Thanks to a secure region-wide patient portal powered by InterSystemsHealthShare® and Hixny, Marla and her entire family feel a whole lot better.
During a hospitalization, Marla and her husband had access to a complete online medical record spanning the entire care community. No one had to worry that crucial information might be lost or forgotten. It was all right there, accessed with a Web browser.
What does the family know now about patient engagement? It means peace of mind.
To learn more about Hixny and HealthShare, InterSystems’ health informatics platform, visit InterSystems.com/Patient2Z
A HealthShare Success Story: Hixny
“Patient engagement?”We just feel better.
Better Care. Connected Care. HealthShare.
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Changing needs, clinical interoperability, mobility, and ever increasing data and security requirements
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THE NEWS SOURCE FOR HEALTHCARE INFORMATION TECHNOLOGY ■ DECEMBER 2015 www.HealthcareITNews.comHIMSS Media / Vol. 12 No. 12
BENCHMARKS: A year of solid gains. On a variety of technological fronts, healthcare providers embraced new tools, adapted to change and set their sights on the future. PAGE 34
See our ad on page 40
2015: The year health IT got BIGBig data. Big data breaches. Big EHR contracts. Big M&A deals. Big anticipation for ICD-10. Big plans for meaningful use. Big frustrations with poor usability and lack of interoperability. Big fears about cybersecurity. Big hopes for the future of connected care, patient engagement and population health. PAGE 4
It’s on.At long last, ICD-10 became a reality in 2015. To the surprise of some, the Oct. 1 go-live date came and went with little incident. PAGE 10
Seal of approvalThe Department of Defense made a big decision on its new EHR this year, selecting Cerner for the largest health IT contract in history. PAGE 25
Thanks to a secure region-wide patient portal powered by InterSystemsHealthShare® and Hixny, Marla and her entire family feel a whole lot better.
During a hospitalization, Marla and her husband had access to a complete online medical record spanning the entire care community. No one had to worry that crucial information might be lost or forgotten. It was all right there, accessed with a Web browser.
What does the family know now about patient engagement? It means peace of mind.
To learn more about Hixny and HealthShare, InterSystems’ health informatics platform, visit InterSystems.com/Patient2Z
A HealthShare Success Story: Hixny
“Patient engagement?”We just feel better.
Better Care. Connected Care. HealthShare.
CONNECTDecember 2015 | Healthcare IT News | www.HealthcareITNews.com 3
WHAT’S INSIDEThe biggest healthcare breach ever reported. George W. Bush at HIMSS15. IBM’s billion-dollar bet on Merge. Meaningful use worries throughout the year. Steady talk of interoperability on FHIR. Health Catalyst’s prospects for an IPO. Let’s not forget the massive and long-awaited Department of Defense EHR contract awarded in July to Cerner, Leidos and Accenture. And, of course, there was the ICD-10 rollout. (The sky did not fall.) All of this and more made for an exciting year for healthcare IT. We capture some of the best moments in photos.PAGE 8
10All’s right with the world? After years of prep, a few delays and not a little worry, ICD-10 happened. Things seem OK, so far.
October surprise In a big day for rulemaking, CMS makes it clear: Stage 3 meaningful use rules are final.
16Uncommon alliance Partners HealthCare, Health Catalyst partner for population health.
Mobile mojo Smartphone apps help reduce readmissions at Cleveland Clinic.
24Big deal IBM spends a cool $1 billion to buy Merge Healthcare, help Watson “see.”
Calculated risk Allina Health bets big on Health Catalyst in unique shared-risk deal.
28Breach blues UCLA suffers massive cyberattack, joins long and unfortunate list of others.
Do it right When it comes to health data analytics, it’s best to go for help.
Benchmarks ........................... 34
Trends ................................... 36
People ................................... 38
CALENDAR OF EVENTS
DECEMBER1-3: Healthcare IT News Privacy & Security Forum, Boston7-8: Healthcare Finance Revenue Cycle Solutions Summit, Atlanta
JANUARY25-29: IHE North American Connectathon 2016, Cleveland
FEATURED EVENTThe Privacy & Security Forum kicks off Dec. 1 at the Westin Boston Waterfront Hotel.
Entering a new era of population healthIn the six years since it became law, the HITECH Act has done much to advance the use of health IT and provide a foundation for population health management.
bit.ly/new-era-pop-health
What to look for in population health at HIMSS15Population health efforts are intensely data-driven. Attaining the goals of those efforts will require we master the art of capturing data, sharing data and using data.
bit.ly/pop-health-himss15
10 tech trends to watch in 2015Is telehealth at a tipping point? Is 3-D printing here to stay? ECRI Institute spotlights 10 technology trends hospitals should be sure to keep an eye on.
bit.ly/10-tech-trends
DoD awards Cerner, Leidos, Accenture EHR contractThe Department of Defense hand-ed down the largest and most-anticipated EHR contract in his-tory on July 29, and it went to the Cerner team.
bit.ly/dod-contract
ICD-10: CMS won’t deny claims for first yearIn a surprise concession, CMS announced on July 6 it would work with the American Medical Asso-ciation on four steps designed to ease the transition to ICD-10.
bit.ly/icd10-claims
Mayo Clinic moves to EpicIn the latest example of a world-class health system yanking its established electronic health record in favor of a blue chip vendor, Mayo Clinic migrates to Epic.
bit.ly/mayo-epic
18 health technologies poised for big growthHIMSS Analytics shares its list of tools with biggest positive growth potential, pointing to where the market will be heading in the com-ing years.
bit.ly/tech-growth
CMS lays out vision for Stage 3 meaningful useTo a packed auditorium at HIMSS15 on April 13, CMS officials laid out Stage 3 requirements for eligible providers and hospitals.
bit.ly/stage3-vision
5 health IT trends set to shake up industryA new Accenture report, Health-care Technology Vision 2015, which lays out five key trends in health-care shows adaptation might be the best business model.
bit.ly/healthit-trends
How satisfied are you with your EHR? 2015 Satisfaction Survey results
readers weigh in on what works and what hurts when using their EHRs.
bit.ly/2015-ehr-survey
Top 10 online stories of 2015
2015 WAS a year of BIG. Big data, of course (and what years aren’t filled with that buzzword these days,
straight through from the Rose Bowl Game to the Times Square ball drop?). But also, alas, some big data breaches: Hackers and cyberattackers had a field day, helping themselves to millions upon millions of medi-cal and financial records as the true scope of healthcare’s security chal-lenges became impossible to deny.
There were big EHR contracts (the biggest ever, in fact, with Cerner landing the Department of Defense’s multi-billion dollar big fish of a deal after much anticipa-tion this summer). There were big mergers and acquisitions (again, in the biggest tech deal in history, Dell acquired EMC, with big implication for healthcare’s data storage, cloud computing and analytics in the years ahead).
There was big anticipation for ICD-10, which after big lead-up of many years, many millions of dollars and many delays, finally happened on Oct. 1 — thankfully (so far, at least!) without any big disruption.
There were big plans for mean-ingful use and interoperability from policymakers in Washington, big frustrations with those two very topics from politicians and provid-ers nationwide.
But mostly, driving it all, were big plans for a future of seamlessly connected care, where the patient is engaged and in charge and popula-tions are getting healthier by the day.
We look back on the big themes of this big year, starting there.
POPULATION HEALTH: BUZZWORD OR ZEITGEIST?It’s neither an entirely new term nor a nascent concept but technologies to fuel population health certainly caught fire at HIMSS15 and have been hot ever since.
Just about everyone was a population health vendor, in fact, whether focused on care coordi-nation, chronic care management, EHRs, health information exchange, enterprise applications or any num-ber of innovative upstarts trying to gain a foothold in the digitization of healthcare.
The truth about population health to date, of course, is that the real
success stories have resulted more from policy levers than technologi-cal achievements. Smoking bans all over the country are perhaps the best example and the Centers for Disease Control and Prevention reports marked decreases in hospital admission for heart attacks, asthma and chronic obstructive pulmonary disorder, among others, since those took effect.
One could argue that technologies working in conjunction with policy are the winning combination for population health moving forward.
Indeed, during the time since HIMSS15, a number of providers have stood up population health initiatives, such as Partners Health-care Population Health Manage-ment Center. Senior Vice Presi-dent Timothy Ferris, MD, said the concept has evolved from what was managed care and then pay-for-per-formance, and now it comes down to two key factors: cost and quality.
That’s one take. Other defini-tions that manifested are slightly more descriptive, and back in the spring boiled sev-eral down into this:
Population health means effi-ciently managing the health needs of a defined group’s entire lifes-pan by coordinating across the continuum — harnessing modern technologies to proactively spot,
ideally prevent and, when need be, effectively treat and manage chronic illness, all while continu-ously improving best practices and standards of care.
Any attempt to outline exactly what population health really is must almost by definition be an evolving organism since the entire industry is essentially still trying to figure out exactly what it will become.
The future state of a digitized system practicing population health is also a foundation for precision medicine and, beyond that, the grandest of our industry’s visions: a learning health system.
“It’s not so far-fetched that we won’t see it in our lifetimes. We’ve been seeing incrementally more interoperable systems that can be used for analytics,” said Lucila Ohno-Machado, MD, chair of the Biomedical Informatics department at UC San Diego. A learning health system “will not come with a bang but will come slowly. I think within five years we’ll see it.”
ICD-10:IT ACTUALLY HAPPENED The road to our new classification system was, by most accounts, a tortuous one. Delays. Public debate. Vigorous opposition. In the end: hospital war rooms, crossed fingers, some confusion but little in the way
of systemic or sustained chaos dur-ing October.
First proposed in 2008, with an original target of October 1, 2011, the compliance deadline was pushed back to 2013, then 2014, and there was speculation it might get pushed back even beyond 2015 until ICD-10’s staunchest opponent, the American Medical Association, called a truce with the Centers for Medicare and Medicaid Services, wherein the lat-ter agreed to four concessions the
former accepted as lightening physi-cian’s burden enough to stop pursu-ing another delay.
Once Congress broke for summer vacation in August, from which it was slated to return Sept. 8 leaving a mere three weeks to push through another piece of legislation naming a new deadline, the path ahead was effectively clear, and even those providers still hoping ICD-10 would never arrive had to brace for it.
Industry associations focused on ICD-10, including AHIMA CEO Lynn Thomas Gordon, declared themselves and members ready to put the new codes into action.
And in the final weeks consul-tancies, hospitals and vendors set up war rooms to essentially triage ICD-10 problems as they arose by connecting clinicians or staff with questions to point people likely to either have answers or know where to find them quickly.
At Rochester Regional, the com-mand center was a necessity even though the hospital’s coding com-pliance coordinator Diana Adam-Podgornik was expecting business as usual.
“With planning, testing, educa-tion and training behind us or in the final stretch, our hope is that all of the hard work has paid off,” Adam-Podgornik said. “Once October 1 arrives it should be a non-event.”
That’s not to say there weren’t glitches. Linda Girgis, MD, a family physician in South River, N.J., reported problems with an
It was an eventful year, as always, for the health informaton technology industry. Here are our picks for the top stories of 2015.
YEAR IN REVIEW
The truth about population health, so far, at least, is that the real success stories have resulted more from policy levers than technological achievements.
COVER STORY www.HealthcareITNews.com | Healthcare IT News | December 20154
unprepared clearinghouse, for instance, as well as a payer website unavailable for eligibility checks or referrals and reps unable to answer ICD-10 questions. The biggest issue Girgis faced? Insurance companies that — despite the year CMS said it would not deny claims as long as they’re filed in the right family of codes — required her practice to submit claims to the highest level of specificity.
“To be fair,” Girgis explained, “some of these problems have been ironed out already and oth-ers will no doubt be fixed in the coming weeks.”
That right there might be the ultimate irony of ICD-10. The con-version was called healthcare’s Y2K for so many years, most of those references wrapped in doomsday predictions of dropped coder pro-ductivity, denied claims and lost revenue, physicians retiring in pro-test to one more mandated admin-istrative burden, medical practices unwittingly driven out of business by the enormous expense, patients who couldn’t access care when they needed it.
Yet, as of press time, the more apt analogy to Y2K is that the ICD-10 switch flipped with none of the predicted disturbances, none of the post-apocalyptic destruction. In the end, it was more non-event than nightmare.
EHRS: WHAT ABOUT EASE OF USE, EVEN ELEGANCE?They’re expensive, they’re clunky, they are tied to government red tape, inextricably, it seems, and they can’t talk to one another.
Some healthcare providers love their EHRs. Most hate them.
2015 headlines captured some of the troubles and frustrations:
■ McKesson EHR goes dark after HVAC burnout (March 23)
■ ‘Dissatisfaction’ leading to EHR replacement trend (July 17)
■ IT, EHR go dark at 13-hospital system (Aug. 3)
■ ONC yanks certification for two EHR products (Sept. 3)
■ EHR song parody pokes fun at serious usability frustrations (Oct. 21)
But, who would abandon their machine to return to the paper-mired healthcare system that was in place 10 years ago. That was before the government’s meaningful use program, while meaning well, turned the industry on its head in an effort go digital.
Some would say ‘yes’ to paper even today, but it’s hard to imagine many would.
The results of a survey of providers using EHRs, released in September 2015, showed plenty of gripes across the board, but no indication users were so frustrated they were ready to give up their machines.
Yes, some physicians retired rather than go digital, but most pro-viders still at work would be hard pressed to return to manila folders.
They are simply looking for a bet-ter EHR, one that offers ease of use, fluid workflow and a little elegance, perhaps.
Take heart. In March 2015, IDC’s Judy Hanover released a report on what she called “3rd Platform EHRs,” that offers a glimpse of what’s to come on the EHR front.
Third-Platform systems, she said, are “characterized by ease of access, and ubiquitously avail-able applications that can be securely accessed from multiple endpoint devices, coupled with the use of commodity infrastruc-ture available from service provid-ers through software-as-a-service, platform-as-a-service and analyt-ics-as-a-service offerings, among other constructs.”
They’re not available yet, but she projects they will be within three to five years.
What will EHRs look like in 2020, just five years from now? AMIA con-vened a task force of EHR experts to contemplate that very question. On May 29, 2015, it released a five-point plan that calls for:
■ Simplifying and speeding documentation
■ Refocusing regulation■ Increasing transparency and
tions will improve the value that EHRs will provide to patients, and set the stage for more signifi-cant benefit in the future,” said Douglas B. Fridsma, MD, presi-dent and CEO of AMIA, in a state-ment accompanying the task force recommendations.
It appears what providers see as an ungainly nuisance today could one day morph into the object of beauty they imagine.
INTEROPERABILITY: NOW A ‘MUST’ — BUT WHEN?Interoperability — the imperative for EHRs to talk with one another and exchange data — goes way back. Think Interoperability Show-case, first introduced at the HIMSS Annual Conference in 2006 and the IHE Connectathon that has been going strong since 2001.
However, interoperability in healthcare remains elusive.
The year 2015, however, seems to have ushered in a new resolve to push forward.
The road ahead is likely to be a bumpy one, even with the Roadmap to Interoperability released on Jan-uary 30 by the Office of the National Coordinator.
And, although National Coor-dinator for Healthcare IT Karen DeSalvo, MD, called for interop-erability by 2017, true and wide-spread interoperability seems more likely far off than just ahead. Time will tell.
Congress has gotten into the milieu. In March, the Senate HELP Committee, chaired by Sen. Lamar Alexander, R-Tenn., put interoper-ability center stage.
