Cerner executive Amanda Adkins won the Republican primary for Kansas' 3rd Congressional District on Tuesday and will face incumbent U.S. Rep. Sharice Davids in the upcoming November election.

Adkins, who formerly chaired the state Republican Party, took an unpaid leave of absence from her role as Cerner's vice president of strategic growth in January. Adkins was among five Republicans running for the spot.  

According to the Kansas City Star, Adkins and Cerner will make a decision about her continued role at the company after the election.   

The Center for Responsive Politics reports that Adkins' campaign has received $16,425 in contributions from Cerner members, employees or owners, and those individuals' immediate family members. The National Institute on Money in Politics lists Cliff Illig, Cerner's cofounder who retired from the company in January 2019, as donating $5,600 to Adkins' campaign.

Davids' campaign has received $2,916 from individuals affiliated with Cerner.  

Campaign Legal Center Federal Reform Director Brendan Fischer said such donations sounded neither illegal nor unethical.   

"It's not terribly surprising that a candidate would raise money from his or her colleagues," he said. But he noted that it does speak to the broader issue of the hurdles non-wealthy people, or those without wealthy connections, face when running for Congress.  

"The only place that there could be a potential legal issue is that if there were corporate resources used to support her campaign or if there was pressure from execs to support the campaign for employees to make contributions; either of those things would be unlawful," continued Fischer. "I only raise this to point out the potential issues; I've not heard any evidence of this."  

"Cerner encourages associates to be active participants in their communities and offer their talents and skills on their personal time. While Cerner may occasionally prioritize certain policy items we believe are in the best interest of our clients, we do not endorse a single party or candidate. We also continue to support our associates’ ability to exercise their rights, regardless of political affiliation. While Cerner as a corporation does not endorse specific political candidates, associates are free to make personal contributions to parties of their choice," said a Cerner spokesperson via email.  

"Amanda is grateful for the experience she had for 15 years as a Cerner associate improving health care in Kansas City and across the United States," said Matthew Trail, communications director at Amanda Adkins for Congress. "Amanda's professional achievements are well known, and she has always been committed to transparency and full compliance with ethics rules."  

WHY IT MATTERS 

Adkins' platform, according to her campaign website, includes pushback against the Affordable Care Act, which she says has increased the cost of care for Americans.   

Kansas has not expanded Medicaid under the ACA. This past week, Gov. Laura Kelly, a Democrat, urged state lawmakers to do so.  

Between 2013, the first open enrollment period for the health insurance exchanges, and 2016, the percentage of uninsured people in Kansas dropped from 12.3% to 8.7%.   

But according to the Kansas Health Institute, 11.9% of nonelderly Kansas adults were still uninsured in 2017. Most of these individuals were working, had completed high school or higher and were U.S. citizens. Those with less than a high school education and those without U.S. citizenship were less likely to be insured. Roughly one-quarter were not eligible for Medicaid and did not qualify for marketplace financial assistance.

Regarding the COVID-19 crisis, Adkins expressed in July the importance of balancing public safety with privacy. She also said a greater percentage of medical supplies need to be produced in the United States.   Adkins' website also lists her support for defunding sanctuary cities and building a wall between the United States and Mexico; for investing in infrastructure such as highways; and for gun rights. It also cites her stance against abortion.  

Davids, a citizen of the Ho-Chunk Nation who in 2018 made history as Kansas' first openly gay U.S. representative, has pushed for the expansion of Medicaid in the state.

"The need to expand Medicaid in Kansas has become even more urgent than ever as millions of workers have lost their jobs and health care coverage due to the coronavirus pandemic. Congress must incentivize Medicaid expansion and support states that do so by passing the Incentivizing Medicaid Expansion Act, which would help Kansas afford to expand quality health coverage to an estimated 150,000 Kansans," said Davids in a June statement.  

THE LARGER TREND  

Campaign watchdogs, including Fischer, have said Adkins' role at Cerner means she needs to be wary of potential conflicts of interest, given that the company provides services to five federal clients.

The most notable of these include the U.S. Departments of Defense and Veterans Affairs. In 2015, DoD chose Cerner to lead its massive EHR modernization, MHS-Genesis. And in 2018, the VA tapped the company for a decade-long, $10 billion project overhauling the VA's legacy VistA electronic health record.  

Although the VA project has been put on pause amidst the COVID-19 pandemic, it is scheduled to start up again in October. A recent Office of Inspector General report said that Cerner's implementation would hopefully address some of the ongoing roadblocks to implementing health information exchange networks.   

ON THE RECORD 

"I've worked in healthcare for 15 years," said Adkins in a July GOP congressional debate. "I think healthcare should be smarter, more transparent and more affordable overall. Smarter means that we should have a direct relationship with our healthcare providers … more transparent means that we should, in the first place, know what things cost and be able to make decisions. And more affordable: it is all about families being able to determine what their needs are based on their health needs and what they're able to spend."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

COVID-19 has brought up the issue of fragmented health information again, making interoperability of health data paramount. Therefore, there could have been no better time for the interoperability and patient access rule.

The rule helps improve the decision-making process for physicians and health systems by connecting siloed information across the care continuum. According to Grahame Grieve, the founder of HL7 FHIR, interoperability is all about people and connecting their health stories across different specialties, visits, and consults across multiple locations. Connecting the health story of an individual holds valuable clues to the diagnosis and treatment.

Advantages of FHIR

Data today is still locked down in individual EMR systems after each patient visit. The payers, too, have a large portion of this data through the claims and encounter data that flows to them during billing processes.

As an example, a patient’s journey from ambulatory care to urgent care and acute care in an episode of COVID has tons of important healthcare information generated in a short span. Seamless access to this information about a patient across the care continuum is the solution to better care coordination that can be solved by the Interoperability and Patient Access rule primarily by using FHIR APIs.

• FHIR is free to use. FHIR is built on existing web technologies such as https, REST, XML, and JSON. The FHIR API standards support technologies that mobile devices use - both Android and iOS devices - making it easy for developers to build on it. 
• FHIR allows for vendor-neutral information exchange. The HL7 Argonaut project is a private sector initiative that is an implementation community led by technology leaders in healthcare. The primary goal is to collaboratively work on industry use cases using FHIR and secure authentication protocols for healthcare information exchange. The goal is to create vendor-neutral applications that can be leveraged across the healthcare industry by all patients. So, it becomes easier for patients to visit multiple facilities using different EMR technologies to get information on their smartphones using standard technologies and interfaces.

FHIR API standards help to solve the problem of different technology standards of the entire list of software products used in the healthcare industry. Most leading EMR s and payers have already stayed ahead of the curve by having robust developer platforms with sandboxes to access and play around with sample data. The industry realizes the benefits of FHIR over 2.x, and other standards are moving fast from HL7 2.x to FHIR.

Uniform terminology standards to ease interoperability

The USCDI terminologies have been prescribed for all clinical and administrative data classes for the exchange of data. Irrespective of the EHR used and the terminology nomenclatures by individual physicians, the vocabularies and content are coded at the back end with the verbiage defined by the vocabulary standards. Terminology standards such as SNOMED CT, LOINC make it possible to interpret data irrespective of their origin or language without any loss of meaning. This helps with the consolidated view of the patient’s health journey.

According to Aaron Miri, CIO of Dell Medical School and UT Health Austin, to realize the real value of interoperability, all other care systems along the care continuum such as SNFs, home healthcare, and PCPs must be connected. He suggests that a general baseline of standards-based data capture for public health using USCDI standards and recording the social determinants of health along with a better partnership between the public health and private sector would pave the way towards interoperability.

The COVID-19 pandemic has made it even more imperative for all healthcare systems to have interoperable systems. In late 2015, capturing pregnancy status was not mandatory during electronic documentation. During the Zika outbreak, this resulted in congenital disabilities like microcephaly in newborns of infected mothers. Electronically documenting and sharing patient records across the care continuum helps physicians be aware of possible complications in the event of an outbreak even when a patient is visiting them for an unrelated reason.

Privacy and security concerns

There have been concerns about the privacy and security issues about the interoperability ruling. Patient medical records include personal and family history. There is a probability of information falling into unscrupulous hands with open access and multiple app developers. But to counter the arguments of privacy and security, there always are technology guardrails in place to allow for a smooth exchange of PHI across systems.

Most of the leading EHR platforms provide access to patient data by granting consent at the patient level on all their consumer platforms, which makes it secure for the patient and allows for a single view of the patient information.

Impact of COVID-19 and interoperability

COVID 19 has brought about a transition in the way medicine is practiced across the world. Physicians who were earlier reluctant to go virtual are now opting for it to facilitate care coordination during COVID-19 times. According to Dr. Jonathan Slotkin, vice chair of neurosurgery and associate chief medical informatics officer of Geisinger, there are troves of important data like positive COVID results, signs, and symptoms, sitting in siloed EHRs across different hospital systems in care settings across the country.

