CommonWell Health Alliance on Tuesday announced the new CommonWell Connector program, which offers access to the data exchange network for care providers and electronic health records who may not necessarily be CommonWell members.

WHY IT MATTERS
Through the program, specific CommonWell vendor members who make integration platforms can offer the alliance's interoperability services to their customers, officials said. Those EHR companies who link up via a connector wouldn't be required to become a CommonWell member or certify their products on its network, because the member serving as the connector will have a certified product and act as an intermediary.

CommonWell said it will enable certified CommonWell Connectors to "minimally pass-through its flow-down terms to their connected EHRs while enabling those CommonWell Connectors to include additional services, as needed by their customers."

This will be useful for hospitals and health systems looking to manage the requirements of an array of new regulations, such as the CMS Promoting Interoperability Programs and the Trusted Exchange Framework & Common Agreement.

Among the CommonWell members who are the first CommonWell Connectors: Health Gorilla and InterSystems, each of whom plans to roll out connectivity service later this year.

InterSystems will allow users of its HealthShare suite to link up with CommonWell, getting a more "comprehensive view of the patient (that) drives care toward the triple aim," said Don Woodlock, vice president of HealthShare for InterSystems.

Health Gorilla CEO Steve Yaskin said that broader access to clinical data can help "rally the entire ecosystem to improve access to high quality care, especially in underserved markets like Puerto Rico."

THE LARGER TREND
As it stands, CommonWell, whose members include some of the biggest EHR vendors and their health system clients, offers a wide footprint for its interoperability services. In combination with Carequality – the two rolled out general connectivity to their members this past November– the hope is, when that connection is fully live, some 80 percent of physicians will be able to share data, irrespective of which EHR they use, as Micky Tripathi (who sits on the board of both CommonWell and The Sequoia Project, which oversees Carequality) explained.

There's clearly big value in such a network, allowing the "ability to exchange patient records within the reach of most acute care or clinic-based provider organizations, regardless of size or financial situation," as KLAS put it this past December, in a report encouraging more providers to sign on with those efforts. The new CommonWell Connector Program offers another way in for those hospitals and practices who may not yet be full-fledged members.

ON THE RECORD
"The CommonWell network enables participating practitioners to meaningfully engage in data exchange to provide the best care possible for their patients," said CommonWell Health Alliance executive director Jitin Asnaani in a statement. "With this new option, organizations interested in connecting to CommonWell, such as EHRs, can dramatically reduce the development effort required to connect to the CommonWell network and enable their clients to participate in – and derive value from – this data sharing."

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

Healthcare IT News is a HIMSS Media publication.

A major centerpiece of discussion at Epic's booth at HIMSS19 in Orlando next week will be the continuing evolution of the One Virtual System Worldwide initiative it launched just over a year ago– functionality that enables Epic customers to be be able to do more with their clinical data within and across different healthcare providers.

As Epic CEO Judy Faulkner explained at the company's annual User's Group Meeting this past summer, the technology is able to leverage the sheer size of Epic's customer base to enable more holistic data sharing for more complete narrative views of patients: "You've eliminated the silos from within your organization," she said. "Now it's time to eliminate the silos from outside."

But that's not all, of course. In Orlando, the vendor will be showcasing its innovations in a variety of areas, said Sean Bina, Epic's vice president of patient experience and access: "voice assistants, social care, population health, and many other areas – especially new features for patients," he said.

Epic is focused too on helping its clients navigate some of the seismic changes and new imperatives  affecting healthcare in 2019, said Bina, such as improving the patient experience, enabling ease of use for clinicians who interact with its technology each day and helping achieve "healthy operating margins for health systems."

The company is working to help providers take a more expansive view of population health, he said including "social care, connecting health outside the traditional clinic and hospital walls – with insurers, dental, retail clinics, labs – and much more."

Epic touted the fact that invests 40 percent of its operating expenses in R&D. So what are some innovations it's pursuing right now? Bina sees an exciting future set to be transformed by leading-edge technologies, and HIMSS19 will offer the chance to explore these advances in-depth.

More and more, he said, healthcare is moving toward an state where "artificial intelligence and machine learning are increasingly embedded directly in workflows, and virtual assistants combine speech recognition with natural language processing to help clinicians come up-to-speed on patients and easily document notes and follow-up," he said.

And the era of consumerism and mobile device ubiquity is also transforming the way Epic prioritizes its efforts, said Bina, as its technology is put to work "incorporating price transparency for patients and cost awareness for clinicians," as well as "identifying patients at risk and mobilizing resources to help them."

For instance, Epic's MyChart portal is "enhancing the patient experience by providing three dimensions of contextual awareness: 1) Who the patient is and how they want to be treated, 2) Where the patient is and the tools they need in that venue of care, and 3) What patients need given their clinical situation," he explained.

The big-picture goal of all this, said Bina, is "helping patients find the right path through the healthcare system – regardless of whether they prefer an e-visit, video visit or a visit with the doctor."

Epic will be in booth 2159 at HIMSS19.

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

Healthcare IT News is a HIMSS Media publication. 

Meditech has announced it is adding an opioid stewardship toolkit to Meditech Expanse, the company's web-based electronic health record.

WHY IT MATTERS

Research firm KLAS found that many healthcare providers are looking to EHRs for help with the opioid epidemic, whether that is with new clinical decisions support features or connections to state prescription drug monitoring programs. Still others are customizing their EHR for similar purposes. 

Meditech's toolkit is aligned with 12 chronic pain management recommendations from the Centers for Disease Control and Prevention (CDC), and includes in-workflow access to state-regulated prescription drug monitoring programs (PDMPs), access to an electronic prescribing for controlled substances (EPCS) solution and an embedded opioid risk tool (ORT).

THE LARGER TREND

Meditech said the toolkit will support healthcare organizations in the effort to identify high-risk patients, realize safer opioid prescribing, and reduce opioid-related harm. The toolkit consists of evidence-and experience-based tools and clinical decision support interventions, along with best practice workflows and educational materials, the company said. 

[Special Report: How tech and policy are fighting the opioid epidemic]

Meditech’s announcement comes as the Bipartisan Policy Center seeks better integration of clinical, behavioral health data in EHRs to prevent suicides and to quell the opioid crisis.

Drug overdose deaths involving prescription opioids has risen from 3,442 in 1999 to 17,029 in 2017, according to the National Institute on Drug Abuse.

The Center is calling for Congress and the Department of Health and Human Services to do more to enable data sharing for at-risk patients. Recently, both the House and the Senate have supported bipartisan bills designed to incentivize adoption of EHRs by psychologists, psychiatric hospitals, community mental health centers and others.

In a December article in Healthcare IT News, John Glaser, senior vice president of population health at Cerner and Michael Fadden, Cerner’s chief medical officer, said properly configured EHRs are a start for helping to fight the opioid crisis. From there, top leadership can employ several tactics to address the difficult and complex challenge.

This is the second time in a couple of weeks that Meditech has announced an addition to its EHR. On Jan. 31, Meditech and Nuance said they will integrate Meditech’s Expanse EHR with Nuance’s Dragon Medical Virtual Assistant to enable clinicians to perform clinical and administrative tasks with voice activation.

