Bernie Monegain

Cincinnati, Ohio-based Mercy Health has saved more than $42 million on drugs since 2010 by building a formulary within its electronic health record platform. The move, according Wayne Bohenek, vice president of care transformation at Mercy Health, makes it easier for the system’s network of providers to order medications that are on its list and compliant with Mercy’s pharmaceutical contracts. The 23-hospital system went live with its Epic EHR in 2010. It took Mercy Health’s pharmacy and therapeutics committee three years to create the formulary -- a comprehensive list of medicines that Mercy Health would prescribe, said Bohenek. The committee, composed of prescribers from all specialties, evaluated the cost-effectiveness, side effects, comparable efficacy, indications and available literature for medications in 100 classes. [Also: Managed care pharmacies reap benefits of EHRs] Mercy places drugs in one of four categories: on the formulary and available from order sets; on the formulary but not available from order sets; restricted to a specific disease state or provider type; and neither on the formulary nor in order sets. These categories correspond to Mercy’s “bullseye” -- a visual representation of each medication class that committee members use to review their decisions.  For drugs that are neither on the formulary nor in order sets, Mercy built more than 800 therapeutic interchanges. When providers order a non-formulary medication, the system suggests formulary alternatives. If providers don’t choose an alternative, they document a reason. Mercy reports on the data to identify providers who routinely order non-formulary medications. “We generate reports on non-formulary drugs -- how many times they were ordered, and what the cost savings would be if we were to use a formulary drug instead,” Bohenek said. “We can provide that report by region and provider and have discussions with providers who are using non-formulary drugs. The reports show providers how much non-formulary drugs are costing the region.” “We’re pretty prescriptive about it,” said Susan Mashni, chief pharmacy officer at Mercy Health. “An extensive drug monograph is completed for each class of medications.” So far, Bohenek and Mashni said providers have been receptive tot eh workflow. “I think most prescribers see the reality of how much drugs cost and what the impact of prescribing them is,” Mashni said. “As long as it’s just an educational discussion, they’re very responsive to the concept that you’re going to improve patient compliance if you don’t give them the most expensive drug out there.” Mercy Health now has an average formulary compliance of more than 98 percent. [Like Healthcare IT News on Facebook] The formulary management is most effective with a single EHR across the health system because it enables the health system to make modifications as their contracts change and to monitor compliance.   The move to Epic – and the health system board’s insistence that 85 percent of content be standardized – provided the impetus Mercy needed to adopt a formulary. Prior to rolling out Epic, Mercy employed a mix of technology, primarily from McKesson and Meditech  – and paper. Twitter: @HealthITNews

The Medical Group Management Association, which represents medical practice leaders across the country, has signed up for space in the Catalyst Health-Tech Innovation development, a new healthcare technology hub in Denver. It will join other health-focused organizations, practice groups, health finance companies and high-tech organizations as a tenant. [Also: Extend meaningful use reporting, says MGMA] MGMA, which represents more than 33,000 medical practice administrators and executives in practices of all sizes, types, structures and specialties, is headquartered in Englewood, Colorado, with a government affairs office in Washington, D.C. The 5,000-square-foot addition to MGMA's existing campus in Englewood will be part of the Catalyst Health-Tech Innovation development, which encompasses a full city block in the River North neighborhood of Denver. [Like Healthcare IT News on Facebook] The additional space will provide an environment for MGMA staff and leaders to collaborate with other industry leaders on developing efficient and cost-effective strategies for medical practices and improving care for patients, said MGMA President and CEO Halee Fischer-Wright, MD, in a statement. The hub is slated to open in 2018. Twitter: @Bernie_HITN

