The National Association for Trusted Exchange and CommonWell Health Alliance are teaming up to keep momentum on interoperability, with each becoming a member of the other's organization. Members of the two groups will begin working together immediately.

"The nation's focus is shifting toward increasing a consumer's capabilities to exercise their Patient Right of Access under HIPAA and NATE is excited to continue to collaborate with CommonWell and its membership in realizing this important goal," said Aaron Seib, CEO of the not-for-profit group, which focuses on trusted exchange among organizations differing regulatory environments and exchange preferences.

NATE expertise is to help address the legal, policy and technical barriers that inhibit health information exchange between HIPAA-covered entities and consumers.

"Many opportunities exist and will emerge between CommonWell and NATE that will enable the trustworthy sharing of professionally- and patient-generated health information," said Seib.

[Also: eClinicalWorks, HIMSS among 7 new organizations joining CommonWell Health Alliance]

CommonWell – the interoperability-focused industry association comprising IT vendors such as Cerner, McKesson, Allscripts, athenahealth and Brightree – looks to remove barriers by its members' incorporation of data exchange capabilities into their software.

"CommonWell looks forward to participating in NATE's efforts to encourage the sharing of information between our members and the patients they serve and is eager to welcome NATE's contributions to our work," said Brightree VP Nick Knowlton, CommonWell's membership committee chair.

"Our organizations agree that patients should be at the center of their health care and that their providers can be empowered to deliver care that is informed by secure and authorized access to that patient's data, no matter where care has occurred," he said.

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Two-thirds of healthcare organizations believe personalized medicine is already having a measurable effect on patient outcomes, according to a new survey. Even more, 75 percent, say it will impact their organizations over the next two years.

Meanwhile, 92 percent of respondents said in five years their hospital will no longer be focused on traditional approaches to care, according to the survey, from Oxford Economics and SAP, which polled 120 healthcare professionals in Europe and North America.

"Personalized medicine offers better and more efficient ways to address a wide range of challenging medical issues," said Edward Cone, deputy director of thought leadership and technology practice lead at Oxford Economics, in a statement.

"At the same time," he said. "There remains a lot of work to be done on the details of governance, culture, and information technology."

Precision Medicine has seen a major push in the past few years, including the highly-visible $215 million Precision Medicine Initiative announced by the Obama administration last year. However, to be able to reap the benefits of this new paradigm, there are a few crucial challenges that need to be addressed.

[Also: Big data: Hardest part of population health and precision medicine?]

The right tools are imperative to supporting the shift into more personalized care. More than 70 percent of survey respondents said big data capture and storage were necessary to the success of personalized medicine, while another 65 percent called for an increase in the use of predictive analytics.

While barriers are prevalent, many healthcare leaders are beginning to change policies needed to support precision medicine: 64 percent have created new privacy policies, and 60 percent have increased security measures to safeguard patient data.

And almost half of the respondents are working toward changing institutional culture to reflect some of these privacy and security challenges.

"Personalized medicine leverages broad data sets including clinical data and genomics to move beyond the one-size-fits-all model into more individualized care," said David Delaney, MD, chief medical officer at SAP, in a statement.

"To reach the full potential of personalized medicine, however, industry stakeholders must take definitive steps to invest in advanced technologies and workforce talent," he added. They should also "adjust to new governance models and accept significant cultural shifts around data sharing and standards that foster easy interoperability of information."

The May 2016 iteration of FHIR, as in Fast Healthcare Information Resources, has arrived. Most notable among its new capabilities: support for the Clinical Quality Language for clinical decision support as well as further development of work on genomic data, workflow, eClaims, provider directories and CCDA profiles.

"We’re adopting syntax for querying FHIR resources to do more clinically-oriented things," said Dave Shaver, an HL7 Fellow and the founder and CTO of Corepoint Health. Part of that is FluentPath, which is an extraction language for more effective queries.  

Shaver pointed to the ability to find patients who are eligible for clinical trials as one example. Another would be running queries against a document registry to determine, say, information about pregnant females that came in for a well visit during the past 72 hours.  

[Also: How FHIR is setting the stage for population health]

HL7 calls the latest iteration release candidate number 3 and developers will be banging away on it May 7-8 at the Montreal Connectathon in the emerging interoperability specification’s march toward what Shaver called a normative version, expected in the spring of 2017, after which all future versions will be backward-compatible – which appears to represent something of a milestone in the standard development that providers and vendors should pay attention to.

Chilmark Research analyst Brian Murphy said that at this point provider interest in FHIR is low and the number of applications relatively small from a clinical perspective.

"Major vendors are going to have to run with this and begin building applications that use the standard if ordinary providers are ever going to make use of it," Murphy said. "Until then, it will only be of interest to large healthcare organizations that can afford functional development teams."