ON THE RECORD

"Meditech Expanse provides consistency and guidance so that anyone using the Opioid Stewardship Toolkit can appropriately follow CDC guidelines and minimize misuse of opioids, and also minimize the side effects of opioids," said Upendra Thaker, MD, Associate CMO, Mount Nittany Medical Center in State College, PA. 

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com

The U.S. Department of Justice on Wednesday announced that Greenway Health settled a False Claims Act suit by paying $57.25 million.

“In its complaint, the government contends that Greenway falsely obtained 2014 Edition certification for its product Prime Suite when it concealed from its certifying entity that Prime Suite did not fully comply with the requirements for certification,” the DOJ said in a statement. “Among other things, Greenway’s product did not incorporate the standardized clinical terminology necessary to ensure the reciprocal flow of information concerning patients and the accuracy of electronic prescriptions. Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary.”

Specifically, DOJ said Greenway’s EHR did not include clinical terminology necessary for the “reciprocal flow of information,” and accurate electronic prescriptions.

“Greenway accomplished its deception by modifying its test-run software to deceive the company hired to certify Prime Suite into believing that it could use the requisite clinical vocabulary,” DOJ explained.  “The government further alleges that Greenway was aware that an earlier version of Prime Suite, which was certified to 2011 Edition criteria, did not correctly calculate the percentage of office visits for which its users distributed clinical summaries and thereby caused certain Prime Suite users to falsely attest that they were eligible for EHR incentive payments.”  

Greenway did not correct the problem, DOJ said, so that its users could continue attesting to meaningful use measures and get reimbursed accordingly.

“Finally, the government alleged that Greenway violated the Anti-Kickback Statute by paying money and incentives to its client providers to recommend Prime Suite to prospective new customers,” the DOJ said. 

Greenway CEO Richard Atkins said: "the settlement is not an admission of wrongdoing by Greenway, and all our products remain ONC-certified. This agreement allows us to focus on innovation while collaborating with our customers to improve the delivery of healthcare and the health of our communities.”

Greenway is the second EHR maker to settle a False Claims Act suit with the DOJ in two years. The first, eClinicalWorks, agreed to pay $155 million in May of 2017 to settle allegations that it faked meaningful use certification — a charge that at the time was taken as a signal that the DOJ would probe more EHR makers with similar investigations.

“In the last two years my office has resolved two matters against leading EHR developers where we alleged significant fraudulent conduct.  These are the two largest recoveries in the history of this District and represent the return of over $212 million dollars of fraudulently-obtained taxpayer monies,” said United States Attorney Christina Nolan for the District of Vermont. “These cases are important, not only to prevent theft of taxpayer dollars, but to ensure that the promise of health technology is realized in the form of improved patient safety and efficient healthcare information flow.” 

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

Healthcare IT News is a HIMSS Media publication. 

When Greenway Health settled the $57.25 million False Claims and Anti-Kickback charges with the U.S. Department of Justice on Wednesday, the EHR vendor became the second one to meet a similar fate.

eClinicalWorks in late May of 2017 settled its own False Claims case to the tune of $155 million.

With the major settlements completed, the attorneys involved are cautioning other electronic health record vendors as well.

"In the last two years my office has resolved two matters against leading EHR developers where we alleged significant fraudulent conduct," said United States Attorney for the District of Vermont Christina Nolan in a statement. "These are the two largest recoveries in the history of this District and represent the return of over two-hundred and twelve million dollars of fraudulently-obtained taxpayer monies."

Nolan added that the False Claims Act and Anti-Kickback cases are important because they help to both prevent theft of taxpayer money and to advance patient safety, information flow and the broader promise of health IT.

After the eClinicalWorks settlement, a DOJ official declined to comment to Healthcare IT News about whether it would pursue similar investigations into other electronic health record companies.

Legal experts, meanwhile, said the industry should expect more DOJ probes of EHR makers— and now Nolan spoke out with a similar message.

"This resolution demonstrates my office’s initiative and resolve to vigorously uncover and to doggedly pursue these complex cases. We will be unflagging in our efforts to preserve the accuracy and reliability of Americans’ health records and guard the public against corporate greed," said Nolan. "EHR companies should consider themselves on notice."

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

Healthcare IT News is a HIMSS Media publication. 

When Greenway Health settled the False Claims Act and Anti-Kickback charges with the U.S. Department of Justice on Wednesday, the electronic health record vendor also committed to what the DOJ called an "innovative" corporate integrity agreement.

Keen observers of EHR vendors and False Claims settlements, this being the second in two years, might recall that back in May of 2017 the DOJ also described the CIA eClinicalWorks signed as innovative when announcing that $155 million fine. 

Not surprisingly, there are similarities. Both CIAs last five years and require that the vendors enlist an independent review organization to assess and monitor software quality and compliance, and to review arrangements with healthcare providers relative to the Anti-Kickback Statute. 

DOJ also mandated that each EHR maker promptly notify customers of any patient safety issues.

Both Greenway's and eClinicalWorks' CIAs also require the vendors to give existing customers either a free upgrade to their newest EHR versions or enable clients to transfer their data to a rival’s EHR. 

That stipulation has proven to be a sticking point for at least several eClinicalWorks clients. 

Some have even gone on record as saying the vendor is holding their data hostage and neither delivering it in a format that would enable them to transition to a different EHR nor making that process entirely free. Other customers allege that eClinicalWorks is not complying with the CIA and essentially leaving them to fend for themselves. 

It’s too soon to tell whether Greenway’s clients will face a similar fate or not, but this settlement is likely to fortify the thought that the DOJ will continue probing other EHR vendors with similar investigations. 

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

Healthcare IT News is a HIMSS Media publication. 

[Editor's note: An earlier version of this article said the Epic deployment would result in 1,650 displaced employees. This version is now corrected. We regret the error.] 

Trinity Health on Friday said, despite earlier reports that its enterprise Epic rollout would mean job changes or relocation for 1,650 employees, it is making workforce changes.

“It’s not happening because of Epic,” the spokesperson said. “They’ll be given longer-terms career opportunities because their current EHR is being sunsetted.”

That goes for 450 health IT professionals. As for the other 1,250 people involved, they are “looking at possible relocation,” as the health system consolidates its patient billing into three centers, the spokesperson said.  

ON THE RECORD

"Trinity Health is transforming at the clinical and administrative levels for the benefit of the people and communities we serve," said Michael Slubowski, president and chief operating officer for Trinity Health. "We are committed to supporting our teams and colleagues through the changes, all of which position us for improved patient experiences, an information technology structure that enables us to provide coordinated care to patients across the system and increased efficiency to help make care more affordable."

Leidos Health Group President Jon Scholl added: “I’m extremely excited to welcome the talented colleagues from Trinity Health. Their skills and experience are significant, and we are grateful for their careers managing complex technical issues in health care. We are especially pleased to continue our partnership with Trinity Health, an organization whose values are aligned with our own, and with whom we share a common purpose: to transform the health of people in our nation.”

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com

Hard as it may be to believe, it's been a decade, almost exactly, since the healthcare information and technology industry was turbocharged and totally transformed by tens of billions of federal incentive dollars.

It was February 17, 2009, when, in the ongoing aftermath of the Great Recession, a newly-inaugurated President Barack Obama signed the American Recovery and Reinvestment Act into law.

It contained $787 billion of stimulus funding at the time, with $19 billion of it earmarked specifically for health technology investments – a number that would almost double in the years ahead. (Read our coverage of it here.)