The Centers for Medicare and Medicaid Services and the Office of the National Coordinator announced Monday that CMS would extend the deadline for commenting on quality reporting and certification of EHR products. CMS posted the extension notice on the Federal Register. As first outlined in the request for information, which was posted on the Federal Register on Dec. 31, 2015, CMS and ONC seek public comment on several items related to the certification of health information technology. [Also: CMS, ONC seek feedback on quality measures reporting] These include EHR products used for reporting to the EHR incentive programs and certain CMS quality reporting programs such as – but not limited to – the Hospital Inpatient Quality Reporting Program and the Physician Quality Reporting System. CMS and ONC want industry perspective how often to require recertification, the number of clinical quality measures a certified health IT module should be required to certify and ways to improve testing of certified health IT modules.  [Like Healthcare IT News on Facebook] That feedback will help inform CMS and ONC about what factors may need to be considered for future rules relating to the reporting of quality measures under CMS programs. The two agencies note the request for information is part of the effort of CMS to streamline and reduce the burden around government requirements for eligible professionals, eligible hospitals, critical access hospitals and health IT developers. Twitter: @HealthITNews

New offering on Welltok platform aimed at some of largest employers, including IBM.

Physician adoption of electronic health records rose steadily between 2013 and 2014, with nearly 75 percent of doctors going digital, according to the Centers for Disease Control and Prevention’s National Electronic Health Records Survey. The CDC’s four key findings based on the survey: In 2014, 74.1 percent of office-based physicians had a certified electronic health record system, up from 67.5 percent in 2013. The percentage of physicians who had a certified EHR system ranged from 58.8 percent in Alaska to 88.6 percent in Minnesota. In 2014, 32.5 percent of office-based physicians with a certified EHR system were electronically sharing patient health information with external providers. The percentage of physicians with a certified EHR system electronically sharing patient health information with external providers ranged from 17.7 percent in New Jersey to 58.8 percent in North Dakota. Access the full CDC report here.

MidMichigan Health, a nonprofit health system affiliated with the University of Michigan Health System, is ready to replace a mixed bag of technology with an electronic health record from Epic Systems, which will provide the clinical, administrative and billing software. The goal: to connect its hospitals, physician practices and outpatient care facilities on one platform for medical records, registration, scheduling and billing. Contract cost: $55 million. MidMichigan Health executives say they expect to recoup that investment within six years through efficiencies gained. They've named the endeavor the One Person, One Record project. [See also: 11 Epic stories worth reading again.] The health system's leaders announced the decision in a January 26 post on the MidMichigan Health website. The EHR rollout is one of several initiatives the health system is undertaking to put patients and their families at the center of care while enhancing safety and quality, patient experience, employee and provider engagement and financial stability, officials noted. Project team members have already begun traveling to Wisconsin for Epic training and will begin configuring the system in early 2016. MidMichigan anticipates the system will be fully operational at its hospitals and doctors' offices in April 2017. A second phase of the project in late 2017 will connect MidMichigan Home Care and other newly owned subsidiaries to the rest of the health system. "Our current state of multiple vendor systems requires us to maintain a large number of custom interfaces," said Dan Waltz, CIO. "This has simply become unsustainable, both in terms of the cost to maintain those systems and the potential risk and confusion that it introduces." [See also: Epic scores EHR contract from Vanderbilt University Medical Center, beats Cerner.] There is more to the project than setting up new technology. "As part of the process, we will be evaluating all of our workflows, comparing them to industry best practices and making improvements," said Pankaj Jandwani, MD, MidMichigan Health's CMIO, in the news release. "It's an opportunity for us to think differently about how we work and to design our tools and our processes around what patients and their families need. Jandwani added the changes would also help improve productivity and satisfaction, with tasks and roles "dramatically transformed." As a result of the project, patients will be able to schedule appointments online and self-check-in from home or at on-site kiosks. The health system will also offer virtual care options such as telemedicine and e-visits, and the ability to view and pay MidMichigan Health bills from one account.