Release candidate number 3 brings FHIR closer to that reality and Shaver explained that the testing it undergoes at the Montreal Connecathon will ultimately inform the next version which will potentially see the light of day in September. 

[Also: Innovation Pulse: Hardest part for FHIR lies ahead]

While many providers are asking when FHIR will be done and when their vendors will implement it, Shaver added, those are not necessarily the top priorities at this point in the process.

The real questions providers should be asking instead are whether their software vendors are participating in HL7, whether they’re trialing FHIR and gearing up to support it.

"We’re marching on this process to create a standard, a very challenging problem," said Shaver. "You get feedback and need to change it based on that feedback. Just like an artist we work hard to create the standard but in the end you don’t whether the audience will receive it well or not."

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Health and Human Services Secretary Sylvia Burwell said the department is committed to an open, connected health system, and is focusing on three areas to bring that about: data blocking, interoperability and security.

“We all want a health system where information flows seamlessly and securely when and where you need it most,” Sylvia Mathews Burwell said last week at the American College of Physicians. “When you have all the information you need, you can see the whole health picture.”

To enable that, HHS is trying to change the culture “so doctors and hospitals understand that patients have a right to their records, data blocking is not tolerated, and providers share data with others caring for their patients,” Burwell said.

Eliminating data blocking is also a step toward enabling more information interoperability wherein “health IT systems are speaking the same language through common standards so they can communicate with one another,” Burwell said, noting that in the last six years the industry has tripled its adoption of electronic health records but considerable work remains.

And as patient and medical data flows more effectively, Burwell said HHS is also girding to protect it via rules and regulations designed with the idea that interoperability is vital to market success in mind.

“Whether it’s helping doctors make more informed decisions, giving people the tools to be active partners in their own health, or advancing our understanding of quality, better use of data moves our whole system forward,” Burwell said at the ACP. “That’s why it is so important that hospitals and physicians stand up against data blocking.”

HHS has been working on interoperability and data blocking for some time now and in early March most electronic health records vendors signed a pledge to not block data and also support standardized APIs to make information sharing easier, a move Burwell said at HIMSS16 was “a critical first step.” 

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The Office of the National Coordinator on Monday announced a pair of new funding initiatives to advance common standards and increase interoperability and ONC head Karen DeSalvo revealed that the agency is allocating $1.5 million to the projects.

"Our goal is to accomplish a system where we improve the way providers are incentivized and the way we distribute information," DeSalvo said at the 2016 Health Datapalooza held in Washington, DC. "Not just free and available data, but to improve transparency. We need to data to be open and available. And perhaps more importantly, to give people the information they need to be engaged and empowered.”

The first cooperative agreement program, High Impact Pilots, will divide $1.25 million among three to seven awardees who will focus on implementing HIT Standards Committee recommendations and the Nationwide Interoperability Roadmap. Awardees must choose a priority category on which to focus, with a minimum of three impact dimensions.

The other program, Standards Exploration Award, will give $250,000 to three to five organizations and follows the same goals as High Impact Pilots. However, awardees must choose a minimum of one impact dimension. They'll test IT platforms and evaluate scalability to determine the impact of the awardee's selected standards and IT platform.

Awardees must produce results within one year and the programs are designed to improve care delivery and data sharing among health organizations.

"The data is bursting at the doors. And providers are demanding we set it free," she said. "We need to move quickly to where access to data is the norm and not the exception."

There are three key drivers to accomplishing this, DeSalvo said: data standards, wherein health IT products speak the same language; a move toward culture change to make access to data the norm; and eradicating data blocking.

These funding programs were designed in response to these needs, DeSalvo added. And to create a "person-centered system."

"We want to make sure we're all focused on national standards," she said. "It shows we have common ground. Your innovation, input and insights will drive us forward into a new era of health IT."

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For Vice President Joe Biden, his National Cancer Moonshot Initiative is more than just a government program – it's personal.

When his son Beau was fighting cancer, getting his different hospitals to share information was incredibly difficult, Biden said Monday at Health Datapalooza in Washington. If the Vice President of the United States struggles to get access to information, he said, how difficult is it for those patients who don't have that sort of sway?

"This matters," said Biden. "It's a matter of life and death."

Biden took to the stage at Health Datapalooza not just to share his own experiences, but to put out a call to action: While the government has taken great strides to increase access to technology-enabled healthcare, it's still not enough, he said.

More hospitals, researchers, scientists and providers need to "open access to their data to prevent cancer," said Biden.

"We have to ask ourselves, why are we not progressing more rapidly?" he said. "While our government can do a great deal, this is not the work of the government alone. We all have to work together to make progress.

[Also: Obama taps Biden to lead cancer cure 'moonshot', touts precision medicine, in State of the Union]

"Big data and computer power together provide the possibility of significant insight to what can trigger cancer," he added. "In order for this promise to be realized, we first need to generate enough data to qualify as big data."

