While Direct messaging has had a circuitous path into health information exchange, Nemours is already using the protocol to meet the 10 percent threshold for sending electronic summary care records when transitioning patients to other care settings under meaningful use.

Nemours has Direct messaging integrated with its EHR and also contracts with a separate HISP – health information services provider – which senior manager of strategic process implementation Alex Koster likened to "a telecom company for Direct messaging," during a National Health IT Week webinar on Wednesday.  

In Nemours' case, the HISP is Surescripts, but others include DataMotion MedAllies, Medicity, Orion, RelayHealth and many more.

"Once we have that in place, it allows us to generate Direct secure messaging addresses for all the physicians, nurse practitioners and others in our system," Koster added. "And also to create, if we wanted departmental address, such as an endocrinology address or a hospital-level address as well."

That function, he said, is embedded in Nemours' EMR, and routes messages as part of the system's communication and ordering workflows.

"As a large subspecialty and specialty pediatric system we receive many more messages than we send," Koster pointed out. "We have been receiving messages from a variety of different sources, and we've identified message types that come into our system using the Direct messaging framework."

Among them:

1. Inpatient and ED discharge notifications. "We are the primary care physician of record, and one of our patients goes to a hospital that's not ours. If they have updated their provider directory, they know when they discharge that patient to send us information about the hospital stay via a CCD," he said."

2. Referrals from primary care sites. "Most of them have explored Direct messaging through their local EHRs. They select Nemours – whether it's just our generic address or the address of one of our doctors – from their directories. And they're able to send us referrals directly, using this mechanism."

3. Post-visit notes to PCPs from specialists who come from other health systems. "And also from retail clinics such as CVS," Koster added. "When one of our patients goes to a CVS, they send us a post-visit note via Direct and that goes into our system."

4. Immunization notifications from organizations such as Walgreen's. "Those are coming int our EMR via Direct.

5. Medication renewal reminders from groups such as ExpressScripts

6. Medication adherence notices. "I won't say we've gotten many of these, but where there has been some discussion between patients and a pharmacy on a medication regimen; we've gotten a clinical note, via Direct, where a patient has admitted they haven't followed up with the fact that they've discontinued their medication regimen."

7. Drug substitution notices.

8. Some patient generated messages. "One of the requirements for functionality with patient portals is that they have to have the capability for the patient to transmit using this avenue as well," Koster said. "We have had patients who are relocating from other areas of the country and are coming under our care, sending us their own care summaries."

Nemours analyzes which doctors are transitioning patients to specialists or other facilities, for example.  

"We then reach out to those organizations to see how we can enable this electronic transmission, so they have easy access through our communication workflow, our ordering workflow, to select that common referral partner and that (continuity of care document) will go out electronically,” Koster said.

What’s more, Koster added that staff at Nemours has been "making sure, as we've been working with different primary care sites, to capture the Direct address for the physicians or practices, in a way that will be readily available."

That way, when a patient is discharged from a Nemours hospitals and is managed by a referring physician for whom a Direct address is noted, "they will automatically get a discharge summary," he said. "That is also happening from our urgent care."

How Direct got where it is today
When it was first unveiled as a new vehicle for health information exchange back in 2011, Direct messaging was described as "a classic, fantastic, soon-to-be-legendary example of how the public and private sectors can come together in a collaborative, entrepreneurial explosion of mojo to improve and advance healthcare in America."

The secure, scalable, email-like messaging system was touted by one of its architects as "the first technology that could really kill the fax in healthcare." 

[Also: Direct messaging finding its stride despite hurdles]

More than five years later, the hype has abated a bit. Direct messaging has spread somewhat as reliable and cost-effective way for physicians, clinicians and even patients to exchange data, but it still hasn't quite caught on to the extent some – not least government agencies like ONC, which initially convened the who's-who of private-sector IT vendors to helped develop its specs – had hoped.

As David Kibbe, MD, CEO of Direct Trust, which accredits and supports its protocols, told Healthcare IT News in 2015: Direct's use has grown, but it has also, at times, felt like "an uphill struggle."

According to HIMSS' 2015 Direct Messaging Survey, Direct is broadly available and substantially put to work for certain use cases. But many respondents reported difficulties incorporating the messaging with theirs EHRs – while also citing cost, workflow integration challenges and a lack of other Direct-enabled providers as barriers to wider use.

But Direct offers a familiar and intuitive way to exchange information about admissions, discharges and transfers; enables easy consultations between physicians and other clinical staff; offers new avenues for patient communication and much more.

It's also, not insignificantly, a key way to comply with the health information exchange requirements of Stage 2 meaningful use.

More than meaningful use compliance
While Nemours has achieved success in complying with meaningful use, Koster has additional future plans for the protocol.

"If organizations take the stance that this is really all about checking a meaningful use box, it might limit the imagination or creativity that could be applied enhancing their patient experience," said Koster.

Koster recommended taking an approach that technology and tools can be applied to make a better patient experience as well as improving treatment and outcomes.

"We're very much interested in seeing how we can streamline and remove paper from our workflows," he said. "That's part of the reason why we will actually accept referrals that come in via Direct – rather than saying, 'No, send us Direct so we can meet meaningful use, but also fax it to us.' We're trying to eliminate that duplication. I'm not going to say it's been smooth, or perfect, but it's working most of the time and when it doesn't work we're able to follow up and figure out why."

Helpful advice for planning to purchase a population health platform:

⇒ Experts explain what to look for when choosing a population health platform
⇒ Comparison chart of 8 population health products 
⇒ An in-depth look at 8 population health software programs

Like Healthcare IT News on Facebook and LinkedIn

Blockchain technology gained international attention as the technology supporting bitcoin, a digital asset and a payment system that relies on peer-to-peer transactions taking place between users directly, without an intermediary. These transactions are verified by network nodes and recorded in a public distributed ledger, or the blockchain.

