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Cloud-based EHR vendor showing its information search engine, virtual scribe and voice assistant that CEO Girish Navani said are built to help providers save time at the point of care.

In an effort to deliver on safety for patients through the establishment of protocols around AI, the Royal Australian and New Zealand College of Radiologists (RANZCR) has created a working group that determines how the technology fits into the world of radiology and healthcare. Composed of practicing radiologists, data scientists, computer scientists and professionals in AI, the working group will explore what AI means for radiologists, the safety of the technology and training needed for doctors to use it. RANZCR President Dr Lance Lawler told HITNA that the group will also be working towards evaluating the impacts of the technology, the ethics of it, as well as how it fits into accreditations and regulatory frameworks. “We’re trying to be proactive with it so that we don’t end up in a situation where implications are not thought through,” he said. “Nowhere have we seen anyone seriously looking at these issues, which is often the way that regulations and new technologies come about. We want the technology to be used so that the benefits of it are reaped without being exposed to undue risk.” According to Dr Lawler, AI is of huge potential to radiology as it’s “very good at image recognition and pattern recognition”, which the field uses for image analysis to diagnose and follow up on diseases. But, even with the increasing hype around AI, there has not been enough work done to understand what the technology is, what it will be good for, what the risks of it are and how it can be applied to deliver better quality, lower cost healthcare to Australian patients, he said. As such, the organisation is embarking on a multi-layered approach to the issue. Dr Lawler said it will be looking into how AI is working in other countries, particularly in the US, with the FDA approving certain AI algorithms for use under certain conditions. “We want to understand their approach, and how that applies to us,” he said. On the other hand, it will be looking at bringing to market a training element that educates medical practitioners about the technology. “This new technology will be a tool that doctors use, so they have to know about this technology in order to deliver safe healthcare to their patients. The training element will look into what they need to know, how it will be delivered, how it will be assessed, etc.” [Read more: Standard bearers: The RANZCR’s journey to establish teleradiology protocols | AI gives robotic wheelchair facial recognition upgrade] The working group is also collaborating with Standards Australia to focus on standards and regulation. “We’re working with Standards Australia to decide what the standards are that need to be met, as well as the minimum standards for the applications of the technology, and then use those standards as the basis for safely regulating it, the way that everything else is regulated in healthcare,” Dr Lawler said. He addressed the need for a more combined, coherent response from government departments to actively investigate the use of this technology and involving medical academia and healthcare providers in strategy for it. “The ministries and regulatory bodies have been conspicuously quiet with AI, so we’d like to start engaging them in even basic discussions about this technology because it will make a very big impact, it’s only a matter of when.” IS AI REPLACING RADIOLOGISTS? Dr Lawler also spoke about concerns that roles will change significantly with AI infiltrating the market, in terms of machines replacing work done by radiologists. “There has been a lot of hype around this technology, some resulting in statements made about the future of radiology. They suggest that radiologists will be replaced by machines. Hypes aren’t based on facts and this is just an assumption,” he said. “There’s always going to be work for radiologists and it may just be an issue of reapplying people to different areas. There is fear of the unknown and the purpose of the working group is to put some shape around this whole issue so that people aren’t afraid of it.” [Read more: AI and machine learning – how soon will it be key to a learning health system? | AI algorithms show promise for colonoscopy screenings] At the moment, there’s very little impact of AI on health and radiology because it’s not being used to its full potential and is still under development, according to Dr Lawler. But he said AI is the “next big thing for the industry” and “is a great move for society as a whole”. “This is because there are some things that AI can do better than humans, but there are also some things that humans do better than AI so, we need to find a way to balance the two to deliver better quality healthcare overall,” he said. “And the best way to do that is to get ahead of the curve than be chasing our tails, which happens a lot in healthcare. “We want to get to a point where there’s an accepted and routine use of certain AI tools for some clinical circumstances. For radiology, that may be for breast cancer or lung cancer screening, or comparing responses to treatment – basically in high volume, repetitive cases that machines can do easily.”

These are two trends the electronic health record giant will be discussing with attendees at HIMSS19 in Orlando.