Secondly, data needs to be more readily shared, Biden said. One of the biggest barriers to progress is different technology platforms can't talk to each other, while this is the information that will help providers make more accurate assessments. Additionally, all of those involved in healthcare must be willing to share this data in a safe and effective matter.

"We need to break down silos that keep research away from the world," Biden said. "Researchers aren't incentivized to share data, but they need to share data to find results more rapidly.

"You've developed this technology," he added. "And we need to use these same talents in the fight against cancer. To do this we have to build a network around the patient. We need you. We need your talents, your drive and your passion."

Biden asked all of those in attendance to visit Whitehouse.gov/CancerMoonshot to join the fight against cancer and provide insight to help shape the moonshot into a more effective initiative.

"I desperately need your input," he added. "Everyday thousands of people are dying and millions more are desperately looking for hope. That's why I'm asking individuals and organizations to join us as a part of this cancer moonshot. Tell me about your plans and solutions to overcome these barriers. Help in the fight against cancer."

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There are many promising initiatives underway that seek to combine rich clinical data from electronic health record systems running in provider sites across the county into large patient cohorts and then combine that data with genetic sequences created from samples provided by each patient in the cohort.

The sponsors of these initiatives span industry, private foundations and the federal government. While the ambitious goals are commendable and the potential for discovery is worthy of the effort, there are data quality and semantic interoperability requirements that must be met prior to the combining of the clinical data. 

Without these standards, consolidation and harmonization of rich clinical data will yield only a portion of the expected value. Identifying genetic determinants of disease from this large population, for instance, requires a clinical data set based on standards such that large subpopulations can be compared using common clinical vocabularies. 

The standards to be addressed fall into two categories: 1) Existing, popularly used or incentivized coding systems and 2) value lists that need to be defined.

Category 1 includes coding systems such as: ICD-10 diagnosis codes (and historically ICD-9), CPT and ICD-10 procedure codes, LOINC codes for lab orders and results and RxNorm codes for drugs.

The ICD and CPT coding systems have been used in EMRs and billing systems for decades. LOINC and RxNorm are relatively recent additions thanks to Meaningful Use Stage 2 incentives but given the less than 100% achievement of Stage 2 in the industry combined with large volumes of historical data that is not codified, it cannot be assumed that all lab orders and results residing in EHRs and clinical data warehouses have been associated with valid LOINC codes.  Similarly with orderable drugs and RxNorm.  

Category 2 data include critical items used for cohort subdivision such as: vital signs (height, weight, blood pressure, etc.); allergies; smoking history; demographics such as race, ethnicity, address, age, socio-economics; and encounter types, notably inpatient, outpatient, home health, and so on.

The second category is the most challenging given the lack of common national standards in these areas. This means that the organizations sponsoring the creation of the cohort must define standards in advance and provide the funding to the contributing providers to map their local data to those standards.

In addition, a common patient probabilistic matching algorithm should be defined by each sponsor to ensure data from the same patient across multiple contributing sites is linked to the same human being in the cohort. 

Lastly, unstructured text extraction software and models should be defined by the sponsoring organizations such that all exam notes, pathology reports, radiology reports, etc. can be processed to extract or derive clinical facts from the rich collections of unstructured text in every contributing EHR.

While the above efforts are daunting, they are critical to the success of any attempt to join clinical data from multiple providers into a common repository. Discoveries from large populations of patients’ genetic variant data cannot be made without common clinical vocabularies and ontologies that enable consistent profiling of millions of patients. 

Brian Wells is associate vice president of health technology and academic computing at Penn Medicine. 

Two southeast Missouri healthcare organizations – SoutheastHEALTH, in Cape Giradeau, and Missouri Delta Medical Center, in Sikeston – will each install a Cerner Millennium EHR system.

The platform provides an integrated digital record of a patient's health history, including clinical and financial data. Also, by using the online patient portal, patients will be able to securely message their physicians, schedule appointments and access their health history.

"SoutheastHEALTH prides itself on being a high-tech, high-touch hospital focused on making a positive impact, and the EHR will help fulfill that mission," said Ken Bateman, president and CEO of SoutheastHEALTH, in a statement.

Besides transitioning to Millennium, Missouri Delta Medical Center will also deploy Cerner's CommunityWorks technology, a prescriptive and remote-hosted IT platform tailored to support community healthcare organizations that provide care to rural communities.

[Also: Cerner taps John Glaser to lead EHR company's population health efforts]

More than half of Cerner clients that are live with the CommunityWorks model have achieved Stage 6 of the HIMSS Electronic Medical Record Adoption Model.

"As a rural community hospital, we have been recognized with top performing patient satisfaction scores and clinical process of care measures," said Jason Schrumpf, president and CEO of Missouri Delta Medical Center, in a statement.

Both organizations expect to benefit from advanced interoperability capabilities, which will enable the transfer of patient data between the organizations and among health systems across the country.

