Health Information Exchange (HIE)

Adopting application programming interfaces enables health information exchanges such as CRISP to more effectively deliver data to hospital and payer members.

Health Catalyst announced a new surveillance module for its Patient Safety Monitor suite that aims to help hospitals protect patient safety by deploying predictive analytics to monitor, predict and prevent inpatient risk. Built atop the Health Catalyst Data Operating System, the new module was developed over two years of intensive and expensive research – nearly $50 million, the company said. It's a trigger-based surveillance system, incorporating predictive algorithms and artificial intelligence, that can spot patterns of harm and offer decision support to address potential hazards. By combining text analytics and near real-time data from multiple sources, the technology can detect safety risk for inpatients. Health Catalyst noted that the standard approach of manual reporting of hospital safety events, often using data that is at least 30 days old, reportedly finds less than 5 percent of all-cause harm. Meanwhile many electronic health records and data warehouses have drawbacks of their own, missing the AI capabilities that could enable wider surveillance. Many hospitals, therefore, are limited in their approach to patient safety, using point solutions focused on specific risks, rather than whole-person safety. As part of its patient safety efforts, Health Catalyst has applied for certification as a Patient Safety Organization with the Agency for Healthcare Research and Quality. If approved, the Health Catalyst PSO will offer an environment where hospital clients can collect and analyze patient safety events from their EHRs to learn and improve, the company said. The surveillance technology release comes on the heels of Health Catalyst completing the acquisition of Medicity from Aetna to expand its footprint in the outpatient space and combine analytics with HIE. The merger adds Medicitiy's 75 health system clients, with more than 1,000 hospitals and 185,000-plus physicians, in addition to nearly two-dozen HIEs as well as payers and employers. In an interview, Health Catalyst CEO Dan Burton said the company will leverage Medicity’s data sets and transactional capabilities to complement its own analytics tools and help its clients maker smarter, data-driven decisions to enable value-based care. "We've amassed a big data set focused more on the acute care setting, which is were we grew up, whereas Medicity has strong transactional capabilities that are really a complement to our analytics space capabilities, and they're more ambulatory focused," Burton said. By adding Medicity's technology, Health Catalyst expands its reach beyond its existing client base of 400 hospitals and 4,000 ambulatory sites, bringing real-time analytics right to the workflow inpatient and outpatient EHRs, he said. "Clinically integrated networks and others have rightly noted a gap in Health Catalyst's experience set with real-time transactional capabilities," said Burton. "Offering that data exchange capability, in-depth, is not something we've had a great answer for." Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

Tech initiative enables hospitals across the Carolinas to build apps that merge patient records.