“The issue of interoperability between electronic health records represents one of the most complex challenges facing the healthcare community,” Robert Wergin, MD, president of the American Acad-emy of Family Physicians, testified before the panel. The government “must step up efforts to require interoperability.”
By the time April rolled around the CommonWell Health Alliance, a vendor-led interoperability initia-tive launched in 2013, announced it would expand nationwide.
At the HIMSS Annual Confer-ence and Exhibition in April, HL7 demonstrated the power of FHIR, Fast Healthcare Interoperability Resources.
In an analysis piece published on , John Loonsk,
MD, warned against interoperability pitfalls, in which he alluded to FHIR.
“In the past, interoperability has been forestalled numerous times by folks chasing after the next bright and shiny object on the horizon,” Loonsk wrote. “It is always nice to think that the next standard or technology will be so great that it will become the ‘only one’ and that consistency and interoperability will ensue.
“Inevitably though, the new standard and technology does not become the ‘only one,’ but becomes ‘another one’ and for a while at least, the environment is even more complicated,” he added.
Loonsk, chief medical informa-tion officer at CGI and Johns Hop-kins Center for Population Health
IT, held the position of Director of Interoperability and Standards at ONC between 2005 and 2009.
By September, Epic Systems, which rightly or wrongly had been characterized by some in the industry as blocking interoper-ability efforts, was at work on its image, having hired a lobbying firm to help.
By October, a coterie of develop-ers and interoperability champions had gathered at Epic headquarters in Verona, Wis. for “FHIRWorks,” an interoperability jamboree hosted by Epic.
Stay tuned: 2016 is just ahead — and while the road to interoper-ability may be long and rough, it could take healthcare closer to its destination. Anything could happen along this long and winding road.
PRIVACY & SECURITY: WAKE-UP CALLThis was the year where things got really real for health data security. In early February, Anthem cele-brated the New Year by informing nearly 80 million of it plan mem-bers that their data had been com-promised in (so far, at least) the biggest healthcare data breach in history. Barely a month later, Pre-mera Blue Cross announced it had been targeted with a “sophisticat-ed cyberattack” that compromised financial and medical information of 11 million members.
This summer, UCLA Health Sys-tem (4.5 million victims) and Medi-cal Informatics Engineering (3.9 million) realized to their chagrin that it’s not just payers: hospitals and IT vendors can also be hit with big-ticket hacks.
And some health systems just can’t seem to get enough: In April, we reported on the 20-hospital St. Vincent health system in Indianapo-lis, of which 760 patients’ data were compromised in an email phishing incident — the seventh breach for the
“In the past, interoperability has been forestalled numerous times by folks chasing after the next bright and shiny object on the horizon,” writes John Loonsk, MD.
2015 was the year where things got really real for health data security, with some of the biggest breaches ever making headlines.
COVER STORYDecember 2015 | Healthcare IT News | www.HealthcareITNews.com 5
health system in a less than five years. Lax controls, ill-considered poli-
cies and weak IT protections can allow things like this happen. That’s something healthcare seems — finally — to be grasping, as payers and pro-viders of all shapes and sizes fever-ishly work to shore up their defenses and learn as much as they can about a shadowy and shape-shifting security.
In fact, 87 percent of respondents to the 2015 HIMSS Cybersecurity Survey indicated that privacy and security has become a more signifi-cant priority during the past dozen months.
Increasingly, part of that strategy is to empower a point person — most often the chief information secu-rity officer — to be in charge of an organization’s data. More than half of respondents to the survey have already hired a full-time employee to manage information security.
As we write in our October cover story, “CISOs: Healthcare’s new rock stars,” we described the needs of the role: someone who’d be “responsible for developing organizational policy, handling remediation and notifica-tion of breaches, interacting with government compliance authorities as well as third-parties responsible for securing information.”
Also, someone — given the high-risk nature of the security chal-lenges — who’s likely to be very well-compensated.
“Chief information security offi-cers are going to be rock stars in the future,” we quoted Kleiner Perkins Caufield & Byers Partner Ted Schlein. “I would argue that they’ll probably be the most highly paid people in cor-porate America and around the world going forward.”
Healthcare organizations have a lot to lose in a big data breach, after all: embarrassing headlines, potentially enormous federal fines, loss of pres-tige and competitive advantage.
But their patients do too, of course: We ran an article in June — “Medi-cal identity theft hits all-time high” — that reported how victims of healthcare data breaches “can expect to pay upwards of $13,500 to resolve the crime.
“As humans, we’re more concerned about whether or not a credit card number has been stolen,” ethical hacker Kevin Johnson, CEO of secu-rity consulting firm Secure Ideas, told Healthcare IT News. “And there’s such a lack of concern about my medi-cal records, my personal data.”
BIG DATA/ANALYTICS: INROADS TO INSIGHTMore and more nowadays, healthcare providers understand there are some pretty cool things to do with all the data they’ve been amassing in those EHRs these past few years. Now it’s just a matter of figuring out which things to tackle first and how to go about doing them.
Driving clinical and financial improvements with robust analyt-ics and BI tools is no longer just the domain of perennial leaders such as Geisinger Health System.
As its CIO Frank Richards told us in July, “We have had a sophisticated data warehouse for 10 years. This ware-house now services about 2,000 users. We look for patients who may not be receiving the care that they should be based on lab studies or other things that fall through the cracks across our multiple venues of care.”
Geisinger’s real-time alerting dashboards, first deployed with the emergency ICU and now used with some regular high-acuity beds, have been key to driving real insights into better clinical processes, he said. But there’s so much more work to do.
“We’re going to need systems that can more effectively monitor all our clinical data in real time, getting information to the correct provider to take action,” said Richards. “You need massive amounts of compute power to collect data and do some-thing with it.”
In the meantime, more and more hospitals and health systems are embracing clinical and busi-ness intelligence tools and strate-gies, hoping to mine data toward improved diabetes compliance, better protections against health-care-associated infections, reduced readmissions and more.
The challenge? Some are too trepi-datious, timid and unsure about how to proceed. Others are charging right ahead and doing it all wrong. In June, Healthcare IT News ran a three-part cover story exploring health systems at the “beginner,” “intermediate” and “advanced” stages of their analytics journey.
For beginners, Seattle Children’s Hospital’s Chief Data Officer Eugene Kolker offered the discouraging ver-dict that most providers, large or small, are “going to do it wrong,” at least at first.
One important bit of advice is to staff projects with people who have empathy and can communicate the importance of improvement proj-ects. After all, he said, half-jokingly, “Usually data scientists are data sci-entists not because they like to work with people but because they like to
work with data and computers, so it’s a very different mindset.”
Jeff Fuller, meanwhile, tells pro-viders in the middle stages of their analytics journey that executive buy-in — more than that, execu-tive-driven vision — is critical to success.
“It needs to be a strategic goal to become a data-driven organization,” said Fuller, director in advanced analytics at Carolinas HealthCare System. “That needs to be stated from the very top level for your hos-pital or system.”
Another bit of wisdom? Making smart use of data means making use of the correct data.
“Many middle-of-the-road orga-nizations, when it comes to data maturity, don’t have their hands around all the data,” said Fuller. “They’re making decisions on the data that’s readily available to them, which is not always the right data.”
That can be hard to determine sometimes. But one tip, from Sri-ram Vishwanath, a professor in the Electrical and Computer Engineer-ing department at The University of Texas at Austin, rings true. Don’t try to tackle “everything under the sun,” he said. “Focus.”
PATIENT ENGAGEMENT: MAKING IT HAPPENFor a status update on the evolution of mHealth and telemedicine, one need look no further than the recent 2015 mHealth Summit.
The annual conference, hosted by HIMSS and the Personal Connected Health Alliance, is now one of three summits under the Connected Health Conference umbrella (the other two summits, both new, focus on popu-lation health and cybersecurity). It signals a shift in emphasis from the technology to the connections — in other words, how providers are reaching out to patients, and vice versa, to improve care coordination.
As 2015 ends, concepts like patient engagement and popula-tion health are taking their place at the top of the healthcare “to do” list, as providers realize they need to find a better way to communicate and collaborate. No longer can they just put together a patient portal or make an app available and expect it to be used — they have to figure out what consumers want, and when and where they want it and work with them on a care plan that meets their needs and motivates them.
“Healthcare is a collaboration,”
Danny Sands, an instructor at the Harvard School of Medicine and co-founder and co-chair of the Society for Participatory Medicine, said during the recent HIMSS Media Patient Engage-ment Summit in San Diego. “We’re moving from healthcare to health, and we’re moving from the office to the home and, actually, anywhere.”
Sands said the nation’s healthcare industry is in flux, trying to work its way away from episodic, catastroph-ic care — “epistrophic” care, he called it — and toward value-based care. To do that, however, providers have to shift from reacting to their patients’ clinical needs to creating a health and wellness regimen that emphasizes care management.
The problem, so far, is that reim-bursement for that kind of health management isn’t keeping up with the advances, so providers are reluc-tant to embrace mHealth if they can’t find a means of supporting it. This past year, the Centers for Medicare & Medicaid Services took an impor-tant step forward in allowing Medi-care to bill for a limited amount of telehealth in managing chronic-care patients at home, but far too many doctors are ignoring the code because it’s too confusing or they don’t have the resources to take advantage of it.
That small step forward will lead to bigger steps, as providers realize they have to start meeting consum-ers where they are and providing services that will improve out-comes and keep them from coming to the hospital or clinic when they don’t have to. To do that, they’re going to have to start paying atten-tion to the consumer, and they’re going to have to find a way to turn those consumer-facing wearables around to give them information they need. EHR providers are just now embracing that effort, with apps and platforms that can pull information from the Fitbits and Apple Watches of the world into the medical record.
But it’s up to the provider to make that connection — to engage with patients at the time and place of their choosing, and to give them advice and insights that will compel them to come back for more.
“We’re going to need systems that can more effectively monitor all our clinical data in real time, getting information to the correct provider to take action,” says Geisinger CIO Frank Richards.
As 2015 ends, concepts such as patient engagement and population health are taking their place at the top of the healthcare “to do” list. The new era of value-based care demands it.
COVER STORY www.HealthcareITNews.com | Healthcare IT News | December 20156
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JANUARY To kick off 2015, our January cover feature took a look at how health IT is being leveraged to address the Triple Aim. We caught up with Cleveland Clinic’s RCM Director Karen Mihalik, Montefiore Medical Center’s CIO Jack Wolf and more to hear their innovative approaches to taking on these three goals.
APRIL Former President George W. Bush took the big stage at HIMSS15 this year in Chicago. HIMSS CEO H. Stephen Lieber talked with Bush about his role in creating a national digital health policy and launching the Office of the National Coordinator for Health IT.
MARCH We covered data analytics company Health Catalyst landing $70 million in Series D funding. The company, valued at more than $500 million, plans to go public in two years. “While some other companies have gone public at our size, we want to make sure we can be a really successful, predictable public company, so we wanted to achieve some additional size and scale before going public,” Health Catalyst CEO Dan Burton told Healthcare IT News.
YEAR IN PHOTOS
FEBRUARY In one of the biggest data breaches ever reported, Anthem, the nation’s second largest health insurer, notified 80 million of its members that hackers penetrated its IT systems and swiped personal data.
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COVER STORY www.HealthcareITNews.com | Healthcare IT News | December 20158 2015 TOP PHOTOS
JUNE For our June cover feature we did a three-part series on what healthcare organizations are doing with analytics and how they’re doing it — a beginners guide; tips for those in the middle of their journey; and advice for those in the advanced stages of analytics. One revelation? “The majority of places, whether they’re small or large, they’re going to do it wrong,” said Eugene Kolker, Seattle Children’s chief data officer.
MAY Our May cover feature reported on the pitfalls of meaningful use: “We’ve blown through the better part of the $30 billion, but when I go to the doctor, I still get a clipboard. That’s what Washington, D.C., paid for,” said Dan Haley, VP at EHR vendor athenahealth.
AUGUST IBM in August announced it was spending a staggering $1 billion to acquire Merge Healthcare, a deal officials say will combine IBM’s analytics and cognitive prowess with Merge’s medical imaging capabilities. The deal marked IBM’s third healthcare related acquisition since April.
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JULY In late July, we reported that the U.S. Department of Defense awarded its behemoth $9 billion EHR contract to Cerner, Leidos and Accenture over Epic. The trio received an initial contract of $4.3 billion to provide an “electronic health record off-the-shelf solution,” said DoD officials.
PHOTO: FRANK KENDALL, DOD’S UNDER SECRETARY FOR ACQUISITION, TECHNOLOGY AND LOGISTICS, 2012
OCTOBER No more delays. The ICD-10 diagnostic code set finally went live Oct. 1, with most healthcare providers and coders out in the field reporting little if any disruption. Back in July, CMS announced they would not deny incorrect ICD-10 claims for the first year.
SEPTEMBER In September, we published the results of our inaugural EHR Satisfaction Survey, which rated nine different EHR vendor platforms. We heard from nearly 400 active EHR users and IT professionals nationwide who rated their EHR across nine different metrics. Epic came out No. 1, with eClinicalWorks, Allscripts and Cerner trailing behind.
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OCTOBER CMS and ONC finally dropped its long-awaited final rules for the EHR Incentive Programs, which they said would ease reporting requirements for providers and allow 90-day reporting periods. Officials also announced that Stage 3 will go on as planned and will not be delayed.
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COVER STORYDecember 2015 | Healthcare IT News | www.HealthcareITNews.com 92015 TOP PHOTOS
POLICYwww.HealthcareITNews.com | Healthcare IT News | December 201510
CMS lays out vision for Stage 3 meaningful use
IF ROBERT Anthony had his choice, he said at HIMSS15 in April, “it wouldn’t be called the Stage 3 meaningful use regulation. It would be called the
‘meaningful use for everyone’ regulation.”“Even though we’re talking about Stage
3,” said Anthony, deputy director of the quality measurement and health assess-ment group at the Centers for Medicare & Medicaid Services, “what we’re really talking about is what everybody will be doing — or we’re proposing that everyone
ICD-10 go-live: nightmare or non-event?The closer we got, the more it appeared the compliance deadline will pass much like Y2K.
IN SEPTEMBER, as the Oct. 1 ICD-10 deadline loomed, it seemed to become clear that — after all the years of debate, disdain and doomsday predictions — the long-
awaited go-live would likely pass in much the
same fashion that Y2K did: imperfectly, but more or less quietly.
None of which was to say that there wouldn’t be problems in the near-term. But a growing consensus suggested they wouldn’t be nearly as apocalyptic as so many have prophesized.
THERE WILL BE GLITCHESAs we predicted then (and has since proven more or less correct) some problems would
Two biggest days of 2015 for health IT policy were less than a week apart: October 1 and October
6. The first, of course, was when ICD-10 finally kicked in after so many years of debate and delay. Just a few short
days later, the Centers for Medicare & Medicaid Services dropped final rules for 2015 meaningful use changes and
Stage 3 of the program, and the Office of the National Coordinator for Health IT unveiled its final 10-year Interoper-
ability Roadmap. Meanwhile, chronic care management picked up steam this year — with the new CPT code 99490,
which enables providers to be paid for 20-minute virtual visits when treating patients with two or more chronic
conditions. Telehealth, too, got several booster shots from members of Congress proposing legislation to make it
easier and more worthwhile for hospitals to embrace it. Accountable Care Organizations, on the other hand, took a
hit when many of them cut costs — just not enough to reap shared savings. Dartmouth-Hitchcock, for one, withdrew
from the Pioneer ACO program.