After years of dwelling in the shadows of healthcare, the long-term and post-acute care industry may finally be ready to join its hospital colleagues in the IT spotlight.

The path is long and steep, but operators of skilled nursing, outpatient rehabilitation, assisted living, memory care, hospice and home care agencies are embracing their important new roles as providers in the dynamic post-acute care environment.

When the Office of the National Coordinator put together the electronic health record and interoperability initiative in 2004, long-term care got nary a mention; and as recently as 2009, LTC providers got left out of the multi-billion dollar incentive from the American Recovery and Rehabilitation Act because designers didn't consider their relevance for the program.

How times have changed in just a short period of time. With the advent of accountable care organizations, post-acute care provider networks and the move toward population health, suddenly long-term care facilities have gained prominence as valuable components in the equation.

But while they now have a higher profile, long-term care operators are also coming to terms with the fact that they are still largely dependent on manual processes and that they are woefully deficient in IT personnel. In essence, this new role comes with the huge responsibility of joining the digital revolution.

"It's getting interesting," said LaDonna Sweeten, managing director with Chicago-based Huron Healthcare's technology consulting practice. "You can understand how some post-acute care providers were forgotten in federal initiatives. But now we're seeing them organize and have a stronger voice, with implications on the acute care side."

[Also: In push to population health and value-based payments, health systems look to post-acute care networks]

As the ACO movement gains momentum, providers in both acute and post-acute sectors are looking for enhanced dialogue, Sweeten said, because "they realize they aren't separate pieces of care anymore."

For post-acute care, it means a serious focus on adopting EHRs and understanding the machinations of analytics and interoperability. Some of the actual data on interoperability has been tackled with standards like HL7, but other areas like care plans, clinical documentation and care pathways still need to be addressed, Sweeten said.

Those processes will require collaboration between the sectors and while that has yet to be done, she believes it will as the population health model takes hold.

"Vendors are looking at software for post-acute providers and it is very specialized," she said. "One of the biggest issues is with the continuum – if we have an acute care patient with a follow-up plan to transition into skilled nursing or senior living, there are duplications of effort because the sectors are different. These processes must be combined to avoid duplication. We have done a lot with hospitals on the acute care side and we need to make the same progress as we connect acute and post-acute. There isn't a pathway yet."

Hal Tierney, director of technology for Boston-based Sapient, says a major EHR obstacle for long-term care operators is the lack of full clinical information system enterprises required to populate an EHR.

"The lack of clinical information systems, such as laboratory, pharmacy and radiology reduce the capability of the EHRs to provide clinical or diagnostic value," he said.

Eyeing analytics
A 2013 report by the U.S. Commission on Long-Term Care estimates that the number of people who are dependent on long-term care is expected to rise from 12 million in 2010 to 27 million in 2050. Analytics will be a critical function to support the treatment and tracking of these patients from patient care and operational standpoints, notes Adrianna Iorillo, vice president of professional services for Jacksonville, Fla.-based CSI Healthcare IT.

Analytics are the key to improving communications between acute and post-acute entities, which lead to better patient outcomes, Iorillo says.

"Long-term care facilities can find improved patient satisfaction from better response times in medication and pain management, while improved methods to document provider and caregiver notes will help patients stay engaged in their well-being," she said.

"Overall, better outcomes from the patient can help reduce the need for admissions or readmits to hospitals and the increased communication tools available can decrease the number of cases of depression and isolation that are sadly common in nursing home settings."

[Also: Post-acute HIEs make strides]

Long-term care operators should move to accelerate their adoption of analytics systems to maximize their accessibility to all data relevant to the treatment history of their patients, and to maximize the acquisition and retention of data as part of the continuing provision of care, Tierny said.

"When combined, this data can underpin retrospective and prospective data analysis pertaining to patient specific care milestone events, trends and adherences," he said.

"Operators need to understand that the information captured across the continuum of care has the most opportunity as a resource for the provision of healthcare to their patients.

Analytics done well can move long-term care operators from 'reactive' operations and decision making, to 'proactive' modes of operations."

Iorillo adds that "technology and analytics have a compounding affect over time – easier and secure methods for a provider to communicate immediately with other care providers can only improve care."

HME at last
Alongside the long-term care industry, home medical equipment providers have also brought up the rear when it comes to technology adoption. Both sectors have shared similar challenges when it comes to maintaining cash flow, overcoming constant reimbursement cuts and finding the funds to deploy IT in a way that benefits them.

For HME providers, technology strength lies within their billing systems, which in recent years have grown from strictly conducting business transactions to controlling multiple aspects of the business. One such system is CommandCenter, a business process management platform from Suffern, New York-based Medforce.

"Business process management can act as a backbone for an entire organization, gathering data and connecting to disparate business applications from intake to order management," said Medforce CEO Esther Apter.