While acceptance has proceeded slowly, blockchain is gaining respect for its ability to support enormous data sets and transactions — and that capability has not gone unnoticed by healthcare industry innovators on the lookout for technology that can manage the evolution of complex and wide-ranging information systems.

Consultancy Deloitte, for instance, makes the case in a new report that a nationwide blockchain network may improve efficiencies and support better health outcomes for patients. 

[Innovation Pulse: Interoperability: Ripe for disruption?]

“While blockchain technology is not a panacea for data standardization or system integration challenges, it does offer a promising new distributed framework to amplify and support integration of health care information across a range of uses and stakeholders,” the report explained. “It addresses several existing pain points and enables a system that is more efficient, disintermediated, and secure.” 

The technology holds particular promise in use cases for Precision Medicine Initiative, Patient Care and Outcomes Research (PCOR), and the Office of the National Coordinator for Health IT’s Nationwide Interoperability Roadmap. 

Indeed, Blockchain has potential value due to its shared, fixed record of peer-to-peer transactions, built from linked transaction blocks and stored in a digital ledger, Deloitte said. The network is both secure and actionable by relying on established cryptographic techniques, and letting participants in a network interact (e.g. store, exchange, and view information), without pre-existing trust between the parties.

“Interactions with the blockchain become known to all participants and require verification by the network before information is added, enabling trustless collaboration between network participants while recording an immutable audit trail of all interactions,” Deloitte explained. 

This network architecture is potentially suited to work ONC has undertaken with its Shared Nationwide Interoperability Roadmap and efforts at defining critical policy and technical components needed for nationwide interoperability.

These ONC needs include ubiquitous, secure network infrastructure, verifiable identity and authentication of all participants, consistent representation of authorization to access electronic health information, and several other requirements. Current technologies do not fully address these requirements, because they face limitations related to security, privacy, and full ecosystem interoperability, the report said.

“The current state of health care records is disjointed and stovepiped due to a lack of common architectures and standards that would allow the safe transfer of sensitive information among stakeholders,” Deloitte said. “Healthcare providers track and update a patient’s common clinical data set each time a medical service is provided. This information includes standard data, such as the patient’s gender and date of birth, as well as unique information pursuant to the specific service provided, such as the procedure performed, care plan, and other notes.” 

The traditional siloed approach of tracking information in a database within a singular organization or within a defined network of health care stakeholders runs up against the needs for greater interoperability across systems as data and records need to be distributed.

“Instead, health care organizations could take one more step and direct a standardized set of information present in each patient interaction to a nationwide blockchain transaction layer,” the report stated. 

Both interoperability and security needs could be met through such a transaction layer.

Non-personally identifiable information that could enable health care organizations and research institutions to access an expansive and data-rich information sets could be made available on the surface information on this transaction layer and would not  contain information that is not Protected Health Information or Personally Identifiable Information.

[Also: Health IT executives have a new favorite dirty word]

Information stored on the blockchain could be universally available to a specific individual through the blockchain private key mechanisms, enabling patients to share their information with health care organizations much more seamlessly. “This deployment of a transaction layer on the blockchain can help accomplish ONC HIT’s interoperability goals while creating a trustless, and collaborative ecosystem of information sharing to enable new insights to improve the efficiency of the nation’s health care system and health of its citizens,” the report states.

Before a health care blockchain can be adopted by organizations nationwide, several technical, organizational, and behavioral economics challenges must be addressed. 

These include scalability constraints, or tradeoffs between transaction volumes and available computing power; data standardization and scope; adoption and incentives for participation; costs of operating blockchain technology; and regulatory considerations.

To shape blockchain’s future, Deloitte urged the U.S. Department of Health and Human Services to should consider mapping and convening the blockchain ecosystem, establishing a blockchain framework to coordinate early-adopters, and supporting a consortium for dialogue and discovery.

“The promise of blockchain has widespread implications for stakeholders in the health care ecosystem,’ the report noted. “Capitalizing on this technology has the potential to connect fragmented systems to generate insights and to better assess the value of care.”

Helpful advice for planning to purchase a population health platform:

⇒ Experts explain what to look for when choosing a population health platform
⇒ Comparison chart of 8 population health products 
⇒ An in-depth look at 8 population health software programs

Like Healthcare IT News on Facebook and LinkedIn

Klara, a New York-based healthcare messaging company launched in 2014, has raised $3 million in its most recent round of funding.

Company executives describe its cloud-based HIPAA-compliant messaging platform as a professional “WhatsApp” for medicine.

With the new funding, Klara will pursue its vision to build “the central nervous system of healthcare,” which will connect all medical providers, patients and other medical professionals such as pharmacies, labs and specialists together on one platform.

Founders Simon Bolz and Simon Lorenz, MD, launched Klara as a business-to-consumer telemedicine app and have since evolved the product into a messaging platform for connecting businesses to each other as well.

[See also: Healthcare IT startups to watch in 2016: Running list of big news.]

Klara’s cloud-based web and mobile apps are used by hundreds of health systems across the country, ranging from solo-provider practices to pharmacy companies, large medical groups and enterprise-level hospitals. Medical teams communicate with tens of thousands of patients sending hundreds of thousands of messages every month, according to the founders.

“We see healthcare as a network, with doctors and patients being the most important nodes communicating with each other,” Bolz said in a statement. “If we want to digitize healthcare, we have to build something that both, medical staff and patients love using everyday to communicate. Messaging has turned out to be the perfect fabric to build this network, as it has already become the standard way to communicate in our personal and professional lives.”

New York’s Lerer Hippeau Ventures and Project A Ventures from Berlin led the funding, with existing investors including German VC Atlantic Labs and Groupe Arnault also participating in the round. 