VISION SEE PAGE 12
A HIGH BAR: “Even though we’re talking about Stage 3,” said Rob Anthony, “what we’re really talking about is what everybody will be doing — or we’re proposing that everyone will do — in 2018 and beyond.”
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POLICY www.HealthcareITNews.com | Healthcare IT News | December 201512
will do — in 2018 and beyond.”To a packed auditorium,
Anthony — together with Elisa-beth Myers, policy and outreach lead in CMS’s division of health IT — laid out Stage 3 require-ments for eligible providers and hospitals, explaining what pro-posed rules (which, when final-ized, will take effect starting in 2017) would mean for them.
The hope was that some les-sons were learned from earlier stages of the process.
“We heard loud and clear that the framework for meaningful use as we’d devised it in Stage 1 and Stage 2 had become some-thing that was fairly complex,” said Anthony. “It had become somewhat burdensome.”
Some of that was related to workflow issues, he said. “Some of it was the sheer amount of what we were talking about measuring and reporting on.”
With Stage 3, said Anthony, “the goal was to become sim-pler; to get to something that was sustainable for future achievement. To focus in areas that were priorities for us as an agency, but also for us as health-care providers and consumers: promoting health informa-tion exchange and focusing on improved outcomes.”
Part of that would be streamlining — eventually syn-chronizing on a single stage, “whether you’re a new physi-cian or one who has been doing this for five years,” with a sin-gle reporting period, aligned to the calendar year.
Part of that is simplification, he said, moving from more than 20 objectives to a core of “eight that everyone should do, with some internal flexibility,” he said.
The goal, in other words, was
to reduce the ‘hoop jumping,’ to enable hospitals and provid-ers “to focus on objectives of advanced use.”
Health organizations would have the option to report in Stage 3 criteria in 2017. They’ll be required to do so beginning in 2018, regardless of prior partici-pation/stage of meaningful use.
Myers spent some time explaining the measures for Stage 3’s eight advanced use objectives:
exchange8. Public health reportingSome of those would be
retained Stage 2 objectives with small modifications, she said. Some were objectives with more expanded scope. All of them were about the “movement of informa-tion to support the improvement of healthcare,” said Myers.
In most cases, “we delib-erately put in some flexibil-ity,” in order to better fit with how patients and providers do things, she said.
For example, for the patient access objective, CMS would allow providers to use APIs to help meet the criteria, said Myers — suggesting that the wearable devices and wellness apps that have become so popular could be one way to meet the criteria.
The a im, she sa id , i s “allowing for different types of technology for different types of use cases for differ-ent types of providers and patient populations.”
VISIONCONTINUED FROM PAGE 10
arise, claims would be denied, clini-cians would grow impatient with the new classification system and a dip in coder productivity was probably inevitable.
Worse, we guessed some small providers will really struggle as their cash flow is disrupted and a subset of those may even shut down, be gobbled up or otherwise align with organizations more pre-pared for ICD-10 – or they’ll sim-ply open lines of credit to keep their business operational until this gets straightened out.
But that didn’t mean we’re in for a total disaster, either.
While it would be a stretch to call ICD-10 déjà vu, there are two
existing points of comparative precedent: Y2K and HIPAA 5010.
POINTING TO PREDECESSORSDuring the months, weeks, then days leading up to Y2K, fearful predictions were rampant. Power outages striking homes, banks and food markets would lead to looting and rioting in streets full of freezing people. Nuclear meltdown? Well, perhaps in hindsight that was not actually a legitimate concern but it did get bandied about nonetheless.
That fear was ingrained into the American conscious enough that my father-in-law — and no I am not making this up, dispensed supplies for Christmas of 1999, including batteries, cash, flashlights, water,
canned food and, to one of his daughters, a portable toilet.
HIPAA 5010, only pertinent to the healthcare industry, was admit-tedly different, smaller, and with considerably less at stake. But that didn’t stop healthcare profession-als from predicting a train wreck of denied claims and the potential for smaller medical groups to collapse on account of disrupted cash flow.
In the cases of both HIPAA 5010 and Y2K, in fact, glitches emerged. Claims got confus-ing and reimbursement was, in certain instances, delayed in the wake of HIPAA 5010 but those problems were worked out in reasonably short order.
History has already let 5010 slip from memory and as for Y2K well, it has since been called the disas-ter that never happened, a col-lectively imagined threat, as well as a quiver of conspiracy theories suggesting the whole thing was a scam born of FUD (as in fear, uncertainty and doubt).
And as the Oct. 1, 2015 ICD-10 deadline drew closer, the possibility that the actual turnover would follow suit with few hitches became more and more distinct. The sun would rise come October 2, we predicted, hospitals would do what it takes to get paid under the new coding sys-tem, and life would indeed continue.
So far, at least, that still seems to have been the case.
ICD-10CONTINUED FROM PAGE 10
While it would be a
stretch to call ICD-10
déjà vu, there are two
existing points of
comparative precedent:
Y2K and HIPAA 5010.
A huge profusion of new codes made many in healthcare, from physicians to coders, uneasy to say the least. Maybe ICD-10 won’t be as bad as they feared?
The aim, said Myers, is “allowing for different types of technology for different types of use cases for different types of providers and patient populations.”
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Who has the biggest impact on our health? The doctor, the pharmacist, the health plan, public policy? To power modern health care, we believe the answer is all of the above and more. After all, the only way to treat the whole person is to engage the whole health system. As a health services and innovation company, we’re connecting every part of the system by combining data and analytics with technology and expertise. Because when it comes to making Healthier happen, we’re all in this together.
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POLICY www.HealthcareITNews.com | Healthcare IT News | December 201514
CMS drops final EHR meaningful use ruleStage 3 gets green light, 90-day reporting period approved
IN OCTOBER, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT
released final rules and certification criteria for the EHR Incentive Pro-grams, which they said would ease reporting requirements for provid-ers and allow for 90-day reporting periods. They also announced major news on Stage 3 of the program.
The 2015 rule built on 2011 and 2014 and was reflective of input from industry stakeholders, accord-ing to Karen DeSalvo, MD, national coordinator for health IT and act-ing assistant secretary for Health at HHS.
The final rules, as CMS and ONC officials announced, “make signifi-cant changes in current require-ments.” Chief among them were easing the reporting requirements for providers, said Patrick Con-way, MD, of CMS, in a media call. The rules would allow for a 90-day reporting period for providers in 2015, and new providers in 2016 and 2017.
There were also big changes to the number of objectives for eli-gible hospitals, which have been reduced from about 20 in prior stages to eight.
Clinical quality measures for
both hospitals and providers would remain the same.
Stage 3, CMS officials also announced, would go on as planned and not be delayed, but they would extend the public comment period for Stage 3.
After receiving some 2,500
comments from industry stake-holders on the two proposed rules, CMS made some big changes to the regulations:
■ Give providers and state Med-icaid agencies 27 months, until Jan. 1, 2018, to comply with the new requirements and prepare for the
next set of system improvements.■ Give developers more time to
create the next advancements in technology that CMS says will be easier to use and more appropriate to new models of care and access to data by consumers.
■ Support provider exchange of
health information and interoper-able infrastructure for data exchange between providers and with patients.
■ Give developers additional time to create the next advance-ments in technology that will be easier to use and more appropriate to new models of care and access to data by consumers.
■ Address health information blocking and interoperability between providers.
STAGE 3 MAJOR PROVISIONSIn 2017, Stage 3 requirements are optional, but providers who opt to start Stage 3 that year will have a 90-day reporting period. Come 2018, all providers must comply with Stage 3 regulations using a certified EHR.
According to a CMS fact sheet detailing the final rules, major pro-visions pertaining to Stage 3 mean-ingful use include:
■ 8 objectives for eligible docs, eligible hospitals and CAHs: In Stage 3, more than 60 percent of the proposed measures require interoperability, up from 33 percent in Stage 2.
■ Public health reporting with flexible options for measure selection.
■ CQM report ing a l igned with the CMS quality reporting programs.
■ Finalize the use of application program interfaces that enable the development of new functionalities to build bridges across systems.
CMS officials announced Stage 3, with a 90-day reporting period, would go on as planned and not be delayed despite an extended public comment period.
ONC reveals final interoperability roadmap
IN OCTOBER, the Office of the National Coordinator for Health IT finalized its eager-ly awaited interoperability
roadmap.“Data needs to be free,” said
national coordinator Karen DeSalvo, MD, at the time. “If we’re going to change the care model we need an information model to support it.”
That thinking was at the heart of the report, Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Road-map, which DeSalvo labeled a criti-cal part of the broader delivery sys-tem reform effort.
The three overarching themes of the roadmap were: giving consum-ers the ability to access and share their health data, ceasing all inten-tional or inadvertent information
blocking, and adopting federally recognized national interoperabil-ity standards.
“There is a significant focus on near-term activities,” said Erica Galvez, ONC’s interoperability and exchange portfolio manager.
The final roadmap, as was the case with previous drafts, included three-, six- and 10-year goals and milestones.
Between October and 2017 ONC intends to enable the send-ing, receiving, finding and using of health data domains with an eye on improving care quality and outcomes.
ONC’s next phase, slated to span 2018-2020, aims to expand data sources and increase the number of users to create healthier popula-tions at a lower cost.
The ultimate goal is to build a learning health system by 2024. That will require nationwide interopera-bility putting “the person at the cen-ter of a system that can continuously improve care, public health and sci-ence through real-time data access.”
Galvez added that the roadmap was about action, not just talking over ways to get through pesky interoperabil-ity hurdles.
“ T h e w o r d action is used 107 times in the docu-ment,” she said.
Indeed, ONC’s roadmap was a clarion call to pri-vate hea l thcare providers , pub-lic organizations and U.S. states — if only because the federal gov-ernment cannot achieve a learning health system without them.
Such an ambitious goal would take incentives properly aligned to stimulate information exchange, policy components that move interoperability, patient match-ing, privacy and security and trust
environment, DeSalvo said.With those in place, the nation
will have a platform on which to innovate and drive grand initiatives such as population health and pre-cision medicine.
“This is part of our work to build
a system with better care, smarter spending and healthier people,” DeSalvo said. “We have a strong sense of urgency and want to see that we receive a return on the investment of establishing elec-tronic health records.”
CLINICALwww.HealthcareITNews.com | Healthcare IT News | December 201516
From the idea that quality metrics reporting could actually hurt patients, to the ways OpenNotes
has turned patient empowerment into a movement, the breadth and depth of clinical issues appear to be growing every
year. In 2015, we explored worries over readmissions, healthcare-acquired infections, medical errors and care coordina-
tion. We showed how healthcare providers are approaching the new demands that come with population health, how
physicians are still grappling with how best to use EHRs and how patients are still worried about the security of their
personal health information. Technology has become integral and essential to the day-to-day delivery of care, but in
2015 it was clear the exact impact of what it means for the clinical side is still far from settled.
Mobile apps helping reduce readmissions
CYNTHIA DEYLING, MD, chief qual-ity officer at Cleveland Clinic, reported seeing burgeoning use of mobile technology at
the health system in July.While emphasizing that, of course,
“some readmissions are clinically appro-priate and necessary,” Deyling said Cleveland Clinic, like so many other hos-pitals and health systems these days, is putting a focus on “reducing preventable readmissions through improved patient education, follow up, communication and care coordination.”
Smartphones played a big part in help-ing them get there.
“We have apps in development that will support access by allowing patients
to quickly identify local Cleveland Clinic resources, including on-demand schedul-ing,” she said. “Other tools, including apps that promote patient wellness and chronic disease management, are also in use.”
A 2014 study from the Mayo Clinic showed that patients who used smart-phone apps to record weight and blood pressure — and participated in cardiac rehab — lowered cardiovascular risk fac-tors and 90-day readmissions. According to the study, 20 percent of the app-user patients experienced readmission com-pared to 60 percent of patients who com-pleted rehab only.
Another mobile technology survey from HIMSS in 2015 suggested “healthcare orga-nizations are widely beginning to deploy mobile technologies with the aim of engag-ing patients.” Use of mobile technology continues to interest providers as a way to meet requirements for meaningful use and Medicare reimbursement require-ments, the study showed.
Andrey Ostrovsky, MD, CEO of
Partners forges huge pop health dealPartners HealthCare, Health Catalyst team intent on transforming care
IN AN unprecedented alliance between cli-ent and vendor, Boston-based Partners HealthCare, the client, and Salt Lake City-based Health Catalyst, the vendor,
agreed in September to share best practices, intellectual property, technology and training in an effort to take population health manage-ment to new heights.
Money was involved — at least $30 mil-lion. Partners, which was already invested in Health Catalyst, raised its equity ownership stake in the growing health data warehous-ing and analytics company. Health Catalyst, meanwhile, was investing in money, time and effort in the initiative.
Neither party said much about the finan-cial piece of the deal. Nor did they unravel how much capital either partner contrib-uted to which aspect of the collaboration. Both, however, eagerly emphasized the goals and the expected gains from their unique collaboration.
As Timothy G. Ferris, MD, Partners’ senior vice president of population health manage-ment saw it, the health system’s agreement with Health Catalyst would turbocharge its
care management program and improve out-comes for its patients.
Ferris, a practicing internist, pediatrician and Harvard professor, who has spent more than two decades focused on health policy and care coordination, is vice president of popula-tion health management at Partners Health-Care. Ferris leads the new population health management center at Partners. Both Partners HealthCare and Health Catalyst teams will train there in population health management.
The goal, said Ferris, was to provide the infrastructure and knowledge base for broader outcomes transformation, not just for Partners HealthCare, but also for healthcare organizations across the country.
One key element of the deal between Part-ners and Health Catalyst was an agreement not only to create new technology, which Partners HealthCare has already done sup-ported by its Health Catalyst platform, but also to make the new technology available to other health systems by commercializing it.
“We saw some of the innovations they had developed, specifically in the area of care man-agement and population health management, as being very, very impressive,” Health Cata-lyst CEO Dan Burton told .
“As we talked about what they had devel-oped,” Burton said, “our assessment was that these are relevant to the broader market. They Mobile technology interests providers as a way to meet meaningful use and
Medicare reimbursement requirements.
READMISSIONS SEE PAGE 18
PARTNERS SEE PAGE 20
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www.HealthcareITNews.com | Healthcare IT News | December 201518 CLINICAL
Boston-based Care at Hand, developer of an app-based care coordination system, said the move toward value-based pay-ments drives efficient use of affordable, accessible technolo-gies, such as mobile apps.
“Our company wouldn’t exist if not for Affordable Care Act,” he said.
Indeed, the rise in mHealth technologies correlates with ACA’s plan to reduce prevent-able, excessive readmissions with cuts to the Inpatient Pro-spective Payment System in 2012. Medicare spends more than $17 billion annually on avoidable readmissions with penalties that total up to 3 percent of inpatient claims for 30-day readmissions.
“Payers have begun penal-izing healthcare providers for readmissions in excess of the national average, but, more importantly, readmissions rep-resent a failure to optimize patients’ clinical condition for discharge or set them up with appropriate post-discharge care and services,” said Deyling.
The Cambridge, Mass.-based Institute for Healthcare Improvement showed how dis-charge planning and transition (moving patients from one care setting to another) can reduce avoidable re-hospitalization. It called for “Improving tran-sitions and care coordination at the interfaces between care settings and enhancing coach-ing, education, and support for patient self-management.”
“It is important to keep people stable and healthy who are living with serious chronic conditions,” said Joanne Lynn, director, center on elder care
and advanced illness at Ann Arbor, Mich.-based Altarum Institute. “They need to spend more time at home and less in hospitals. To the extent that readmissions result from poor discharge processes and limited support in the community, we should fix those things.”