These troves of patient data, when harnessed in an automated, real-time manner, can be used by health systems, states, and the federal government to predict surges in COVID-19 cases, to determine which patients are more likely to get acutely infected, and to provide healthcare systems with risk and severity adjusted information to predict other findings.

COVID-19 has demonstrated the need to go virtual and seamless to provide improved care to patients. As more health systems continue to remodel their businesses around these needs and the rule, interoperability will become the lifeline of better care coordination across the care continuum in the healthcare industry.   

Dr. Joyoti Goswami is a Principal Consultant at Damo Consulting

A study published this past week in JAMA Network Open suggests symptom-specific ICD-10 codes don't always capture COVID-19-related symptoms.

An electronic health record review of 2,201 patients who had been tested for COVID-19 found that ICD-10 codes had low sensitivity and negative predictive value for capturing cough, fever and labored breathing.

"Symptoms are an essential part of data collection for SARS-CoV-2 and COVID-19 surveillance and research, but symptom-specific ICD-10 codes lack sensitivity and fail to capture many patients with relevant symptoms; the false-negative rate is unacceptably high," wrote researchers.

WHY IT MATTERS

Researchers at the University of Utah reviewed the EHRs of 2,201 patients who had been tested at UU Health for COVID-19. Most of the patients had been tested in an outpatient setting; 7% had been tested in the emergency department; and 3% were tested in an inpatient setting.

On the basis of EHR review, which researchers referred to as the reference standard, 66% of patients had fever; cough was present in 88%; and dyspnea was present in 64%.

For fever, the sensitivity – or the ability to correctly identify those with a condition – of ICD-10 codes, when compared with the reference standard, was 0.26. For cough, it was 0.44, and for dyspnea, it was 0.24. 

The ICD-10 codes fared better when it came to specificity, or the ability to correctly identify those without a condition. For fever, the specificity was 0.98. For cough, it was 0.88, and for dyspnea, it was 0.97. 

ICD-10 code performance was better for inpatients than outpatients when it came to fever and dyspnea, but not for cough.

Negative predictive value was also poor for all symptoms.

"The proportion of patients with a false-negative ICD-10 code result ranged from 35.8% for fever among patients older than 64 years to 54.5% for fever among patients who tested positive for SARS-CoV-2 infection," wrote the researchers.

"Common data models and other aggregation tools rely heavily on ICD-10 codes to capture clinical concepts; inaccuracy has implications for any downstream scientific discovery or surveillance," they continued. 

"For example, symptom surveillance could be important to detect subsequent waves of COVID-19, similar to the US Outpatient Influenza-Like Illness Surveillance Network. A substantial number of patients would be missed if ICD-10 codes were used for this task," researchers added.

Regarding possible limitations, researchers pointed out that their study only included a single center and that it used data from March 10 to April 6 – early in the pandemic. They also noted that clinicians may not document all symptoms in every case.

THE LARGER TREND

Researchers noted that patient-reported outcomes, such as those self-reported through smartphone apps, could lead to more reliable symptom capture than billing codes or clinician documentation.

A wave of such apps– including informational, tracking, assessment and science research tools – rolled out in the spring.

"With New York City among the cities with the largest number of cases – a number that continues to grow – we see a critical and urgent need to understand more about the clinical course of the disease," said Dr. Girish Nadkarni, clinical director of the Hasso Plattner Institute for Digital Health, regarding an app released by Mt. Sinai in April.

"This is a unique opportunity to collect data in a diverse population during an outbreak surge, which could provide powerful predictions of the clinical outcomes of our most vulnerable patients," Nadkarni continued.

But privacy concerns have also dogged some apps' release, with only 16 out of 50 apps in one study stating they would anonymize and encrypt users' data. 

ON THE RECORD

"Critical data elements require careful validation to ensure that discoveries translate into effective interventions that reduce morbidity and mortality," researchers wrote. "As with many aspects of this pandemic, we must pay careful attention to socioeconomically vulnerable populations, including racial minorities, rural patients, and low-income patients, for whom the gap between ICD-10 coding and clinical reality could be greater."

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

On Monday, Eastern District of New York Judge Frederic Block issued a preliminary injunction stopping the U.S. Department of Health and Human Services' move to roll back protections for transgender patients, one day before the changes were set to go into effect.

The Trump administration's final rule reversed Obama-era expansions of sex-based discrimination under Section 1557 of the Affordable Care Act to include gender identity or the desire to obtain an abortion.

Its longevity had been thrown into question earlier this summer, when the U.S. Supreme Court ruled in Bostock v. Clayton County that sex-based discrimination in the workplace encompasses discrimination based on gender identity or sexual orientation.

"The Court concludes that the proposed rules are, indeed, contrary to Bostock and, in addition, that HHS did act arbitrarily and capriciously in enacting them. Therefore, it grants plaintiffs’ application for a stay and preliminary injunction to preclude the rules from becoming operative," wrote Block in his order Monday.

WHY IT MATTERS

The Trump administration's move to undercut antidiscrimination protections for LGBTQ people alarmed some clinicians, who pointed to the difficulty it could present in providing care. 

In June, UCLA Health's Dr. Amy Cummings and her colleague Heather Hitson spoke with Healthcare IT News about their years-long project to include information related to sexual orientation and gender identity in patients' electronic health records.

During that interview, Cummings pointed out that a patient's reluctance to disclose their identity out of fear of being denied care could affect their access to the appropriate screening. And from a broader health data perspective, Hitson said the new rule could make it harder to collect information that could help advance care. 

"If we're not collecting data and asking these questions" about transgender people and healthcare, "it's going to delay research," Hitson said. "There's limited research in the healthcare community around trans people, and this is going to increase the barrier."

Now, Cummings says she's cautiously optimistic.

"As you can imagine, [the] preliminary injunction is a glimmer of light," said Cummings. 

"The stripping of LGBTQ health protections by the Trump administration is abominable, and while the injunction is a sign of integrity from the judicial system, the fight is far from over.

"At UCLA Health, we will continue to keep protections for our LGBTQ populations at the front of our decision-making when it comes to data sharing, but at the same time, we will continue to develop supportive and inclusive programming for our LGBTQ and intersectional patients," Cummings continued.

THE LARGER TREND

Clinicians have pointed to inclusive IT– including EHRs – as a vital way to safeguard LGBTQ patient health on both individual and population-wide levels.

“What’s happening is that, with a lot of transgender patients, the provider isn’t being notified that the patient’s due for a procedure because these systems are not accurately pulling in the correct information,” said Chris Grasso, associate vice president for informatics and data services at the Fenway Institute, in an interview with Healthcare IT News in September 2019.

“The EHR was created for a documentation tool, but now we want it to be a lot smarter. We want it to provide us with more statistics and more data – and how do we best care for these patients,” said JoAnne Dombrowskas, MSHI, RN, manager of Massachusetts General Hospital eCare clinical informatics team.

ON THE RECORD

"The Court reiterates the same practical concern it raised at oral argument: When the Supreme Court announces a major decision, it seems a sensible thing to pause and reflect on the decision’s impact," wrote Block in his ruling.

"Since HHS has been unwilling to take that path voluntarily, the Court now imposes it," he continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

A Queensland government project will use the HIMSS Digital Health Indicator to help health workers in the Australian state understand the technology used in local health services.

The initiative will run in hospitals and health services, as well as some primary health networks across the state, with the aim of building a data-driven roadmap for digital transformation.

Health research body, the Digital Health Cooperative Research Centre (DHCRC) is supporting the collaboration between the state’s largest healthcare provider, Queensland Health, the University of Queensland and HIMSS.

HIMSS, which owns Healthcare IT News, has developed a virtual assessment process, which will reduce the burden on the hospitals and health services and Queensland health team.

WHY IT MATTERS

The project aims to map a baseline to show the current levels of digital health, measure maturity and discover how technology can help achieve better patient outcomes.

Professor Keith McNeil, Queensland Health’s chief clinical information officer and acting deputy director-general prevention division, said it would “show those services that need investment and support, so we can develop a plan that allocates resources where they will have the strongest impacts.”

The project will also identify rapid response opportunities for investment to boost services fast.

THE LARGER CONTEXT

This project will form part of a global series of tests for the new HIMSS Digital Health Indicator, which launched in April. Based on the principles and evidence of the HIMSS Digital Health Framework, it measures four dimensions of digital health that health systems globally can build a roadmap and strategy against.