Over the past 10 years, electronic health records were installed or upgraded at hospitals and physician practices nationwide, and are now nearly ubiquitous. It's been a sizable change for a healthcare industry that was still largely paper-based for the early part of the 21st Century.

WHY IT MATTERS
As will be visible to anyone attending the HIMSS Global Conference and Exhibition in Orlando next week (follow along with our full coverage here), a whole lot has happened with health IT since 2009.

The rocket fuel of federal funding enabled mass uptake of essential technologies, and has helped enable a wide array of other innovations to flower. It's ushered in huge opportunities – but also plenty of challenges.

Not least of them: ongong frustrations with the usability of EHRs. In fact, those complaints seem in many ways to be approaching a boiling point, with more talk than ever about the epidemic of physician burnout– caused in no small part by poor UX and burdensome documentation requirements.

Writing this week in the Journal of the American Medical Association, three healthcare experts take a look back at the decade since the HITECH Act, and offer what they call a "path forward," with suggestions to help EHRs fulfill their potential.

Raj M. Ratwani, director of MedStar Health's National Center for Human Factors in Healthcare; Dr. Jacob Reider, CEO of Alliance for Better Health (and former chief medical officer of Office of the National Coordinator for Health IT); and Dr. Hardeep Singh, chief of the Health Policy, Quality & Informatics Program at Michael E. DeBakey VA Medical Center, agree that HITECH was a success at boosting promoted the adoption of health IT.

"The majority of US hospitals and ambulatory clinicians have adopted an EHR and some benefits, such as easier access to patient information and the ability to more easily order certain medications, laboratory tests and diagnostic tests, have materialized," they said.

"However, usability – defined as the extent to which technology can be used efficiently, effectively, and satisfactorily – remains suboptimal," they added. "Usability challenges in the last decade have had unintended consequences. Poor EHR usability contributes to errors that are associated with patient harm. It also results in clinicians spending extra time using the EHR, contributing to clinician frustration, which, in turn, has been reported to jeopardize patient safety."

THE LARGER TREND
While federal incentive money might have wonders to encourage wide adoption of these IT systems, government efforts to address improved usability have had only "modest effect," according to Ratwani, Reider and Singh.

ONC's certification programs, for instance, "require a design and development process that promotes usability and requires usability testing, but some vendors have not adhered to these requirements."

And while research from AHRQ – which has advocated since the early days of HITECH for usuability certification– has allowed for a better understanding the "nuances and complexities" of EHRs and other healthcare software, "the scope of usability challenges is much larger than anticipated, and useful research findings have not been effectively translated by industry, they said.

Still, clinicians and patients expect and deserve much better: "Usability of commonly used software tools has improved exponentially in the past decade," but health IT systems still often seem stuck in the now-distant past.

Toward a better way forward for usability and user experience, the JAMA article offers five suggestions:

1. Create a National Database of Usability and Safety Issues
2. Establish Basic Design Standards
3. Unintended Harms Must Be Addressed
4. Simplify Mandated Documentation Requirements That Affect Usability
5. Develop Standard Usability and Safety Measures So Progress Can Be Tracked and the Market Can React

ON THE RECORD
"Overcoming usability challenges that have affected health IT for the last decade will require shared responsibility and greater collaboration among vendors, researchers, policy makers, health care organizations, clinicians, and patients," write Ratwani, Reider and Singh.

"While policymakers need to initiate many of these actions, success is dependent on true engagement from all groups, particularly vendors who should now consider greater transparency of their products," they said. "This shared commitment is imperative because another decade of poor usability and related patient safety challenges would be unbearable, especially for patients."

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

Healthcare IT News is a HIMSS Media publication. 

Northland and Auckland district health boards (DHBs) have been given the green light for the long-awaited upgrade to their clinical record portal, according to an official release by healthAlliance, the Northern region’s shared IT service provider.

The two DHBs’ current system, Concerto 6, will be replaced with the latest version of Orion Health’s clinical record viewing software Clinical Portal 8 by early 2020.

The project follows the successful implementation of Clinical Portal 8 at Counties Manukau and Waitematā DHBs in 2018.

WHY IT MATTERS

It will result in a single, connected clinical viewing system that will deliver a patient-centric record accessible from any Northern region DHB location, including authenticated health providers.

Clinical Portal 8 is a patient-centric dashboard to view health information. It includes medical alerts, radiology and laboratory results, clinical history and patient movements from a variety of clinical applications.

Once rolled out at Northland and Auckland DHBs there will be 24,700 users in the region supporting a population of 1.8 million people.

For the many clinicians who work across one or more DHBs, the user experience will be consistent regardless of location, and their access to information will improve.

Underlying infrastructure upgrades will also provide more resilience, while single sign-on functionality means it will be faster and easier for clinicians to access patient data.

The upgrade projects are being managed by healthAlliance in collaboration with the DHBs and technology provider, Orion Health.

THE LARGER TREND

In December 2018, a national group was formed to start work on linking New Zealand’s four regional clinical portals, with approval from the DHBs chief information officers. The group is being led by Stella Ward, chief digital officer at Canterbury DHB.

If successful, the project would allow any clinician involved in a patient’s care to view that person’s computerised health data from anywhere across the country.

New Zealand’s 20 DHBs are grouped into four regions that each have a shared view of their region’s patient information via Clinical Portal 8 from Orion Health. Of the 20 DHBs, three are not yet using their regional shared portal, but all have imminent plans to move on to one.

ON THE RECORD

Project sponsor and Northland DHB General Manager, Medicine, Health of Older People, Emergency & Clinical Support, Neil Beney, says the regionally-connected clinical portal will form the largest patient information ecosystem in New Zealand.

“It will facilitate better sharing of patient information within and between the Northern Region DHBs and across care providers. It will also provide a better way for clinicians to follow their patients’ journey across all care settings.”

healthAlliance Chief Clinical Information Officer Dr Karl Cole says the upgrades are part of the foundational work of the region’s IS Strategic Plan (ISSP) which aims to join up the DHBs through technology and prepare them for a rapidly advancing digital future.

“A modern regional Clinical Portal is a key enabler for improving patient care in our communities so it’s a very exciting time,” Cole says.

“Once implemented, it will mark a significant milestone toward a more connected health system in our region.”

ORLANDO – Veradigm, which was launched this past November as a rebrand of Allscripts' payer and life sciences division, announced a new partnership today at HIMSS19 to work with MIB, which provides data-driven risk management services for the life insurance industry.

Through the agreement MIB's electronic health record will gain access to medical data via Veradigm’s eChart Courier service, helping its 400 U.S. life insurance members manage the underwriting process.

WHY IT MATTERS
Veradigm's eChart Courier helps with medical chart retrieval by automating the process, exchanging encrypted records electronically. MIB will leverage that technology to  provide EHR data to life insurers, when authorized to do so by consumers applying for life insurance.

Applying for life insurance often still requires telephone and fax communication to retrieve medical records. This new partnership will allow for a more efficient workflow, the companies, said, helping speed risk selection by carriers while giving consumers faster time-to-issue for their coverage.

THE LARGER TREND
The Veradigm-MIB deal is just one of the many projects on tap with Allscripts as HIMSS19 kicks off in Orlando. And it squares with what Allscripts CEO Paul Black told Healthcare IT News earlier this year will be one of the defining features of 2019: consumers expecting and demanding better healthcare and technology experiences.