"It creates comprehensive reporting that provides predictive analytics and actionable insights. You can look at not just top line numbers, but actual productivity throughout the organization to identify bottlenecks, duplication of effort, wasted effort and other opportunities for process refinement."

By centralizing business analysis, HME providers are able to create accountability and present cogent operational data – a distinct advantage in the competitive ACO marketplace, Apter said.

Nashville-based Ardent Health Services plans to unite all its hospitals and physician groups on an Epic Systems EHR platform.

The move, Ardent officials note in an announcement on its website, will offer caregivers with a single, stronger patient information system to help streamline their work. The main goal is to give caregivers more time at the bedside to boost care quality and patient outcomes.

"This investment is a significant step in our journey to deliver high-quality clinical care and exceptional customer service more efficiently," said David T. Vandewater, president and CEO of Ardent Health Services in a statement. The estimated cost of the project is $150 million.

Nearly 500 Ardent team members, including physicians, bedside nurses, registration and discharge staff representing each part of the care continuum and all specialties participated in the demonstrations and assessment, Vandewater added.

Ardent will replace 80 information systems currently in use across its facilities with the Epic platform. The goal is to increase efficiencies by streamlining services such as registration, billing, clinical applications and population health initiatives.

[Also: 11 Epic stories worth reading again]

Ardent will become the first investor-owned hospital company to use Epic throughout the entire organization, which includes BSA Health System in Amarillo, Texas; Hillcrest HealthCare System in Tulsa, Oklahoma; and Lovelace Health System, in Albuquerque, New Mexico. They include 14 hospitals and three multi-specialty physician groups.

Epic staffers will begin working alongside Ardent employees this summer to build the software system, a process that typically takes nine to 10 months. The first Ardent health system is due to transition to Epic in the fall of 2017 and the others are scheduled to follow each quarter.

As part of the deal, Ardent will also deploy Epic's MyChart software, a portal that enables patients to find personal and family health information online. Patients will be able to message doctors, attend e-visits, complete questionnaires and schedule appointments.

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King Khaled Eye Specialist Hospital has reached Stage 7, the pinnacle on the HIMSS Analytics EMR Adoption Model, known as EMRAM.

KKESH becomes the first hospital in the Middle East to earn this global recognition, an achievement that also puts KKESH in an elite group of nine hospitals outside North America to accomplish Stage 7. The designation indicates the hospital is employing the highest level of clinical information technology and advanced safety features to provide top care.

KKESH demonstrated significant quality of care and efficiency improvements following the implementation of TrakCare from Cambridge, Mass.-based InterSystems, hospital officials noted.

TrakCare provided KKESH with a unified healthcare information system, consolidating all patient administration and clinical information in a single data repository with a common user interface, while also integrating KKESH’s existing systems.

Hospital officials credit TrakCare’s advanced clinical functionality with helping them achieve HIMSS EMRAM Stage 6 five months after deployment and Stage 7 in less than two years.

The hospital’s paperless environment has led to cost-savings and directly impacted efficiency of staff members in emergency situations, they assert.

HIMSS Analytics global vice president John Daniels called KKESH one of the most paperless hospitals on the planet.

“They did not have any folders or charts on the wards to store paper because they were not creating any paper documentation,” Daniels explained. “All clinical documentation is captured in the EMR by nurses, physicians and allied health professionals from the emergency room to the ward, during resuscitations, and in the operating room.”

King Khaled Eye Specialist Hospital will be recognized at the Ministry of Health and HIMSS Middle East Conference 2016 from October 12-13, 2016, at the Four Seasons Hotel, Riyadh, Kingdom of Saudi Arabia. 

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CONCORD TOWNSHIP, OHIO - Lake Health, with 14 facilities, staffed by more than 600 physicians and 2,700 healthcare professionals, will be rolling out a Cerner EHR.

The goal: support the Lake Health system and its employed providers, as well as create greater integration with its community physician network and to provide the best patient experience possible.

Also, patients will benefit from a single health record accessible from a patient portal.

“A strong relationship with our medical staff is the cornerstone of who we are, evidenced by their role in our mission and vision statements and in working with us to provide high-quality patient and family-centered health care in Lake County,” Jerry Peters, VP and CIO for Lake Health, said in a statement.

The EHR will enable the health system to share and receive patient health records with affiliated providers, other area hospitals and participating healthcare entities nationally. Patient data is produced, managed and stored across multiple care organizations in Lake County, Peters noted, and Lake Health was focused on selecting an IT platform that could collect and analyze data from multiple disparate systems.

“Lake Health determined that Cerner’s EHR and Healthelntent population health management platforms were the best choice to support its future initiatives and business model,” Peters said. “Understanding that this investment would most likely shape the future of Lake Health and the care we provide to patients, we completed a thorough evaluation of leading health IT suppliers and collaborated with our physicians and ultimately determined that Cerner was the right choice to support our needs now and into the future.”