ON THE RECORD

Professor McNeil, the previous CCIO of NHS England, said: “The HIMSS program gives us the chance to assess our digital health and continuity of care maturity in an Australian context, and to measure our progress towards a digital health ecosystem.”

Tim Kelsey, senior vice president at HIMSS Analytics International, said: “Many jurisdictions and health services around the world want to know the level of their digital capability. The new Digital Health Indicator provides actionable insights which can support improved clinical and economic outcomes. The COVID-19 pandemic has highlighted these knowledge gaps.”

Dr Michael Costello, CEO (interim) of the Digital Health CRC, said: “By better understanding our national digital health footprints we can identify ‘maturity’ leading and lagging indicators, so our support is directed at identifying and improving our digital health maturity.”

Associate professor Clair Sullivan from the centre for health services research at the University of Queensland, said: “This project is about centring our digital transformation around the consumer by understanding their journeys across the care continuum, recognising what health outcomes are important, and learning how digital technology can help us achieve these better outcomes for our consumers”.

Learn more at the HIMSS & Health 2.0 European Digital Event taking place on 7-11 September 2020. 

Digital innovation is becoming increasingly critical to clinical practice, not just as a workforce management tool, but as a foundation to change the way care is delivered. Healthcare IT News spoke to senior nursing informatics officer for Abu Dhabi Health Services, Hana Abu Sharib and professor in health and human services informatics at the University of Eastern Finland, Dr Kaija Saranto, to find out exactly how nurses and midwives are leading the digital transition.

Nurses and midwives have played a key role in leading the digital and informatics arena to improve patient care, particularly in the COVID environment where the quality of digital care delivery has come to the forefront of healthcare and been under more scrutiny than ever. In September, they will be speaking at the HIMSS & Health 2.0 European Digital Event, in the ‘Nurses 2.0’ session, where they will expand on some of these key issues in greater detail.

“During the pandemic, nurse informatics teams were involved in training for different EMR applications and devices for nurse shifting cross settings (ED-OPD-Inpatient) based on operational needs. They were also very actively involved in building the input forms for nursing and addressing the patient surge during the crisis. From a data perspective, they were validating the reports and dashboard,” explains Abu Sharib.  

Saranto adds: “Recording has been more crucial, and a variety of mobile applications have been tested and partly implemented to control the outbreak of the virus. I assume that both nurses and midwives have worked under a heavy pressure to guarantee safety and continuity of care.” 

With the recent growth of digitalisation, nurses and midwives are continuing to lead the digital transition and using informatics to improve patient care.

Saranto said: “The most important or effective key to success is education. I believe that there still is a lot of nurses who do not have proper knowledge and skills to use health information technology tools. Nursing and midwifery programmes have integrated health informatics into their curricula, but it concerns newcomers in the field and the 40 plus age groups are left behind. Thus, in-service training is badly needed.”

Nurses and midwives recognise the importance of this transition and the value of health informatics education and training, as Abu Sharib commented: "RN level and the nursing informatics speciality roles are adopted by many nurses and they are addressed for many clinical documentation requirements or technology adoption as they have advanced knowledge in that field. Nurse informatics is now classified under nursing as one of the specialities acknowledged by senior management.”

In Finland, technology is helping to bring healthcare to the homes of the ageing population, and nursing has subsequently been pushed to the forefront of this community-based care. Finland recently adopted a national information system called Kanta, which includes electronic prescriptions, a patient data repository and an online system which allows patients to view their health information.

Saranto explains: “The situation in Finland is partly easy, but also complicated when we already have 100% EHR coverage in the country. Thus, moving from electronic to electronic systems creates a lot of challenges around how to convince staff that the new system is better. So, the old way was a step-by-step or phased implementation, and now we have moved to big-bang implementations."

The importance of nurse involvement was also highlighted by Saranto, as a way to optimise cooperation between health professionals: “Whatever the model, I think nurses and midwives should be involved right from the beginning and I would like to stress the importance of cooperation between all expert groups.

“Too often nurses and midwives are invited too late to participate in projects. This often leads to misunderstanding and neglects the relation of information flow and work processes. I believe that participation in the HIT projects will also facilitate health informatics (HI) skills, as the need for education becomes real and is attached to your daily practice.”

When discussing the future of innovation and informatics, Saranto said: “Multidisciplinary education is not an innovation, but it is far too seldom used as a model for basic or advanced HI education, although we have encouraging outcomes.

“I have always found IT as a tool to support practice. I hope that those coming to the healthcare arena also have at least minimal knowledge and skills from the context.

“Often in multidisciplinary groups, concepts and terms can cause severe misunderstanding. For example, when planning interfaces. I believe that this could lead to more efficient implementations and satisfied users.”

Abu Sharib concludes: “My hopes are to build the capacity on nurse informatics designated roles in the nursing workforce, and the improvement of nursing informatics use in the innovation of nursing practice based on process enhancement and improving patient outcome.”

Learn more at the HIMSS & Health 2.0 European Digital Event taking place on 7-11 September 2020. 

In a first step for its long-planned, decade-long, $16 billion Electronic Health Record Modernization program, the U.S. Department of Veterans affairs announced today that it has gone live with a scheduling tool that will, eventually, find its way into VA facilities across the country.

WHY IT MATTERS
The new Cerner-developed Centralized Scheduling Solution is up and running at VA Central Ohio Healthcare System in Columbus, and will enable more efficient patient scheduling by offering visibility into clinician availability within a unified system.

Cerner says it has migrated and tested demographic information for the 60,000 veterans who receive care at the facility. The CSS will be integrated with the full EHR systems set to be implemented at the next go-live site, Mann-Grandstaff VA Medical Center in Spokane, Washington, this autumn.

The new implementation will make it so VA staff in Columbus doesn't have to log in to multiple applications to coordinate calendars, clinicians, rooms and equipment, eliminating time-intensive manual data entry and workarounds to finalize appointments.

Instead, according to VA officials, color-coded time slots and a unified view for coordinating schedules across multiple locations will make scheduling easier for both VA staff and for veterans, who can make, reschedule and cancel appointments online.

"With CSS, VA staff will be able to identify and fill no-show appointments in real-time using a single system," according to the VA. "CSS also benefits Veterans by optimizing their access to health care with a more efficient online scheduling experience."

THE LARGER TREND
The EHRM program kicked off in May 2018, when VA signed a $10 billion deal with Cerner to build a new EHR, interoperable with the one Cerner is building for the U.S. Department of Defense, to replace its existing VistA system.

The planned price tag for the project soon climbed to $16 billion, and VA officials this past February asked Congress for an additional $1.2 billion, even as it was missing its own initial March deadline for go-live at Mann-Grandstaff. That deadline was recalibrated for July, but the COVID-19 crisis caused it to be delayed once again – but after hitting pause in April, the agency announced it would restart the program in October, in hopes of going live in the Pacific Northwest this fall.

ON THE RECORD
"VA has delivered an enhanced scheduling system that will benefit Veterans and health care providers," said Acting VA Deputy Secretary Pamela Powers, who has oversight of VA’s EHRM program, in a statement. 

"This is another successful launch of a major milestone in the EHRM effort and will optimize Veterans’ access to health care by improving appointment scheduling. CSS also provides an efficient and transparent method of identifying and eliminating double bookings, flagging canceled appointments and maximizing provider time spent with patients."

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

Healthcare IT News is a HIMSS Media publication.

Contact tracing has become a key strategy in combating the novel coronavirus – particularly with regard to asymptomatic people who may not know they've been exposed. 

However, trying to track down those with whom a COVID-19-positive patient has been in contact can be both time- and labor-intensive. A new case report in the Journal of the American Medical Informatics Association shows how one hospital in Singapore used an algorithm to improve the efficiency of the contact-tracing process.

"Prior to the establishment of the algorithm, contact tracing teams comprising six members each would spend up to 10 hours to complete contact tracing for five new COVID-19 patients," wrote the researchers from Changi General Hospital.

"With the augmentation by the algorithm, we observed ≥60% savings in overall manhours needed for contact tracing when there were five and above daily new cases through a time-motion study and Monte-Carlo simulation," they continued.

WHY IT MATTERS

The hospital's contact tracing process, as described by the researchers, involved mapping all activities of the patient for the period from 14 days before the onset of their symptoms, as well as those of the healthcare workers who attended to the patient and other patients in close contact with them.

The hospital then shared that information with the Ministry of Health within 24 hours to ensure timely follow-up.

In order to identify exposed healthcare workers and neighboring patients more efficiently, the researchers developed an algorithm using data from five separate informatics systems used in the hospital's day-to-day operations.

Those systems were the clinical electronic health records system; the inpatient module recording patient movements from registration to inpatient admission to discharge; the real-time locating-system, tracking patient movements through a radio-frequency identification tag; the outpatient appointment system; and the radiology information system.