SCIO Health Analytics has acquired Westlake Village, California-based Clear Vision Information Systems, the companies announced Thursday. Financial terms of the deal were not disclosed. Clear Vision provides software-as-a-service analytics focused on risk adjustment and quality metric strategies for health plans and providers. SCIO Health Analytics CEO Siva Namasivayam said combining Clear Vision's analytics offerings and outreach services with SCIO's predictive and prescriptive analytics tools will help clients better manage the transition from fee-for-service to value-based care. Namasivayam points to the government’s goal of tying 30 percent of payments to value-based mechanisms such as accountable care organizations by the end of 2016, and 50 percent by the end of 2018, and said the combined offering will help ease the shift. [Like Healthcare IT News on Facebook] The acquisition of Clear Vision – whose clients include government and commercial health plans/payers, providers, medical groups and ACOs – adds to SCIO’s offerings in the ever-growing analytics market. "The two sets of technologies dovetail nicely to deliver a well-rounded picture of the changes organizations need to make to achieve their goals,” said Tom Peterson, founder, president and CEO of Clear Vision, in statement Peterson founded Clear Vision with Pam Klugman in 2006. Both will join SCIO Health Analytics in executive roles. Twitter: @HealthITNews

The Patient-Centered Outcomes Research Institute has approved $70 million for nine new patient-centered research projects. The new studies will focus on conditions ranging from a type of very early-stage, localized breast cancer to diabetes, chronic lung disease and migraines. [Also: PCORI adds $142M for big data research] With these latest awards, PCORI has now approved or awarded more than $1.2 billion for research. The new studies will compare: active surveillance to traditional treatments, effectiveness of two common medications for chronic obstructive pulmonary disease, varying approaches to smoking cessation among adults with mental illness, competing approaches to managing chronic migraines and the use of inhaled corticosteroid versus symptom-based use in treating asthma exacerbations.  PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research to provide patients, their caregivers, and clinicians with evidence-based information needed to make better-informed healthcare decisions. [Like Healthcare IT News on Facebook] PCORI also awarded $6.7 million to three members of PCORnet as part of its ongoing work to establish a national patient-centered clinical research network. That money will go toward studying population health policies and interventions for type II diabetes. The agency awarded another $5.2 million to researching the effectiveness of wellness coaches for African Americans with uncontrolled diabetes. And PCORI allocated $3.8 million for a study to determine the optimal dose of aspirin for preventing heart attacks and strokes. Twitter: @HealthITNews

Steward Health Care Network, the second largest physician network in Massachusetts, will offer Quartet Health's platform as a service to its providers and their patients. The multi-year agreement expands the partnership between Steward and Quartet Health that started in 2015. Boston-based Steward Health Care, a Next Generation ACO,  is the largest integrated community care organization and hospital network in New England, with more than 17,000 employees in more than 150 communities. [Also: Steward Healthcare: ACO success hinges on IT strength] Former Rhode Island Congressman Patrick Kennedy joined the board of the New York-based startup last October. Kennedy has been open about his addictions to alcohol and prescription drugs, and he recently wrote about his struggles – and those of his family – in his book, A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction. While serving in Congress, Kennedy authored the Mental Health Parity Act, which required health insurance companies to provide coverage benefits for treatment of mental health conditions that are comparable to coverage provided for physical conditions. Quartet estimates that 7 to 9 percent of Massachusetts residents are treated for both a chronic medical condition and behavioral health condition in a given year. [Also: Legislation seeks to extend meaningful use incentives to behavioral health] Also, an additional 20 percent of this population is either not diagnosed or not treated for behavioral health conditions. As Quartet executives put it, care is often disjointed. Quartet's technology platform identifies individuals in need of behavioral health resources and enables primary care providers to set those individuals on effective treatment paths in tight collaboration with behavioral health professionals. To date, more than 70 percent of Steward providers who used the Quartet platform for the first time became repeat users. Under the expanded agreement with Quartet, all Steward primary care providers will be able to use the Quartet platform and all Steward patients will be able to access free tools and services including online self-care resources, peer support interventions and telepsychiatry. "Access to behavioral health resources is one of the most pressing challenges in primary care today," Steve Stein, MD, said in a statement. Stein is part of Family Medical Associates, a practice within the Steward Health Care Network. Besides Kennedy, Quartet is backed by Annie Lamont from Oak and Carl Byers from Fidelity Bio. Twitter: @HealthITNews