Peters did not reveal the anticipated cost of the technology.

Cerner’s Healthelntent platform aggregates and normalizes data from various sources in near real time, regardless of EHR supplier and is designed to provide physicians and mid-level providers with meaningful data to identify and stratify populations to locate gaps in care.

St. Charles Health System has selected the EHR of Epic Systems to digitize its patient information across all provider locations.

The health system in Bend, Oregon, said it is going with Epic after an extensive assessment and selection process driven by the organization’s caregivers and providers.

“Our patients, caregivers and providers will all benefit from our hospitals, ambulatory clinics and business offices using one system across all departments,” said Jeremiah Brickhouse, St. Charles’ CIO. “We’ll be able to better manage the health of our patients and our community throughout the health system and other organizations across the region, providing better continuity of care.”

St. Charles is fine-tuning the details of its implementation timeline but the official implementation project kickoff currently is targeted for early fall.

To facilitate the EHR and the technology’s implementation, St. Charles Health System is planning to hire more than 100 people.

St. Charles Health System owns and operates St. Charles Bend, Madras, Prineville and Redmond hospitals. It also owns family care clinics in Bend, Madras, Prineville, Redmond and Sisters. St. Charles reported it is the largest employer in Central Oregon with more than 3,800 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system.

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HIMSS16 Social Media Ambassadors John Lynn and Shahid Shah exchange opinions on the state of interoperability and patient care. Part of the Social Media Debates series hosted by Beth Jones Sanborn, Managing Editor of Healthcare Finance.

The Office of the National Coordinator (ONC) for Health IT should add information about Precision Medicine to its Interoperability Roadmap, the office’s Precision Medicine Task Force recommended.

Specifically, the task force said the ONC should provide an Interoperability Roadmap addendum for PMI and that it should engage stakeholders to accelerate the definition of a minimum data set and standards for PMI as well as Patient-Generated Health Data.

President Barack Obama announced the Precision Medicine Initiative — a medical model that proposes the customization of healthcare, with medical decisions, practices, and products being tailored to the individual patient — during his 2015 State of the Union Address.

ONC’s advisory task force also said the office should consider high value, non-EHR data sources to promote completeness of patient information documentation and that the PMI should encourage use of standard APIs to source data.

“The volumes of data inherent in these queries and these exchanges would be well beyond what is currently encountered in our newborn but growing EHR ecosystem,” Andy Wiesenthal the Task Force’s co-chair, said. “There’s going to be lots of data sources that we are not currently including, especially data directly from patients.”

Due to the variety of these data sources, the task force suggested greater emphasis on interoperability and data reciprocity, where individual’s access to their aggregated PMI data will promote participation, retention and engagement.

“Data return should offer dynamic, compelling visualizations to promote its use,” the task force wrote. “Patients should have access to computable, raw genetic testing and sequencing data. These data are among the most potentially useful to patients in the long term.”

What’s more, the PMI within ONC’s Interoperability Roadmap should define means of access including tools such as patient portals and APIs that enable individuals to access all data types, whether lab results, medications or even genomics.

“Participants’ access to their aggregated information will promote participation and retention,” said the Task Force’s other co-chair, Leslie Kelly Hall. “So data return should offer dynamic and compelling visualizations to promote its use. And patients should have access to computable, raw genetic testing and sequencing data.”

The task force made its recommendations at a joint meeting of ONC's Health IT Policy and Standards Committees. The recommendations were the result of nine meetings by the task force, held from February to May. 

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The Medical University of South Carolina Health has embarked on an initiative to transform monitoring for more than one million patients a year.

To that end, MUSC inked an 8-year, $36 million partnership with Royal Philips, which will install, integrate, and manage patient monitoring systems as well as provide maintenance.

Philips will also provide MUSC, the clinical enterprise arm of Medical University of South Carolina, with continuous access to standardized, current-state patient monitoring technology, implementation, and asset management services. 

[Also: Mayo Clinic's quick tips for driving patient engagement]

This approach is designed to standardize clinical practice and enable integration and interoperability with other clinical IT systems.

MUSC will have better collection and management of patient data across its four hospital facilities in Charleston and more than 100 outreach sites, in order to provide more informed, proactive diagnostic and treatment services, helping to reduce complications, adverse events, length of stay and readmissions.

“We want to give our staff and patients access to patient monitoring technologies to deliver on the highest quality, safest, and most reliable healthcare through the use of Phillips patient monitoring equipment across our entire enterprise,” MUSC CEO Patrick J. Cawley, MD, said in a statement.

Over the past year, Philips has signed similar long-term, strategic partnerships including Westchester Medical Center Health Network; Mackenzie Health and Marin General Hospital.

