Electronic Health Records

And there’s already one in the JASON Report from 2014 that was eclipsed by the industry’s excitement about open APIs.

Beginning Sept. 21, VA will start accepting proposals for contractors to handle the technical and administrative services of its legacy EHR.

With a rare near-unanimous vote, the United States Senate passed The Opioid Crisis Response Act of 2018 on Monday evening. It's a massive bill comprising a wide array of proposals drawn from five Senate committees, and has many implications for the use and funding of health IT. Senate Majority Leader Mitch McConnell, R-Kentucky, called the bill – drawn up using input from more than 70 senators and passed by 99-1 vote – a "landmark" piece of legislation meant to combat the nationwide opioid epidemic from all angles. The legislation comes amid an ongoing opioid crisis in the U.S. as policymakers and technology vendors are working to address the issue, while hospitals are piloting apps to find blindspots in prescription drug monitoring programs and using mobile technologies to write fewer prescriptions. It contains funding for stopping the flow of illegal opioids from other countries, and for supporting local programs for prevention, treatment and recovery. The bill also seeks to spur research and development of new non-addictive painkillers and stem "doctor shopping" by boosting prescription drug monitoring programs. It also has funds to give behavioral and mental health providers the tools they need to offer treatment and recovery – including potential electronic health record incentives – and for hospitals to better care for infants with neonatal abstinence syndrome. The legislation's sponsor, Senate HELP Committee Chairman Lamar Alexander, R-Tennessee, said he is working to combine the Senate bill and a similar House version passed in June "into an even stronger law to fight the nation’s worst public health crisis, and there is a bipartisan sense of urgency to send the bill to the President quickly." The Senate bill contains many new proposals specifically related to information technology. Among them, it would: Call for the U.S. Department of Health and Human Services to "develop best practices for prominently displaying substance use treatment information in electronic health records, when requested by the patient." Enable the Centers for Medicare and Medicaid Services to test various models that "provide incentive payments to behavioral health providers for the adoption and use of certified electronic health record technology to improve the quality and coordination of care through the electronic documentation and exchange of health information." Require physicians to prescribe Part D-covered controlled substances electronically and direct CMS specify a list of exceptions and outline the penalty for failure to comply when the e-prescribing requirements. Require that prior authorizations related to Part D e-prescriptions use a standard format to improve the way the authorizations are processed. Provide support for states and localities to improve their Prescription Drug Monitoring Programs and "implement other evidence-based prevention strategies, encourages data sharing between states, and supports other prevention and research activities related to controlled substances." Reauthorize HHS's NASPER grant program, allowing states to "develop, maintain, or improve PDMPs and improve the interoperability of PDMPs with other states and with other health information technology." Authorize new program through the Substance Abuse and Mental Health Services Administration for the establishment of comprehensive opioid recovery centers. "These entities may utilize the ECHO model, which supports care coordination and services delivery through technology." Give support for states to collaborate on strategies to improve care substance-exposed infants, including the development and upgrades of new technology and monitoring systems to more effectively implement plans of safe care. Require CMS to set up an online portal to enhance communication between the agency, Medicare Advantage plans with prescription drug plans, stand-alone drug plans and Medicare Drug Integrity Contractors.   .jumbotron{ background-image: url("http://www.himss.org/sites/himssorg/files/u351641/opioid-collection-hero-712.png"); background-size: cover; color: white; } .jumbotron h2{ color: white; } Opioid Crisis: Tech fights epidemic Learn how tech is being used to battle abuse. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