According to the researchers, these five systems are among those that feed into the enterprise analytic platform SingHealth-IHiS Electronic Health Intelligence System, or eHints. 

"The algorithm was scripted to extract the information required in a sequential manner from the eHints repository data derived from these five source systems to meet the contact tracing requirement," they explained.

After the algorithm generated a customized contact-tracing report for each COVID-19 patient based on the patient's presence in the various areas and time period, the contact-tracing team would scope the contacts to be interviewed.

"The model demonstrated significant time savings as well as manpower to complete the contact tracing process, especially for days with higher volume of new COVID-19 patients detected," wrote the researchers.

THE LARGER TREND

In the United States, companies have developed contact-tracing software to try and augment the process of finding those who may have been exposed to novel coronavirus patients. 

Apple and Google's contact tracing API went live in May. The technology was aimed at helping public health agencies deploy apps to notify individuals of potential COVID-19 exposure.

But privacy concerns and public doubt have slowed mass adoption of the software, with 71% of Americans in one survey saying they wouldn't use the apps.

ON THE RECORD

"In the COVID-19 pandemic, expedient identification of individuals with significant exposure to COVID-19 patients is a key strategy to break the chain of transmission and flatten the epidemiology curve," wrote the Changi Hospital researchers. 

"With the increasing number of new cases diagnosed daily, the capacity for timely contact tracing would have to be met by increasing staff numbers to perform interviews of the COVID-19 patient and the contacts. The algorithm’s value-add was the rapid and comprehensive identification of the COVID-19 patient’s activity as well as individuals at risk – [healthcare workers]  and other patients, to be interviewed. The contact tracing staff could then focus on the interviews and risk assessment of the contacts," they continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

The pandemic has drawn attention to the inadequacies of the world’s data sharing frameworks. It has highlighted the lack of interoperability (the ability of computer systems to exchange information and operate in conjunction with each other) of many medical systems used by public and private providers, laboratories, and pharmacies globally. As a result, data exchange within a healthcare system, which utilises different data sharing frameworks, is not as streamlined as it should be. From the number of beds to the level of occupancy, the world is struggling to pool data from disparate and complex systems into one centralised location. By reshaping the way this crucial data is collated, analysed and disseminated into a coherent and easily accessible system, we will give healthcare professionals the tools they need to tackle the current crisis, and any we may face in the future.

Speaking the same language

Effective communication is the road network that transports information between locations. By speaking the same language, important data can move and lead to solutions much faster. Introducing better data standardisation will allow the health industry to speak a common language, with all the parameters used and understood in the same way. If there is no common standard set between different entities, data sharing becomes a challenge.

Systems must be interoperable; however, data sharing must also be governed. We can learn much from the vast experience of our colleagues in the banking sector in this regard. Modern banking technology allows us to easily transfer money across borders from one bank to another in the knowledge that the required security and controls are in place to enable this to happen. In addition to governance that allows the exchange, the systems are interoperable. This vital element is sometimes lacking in the healthcare sector. Transferring encrypted personal medical data from one healthcare provider to another within a secure network can be challenging, because data is not always recorded in a way that it can be allow an easy exchange of medical records in a universal clinical language.

During a pandemic, as we witnessed, information needs to be shared efficiently for the authorities to be able to make quick and scientifically sound decisions based on accurate data. In Abu Dhabi, the Department of Health (DOH) and Malaffi have started the journey of making the exchange of data possible. Malaffi, the region’s first Health Information Exchange (HIE) platform, connects all public and private healthcare providers in the UAE capital, allowing them to exchange in real-time important patient health information.

The platform has a strong foundation. Through Malaffi, we have been able to help tackle the COVID-19 pandemic by gaining better insights about the spread of the disease in Abu Dhabi. This centralised platform has enabled the DOH to strengthen its COVID-19 response. It has allowed the identification and tracing of newly diagnosed cases in real-time and by centralising all test results helped policy-makers to more efficiently allocate resources for better capacity utilisation and care coordination in the Emirate. The standardisation of clinical datasets will further help improve the interoperability and exchange of information between the different systems through Malaffi.

Taking standardisation further

Today, there are some datasets that are properly standardised, while others do not have a standardised coding system. This seriously hinders interoperability. For example, in the UAE, laboratories use different coding systems for orders and results, which are a combination of Current Procedural Terminology (CPT) codes and their own local codes. The CPT is a procedural code used by healthcare providers or laboratories to bill insurance companies for procedures or medical tests rendered to patients. While CPT codes can be used to refer to laboratory services, the Logical Observation Identifiers Names and Codes (LOINC) coding system is more appropriate to specifically describe lab results. LOINC is the world's most widely used terminology standard for lab tests and results. By fostering this kind of interoperability, LOINC can help healthcare organisations achieve better patient care and improved revenue in the years to come. In the near future, laboratories should consider adopting the LOINC terminology.

Another example of standardisation is how Electronic Medical Records (EMR) systems capture allergies. This is important to enhancing the quality of documentation and data. Some EMR systems will have a free text field for the recording of allergies instead of providing a drop-down menu of standardised allergy terminology, which is much easier to match and exchange. Recording allergies in the Health Information Exchange (HIE) platform in a standardised way brings immeasurable value. Having this information is critical to making all the difference between prescribing medicines that might cause an allergic reaction and others that won’t, which can ultimately save lives, especially in an emergency.  

In Abu Dhabi, diagnoses are linked to a coding standard in the healthcare industry, known as International Classification of Diseases (ICD). This coding standard is used by healthcare providers to refer to diagnoses when sharing patients’ medical claims with insurance companies. However, for medical procedures, providers use a different coding system, called CPT, in insurance claims to communicate information relating to the procedures.

Chronic problems

Now, during a pandemic, it is also important for doctors to have access to patients’ medical history in order to be able to assess the risk level of the COVID19 positive patients. This is where the standardised recording of chronic problems in patients’ HIE file becomes more important than ever. Currently, the market is using a combination of ICD10 and Systematized Nomenclature of Medicine (SNOMED) codes, but there are also a number of EMRs which don’t support recording of chronic conditions as structured and coded data elements.

The accuracy of the reported pandemic’s indicators is affected by the above – in other words, the better the data standards are, and the more accurate and qualitative the HIE data, the better standard of patient care and more reliable reporting to authorities are.

The Department of Health Abu Dhabi (DOH) has taken immediate steps to tackle these challenges. During the pandemic, the DOH have mandated for all labs to capture a patient’s Emirates ID details and key demographic information for each sample they test, so that the record of the patient can be easily matched within Malaffi. The DOH is working to further support the data standardisation and interoperability efforts in Abu Dhabi, to ease the data flow between different systems and create a stronger unified patient record and data repository through Malaffi.

We’re all in this together

Data standardisation is not the onus of one entity, institution or organisation. The change cannot happen on its own unless everyone is on board and collaborates.

The bottom line is that it is critical for all of these systems to be interoperable for data to be easily shared between different systems.

This pandemic has opened up the discussion of having more interoperable systems to allow the easy exchange of data for specific uses and scenarios where it is needed. The big question that the healthcare sector around the world now faces is: Are we ready to take the big steps that will allow us to truly collaborate in the best interests of humankind?

Atif Al Braiki is CEO of Abu Dhabi Health Data Services LLC (Malaffi).

The coronavirus pandemic has disrupted the daily lives and workflows of healthcare providers across the globe.

THE PROBLEM

Whole Life Health Care in Newington, New Hampshire, is a family practice providing conventional medicine and complementary therapies. It needed advice on best practices to adjust to life during COVID-19 and continue treating patients safely and effectively. The team needed to create rapid-fire solutions to address the changes that happened seemingly overnight.

One of the challenges Whole Life faced during the onset of the pandemic was access to a reputable and efficient telehealth system to continue care for patients. Another challenge was how to leverage its digital billing platform to respond to the rapidly changing landscape of regulations and requirements around reimbursement.

PROPOSAL

Cloud-based IT vendor athenahealth leveraged its existing online platform, the Success Community, to enable its healthcare provider clients to connect with each other and exchange ideas during COVID-19.

“In addition to exchanging advice, the platform also acted as a central COVID-19 information hub with up-to-date regulatory information, workflow recommendations, and the promotion of new tools and enhancements designed to help address customer pain points related to COVID-19,” said Amy Coombs, an advanced registered nurse practitioner at Whole Life Health Care and founder and creator of the integrative medical concept Whole Life Health Care.

“Athenahealth’s clients frequently collaborated on topics such as telehealth solutions, revenue cycle management practices and ways to support their new remote patient experience,” she said.

