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Predictive analytics in EHRs aren't yet effective enough for clinical decision support at the point of care.

While traditionally deeply skeptical of artificial intelligence in clinical settings, in today's fast-changing care delivery landscape many physicians are thinking more proactively about how AI can improve quality and patient experience.

The clinical manifestations of COVID-19 are varied, and patients are known to have rapidly changing signs and symptoms that must be tracked with laboratory testing. A patient may start his treatment journey with his primary care physician and will include lab centers, diagnostic centers, inpatient, and home quarantine centers.  It is crucial for the respective laboratory information or electronic health record systems to share the lab tests and diagnostic information with each other. Communicating the lab orders and results across multiple care settings and with treating physicians, quickly and effectively, is the need of the hour.   A patient encounter creates observational data such as vital signs, symptoms, diagnoses, and diagnostic information, along with prescription details. The observational data findings, and laboratory and diagnostic information, along with medical knowledge and clinical guidelines, forms part of a clinical database. The data here can be turned into information only when systems use the right terminology standards.  Terminologies are the heart and soul of a system  Terminology services help two health systems talk to each other and make the information stored within them, useful to both patients and practitioners across the care journey. Terminologies are the language in which computer systems can communicate physicians’ notes and observations with each other.  The HL7 2.x or FHIR API standards are the messengers that help deliver the language (read information) from one system to another. A simple example is the way different clinicians would write COVID-19 (is it COVID-19 or COVID 19 or just COVID?). As is always said, technology must adapt to its end users, and for a software to quickly understand and transmit information across systems terminologies packaged within HL7 2.x or FHIR standards are used. Laboratory testing is one of the significant parameters to track a pandemic like COVID. Public health management of the COVID-19 response needs complete laboratory testing data, including standardized test results and demographic details for contact tracing, mitigation, and control of the spread of the disease. One of the critical roles of technology is the usage of standard terminologies used by clinicians and laboratories while communicating patient information across different care settings and specialties. Two of the terminology standards used:  LOINC codes are used for the orders placed or the question that is asked of a viral test specimen, e.g. SARS-Coronavirus-2 RNA [Presence] in respiratory specimen by NAA with probe detection. The SNOMED-CT codes are used for the results or diagnostic answers, e.g. positive, negative, invalid, or specimen is unsatisfactory for evaluation. Specimen types, e.g., the serum, plasma, and nasopharyngeal swabs, are coded with SNOMED CT. The CARES Act mandates the use of de-identified data elements that must be reported for each test to the public health authorities, and these are available on the HHS site. The Regenstrief Institute has released new LOINC codes in the wake of the pandemic.  To increase semantic interoperability for laboratory reporting for detection of SARS-Coronavirus-2, the FDA, CDC, IICC, the Regenstrief Institute, and the Association of Public Health Laboratories (APHL) have developed a LOINC map for all SARS-Coronavirus-2 diagnostic tests listed on FDA Emergency Use Authorizations.  The CDC and FDA maintain the mapping of all the currently approved SARS-Coronavirus-2 in vitro diagnostic labs and their corresponding specimen types and results under the stewardship of the Office of the National Coordinator (ONC).  The ‘Observation’ resource in HL7 FHIR Real-world concepts in the healthcare system are linked together by FHIR packages called Resources. A Resource in FHIR is an entity with a URL by which it can be addressed and contains a set of structured data items as defined in the resource.  The ‘Observation’ resource in FHIR includes elements where the different components of terminology, i.e., the code, its description, values, units, and interpretation of the result, are contained within a resource or message. Systems transmit this resource or message to exchange information. Each resource includes elements where the terminologies and clinical concepts are included. This package, when exchanged across healthcare systems, helps to create interoperable information for the consumption of clinicians associated with the management of the patient. The FHIR framework includes four elements that have clinical terminologies: System: This is the URL that identifies the coding system. E.g. (www.loinc.org, http://snomed.org/) Version: The current version of the coding standard. E.g., LOINC V 2.68, SNOMED September 2019 Release Code: This is a unique identifier for the concept as defined by the code system Display: A description of the concept as defined by the code system Typically for lab tests, the ‘Observation’ resource within FHIR is used to convey the orders and results relevant to laboratory tests. The ‘Code’ and the ‘Display’ elements within the ‘Observation’ resource include the clinical terms for exchanging information.  In HL7 V 2.x data transmission, the Observation Request Segment (OBR) and Observation Result Segment (OBX) contain the laboratory tests and their corresponding results in lab test codes of LOINC or SNOMED CT. The LOINC and SNOMED CT codes are updated regularly, recently a set of new terms and codes for SARS coronavirus 2 have been released. Improve decision making and reporting of patient data across the care continuum In the scenario where a patient with COVID-19 moves from primary care to emergency care, quick decisions and tracking of laboratory results is necessary. The use of terminology standards can help reduce the time spent in exchanging, tracking, and reporting these tests across the patient journey.  This is a one-time activity that laboratory systems need to undertake to define all the tests in their catalogue correctly. Hospital systems will need to update their EHR systems with the updated orders for the COVID specific tests that they are ordering in collaboration with the referring labs.  This is a foundational activity not only towards data interoperability but also towards research with real-world evidence for the management of COVID. As Dr. Atul Gawande said in The New Yorker recently, the technologies are in place – it's the implementation that needs to be streamlined. Joyoti Goswami is a Principal Consultant at Damo Consulting, a growth strategy and digital transformation advisory firm that works with healthcare enterprises and global technology companies; she is a physician with varied experience in clinical practice, pharma consulting and healthcare IT.