Lynn questioned the viabil-ity of hospital-wide mHealth solutions.
“If they support processes, they would be helpful,” she said. “If they’re a patch thrown into an error-prone system, they will be expensive and frustrating.”
According to the HIMSS survey, organizations “con-tinue to struggle to effectively engage patients using existing mobile devices, noting that
app-enabled portals allowed 73 percent of respondents to engage with patients, but that only 36 percent described that engagement as ‘highly effective.’
“Many respondents reported a need to fully optimize and leverage the wide capabilities that mobile technologies and platforms offered,” according to the report.
Another wrinkle is that 2 per-cent of the mHealth solutions achieved the IHI’s Triple Aim of improving the patient expe-rience and population health and reducing per-capita costs — with “only 23 percent hav-ing any peer-reviewed research evidence for their claims,” said Ostrovsky.
He offered the following guidelines to help direct effec-tive technology selections. Tech-nology should:
■ be evidence-based■ validate quality improve-
ment claims within six months of deployment;
■ support National Quality Forum Committee measurements;
■ produce positive outcomes for reimbursement;
■ identify risk factors for patients;
■ improve workforce quality and satisfaction;
■ be platform agnostic;■ adhere to interoperability
standards;■ sustain long-term supports
and services and■ provide technical assistance
for baseline capacity.Mobile apps represent “a natu-
ral home for medication informa-tion” and patient appointments according to “The ROI of Patient Engagement: Readmissions Reduction” from Axial Exchange, a Raleigh, N.C. developer of hos-pital mobile technology.
Noting that 37 percent of discharged patients didn’t know the purpose of their medications and those with-out an appointment number 50 percent of readmitted cases nationally, it called apps a simple way to help patients, one that doesn’t require com-plicated integration.
“Cleveland Clinic is begin-ning to have success using deci-sion support tools in our EHR to ensure a patient is ready for discharge,” said Deyling. “These checklists ensure key activities, assessments, hand-offs and interventions take place. Technology that supports standardized, evidence-based care plays a role in preventing readmissions.”
“It is important to keep people stable and
healthy who are living with serious chronic
conditions. They need to spend more time at
home and less in hospitals.”Joanne Lynn
Do quality metrics hurt patient care?Primary care docs give thumbs
up to healthcare IT, thumbs down
to quality measures, penalties
HALF OF primary care physicians across the country viewed the increasing use of quali-ty-of-care metrics and penalties for unnec-essary hospitalizations as potentially trou-
bling for patient care, according to an August survey from The Commonwealth Fund and the Kaiser Family Foundation.
The same survey showed 50 percent of physicians who responded see healthcare information technology as a boon for quality care.
The physicians said the increased use of quality met-rics to assess provider performance was having a nega-tive impact on quality of care. Far fewer (22 percent)
saw quality met-rics as having a positive impact on quality.
Also, 52 per-cent said pro-g r a m s t h a t impose finan-cial penalties fo r unneces -sar y hospital admissions or r eadmis s ions were having a negative effect
on quality of care, while just one in eight, or 12 per-cent, said such programs have a positive effect. Nurse practitioners and physician assistants viewed qual-ity metrics and admissions penalties somewhat more favorably but still were more likely to see negative impacts than positive ones.
The findings were from a brief based on the 2015 National Survey of Primary Care Providers, which captured the experiences and views of primary care physicians, nurse practitioners and physician assis-tants related to changes in healthcare delivery and payment, including accountable care organizations, medical homes and increased use of health informa-tion technology.
“The survey results indicate that primary care
providers’ views of many of these new models are more negative than positive,” the authors of the brief wrote. “There are exceptions: health information technology gets mostly positive views and medical homes receive mixed opinions with a positive tilt. With regard to HIT, our study indicates that primary care provid-ers generally accept the promise of HIT to improve quality of care even if previous research shows they dislike the process of transitioning from paper-based records. Our survey results also may reflect clini-cians’ earlier exposure to certain models and tools.”
Half of physicians and nearly two-thirds — 64 percent — of nurse practitioners and physician assis-tants saw the advance of health IT having a positive impact on practices’ ability to provide quality care to their patients. Fewer physicians (28 percent), nurse practi-tioners and physician assistants (20 per-cent) said health IT was having a negative impact on quality.
More primary care physicians viewed the spread of ACOs as having a negative (26 percent) rather than positive (14 percent) impact on quality, though the majority either saw no impact or was not sure. Three in 10 (29 percent) primary care physicians said they participated in an ACO at the time. Among those who participated, views were more favorable, though still mixed (30 percent positive, 24 percent negative).
Other key findings:
A third (33 percent) of primary care physicians saw the increased use of medical homes as having a positive impact on quality, more than twice the proportion who saw a nega-tive impact (14 percent). An even larger share (40 percent) of nurse practitioners and physician assis-tants viewed the impact as positive. Those who participated in medical homes were more likely to take a positive view than those who didn’t: 43 percent of physicians and 63 percent of nurse practitioners and physician assistants practicing in medical homes had a positive view of their impact on quality of care.
Most (55 percent) of the nation’s primary care physicians were receiving financial incentives based on quality or efficiency measures, an indication of the reach of ongoing efforts by public and private payers to reward providers for quality of care rather than for the amount of services delivered to patients.
Nearly half (47 percent) of phy-sicians and just over a quarter (27 percent) of nurse practitioners and physician assistants said the trends in healthcare were leading them to consider an earlier retirement. This continued a 20-year trend of phy-sician dissatisfaction with market trends in healthcare.
Half of primary care
physicians across the
country viewed the
increasing use of
quality-of-care metrics
and penalties for
unnecessary
hospitalizations as
potentially troubling for
patient care.
READMISSIONSCONTINUED FROM PAGE 16
Fifty-two percent of physicians said programs that impose financial penalties for unnecessary hospital admissions or readmissions were adversely affecting quality of care.
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CLINICAL www.HealthcareITNews.com | Healthcare IT News | December 201520
Telemedicine market to soar past $30BAn increasingly aged population and higher healthcare costs are propelling the market growth.
THE GLOBAL market for tele-medicine is expected to be worth more than $34 billion by the end of 2020.
That’s according to an August market research report, “Global Telemedicine Market – Growth, Trends & Forecasts (2015-2020),” published by Mordor Intelligence.
North America is the largest market globally, accounting for more than 40 percent of the global market size.
Driving growth in this market, researchers said is an increasing aged population, increasing inci-dences of chronic diseases and rapid rise in the software market.
Also, many healthcare systems try to reduce both the number of hospital visits and the length of stay in hospital, which led a growing trend for patients to be monitored in their home environment and as a result, a growing trend for tele-medicine market.
Increasing healthcare costs pro-vided a clear and more efficient way for telemedicine and related appli-cations, according to the report. Telemedicine holds a great poten-tial for the population aged 60 years and above. The scope of telemedi-cine was increasing in developing countries because of increasing population and increasing inci-dence of chronic diseases. Increase in remote monitoring of patients was expected to propel the market.
However lack of physician sup-port, poor cases of implementa-tion, high technology costs, and legal and reimbursement concerns hindered the growth of the market.
The global telemedicine market could be segmented on the basis
of type (telehospitals, clinics and home), Technology (hardware, software, telecom and services), applications (teleconsultation, telepathology, telesurgery, telera-diology, teledermatology and oth-ers) and geography (North America, Europe, Asia Pacific, Middle East & Africa, Latin America and Rest of the World).
Some of the key participants in the global telemedicine market included Aerotel Medical Systems, IBM, Intouch Technologies, Medical International Research, Medtronic, Roche, Siemens Healthcare, 3M Health, Allscripts Healthcare Solu-tions Inc. and a few others.
The relation between telemedi-cine and health IT is complemen-tary, researchers said. Telemedicine
is a method of delivering health care that makes use of health information technologies to achieve its goals.
Telehealth is a broader term that includes the use of electronic information and telecommunica-tions technologies to support long-distance clinical health care, patient and professional health-related education, public health etc., the
report noted. The various technolo-gies involved are videoconferenc-ing, the Internet, store-and-forward imaging. While telemedicine is dif-ferent from telehealth as it provides narrower scope of remote health-care services. Telemedicine refers specifically to remote clinical ser-vices, while telehealth can refer to remote non-clinical services, which include provider training, admin-
istrative meetings and cont inuing medical education.
Telemedicine is a subset of tele-health. It includes many medical sub-specialties, such
as telepediatrics, telepsychiatry, teleradiology and telecardiology. Specialties such as telepediatrics and telepsychiatry are practiced by using live videoconferencing systems. In recent years, the term telehealth has risen as a favorable expansion upon telemedicine.
The global market for telemedicine is expected to be worth more than $34 billion by the end of 2020.
Healthcare systems attempt to reduce the number of hosital visits and lengths of stays by monitoring patients at home.
were interested in the opportu-nity to commercialize. I think they were intrigued at the pos-sibility of using Health Catalyst as the commercialization partner or agent. And we were interested in and excited about being the commercialization partner.”
“We’re not disclosing the price tag,” Burton said, “but the terms include cash and equity. So Part-ners is deepening its equity stake as part of this commercialization process.”
For its part, Health Catalyst granted Partners HealthCare “an enterprise-wide, complete sub-scription to our entire library of everything we have built, everything we are building, everything we will build in the future,” Burton said. “The best way to further Partners Health-care’s objectives — and to fur-ther the commercialization of care management and broader health population management IT, was this expan-sion of our tech-nology and pro-fessional services relationship.”
“It’s similar to discussions that we had with Allina Health, where they developed some IT that we felt was compelling; it was tested in the field, and it had produced real outcomes, improvements,” Burton said. “We were interested in and excited about being the com-mercialization partner.”
The collaboration with Part-ners HealthCare was not the first partnership Health Cata-lyst had crafted with its clients. Besides the collaboration with Allina Health, its first customer, which had developed informa-tion technology that tested well in the field and produced outcomes and improvements, Health Catalyst also had part-nership agreements with a few of its other clients.
The Health Catalyst relation-ship with Partners HealthCare called for the former to purchase meaningful care management and population health IP from the latter, so the two can jointly commercialize the technology by using Health Catalyst as the com-mercialization engine.
“We very much look forward to working with Health Catalyst to enable greater use of analytics within our system,” Ferris said. “So, that’s one piece of it.” The second piece, he said, is about the collaboration around Part-ners’ population health informa-tion management programs.
“We’re excited about working with them in further develop-ment,” Ferris said. “Despite our
successes in population health management, we are nowhere near done innovating, dem-onstrating our ability to move the needle on quality and cost. Partnering with Health Catalyst allows us an opportunity to share those practices much more wide-ly as we continue to innovate.”
SUMMARY OF THE AGREEMENTThe expanded agreement between Partners HealthCare and Health Catalyst included four major elements:
Health Catalyst and Partners HealthCare would collaborate through the creation of a new Partners HealthCare Center for Population Health. The Center would train Health Catalyst and Partners HealthCare clinical and administrative teams in best practices for care management and population health, build-ing on the knowledge base that enabled Partners HealthCare to
save $40 million in providing care to the seniors as part of the feder-al government’s Pioneer account-able care organi-zation from 2012 to 2014. Health Catalyst gradu-ates of the pro-gram would dis-
seminate these best practices to client healthcare organizations across the country.
Health Catalyst would license technology, content and analyt-ics innovations that Partners HealthCare, the Massachusetts General Physician Organization and the Brigham and Women’s Physician Organization devel-oped as part of its decade-long, nationally recognized care man-agement and population health management programs. Health Catalyst would commercialize these innovations to further enhance Partners HealthCare’s population health and care man-agement programs, and to ben-efit other health systems in their care management and popula-tion health initiatives.
Partners HealthCare signed an expanded enterprise-wide technology subscription agree-ment, giving it access to Health Catalyst’s full suite of technol-ogy solutions to accelerate out-comes improvement. In keeping with Health Catalyst’s mission to improve outcomes, a portion of the company’s revenue from the subscription would be tied to the attainment of measure-able improvements in Partners HealthCare’s clinical and finan-cial performance.
Partners HealthCare increased its equity ownership stake in Health Catalyst, after first invest-ing in the company in 2013.
“We very much
look forward to
working with
Health Catalyst to
enable greater use
of analytics within
our system.”Timothy G. Ferris
PARTNERSCONTINUED FROM PAGE 16
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‘A lot of doctors told us to go to hell’
TOM DELBANCO, MD, profes-sor of general medicine and primary care at Har-vard Medical School and
former chief of general medicine at Beth Israel Deaconess Medical Cen-ter, is also co-director of the Open-Notes project, which gives patients access to the clinical notes written by their doctors and nurses.
OpenNotes initially launched in 2010 as a pilot program in three select locations: BIDMC, Geisinger Health System and Harborview Medical Center in Seattle. It soon became apparent that what may have seemed, at first, to be a revolu-tionary concept had struck a nerve.
Over the past five years, the initiative — which Delbanco first developed alongside BIDMC researcher Jan Walker, RN — has grown almost exponentially, find-ing footholds at some of the largest and most prestigious providers in the country, including the VA, Kai-ser Permanente Northwest, Oregon Health & Science University and University of Colorado Health.
On Feb. 10, at the Healthcare IT News/HIMSS Media Patient Engagement Summit, at the Hyatt Regency in Orlando, Delbanco’s BIDMC colleague, National Open-Notes Program Director Melissa Anselmo, talked about why Open-Notes was such a hit with patients and, despite some initial resistance, most of the physicians who take part in it as well.
Delbanco described, in a Janu-ary interview, how the project has evolved, and how it plans to expand to a truly nationwide movement.
Q: OpenNotes has experi-enced some pretty impressive growth since that first pilot in 2010.A: We’ve gone from 20,000 people two years ago to, we think, between 4.5 million and 5 million now, who have access to their notes via secure electronic portals.
Q: Clearly this is an idea that had legs. So how did it all get started?A: I’ve always thought the medi-cal record is the hub of the wheel, the way to bring patients much closer to those who care for them. I did an experiment 30 years ago where I actually had patients walking around this hospital with records they kept — and writing their own records along with the doctors writing theirs — and say-ing, ‘Let’s compare notes.’ We
published a paper about that, the doctors thought the patients were crazy. It was a little early.
Then we got a grant (in 2010) from the Robert Wood Johnson Foundation to try this out in a big way using electronic portals. We asked doctors to volunteer in three settings. One is Beth Israel Deacon-ess, one of the big Harvard teaching hospitals. Another is the Geisinger Health System, which is this enor-mous integrated health system, serving rural Pennsylvania. And the third is Harborview, a safety net hospital in Seattle. We wanted three very different sites.
A lot of doctors told us to go to hell. But we got more than 100 to volunteer — primary care doctors — which meant that automatically their patients who were registered on portals would be part of the study. There were about 20,000 of them.
Q: Did you notice any differ-ences between those three very different locales?A: We found extraordinarily few differences, which was very inter-esting. Much fewer than we expect-ed. Part of what helped our study was that we didn’t just do it in one place, and that the findings, from both doctors and patients, were so similar. People felt it really had some generalizability to it.
The intervention was very sim-ple: After the doctor signed his or her note, the patient automatical-ly got an email saying, “Tom just signed his note; Mike, you’re wel-come to read, it.” And then, two weeks before your appointment with your primary care doctor, you got a reminder email saying, “You might want to review your notes.”
That’s all there was to it. A very simple intervention. All the vendors have them. But what’s been hid-den, up to now, is what the doctor writes, and what he or she thinks about you. You can look up your lab work, you can look up your X-ray results, you can send secure emails, you can ask for appointments and refills. But you have not, in the past, been able to look up what the doc-tor wrote about you. That’s what the disruptive innovation is.