More and more healthcare organizations are urging a broader swath of the industry to get involved driving interoperability. The latest is a Jan. 22 report from seven leading national hospital associations urging “all stakeholders” to take part. The report, titled, “Sharing Data, Saving Lives: The Hospital Agenda for Interoperability,” outlines some pathways to get the job done. Working with policymakers and other stakeholders, contributors of the report hold that this is what it will take to get interoperability finally where it needs to be in healthcare: data security, enhanced infrastructure, standards that work, connecting beyond EHRs and shared best practices. WHY IT MATTERS According to Chip Kahn, president and CEO of the Federation of American Hospitals, data is everything when it comes to quality care. Having the right information at the right time is critical for clinicians and patients alike.  THE BIGGER TREND Hospitals and health systems are making progress in sharing health information, with 93 percent of them offering the records to their patients online and 88 percent sharing records with ambulatory care providers outside their system. “They have worked to create the most interoperable systems possible given the tools available to them, but at great cost and effort,” the groups added. That said, the federal government is also making moves to bridge the gap in achieving interoperability. Last week, the Office of the National Coordinator for Health IT released its latest version of standards to promote successful interoperability with the Interoperability Standards Advisory Reference 2019. The reference manual is traditionally how ONC coordinates the identification, assessment, and public awareness of interoperability standards and implementation specifications, encouraging all stakeholders — clinical and research — to use them. ONC also encourages pilot testing of the standards. ON THE RECORD “We see interoperability in action all around us,” said AHA President and CEO Rick Pollack. “Mobile phones can call each other regardless of make, model, or operating system. The hospital field has made good headway, but it’s time to complete the job. We are united in calling for a truly interoperable system that allows all providers and patients to benefit from shared health records and data, leading to fully informed care decisions.” The report was written by America’s Essential Hospitals, the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association of the United States, the Children’s Hospital Association, the Federation of American Hospitals and the National Association for Behavioral Healthcare, and it also names the benefits of fully interoperable data for patients and providers; lists the challenges to getting there and how interoperable records can improve outcomes. Diana Manos is a Washington, D.C.-area freelance writer specializing in healthcare, wellness and technology.  Twitter: @Diana_Manos Email the writer: dnewsprovider@gmail.com  Healthcare IT News is a HIMSS Media publication.   

The theme is how health IT community stakeholders can take advantage of collaboration opportunities with 11 key federal agencies.

How two of today’s biggest health IT trends are driving cultural changes: Big Data and new care delivery models. 

Electronic health records are very good at being repositories for valuable patient data. But they need help when it comes to putting that data to work for more innovative care delivery. The ever-expanding volume and variety of clinical and social-determinant factors will require more advanced technologies to be optimally harnessed for precision medicine. Enter AI and machine learning, which "will play a growing role in healthcare, under two main categories – generating knowledge and processing data," according to Auckland, New Zealand-based Kevin Ross, who will speak next month at HIMSS19. Ross is General Manager at Precision Driven Health, launched as a partnership between Orion Health (where he is Director of Research) and government agencies and academic organisations in New Zealand to explore and promote precision medicine. He sees machine learning as a key enabler in the years ahead as health systems look to unlock the data and in their EHRs and put it to work for more personalised care. "Health records have been electronic – and therefore accessible for analysis – for a relatively short period of time, but we are now seeing huge volumes of data being generated from different sources," he explained. "We've had insufficient computational power to process the volume of data in a genome, let alone a microbiome, etc. until fairly recently." The advent of AI and machine learning opens new avenues for healthcare wisdom to be accrued. Medical research has traditionally come through "targeted studies on narrow subsets of the population," he said, "now we can analyse over large populations in relative real time, because the data is being collected digitally. New knowledge will come about by applying machine learning to these increased data sets to uncover patterns that are occurring today without being noticed." In Orlando, Ross will explain how he and other researchers are making the most of some unique aspects of New Zealand's healthcare landscape – connected electronic healthcare data across the population, leading-edge research organisations – to enable the development of new technologies and data strategies for precision medicine. "New Zealand has some unique benefits, including a long history of digital health records with well managed health ID numbers, so it is a lot easier to link different data sets together," he said. Add to that: Linked data between social services (health, education, justice, welfare, tax) available for research purposes; A single payer system whereby the incentive of patient, provider, and system are typically well aligned (e.g. early intervention benefits all) Willing collaboration between commercial and public provider organisations as well as between clinical and data science researchers A unique ethnic diversity (74 per cent European, 15 per cent Maori, 12 per cent Asian, seven per cent Pacific Islander – including those identifying multiple) A strong data science research community A population relatively comfortable with technology and with broad access