The ongoing saga of athenahealth and Elliott Management continues. Shares of the cloud-based health IT company fell sharply Tuesday morning on news that the hedge fund – which has recently been seen as the most likely candidate to acquire the company after a long and contentious courtship – has reportedly recoiled from the $160 share price. While activist investor Paul Singer may finally be throwing in the towel after many months of pressure on the Watertown, Massachusetts company, he may also simply be angling for a lower price. Reports earlier this month, in fact, indicated that EHR rival Cerner and insurer UnitedHealthcare are not interested in athenahealth. Now, athenahealth seems willing to be patient and weigh its options, having extended the due date for a final bid by 10 days, according to the New York Post. Elliott Management had indicated its willingness to pay the $160 share price, a total of some $6.9 billion, for the company in May. But by June – when athenahealth founder and CEO Jonathan Bush was forced to step down after allegations of past domestic violence – at least one Wall Street observer wondered whether the sale process might eventually drag on so long that Elliott would rescind its offer, likely knocking the share price back down to the $135-$140 range. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

When its EHR vendor wasn’t going to be ready until 2020, the IT team took matters into its own hands in a low-budget open source project that is already paying off.

The first House VA Subcommittee on Technology Modernization hearing revealed that officials and congressional members are not on the same page when it comes to governance.

Glen Tullman has served as the CEO of a major EHR vendor and the founder of a startup app maker focused initially on diabetes. That background gives him a unique insight into the possibilities and constraints of each. For our Focus on Innovation, I spoke with Tullman about the foundation EHRs have created for the future of digital health, what to expect next from Livongo, and where he expects next-gen innovations to come from. Q: You formerly ran Allscripts and now lead Livongo. Given that perspective, what’s your take on the innovation happening in so many corners of healthcare right now? A: EHRs are fundamentally data repositories, so what do you need to do? You need to make them much easier for physicians to use on the front-end. On the back-end a lot of companies like IBM Watson and smaller startups are saying ‘we’ll take the data from the EHR and analyze it to give you real feedback on how to provide better care.’ But EHR vendors aren’t doing any of that innovation. Q: We are seeing EHR vendors take steps to open their platforms to third-party developers and enable them to drive some of that innovation but is that the answer? A: EHRs were an important step to get things digitized but they have not realized the promise of making it easier for physicians to deliver care and they haven’t been connected to each other. Why not? Technology-wise, they could be connected. Q: Well, there’s a lot of innovation happening in healthcare and much of has little to with EHRs. Where is it all going? A: The future of healthcare is not about big software systems in hospitals. That’s important but healthcare today is about how we empower people with chronic conditions, how we empower those people with software and technology to make it easier to be happier and healthier. Everything people can rip out of a hospital they’re ripping out of a hospital. Surgery centers, urgent care. Q: In which case, what’s next for Livongo? A: We’re going to release a cellular-enabled blood pressure monitor so we have hypertension data and give people real-time feedback outside the doctor’s office because 24 percent of people on meds actually have white coat hypertension instead of high blood pressure. Imagine if we could get them to check their blood pressure at home versus in the doctor’s office? It’s available now but the official release will happen at Health 2.0.   Q: And what about the broader industry, not just Livongo? A: We’re going to see a lot of innovation.  The world we’re talking about, tons of activity in digital health, making people smarter, helping them navigate the complex world of healthcare, making payments easier — that’s where the innovation is going to come from. .jumbotron{ background-image: url("http://mobihealthnews.com/sites/default/files/u751/Innovation-month-jumbotron-1.jpg"); background-size: cover; color: white; } .jumbotron h2{ color: white; } Focus on Innovation In September, we take a deep dive into the cutting-edge development and disruption of healthcare innovation. Twitter: SullyHIT Email the writer: tom.sullivan@himssmedia.com