Despite his high profile and the deep pockets of its investors, the Amazon, Berkshire Hathaway and JP Morgan Chase joint venture has so far shown limited progress on its aspirational tech-driven healthcare goals.

Despite one senator's hope to move deliberately with rulemakings and not repeat some errors of meaningful use, National Coordinator Donald Rucker said delays only lengthen the time that consumers are "not in control of their care."

More than a year after it was first announced, the joint venture between Amazon, Berkshire Hathaway and JPMorgan Chase finally has a new moniker. The company will be called Haven. The brainchild of heavy-hitting CEOs Jeff Bezos, Warren Buffett and Jamie Diamon, the Boston-based company aims to "bring together the resources and capabilities of the three companies to create better outcomes, greater satisfaction, and lower costs for their U.S. employees and families," according to a statement on its new website. It will start this large undertaking by reimagining the way healthcare is delivered to the 1.2 million employees of those three companies. But it clearly has bigger goals, as evidenced by its hiring of renowned surgeon, author and health policy expert Atul Gawande as CEO this past June. "I feel incredibly lucky in this role," Gawande said. "I will get a million new patients." In a statement on Wednesday, he explained that the new company wants to "change the way people experience health care so that it is simpler, better, and lower cost. We'll start small, learn from the experience of patients, and continue to expand to meet their needs." On its website, the company says its name was chosen because it "reflects our goal to be a partner to individuals and families and help them get the care they need, while also working with clinicians and others to make the overall system better for all." Information and technology are going to be key in driving that vision. In November, for instance, Haven hired Dana Gelb Safran from Blue Cross Blue Shield of Massachusetts to oversee its analytics and quality improvement efforts, with the innovative title "Head of Measurement." Haven's aim, officials said, is to "deliver simplified, high-quality, and transparent health care at a reasonable cost. We are focused on leveraging the power of data and technology to drive better incentives, a better patient experience, and a better system. Our work may take many forms, and solutions may take time to develop, but Haven is invested in making health care much better for all of us." While it's initially focused on Amazon, Berkshire Hathaway and JPMorgan Chase employees, "in time, we intend to share our innovations and solutions to help others," said Haven officials. I’m not a branding pro, but in thinking about it more, Haven seems like the perfect choice if you want to send a message to the industry that you’re not intending to disrupt anything. It invokes calm, tranquility, friendliness. I’m sure a very thought out and delibeate choice. — Christina Farr (@chrissyfarr) March 6, 2019 From a branding perspective, I agree. And in an industry that feels chaotic and under attack it works on many levels. — Daniel Fell (@danfell) March 6, 2019 Also a destination - a place you want to get to - clever — Chris Steel (@chrissteel1) March 7, 2019 Haven for whom though? Consumer? Payer? Hospital system? Not sure it can or will be Haven for all constituents — John Moore (@john_chilmark) March 7, 2019 Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com Healthcare IT News is a HIMSS Media publication. 

HHS Secretary Alex Azar joins the roster, which also features Aneesh Chopra, Karen DeSalvo, Michael Levitt, Mick Ebeling, Seema Verma and Susan DeVore.

With EHR frustrations at a boiling point and physician burnout at epidemic levels, it's time to rethink the way IT is designed, developed and deployed to better enable a human touch, says one clinician.

The healthcare venture formed by Amazon, Berkshire Hathaway and JPMorgan Chase has hired insurance executive Dana Gelb Safran as head of measurement, a data-driven technology position, according to CNBC. Safran is the chief performance measurement and improvement officer and senior vice president of Enterprise Analytics, at Blue Cross Blue Shield of Massachusetts. She joins the Boston-based group headed by Dr. Atul Gawande. WHY IT MATTERS In her role at BCBS Massachusetts, Safran was responsible for leading efforts to use data, measurement, incentives, and reporting to improve the quality, outcomes, and affordability of care, according to biography information from the Medicare Payment Advisory Commission. Webinar: Women in Blockchain: Making a Difference in Healthcare through Distributed Ledger Technology Safran’s experience improving quality and outcomes while lowering the cost of care through IT is exactly how the industry views Amazon’s new venture and its potential to tackle healthcare’s greatest challenges. Data and analytics will loom large, as will offering the 1-plus million employees of the three companies a personalized approach to healthcare benefits. THE TREND Not much has been released about the new venture, which the big three formed earlier this year. It still has no official name. Gawande was named CEO in June. Safran’s background in health insurance, however, aligns with the innovations expected of Gawande, a Brigham and Women’s Hospital surgeon, author and New Yorker staff writer who, in the November 12 issue, sympathized with physicians struggling to balance EHR technology with work schedules and patient care. DANA SAFRAN: THERE'S MORE TO KNOW Safran was appointed to serve on MedPAC in 2017 in a term through April 2020. She is also an associate professor at Tufts University School of Medicine. She serves on a number of state and national advisory bodies related to healthcare quality and affordability, including the National Quality Forum Consensus Standards Approval Committee and the CMS Technical Expert Panel on the Quality Rating System. Twitter: @SusanJMorse Email the writer: susan.morse@himssmedia.com