"The team at Whole Life has learned so much from other healthcare providers during the COVID-19 pandemic, and we’re coming out stronger than before with new ideas on how to best serve our patients and improve safety measures."

Amy Coombs, Whole Life Health Care

The athenahealth Success Community platform not only worked to alleviate COVID-19 problems, but also showed providers the strength of the healthcare community during difficult times, Coombs added.

“Healthcare providers used the platform to come together and collaborate to combat similar issues, which led to empowering each other on how to address situations in a safe way,” she explained. “Ultimately, the platform’s goal was about making technology work for providers by leveraging a network of peers and allowing them to share on-the-ground experience and brainstorm solutions.”

MARKETPLACE

There are many vendors with electronic health records systems on the health IT market today, including Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.

MEETING THE CHALLENGE

Having access to the Success Community platform enhanced Whole Life’s workflows, as COVID-19 guidance changed daily, if not hourly. The platform was helpful in coming up with solutions to help fine-tune different processes at the clinic.

“Originally, starting out with different telehealth platforms such as FaceTime for virtual patient appointments, we switched to the athenaTelehealth solution for all telehealth visits in late spring,” Coombs said. “The team of clinicians at Whole Life thoroughly enjoys the athenaTelehealth solution as it allows us to meet with patients virtually and talk to them while having the ability to document at the same time, and offers an embedded image for video conferencing.”

So instead of having two split screens – one to chart and one to see the patient – with athenaTelehealth, the video image is inside the image of the chart, so the provider only has to look at one screen.

“The image also is movable, so the provider can reposition it, depending on what the chart view is,” Coombs explained. “During March, April and May, there were days our team would see 90% telehealth visits, so having a solution that was very easy helped our visits increase efficiency.”

Another asset the vendor provided to Whole Life during this time was a weekly conference call for athenahealth providers to discuss tips and learn about new digital tools such as billing solutions. The vendor put together a document on the different billing rules that were changing regularly – Whole Life could pull up that document when it needed to, and the vendor’s team was tracking this insurance information regularly.

RESULTS

At Whole Life Health Care, the advice has made a real difference, Coombs stated.

“The vendor’s team always has had our backs as business partners and the current situation is even more proof of that,” she said. “The demand on time, our ability to glean the most important information and make business decisions, then communicate that with staff has never been so tested. Additionally, athenaText, the mobile communication tool that allows the staff to exchange text messages and notifications, has never been so utilized.”

The combination of Whole Life staff and the support of athenahealth and its provider community helps the clinic gain ground on beating the challenges created from the coronavirus, she added.

“Not only has our staff been pleased with the vendor’s COVID-19 resources, but our patients also have been happy with the offerings, including the athenaTelehealth solution,” she said. “The solution has been a lifeline to us as we navigate uncharted territory while still seeing patients in a safe way.”

ADVICE FOR OTHERS

During difficult and unprecedented times, it’s important for healthcare providers to turn to their peers to learn from their similar challenges and best practices, Coombs advised. The healthcare community is filled with information and recommendations, and has created a strong sense of community, she said.

“Additionally, leveraging your EHR partner and solution can provide unexpected, helpful resources for any practice,” she concluded. “The team at Whole Life has learned so much from other healthcare providers during the COVID-19 pandemic, and we’re coming out stronger than before with new ideas on how to best serve our patients and improve safety measures.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

Konica Minolta Healthcare Americas will pay $500,000 to settle a whistleblower case that alleged its Viztek electronic health record subsidiary had falsified data for certification tests.

WHY IT MATTERS
In the qui tam complaint, filed in 2017 in U.S. District Court in New Jersey – where Konica Minolta is based – was filed by whistleblower Leighsa Wilson, who worked for two years at Viztek, best known for its PACS and imaging technologies, as a project manager for its EXA EHR product.

In mid-2015, the complaint alleges, Viztek, which was in negotiations to be acquired by Konica Minolta, worked together with InfoGard Laboratories (which was then an ONC-authorized certification and testing body) to make false representations that the EHR software complied with requirements for certification – and qualified for receipt of incentive payments under the federal meaningful use program.

"To ensure that their product was certified and that their customers received incentive payments, Viztek and Konica Minolta: (a) falsely attested to InfoGard that their software met the certification criteria; (b) hard-coded their software to pass certification testing requirements temporarily without ensuring that the software released to customers met certification criteria; and (c) caused their users to falsely attest to using a certified EHR technology, when their software could not support the applicable certification criteria in the field," according to the complaint, which also alleges that InfoGard "facilitated and participated in" these false attestations, "knowingly or with reckless disregard," certifying the EHR software despite its inability to meet ONC's certification criteria.

The flaws in Viztek's software "not only rendered the system unreliable and unable to meet meaningful use standards, but the flaws also created a risk to patient health and safety. Rather than spend the time and resources necessary to correct the flaws in its EHR software, the EHR defendants opted to do nothing."

THE LARGER TREND
This is only the most recent settlement of this type from health IT vendors accused of False Claims Act violations, of course.

Most notable, was the case of eClinicalWorks, which was alleged by the Department of Justice to have falsely claimed meaningful use certification, to have neglected to have safety addressed issues in its software and to have paid kickbacks to clients. That case was settled in 2017 for $155 million.

More recently, similar complaints were lodged against companies such as Practice Fusion and Greenway Health. They settled with DOJ for $145 million and $57 million, respectively.

"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 U.S. Attorney for the District of Vermont Christina Nolan after the Greenway case this past year. "EHR companies should consider themselves on notice."

ON THE RECORD
"The lives of patients depend upon the information processed by electronic health records," said Wilson – who, as a qui tam whistleblower will receive 20% of the financial settlement – in a statement. "Functionality testing and subsequent certification must be performed and obtained through a reliable, measurable process."

"Filing a qui tam lawsuit is a powerful and effective way to report problems with EHR software purchased with federal funds and get the problems fixed when they are ignored," said Luke Diamond, an associate at Phillips & Cohen. "The False Claims Act protects whistleblowers from job retaliation and offers rewards if the government recovers funds as a result of the qui tam case."

"Our client was concerned about possible patient harm that can occur if EHR software isn't properly certified, so she stepped forward to inform the government about what she had witnessed," said Colette Matzzie, a partner and whistleblower attorney with Phillips & Cohen, which brought the case. "Ensuring that EHR software meets all governmental requirements is important to safeguard both patient care and federal funds."

Artificial intelligence technologies are being increasingly relied upon in the healthcare domain, particularly when it comes to decision support, precision medicine, and the improvement of the quality of care. Regarding primary care specifically, AI also represents an opportunity to assist with electronic health record documentation.   

A new study published in the Journal of American Medical Informatics Association this week shows that, although AI documentation assistants (or digital scribes) offer great potential in the primary care setting, they will need to be supervised by a human until strong evidence is available for their autonomous potential. 

In workshops with primary care doctors, wrote researchers from the Australian Institute of Health Innovation, "There was consensus that consultations of the future would increasingly involve more automated and AI-supported systems. However, there were differing views on how this human-AI collaboration would work, what roles doctors and AI would take, and what tasks could be delegated to AI."  

WHY IT MATTERS 

Researchers worked with primary care doctors who use EHRs regularly for documentation purposes to understand their views on future AI documentation assistants. They identified three major themes that emerged from the discussions: professional autonomy, human-AI collaboration and new models of care.  

First, the doctors emphasized the importance of their ability to care for patients in their own way with the abilities AI technology provided.

"If they [patients] think that we're just getting suggestions from a computer, then maybe they can just get suggestions from a computer. I think it becomes more difficult to convince them that our recommendations are more valuable than what they can pick up on the internet," said one physician.
 
They noted the need for a bottom-up approach to technology development, with a focus on delivering clear benefits to practice and workflow, and expressed fears around potential legal complications that could stem from working with an AI assistant.

With regard to human-AI collaboration, doctors expressed a variety of viewpoints about what tasks could be delegated to AI. Many believed that an AI system could assist with tasks such as documentation, referrals and other paperwork. Most said that AI systems would lack empathy. 

"GPs voiced several concerns, including some potential biases in patient data and system design, the time needed to fix the errors and train the system, challenges of dealing with complex cases, and the auditing of AI," wrote the researchers.  

However, doctors also discussed how AI could help with emerging models of primary care, including preconsultation, mobile health and telehealth.   

THE LARGER TREND  

The question of reducing EHR-related clinician burnout has loomed large, with vendors and researchers trying to pinpoint major causes – and, in turn, potential solutions.   

AI has been raised as one such solution, with several major EHR vendors offering plans for incorporating the technology into their workflows. 

But human input remains vital, as the new JAMIA study and other research has noted.  