Cyberattacks around the world are growing in size and complexity, according to Arbor Networks 11th Annual Worldwide Infrastructure Security Report, released January 26 by Arbor Networks, the security division of NETSCOUT. For the first time, nearly half of the respondents were from enterprise, government and educational organizations, with service providers at 52 percent. Healthcare is one of the verticals included in the enterprise category. The survey garnered 354 responses, up from 287 received last year, from a mix of Tier 1 and Tier 2/3 service providers, hosting, mobile, enterprise and other types of network operators from around the world. [Also: Understanding the 5 enemies of healthcare IT security] “This report provides broad insight into the issues network operators around the world are grappling with on a daily basis,” Arbor Networks Chief Security Technologist Darren Anstee said in a statement announcing the report. “The findings from this report underscore that technology is only part of the true story since security is a human endeavor and there are skilled adversaries on both sides.” Arbor Networks lists the top five Distributed Denial of Service trends and also the top five advanced threat trends. DDoS usually involves a system infected with a Trojan: malware designed to give unauthorized access to a user’s computer. DDoS trends: Change in attack motivation: This year the top motivation wasn’t hacktivism or vandalism, but ‘criminals demonstrating attack capabilities’ - something typically associated with cyber extortion attempts. Attack size continues to grow: The largest attack reported was 500 Gbps, with others reporting attacks of 450 Gbps, 425 Gbps and 337 Gbps. In 11 years of the Arbor Networks survey, the largest attack size has grown more than 60X. Complex attacks on the rise: 56 percent of respondents reported multi-vector attacks that targeted infrastructure, applications and services simultaneously, up from 42 percent last year. Ninety-three percent reported application-layer DDoS attacks. The most common service targeted by application-layer attacks is now DNS (rather than HTTP). Cloud under attack: Two years ago, 19 percent of respondents saw attacks targeting their cloud-based services. This grew to 29 percent last year and to 33 percent this year. Fifty-one percent of data center operators saw DDoS attacks saturate their Internet connectivity. There was also a sharp increase in data centers seeing outbound attacks from servers within their networks, up to 34 percent from 24 percent last year. Firewalls continue to fail during DDoS attacks: More than half of enterprise respondents reported a firewall failure as a result of a DDoS attack, up from one-third a year ago. Firewalls add to the attack surface and are prone to becoming the first victims of DDoS attacks, as their capacity to track connections is exhausted. Because they are in line, they can also add network latency. Advanced threat trends: Focus on better response: 57 percent of enterprises are looking to deploy solutions to speed the incident response processes. Among service providers, one-third reduced the time taken to discover an advanced persistent threat in their network to under one week, and 52 percent stated their discovery to containment time has dropped to under one month. Better planning: 2015 saw an increase in the proportion of enterprise respondents who had developed formal incident response plans and dedicated at least some resources to respond to such incidents, up from around two-thirds last year to 75 percent this year. Insiders in focus: The proportion of enterprise respondents seeing malicious insiders is up to 17 percent this year (12 percent last year). Nearly 40 percent of all enterprise respondents still do not have tools deployed to monitor BYOD devices on the network. The proportion reporting security incidents relating to BYOD doubled to 13 percent - up from 6 percent last year. Staffing quagmire: There’s been a significant drop in those looking to increase their internal resources to improve incident preparedness and response, down from 46 to 38 percent. Increasing reliance on outside support: Lack of internal resources has led to an increase in the use of managed services and outsourced support, with 50 percent of enterprises having contracted an external organization for incident response. This is 10 percent higher than within service providers. Within service providers, 74 percent reported seeing more demand from customers for managed services. Twitter: @HealthITNews