Q: You can understand why many doctors would be resis-tant to this.A: Oh yeah. They had many fears that they said out loud. The big-gest was that it would disrupt their workflow — and primary care doc-tors feel overwhelmed already. The second was that it would scare the hell out of their patients. Those were the two biggest fears.
And I think there were other fears … I guess we can get into it, because we’ve been writing about it. (Pauses.) I think that notes are not always truthful. I asked an internist recently at a New England Journal of Medicine meeting, “How many 40-minute visits can you do in an hour?”
Because of reimbursement in a fee-for-service world, doctors are really paid for their time and what they do. We’ve had quite a few anecdotes now of a note that says, “I spent 40 minutes with a patient and examined him from stem to stern. And the patient reads it and says, “Wait a minute, you never touched me.” And I think although the doctors won’t say it out loud, that’s one of the reasons they’re hesitant to do it.
Now, when you go to population-based care, when you go to ACOs, when you go to systems that reward quality rather than quantity, that doesn’t become an issue anymore. You don’t have to write that kind of note.
Q: The doctors who did sign on — did they do so grudg-ingly, or enthusiastically?A: There was a broad range. Some were enthusiastic. Some kind of said, “Well, it’s going to come any-way, I might as well try it.” And some were, frankly, almost con-scripted. So there was a range of expectations. About 80 percent of the doctors who told us to go to hell felt it would mean more work for them. About 50 percent of the doctors who volunteered also felt it would mean more work.
We did a study before we started — we studied the expectations of doctors and patients — and then the study that got us all the atten-tion was, after we had done it for a year — what happened.
We asked three basic questions: First, will patients read their notes, and will they report benefits from them? Number two, will it (over-burden) the doctor? And number three, after a year, will the patient and doctor want to continue? They were very simple research questions.
The results were that the patients were extraordinarily enthusiastic: 80 percent of them read their notes. That said, one out of five chose not to read their notes. I always make that point: Freedom of choice. We had a wonderful quote from a woman in Maine who said, “I want to have it, it’s all mine, it’s my busi-ness. But I may not read it.”
So, 80 percent read them, but 99 percent said the practice should continue. The patients loved it. And more importantly they reported
really important clinical benefits: 70 percent felt more in control of their care, and better educated. They felt better prepared for visits. They remembered their visits bet-ter, which is a big issue — you go to your doctor and you remember about 40 percent of what happened, and what you remember may be wrong. It’s a high-stress situation, even if you’re well.
It’s a big deal. And the biggest deal of all is that about 70 percent of patients said they were taking medicines better. Which, even if it’s a five-fold exaggeration would be mind-blowing.
They also shared them with other people: 35 to 40 percent of patients shared their notes with other peo-ple. That’s important. You share them with your aunt the doctor, or your cousin the lawyer. You can put them on Facebook if you want. The doctor-patient relationship is con-fidential. But whether it’s private now is up to you. You can down-load now and share with whomever you want and say, “What do you think?” You’re in control. It’s much more your record than it ever was.
Q: And the doctors? What were their early thoughts?A: Not one doctor quit. They didn’t all love it. They wrote their notes somewhat differently — about a quarter of them did — but not one quit after a year. And we now have thousands and thousands of doc-tors doing it and we’ve not heard
yet about one who’s started, then stopped.
Partly, because I think patients just expect and want it. Eighty-five percent of patients said it would help determine their future choice of provider — whether or not Open-Notes was present. Once they tast-ed it, they really wanted it.
Two years after we published these results, we had this amazing spread — and to flagship places. It’s kind of a who’s-who of Ameri-can medicine: Mayo and Cleveland Clinic and Kaiser Northwest and Dartmouth-Hitchcock and Univer-sity of Colorado. etc. It’s a lot of very fancy places.
The next trick is to spread it to what’s called the early majority. The people in the real world who serve real America. Mayo Clinic is not the real world. So that’s our next goal, to go from 5 million to 50 mil-lion. And our real goal is to have it become the standard of care in this country.
Q: In the meantime, what else is next?A: (OpenNotes) has implications for patient safety. We’re doing a big study to see what errors are picked up by patients, what mistakes are averted. And we have lots of anec-dotes along those lines already.
It has big implications for cost and quality and value: The patient who says, ‘I did what you said, Tom. I’m doing fine, I feel better, I’ll cancel the next visit.’ Cancel a
OpenNotes: ‘This is not a software package, this is a movement’
“The patients were extraordinarily enthusiastic,” says Delbanco. “80 percent of them read their notes.”
CLINICALDecember 2015 | Healthcare IT News | www.HealthcareITNews.com 23
few visits, keep people out of the doctor’s office, and that becomes a serious money saver if you multiply it by a few million people. So it has big implications for value.
It has implication for medical education. Why shouldn’t a young doctor have his notes critiqued by a patient?
But it’s not black and white. For example, we’re about to send off a paper that shows that if you remind patients to read the notes, they’re much more apt to do it than if you don’t. Doctors want to be able to hide some notes. Should they be able to hide part of their notes? Patients may want to have part of their notes hidden from their caregivers.
Q: Have you found that any physicians are less than forthcoming?A: That’s a good question: Is the note dumbed down? We have no evidence of that. People were afraid it would happen but we have no evi-dence that it’s happened.
There are fewer abbreviations. (Doctors) are quietly, I think, aiming the note more toward the patient. The example we always give is SOB: SOB to me means short-ness of breath. To you it may mean something else. There are abbrevia-tions we use that you don’t know. There are words we use that you don’t know.
We use the word “dyspnea.” It also means shortness of breath. Pretty soon, with new technolo-gies, you’ll be able to put a cursor on that word and it will say “short-ness of breath.”
Q: Talk about the technology angle of all this.A: The big players are Epic, Cern-er, Meditech, athenahealth and folks like that. We’ve been work-ing with Epic. Epic next year plans to have OpenNotes as the default foundation. If a hospital buys Epic, it will be delivered with Open-Notes in it. That’s a big deal for us. And the upgrades, too: every upgrade they have will make it very easy to go to OpenNotes if you don’t have it already.
Epic is going to instruct their customers how to work with Open-Notes. We’re working with Cerner, we’re working with other people, too. Epic says it serves 170 million people. Cerner says it serves 60 mil-lion people. That’s a lot of people.
The other targets for us are the CMIOs. They become the transfor-mational officers for their institu-tions. We’re working very closely with them because they’re the ones who can flip the switch and make it work.
Our hospital has a homegrown EHR. Most people buy them off the shelf or adapt the portal to their own needs. Epic supplies Geisinger; Geisinger doesn’t have MyChart, it has MyGeisinger, which is their adaptation of the portal that Epic provides them. Into that, they can build OpenNotes — which they’re
increasingly doing.But I want to emphasize: This is
not a software package. This is a movement. This is a movement of full transparency. It’s a movement to engage patients and enhance communication between patients and those that take care of them.
We’re going to target several groups of people. We’re going to target CEOs; we’re going to target payers. We’ve talked with ONC. We’ve talked with the American College of Physicians, who are advocates for this. We talked with provider groups of all sizes. We try
to allay their fears: Try it, you may like it.
We’ll also put pressure on from the consumer side. Consumer Reports has written about us a lot, and we work with them closely. We work with the AARP. We’re meeting with the Alzheimer’s Association next week.
Q: What are some other things you’ve noticed as OpenNotes has spread?A: There will be pressure on and among the providers, I think. Another thing that happens is
competition. In three parts of this country we’ve seen a fascinating phenomenon. In Portland, Ore. and Seattle, and in the middle of Penn-sylvania, we’ve seen organizations adopting OpenNotes because the other guy has it.
In Portland, Ore., nine normal-ly competing organizations got together to work together on Open-Notes. And extraordinary thing. We call it the Portland Consortium.
In Seattle, basically all the big players are doing it with one other thinking about doing it. University of Washington. Virginia Basin, Group
Health, Kaiser Northwest. The only big outlier is Swedish Hospital, and I bet you they’ll be doing it within the year. So the word gets around.
The registrations on our portal here are way up since we started OpenNotes. It brings patients to the portal. It keeps patients in the insti-tution. It’s a way of both attracting and retaining patients. That’s one of the business cases for it.
It’s the right thing to do, and there’s also a business case as (pro-viders) compete in a crowded mar-ket. That’s one of the reasons we think we’re spreading so quickly.
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Allina goes all in for outcomes with Health Catalyst
IN WHAT Health Catalyst CEO Dan Bur-ton called a groundbreaking deal, in January Minneapolis-based health system Allina Health — Health Cata-
lyst’s first client — announced it would invest $100 million in the data warehous-ing company.
Allina also committed to work with the Salt Lake City-based data warehousing company on a 10-year initiative to build a new model for improving outcomes system-wide.
The deal combined the two organiza-tions’ analytics technology, clinical con-tent and personnel to “turbocharge” finan-cial, operational and clinical outcomes improvement via “living laboratory” for healthcare transformation,” Burton said.
The end goal being to improve the quality and lower the cost of care for Alli-na’s patients and to provide a model for
outcomes improvement across the country.The 10-year agreement marked the cul-
mination of a relationship that began in 2008, when Allina Health became Health Catalyst’s first customer.
“This agreement with Health Catalyst is unique in the industry and will accelerate outcomes improvement for those served through Allina Health as well as create a roadmap for broader outcomes transfor-mation both here and across the country,” said Penny Wheeler, MD, president and CEO of Allina Health, said in announc-ing the deal. “We have made significant progress with care outcomes improvement over the last six years, and we now believe we can take our efforts to the next level by leveraging the experience and know-how of both organizations and our shared his-tory of innovation and transformation.”
Burton told that Wheeler, who had been named CEO last year, had been a real champion for out-comes improvement using data analytics.
“By 2010, Allina had such an appetite, had really committed to use this platform
The top health IT business deal of 2015 also happened to be the biggest and most buzzed-about
health IT business deal of all time. When the U.S. Department of Defense chose Cerner, alongside its team members
Leidos and Accenture, for its long-awaited EHR modernization initiative, some were surprised the winner wasn’t
Epic. They were also surprised at the smaller price tag (a “mere” $4.3 billion up front). But everyone knew that the
contract would be an industry shaper in the years ahead. It was so big that it made other deals, such as IBM’s $1
billion acquisition of Merge – its imaging technology allowing Watson to “see” – seem small-change by comparison.
They weren’t, of course. Nor was the big-picture thinking that led a health system like Allina Health to strike a unique
deal with vendor Health Catalyst on a 10-year, $100 million initiative to drive outcome improvements. Hospitals
everywhere are looking for new efficiency and revenue strategies, as the push toward value-based care changes the
calculus, sometimes in ways yet to be understood.
ALLINA SEE PAGE 26
IBM Watson antes up $1B to buy Merge
CONTINUING ITS shopping spree, IBM in August announced that it would spend a cool $1 billion to acquire Merge Healthcare in a
deal that would combine Merge’s medical imaging technologies with IBM’s Watson.
Watson would gain the ability to “see” by bringing together Watson’s advanced image analytics and cognitive capabilities with data and images obtained from Merge Healthcare’s medical imaging management platform, IBM executives said in announcing the deal.
The intent, said IBM executives was to unlock the value of medical images to help physicians make better patient care decisions.
Merge’s technology platforms are used at more than 7,500 U.S. healthcare sites, as well as most of the world’s leading clinical research institutes and pharmaceutical firms to manage a growing body of medical images.
As IBM execs saw it, these organizations could use the Watson Health Cloud to surface new insights from a consolidated, patient-centric view of current and historical images, electronic health records, data from wearable devices and other related medical data, in a
HIPAA-enabled environment.Under terms of the transaction, Merge
shareholders would receive $7.13 per share in cash, for a total transaction value of $1 billion. The closing of the transaction was subject to regulatory review, Merge shareholder approv-al and other customary closing conditions. It was expected to occur later in the year.
It was IBM’s third major health-related acquisition — and the largest — since launch-ing its Watson Health unit in April, follow-ing Phytel, a population health company and Explorys, a cloud-based intelligence firm.
TEACHING WATSON TO ‘SEE’The goal, said IBM execs, was to advance Watson beyond the supercomputer’s natural language skills and give it the ability to “see.”
IBM researchers estimated that medical images accounted for at least 90 percent of all medical data at the time. They also pre-sented challenges:
■ The volume of medical images can be overwhelming to even the most sophisticated specialists — radiologists in some hospital emergency rooms are presented with as many as 100,000 images a day.
■ Tools to help clinicians extract insights from medical images remained very limited, requiring most analysis to be done manually.
John Kelly (left), senior vice president, IBM Research and Solutions Portfolio, reports that healthcare will be one of the company’s biggest growth areas in the next 10 years.
IBM SEE PAGE 26
“This agreement with Health Catalyst is unique in the industry and will accelerate outcomes improvement for those served through Allina Health.”
BUSINESSDecember 2015 | Healthcare IT News | www.HealthcareITNews.com 25
7 things DoD sought in Cerner EHR‘Taking our time to do this right, we wanted to make sure we contracted properly’
HOW DID the Department of Defense decide upon Cerner, anyway? That’s a question healthcare industry insiders wondered in
August when the DoD shocked so many expecting Epic to win the contract.
During the August pre-announcement conference call with a fistful of reporters, Defense officials revealed some of the pri-oritized criteria that went into their final decision.
“We did extensive analysis of alterna-tives,” said Frank Kendall, DoD under secretary for acquisition, technology and logistics. “We had the opportunity to do competitive procurement, and our analysis said it would be much cheaper.”
Part of that analysis involved pulling together clinicians — doctors, nurses, dentists — with IT people and leadership, said Chris Miller, executive officer for DoD’s Healthcare Management Systems Modernization and Integrated Electronic Health Records.
Kendall, Miller and Jonathan Woodson, MD, assistant secretary of defense for health affairs, outlined important factors — with-out putting them in order — critical to the
agency’s decision.1. Modifications. Just about any software
installation of this size is going to require some heavy-duty tailoring and customization, so the DoD “wanted to do minimum modifications to the software,” according to Kendall.
2. Vendor lock-in and upgradability.It will certainly take until the DoD actually has Cerner up and running in at least the planned eight Pacific Northwest test sites to really know if they’re not locked in, but the thinking was to pick the team that best dem-onstrated an ability to work with modular capabilities from other vendors, just in case the DoD opts for any in the future.
3. DoD owns the data. This is a big one. “Taking our time to do this right, we wanted to make sure we contracted prop-erly,” Miller explained. “We own 100 per-cent of our data. There are a lot of nuances. We also have all the data rights to deal with training,” as well as the “ability to move from one vendor to another.”
4. Training. As is often the case in massive software implementations, training eats up a lot of the costs and, in the DoD’s case, “over 25 percent of the contract goes to training users and clinicians,” Miller said. “An EHR is not just a simple piece of software.”
5. Cybersecurity. Mastering the obvi-ous, of course, the U.S. military had to make security a paramount consideration. Cybersecurity was an explicit piece of the
RFP, Miller said, and Cerner had to scan its software and report all vulnerabilities back to the DoD. “Cybersecurity risk is something we take very seriously.”
6. Interoperability. Cerner’s EHR will be what Woodson called “an impor-tant enabler of sustaining care anywhere people might serve, a vital piece of care coordination,” that will reside in more than 1,000 sites around the globe and that means the commercial software must interoperate not only with VA but also with the private sector healthcare enti-ties that conduct as much as 70 percent of service-member’s care.