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

ON THE RECORD
"Both MIB and Veradigm share a similar commitment to improving efficiency and streamlining processes using high-speed, electronic clinical data," said Lee Oliphant, MIB's president and CEO, in a statement. "MIB EHR solves a vexing problem for our life insurance members how to more efficiently provide life insurance products to customers in today’s rapidly evolving online environment."

"By working with companies like MIB, we help solve for inefficiencies and reduce bottlenecks for our clients and their customers," added Veradigm CEO Tom Langan of the new partnership. "We reduce the administrative burden placed on healthcare providers through automating manual processes that add cost and complexity to the healthcare system. We will continue to deliver on our promise to provide next-generation solutions that make a positive difference from the point-of-care to everyday life."

Veradigm can be found in Allscripts' Booth 3501 at HIMSS19.

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

Healthcare IT News is a HIMSS Media publication. 

Cerner today has debuted at HIMSS19 Chart Assist, a new AI-enabled workflow, to join a suite of systems designed to reduce physician burnout, enhance the clinician’s experience and increase productivity.

Cerner’s suite of AI-enabled systems goes beyond traditional processing and focuses on user efficiency to identify gaps and inconsistencies within the patient record, the vendor explained.

These advancements will help providers address patient care and validate diagnoses, ultimately helping to reduce the physician workload, while supporting the financial strength of the health system, the vendor contended.

“The healthcare environment is demanding, fast-paced and can take an emotional toll on clinicians; Cerner has set out to make the physician experience easier with our AI technology,” said Dr. Jeffrey Wall, director and physician strategy executive at Cerner. “Some physicians express feelings of fatigue, frustration and disempowerment.”

This can have a real impact on their personal wellness and the quality of care they deliver to patients, Wall added. The new AI-driven advancement will complement Cerner’s existing workflows to enhance the physician experience with the goal of bringing real change to the industrywide challenge of physician burnout, he said.

Recently, Cerner participated in a study reported by MedStar Health that is designed to help push for changes to address risks to patient safety and clinician burnout. Cerner has been actively engaged in addressing burnout as an industry challenge, with focus on engaging the physician in the building of EHR workflows to better reflect how they deliver care, the vendor said.

The use of analytics, research and feedback are key to continuously optimize systems to deliver a more personalized and intuitive care delivery experience, the vendor added.

“With hundreds of millions invested in research and development, we’re evolving the EHR to deliver a more personalized and intuitive design,” Wall said. “Continued investment in AI-enabled workflows, machine learning solutions and natural language processing are key ways we’re committed to ensuring the EHR remains a tool that helps physicians do their jobs and deliver the best care.”

Cerner is in Booth 2941 at HIMSS19.

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

Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center, traveled 400,000 miles in 2018 – jetting all over the world, from China to India to Scotland to Scandinavia.

On those journeys, he's seen how care is delivered in very different ways. In China, for instance (he's been there 35 times), there is no primary care. As a result, patients can self-select any provider, leading to a scattered lifetime record across diverse provider sites.

In India, where active tuberculosis is widespread, access to care is much more difficult, and treatments are often mismatched to illness.

"This is not precision medicine," said Halamka, speaking Monday at the HIMSS19 Precision Medicine Summit.

What is precision medicine? It's not just genomics. It's more than just social determinants of health (although those do play a much bigger role than many realize). At its core, he said, precision med is "the right care in the right setting from the right provider at the right time."

That's a easier said than done, of course. There are big differences between diagnosis and treatment, and so much depends on demographics, genetics and other biomarkers, geography, climate and more.

Data – structured, complete, well-governed and easy to see  – will be key to precision medicine becoming more widespread, Halamka said: "On the precision medicine journey, having the data accessible is going to be hugely important."

That's why Scotland, for instance, which has set up a single database for most of its 5 million-plus people, may be in a better position than, say, Australia, whose health record modernization was at first planned to be centered around PDFs and fax machines, said Halamka -- until he raised the alarm about the need for discrete and well-groomed data that can be mined by AI-powered analytics.

The good news? "In 2019 tools are finally good enough to help us realize the promise of precision medicine," Halamka said. The challenge? There's also a lot of "interesting politics and policy issues that are part of our precision medicine journey. It's not just technology."

But there are some urgent imperatives that will force those issues to sort themselves out soon,  such as aging societies all over the world, falling birth rates, clinician shortages and, of course, wildly unsustainable healthcare costs, he said. In the U.S., we spend more than 18 percent of our GDP on "very imprecise care," Halamka added.

That's got to change, of course, and has been slowly. The pace will quicken in the years ahead, with a profusion of emerging tech, he said. The internet of things and connected health devices are exploding; AI and machine learning are going mainstream; apps and cloud hosted services are ubiquitous; application programming interfaces are "increasing in number and sophistication," he explained.

But more needs to happen to help harness those new technologies for this larger purpose on a wider scale: "Precision medicine means that we need to deliver in the context of workflow decision support to the clinician to do the right thing at the right time," said Halamka. "None of this happens without a policy driver."

He listed some of the policy changes that could help achieve that – notably, ONC's long-awaited information blocking rule, which was being released at HIMSS19 as he spoke. Other policies, such as CMS' rules meant to reduce clinician burden and various other governmental nudges to encourage third-party innovation, will only help move the needle.

But in the meantime, the challenges persist, said Halamka, whether related to data provenance and quality or security and privacy concerns.

A subsequent panel discussion at the Precision Medicine Summit drove that point home.

The promise and potential are all there, but "it's still in this very squishy phase right now," said Dr. Adam Dicker, professor and chair of radiation oncology at Jefferson Institute For Digital Health.

"We're not ready for prime time," agreed Jean Wright, chief innovation officer at Atrium Health.

Part of that has a lot to do with technology – at least as the infrastructure exists today.

"Epic and Cerner are not at the leading edge of this," said Wright. There's plenty of valuable, envelope-pushing tools developed by some very creative smaller vendors, but "much of the technology is out there, but not in a plug-and-play format."

That too is fast-evolving, however, as APIs proliferate – many of them mandated by ONC – and patients get more comfortable using apps and devices that can then easily integrate with electronic health records.

That's creating a wellspring of genomic and social determinant information. And while interoperability and decision support still need to catch up, the data is there, more every day, and ready to be integrated into clinical workflows for personalized care.

Every health system understands the potential of precision medicine, but not all of them are quite ready to take the plunge into the complex and expensive project of actually starting a precision medicine initiative.

At HIMSS19 on Monday, Dr. James Weese, vice president of Aurora Cancer Care at Milwaukee-based Advocate Aurora Health, offered some up-close perspective on how to assess the success of a precision medicine program and molecular tumor board.

Aurora Cancer Care, which treats some 8,000 new cancer patients each year, launched its own precision medicine initiative two years ago, after extensive planning, preparation and goals assessment. What was immediately apparent, Weese said, is that its impact on the bottom line is not the only metric by which a program's worth should be judged.

It's key to demonstrate value, he said, and that shows itself in three interlinked but distinct groups.

"Value depends on different perspectives," Weese said. "The perspective of the institution, the perspective of the patient and the perspective of the provider."