Royal Philips CEO Frans van Houten said in a statement that such long-term contracts enable healthcare providers to move toward value-based models and improve the patient experience. 

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Many in the health IT industry argue that meaningful use has inhibited EHR usability because electronic health record systems vendors have been forced to meet federal criteria rather than focus on building innovative products. But meaningful use now is winding down. So what does that mean for EHR vendors?

“The regulatory oversight list of desires is not going to go away; there will continue to be a high regulatory-driven bar of capabilities that will have to be there,” said Rick Poulton, president of EHR maker Allscripts. “But vendors need to start moving from regulation-driven investments to things that will deliver value to healthcare providers, things that will allow providers to continue to be effective in a highly changing healthcare world.”

Among the forces changing healthcare today are new, value-based reimbursement models, where providers increasingly are being paid for value delivered versus procedures performed.

“That will require modifications if not wholesale changes to the IT tools today,” Poulton said. “At Allscripts, we are trying to think of these macro trends as we spend our innovation dollars. Reimbursement changes and personalized medicine, for example, will become bigger parts of healthcare delivery in the future, and this change to a much more consumer-empowered world. And all of this has to be accounted for, for our healthcare providers. So these are areas we are thinking about a lot, in terms of where do we go from here. We have made investments in these spaces.” 

[Also: Epic CEO Judy Faulkner: 'Good software is art']

On another note, many EHR market observers say the fray is on the cusp of a big switch, where hospitals tear out existing EHR systems and replace them with systems from different vendors. Allscripts, however, does not view providers taking that direction, especially for hospitals that have made large, enterprise investments. The key word there: enterprise.

“From our perspective, switching costs are large when you make a switch with a large enterprise system,” Poulton said. “So we adhere to ‘the four C’s’ – confidence, competence, cost-effectiveness and care. Do I have confidence that my vendor will be around for the long run and continue to invest in this platform? Is the vendor competent, delivering high-quality code? Is their solution cost-effective in this world of increasing financial strain? And does the vendor care about my success?”

Poulton acknowledged that every EHR vendor has at times failed on one or more of these C’s in the eyes of their clients. In other words, nobody’s perfect.

“But when you fail, that creates questions about where you go from there,” he explained. “Can you restore confidence or not? However, with confidence, the question then becomes, as a vendor, what can you do with that clinical repository of data in the EHR to help providers deliver better care? It is a tough business case to make to rip out a perfectly good EHR that is checking off all four of the four C’s. You are just spending money to spend money.”

And then there’s the issue of interoperability hovering over the health IT industry. All IT vendors, including EHR vendors, have to be moving in the direction of making their systems work well with other systems, passing data back and forth. Poulton said Allscripts has been working diligently on interoperability, especially when it comes to APIs.

[Also: Q&A: MEDITECH CEO on more than 40 years of healthcare change]

“There is a story that doesn’t get a lot of attention,” he said. “There were two ways to achieve interoperability: One way was a national standard that governs how data would go from system to system, and the other approach is the one that happened, where the industry got there on its own as well as through incentives the government provided, and thus there were disparate solutions. A commercial market approach as opposed to the public sector dictating standards. And we might all be dead waiting for that standard to be developed to get IT tools out in a widespread fashion.”

When the dust settles and more progress is made on interoperability, there will be a consensus that the commercial avenue taken was indeed the better road, Poulton added.

“The real thing to focus on today goes to the prefix: interoperability as opposed to intraoperability,” he said. “Passing data elements within a single vendor’s set of solutions is easy, clients expect it. But how do we pass data between different vendors? That takes an attitude as much as technical delivery.”

Poulton points to the APIs as success with interoperability.

“That to us is the real definition of interoperability,” he concluded. “That is the real measure of things like interoperability. It’s actually happening today.”

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

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Hospitals are gearing up to for population health management, according to a new survey by the nonprofit eHealth Initiative, but complex electronic health records systems continue overburdening physicians at the point of care enough to inhibit progress.

eHealth Initiative’s survey of population health trends found that 68.1 percent of healthcare responders had created new roles or hired staff for population health. Also, 68.1 percent said they had begun activities and 76.6 percent had purchased population health or analytics technology, with 72.3 percent anticipating making such investments.

Eighty-three percent of respondents, meanwhile, said they measure success by intermediate outcomes and healthcare processes (72 percent), cost savings (70 percent) and patient satisfaction (70 percent). Thirty-seven percent said they're integrating patient-reported data. 

[Also: Healthcare analytics has long journey to deliver real value, data scientist says]

The survey drew on responses of individuals used from accountable care organizations, hospitals and health systems, physician practices, health insurance companies and elsewhere.

That said, physicians continue being overburdened by reporting into complex systems, said Shawn Griffin, MD, chief quality and informatics officer for Houston-based Memorial Hermann Physician Network.