AI could "bring back meaning and purpose in the practice of medicine while providing new levels of efficiency and accuracy," wrote Stanford researchers in a 2017 Journal of the American Medical Association study. But, they continued, physicians must "proactively guide, oversee, and monitor the adoption of artificial intelligence as a partner in patient care."

ON THE RECORD

"AI documentation assistants will likely ... be integral to the future primary care consultations. However, these technologies will still need to be supervised by a human until strong evidence for reliable autonomous performance is available. Therefore, different human-AI collaboration models will need to be designed and evaluated to ensure patient safety, quality of care, doctor safety, and doctor autonomy," wrote the Australian Institute for Health Innovation researchers.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

When the pandemic struck, tech-savvy oncologists at the Royal Marsden Hospital (RMH), which specialises in cancer treatment, wanted to develop a new system to protect cancer patients from COVID-19 exposure. The oncologists asked their CIO, Lisa Emery, to help them develop software to pre-screen patients for the infection, before arrival at hospital, to protect immuno-compromised cancer patients. To pre-screen patients effectively, they needed to know when newly admitted patients tested positive for COVID-19, when patients exhibited symptoms of the disease and when patients came into close contact with someone with the virus. Additionally, the cancer specialists wanted to monitor the health of COVID-19 patients already discharged from hospital.

Manual pre-screening process was labor intensive

A COVID pre-screening questionnaire already existed in paper form at the hospital, but completing it was a labour-intensive, manual process. According to Emery, skilled nurses spent time calling patients to administer the questionnaire, removing them from more pertinent tasks. The right solution would allow  RMH to pre-screen patients simply and quickly, allowing nurses to return to more pressing work. It would also empower patients, allowing them to take a more active role in their care.

Collaboration and flexibility produce innovative solution

RMH turned to OnBase, Hyland’s enterprise information platform, to build the solution. Emery and her team suggested transforming the paper questionnaire into a dynamic electronic form, which could check symptoms remotely. As the teams began to collaborate, they reimagined the content of the form. Beyond a simple pre-screening, collected data could, in turn, trigger a response from a nurse cancer specialist to contact the patient, provide reassurance and set up a video-consultation, if necessary. It was imperative that Information could be collected easily and shared quickly.

Automated workflow notifies clinicians of patient needs

The teams also wanted to make sure the software was simple for patients to use as they did not want to overload cancer patients with too many system changes. RMH worked with the Hyland team to create a web portal where patients could easily access and fill out the symptom checker. Patients could provide up-to-date medical information, as well as any COVID-19-specific symptoms they may be experiencing. The answers provided could trigger a specialist response and other clinical intervention. The trigger would arrive via automated workflow and an email would notify the specialists that patients may be in need.

RMH expands symptom checker throughout enterprise

After development and launch, adoption of the remote symptom checker has increased. It is now used to check any patient for COVID-19 symptoms, prior to arrival, for any form of treatment. RMH is now working with several clinical teams and expanding its use of the symptom checker to outpatient clinics as well. The hospital also plans to revisit the technology and apply it to other communicable diseases, like the flu.

To learn more, visit the Hyland booth at the HIMSS & Health 2.0 European Digital Conference (7-11 September). Click here for further information and to get your ticket.

Online patient portals are an increasingly popular way for health systems to allow appointment scheduling, with many major electronic health record vendors offering them as an option.

But a study of more than 134,000 completed primary care visits published this past week in the Journal of the American Medical Association found that early adopters of direct scheduling – as opposed to making appointments with clinic staff via the telephone or in person –  were more likely to be young, white and commercially insured.

"To the extent these differences persist as direct scheduling is used more widely, this service may widen socioeconomic disparities in primary care access," wrote the researchers.

WHY IT MATTERS

Direct scheduling can offer patients an option to make appointments at their own convenience, outside of business hours. Small-scale studies also suggest that direct scheduling may be associated with lower no-show rates.

By January 2018, as researchers write, a large Boston-area academic medical center had implemented direct scheduling in 17 adult primary care centers. The team used EHR data to identify the characteristics of more than 62,000 patients who sought appointments with 140 primary care physicians between March 1, 2017 and March 1, 2019.

Among those patients, 5,020 used direct scheduling during the study period. These adopters, compared with nonadopters, were more likely to be younger and white. They were also more likely to have commercial insurance, more comorbidities and higher prior utilization.

Most directly scheduled visits were done with the patient's own primary care physician. They were less likely to be billed at the highest complexity level.  

"We also found evidence that patients might find direct scheduling more convenient than usual scheduling: Most directly scheduled visits were scheduled during usual business hours, when patients could have called the office, yet chose to schedule online," wrote the researchers.

The results suggest, according to the study, that direct scheduling may contribute to continuity and access, which are associated in turn with better health outcomes and lower costs.

At the same time, the research team warned, "our findings raise the possibility that direct scheduling might contribute to disparities in primary care access."

They noted that they restricted the sample to patients who had enrolled in the portal. Prior research has shown that patients of color are less likely to enroll in patient portals in the first place. Half of primary care patients across the larger health systems were active portal users, and these users were more often women, English-speaking, and white.

"Even among patients with portal access, those who are socioeconomically disadvantaged are less likely to use the technology," they wrote.

THE LARGER TREND

Patient portals and online scheduling technology have been found to offer financial benefits and improve efficiency and engagement, and to lower no-show rates.

But some patients say they're clunky, and complain of confusing interface design and too much time investment for setup. They also often complain of having a different portal for every provider, and suffer from so-called "multi-portalitis."

And, as the JAMA study notes, the disproportionate use of direct scheduling by younger white patients could "crowd out visit access" for older patients and those of color – who may have historically decreased access to primary care.

ON THE RECORD

"Direct scheduling is intended to improve patient convenience while reducing administrative burden for practices," wrote the researchers. "This offering may have additional benefits, especially in the primary care setting, such as promoting continuity with one’s usual primary care physician." 

"Conversely, direct scheduling might worsen disparities in access to care via the so-called digital divide," they added.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

A new report from research firm KLAS found that nearly half of the 19 healthcare executives surveyed say that either telehealth functionality or capacity has been their primary problem to solve during the early stages of the COVID-19 crisis.

Other major challenges include remote patient monitoring, interoperability, real-time data analytics, work-from-home resources and patient surveillance.

"While healthcare organizations have found stopgaps in many areas, few have successfully implemented permanent solutions that serve a long-term strategy," wrote the report authors.

WHY IT MATTERS

As the novel coronavirus pandemic spread across the country this spring, the need became quickly evident for healthcare organizations to spin up telehealth solutions.

Aided by relaxed federal regulations, many health systems modified existing infrastructure or relied on consumer-facing products to fill the gap and address increased demand.

"We have had the ability to perform video visits for six years. Until the middle of March, we had performed just over 1,000 visits total during that time. Since the middle of March, we have performed over 160,000 due to payment waivers and necessity," wrote one customer quoted in the report. 

“We used a few tactics. First, we used tools like Skype, Google Duo and FaceTime as a stopgap. Then we expanded our Epic/Vidyo integration from urgent care visits to all visit types, including surgical and non-surgical specialties and all primary care. This let us replace the stopgap tools," wrote another respondent.

"We also implemented on-premises telehealth in the ER, ICU and floors; that way, a provider can be in the same building as the patient but not in the same room, decreasing exposure and limiting PPE usage," they continued.

Nearly half of executives said their organization had enhanced telehealth-related electronic health record functionality the most because of the COVID-19 crisis, with another 50% saying they'd enhanced such tools "somewhat."

"While a few leverage EHR dashboards to get the real-time data they need, most load the data from their EHRs into other software solutions (e.g., Microsoft Power BI and Tableau) to either house the data or build data visualizations," wrote the report authors.

And although remote patient monitoring has been another technology concern, only four organizations out of 18 say they have a workable solution.

"Eight organizations say their RPM technology problem remains unsolved," write the report authors.

THE LARGER TREND

As the report notes, the longevity of telehealth is still uncertain. Although many legislators have signaled their support for some permanent policies that would enable access to virtual care, the details – particularly around reimbursement – remain murky.

This past month, the American Hospital Association wrote an open letter to President Donald Trump and leaders at the U.S. Department of Health and Human Services urging them to take specific actions to safeguard telehealth in the longer term.

"We urge the Administration to work with the AHA and Congress to create a future for telehealth that allows not only clinicians, but also hospitals and health systems, to code and bill for virtual services," wrote AHA president and CEO Richard J. Pollack. 

ON THE RECORD

Regarding the executives surveyed in the KLAS report, "Several mentioned using consumer-facing products – e.g., Apple FaceTime, Google Duo, Zoom or Skype – that enable organizations without existing telehealth capabilities to quickly ramp up and handle increased demand," wrote the authors. 