7. Data blocking. An increasingly con-tentious topic at the time, particularly when ONC issued its report to Congress spotlight-ing how vendors and providers were inter-fering with the exchange of health infor-mation, this builds on the DoD owning its own data and interoperability requirements. Patient information must be able to flow to the VA and private sector, and the DoD was looking to the private sector to increase its efforts as well, and Woodson said in a pre-vious Healthcare IT News article that the DoD would be both advancing public pre-paredness and looking to the private sector to follow suit.
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IBM builds out Watson Health
IBM ANNOUNCED in April it would be buying pop-ulation health company Phytel and Cleveland
Clinic spinoff Explorys, a cloud-based data analytics company. The technology giant announced the pend-ing acquisitions in a news conference at HIMSS15.
In a field of many ven-dors offering population health services, research firm KLAS pegged Phytel No. 1 in a report it released in 2014, which noted that 100 percent of Phytel cli-ents interviewed reported tangible benefits and a high number of linked clinics.
“Over the past year we have seen an exponential increase in interest sur-rounding population health management, especially as healthcare organizations work to make the transition to shared risk and pay-for-performance,” Steve Schel-hammer, CEO of Phytel, said at the time. “As provid-ers continue to pursue the Triple Aim, we are excited that KLAS has recognized Phytel as the sole ‘early leader’ in this space.”
Phytel software works with healthcare providers’ EHR technology to reduce
patient hospital readmis-sions, automating popula-tion health management and improving patient outreach and engagement.
“IBM is continuing a signif-icant investment in support-ing the needs of our healthcare clients by bringing together powerful cognitive comput-ing with new insights into all the factors that influence a person’s health,” said Mike Rhodin, senior vice presi-dent, IBM Watson, in April. “The acquisition of Phytel furthers our mission of giving providers insights into patient health from data about patient behaviors and their engage-ment with care plans.”
Explorys, meanwhile, has built one of the larg-est clinical data sets in the world, representing more than 50 million lives, IBM executives pointed out in a news release.
Twenty-six healthcare systems and clinically inte-grated networks used the Explorys platform at the time to identify patterns in diseases, treatments and outcomes. Its network included Cleveland Clinic, Trinity Health, St. Joseph Health System, Mercy Health, Adventist Health System and many others with patients across the country. Market intelligence firm IDC named Explorys
global leader in the Health-care Clinical and Financial Analysis categories.
“As healthcare provid-ers, health plans and life sciences companies face a deluge of data, they need a secure, reliable and dynamic way to share that data for new insight to deliver quality, effec-tive healthcare for the individual,” said IBM’s Rhodin. “To address this opportunity, IBM is build-ing a holistic platform to enable the aggregation and discovery of health data to share it with those who can make a differ-ence. With Explorys, IBM will accelerate the deliv-ery of IBM Health Cloud and IBM Watson cognitive solutions to model and apply medical evidence and large scale analytics to data.”
“Information is chang-ing the way care is deliv-ered and paid for. The combination of Explorys technology with IBM’s powerful Health Cloud and Watson cognitive capabilities will expand the reach of health insights so that Big Data can final-ly be used more easily to transform healthcare,” said Stephen McHale, CEO and co-founder, Explorys.
-BM
■ At a time when the most powerful insights came at the intersection of diverse data sets (medical records, lab tests, genom-ics, etc.), medical images remained largely disconnected from mainstream health information.
■ IBM planned to leverage the Watson Health Cloud to analyze and cross-reference medical images against a deep trove of lab results, electronic health records, genomic tests, clinical studies and other health-related data sources, already representing 315 billion data points and 90 million unique records.
Merge’s clients could compare new medical images with a patient’s image history as well as populations of similar patients to detect changes and anomalies. Insights generated by Watson could then help healthcare provid-ers in fields including radiology, cardiology, orthopedics and ophthalmology to pursue more personalized approaches to diagnosis, treatment and monitoring of patients.
Cutting-edge image analytics projects underway in IBM Research’s global labs sug-gested additional areas where progress could be made. They included teaching Watson to filter clinical and diagnostic imaging infor-mation to help clinicians identify anomalies and form recommendations, which would help reduce viewing loads for physicians and increase physician effectiveness.
“As Watson evolves, we are tackling more complex and meaningful problems by con-stantly evaluating bigger and more challeng-ing data sets,” Kelly said. “Medical images are some of the most complicated data sets imaginable, and there is perhaps no more important area in which researchers can apply machine learning and cognitive com-puting. That’s the real promise of cognitive computing and its artificial intelligence com-ponents — helping to make us healthier and to improve the quality of our lives.”
“As a proven leader in delivering health-care solutions for over 20 years, Merge is a tremendous addition to the Watson Health
platform,” said John Kelly, senior vice presi-dent, IBM Research and Solutions Portfolio, in a news release. “Healthcare will be one of IBM’s biggest growth areas over the next 10 years, which is why we are making a major investment to drive industry transformation and to facilitate a higher quality of care.”
“Watson’s powerful cognitive and analytic capabilities, coupled with those from Merge and our other major strategic acquisitions, position IBM to partner with healthcare providers, research institutions, biomedical companies, insurers and other organizations committed to changing the very nature of health and healthcare in the 21st century, he added. “Giving Watson ‘eyes’ on medical images unlocks entirely new possibilities for the industry.”
“Today’s announcement is an exciting step forward for our employees and clients,” added Merge CEO in August. “Becoming a part of IBM will allow us to expand our global scale and deliver added value and insight to our clients through Watson’s advanced ana-lytic and cognitive computing capabilities.”
BOON FOR RESEARCHERS, CLINICIANS, INDIVIDUALSIBM’s Watson Health unit planned to bring together Merge’s product and solution offer-ings with existing expertise in cognitive com-puting, population health and cloud-based healthcare intelligence offerings to:
■ Offer researchers insights to aid clinical trial design, monitoring and evaluation;
■ Help clinicians to efficiently identify options for the diagnosis, treatment and monitoring a broad array of health condi-tions such as cancer, stroke and heart disease;
■ Enable providers and payers to integrate and optimize patient engagement in align-ment with meaningful use and value-based care guidelines; and
■ Support researchers and healthcare pro-fessionals as they advance the emerging dis-cipline of population health, which aimed to optimize an individual’s care by identifying trends in large numbers of people with simi-lar health status.
IBMCONTINUED FROM PAGE 24
to significantly drive change,” Burton said. “Frankly, that appetite outstripped Health Catalyst’s bandwidth. Allina bought every-thing we built, and they still had a really long list of stuff they wanted to keep doing.”
“I don’t think they fully realized how inno-vative they were nationally.” Burton added that Health Catalyst had the good fortune of working with some of the most innova-tive health systems in the country — Kaiser Permanente and Partners HealthCare among them. In his opinion Allina was the most innovative with its data-driven approach to improving outcomes, he said.
Allina Health was at the time a $3.7 billion not-for-profit organization whose more than
90 clinics, 12 hospitals and related health-care services provided care for nearly 1 mil-lion people across Minnesota and western Wisconsin.
The agreement between Allina Health and
Health Catalyst included two major elements:■ Allina Health outsourced its data ware-
housing, analytics and performance improve-ment technology, content and personnel to Health Catalyst to further accelerate the health system’s significant advances in improving care. The Allina employees who worked in these areas would become onsite Health Catalyst team members in phases beginning in January.
■ Allina would gain access to Health Cat-alyst’s full technology, content and deploy-ment expertise to accelerate outcomes improvement at Allina. The partnership’s governing committee would annually iden-tify a prioritized list of improvement projects, each designed to provide measurable care improvement and financial value to Allina,
and as success was realized, the partnership would share in the economic benefits of that success.
“As payment models continue to transition away from fee-for-service, it becomes “Allina
Health was one of the first healthcare orga-nizations in the nation to recognize the need for a data-driven culture and infrastructure to enable outcomes improvement,” Burton said. increasingly vital for health systems to deeply understand their data in order to pinpoint inefficiencies and then reduce those inefficiencies,” said Duncan Gallagher, CFO of Allina Health, in a statement. “This part-nership is designed to accomplish that goal in a measurable, scalable, repeatable manner.”
Each year, the committee governing the partnership would agree to a prioritized list of data-driven improvement projects with specific, measurable outcomes goals for each
project. Economic rewards would be based on the attainment of these goals.
“We expect that this process of using ana-lytics to prioritize projects, in combination with risk-sharing economics, will encourage far more focus and alignment than is found in traditional health system-vendor relation-ships,” said Gallagher.
“Allina Health was one of the first health-care organizations in the nation to recognize the need for a data-driven culture and infra-structure to enable outcomes improvement,” Burton said. “They recognized that trans-formational quality improvement requires more than great software — you also need
ALLINACONTINUED FROM PAGE 24
“As payment models continue to transition away from fee-
for-service, it becomes increasingly vital for health systems
to deeply understand their data in order to pinpoint
inefficiencies and then reduce those inefficiencies.”Duncan Gallagher
“Allina Health was one of the first healthcare organizations in the nation to recognize the need for a data-driven culture and infrastructure to enable outcomes improvement.”
BUSINESSDecember 2015 | Healthcare IT News | www.HealthcareITNews.com 27
Revenue cycle headed for a ‘new world’
TOO MANY revenue cycle man-agement systems are too old and too ill-prepsaid for the future demands of value-
based reimbursement, said John Hoyt, executive vice president of HIMSS Analytics, in January.
Then, as now, we were living in an era where most providers’ RCM technology was years out of date. As healthcare pushed toward pay-for-performance and bundled payments, many systems were still living in an era of simple claims processing.
The Centers for Medicare & Med-icaid Services are pushing the needle on payment reform, knowing, as we all do, that “they’ve got to take the inflation out of the annual healthcare costs,” said Hoyt, speaking to Health-care IT News for the January install-ment of our “Benchmarks” column.
Still, despite a slew of interesting and innovative value-based initiatives these past few years, CMS still hasn’t quite figured it all out, “so they’re going down several paths at once,” he said.
Whatever would up happening with payment reform, providers knew the era of getting reimbursed for volume was in its gloaming — and that the
technologies they deployed to manage their revenue streams needed to evolve.
That will happen. Soonish. But with most providers having focused invest-ments on clinical technology to capital-ize on meaningful use these past few years, there wasn’t much cash left over for investments in financial tools.
“The writing has been on the wall for a long time,” added HIMSS Ana-lytics Senior Director of Research Jen-nifer Horowitz. “Because we’ve had such an unnatural market with the clinical applications, and the amount of focus there, at some point (provid-ers) are going to have to focus on the revenue side. They’re just not going to be able to accommodate what they need to do anymore.”
Mergers and acquisitions will play a big role in the change going forward, said Hoyt.
“Look at the banking industry: They did what exactly we’re doing: A big investment in IT, redesigning processes, in the way they deliver their services, and they had massive consolidation.”
That’s where we’re headed, he said. “I know healthcare is local, but that doesn’t mean billing is. There’s no reason you can’t go to your local hospital and have the bill generated from Minot, N.D., just like your Mas-tercard bill is.”
More and more big players were following that route, such as the giant Catholic Health Initiatives (86 hospi-tals in 17 states at the time), which outsourced its entire revenue cycle operations in 2012.
“I think that’s clearly the way to go,” said Hoyt. “Frankly, one of the jobs of clinical sys-tems is to produce billing codes, and then who cares where they go? Send them to some bill-ing company! You don’t have to be sending bills out of St. Mary’s hospital. There’s no reason for that.”
Such large-scale billing consolida-tion, of course, meant “there’s going to have be some standard around what we do,” said Hoyt. “Get the Cerners and the Epics and the Meditechs of the world to generate all the ICD and CPT codes you need, the HCPCS codes and all that. And then you can consolidate billing. You have one central billing office. Or you outsource it. I think those are the trends of the future.”
One of the first sites that
successfully did that, a decade or so ago, was the University of Iowa, said Hoyt. “They got their act together, they sent out one bill, with doctors and hospitals on it.”
Providers weren’t the only ones facing big changes, however. Payers would have to make their own adjust-
ments, he said.“Of course, the
insurance industry is going to have to change a little bit, too, to accept that, but Medi-care is leading that trumpet by forc-ing consolidated billing: I’m gonna give you one pay-ment, and then you go figure out how much goes to the anesthesiologist.”
Or here’s anoth-er interesting thought: Given the arduous time so many providers had trying to meet Stage 2 meaningful use, what if some were to just opt to skip it, and instead plowed money that would have been invested in attestation into rebooting their rev-enue cycle technologies — hopefully offsetting any Medicare penalties by improving their bottom line?
“The number of people who quali-fied for Stage 2 stunned everybody, including the government,” said Hoyt. “And the government is obvi-ously embarrassed by it. If it’s not massively improved, I think you’re right: ‘I’m gonna take that money and invest it in revenue cycle as I continue to grow my IDN. Acquire hospitals, acquire physicians, acquire home care, nursing homes, and fix my whole revenue cycle. Or outsource it.”
That happened, according to a Black Book survey, which found that the market for end-to-end RCM out-sourcing could reach $10 billion by 2016, as “overwhelmed hospital lead-ers have realized that RCM isn’t their organization’s core competency.”
Financial resources are scarce, of course, and properly allocating them is critical to having a robust suite of revenue cycle tools.
A report from Black Book showed some 40 percent of hospital CFOs sur-veyed said their had been so damaged by “misjudged EHR, HIE and patient portal expenses,” that they were post-poning acquisition of new revenue cycle software until at least 2016.
Still, another the 41 percent of CFOs said their hospitals were in good shape and would be moving ahead with “next generation” rev-enue cycle management tools.
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DATAwww.HealthcareITNews.com | Healthcare IT News | December 201528
Hackers swipe data of 4.5M at UCLA Health System in massive cyberattack
THE FOUR-HOSPITAL UCLA Health System, in July, notified a stag-gering 4.5 million of its patients that their protected health
information and Social Security numbers were compromised following one of the largest HIPAA breaches ever reported.
Despite the cyberattack having occurred nearly a year prior, in September 2014, officials did not notify patients until July 17. UCLA first detected suspicious activ-ity on its networks back in October 2014, according to a company statement.
Social Security numbers, medical diag-noses, diseases, clinical procedures, test results, address and dates of birth were all among the data swiped by hackers in the cyberattack.
“We take this attack on our systems
extremely seriously,” said James Atkin-son, MD, interim associate vice chancel-lor and president of the UCLA Hospital System, in a July 17 statement. “We sin-cerely regret any impact this incident may have on those we serve.”
UCLA Health System’s breach follows a series of similar cyberattacks impact-ing the healthcare industry in recent months. The Anthem cyberattack reported in February, for instance, compromised the Social Security numbers and personal data of nearly 80 million members and employees. In January, hackers also struck Premera Blue Cross, which exposed the financial and medical data of another 11 million members.
As of July, the UCLA breach was tied for the fourth largest HIPAA breach ever
Payers and providers alike proved equally apt to have their data targeted by hackers and cyber-
attackers in 2015. In February, Anthem, the massive health plan, had to notify some 80 million members that hackers
had made it through its IT defenses and swiped troves of sensitive information, in perhaps the largest breach ever.
A few months later it was four-hospital UCLA Health System’s turn to send breach notification letters to 4.5 million
patients on July 17 — nearly a year after the attack first manifested itself. They were hardly the only health organi-
zations to hear the security wake-up call this past year, as more and more across the industry realized — and were
sometimes reminded by the FBI — that a digitized and interconnected health system is one fraught with risk. But it
wasn’t all bad news on the big data front, as providers made deeper inroads with clinical and business intelligence,
using analytics to mine patient data and arrive at valuable insights in their pursuit of the Triple Aim.
