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The More Hospital IT Changes, The More It Remains The Same

Posted on June 23, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Once every year or two, some technical development leads the HIT buzzword list, and at least at first it’s very hard to tell whether that will stick. But over time, the technologies that actually work well are subsumed into the industry as it exists, lose their buzzworthy quality and just do their job.

Once in a while, the hot new thing sparks real change — such as the use of mobile health applications — but more often the ideas are mined for whatever value they offer and discarded.  That’s because in many cases, the “new thing” isn’t actually novel, but rather a slightly different take on existing technology.

I’d argue that this is particularly true when it comes to hospital IT, given the exceptionally high cost of making large shifts and the industry’s conservative bent. In fact, other than the (admittedly huge) changes fostered by the adoption of EMRs, hospital technology deployments are much the same as they were ten years ago.

Of course, I’d be undercutting my thesis dramatically if I didn’t stipulate that EMR adoption has been a very big deal. Things have certainly changed dramatically since 2007, when an American Hospital Association study reported that 32% percent of hospitals had no EMR in place and 57% had only partially implemented their EMR, with only the remaining 11% having implemented the platform fully.

Today, as we know, virtually every hospital has implemented an EMR integrated it with ancillary systems (some more integrated and some less).  Not only that, some hospitals with more mature deployments in place have used EMRs and connected tools to make major changes in how they deliver care.

That being said, the industry is still struggling with many of the same problems it did in a decade ago.

The most obvious example of this is the extent to which health data interoperability efforts have stagnated. While hospitals within a health system typically share data with their sister facilities, I’d argue that efforts to share data with outside organizations have made little material progress.

Another major stagnation point is data analytics. Even organizations that spent hundreds of millions of dollars on their EMR are still struggling to squeeze the full value of this data out of their systems. I’m not suggesting that we’ve made no progress on this issue (certainly, many of the best-funded, most innovative systems are getting there), but such successes are still far from common.

Over the longer-term, I suspect the shifts in consciousness fostered by EMRs and digital health will gradually reshape the industry. But don’t expect those technology lightning bolts to speed up the evolution of hospital IT. It’s going take some time for that giant ship to turn.

The Important Role of HIM in Healthcare Cybersecurity – HIM Scene

Posted on June 21, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Healthcare organizations that rely on their CSO (Chief Security Officer) to handle cybersecurity in their organizations always annoy me. Cybersecurity requires everyone at the organization to be involved in the effort. One person can have a large influence, but your healthcare organization will never be secure if you don’t have everyone working their best to ensure your organization is secure.

A great example of someone who’s often forgotten in healthcare cybersecurity efforts are HIM professionals. Organizations that do this, do so at their own peril. If you’re not involving your HIM professionals in your cybersecurity efforts, I exhort you to do so today.

One of the best reasons to involve HIM professionals in your security efforts is that they’re often experts on the patchwork of healthcare privacy and security laws. It’s not enough to just ensure you’re being HIPAA compliant. That’s essential, but not sufficient.

Healthcare privacy and security are so important, there are multiple layers of laws trying to protect your health information. Or maybe the laws just aren’t well planned and that’s why we have so many. I’ll let you decide. Either way, in your privacy and security efforts you’re going to need to know HIPAA, HITECH, MACRA, and of course don’t forget the state specific privacy and security laws. No doubt there are more and your HIM professionals are likely some of the people in your organization that knows these laws the best.

Beyond the fact that HIM professionals know the privacy and security laws, HIM professionals are usually well versed in ensuring the right access to the right information in your system. One of the biggest form of breaches is internal breaches from people who were given the wrong permissions on your IT systems.

Making sure someone is auditing and monitoring these permissions is a very important part of your cybersecurity efforts. Plus, don’t forget to have a solid process for removing users when they leave your organization as well. Those zombie user accounts are a ticking time bomb in your security efforts. When your employees verify that their records are in order before they leave with HIM, that might be a good time to remove their access.

