam or phishing emails with a virus hidden in an attachment, like a .ZIP file. Once opened, MakTub encrypts all data and systems connected to the network.

What's interesting about Maktub is that it doesn't just send an email and download items onto a computer. As soon as the .ZIP file is opened, a malicious rich text file infects the entire system, said Lee Kim, HIMSS director of Privacy and Security, Technology Solutions. And the email looks legitimate, such as a "Terms of Service" or "Terms of Use" document.

It differs from other ransomware, such as Locky, as it's an "all-in-one" attack. Other viruses require a downloaded key and send a message “home” to gain the
encrypting tools. But Maktub and Samsam have the tools locally.

[Also: Latest cybersecurity threat, 'Locky,' spreads faster than any other virus]

"Even if your network’s connection is shut off, it can encrypt anything and everything it has access to," Kim said. "All that you need is the email; even if you're offline, that won't protect you."

Both viruses encrypt data and files - including backups on the network, while Maktub can also compress the encrypted files and data. Strong encryption is used to hold the files, until the encryption key is released by the attacker.

"There are more and more healthcare organizations getting hit, but it's because the virus has evolved into this complex beast on how it's deployed," Kim said.

She recommended that healthcare organizations backup data in real-time, in order to revert to those files without losing information in case of an attack. Organizations also need store data offline, and networks should be segmented with a properly-configured firewall with routine risk assessments.

"We need to make sure we have a complete, strong security program that blocks the malware we know about," Kim said. “So if something gets into our system, we can stop and eradicate it to stop the bleed. It's also really important to block and tackle what you can – and have a plan."

Kim added that there's no substitute for good security.

"It really is a battle between these cyber criminals and the rest of us," she said. "There definitely is a learning curve, but we can benefit as a community to try to build these solutions together."

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

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