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

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By: Dr. Russell Leftwich, senior clinical advisor, interoperability, InterSystems

Interoperability begins at home. 

The most fundamental interoperability is the ability to access the data in your own system and use that data for care delivery.  There are two steps: first accessing the data and then viewing it in a way that you can most effectively and efficiently use it. A part of the promise that the HL7 FHIR standard is already delivering on is a new and easier way to access and use the data in your own organization’s EHR system. 

FHIR is based on the same technology behind social media, e-commerce, travel sites, and other familiar web services many of us use every day.  It is easy for those familiar with this web development technology to begin building with FHIR.

Because like these familiar web services FHIR is very adaptable to mobile devices, there is an early explosion of innovation of FHIR apps on mobile devices in a number of organizations. Most of these innovative apps are built around access to data in one’s own system and use fundamental data like patient demographics, vital signs, medications, and problem lists.  This has given clinicians customized views of their data and customized decision support for clinical care.  Clinicians have long desired these customizations, but such customized functions were prohibitively expensive to develop as add-ons for individual EHR implementations.

Notable examples of such apps include a pediatric growth chart app already in use in a number of institutions and an app that displays an individual’s blood pressure over time and that is easily implemented in different EHR systems. There are also simple decision support apps being deployed that are invoked by a medication order (prescription) and can show alternative medications based on cost or formulary restrictions.  Decision support apps under development with expectation that they can be implemented within weeks identify patients at the point of care at risk for conditions like Zika virus and associated complications. 

It is already apparent that like the new functions that have appeared with each version of a smart phone, the development cycles of the FHIR standard will bring new capabilities and value to healthcare every few months.

We know we didn’t have to wait for smartphone-5 to start seeing innovation, and the same is true of HL7 FHIR.  

Register for Dr. Leftwich’s upcoming webinar, "Three Apps Fan the Flames as HL7 FHIR Spreads," at http://www.intersystems.com/who-we-are/events/event/three-apps-fan-flames-hl7-fhir-spreads/

HealthX Ventures closed a first round of funding worth $20 million. The Wisconsin-based venture capital fund is focused on investing in software businesses that solve cost, quality and access issues in the healthcare industry.

HealthX has already invested in five early stage startups, including Redox, which was founded by former Epic employees to integrate apps with EHRs. The company has also invested in cloud-based machine learning startup EnsoData, a patient rehab company called Moving Analytics, billing specialist HealthiPASS and Epharmix, which monitors the sickest 20 percent of a client’s patient population to enable disease-specific interventions.

[Also: Health IT startups to watch in 2016: running list of big news]

The new round of capital commitments came from investors across the country. HealthX Ventures has expanded its investment team to five members. The firm targets companies that are early in their life cycle and typically participates in the first rounds of funding.

“Our fund supports companies solving hard problems that will not only lower the cost of healthcare, but also improve the lives of clinicians, patients, and their families," HealthX founder and managing partner Mark Bakken said in a statement.

Before HealthX Ventures, Bakken, a serial entrepreneur, founded Nordic, a Madison Wis.-based company that bills itself as the world’s largest Epic consulting firm. Nordic offers help with the EHR giant’s implementations, optimization, data and analytics, managed services, population health and more.

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

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The line of scanners from Panasonic System Communications have successfully passed the Drummond Group test suite for interoperability with all EMR, EHR, PM and ECM electronic medical record software, the company announced.

Panasonic is the first scanner manufacturer to offer independent third-party certified test assurance its scanners are interoperable with all health information and practice management software, according to Peter Bedell, senior business development manager of Panasonic.

[Innovation Pulse: Interoperability: Ripe for disruption?]

“We see this as a win for our hospital and physician practice customers who historically have had the burden of determining compatibility for themselves,” Bedell said in a statement.

“Now we can take the guesswork out of making technology decisions by placing the responsibility for compatibility where it should be: with the hardware manufacturer and the software vendors,” he added. “Certification upfront saves downtime and support calls in the future.”

Drummond scanner certification is part of the company’s mission to provide organizations with the confidence needed when buying a product that it will be compatible with its current software, added Drummond president David Dolan.

The company’s test suite compatibility analysis is designed to eliminate technical support issues caused by interoperability problems, Dolan explained.

As Drummond is part of the TWAIN Working Group, the analysis can also be used by healthcare providers using medical records and document imaging systems with TWAIN drivers.

“We see scanner certification testing as an extension of what we are already doing with EMR/EHR testing and certification,” Dolan said. “It gives customers the confidence of knowing before they buy, and it helps hardware and software vendors collaborate better to cut down on development time and catch bugs early.” 

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

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ACOs with commercial contracts are larger and more efficient than their non-commercial counterparts. But both types have something in common: They must make major investments in information technology if their success is to be sustainable, according to a new report from the Commonwealth fund.

The study examined three years of data (between 2012 to 2015) from the online National Survey of Accountable Care Organizations, looking at Medicare or Medicaid ACOs' organizational structure, provider compensation, efficiency and outcomes.

They also compared commercial and non-commercial ACOs on various quality measures, such as care coordination, patient experience, preventive care and at-risk measures.

Commercial ACOs tend to outperform public-payer ACOs on quality and cost but both "need to make major investments in critical infrastructure if they are to support delivery system reform," according to the report published in Health Affairs. 

Specifically, the report pointed to the need for tools to help with quality improvement coordination and managing physician financial incentives. But "the immature state of most ACOs' information technology platforms" isn't helping those efforts, the authors said. 

[Are EHRs getting better? Readers rank vendors higher than last year in new survey]

Commercial ACOs are much more likely than noncommercial organizations to comprise multiple hospitals (41 percent vs. 19 percent), for instance – pointing to an acute need for interoperable electronic health records for more robust data exchange.

Notably, only 30 percent or so of commercial ACOs use a single EHR system. With noncommercial groups, fewer than 20 percent have members on one common EHR.