Another place HIM professionals can help with healthcare cybersecurity efforts is around information governance. More specifically, HIM can help you properly manage your health data and legacy systems. HIM can ensure that your legacy systems are properly managed until their end of life. No doubt this will be done in tandem with your IT professionals who have to keep these legacy systems secure (not always an easy task). However, an HIM professional can assist with your information governance efforts that impact cybersecurity.

In what other ways can HIM be involved in healthcare cybersecurity?

Cybersecurity is always going to be a team effort. That’s why it’s shocking to me when healthcare organizations don’t involve every part of their team. HIM professionals should step up and make the case for why they should be involved in healthcare’s cybersecurity efforts. However, when they don’t, a great leader will make sure HIM is involved just the same.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

We Can’t Afford To Be Vague About Population Health Challenges

Posted on June 19, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today, I looked over a recent press release from Black Book Research touting its conclusions on the role of EMR vendors in the population health technology market. Buried in the release were some observations by Alan Hutchison, vice president of Connect & Population Health at Epic.

As part of the text, the release observes that “the shift from quantity-based healthcare to quality-based patient-centric care is clearly the impetus” for population health technology demand. This sets up some thoughts from Hutchison.

The Epic exec’s quote rambles a bit, but in summary, he argues that existing systems are geared to tracking units of care under fee-for-service reimbursement schemes, which makes them dinosaurs.

And what’s the solution to this problem? Why, health systems need to invest in new (Epic) technology geared to tracking patients across their path of care. “Single-solution systems and systems built through acquisition [are] less able to effectively understand the total cost of care and where the greatest opportunities are to reduce variation, improve outcomes and lower costs,” Hutchison says.

Yes, I know that press releases generally summarize things in broad terms, but these words are particularly self-serving and empty, mashing together hot air and jargon into an unappetizing patty. Not only that, I see a little bit too much of stating as fact things which are clearly up for grabs.

Let’s break some of these issues down, shall we?

  • First, I call shenanigans on the notion that the shift to “value-based care” means that providers will deliver quality care over quantity. If nothing else, the shifts in our system can’t be described so easily. Yeah, I know, don’t expect much from a press release, but words matter.
  • Second, though I’m not surprised Hutchison made the argument, I challenge the notion that you must invest in entirely new systems to manage population health.
  • Also, nobody is mentioning that while buying a new system to manage pop health data may be cleaner in some respects, it could make it more difficult to integrate existing data. Having to do that undercuts the value of the new system, and may even overshadow those benefits.

I don’t know about you, but I’m pretty tired of reading low-calorie vendor quotes about the misty future of population health technology, particularly when a vendor rep claims to have The Answer.  And I’m done with seeing clichéd generalizations about value-based care pass for insight.

Actually, I get a lot more out of analyses that break down what we *don’t* know about the future of population health management.

I want to know what hasn’t worked in transitioning to value-based reimbursement. I hope to see stories describing how health systems identified their care management weaknesses. And I definitely want to find out what worries senior executives about supporting necessary changes to their care delivery models.

It’s time to admit that we don’t yet know how this population health management thing is going to work and abandon the use of terminally vague generalizations. After all, once we do, we can focus on the answering our toughest questions — and that’s when we’ll begin to make real progress.

Educational EHRs – A Void that Needs to Be Filled?

Posted on June 16, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

Last week I had my eyes opened to the issue of EHRs in medical education at the #eHealth2017 conference in Toronto. Prior to last week, I had assumed medical schools in North America had incorporated EHRs into their curriculums a long time ago. I learned my lesson (excuse the pun) after attending a breakout session on the use of #HealthIT in medical education.

Lynn Nagel RN, PhD, assistant professor at the University of Toronto in nursing, gave me my first shock when she told the story of how no one raised their hands when she asked her final-year nursing class who had used an actual EHR before. My jaw hit the floor. This would be akin to a class of accountants who had never used a spreadsheet before or computer science majors who had never used a tablet before.

Nagel was not surprised to learn that there simply wasn’t any room for EHR training in the nursing school’s curriculum. Plus, there was a belief by the professors that the healthcare institutions would train these newly minted nurses how to use their EHR.