It's critical for any precision medicine program to pay dividends for each of those audiences, he said. Otherwise, any such initiative will just be another overly expensive boondoggle with little to show for it except for frustrated staff.

Precision medicine has huge promise, of course, but presents a host of new challenges for even the most advanced health systems. Molecular testing, for instance, represents a sizable burden for already "click-crazy" clinicians, Weese said. Results can take weeks, reports can exceed more than 30 pages, and discussions with patients can take hours. So it's important to make all that extra work show value.

Weese offered some advice for ensuring precision medicine programs are worthwhile for those three groups:

• Healthcare institutions need to ensure molecular medicine represents legitimate treatment for patients who might have limited options, he said. They should weigh the cost of therapy, the expense of the program at large and the reimbursement rates for very expensive drugs – no small task in itself.

• Patients, meanwhile, should gain new and valuable treatment options. They should be able to understand how targeted therapies will work for them – something that more and more savvy patients are very capable of, Weese said. And they'll want to be sure that toxicity and side-effects for novel treatments are manageable – and that experimental therapies won't require great expense for something that doesn't work.

• From the provider perspective, health systems should ensure their programs are properly calibrated toward optimal results. Molecular therapy is "currently most effective in advanced disease," he said. The value of a molecular tumor board is that it "provides interpretation, advice and saves time." It helps steer treatment toward drugs that work and avoidance of drugs that don’t.

At Aurora Cancer Care, the organization has determined that "there is value in our precision medicine program," Weese said.

But that might not be the case for everyone. An audience member asked him how to raise awareness among the healthcare C-suite and other decision makers that precision medicine is a worthwhile investment.

At Aurora, he said, there's an employed medical staff that specialized in getting precision medicine and MT data back out to the primary care physician, who can then interpret it for their patients. Having a "large group who can spread it out to a larger clientele" may be key to building grassroots support by showing value on a wide scale, he said.

And much of the impetus for launching many precision medicine programs may eventually come from a groundswell of popular opinion, said Weese: "Patients are becoming much smarter. Many are coming in seeking the opportunity to ask questions about molecular therapy."

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

Healthcare IT News is a HIMSS Media publication. 

Countries in the European region should “move beyond an understanding of the promise of digital health” and accelerate the process of implementation, Zsuzsanna Jakab, WHO Regional Director for Europe, told delegates at an event organised by WHO and the Norwegian Centre for eHealth Research in Copenhagen last week.
 
Jakab said the 53 states should adopt a “strategic approach” and ensure investments in digital technology were linked to “key public health and health policy goals”.
 
“Without this, we risk delivering information technology solutions that are orphaned from the broader health system, that disengage healthcare professionals, and that ultimately end in lost opportunity and wasted potential for health systems integration.
 
“Perhaps even worse, we risk the emergence of an unwanted digital divide in Europe, where the focus of investments in digital health are misaligned with real societal need and where innovations benefit only those who are wealthy enough to pay for them,” the director warned.
 
WHO is the authority responsible for public health within the UN system, with six regional offices, including WHO Europe, which covers 53 countries.
 
Last week’s Symposium on the Future of Digital Health Systems in the European Region brought stakeholders to the Danish capital with a view to contribute to the development of a Europe-wide “vision and roadmap”. 
 
In the opening speech at the conference, Jakab acknowledged the barriers faced by decision makers when looking to bring innovation to healthcare, from a lack of interoperability to stretched budgets and a pressing need to invest in workforce training and support.
 
The director said these challenges also brought “immense opportunities”, but warned: “While excitement and potential are one thing, evidence and implementation are another.”
 
On Thursday, Hal Wolf, CEO and President of HIMSS, parent company of Healthcare IT News, spoke of the global perspective and six challenges hitting every healthcare system around the world: an ageing population, high chronic disease burden, geographic displacement, challenging funding models, a highy-educated consumer, the lack of actionable information and growing staff shortages.
 
The chief executive said stakeholders had to find compromises, adding:
 
“Innovation only succeeds when there are diverse stakeholders that can be aligned so that the trade-offs can happen. This is an important issue and we all recognise that we’ve got to adopt a different way of working, so there has to be compromise. 
 
“But it has to be driven from an important point. It is never about the technology, it is about all three: people, process and technology.”

EU member states make progress in enabling cross-border access to health data
 
Meanwhile, the European Commission released a new set of recommendations for the development of an exchange format for EHRs earlier this month that would enable EU citizens to access their electronic health information securely across member states. Figures cited by the Commission in the document indicate that two million EU citizens seek care every year in a different state than the one that they are living in.
 
While it’s still early days, through the eHealth Digital Service Infrastructure, Finland and Estonia have already started making some areas of health records interoperable – Finnish citizens can now buy medicines prescribed electronically by their doctors in Finland in Estonian pharmacies participating in the initiative.
 
Luxembourg and the Czech Republic are also expected to make progress soon and enable the sharing and access of patient summaries – including data on allergies, medication, previous illnesses and others.
 
By the end of 2021, 18 more countries will also join them, and the Commission proposed this week that the exchange be extended to laboratory tests, hospital discharge and medical imaging reports.

Veritas Capital and athenahealth closed the highly publicized $5.7 billion merger that also involves Evergreen Coast Capital and Virence.

As part of the transaction, Virence's Workforce Management business will become a separate Veritas portfolio company under the API Healthcare brand.

WHY IT MATTERS

Virence Chairman and CEO Bob Segert, along with an executive leadership team from athenahealth and Virence, will lead the company from the athenahealth campus in Watertown, Mass.

The transaction follows a merger announcement last November, which was approved by athenahealth shareholders Feb. 7, according to the company statement.

As a result of the completion of the transaction, shares of athenahealth common stock will be removed from listing on Nasdaq, with trading in athenahealth shares to be suspended following the closing of business on Feb. 11.

Athenahealth is a provider of medical record, revenue cycle, patient engagement, care coordination, and population health services — with a network of more than 120,000 providers and approximately 117 million patients. Virence Health sells its own health IT products and was formerly part of GE Healthcare.

THE LARGER TREND

The merger follows last June’s departure of athenahealth’s founder and CEO Jonathan Bush, who left in the midst of sexual harassment allegations and following the release of a video with lewd comments at a 2017 healthcare industry event and domestic abuse in 2006 during a divorce.

The company has been surrounded by merger talk and takeover propositions over the past year. Athenahealth received multiple bids for purchase, reportedly at $131 per share — or below a previous cash bid for the healthcare software firm — in an unsolicited move by Paul Singer’s Elliott Management.

ON THE RECORD

“athenahealth is one of the most unique and valuable assets in healthcare – with industry-leading solutions and a vision and model for delivering financial and clinical results for providers,” said Bob Segert, chairman and CEO of the newly combined company. “By combining our companies’ cultures, solutions and teams, we have an opportunity to accelerate that vision, achieving a scale that will allow us to unlock new value for all of our customers.”

Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.

Twitter: @Diana_Manos
Email the writer: dnewsprovider@gmail.com

Epic CEO Judy Faulkner has been to many, many HIMSS conferences. So many, she says, that she's lost track. As the company she founded in 1979 turns 40 this year, Faulkner sat down with Healthcare IT News at HIMSS19 for a conversation about interoperability, usability, patient engagement, her own plans for the future and much more.

Q. So, a certain cable TV financial guru suggested recently that Apple should buy your company – which he just seemed to think was a no brainer. What did you think of that?