SAN DIEGO - Atul Gawande, MD, addressed a range of topics concerning the direction healthcare needs to move at America's Health Insurance Plans Institute & Expo Thursday.  Gawande took the AHIP stage a day after Amazon, Berkshire Hathaway and JPMorgan Chase announced that he will take the helm at their venture, an independent entity free from profit-making incentives based in Boston. It's "the day after the venture was announced," Gawande said. "It will take on greater significance. I'm delighted that's true." Susan Denzer, CEO of the Network for Excellence in Health Innovation at AHIP, asked about his future plans.  "At this point I can only think about this new job I'm taking on," Gawande answered. "I  can only say it's a long target … over the next decade it will be a gradual progress, it won't be instant solutions." The exact nature of the new healthcare company has yet to be announced, but Gawande confirmed that the venture will be an insurer for the million-plus employees of Amazon and partners. "I feel incredibly lucky in this role," Gawande said. "I will get a million new patients." While he didn't say more than that, Gawande also illuminated some of the issues healthcare is currently struggling with and said caregivers need to ask more questions of patients.  Gawande, who among his many titles as surgeon, public health researcher and author, said when he thinks about what he wants to accomplish on the writing side, he thinks about connections, "understanding the aspirations of how lives should go, and the reality." The reality is that care, especially end-of-life care and how physicians treat serious and life-limiting illnesses does not always fulfill or align with the patient's desire for quality of life at the end of life. Unnecessary tests and treatments waste about 30 percent of healthcare spending, and these interventions often do more harm than good. An estimated 45 percent of Medicare patients get EKGs, CT Scans, MRIs, have a stent placed or receive other procedures without good reason, Gawande said.  Physicians offer options to patients, but don't always ask what the individual wants to achieve by treatment. Doctors must be more than technicians, he said. "The goal of the healthcare system is not survival at all costs," he said. "The goal is a good life as you define it. We've never even asked what that means." Patients need to be asked, Gawande said, what they consider worthwhile living, what are the tradeoffs they're willing to make for more time, what is their minimum quality of life?  When Gawande asked this question of one patient, the reply was, eating chocolate ice cream and the ability to watch football. Gawande reported his own experience with his mother at a rural hospital in Ohio where he grew up. His mother was a pediatrician; his father a surgeon. His mother had a fainting episode and the ambulance took her to the emergency room where physicians performed an ultrasound for a carotid artery. They found nothing and put her on a helicopter to a larger hospital. At 11 p.m., laid out flat in the ER, a doctor finally asked her what exactly happened with the fainting episode. It turned out she had started on an increased dose of blood pressure medicine that morning, went for a walk and felt faint. "She was dehydrated," Gawande said. "It took all of that to figure it out." Another person he called the father of his friend Bruce fainted, but this individual had end stage renal disease and was on dialysis. His artery was 99 percent blocked. The physician said they needed to do surgery to clean out the artery and do a cardiac bypass operation.  "Here's a guy who's on the edge of not being independent anymore," Gawande said. They wanted to do two procedures to address future problems.  "The benefit is in years to come. You don't need AI to determine the benefit, it's 15 years before he a sees benefit. None of it was discussed." Bruce's father came out of surgery with a stroke, paralyzed one side of his body and was unable to speak. The man died six months later in a facility. Bruce's dad never got the right care for a chronically ill person, said Gawande, who interviewed 200 people with serious conditions and their family members. None had been asked what they wanted to achieve.  "It's shocking to me we've not understood it," he said. "People have priorities besides just living longer. We need to learn what their priorities are for life, we have to ask them. But we don't ask."  Where this model has been deployed, when physicians do ask, it reduces cost and actually increases life expectancy, he said. Healthcare has the education and the science. It now needs a better delivery system. "Precision medicine has to be matched by precision delivery," he said. "We're still in a stage of primitive thinking in how we create delivery."  After five years of work in South Carolina using this approach, physicians have reduced the death rate by 22 percent. At Dana Farber in Boston, more than 90 percent of clinicians now ask questions of chronically ill patients months, not weeks prior to end of life. "When we ask, what is the goal of our care, we still don't have an answer to that," he said. "What is our goal when health and independence isn't possible anymore?" Having health insurance has been found to help the health of patients and has shown a 5 percent reduction in mortality over five years. There cannot be exclusions for pre-existing conditions and coverage can't just be catastrophic care.  There's been enormous amount of investment in discoveries, but only now is healthcare looking at the social environment of isolation, food insecurity and the other social determinants of health. "The genetic code is not as powerful as your zip code," Gawande said. In Boston, when investments were made in housing rather than in shelter beds, treatment improved for chronic conditions and that, in turn, reduced costs. "We will come to a place where we can generate scalable solutions to change the practice of medicine," Gawande said. "It's a long road. It's cleary possible." Twitter: @SusanJMorse Email the writer: susan.morse@himssmedia.com

The database will help EHR vendors incorporate health IT standards to smooth the exchange of patient information across care settings.

It doesn’t need express written consent to use the technology for “essential” alerts, the HIE’s CEO explains, and the result is better care.

A new report from KLAS shows NHS data sharing to be cumbersome and disruptive to clinical workflows.

eHealth Exchange will become both a member of Carequality and an implementer of its standards, helping expand its presence to other participants.

AHIMA, CHIME, HIMSS and others say lack of support for a nationwide patient identity strategy has stymied innovation, cost hospitals revenue and put patient safety at risk.

The network also noted a big uptick in e-prescribing, with 77 percent of all prescriptions now delivered electronically, including a substantial increase in EPCS.