Oakland, California-based Alameda Health System has named its new chief information officer. Mark Amey will relocate to the Bay Area from San Diego, where he was most recently associate CIO at University of California San Diego Health. Alameda Health appointed Amey in the same week that Sanford Health named former VA Secretary David Shulkin, MD, as its chief innovation officer. Much like Shulkin, Amey brings considerable familiarity with electronic health record implementations. Alameda cited its work to roll out a $200 million Epic EHR across the five-hospital public health system as among the reasons it brought Amey onboard. Amey has been working in health IT for more than two decades. Before his stint at UC San Diego, he served as Chief Technology Officer during another Epic rollout at Lucile Packard Children’s Hospital-Stanford Health. Prior to that, he also held CIO positions at University of Southern California Health, Ascension Health and Adventist Health. In San Diego, his day-to day responsibilities included oversight of its infrastructure teams, the project management office and security operations. It was at UCSD that Amey helped transition its on-premise Epic system to a hosted cloud model. The mover not only helped the health system be more agile and maintain disaster recovery capabilities, he explained at the time, but "by creating greater operational efficiencies, we can invest more time and resources in patient care." Other areas of expertise include management of outsourced IT vendors, conversion of services to in-house operations and more. "I am excited to join Alameda Health System at this pivotal time in the history of the organization," said Amey. "Having gone through similar projects in the past, I know this implementation will transform the care we provide, including the exchange of information and communications with patients and medical colleagues." Alameda Health partners with five other health systems in the Bay Area on an interoperability project designed to reduce emergency department usage but also boost the ED care that is delivered. With its new Epic rollout, it's hoping to spur easier data sharing among its own five hospitals. "Mark’s in-depth knowledge and impressive experience align with the future direction of Alameda Health System," said Alameda's CEO Delvecchio Finley in a statement. "As CIO, we are confident he will guide the organization through a smooth transition to electronic health records that will enhance our commitment to serve our patients with highest-quality care." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

Imagine knowing, in real time, whether a patient will suffer a surgical infection as a surgeon closes up a wound. That's the kind of clinical situation that machine learning is enabling at the University of Iowa Hospitals & Clinics. In a 3-year pilot study ending in 2016, in a subset of general and colorectal surgery, the health system's innovation with AI analytics has led to a 74 percent reduction in surgical site infection. At scale, this would translate to approximately $1.2 million in cost savings – not including savings from value-based purchasing because of the reduced surgical site infection rate. Iowa’s work with comes as more and more hospitals and tech vendors are undertaking innovative initiatives with machine learning and artificial intelligence. Johns Hopkins for instance, is using deep learning to improve how it handles pancreatic cancer and Amazon Web Services is harnessing machine learning to enable customers to better treat depression. Co-developing machine learning The university is co-developing the machine learning technology with vendor DASH Analytics. The system is called the DASH Analytics High-Definition Care Platform, or HDCP. Its proprietary design uses machine learning as it provides valuable data, metrics and decision support at critical moments during the point-of-care timeline. HDCP, the university said, helps lower the rate of surgical infections, reduces the risk of requiring a blood transfusion during surgery, saves lives from brain failure and saves lives from unrecognized sepsis. The technology combines several features, said John Cromwell, MD, associate chief medical officer and director of surgical quality and safety at the University of Iowa Hospitals & Clinics. "The system uses curated knowledge of where and when specific critical decisions that drive outcomes are being made by providers for numerous clinical conditions where there is massive room for improvement," he explained. "It is a machine learning system that integrates with the EHR using industry-standard and vendor-specific APIs and in real time measures individual patient risks and evaluates appropriate best practice based upon these risks." With those two features, HDCP integrates decision support within the provider's EHR workflow, and it generates feedback on how their use of the data changes their patient's outcomes, reinforcing high-value practices, he said. The system works silently in the background, monitoring for specific points in patient care where decision support may improve patient outcomes. At that point in time, the decision support becomes visible to the clinician or other front-line provider within their usual workflows in the EHR. It will present them with the specific risk for their specific patient along with actions to potentially mitigate that risk. "The risks are assessed by using best-in-class machine learning algorithms that use both real-time and historical data on individual patients," Cromwell said. "These risk models are calibrated specifically to patients in each individual hospital using the platform." Here's how it works The surgical site infection reduction module in HDCP is integrated within the World Health Organization Surgical Safety Checklist that virtually all hospitals use during surgery. The module is activated near the completion of a surgery as the circulating nurse is going through his or her routine closing checks. At the time of module activation, real-time data from the EHR such as the surgeon, case duration or estimated blood loss flows into the platform and is combined with historical data on the patient. All of this data then flows into the surgical site infection prediction model. "The machine learning model calculates the infection risk and links this risk to specific interventions that the surgeon may take at the time of wound closure to reduce the infection risk," Cromwell explained. "The risk information and possible interventions are then presented in an interactive interface back to the nurse at her workstation – the whole process takes mere seconds to complete – who then delivers the information to the surgeon." Using a single click, the nurse records whether the surgeon used the decision support recommendations. Ultimately the patient's outcome with respect to surgical site infection is returned to the platform and used to generate an aggregate report for the surgeon regarding his or her outcomes when recommendations were or were not used, thus reinforcing the use of appropriate decisions. "It is very difficult for surgeons to integrate the information necessary to determine whether a patient is at high risk for a surgical site infection," Cromwell said. "There are certainly obvious cases where there is a break in technique, contamination, or very high-risk patient factors, but these are the minority of the cases." There are interventions that can be done at the time of wound closure, but these can be costly or invasive. Would one do these interventions to 100 percent of patients if only a fraction can actually get a surgical site infection? "Selectively using these interventions in patients where it is warranted by objective markers of risk maximize the therapeutic effect, while minimizing the cost and potential risks to patients," Cromwell explained. "In this case, we were able to selectively use negative pressure wound therapy on patients with markers of high risk to achieve the 74 percent reduction. Without the system, we could not have known objectively which patients to use this costly therapy on." Ultimately, machine learning is critical for integrating hundreds or thousands of variables for individual patients in order to objectively measure risk, he added. "Integrating such massive amounts of information that is impossible for any individual caregiver to perform," said Cromwell. "And no matter how much experience one has, the exponential increase in medical knowledge makes it impossible for a caregiver to assimilate all of the data necessary to consistently apply best practices in every situation." A systematic approach to mitigating adverse outcomes or complications requires that one systematically identify the risks, he added. Machine learning algorithms, with few exceptions, are able to do this much more effectively than humans on a consistent basis, he said. "This removes the variation in risk assessment that one may get between different physicians," he said. "Once a provider has an objective assessment of risk, then they may move on to mitigating that risk. When best practices are known and supported by data, machine learning can identify which patients these best practices should be applied to, in a consistent manner. By approaching risks objectively and systematically, we can have an effect greater than any pharmaceutical can provide." Twitter: @SiwickiHealthIT Email the writer: bill.siwicki@himssmedia.com