"While many solutions are suitable for this emergency purpose, solutions that serve a strategic, long-term telehealth vision are much scarcer," they continued.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Healthcare IT News is a HIMSS Media publication.

At TriHealth, a health system based in Cincinnati, Ohio, clinicians were feeling the pinch between balancing their actual jobs (in caring for patients) and administrative work, like electronic health record data entry.

THE PROBLEM

Staff members previously had to search through paper records to find the patient information they needed, thus hindering efficient and informed decision-making. Every transition in care is also an opportunity for a breakdown if there is no real-time and discreet sharing of information. The staff wanted a way to make transitions seamless, automatic and secure.

The hospital was sending a continuity-of-care form to the skilled nursing facility to alert them to patient needs, and then this document was manually entered into the EHR. This could have been an automated process to avoid any potential bumps in the road that could lead to a gap in care.

TriHealth originally started working on an integration with health IT vendor PointClickCare with the hope of automating the flow of all patient data between institutions, ultimately giving clinicians back precious time in their days and improving the quality of care that patients receive.

"With any integration, it’s not always 100% right away. We consider [83%] to be highly impressive, especially considering the large volume of patients that we were transferring at the time due to COVID-19."

Lori Baker, TriHealth

“So, it’s fair to say that prior to COVID-19, we definitely understood the innate value of having this depth of digital connectivity between our institutions,” said Lori Baker, director of ambulatory care management and senior services/post-acute care at TriHealth.

“Once the pandemic hit, it became clear that we needed to ramp up these existing operations quickly, in order to efficiently care for the number of patients being transferred between TriHealth hospitals and post-acute care facilities, all at the same time,” Baker continued.

PROPOSAL

PointClickCare is a cloud-based software vendor for the long-term and post-acute care market, supporting more than 21,000 skilled nursing facilities, senior living communities and home health agencies across North America. PointClickCare’s technology works to eliminate data silos among care settings and teams in order to enable clinical insights and mitigate risk.

“Harmony by PointClickCare facilitates the seamless, automatic flow of patient data between our acute and post-acute care institutions,” Baker explained. “This means that when a patient is transferred from the hospital to a skilled nursing facility, their data is sent with them, so there are no gaps in care or miscommunications between care teams. This continuity helps to make processes more efficient for our staff and provide families with accurate information to make the best transition decisions for their loved ones, through a single, secure platform.”

In this way, the patient gets the best, most-coordinated care possible and the clinician gets to spend more time with the patient and less time on administrative work. The result is shown to alleviate symptoms of burnout, she added.

“Improving outcomes for all stakeholders involved in the care journey has always been our goal, and especially while navigating the uncertainties of the COVID-19 pandemic, the software has helped us to realize that goal,” she said.

MEETING THE CHALLENGE

Because TriHealth had been working with the vendor on a larger EHR integration project, it was able to deploy a pilot project with five facilities when COVID-19 really began to hit in March. Those five facilities completed all communications between acute and long-term care via EHR for all transitions of care. TriHealth was so pleased with the initial results that it believed it could start the next phase of this work. It has now onboarded 20 more facilities in the past month.

“In order to accomplish this quickly and rather seamlessly, the TriHealth team engaged the pharmacy team, emergency department physicians and other clinicians on the medical floor to ensure they were aware of the information and [knew] where to find the information they needed in the medical chart,” Baker said. “We continue this education process to help ensure that we are making the right information visible and helpful to providers, when they need it.”

TriHealth also now holds bimonthly team meetings to identify any glitches, do a bit of root-cause analysis and then work with PointClickCare to refine the process and technology as necessary with all the providers who are using the new systems. This has proven to be a very helpful process, and a demonstrable sign of skilled nursing facilities and TriHealth working together to help sites be successful and grow stronger in the long run, Baker remarked.

RESULTS

“With any integration, it’s not always 100% right away,” Baker noted. “That said, 83% of EHR transfers using the PointClickCare integration were successful between March and April of 2020. We consider this to be highly impressive, especially considering the large volume of patients that we were transferring at the time due to COVID-19.”

Since integrating with the vendor’s software, TriHealth also completed a pilot readmission study with the first five skilled nursing facilities to be onboarded. The study compared readmission rates between April and May 2019 to readmission rates between April and May 2020. The health system found there was a 6.7% decrease in readmissions. While the denominators were relatively small in this pilot, TriHealth is excited about this early win, Baker said.

“We’ve definitely learned a lot from the pilot with the vendor and feel confident that we can work together to fine-tune the process even further,” she said.

“The next challenge we anticipate will be finding locations to house a potential second wave of COVID-19-positive patients who are ready for acute care discharge, but unable to enter a skilled nursing facility. Of our more than 200 skilled nursing facilities in the Cincinnati area, only five are able to take in COVID-19-positive patients. This is through no fault of the facility, but rather a reflection of just how vulnerable this particular population is.”

Everyone is stepping up to the challenge every day, she added. That said, TriHealth has seen an increase in the amount of skilled nursing facilities that offer isolation units. It continues to test each patient for COVID-19 prior to discharge from the hospital in an effort to mitigate the spread of the virus, she said.

ADVICE FOR OTHERS

“In attempting to alleviate the strain placed on our health system due to COVID-19, we’ve learned to implement and use digital care solutions more quickly and effectively during the past few months than ever before,” Baker noted.

“At TriHealth, had we already been further along in our EHR integration with PointClickCare at the time that the pandemic hit, we definitely would have experienced better connectivity between facilities at the onset,” she continued.

Regardless, the integration allowed TriHealth to better handle the complexities of the pandemic, she stated. Now the health system is trying to do what it can and leverage what it has learned to prepare for a potential second wave of COVID-19, she said.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

AI-POWERED SURGICAL INTELLIGENCE PLATFORM PARTNERS WITH ISRAELI HOSPITAL

Surgical intelligence platform, Theator, has announced a new partnership with Tel Aviv Sourasky Medical Center (Ichilov Hospital), the largest acute care facility in Israel, treating about 400,000 patients and hosting 1.8 million patients visits per year.

This marks the first time that an Israeli hospital will implement a surgical intelligence platform in its operating rooms. Theator’s AI-powered technology will be the first to enable smart surgical video capture and improved surgeon performance and training.

Powered by advanced AI and computer vision technology, the platform extracts and annotates every key moment from real-world surgical procedures, allowing surgeons to gain scientific insight into their own performance and those of surgeons worldwide.

SWISS BLOCKCHAIN HEALTH CERTIFICATE TRIAL

Results from a trial of Switzerland’s Health n Go blockchain health certificate app have shown that if health certificates are required in the future, they can be digitally delivered securely and remotely.

Health n Go, the secure mobile app for health certificates from the ELCA group, teamed up with the Swiss laboratory network Medisupport and Matisa, a Swiss railway equipment manufacturer, to trial the app with a group of Matisa employees.

Each user downloaded the Health n Go app onto their mobile phone and presented it to the health professional carrying out their coronavirus test. The sample was then sent to a Medisupport laboratory for testing and the result was issued as a digital encrypted health certificate which appeared in the employee’s Health n Go wallet on their phone.

The trial proved that the app could be used to allow coronavirus-free staff to continue to travel if restrictions at border entries were introduced.

MEDICOMMS SELECTED FOR NHSX CLINICAL COMMS PROCUREMENT FRAMEWORK

Armour Comms, provider of specialist communications solutions, has been accepted on to the first edition of the NHSX Clinical Communications Procurement Framework, with its Medicomms by Armour solution. 

Designed for use by health care professionals and patients, Medicomms is a mobile app that converges internal communications to help with the collection and sharing of sensitive patient data. 

It is also an alternative to paging and has the ability to provide a medium for secure video-consultations and patient aftercare communications.

Medicomms is now available to all NHS trusts via the new NHSX procurement framework, and can be used by healthcare professionals via mobile, tablet, and laptop devices from most operating system including iOS, Android and Windows10.

WHO DIGITAL HEALTH VIRTUAL ROUNDTABLE

The World Health Organisation (WHO) invited partners and potential investors to a virtual round table yesterday to learn, collaborate and invest in the future of digital health.

This event, which is a series of roundtables scheduled to be held this year, invited attendees to:

• Present the WHO vision for digital health by building the global digital health community together with key stakeholders including the member states.
• Bring together a global digital health community to work together in the prioritisation, adoption and acceleration of digital health technologies.  
• Commit to a global effort to contribute to and invest in the global digital health ecosystem.

This series of roundtables will be held with all the key stakeholders. Previously, donors and development partners met on 23 June 2020 and member states met on 21 July. Upcoming roundtables will take place with academia at the end of September and the private sector in early October. 