A beginners guide to data analytics‘Don’t do it yourself.If you do, you’re going to fail.’
IN JUNE, pub-lished a three-part cover story on the importance of analytics — a topic many hospitals were
still trying to figure out.Part I focused on the first steps of
launching an analytics program — and kicked things off with a bit of bad news: To those healthcare organiza-tions in the beginning stages of rolling out a data analytics program, chances are you’re going to do it completely and utterly wrong.
At least that’s according to Eugene Kolker, chief data scientist at Seattle Children’s Hospital, who has been working in data analysis for the past 25 years. When talking about doing the initial metrics part of it, “The majority of places, whether they’re small or large, they’re going to do it wrong,” he tells Healthcare IT News. And, when you’re dealing with people’s lives, that’s hardly something to take lightly.
Kolker would much prefer that not to be the case, but from his experiences and what he’s seen transpire in the analytics arena across other industries, there’s some unfortunate implications for the healthcare beginners.
“What’s the worst that can happen if Ama-zon screws up (with analytics)?...It’s not life and death like in healthcare.”
But it doesn’t have to be this way. Careful, methodical planning can position an organi-zation for success, he said. But there’s more than a few things you have to pay serious attention to.
GETTING BUY INFirst, you need to get executive buy in. Data analytics can help the organization improve performance in myriad arenas. It can save money in the changing value-based reim-bursement world. Better yet, it can save lives. And, if you’re trying to meet strategic objectives, it may be a significant part of the
equation there too.As Kolker pointed out in a presentation
given at the April 2015 CDO Summit in San Jose, California, data and analytics should be considered a “core service,” similar to that of finance, HR and IT.
PEOPLE MAKE THE DIFFERENCEOnce you get your executive buy in, it’s on to the most important part of it all: the people. If you don’t have people who have empathy, if you don’t have a team who communicate and manage well, you can count on a failed program, said Kolker, who explained that this process took him years to finally get right. People. Process. Technology — in that order of importance.
“Usually data scientists are data scientists not because they like to work with people but because they like to work with data and com-puters, so it’s a very different mindset,” he said. It’s important, however, “to have those kind of people who can be compassionate,” who can do analysis without bias.
And why is that? “What’s the worst that can happen if Amazon screws up (with analytics)?” Kolker asked. “It’s not life and death like in healthcare,” where “it’s about very complex
ANALYTICS SEE PAGE 30 UCLA SEE PAGE 30
Trying to do too much at once is a common misstep for hospitals looking to make use of analytics.
“We take this attack on our systems extremely seriously.”
DATADecember 2015 | Healthcare IT News | www.HealthcareITNews.com 29
Hackers swipe Anthem data in massive cyberattack
IN ONE OF the biggest data breaches ever reported — and possibly the biggest ever — Anthem, the nation’s second
largest health insurer, notified in February as many as 80 million of its members that hackers pen-etrated its IT systems and swiped personal data.
Anthem discovered hackers had gained unauthorized access to its network, stealing the Social Secu-rity numbers, medical ID numbers, income data, names, address-es and birth dates of Anthem members, former members and employees — a number that could reach 80 million, according to a report in The Wall Street Jour-nal. An initial investigation of the breach, which was detected by company officials, found that the cyberattack impacted all lines of Anthem Business.
The health insurer notified the FBI and conducted an “extensive forensic investigation to deter-mine what members are impact-ed,” read a company notice. At the time of original publication, Anthem had not determined the entity or individual responsible for the attack.
“Anthem was the target of a very sophisticated external cyberattack,” said Anthem President and CEO Joseph R. Swedish, in a statement. “I want to personally apologize to each of you for what has happened, as I know you expect us to protect your information. We will contin-ue to do everything in our power to make our systems and security processes better and more secure.”
Kevin Johnson, chief executive officer of the security consult-
ing firm Secure Ideas, remained unconvinced that the cyberattack was “sophisticated,” as Anthem’s CEO Swedish described. John-son, a white hat hacker, has done extensive security work for insur-ance companies, both as a consul-tant as a security admin, and a lot of what he sees has nothing to do with sophistication.
“I have never found an insur-ance company that required a sophisticated attacking incident,” said Johnson. “Period.” Although he had not worked specifically with Anthem before, Johnson said insurance companies are all very similar in that they have behemoth networks and “tons of systems” that make it challenging from a security perspective. There are systems the physicians connect to; there are systems other companies need to connect to. All in all, “it’s a huge conglomeration of stuff,” he opined.
Anthem officials said no cred-it card or medical data, such as claims or diagnoses, were compro-mised in the data breach.
But as Johnson said, the Social Security numbers stolen are what’s more significant. “I don’t even care about my credit card number. I’ll get another one,” he said. “We’re more concerned about whether or not a credit card number has been stolen … and there’s such a lack of concern about my medical records, my personal data,” he continued.
With that said, Anthem appeared ahead of the game in one arena. They’re better than two-thirds of organizations who discover data breaches by third parties, he said.
“For Anthem to say … ‘Hey, we saw something weird,’” he explained, “that is leaps and bounds ahead of most breaches. It’s already ahead of Target. It’s already ahead of Com-munity Health.”
Mac McMillan, CEO of Cyn-ergisTek, a healthcare security and compliance consulting firm, seemed to agree. In terms of how Anthem has handled the cyberat-
tack publicly, “they are being very proactive,” he said. Nonetheless, “this should serve as yet another wake-up call for those who haven’t gotten it yet,” McMillan added. “Healthcare is a target.”
Anthem had also been working with the HITRUST Cyber Threat Intelligence Coordination Cen-ter, or C3, after discovering the cyberattack, according to a Feb.
4 HITRUST alert. “It was quickly determined that the (indicators of compromise, including MD5 hashes, IP addresses etc.) were not found by other organizations across the industry, and this attack was targeted at a specific organization,” the HITRUST alert said. It was believed, HITRUST added, to be a targeted advanced persistent threat actor.
Anthem officials had not respond to ’ request for comment and addi-tional information surrounding the cyberattack at the time of original publication.
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Anthem notified 80 million members in February of the cyberattack that swiped personal data including Social Security numbers, names, birth dates and more.
Kevin Johnson, chief executive officer of the security consulting
firm Secure Ideas, remained unconvinced that the cyberattack
was as “sophisticated,” as Anthem’s CEO Swedish described.
DATA www.HealthcareITNews.com | Healthcare IT News | December 201530
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When in the beginning stages of anything analytics, the aim is to start slow but not necessarily to start easy, wrote Steven Escaravage and Joachim Roski, principals at Booz Allen, in a 2014 Health Affairs piece on data analytics. Both have worked on 30 big data projects with various federal health agencies and put forth their lessons learned for those ready to take a similar path.
ONE OF THOSE LESSONS?Make sure you get the right data that addresses the strategic health-care problem you’re trying to mea-sure or compare, not just the data that’s easiest to obtain.
“While this can speed up a proj-ect, the analytic results are likely to have only limited value,” they explained. “We have found that when organizations develop a ‘weighted data wish list’ and allo-cate their resources toward acquir-ing high-impact data sources as well as easy-to-acquire sources, they discover greater returns on their big data investment.”
So this may lead one to ask: What exactly is the right data? What met-rics do you want? Don’t expect a clear-cut answer here, as it’s subjec-
tive by organization.First, “you need to know the
strategic goals for your business,” added Kolker. “Then you start working on them, how are you going to get data from your systems, how are you going to compare your-self outside?”
DETERMINING VALUEIn his presentation at the CDO Sum-mit this April, Kolker described one of Seattle Children’s data analytics projects that sought to evaluate the effectiveness of a vendor tool that predicted severe clinical deterio-ration, or SCD, of a child’s health versus the performance of a home-grown internal tool that had been used by the hospital since 2009.
After looking at cost, performance, development and maintenance, util-ity, EHR integration and algorithms, Kolker and his team found for buy versus build, using an external ven-dor tool was not usable for predict-ing SCD but that it could be tested for something else. And furthermore, the home-grown tool needed to be integrated into the EHR.
Kolker and his team have also helped develop a metric to identify medically complex patients after the hospital’s chief medical officer came to them wanting to boost out-comes for these patients. Medically complex patients typically have high readmissions and consume considerable hospital resources,
and SCH wanted to improve out-comes for this group without increasing costs for the hospital.
For folks at the Nebraska Method-ist Health System, utilizing a popu-lation risk management application that had a variety of metrics built in was a big help, explained Linda Burt, chief financial officer of the health system, in ’ sister publication webinar this past April.
“The common ones you often hear of such as admissions per 1,000, ED visits per 1,000, high-risk high end imaging per 1,000,” she said. Using the application, the health system was able to identity that a specific cancer presented the biggest oppor-tunity for cost alignment.
“We like to put a toe in the water and not do a cannon ball off the high dive,” said Katrina Belt, CFO at Baptist Health in Montgomery, Alabama. She said a predictive ana-lytics tool is sifting through various clinical and financial data to iden-tify opportunities for improvement.
In a webinar this April, Belt noted that Baptist Health started by looking at its self-pay population and discovered that, although its ER visits were declin-ing, intensive care visits by patients with acute care conditions were up on upward trend.
Belt recommended starting with claims data.
“We found that with our particu-lar analytics company, we could give
them so much billing data that was complete and so much that we could glean from just the 835 and 837 file that it was a great place for us to start,” she said. Do something you can get from your billing data, Belt continued, and once you learn “to slice and dice it,” share with your physicians. “Once they see the power in it,” she said, “that’s when we started bringing in the clinical data,” such as tackling CAUTIs.
But some argue an organization shouldn’t start with an analytics platform. Rather, as Booz Allen’s Escaravage and Roski wrote, start with the problem; then go to a data scientist for help with it.
One federal health agency they worked with on an analytics proj-ect, for instance, failed to allow the data experts “free rein” to identify new patterns and insight, and instead provided generic BI reports to end users. Ultimately, the results were disappointing.
“We strongly encouraged the agency to make sure subject mat-ter experts could have direct access to the data to develop their own queries and analytics,” Escar-avage and Roski continued. Over-all, when in the beginning phases of any analytics project, one thing to keep in mind, as Kolker rein-forced: “Don’t do it yourself.” If you do, “you’re going to fail,” he said. Instead, “do your homework; talk to people who did it.”
reported, according to data from the Department of Health and Human Services.
As healthcare security con-sultant Mac McMillan told
following the massive Anthem breach, “This should serve as yet another wake up call for those who haven’t gotten it yet,” he said. “Healthcare is a target.”
“In today’s security envi-ronment, large, high-profile organizations such as UCLA Health are under near-con-stant attack,” UCLA Health officials acknowledged in a statement. Each year, they’re able to prevent millions of hacker attempts. But not this time around. In response to the attack, UCLA said it would add to its internal security team and had enlist-ed help from outside security firms to help monitor and better protect their network.
This was not the first HIPAA breach for the Califor-nia-based health system. In 2011, the UCLA hospital sys-tem reported a breach after a laptop containing patient medical data was stolen from a former employee’s home.
UCLACONTINUED FROM PAGE 28
ANALYTICSCONTINUED FROM PAGE 28
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FBI issues alert for IoT device security
WHEN THE FEDERAL
Bureau of Inves-tigation issues an alert to healthcare
organizations and others warning of the serious cyber risks present-ed by the Internet of Things, as it did in September, it’s probably best to pay attention.
For healthcare security folks, this means paying closer attention to the myriad IoT devices within their organizations. And they’re not necessarily all the devices you might think of. They also include things such as HVAC remotes, Wi-Fi cameras, insulin dispensers, thermostats and any type of wear-able and other medical devices. These devices, FBI officials said, are notorious for having serious secu-rity deficiencies. This, combined with patching vulnerabilities, make
these IoT devices an attractive tar-get for cybercriminals.
So what are the most pressing IoT risks, according to the FBI?
The first is exploiting the Uni-versal Plug and Play protocol to gain access to these devices.
The next involves taking advan-tage of those default passwords to transmit malicious and spam emails or swipe personal and financial data. There’s also the risk of cybercriminals overloading these devices, effectively render-ing them inoperable, which could have serious consequences in the realm of healthcare.
In September’s alert, FBI offi-cials specifically underlined the risk of criminals gaining access to unprotected devices used for remote patient monitoring medi-cation dispensing.
“Once criminals have breached such devices, they have access to any personal or medical informa-tion stored on the devices and can possibly change the coding control-ling the dispensing of medicines or health data collection,” they wrote in the alert.
So what can you actually do about all this? The FBI offered a list of recommendations.
1. Keep up-to-date with security patches for these devices.
2. Ditch any default passwords you may still have and make them stronger: “Do not use the default password deter-mined by the device manu fac tu re r , ” since many can be found online.
3. Disable UPnP on routers.
4. Isolate IoT devices on their own protected networks.
How big exactly is IoT? One Gartner report concluded that by 2020, a staggering 26 billion devic-es will be installed worldwide and connecting with each other.
For healthcare, specifically, the IoT represents an economic
impact ranging from $170 billion to a whopping $1.6 trillion each year by 2025, according to a report by McKinsey & Company.
September was not the first time FBI officials issued a cybersecuri-ty alert to healthcare groups and others. In April 2014, it warned healthcare providers specifically
that they needed to shape up their security readiness.
“The healthcare industry is not as resilient to cyber intrusions compared to the financial and retail sectors, therefore the possi-bility of increased cyber intrusions is likely,” according the FBI notice, which was obtained by Reuters.
Healthcare security personnel must pay close attention to the myriad IoT devices in their organizations to ensure data security.
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Coming into focus: Health IT makes steady gains in 2015As industry evolves, hospitals adapt and adopt technology
AS WE do every year,
chronicled the ongoing technological maturity of the industry, as hospitals increas-
ingly moved beyond the basic necessities of the electronic health record, and towards an embrace of tools to help tackle an array of challenges, from getting paid on time to engaging their patients.
In January, revenue cycle manage-ment was the topic of discussion. The tech-nology needed for managing payment was headed for a “new world,” said John Hoyt, executive vice president of HIMSS Analytics. But perhaps a bit later rather than sooner. “Frankly, our revenue cycle tools are built for fee-for-service, and they’re probably not ready” for the era of bundled payments and value-based care, he said.
CMS is pushing the needle on payment reform, but is also going down several paths at once,” he said. That uncertainty, coupled with the fact that most of healthcare has focused its capital on clinical technology for meaningful use these past few years, meant RCM has often taken a back burner.
But “once the (CMS) penalties start kick-ing in for clinicals, most people will have made their big investments,” said Hoyt. “I think the next big thing is mergers/acqui-sitions and payment reform with revenue cycle to handle it.”
Another emerging space for investments, of course, is patient engagement – anoth-er key to keeping a healthy balance sheet in a value-based world, but another one where many providers are struggling to find strate-gies that work.
Patient engagement means “attitude adjustments” for both sides of the provider/patient equation, said Hoyt. Portal technol-ogy represents “clinical transformation,” he said. “It’s a whole new mindset.”
What’s the difference between a good patient portal and a not-so-good one? It’s important to have a user experience similar to the consumer technology patients are used to.
“Multimedia. Educational content,” said Hoyt. “We’re trying to educate the consum-er on maintaining their own health. That’s the whole purpose of these things.”
After all, there are two ways of looking at patient engagement, he pointed out. The first is, essentially, marketing. But the second, much more important goal is improved outcomes.
From outside the hospital walls to deep within them, we took a close look at clinical decision support in March — even if thinking about CDS in terms of technology is not quite the right approach.