Commercial ACOs also more often tie physician compensation to quality incentives, meanwhile, but just half of them say they even monitor physician-level financial performance.

Indeed, ACO uptake of quality improvement initiatives in general has been "modest," according to the report. Even with larger and more complex commercial ACOs, barely 60 percent give performance feedback to their clinicians, or use patient satisfaction data for quality improvement. Just 30 percent say they have well-established chronic care programs.

"Today, more than 800 ACOs cover an estimated 28 million Americans, a figure that some expect to quadruple over the next five years," according to the Commonwealth Fund. "While larger, more mature commercial ACOs tend to score higher on quality measures and have more processes in place to improve efficiency than their non-commercial counterparts do, few ACOs of any variety report having rigorous quality monitoring processes or substantial financial incentives tied to quality." 

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

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Moxe Health, founded in 2012 with the goal of connecting healthcare payers and providers for data exchange, has raised $5.5 million.

The financing led by Safeguard Scientifics will go to expanding the company’s key technology, Substrate, which links payers and their provider networks. The company also plans to hire more staff and boost its sales efforts.

By integrating insurer data using standard processes, Moxe’s technology  makes it possible for providers to incorporate claims, risk and other payer data into their own analytic efforts, thereby enabling clinicians to better understand patient risks and deliver value-based care.

Also, as the market evolves to include more stakeholders, Moxe will be positioned to work with data originating from multiple sources. 

[Are EHRs getting better? Readers rank vendors higher than last year in new survey]

"The rules of healthcare are quickly being re-written, as technology presents an opportunity to facilitate more meaningful interactions between payers and providers," Moxe founder and CEO Dan Wilson said in a statement. "We enable workflows that are beneficial to both sides of the equation and focus on delivering patient health insights to providers while reducing administrative excess."

Moxe also intends to build up its engineering and sales teams.

"The payer-provider dynamic in healthcare is drastically shifting, and there's value being harvested from companies and tools serving as the conduit," added Safeguard's Managing Director, Gary Kurtzman, MD, who will join Moxe’s board of directors.

Moxe is based in Madison, Wis., which is fast becoming a hub for healthcare and technology startups, such as HealthFinch, which develops software to automate healthcare tasks, like setting up routine prescription refills and Redox, an interoperability company launched by seven engineers, all of them former Epic Systems employees.

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

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Most healthcare providers agree that a high level of interoperability across different EHRs is critical for improving patient care, but a new KLAS report showed there’s a lot more work ahead to achieve impactful record exchange.

“We learned that challenges related to effective sharing, especially with a different EMR vendor than your own, are experienced across all facility types and across all vendors,” KLAS VIce President of Provider Relations Bob Cash said in a statement. “No vendor community stood out as exceptional in consistently and effectively sharing with partners using a different EMR.”

The research did find some good news: “Vendors and providers seem committed to working through challenges identified in the study,” Cash added, noting that this year’s findings would serve as a baseline for tracking progress going forward.

[Also: Interoperability: Ripe for disruption?]

KLAS also determined that healthcare providers are optimistic about CommonWell and Carequality, the two networks they use for health data exchange.

Providers see the potential of these initiatives to dramatically improve nationwide interoperability, KLAS concluded. Each initiative claims thousands of participating providers, while KLAS’ validation efforts indicate a relatively small subset of providers are actively sharing data today.

Only 6 percent of healthcare providers polled indicated that information accessed on a different EHR than their own is nearly always or often delivered in a way that helps improve patient care.

Moreover, respondents reported reasonable access only 28 percent of the time, and it’s that limited unavailability that results in low patient impact.

When the aspect of easy-to-locate available records is included, the affirmative response rate drops to only 13 percent, KLAS reported, and when asked about receiving and locating the data in the clinician’s workflow, it drops to 8 percent.

“The low rate of impactful exchange starts with availability,” KLAS noted. 

[Special Report: Are EHRs getting better? Readers rank vendors higher than last year in new survey]

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

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As 2016 enters its final season, healthcare executives are planning for next year and determining which technologies and initiatives to prioritize during the next 12 months.

What will you upgrade in 2017? Security? EHRs? Analytics? Population health?

Which technologies will you introduce or investigate in 2017? Precision medicine? Telehealth? Remote patient monitoring? Smart medical devices?

The questions are brief and will take only five or six minutes to complete. And all answers are confidential and will not be shared with anyone. CLICK HERE to take the survey.

We will report the survey results in a feature article in the January 2017 issue of the print and online editions of Healthcare IT News.

CLICK HERE to get started. 

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

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VERONA, WISCONSIN — Epic Systems CEO Judy Faulkner enters the conference room at the EHR giant’s sprawling – and ever so whimsical – Intergalactic Headquarters at 1979 Milky Way. 

Framed boards with some of her recent favorite quotes bedeck the walls of the conference room, one of several scattered across the campus. As Faulkner reviews some of the axioms, she becomes animated. There’s not one she does not like. She selected them all, and she keeps them fresh by rotating in new ones from time to time.

Her choices are telling. A sampling: “Don’t be a champion of the mediocre.” “If you cannot do great things, do small things in a great way.” “Be an enabler, not an inhibitor.”

One more taste: “If you see a snake, kill it; don’t form a committee on snakes.” 

[EHRs getting better? Readers rank vendors higher than last year in new survey]

Sitting down with a reporter for an interview is a relatively new experience for Faulkner, who admits she would rather focus on “the work.” Until recently she never thought about taking time away from developing new software and running her nearly $2 billion company. Lately, however, she has been more inclined to talk about how her software works, about EHR usability and interoperability and to discuss how Epic fares on these and other related topics.

Faulkner even brought colorful information sheets and graphs showing stats that support the points she wants to make on R&D, data exchange, interoperability and EHR usability.