University Hospital Geelong is upgrading its emergency department clinical workflows with the aim of delivering quality, patient-centred clinical care. The healthcare organisation will soon go-live with its new FirstNet ED Information System (EDIS), from Cerner, and replaces the Symphony ED System that it used previously as it is no longer supported in Australia. Cerner FirstNet is an integrated emergency solution that supports a wide range of functions including registration, triage and tracking, checking nursing documentation, managing physician transfer of care, and integration of documentation into a patient's Electronic Health Record (EHR), all in one system. It also lets the healthcare practitioner include and manage a patient’s past medical, family, social or surgical history, in addition to keeping a record of a patient’s transfer movements. Barwon Health Chief Information Officer Associate Professor Sharon Hakkennes told HITNA that Cerner’s emergency information system was picked following a comprehensive procurement process and will be critical in supporting its goals of high-quality, patient-centred clinical care across the entire care continuum into the future. “We have worked closely with Cerner to ensure the system functions with our current workflows and processes,” Hakkennes said. “The switch to FirstNet has required staff training and preparation in order to minimise clinical disruption and maximise the benefits of the new system when we go live.” According to Hakkennes, implementation of FirstNet at the University Hospital Geelong is aligned to Barwon Health’s strategy to implement a fully integrated EHR over the coming years. “The EHR will enable seamless transfer of health information across Barwon Health services, general practice and other health services, and will support upload of information to My Health Record,” Hakkennes said. “The importance of such functionality cannot be underestimated given the growing population of the Barwon region and the increasing burden of chronic disease.” [Read more: Allscripts and Cerner offer glimpses at tech priorities in new earnings reports | Cerner tops the EHR global market share with almost double that of closest rival Epic] Most recently, Bass Coast Health migrated its systems to experience the benefits of a complete EMR solution, having equipped its healthcare facility with MasterCare EMR. The solution will be used by Bass Coast Health clinicians to govern the assessment and management plans of clients, along with the monitoring and measuring of ongoing outcomes. The contract between Cerner and University Hospital Geelong also follows the former’s largest ever EHR undertaking in the US, announcing in October last year that it will support the US Department of Veterans Affairs’ transition from its legacy VistA EHR, alongside 24 vendors.

New Zealand’s largest primary health organisation (PHO), ProCare, has selected Indici after a year-long practice management system (PMS) review. ProCare chief executive Steve Boomer says, “The ProCare PMS review steering group and ProCare Board have reached agreement that Indici is the system best suited to our needs. “However, we cannot recommend this as a preferred system until we have reached a suitable commercial agreement with Valentia Technologies, Indici’s parent company.” Indici was developed by Valentia in conjunction with Ventures, the commercial and innovation arm of Pinnacle Primary Health Network. The cloud-based mobile PMS supports the Health Care Home model of general practice, which is being adopted by PHOs across the country, and involves improving access to care by offering telehealth options for patients. Seven vendors started in the review process and were narrowed down to Indici and US-based Epic in mid-2018. Tū Ora Compass Health, Te Awakairangi Health Network and Central PHO have also committed to rolling out Indici. Valentia president technical services Ahmed Javad says the review was an extremely thorough and well-managed evaluation process. "We are looking forward to completing contractual arrangements and then embarking upon an exciting transformation journey with ProCare member practices," he says. Boomer says the PHO’s members were updated on progress at the end of last year, and are “encouraged to get in touch with us to discuss any specific needs they may have with their PMS”. “We thank the steering group, made up of GPs, practice nurses and managers from our network, for their dedication to the 12-month review process,” he says. “There were many different perspectives provided by steering group members based on their own PMS experiences, all of which contributed to robust discussion and debate before reaching consensus.” Practices in the region predominantly use Medtech or MyPractice systems currently. An industry expert, who asked not to be named, says the decision is a major accomplishment for Indici. He predicted a steady flow of GPs changing systems.  “Practically the change burden around a practice migrating from one PMS to another is a non-trivial undertaking,” he says. This article first appeared on eHealthNews.nz.