A. (Laughs.) Well, first of all I had no idea who he is. I've never watched that show. But secondly it was like, "This is really weird!" Thirdly, it was just a shrug: "We're not going to do that." And it was just very gratifying that not a single health system contacted us about it and said they were worried. They all said they laughed.

Q. Yeah, I suspect they all know how you guys operate.

A. So isn't that neat that you knew the answer? We'd just say, "No, that's not going to happen." I think the thing that amazed me most about it is not that he said it. But that the message is so clear around the whole industry that we wouldn't do that. And nobody questioned it. That was a real achievement, I think.

Q. As you know there was a big rule that came down yesterday, that's been talked about for a long time and I think it couldn't have been too much of a surprise. Or maybe there were some  surprises, from your point of view? I'm sure you haven't read all 724 pages, but any early thoughts on the information blocking proposed rule? What do you expect?

A. I don't know. I haven't read the fact sheet. Yesterday was CHIME, now we're here (at Epic Booth 2159) all day. So I don't know. On the one hand, there's certainly a lot of value in it. On the other hand, there are things that have to be figured out. Like timing. What if you're supposed to send your data to a third party; how do you ascertain that they're good player or not? Or do you not? I don't know. So those are things where we have to be learning what the government wants. And if in fact they're not a good player, are we supposed to be responsible for figuring that out? Let me put that differently. If we're supposed to send the data to anyone. But then they're not a good player. Are we responsible for that even we can't check them out? So we need to figure out, what are the rules? I've only heard about it a very high level. The next level down this really the important level. The devil's in the details.

Q. One of the points CMS Administrator Seema Verma made today during the keynote discussion was that this rule is largely focused on the payers. Do you think that's a good approach, to kind of help open up that ecosystem?

A. I haven't seen the payers be unwilling. The payers, in our experience, have been very willing to share.

Q. What about the notion of consumer-mediated exchange, which was another major theme in Tuesday's keynote: putting the consumer at the center and making them kind of a vector for interoperability?

A. Well, we already do that. Do you know Share Everywhere? Do you have MyChart? It's a little thing that says "share my record." We already have the patient control where their record goes. So I'm all for it. I want to give responsibility and information to those patients who want it. So we've already done it. We are believers. But we're also are believers in (the fact that) patients who are different. She may want to have a lot of control of her record. You might say, "I expect the health care provider to take care of it. Don't bother me." So they each need to be able to work.

Q. It's been a bit more than a year since Epic launched its One Virtual System Worldwide initiative. What have been some milestones, and what are you looking to help build with that?

A. We've already gotten out some of the features. Like images, you can share across systems now and you can click on an image and it will bring over big version of that image and you can see it and you don't have to take the same image. We now have messaging back and forth between systems, so if I'm a doctor and you're a doctor I can message to your in-basket with secure messaging and we can talk about the patient that I just referred to you. Pretty neat stuff. There's a bunch of other things too, but those are some of the things that I think are going to be pretty useful to customers.

Q. Another big topic of discussion today was FHIR and open APIs. How do you see those continuing to evolve?

A. I'm going to skip on that one, because I don't know the answer to that.

Q. You don't want to gaze into your crystal ball?

A. No, not on that one. I'm not trying to be avoiding it. I just don't think I'd give a reasonable answer.

Q. Understood. Well, here's another question. What about the cloud? Not too many years ago, many in healthcare were deeply skeptical of the cloud. But now there seems to be an acceptance and comfort level here that did not exist before. How do you see the future there?

A. If you consider cloud the same as remote hosting, we're finding many of the health systems want someone else doing remote hosting. It could be for space. It could be for experience, the employees who run it. It could be because they don't feel that they're proficient in it. There's many different reasons. Could be because they feel it could be less expensive if someone else does it. So they might go to a third-party vendor who's done hosting years. They might come to us. Right now they're not going to the major cloud vendors such as Google, Amazon and Microsoft. Because they're not yet – because as far as I understand it, the large amount of data that they would have to run their databases isn't how those three organizations have organized, so they would have to change some things in order to be able to handle that. And I know that we do have at least one customer, probably two, trying to work with them for disaster recovery. And there's hurdles to get them. They've got to figure out those hurdles.

Q. Speaking of some sticking points: We're hearing an awful lot these days about physician burnout and frustration. You know it's no secret that many doctors just don't like their EHRs. What are you doing to kind of help ameliorate some of that? What kind of design choices are you making? What kind of focus groups are you doing with your customers to ensure that the clinicians have an optimal experience with their systems to the extent that they can, and that they can find that joy in medicine we hear so much about?

A. Here's something I wish the press would do. And that is, the latest studies I've seen are showing that there's not a high correlation between happiness with the EHR and happiness with their job and the problem of burnout. I think it would really help if the media understands that, an helps everyone else know it. KLAS did a study I thought was a very interesting. There's been like five papers in the past year that said it's not really the electronic health record. KLAS asked people two questions, among others. One was, how much you like your job? One was, how much you like the electronic health record? And what they found was that there are a lot of people who were satisfied with their job, and who liked the electronic health record. And a lot of people who were satisfied their job but didn't like the EHR. A lot of people who weren't satisfied with their job but did like (the EHR). And by far the smallest number was those who didn't like both. And from that, they concluded that there isn't a whole lot of correlation. There's a little bit, but not a whole lot.

Q. Clearly, there's a lot of blame to go around. And a lot of the data entry they have to do is mandated by the government and has nothing to do with you. But do some of their complaints have merit? About clicking and…

A. I think those are two different things. Do they have merit in saying, “Make it easier, make it faster?” You're right, some of it is going to be government-related, and some of it's going to be that we can keep designing it differently. So, yes, the need to constantly be working on how to make it as wonderful as possible for physicians is there. And we keep working on that all the time. We send our programmers out to customer sites all over the U.S. to try to watch so that if you're developing say the OR system, you go out and watch ORs. You might faint – that's actually happened – but you watch the OR to see, how can these do better? How do we make it better? How do we get feedback from them? So those are called immersion trips, and all of our programmers do that. There was something else that I want to add to that and that is what KLAS studied, which is tens of thousands of physicians. And they found three things were very important for liking the electronic health record. And I think there's a fourth, that I want to add, and that fourth is that they have our latest versions. If they're on a 2015 version and we've spent the past four years making the versions more and more helpful to physicians – getting beyond getting everything out for meaningful use and really working on ease of use – and they haven't installed the latest versions, then that's something they really can do to improve. Number one. That wasn't something that KLAS found. That's mine. But KLAS found that there's three things that really relate to physician happiness. Number one is personalization. That has the highest correlation. If you personalize the system to match your workflow, you are significantly happier than if you don't. So how do we get our health systems to do that? That's a challenge for us. We've been telling them all, go out and do that. So it's really important. Do you get what I mean?

Q. What are some of the challenges involved in that?

A. The biggest challenge is getting a physician in the room and helping the physicians see that these are the places you can customize, and let's go through it with you and help you do it. It's easy. So, number one is personalization – number two is quality of training. Was your initial training good? Or, as one group said, "horrendous"? We train the trainers, and then they go train the end users. One of the things maybe we should do is have our own folks train the end users and hire a bunch of people to do that. Maybe there's better ways we can come up with for training end users. But if they had poor training that's not good. One of the things we've found really helps is if specialist train specialists: dermatologists train other dermatologists, urologists train urologists, etc. That helps a lot. And then, the third thing on the KLAS list has nothing to do with the software itself. It is, are you an agile health system? They said one of the key questions was: If a physician wants a change made and talks to an IT person, how many committees does it have to go through? And if the answer is zero, that's good. So those are three factors from KLAS, and one from me, that affect that. Separate out physician burnout from happiness, and then we're OK.