Indeed, she discussed those points when Healthcare IT News visited Epic’s campus. And we asked a question more personal than technical in nature: Why the change of mind? What made you start talking to the media now?

“It has to do with our growth in the industry,” she said. “When we were smaller, it was fairly easy just to stay below the radar and concentrate simply on ‘are we developing good software? And are we doing a good job with our customers?’ That’s how life was,” Faulkner recalled.

As she sees it, offering a good product, good service and a good relationship with customers is the best way to compete. Or at least it used to be.

“Even though in my mind that’s a wonderful way to compete, I think what it has become is more of a media battle than a quality-of-products and quality-of-services and support battle,” Faulkner said. “At first we tried to resist that — we couldn’t.”

There were too many misconceptions, too many untruths, like the time Faulkner read an article about a healthcare organization that was having an awful time with its Epic software.That provider, it turned out, was not even an Epic customer. The troubles stemmed from another vendor's EHR.

[Innovation Pulse: Interoperability: Ripe for disruption?]

Then came the Coast Guard’s decision in April 2016 to terminate its $14 million EHR contract with Epic prior to go-live, without a clear explanation as to why. It prompted Faulkner to post the facts she knew about the project on Epic’s website to counter any misconceptions that Epic was at fault.

Situations like these have made Faulkner realize that silence might not be the right response to misinformation and assumptions and that, perhaps, setting the record straight might be a more effective course.

But Faulkner readily admits that Epic – with no marketing department, no press releases and no PR people – has not been prepared on this front. Just recently, in fact, Epic vice president of client success Eric Helsher has picked up some of the vendor’s PR responsibilities.

“One person can’t do everything,” Faulkner said. “There needs to be a team with a strategy. We still don’t have a very good machine in place to be able to work quickly. We’re in the process of it. We’re not done with that.”

Healthcare IT News Editor-at-Large Bernie Monegain traveled to the EHR maker's campus. Other Inside Epic articles: 
⇒ Epic reveals R&D spending outstrips Apple, Google and all its competitors
⇒ A look into Epic's EHR design and usability teams 
⇒ Judy Faulkner refutes rivals' claims about Epic EHR being closed

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com
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BALTIMORE – An effective information governance program can bring both tangible and intangible return on investment for healthcare providers – and often the latter is much more valuable than the former.

And HIM professionals should strive to convince their C-suite of the importance of IG against both types of ROI, said Mary Reeves, an information governance and health information management consultant, at the AHIMA Convention and Exhibit in Baltimore on Oct. 17.

While executives will likely be most swayed by the promise of dollars-and-cents savings, a key and lasting benefit of better information management is not so easy to quantify.

There are 10 key domains of information governance, which is distinct from and more inclusive than data governance – encompassing the management of digital data, paper-based info and more.

* IG structure (Who's in charge? More and more organizations are using a new C-suite title, Reeves noted: the CIGO.)
* Strategic alignment ("IG programs must demonstrate value to be sustainable," she said.)
* Privacy and security
* Legal and regulatory (This entails risk management, compliance, etc.)
* Data governance (A sub-domain of IG, this focuses on data quality and integrity.)
* IT governance
* Analytics ("If you do not have quality data, you will not have robust analytics," said Reeves)
* IG performance
* Enterprise information management
* Awareness and adherence (Educating the workforce about the value of information.)

When it comes to convincing executives of the need for an IG program, "clear ROI for each project must be identified," Reeves said.

While tangible gains such as a $500,000 reduction in offsite data storage costs are nice to have, of course, much of the value of IG is subjective and not easily documented.

"More than 25 percent of the value of any enterprise is contributed by intangible assets" such as intellectual property and reputation, said Reeves. "Information is not always recognized as strategic asset."

But that's exactly what it is – and smart organizations will see the value in optimizing the ways they manage it.

"Information is an asset, just like building, equipment, staff and full-time employees,” Reeves explained the worth of an IG program stems for protecing and leveraging it as such.

By ensuring trusted and reliable information, healthcare organizations can enable more timely and accurate data, with faster access to it for more nimble decision-making, she said.

Reeves offered advice on how to highlight IG's value – tangible and intangible – to the C-suite.

Spiraling e-discovery costs, for instance, where evidence gatherers in malpractice suits must  sift through electronic data, paper records, different legacy systems from acquired practices are a common problem. An enterprise-wide IG policy, alongside process improvement initiatives, could reduce both risk and cost, she said.

Better IG can help reduce the risk of data breaches, with sound security plans, mobile device management policies and workforce awareness all contributing to better security.

Storage is another area ripe for ROI. According to IBM, data will double every 73 days by 2020, Reeves pointed out, noting that 69 percent of information has no legal, business or regulatory value.

"Unused data becomes a liability," she said.

Then there are more patient-focused gains to be had from sound information: population health management and care coordination, a blueprint of population based on risk and cost, aggregated data from multiple sources, the ability to identify at-risk patients and direct resources appropriately, the safer use of health IT, with better data helping reduce medical errors.

IG enables actionable real-time analytics to drive clinical and financial results, she said, paving the way for more accurate, timely and consistent decision making.

As they embrace those principles, Reeves said healthcare organizations would do well to consult with AHIMA's IG Maturity and Adoption Model. And she cited a quote from AHIMA Chief Innovation Officer Deborah Green that spotlighted a different sort of ROI:

"As organizations move up the IG maturity curve, they increase their ability to trust their data and information, minimize risk and make critical decisions confidently," said Green. "We like to call this, in IG terms, return on information." 

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

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Phoenix Children’s Hospital recently implemented an electronic medical record, replaced many ancillary clinical systems to create a single database, built an enterprise data analytics program, and significantly increased the size of its organization.