Cerner President Zane Burke, who first joined the company in 1996 and held several executive roles there before being named president, will step down on Nov. 2. John Peterzalek, Cerner's executive vice president of worldwide client relationships, will take on Burke’s responsibilities, with the title of Chief Client Officer, the company said. Over his two-decades at Cerner, Burke had a range of executive positions, ranging from sales and finance to technology implementation and support. He was named president five years ago, reporting to Cerner founder and CEO Neal Patterson, who died in 2017. Brent Shafer, former CEO of Philips North America, was named CEO of Cerner early this year. In recent years at Cerner, Burke was instrumental in helping the company win two massive electronic health record modernization contracts, from the Departments of Defense and Veterans Affairs. In addition to helping grow the company's client base, he's also helped innovate its technology, whether it's by partnering with Apple to help move the needle on patient engagement and interoperability or touting the value of open APIs, a focus on consumerism or more innovative strategies for revenue cycle management. "We thank Zane for his contributions to Cerner across more than two decades," said Shafer in a statement. "Zane leaves the company with a strong client focus and commitment to continued innovation, partnership and sustainable growth deeply ingrained in our culture and leadership philosophy." Burke added that is he pleased with the disruptive accomplishments and positive change Cerner and its clients have achieved. "Complex and evolving challenges remain, and Cerner is positioned to continue innovating for the good of consumers and health care providers," Burke said.   This past week, the Kansas City Business Journal reported that Burke had exercised options to sell almost $10 million in company stock. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com