Q. So, this is HIMSS number 10 for me...

A. Is it? I have no idea how many for me. (Laughs.)

Q. I was going to ask. But clearly a lot.

A. Right. Ever since it was much littler.

Q. Well, let me ask: Has the health industry evolved in the way that you thought it would? Are we about where you thought we would be in 2019? Or did you even think that far ahead back then?

A. I didn't think that far ahead.

Q. OK, but to my original point, this has been 10 HIMSS conferences for me, and we've been talking about interoperability at every one of them. We've been talking about it for a long time and still talk about it every year.

A. It's getting less, though.

Q. Obviously, just by the sheer size of your client base, you have  a lot of that kind of figured out among your clients. But how do you see interoperability continuing to evolve on a larger scale? There's Care Everywhere, there's CommonWell and Carequality and the HIEs that still exist. Do you think it's all eventually going to cohere into something whole, and be the ecosystem that people want and expect?

A. Well, we are creating an ecosystem. And as we go out to customers who are beyond the normal walls of the clinic and hospital, such as dentists. Such as life insurance companies. Post-acute care and many other areas – although post-acute care feels a little more normal. Life insurance doesn't. Payers don't. But we're going out to them as well. We're going out to specialty labs and specialty pharmacies, and things like that. That creates that ecosystem of people involved with health, not just healthcare. And then as we move to working together above that, it helps tie them all in. At least for our customers, it's going to be the ecosystem of everyone together. So I see that. It's a really interesting question you ask. Because if you look back at the history of healthcare IT, I think at first the healthcare systems built their own systems. Because they had to. And then, people who worked on those spun off and made their own companies: Here's an OR company, here's an ICU company, etc. And then the healthcare systems bought best-of-breed: "We're going to buy this one and this one and this one, and we're going to make them work together." And they didn't work together. And then, groups like HBOC said, "Instead of you guys buying the best-of-breed, we'll buy it and we'll put them together, and then we can sell you a system that talks to each other. And that didn't work too well. And so then we came along and said, "Patient at the center. All the data around the patient." And that's, I think, the essence of one of the main reasons why we've been successful. So if your question is really, at the end of it, will we be able to take thousand points of light and put them together and everything will work well? I think we're going to go back to the beginning of healthcare, people will try it, and it won't work well together, is my belief. Because you put in all these systems, and this group uses yellow to mean one thing and this one uses yellow to mean another, and this uses squares at the bottom and this uses triangles at the top. Are they all going to sit together and say, "We're going to have one user interface so nobody gets mixed up when they go from one to another," and then it makes a bad decision for the patient because they got mixed up? Or they're going to use same terminology? What's going to happen? APIs to share data is only one level. So I think they're going to get into best-of-breed again. Now, that isn't everywhere. I still think that there's going to be lots of places where those systems are going to be incorporated into the basic system and going to do a lot of valuable stuff. It could be education: You've got a patient with a certain problem and here's some really good education things. It could be a calculation that's going to figure out precisely where the cancer is and what to do with it. I think those things would be very valuable. But if they're trying to do what has been done before with best-of-breed, that type of use won't be there. Does that make sense to you?

Q. It does.

A. Does it sound reasonable?

Q. I think probably you'd find some people who would disagree with you there on the show floor, but yeah.

A. Well, that's been history.

Q. This is Epic's 40th anniversary. How does it feel for you to kind of be that elder statesman in health IT? You've seen a lot of change in this industry – especially in the past decade.

A. We've been very busy. But the industry is changing right now. Neal is gone from Cerner. Jonathan is gone from athena. The same folks aren't at Allscripts. It's changed. Harvey Wilson, he was with Eclipsys – that used to be one of the biggies. So, yeah. It's changing. Meditech is still there. Neil Pappalardo, I think is retired, but their CIO has been around for a long time, so that's consistency there.

Q. And so how do you see your future? Are you just going to keep doing this until you get tired, or…

A. Yep. I'll do it for as long as I can contribute to it. And if I can't, then you gotta get me out of there. (Laughs.) But assuming that I can, I'll stay around. Warren Buffett, how old is he now? I think he's 88. And he's a good one to keep watching, because he just keeps chugging along. He just seems like an elder statesman in his industry. And his partner, Charlie (Munger) must be 93 (ed. note: he is 95), and he says at his organization you retire at the age of 103.

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

IBM Watson Health will make a 10-year, $50 million investment in research collaborations with two separate academic centers – Brigham and Women’s Hospital, which is a teaching hospital of Harvard Medical School, and Vanderbilt University Medical Center – to advance the science of artificial intelligence and its application to major public health issues.

Problems suited for AI

The scientific collaborations with each institution will focus on critical health problems that are ideally suited for AI solutions. Initial areas of study are expected to include the use of AI to improve the utility of electronic health records and claims data to address significant public health issues like patient safety, precision medicine and health equity. The research also will explore physician and patient user experience and interactions with AI technologies.

“Building on the MIT-IBM Watson Lab announced last year, this collaboration will include contributions from IBM Watson Health’s longstanding commitment to scientific research and our belief that working together with the world’s leading institutions is the fastest path to develop, advance and understand practical solutions that solve some of the world’s biggest health challenges,” said Dr. Kyu Rhee, vice president and chief health officer at IBM Watson Health.

“Today, for example, physicians are spending an average of two hours with their electronic health records and deskwork for every hour of patient care, a phenomenon the American Medical Association says is leading to a steady increase in physician burnout,” he continued. “AI is the most powerful technology we have today to tackle issues like this one, but there is still a great deal of work to be done to demystify the real role of AI in healthcare with practical, proven results, and clear-cut best practices.”

By putting the full force of the company’s clinical and research team together with two of the world’s leading academic medical centers, IBM Watson Health will dramatically accelerate the development of real-world AI solutions that improve workflow efficiencies and outcomes, he added.

A host of physician executives

Drawing on the respective areas of expertise from each organization, the collaborations will be a joint effort among: IBM Watson Health’s newly appointed vice president and chief science officer, Dr. Gretchen Purcell Jackson; Dr. David Bates, chief of general internal medicine at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School; Dr. Kevin Johnson, chair of the department of biomedical informatics at Vanderbilt University Medical Center; and Dr. Gordon Bernard, executive vice president for research at Vanderbilt University Medical Center.

“IBM Watson Health has had a long history of leading in scientific research,” Jackson said. “These collaborations give our scientists at IBM Watson Health the opportunity to work with some of the best health informatics researchers in the world to advance the field in the areas of artificial intelligence, clinical decision support and implementation science.”

Medical data is expected to double every 73 days by 2020, Jackson added.

“We all know that the future of health belongs to AI, but today health around the globe is siloed and not actionable, making timely insights difficult to obtain,” Bates explained. “Through AI, we have an opportunity to do better, and our hope is to find new ways through science and partnerships with industry leaders like Watson Health to unlock the full potential of AI to improve the utility of the EHR and claims data to address major public health issues like patient safety.”