As a result, our team at Phoenix Children’s knew the enterprise needed a large-scale, cross-functional modernization of IT involving all aspects of the organization, from clinical operations and infrastructure to human resources, billing and research.

Many of our peers were committing more than $100 million to replace their clinical IT systems, while we were tasked with delivering similar results for less than 10 percent of those costs. The purpose was to redirect the dollars to improve facilities, provide better care and enhance coverage for Arizona’s pediatric population.

With the knowledge that every penny saved would benefit children in need, our team conceived the Lean IT initiative.

[EHRs getting better? Readers rank vendors higher than last year in new survey]

Running lean in health care is no easy proposition, of course. Heavy regulation, mandates around Meaningful Use of electronic health records, highly complex environments, and the need to support a large number of diverse endpoints – from servers to drug pumps – can be resource- and time-intensive.

Even so, we built a comprehensive infrastructure that ensures the consistent performance, availability and security of critical clinical and operational systems as well as the ability to scale and modernize to meet demand.

Among our efforts, we:

• Reduced ongoing and one-time vendor contracts, creating a savings of $4.5 million per year
• Streamlined IT infrastructure management
• Built and implemented a comprehensive enterprise data warehouse containing real-time data from more than 60 systems and supporting 1,600 self-service reports with 300 active daily users – all in just three months
• Developed patent-pending technology that places secured, managed, and patient-specific iPads in every patient room without any recurring annual costs
• Created a large, scalable and isolated research computing environment – without the cost or complexity of traditional enterprise solutions – to support the hospital’s burgeoning work in research, genomics and imaging. Using open-source technologies, our team built a 180-TB research and video SAN array for $15,000, secured a supercomputer and high-speed fiber network with donated funds, and engineered a complete research environment, all with existing staff.

Moreover, the initiative has produced significant financial and operational results, including:

• An overall reduction in IT Capital Expenditure and Operational Expenditure per employee and per adjusted patient day
• Savings of more than 30 percent per year on major annual IT contracts
• Conversion of all outpatient clinics from paper processes to an EMR within 18 months, which in some clinics reduced net costs and improved patient throughput by up to 30 percent
• Optimization of workflow processes that saved more than $2 million a year, while simultaneously scaling out IT operations and architectures with no increases to IT staffing

“Doing more with less” is long overdue in the IT health care environment. With changing reimbursement  models, changes in our population, and the slow conversion from large 1990s client-server software solutions to cloud-based rapid-development cycle services, health care IT must move to a high-return, low-cost model.

The Lean IT initiative is not one person, one system, one innovation or a one-time change. It’s an innovation of thought, approach, and vision – one that has resulted in many other technologies that solve business problems in a long-term, sustainable way.   

David Higginson is the CIO at Phoenix Children’s Hospital. 

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Credit card and retail banking company Capital One revealed a handful of partnerships with several digital technology providers for its Treasury Management services — including a blockchain-based claims management solution for healthcare clients and another that uses new analytics processes to estimate healthcare patient costs.

“We're seeing unprecedented transformation in the payments space as rapid advances in digital technology are reimagining the client experience,” Capital One executive vice president Patrick Moore said in a statement. “We see the new network models and data analytics capabilities as an opportunity to reinvent treasury management to better meet the needs of clients, not only increasing payment efficiency but also generating actionable information about their business.”

To that end, Capital One also partnered with healthcare specialists Gem, PokitDok, as well as analytics companies Viewpost and ClearGraph.

The GemOS is an emerging platform that enables custom logic development for companies developing scalable blockchain applications for health. Capital One’s Revenue Cycle Management pilot runs on GemOS and is supported by the Gem Health Network, a federated blockchain designed to support specific use case development using GemOS instances.

Capital One will utilize analytics developed along with healthcare e-commerce API provider Pokitdok that estimate the out-of-pocket expenses for which a patient will be responsible.

The partnership with Viewpost enables Capital One to us a secure B2B network for invoicing, payments and real-time cash management, while the deal with ClearGraph involves the company’s Intellix Mobile app, a tool for natural language search.

Capital One said it expects these new offerings to launch in early 2017. 

The American Hospital Association (AHA) urged the Office of the National Coordinator for Health IT (ONC) to provide more information used to develop specifications in its 2017 Interoperability Standards Advisory (ISA).

In a letter sent to national coordinator Vindell Washington, MD, the AHA said the draft ISA should provide greater detail about the characteristics it uses to distinguish between mature and emerging standards. The AHA said ONC should make it a priority to organizations conducting maturity assessments so that future iterations of the ISA can include this reference.

[EHRs getting better? Readers rank vendors higher than last year in new survey]

The ONC should also include information on the readiness of standards for provider use, the AHA said. In the draft 2017 ISA, information should be included on actual standards used in the real world, and not just adoption rate. 

“Experience to date indicates that a standard may have a high adoption rate as a result of a health information technology certification requirement, although it does not meet provider needs,” the letter said. “To evaluate the ability of a standard to support interoperability, the draft 2017 ISA must assess the successful use of the included standards, not just adoption.”

Also, the ONC should disseminate information about the use of identified standards to support interoperability, especially private sector initiatives, the AHA said.

“Support for standards implementation through the development of educational materials, funding for technical assistance, national provider calls and ongoing support will be crucial to the successful adoption of standards and implementation specifications that are updated regularly and federally required,” the letter said.

The hospital association also said the ONC should provide additional information on the characteristics of the standards and implementation specifications, including a hyperlink to information on the specifications in the pilot stage of implementation.

Through the ISA process, the ONC is determining the "best available" interoperability standards and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs, according to the ONC.

Twitter: @HealthITNews

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CLEVELAND — The Cleveland Clinic today revealed it’s top 10 medical innovations to expect in 2017.

The top 10 innovations were unveiled to more than 1,600 doctors, entrepreneurs and other industry leaders at the 14th annual Cleveland Clinic Medical Innovation Summit here.