Tricia Nguyen, MD, executive vice president for population health, Texas Health Resources, and president of the Texas Health Population Health, Education and Innovation Center, agreed and said some of the deficiencies with EMRs lie in a lack of interoperability.

“If we are truly going to manage populations, we need to be able to deliver evidence-based pathways, guidelines and protocols at the point of care, and the only place that’s going to have an impact is in the EHR because the doctors are only working in the EHR,” Nguynen added. “Because the systems don’t talk to each other it’s not easy to integrate and share data across. That’s one thing we could solve, and if we could make it transferable across care settings and providers that (would be) a huge win.”

Memorial Hermann’s Griffin pointed to one positive sign with recent updated regulations in MACRA, which reflect a prevailing view that EHRs are too complex, with a resulting loss of usefulness and efficiency.

“The updated regulations regarding Meaningful Use and MACRA legislation was really an enlightened view of recognizing that EMRs were getting overbuilt and there was a loss of efficiency and usefulness for their tools,” Grffin said. “So I’m hopeful that the simplification we have seen with MACRA will allow greater flexibility for physicians to concentrate on workflow and outcomes not on whether they checked a set of boxes on the screen.” 

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Nearly every U.S. hospital now uses certified electronic health records, according to new research put out today at ONC's annual meeting in Washington – a nine-fold increase in less than a decade since the 2009 HITECH Act spurred widespread IT adoption.

Encouragingly, the survey data gathered by the American Hospital Association also shows that more than 85 percent of hospitals now share clinical information electronically.

According to AHA data published by ONC, use of certified EHRs has increased from almost 72 percent in 2011 to 96 percent in 2015. New data shows that adoption rates for small, rural and critical access hospitals have also increased.

Polling shows the percentage of hospitals sending, receiving and finding key clinical information grew between 2014 and 2015, with about half of hospitals had health information electronically available from providers outside their systems (a five percent uptick from 2014). Meanwhile, about half of hospitals say they "often or sometimes" use patient information received electronically from providers outside their systems.

[Also: ONC's DeSalvo: Time to change the culture of interoperability and health data sharing]

"As we kick off the 2016 ONC Annual Meeting, these data showing nearly universal adoption of certified electronic health records by U.S. hospitals are an indication of how far we have come for clinicians and individuals since the HITECH Act was passed,” National Coordinator for Health IT Karen DeSalvo, MD, said in a statement.

ONC’s meeting, which will be live-streamed, will tackle priorities such as interoperability, delivery system reform and innovation projects including the Precision Medicine Initiative.

Other agenda items at the ONC meeting this week include three "core commitments" the agency expects from the health IT industry: improving access to patients' health information, combating information blocking and implementing federally recognized standards to enable interoperability across systems.

Citing the need for free flowing data to enable initiatives such as Vice President Biden's Cancer Moonshot and the fight against the ongoing opioid crisis, DeSalvo said she looks "forward to these next three days with leaders from across the country to discuss our collective work to ensure health information can flow where and when it is needed."

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

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Touting survey data that the Office of the National Coordinator for Health IT posted Tuesday morning, Deputy Principal National Coordinator Vindell Washington, MD, said that almost every U.S. hospital is using a certified Electronic Health Record to manage care at the point of delivery.

“We're at a critical inflection point, one where technology, policy and demand are poised to change the way we think about access and use of health information to improve care and advance science and public health,” Washington said in kicking off ONC’s Annual Meeting for 2016. “A point where we, as a nation, move beyond adoption and transition to a place where health information is available when and where it matters most to patients who are receiving care. And, when it matters most to improve the health and well-being of the citizens of our country.”

With nearly half of hospitals sharing patient data with outside providers, Patrick Conway, MD, chief medical officer at the Centers for Medicare and Medicaid Services said the nation is moving into the next stage: where patients consistently and reliably have access to their own data that drives better outcomes.

[Also: EHRs hinder population health progress while MACRA has potential to ease workflow burden, doctors say]

“We're seeing a dramatic shift in the health IT arena [with] the MACRA legislation that enabled us to pivot to a more simple, flexible scoring paradigm with less burden and to be focused on interoperability,” Conway said. “That pivot is in the right direction and we are now discussing the details of them and what needs to be changed.”

For ONC’s part, Washington explained that ONC and the Department of Health and Human Services are working toward delivery system reform in a three-tiered approach: changing how doctors are paid, improving the way care is delivered to patients and building an infrastructure that enables good data to flow among providers in the healthcare system.

Washington pointed, for example, to the interoperability pledge that HHS Secretary Sylvia Burwell revealed at HIMSS16, wherein most EHR makers, including Cerner, Epic and Meditech, agreed to make patient information more accessible but not engaging in data blocking and to support standardized APIs.

“In other words,” Washington said, “we're looking forward to [collecting] the digital dividend that we are talking about now that all hospitals and doctor's offices have this delivery system in place and digital data to work with.”

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

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