£800M TENDER LAUNCHED FOR NHS DIGITAL SOLUTIONS FRAMEWORK

The NHS has launched an £800 million tender for the provision of digital solutions within its NHS Digital and social care departments.

Twelve suppliers will be chosen for the framework, intended to address the evolving technical “stacks” associated within the pillars of NHS Digital, which include product development and data services.

Successful suppliers will be required to provide DevOps, support for ongoing live services; digital definition services; build and transition; end-to-end development; and data management services.

They will also need to develop a strategic relationship to encourage suppliers to innovate on their delivery of services.

The tender is managed by Crown Commercial Services (CCS) and is open for applications until 24 September 2020. 

SWEDISH HEALTHTECH COMPANY EXPANDS INTO UK

Swedish healthtech company, Doctrin has announced its plans to expand to the UK.

Doctrin is a healthtech company with a solution that enables healthcare providers to intelligently digitalise the patient journey to create a more accessible healthcare system.

Doctrin is now ready to present their digi-physical solution to patients and physicians globally, starting this autumn by launching in the UK this week (1 September).

Country manager for the new division is newly recruited Craig Oates, who will take lead on this expansion and present the company’s ideas on how to improve healthcare to the UK market.

“Doctrin is transforming how healthcare is delivered, moving to digital consultations that demonstrably improves patient care as well as the experience and efficiency for clinicians.

“This holistic view on digitalising the healthcare system is already proving its value in Sweden and the Czech Republic, showing game-changing benefits which I look forward to sharing with our UK customers,” said Oates.

The majority of Abu Dhabi’s hospitals are now digitally connected, it has been announced. This comes just over a year on from the implementation of the UAE’s first Health Information Exchange (HIE) platform, Malaffi, where more than 60% of hospitals in the United Arab Emirates (UAE) capital are now part of the platform.

Translating into “My File”, Malaffi – which is the country’s first HIE platform – became operational at the end of July 2019, following a contract between Abu Dhabi Health Data Services (ADHDS) and New Zealand technology solutions supplier Orion Health.

ADHDS was set up as a public-private partnership (PPP) between the Abu Dhabi DoH and Injazat Data Systems, which is a subsidiary of the Mubadala global investment company.

THE LARGER CONTEXT

Malaffi reportedly currently connects 35 healthcare groups, as well as 40 hospitals and 403 clinics. Healthcare entities connected include Abu Dhabi Health Services Company (SEHA) hospitals, Emirates Hospital, Emirates International Hospital, Dar Al Shifaa Hospital, Bareen Hospital, and Cambridge Medical & Rehabilitation Hospital. The Malaffi app allows Abu Dhabi residents to access their medical records via smartphones, as reported by Healthcare IT News.

An estimated 25,923 doctors, nurses and other healthcare professionals now have access to Malaffi, enabling them to “make better-informed decisions by safely and securely accessing vital medical information, such as patient visits, medical problems, allergies, procedures, lab results, radiology reports and medications” in “107 million clinical records from 16 different Electronic Medical Records (EMR) systems operated by over 500 connected healthcare facilities,” the Department of Health (DoH) said in a statement.

“Transforming Abu Dhabi’s healthcare sector and delivering the best care possible is at the heart of everything we do. Connecting healthcare and having better data is an integral part of that. This is a time like no other,” said Jamal Mohammed Al Kaabi, acting under-secretary of the DoH Abu Dhabi. “We are seeing people living longer than ever before; the rise of chronic diseases with hospitals operating at full capacity, and new diseases such as COVID-19 have demonstrated the need for innovative platforms such as Malaffi, that serve the healthcare sector in Abu Dhabi and enable the provision of high-quality health services to residents.”

He explained that the DoH was “better set” to evaluate and implement response measures to the COVID-19 outbreak based on real-time pandemic indicators from the centralised database of all COVID-19 results in Abu Dhabi, which was urgently deployed by Malaffi.

“The Platform is enhancing the value of information in the system and speed of connectivity, to help us build a stronger, more resilient and cohesive, knowledge-founded healthcare system that provides better care for everyone.”

ON THE RECORD

Atif Al Braiki, CEO of ADHDS added: “We have been on an ambitious and important journey of connecting healthcare in Abu Dhabi, from the smaller providers – medical centres, dental clinics and pharmacies – to the larger, multi-speciality, cutting edge hospitals.”

Streamlining documentation has always been a goal at New Jersey’s St. Joseph’s Health because more time spent documenting in the computer means less time nurses have to spend with patients.

THE PROBLEM

Specifically, the challenge at St. Joseph’s was that the nursing assessment for patient admissions was very lengthy. There was a lot of information in there, so staff were trying to streamline that process. On the nursing units, they get a lot of admissions every day, and it takes a lot of time to do that initial assessment.

“We wanted to make sure we had the appropriate information in our admissions forms by regulatory standards while also capturing what we needed to design care plans for our patients,” said Judy Padula, RN, vice president for patient care services, and Chief Nursing Officer at St. Joseph’s Health. “We also wanted it to be as streamlined as possible, so the nurse didn’t spend extra time at the computer when they could be using that time caring for patients.”

Staff talked about this before COVID-19, but when the pandemic hit the northern New Jersey area, the organization was getting at least 100 patients in the emergency room daily. Given the extremely high volume of admissions, the pandemic further emphasized the urgent need for staff to streamline the documentation and maximize the efficiency of nurses.

PROPOSAL

St. Joseph’s uses the Cerner electronic health record. Staff met with Cerner’s team well before COVID-19, right after the implementation of the EHR, to talk about ways they could use additional Cerner offerings to enhance existing services. At that time, Cerner mentioned the expedited admission intake essential clinical dataset (ECD), and St. Joseph’s was very interested.

"We wanted it to be as streamlined as possible, so the nurse didn’t spend extra time at the computer when they could be using that time caring for patients."

Judy Padula, RN, St. Joseph’s Health

“The proposed solution was to put in an expedited ECD for adult and pediatric patient admissions forms and patient history form for adult and pediatric patients,” said Janice Wojcik, RN, director of nursing informatics at St. Joseph’s Health.

“We discussed the larger ECD implementation before COVID-19. This solution was especially useful to us because it allowed us to analyze the data we already collected from end users. This was a two-week project where we sat down and did the analysis, then I went through as a clinician to see if it would make sense for us,” Wojcik added.

Cernercompany has regular ECD services that are centered on streamlining documentation, but when the pandemic hit, Cerner developed an expedited offering to quickly help users overcome this barrier.

MARKETPLACE

There are many vendors with electronic health records systems on the health IT market today, including Allscripts, athenahealth, Cerner, eClinicalWorks, Epic, Greenway Health, HCS, Meditech and NextGen Healthcare.

MEETING THE CHALLENGE

St. Joseph’s Health staff nurses are the primary users of this tool.

“The beauty of this solution is that it requires no additional training,” Wojcik remarked. “We didn’t have time during the pandemic to stop operations and train end users on a new system. With this implementation, nurses didn’t have to do anything outside of their regular workflow. That was a big bonus for us. The ECD solution is a feature of our Cerner Millennium EHR, which is a fully integrated platform enabling data to flow seamlessly from one system to the next.”

"The beauty of this solution is that it requires no additional training. We didn’t have time during the pandemic to stop operations and train end users on a new system."

Janice Wojcik, RN, St. Joseph’s Health

Staff reached out to pediatric and adult end users to get feedback. They looked at four fields that were being filled out less than 10% of the time and really looked to see if they made sense there. Staff followed ECD guidelines to eliminate and modify certain fields.

“After implementing the ECD solution, we were able to achieve a 23% reduction in the total number of distinct elements on admission forms, eliminating fields that were duplicative or contained irrelevant information,” Wojcik said.

RESULTS

In partnering with Cerner’s Continuous Improvement Team to expedite ECD, staff achieved noticeable decreases in the average time to complete Adult Patient History Forms, the average number of clicks, and the number of distinct elements nurses had to complete in the admission forms for adult and pediatric patients.

“Cerner’s expedited ECD solution helped save nurses an average of 62 seconds per patient encounter, which works out to 190 hours a year saved,” Wojcik reported. “Nurses also experienced 15 fewer clicks per patient encounter, working out to 165,360 fewer clicks per year. That time is now freed up to spend more time caring for and listening to patients.”

ADVICE FOR OTHERS

“Others considering using this type of technology should move forward with it,” Wojcik advised. “This project was unique in that we implemented it over such a short period of time and during a time where we were experiencing unprecedented levels of surge across our facilities. The bigger message is to work with your vendor to see how you can optimize systems to deliver patient care under very stressful and trying conditions.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himss.org
Healthcare IT News is a HIMSS Media publication.