Here they are:

1. The microbiome. The microbiome is made up of trillions of helpful bacteria that make a home inside the human gut – to prevent, treat and diagnose disease.

2. Diabetes drugs that reduce heart disease and death. People with diabetes are twice as likely to have heart disease or stroke than someone without the chronic condition, according to the National Institutes of Health. Two new drugs recently approved recently approved to treat diabetes. Novo Nordisk’s liraglutide, sold as Victoza, and Eli Lilly’s empagliflozin, sold as Jardiance, have shown promise in reducing these heart-related complications.

3. CAR-T therapy for leukemia and lymphoma. Using a new method called chimeric antigen receptor – T-cell therapy, doctors are now enlisting the patients own immune cells in the fight against leukemia and lymphoma . A patient’s T-cells are removed and genetically modified to seek out and destroy cancer cell, then re-infused via an IV.

4. Liquid biopsies to find cancer. Finding a way to test for a cancer that doesn’t involve the pain and cost of a doctor a chunk of tissue from your body has long been on the wish list of oncologists.. It’s now possible to find tumor DNA circulating the blood, spinal fluid and perhaps even urine. These liquid biopsies could help doctors understand how tumors change in order to beat existing treatments or help identify earlier stages of the disease.

5. Automated car safety features and driverless capabilities. Seatbelts have saved more than 329,900 lives over the past 50 years, according to the National Highway Traffic Safety Administration. Other car safety features such as child safety seats and frontal, curtain and side-impact airbags have saved another 300,000 lives in that time. Starting in 2018, the NHTSA will require back-up cameras in new cars. Collision warning systems, adaptive cruise control, lane assist, and cross-traffic alerts are some other innovations on the horizon to further reduce the more than 38,000 fatal car crashes each year.

6. Fast Healthcare interoperability resources, or FHIR. FHIR is an interoperability specification that can act as a translator for EHRs that don’t normally play well together. It’s been tested in a number of trials. Health Level 7 is expected to release it next year. To date, in spite of some advances, easy sharing of records between and across institutions has been elusive.

7. Ketamine for treatment-resistant depression. For one-third of people with depression, nothing helps – not therapy or medication, not even electro-convulsive or shock treatments. Ketamine, once known as a club drug, improves symptoms rapidly for the majority of these patients in initial studies, prompting the FDA to grant the treatment fast-track status for development.

8. 3D visualization and augmented reality for surgery. Many eye and brain surgeons do their work in very small spaces, peering through high-powered microscopes with their heads bent and necks strained, Cuts made on the retina, for example, are usually smaller than a millimeter. 3-D cameras are helping surgeons and their teams get a better view, according to Rishi Singh, a staff surgeon at the Cleveland Clinic’s Cole Eye Institute. Singh, who has been using the technology for about six months, said it widens his field of view, lets everyone in the operating room see what’s happening in three dimensions, and is a lot more comfortable. There is still a lot of research to be done to see if the technology reduces fatigue or has an impact on surgery, Singh said.

9.  Self administered HPV test. An estimated 12,990 new cases of cervical cancer will be diagnosed in the United States in 2016, according to the American Cancer Association, An estimated 4,120 women with the disease will die from it this years. The HPV test, designed for routine use in women over age 30, detects te presence of high-risk types of HPV in the cells of the cervix with a vaginal swab. It’s a simple test, but women who don’t ger to the doctor will never get it.

10: Bioabsorbable stents. When an artery that supplies blood to the heart muscle narrows or becomes blocked it’s often opened with a stent. The tiny wire mesh tubes are made of metal and stay in place forever. Stents are very common – about 600,000 get them each year in the United States. About 2 percent of people develop life-threatening blood dots at the stent site, according to the National Health-Lung and Blood Institute. What if the stent could just disappear after it’s done its job? Absorbable stents are already in use in Europe and recently approved by the FDA, do exactly that. The absorbable stents also appear to reduce chest pain after surgery compared with the wire option.

We have to make better use of health data.

That was the final sentence spoken at the HIMSS and Healthcare IT News Big Data and Healthcare Analytics Forum this week.

Sree Chaguturu, vice president of population health management at Partners HealthCare spoke those words, which served as something of an ideal, if unplanned, conclusion to the two-day event in Boston.

Indeed, that sentiment permeated through many of the discussions ranging from hype and disappointment to lessons learned and success stories by providers large and small. 

Let's take a look at the insights speakers shared: 

The industry is on the cusp of Data 3.0. Yes, another buzzword emerged onstage. In the new era of information, data will need to be actionable, explainable, trusted and contextualized. Otherwise, providers will struggle to get clinicians onboard.

Machine learning is real. It’s here, the technology has proven its mettle, and it’s happening in healthcare — albeit with less impact than in other industries, including some not frequently compared to healthcare such as casinos, telecom and waste management.

Don't wait for analytics perfection. Instead, focus on predicting events and conducting interventions that can have an impact in the short-term. Actionable outcomes will make the biggest difference. 

Crowdsourcing is a viable option for analytics. Sanford Health proved this by enlisting university researchers specializing in computer science and informatics, public health and even business, to fuel innovations the health system otherwise would not have made on its own. Sanford, in turn, opened those to the community, despite top brass’ initial skepticism about sharing.

You’re going to need governance. Look, it isn’t sexy, it’s not really fun for anyone, but data governance is indispensible. Even though it took 18 months, nailing down governance enabled the University of Mississippi Medical Center to transform its analytics work into what CHIO John Showalter, MD, described as “an amazing asset.” One more thing: Hospitals need governance for information and not just data.

There’s a distinction between data and information, of course, and as many speakers iterated data is the raw material and information is the asset.

The goal “is to turn data into insights and have those insights compel medical action,” Partners’ Chaguturu said. “We need to make decisions faster so analytics are critical.”  

