Electronic Health Records (EHR, EMR)

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

Executives explain how the developer initiatives work and why they’re fueling innovation and shaping future direction of their platforms.

Former CEO Jonathan Bush could receive $4.8 million if he helps with the sale of the cloud IT company, according to a report that shows Elliott partnering with Bain Capital.

During the Wednesday confirmation hearing, James Gfrerer said he’d also be an advocate for maintaining VistA during the 10-year process to implement the new Cerner EHR.

Hospital chief medical information officers are almost unanimous in recognizing the patient safety improvements that have been brought about by better medication management processes, according to a new poll from their U.S. trade group, the Association of Medical Directors of Information Systems. The results come amid the ongoing opioid epidemic in America. Technology vendors are trying to help in the battle. IT-savvy hospitals such as Intermountain, which has tweaked its Cerner EHR to reduce such prescriptions in the first place, and Ochsner, which has integrated an opioid monitoring tool into its Epic system, are taking matters into their own hands. More and more states, meanwhile, are passing e-prescribing laws and standing up prescription drug monitoring programs. Even with all that going on, there is a lot that can be done to further boost hospital safety initiatives, said AMDIS members, and that depends largely on bigger and better investments in health IT systems for inpatient settings. Nearly all of the physician informaticists surveyed, in a poll sponsored by e-prescribing and med management developer DrFirst, agreed that patient safety issues are less likely to occur today, as compared to five years ago. In large part, that's due to better medication administration processes enabled by technology. Some 82 percent of the CMIOs polled say such initiatives have led to fewer adverse drug events, for instance. That said, many still thought there was big room for improvement in medication management processes, and saw broader tech deployments to be a way to further safeguard their patents. Only half of the AMDIS members polled said they were satisfied their hospitals' processes, and 12 percent said they were dissatisfied. The CMIOs pointed to gaps such as incomplete patient medication histories (80 percent) and misaligned medication reconciliation and care transition cycles that lead to misinformed decisions by care teams (75 percent), according to DrFirst. The AMDIS survey also noted several other areas where bolstered technology infrastructure could improve medication safety surveillance. For instance, 91 percent of CMIOs said one of their biggest challenges was a lack of visibility into their patients' medication adherence: Pharmacies know when a prescription has been filled, but hospitals are often left in the dark. And 85 percent of the clinical informaticists polled pointed to the fact that patients aren't often active participants in the med rec process as a big culprit when when it comes to spotty medication history at their hospitals, suggesting a bigger role for more integrated patient engagement technologies. Meanwhile, large majorities of CMIOs pointed to challenges with interdepartmental workflow variations, and challenges with process buy-in, compliance and ownership as issues that could adversely impact safety. Nearly all of the AMDIS members surveyed said a holistic focus on the entire medication management process was key to building on safety improvements. At the same time, they said reducing order entry and data validation burdens for pharmacy and clinical staff will enhance patient safety and process efficiencies, according to DrFirst. "While the industry has clearly made significant strides to improve medication management processes, CMIOs remain troubled by a number of gaps that compromise patient safety and quality outcomes," said the company's president, G. Cameron Deemer, in a statement. Opioid risks top concern The survey also found a lot of concern among informaticists specifically related to opioid related monitoring gaps. Nearly two-thirds (65 percent) of CMIOs called for more tightly integrated clinician workflows to enable better coordinating the entire medication management process – including electronic prescribing of controlled substances and access to state prescription drug monitoring programs. While PDMPs have their limitations, being able to better discern patients opioid histories and EPCS data could help stem the spread of addiction and avoid harmful drug combinations. And almost half (41 percent) of AMDIS members said they had concerns about hospitals' opioid readiness, given the difficulty to get discern so-called drug shoppers from patients with genuine pain management needs. As we noted earlier this week, several technology vendors are exploring, from different angles, the potential of blockchain to help solve that challenge. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

Our poll results were tight with no clear opinion on whether the EHR project should be put on hold until new IT leadership is in place, but the majority are concerned with the current trajectory.

New HIMSS Media research spotlights what innovations are needed most, top areas hospitals are prioritizing and sticking points to avoid.

The bipartisan legislation would require HHS to work with the private sector to analyze data from payers and pharmacists, flagging patients at risk of overuse based on prescription history.