Doing so, said Jerome Osheroff, MD, a for-mer chief clinical informatics officer and edi-tor-in-chief of HIMSS CDS guidebook series, “presumes that clinical decision support is a tool, or an EHR-based intervention.”
Instead, “healthcare does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care,” he argued. “We keep saying over and over again: it’s all about people, process and technology – in that order of importance.”
In April, as the industry gathered in Chi-cago for HIMSS15, where, among innumer-able other goings-on, more Stage 7 hospi-tals than ever before were honored,
asked Hoyt about the secrets to success of climbing to the toppermost of HIMSS Analytics’ EMR Adoption Model.
“At a very high level, what they are doing right is that they are pretty much enterprise-wide with a core clinical system,” he said. “In other words — and this may not sound kind – the best-of-breed organizations are not achieving Stage 7. It’s the enterprise EHRs that are successful.”
That’s why, while some may carp at the fact, Epic is the vendor that finds most favor at large health systems looking to drive quality and efficiency from stem to stern. Despite its high cost and sometimes challenging rollouts, its end-to-end prow-ess helps more than 152 of the 200-plus Stage 7 hospitals optimize their IT.
“They are intensely — intensely — focused on Stage 7,” said Hoyt of Epic, not-ing that CEO Judy Faulkner “will talk about Stage 7 at their annual event,” says Hoyt. “I’ve seen her do it: ‘You owe this to the industry to get this. You owe this to your peers.’ She talks to them like, ‘This is your obligation.’”
Another obligation? Delivering healthcare to the most people at the best quality and the lowest cost. Increasingly, health IT is helping hospitals do that as analytics and clinical & business intelligence tools become more advanced and health systems get smarter about how they deploy them.
The challenge, said Lorren Pettit, vice president for market research at HIMSS, is that, “When we talk about big data, people are now starting to recognize that there are a lot of challenges. And part of that is just: who’s going to do the heavy lifting on this? How do we bridge that gap between people who are data scientists and the need to tell the story in the context of healthcare?”
As summer arrived, we turned our focus to accountable care organizations – and to what lessons struggling stateside ACOs could derive from the continent, where care coordination is widespread.
In “What can ACOs learn from Europe?” Hoyt described HIMSS’ Continuity of Care Maturity Model (developed with input from stakeholders in Germany, Italy, Scandinavia and the Netherlands), which tracks interop-erability, health information exchange, patient engagement and clinical and busi-ness intelligence – all necessary components of care coordination for population health.
ACOs and other value-based initiatives have been pursuing these goals in earnest these past few years. But in many parts of Europe and elsewhere in the world, care con-tinuity has been the byword for some time.
The rest of the world,” said Hoyt, is “more into continuity of care than the Americans are.”
In a similar vein the topic for July was health information exchange — the noun and the verb. Mari Greenberger, director of informatics at HIMSS, noted that “how we’re defining HIE the verb is variable,” She explained: “You have eHealth Exchange, which is a hub and spoke, very much focusing on being an entity, a noun, and connecting all the various other nouns across the country using HIE the verb.
Then there are organizations such as the CommonWell Health Alliance – health sys-tems with specific electronic health records connecting with health systems that use different EHRs – “where, again, it’s a net-work of network type concept, but it’s ven-dors,” she says.
That’s another approach that allows vendors to gain marketshare “while also sending a strong signal that they’ll play well together,” says Greenberger. “It’s another avenue to further health informa-tion exchange, but still another concept of network of networks.”
On the meaningful use front, we remind-ed people that, even though the Centers for Medicare & Medicaid Services were eagerly plotting Stage 3 in 2015, Stage 2 was still an ongoing concern for many hospitals.
Thomas Thrower, chief information officer for The Austin Diagnostic Clinic, reported that one challenge “is around the data cap-ture and reporting required for attestation. While the vendors have been certified to do this reporting, it is hard for us as the attester to know how they are coming up with the numbers. We have to do a lot of analysis to really understand and trust it all.”
At times, he said, “it’s kind of like trying to change a tire on a moving vehicle.”
Telehealth was the topic in October. It may have national and even international implica-tions, but deep down, distance-based care is a state and local — even a personal — issue.
Case in point: a forum in Maine, where the Pine Tree State’s Independent Senator (and former governor) Angus King learned how telehealth is being used to connect lob-stermen on island communities to wellness coaches on shore and how it can bypass the need for a boat-and-car ride — or even an emergency helicopter trip.
He also learned how seniors in the north-ern reaches of the state are connecting in real time with nurses and Tai Chi teachers several hours away to learn how to stay in shape and avoid dangerous falls.
“I can get out my smartphone and find an app that will connect me to a doctor who will listen to me in real-time and prescribe a medication for 25 bucks off of my credit card,” Pret Bjorn, of Bangor-based Eastern Maine Medical Center, told the senator.
In November, we spotlighted 18 health technologies poised for big growth –underused tools ready to take hospitals deep into the post-EHR era.
From bed management to dictation with speech recognition, medical neces-sity checking to infection surveillance sys-tems, these technologies have seen growth of 4–10 percent since 2010, but have yet to be adopted by more than 70 percent of hospitals, according to HIMSS Analytics. In many cases, the percentage of potential customers far exceeds those that have a given product installed.
“While the EMR market itself is pretty sat-urated, and usage has really improved since the HITECH Act, the challenge for hospitals and health systems is, now that you have all this data, what do you do with it?” said Matt Schuchardt, director of market intelligence solutions sales at HIMSS Analytics.
“I think the opportunity for vendors to provide solutions is now,” he says. “There are technologies in place now that can really help, and hospitals need to be aware of them.”
“While the EMR market itself is pretty saturated, and usage has really improved since the HITECH Act, the challenge for hospitals and health systems is, now that you have all this data, what do you do with it?” says Matt Schuchardt, director of market intelligence solutions sales at HIMSS Analytics. “I think the opportunity for vendors to provide solutions is now.”
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TRENDS www.HealthcareITNews.com | Healthcare IT News | December 201536
IT trends go beyond just buzzwordsThese terms mean something, as we learned in 2015.
THERE IS more than meets the eye when looking at IT trends in healthcare. Jargon is heavy on this side of the industry, but to
go beyond scratching the surface, it takes uncovering the meaning, purpose and, most importantly, the impact of emerging and ongoing trends on provider organizations.
Over the course of 2015, the Trends col-umn touched on several key issues that are important to Healthcare IT News readers and sources offered their distinctive viewpoints on the machinations of such high-profile topics as privacy and security, interoperability, meaning-ful use, analytics, population health, care coordina-tion and ACOs, patient safety and telehealth.
In gearing up for what will surely be an active year in 2016, a review of the past 12 months can serve as a guidepost on the critical trends developments that IT departments are facing.
PRIVACY AND SECURITY“There’s an app for that” may be an effective marketing phrase, but don’t expect hospital security officials to appreciate it. The prolifera-tion of personal devices and the apps that drive them is one of the biggest security concerns to hit healthcare in the digital age.
Known as BYOD — Bring Your Own Device — the new environment exists due to the per-vasiveness of personal mobility devices among healthcare professionals in recent years. The devices have become well entrenched in a very short time, as studies show that approximately 80 percent of healthcare workers currently use a personal mobile device, whether smart phone or tablet.
The situation is a double-edged sword, with mobility giving clinicians the ability to access healthcare data at anytime from anywhere, but the flurry of unchecked apps also create an air of hospital IT vulnerability to security breach-es, intrusive malware, viruses and worms.
“This issue is a huge challenge, and the industry needs to get out in front of it,” says Chris Bowen, chief privacy and security officer for Tempe, Ariz.-based ClearDATA. “It is a situ-ation that needs to be controlled.”
INTEROPERABILITYThe Interoperability Roadmap draft released by the Office of the National Coordinator contains so many details in its 166-page length that it has been called “Meaningful Use on steroids.”
The Roadmap draft appeared in early Febru-ary to coincide with the ONC National Meet-ing, which reportedly focused exclusively on interoperability. The document’s language indicates that agency officials appear set to get the healthcare industry to once again place a high priority on becoming interoperable, says Dan Golder, DDS, principal of Naperville, Ill.-based Impact Advisers.
“The Roadmap is Meaningful Use on ste-roids,” he said. Golder senses a shift in tone away from the Meaningful Use that has preoc-cupied healthcare organizations and putting
emphasis back on interoperability.“I look at this and say ONC cut its teeth on
Meaningful Use, and that this is the next logi-cal step forward,” he said. “I’m interested to see how these two tie together.”
STAGE 3 MEANINGFUL USEAlthough it’s still in the formative stages, Stage 3 of meaningful use is shaping up to be the most challenging and detailed level yet for healthcare providers. Among the elements that warrant attention are quality reporting, clini-cal decision support and security risk analysis.
But first things first — Stage 3 isn’t anywhere near final and there are likely to be modifica-tions before a final rule is issued, says Pamela Chapman, implementation specialist with
Austin, Texas-based e-MDs.
One of the new d e v e l o p m e n t s of Stage 3 is the d e c o u p l i n g o f certification and meaningful use, which have been synonymous in the process to date, Chapman said.
With the decoupling, certification becomes modular and not centered around MU, which is “scary,” she says.
“We need to know the criteria and what measures will meet our customers’ needs best,” she said.
ANALYTICSFill in the blank: If molecules are the build-ing blocks of life, healthcare analytics are the building blocks of ____. Whatever the answer, it is likely to be right because analytics are at the root of just about everything being done in the healthcare data universe. From analytics, spring extensive knowledge platforms.
HIMSS Analytics has devoted itself to studying how analytics contribute to the advancement of collective healthcare knowl-edge, from clinical to business to operations. In its most recent edition of Essential Briefs, HIMSS Analytics looked at clinical and busi-ness intelligence.
“Overall our findings point to a growing C&BI market,” said Brendan FitzGerald, research director. “However, as organizations determine which tools they need to make bet-ter clinical and financial decisions; it is a mar-ket in which demand is still evolving.”
POPULATION HEALTHIf population health management is a corner-stone of the new healthcare business model, then providers need to know how to lay that foundation, data analytics specialists say. Gear-ing up for the formidable role of caring for a large collective requires sophisticated tools for data collection, warehousing, synthesis, patient engagement and perspective about how all this fits under the aegis of population health.
As the healthcare business model evolves from fee-for-service to value-based purchasing, the provider community needs to focus on con-necting with consumers and enhancing clini-cal relevance, says John de Souza, president of Redding, Mass.-based Physician Interactive.
“With consumer engagement, it means mov-ing away from just ‘engagement’ and dealing with outcomes,” he said. “Population health is driving outcomes to scale and achieving that
means collecting relevant data, the underly-ing basis of population health. The next step is using that data to drive value.”
ACOS & CARE COORDINATIONFor providers considering how to assemble a viable accountable care organization, experts say the key is to first have a strong care coordi-nation system in place. Without cohesion and collaboration between clinicians, an ACO has no chance of getting off the ground, says John Shankman, senior vice president of clinical innovation for New York-based AMC Health.
“You can’t have an ACO without care coordination,” he said. “An ACO just means you’re accountable and doesn’t address the real issue.”
Care coordination is represented by health information exchanges, electronic medical records and interoperability, but they only serve as the tools, Shankman says. The issue is about who is responsible for the “pain point” of care coordination — managing patients with chronic disease.
“Coordinating and providing the visibility of patients when they’re home must be combined for clinical decision support,” he said. “The problem is that all attention has been placed on structure — who serves as the locus and what to coordinate.”
PATIENT SAFETYThe key to patient safety is transparency, and while more hospitals are showing a commit-ment to being more transparent, they are also struggling to provide consistently safe, high-quality care, says one of the leading patient safety advocates in the healthcare industry.
Leah Binder, president and CEO of The Leapfrog Group and identified by
as one of the industry’s most influen-tial figures in patient safety, says a new report from the watchdog group and Castlight Health shines a light on the progress made and chal-lenges that remain for healthcare providers.
Binder says there has been “strong improve-ment” in key safety areas, including hand hygiene compliance and ICU staffing practices. Still, more work is needed. It’s essential we see this level of improvement in all areas of the healthcare system.”
TELEHEALTHFor years, telehealth existed as an abstract concept that the healthcare industry embraced but couldn’t figure out how to practically utilize. The idea of virtually con-necting medical professionals with patients in lieu of face-to-face encounters had merit, but the technology, logistics and machina-tions remained too elusive to be practical.
But with the development and proliferation of electronic health records and wireless com-munication devices, the pieces have fallen into place, and it can now be said that telehealth finally has the chance to reach its potential of providing care to the masses while greatly reducing healthcare costs, says Aaron Carlock, managing director for Chicago-based Huron Healthcare’s IT solution Vonlay.
“It starts with a robust portal that is tied into EHRs,” he says. “Although telehealth has been around a long time, it has evolved a lot and it now features some cool new stuff. One of the hot new things is the video visit — patients interacting with a physician using a Skype-type workflow. This is getting more and more traction.”
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PEOPLE www.HealthcareITNews.com | Healthcare IT News | December 201538
ON THE MOVEStanford Health Care’s board of directors has appointed a committee to
conduct a nationwide search for a new CEO to succeed Amir Dan Rubin,
who will step down Jan. 4. Deidra A. Wilson has
been named vice president of government relations
for McLaren Health Care Corporation; she was most
recently director of state government relations for
Blue Cross Blue Shield of Michigan. Origins Behav-
ioral HealthCare in Lincoln, Neb., named Bob Lynn
chief clinical officer; Lynn is a veteran in the field with
more than 40 years’ of experience and has served as
Origins’ chief clinical advisor since 2012. Andy Leone, a more than 10-year
government healthcare information technology veteran, has joined Apprio
as executive vice president of health programs at the Washington-based
specialized technology company. The Joint Commission appointed David
W. Baker, MD, the inaugural editor-in-chief of
. HNI Healthcare has appointed Robert Zurcher,
MD, as chief medical officer for emergency medicine;
Zurcher was most recently administrative director
of the Northwest Region for IPC Healthcare, a pub-
licly traded national physician group practice based
in Los Angeles. Moses Lake, Wash.-based Samaritan
Healthcare has appointed Theresa Sullivan presi-
dent and CEO. Christopher Longhurst, MD, chief
medical information officer for Stanford Children’s
Health, will serve as CIO for UC San Diego Health Sciences; he succeeds
Ed Babakanian, who served as CIO for 20 years. The University of Ver-
mont Health Network in Burlington appointed Adam Buckley, MD, CIO.
Sam Kaufman has been named CEO of Henderson Hospital.
Deidra A. Wilson
Robert Zurcher, MD
Shafiq Rab wins CHIME innovator awardCHIME honored Shafiq Rab, MD, vice president and CIO at HackensackUMC, with its 2015 Innova-tor of the Year Award. Rab accepted the award at the CHIME15 Fall CIO Forum in Orlando, Fla. Hackensac-kUMC is one of the first health systems in the nation to link patient-generated data from personal fitness devices and mobile apps to its electronic medical record, enabling clinicians to have a more complete view of a patient’s his-tory. HackensackUMC also teamed with Infor to develop and implement open, vendor-neutral standards as part of the Argonaut Project. Launched in 2014, the Argonaut Project is a national effort geared around speeding up adoption of HL7’s standards framework, Fast Healthcare Interoperability Resources, better known as FHIR. “Through Shafiq’s efforts, we are see-ing how greater connectivity between providers and patients can create more efficient and effective care delivery,” CHIME President and CEO Russell Branzell said in giving Rab the award.
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