  Related articles from the HIMSS and Healthcare IT News Big Data & Analytics Forum in Boston:
​⇒ Big Data and Healthcare Analytics Forum: video interviews with the experts
⇒ Charlotte hospitals analyze social determinants of health to cut ER visits
⇒ Big Data: Healthcare must move beyond the hype
⇒ Tips for reading Big Data results correctly
⇒ Small hospital makes minor investment in analytics and reaps big rewards 
⇒ MIT professor's quick primer on two types of machine learning for healthcare
⇒ Must-haves for machine learning to thrive in healthcare

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Vindell Washington, MD, the National Coordinator for Health IT, visited healthcare clinics and a long-term care nursing facility in St. Louis Oct. 25 to observe data exchange across different EHRs and record locator services.

The exchange took place via the Carequality Interoperability Framework.

SSM Health – including the St. Louis-area outpatient center that Washington visited – uses an Epic EHR to receive patient files from multiple community partners who use NextGen, athenahealth, MatrixCare with Kno2 interoperability services, and eClinicalWorks with Surescripts’ National Record Locator Service.

Carequality announced live exchange in August, with 3,000 clinics and 200 hospitals live and ready for exchange. Today, the effort has grown to more than 150,000 clinicians across 11,000 clinics and 500 hospitals live and able to share health data records, regardless of the technology network, said Dave Cassel, director of Carequality, in a statement.

[See also: Carequality says athenahealth, eClinicalWorks, Epic, NextGen, Surescripts now exchanging data via Interoperability Framework ]

More than 50,000 care documents have been exchanged so far.

"What’s happening here in the St. Louis area is being replicated around the country," Peter Schoch, MD, vice president of Value-Based Care & Payment for SSM Health St. Louis, said.

"The exponential growth we’re seeing is a credit to the diverse stakeholders from across healthcare who came together and developed the framework specifically to be able to scale nationally and very quickly, by leveraging the existing investments and technologies of our implementers," Cassel said.

He explained that connectivity among diverse health systems and EHRs is possible because Carequality delivered the necessary legal terms, policy requirements, technical specifications, and governance processes.

To date, the framework has been adopted by 15 healthcare organizations with dozens more reviewing it for adoption, according to Cassel.

Washington observed health data sharing at Midwest Nephrology Associates, Inc., SSM Health, and Mount Carmel Senior Living, all in St. Louis.

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

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TCGA Expedition, a new new tool developed by the University of Pittsburgh, UPMC and the Pittsburgh Supercomputing Center, can help cancer investigators wade through huge amounts of genomic data.

The open-source technology, which manages data from The Cancer Genome Atlas project, continuously downloads, processes and manages TCGA data, allowing researchers to choose specific tools as they work toward better treatments.

"Starting with TCGA, our goal is to make large data sets available to the average researcher who would not otherwise be able to access this information," said Rebecca Jacobson, MD, professor of biomedical informatics and chief information officer at Pitt's School of Medicine, in a statement.

"There's a growing understanding that further advances in health care are going to require a previously unseen level of data sharing, which will require new tools," she added. "That's particularly true in cancer research, as recognized by the major focus on data sharing in Vice President Joseph Biden's recently announced Cancer Moonshot initiative."

[Also: Vice President Biden announces vast list of federal and private-sector collaborations at Cancer Moonshot Summit]

Cancers are caused by an overgrowth of cells due to an error in DNA. By examining a cancer's complete set of DNA, or genome, researchers can gain new insights into better care plans.

The goal of TCGA - a joint effort of the National Cancer Institute and the National Human Genome Research Institute - is to collect and share genomic data from cancers with poor prognoses and the greatest impacts on public health, researchers say.

So far the initiative has profiled 33 different cancers from more than 11,000 patients; the resulting data has been used in more than 1,000 cancer studies.

"These very large data sets are incredibly hard to work with because they are enormous, not only in terms of the amount of digital storage space they need, but also in terms of the complexity of software and computational processing power that they require," said Jacobson. "Right now, our institutions are choking on data."
 
"This work is about enabling and speeding up science," said Adrian Lee, director of IPM and of UPCI's Women's Cancer Research Center. "Resources such as this will be key in our move to precision cancer genomic medicine."

The fact that the tool is open source and freely available means researchers hope it will be adopted far and wide in the fight against cancer.

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

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Epic Systems CEO Judy Faulkner will be honored this fall with a prestigious Distinguished Alumni Award from her alma mater, the University of Wisconsin, according to the Wisconsin State Journal.

It’s one of three Distinguished Alumni Awards the Wisconsin Alumni Association will hand out.

John Daniels Jr., chairman emeritus of the Quarles & Brady law firm, and Doris Feldman Weisberg, a 1958 UW graduate a co-founder of the Food Network and professor emerita at City College of the City University of New York, will also receive Distinguished Alumni Awards.

Faulkner heads a $2 billion company and has been on the Forbes billionaire list for several consecutive years. She has signed the giving pledge, which will leave her wealth to a charitable foundation she established.

She founded Epic Systems in 1979, at a time when most healthcare systems kept patient records tucked away in manila folders.

[See also: Epic reveals R&D spending outstrips Apple, Google and its competitors.]

Faulkner coded the first Epic software herself. Today, she’s listed as one of the few healthcare billionaires on the Forbes billionaire's list, along with Neal Patterson, who heads rival health IT company Cerner.

She believes her company is better off as a private entity, and she plans to keep it that way.

Faulkner earned her undergraduate degree in math from Dickinson College in Pennsylvania and her master’s in computer science at University of Wisconsin - Madison.

She recently told Healthcare IT News research and development is her sweet spot because she has a technical background. It was at UW-Madison she wrote the code, using the computer language MUMPS.

Twitter: @Bernie_HITN