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

There's been too much talk for far too long about achieving interoperability, said healthcare leaders during two panel discussions jointly hosted by the Healthcare Leadership Council and Bipartisan Policy Center Thursday at HIMSS19.

The time has come to tackle interoperability once and for all, and it will demand aligned incentives, public-private collaboration, and a spirit of compromise from providers, payers vendors and others.

"Society is demanding it," said Change Healthcare CEO Neil De Crescenzo.

"Doing the right thing is not always financially advantageous," added Jeff Rose, senior vice president of clinical strategy at Hearst Health. "We can do this. But there will be give-and-take."

The event accompanied the release of a new report from HLC and BPC that outlines recommendations for advancing interoperability, capitalizing on the momentum of the proposed rulemakings announced this week by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT.

Among the recommendations in the report:

• Make a better business case for interoperability by encouraging payers and providers – and providers and vendors – to agree on basic shared expectations for data exchange, via model contract language or other mechanisms.
• Bolster technical infrastructure for interoperability by adopting standards to improve patient matching across systems, speed up adoption of FHIR and APIs and including testing of interoperability in the ONC Health IT Certification Program.
• Encourage adoption of a "notice of information access" and alignment consent policies for substance use disorder treatment under 42 CFR Part 2, in addition to aligning state privacy laws with HIPAA, making it easier for patients and providers to gain access to data.
• Expand public and private sector collaboration on ways to track interoperability progress and furthering private-sector actions toward that end.

A year in the making, the report drew from the insights of clinicians, health system leaders, payers, life sciences organizations, IT vendors, patients and others – more than 100 different stakeholders in all, according to HLC and BPC.

"Our objective from the very beginning was to bring together leaders from every sector of health care, to chart a course for private-public sector action that could help bring information to the point of care," said Sen. Daschle, a co-founder of the BPC. "There is virtual unanimity around the need to support better clinical decision making and, importantly, to bring information to patients to help them manage both their health and their healthcare."

For his part, National Coordinator for Health IT Dr. Donald Rucker said move toward open APIs was obviously encouraging: "the concept of using modern computing – application programming interfaces – and the big distinction there is that they're standards-based APIs, as opposed to individual vendors," he said.

"That is empowering for a couple of sort of obvious reasons in terms of vendor lock-in and the ubiquity of the tools," Rucker added. "But it's also empowering because it gets into new business models. Because the software stack we're using is the same stack that basically powers all the apps on your phone. We're trying to move healthcare back into the modern computing environment, where there are hundreds of thousands of people capable of helping us."

Speaking from the hospital perspective, however, Terry Shaw, president and CEO of AdventHealth, said more needed to be done with the data that is already flowing. Merely having access to it isn't enough, he said.

"Data is interesting, and we're getting better at having pipes that push information around, but we're not turning it into information," said Shaw. "We need AI tools running across that that knows, your diagnosis is X and you're in the ICU and this your background, and because of that, I need to push the right information to the clinician, both the nurse and the doctor to help them do a better job of taking care of you.

"Today, we say to the clinician, 'Merry Christmas, click this icon and if you want to read the 800 pages that's out there and glean something from it, that's great,'" he explained. "That's got to stop. We have to incentivize third parties to have smart AI systems embedded into the process that can help make sense of that information and drive it."

Jonathan Scholl, president of Leidos Health Group, said there has been more progress on interoperability than many realize – albeit not nearly enough.

"Our most notable progress has been hospitals," he said. "Almost 90 percent of hospitals send and receive information to each other. That's a good success story."

The problem, he said, has to do with what Shaw described. "It comes in the form of 600 page reports that doctors have to sift through, and it just doesn't work. So, good progress on interchange, but let's not call that interoperability."

Meanwhile, "about two thirds of hospitals are able to electronically search within and across the medical record," said Scholl. "But a lot of times that comes because they're on the same system. We have to get to a point where we're not asking health systems to spend exorbitant amounts of money to replace systems that already digitized information with other systems, just to achieve the objective of searchability and data-level interoperability."

Add to the the fact that barely 50 percent of patients have easy access to their records, "and almost none of them share data with their providers," and the scope of the problem is apparent.

"The technologies exist," said Scholl. "It's going to take investment and fortitude to get to the answer."

For all the encouraging ideas, both in the panel discussions and in the HLC-BPC study, the question, said Daschle, is "how do you take a report and make it an action plan?"

That's the challenge. And it will most likely continue to be. But it's also fact that more and more stakeholders, from all sides of the challenge, now truly realize that the days of thinking "some agency's going to do a rule and solve our problems" (as Rucker put it) are over.

It's time to make the put into action the private-sector push that the keynote panel at HIMSS19 said was the necessary vector for true progress on interoperability.

"There's wide recognition that it is an essential foundation for improving quality, cost and patient experience," said Daschle. "We've made progress, but there's still a whole lot more to be done."

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

In October 2018, Mayo Clinic achieved a historic milestone with the final Epic implementation in Florida and Arizona. The epic (pun intended) implementation of Epic across the Mayo Clinic’s network of 90 hospitals and clinics began in July 2017 when 24 of its sites in Wisconsin went live. Subsequently, campuses in Minnesota went live in November 2017, followed by Mayo’s Rochester facility in May 2018 and finally in Arizona and Florida.

The Epic EHR rollout at Mayo Clinic was dubbed the Plummer Project in honour of Henry Plummer, MD, who developed a patient-centred health record at Mayo in 1907.

While the movement to a single Epic EHR and revenue cycle management system to replace 3 separate EHR instances, multiple disparate revenue cycle systems and a total of 287 applications was impressive from a technical and execution standpoint, what was more impressive was the training of 51,000 Mayo Clinic employees to be onboard the Epic system. Mayo Clinic has a total of 65,000 employees of which 51,000 had to go through training in Epic as it was essential for their day-to-day duties and operations.

Dr. Steve Peters, co-chair of the Plummer Project, shared lessons learnt from the EHR rollout in a Mayo Clinic Radio video in July last year:

“We’ve learn a lot from the earlier implementations – we’ve modified the training and made it more focused to the tasks or some of the scenarios that an individual needs. We’ve increased the number and the training of the super-users – those are individuals embedded in the practice whether it’s a physician, nurse or desk staff who help to understand the local workflow rather than just how they navigate the tool. We then fine-tune where more support would be needed and which types of workflows.

For example, moving from one setting to another from an outpatient to inpatient or emergency room to an interventional radiology procedure to the operating room, these are opposed kind of special challenges where we can focus some of the training and some of the build-up of Epic so that it is more easily done.”

Dr. Patrick H. Luetmer, chair of Clinical Systems Oversight for Mayo Clinic, responsible for governance of the converged Epic electronic health record and of clinical departmental systems will be at the HIMSS Singapore eHealth & Health 2.0 Summit on April 24 2019 to share about the key lessons learnt from the massive EHR rollout.

In particular, Dr. Luetmer will emphasise the importance of rigorous tracking of co-dependent projects and careful management of a separate team to support legacy systems prior to go lives.

Keen to explore more about the lessons learnt from the Plummer Project? Sign up here to enjoy early bird rates for the upcoming HIMSS Singapore eHealth & Health 2.0 Summit held from April 23-24 2019!