Later in the session Gurprit Randhawa, Manager of EHR Adoption, Use, Research & Development at Island Health in Victoria BC, told the story of recently graduated physicians who had been given minimal exposure to EHRs (less than 5hrs total).

Randhawa spoke about how she watched these new graduates struggle with actual patient encounters – not knowing whether to face the screen or the patient or both. The new physicians also did not know what to enter in the various fields and were confused over what to record in their clinical notes. Randhawa elicited a round of laughter when she talked about one physician who complained that he thought EHRs all came with a Siri-like interface so that doctors could just dictate their notes to the system.

Later in her presentation Randhawa spoke about how the institution eventually adopted an EHR to help acclimate medical students to the “real world”. They chose an EHR based on the US Vista system and it was well received by medical students.

Randhawa made specific mention of how lucky the medical school was in their choice of EHR. Not only did the vendor provide reliable technical support to the school’s IT department, they also took support calls from students free of charge (and often in the middle of the night before an assignment was due).

Cost, maintenance and support for the EHR are significant considerations for educational institutions, especially given their limited IT resources. Implementing a fully functional EHR is simply not an option.

In the Q&A scrum at the end of the breakout session, I listened to a former medical professor (now consultant) talk about the early days of EHRs and how they used the production system from their institution’s medical center to teach students. Although this provided the advantage of being “real-world”, it was difficult to find actual patient use-cases that matched the clinical criteria they were attempting to teach – partly because EHRs at the time lacked adequate search tools. This professor also mentioned how some of the health records used in class were a bit “too real” as the notes were rife with spelling mistakes, dosages in the notes that didn’t match actual prescribed medications and sometimes personal comments from the attending physicians.

Using actual patient data in an educational setting also raised privacy concerns. I can imagine that in some cases, patients were not made aware that their data could be used in this fashion.

In 2014 a study was published in the American Journal of Medicine that tracked 3rd year medical students and their use of EHRs. The study concluded that there was no correlation between EHR usage and academic performance, however, the early exposure to EHRs was deemed to influence attitudes and habits related to the technology as the students became physicians.

Despite the potential impact of the EHR on educational outcomes, no correlation could be identified between EHR use and clerkship performance. These findings suggest that EHR use habits may be learned early in medical training and certain specialties are more prone to increased screen time. More attention should be directed towards the interface between medical students and the EHR. Their experiences with the EHR during these earlier stages of training are likely to influence attitudes and habits later on as physicians.

One interesting solution to the educational EHR challenge is the Regenstrief EHR Clinical Learning Platform which features more than 11,000 clinically accurate but misidentified medical records. This EHR is the result of a collaboration between the Regenstrief Institute (associated with the Inidana University School of Medicine) and the American Medical Association. This EHR is designed specifically for the education of students.

As with everything in healthcare, the use of EHRs in medical education is a multi-faceted challenge. Although the answer seems obvious (teaching EHRs help prepare students for the reality of healthcare), the implementation of the solution is not straight-forward. Will the vendor support educational institutions and the students themselves? Will the cost to install and maintain the education EHR be within the means of the institution? Will the EHR itself be easy enough for students to use?

That last question was the most memorable moment of the #eHealth2017 breakout session. At the end of Randhawa’s presentation she flashed up a slide with student reactions to using an EHR as part of their course. Take a look at the comment on the right.

Since the goal of education is to prepare students for the real world, a sub-optimal EHR experience is about as real-world as it gets.

A Look Into the Future of HIM with Rita Bowen – HIM Scene

Posted on June 14, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

One of my favorite people in the HIM world is Rita Bowen. She is currently Vice President, Privacy, Compliance and HIM Policy at MRO, but she has a really impressive HIM resume previous to MRO and a deep understanding of the evolution of HIM and their role in healthcare.

With this experience in mind, I was excited to interview her on the current state of HIM and where HIM is heading in the future. Here are the list of questions I asked Rita if you want to skip to a specific question or you can just watch the full video interview embedded at the bottom of this post.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

Genomics is Going to Really Blow Up Our Interoperability Issues

Posted on June 12, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I slipped over to the Precision Medicine Summit in Boston that’s hosted by HIMSS Media. I heard some good speakers which I’ll write about in the future including legal issues related to genomics and gene editing. However, this tweet from the conference really stuck with me:

This is a sad example of the reality of healthcare interoperability today. Healthcare organizations have problems even sharing something as standard and simple as a PDF. Once we have real genomic data and the markers behind them, EHRs won’t have any idea how to handle them. We’ll need a whole new model and approach or our current interoperability problems will look like child’s play.

By the time we figured that out, our proverbial child might be graduating high school.

Talking Secure Healthcare Communication with Telmediq Founder and CEO

Posted on June 9, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve had a keen interest in the secure text message space ever since I started advising a company in the space many years ago. That company has since been acquired, but I’ve still been keeping watch over the secure text message market. Even back in the early days, we knew that the real holy grail of secure text was to integrate with the EHR and other applications and become a full communication suite and not just a simple text message platform. However, it would take time to really get there. What’s exciting is that we’re starting to see companies that are finally getting there.

One company that’s been making great progress in this direction is a company called Telmediq. Unlike most secure text message companies who started with the physicians, Telmediq approached the secure healthcare communication problem initially from the perspective of nurses. This together with a number of their integrations with EHR and other hospital IT systems prompted me to sit down with Ben Moore, Founder and CEO at Telmediq to learn more about their company and the evolving healthcare communication market.

If you’ve never heard about Telmediq or if you’re interested in what’s happening in the healthcare communication space now and where it’s heading in the future, then you’ll enjoy our interview with Ben Moore. We cover a lot of ground including things like EHR integration, voice integration, alert fatigue, hands free communication, and future items we’re just starting to see like AI and chatbots.

Enjoy our interview with Ben Moore, Founder and CEO at Telmediq:

Cloud – Biggest Health IT Myths

Posted on June 7, 2017 I Written By

David Chou is the Vice President / Chief Information & Digital Officer for Children’s Mercy Kansas City. Children’s Mercy is the only free-standing children's hospital between St. Louis and Denver and provide comprehensive care for patients from birth to 21. They are consistently ranked among the leading children's hospitals in the nation and were the first hospital in Missouri or Kansas to earn the prestigious Magnet designation for excellence in patient care from the American Nurses Credentialing Center Prior to Children’s Mercy David held the CIO position at University of Mississippi Medical Center, the state’s only academic health science center. David also served as senior director of IT operations at Cleveland Clinic Abu Dhabi and CIO at AHMC Healthcare in California. His work has been recognized by several publications, and he has been interviewed by a number of media outlets. David is also one of the most mentioned CIOs on social media, and is an active member of both CHIME and HIMSS. Subscribe to David's latest CXO Scene posts here and follow me at Twitter Facebook.

If you like CXO scene, you can subscribe to future Health Care CXO Scene posts here or read through the CXO Scene archive.

So many companies are now embracing the reduced costs and agility that come with moving their data to the cloud. However, there are still so many contradictory opinions regarding which is a safer way of storing company data – on-premise storage or cloud storage? In view of this, we are going to start by dispelling the biggest IT myths that are making their rounds on the internet.

By moving your data to the cloud, you will have zero control over your technology

The fact is that by moving your data to the cloud, you can meaningfully reduce the pains and resources spent to continually upgrade software and maintain hardware. Your IT personnel can now focus on the primary business by improving operations instead of focusing on ‘Mr. Fix it’ services. Instead of a company spending a bigger chunk of its budget on expensive servers for workload and email storage, adopting the cloud can help them focus on their business strategy and support their core business in a more flexible and dynamic fashion that allows for quick responses to situations.

Storing data on premise is way safer than cloud storage

Security is principal for any business. A security breach could not only sell your trading secrets to your competitors, but it could potentially bring down your entire site and cause you to lose a lot of revenue and customer trust. It’s therefore a no brainer that the security of your business is one of the greatest concerns, especially when considering cloud storage.

With technology evolving every passing day, security has transformed into a full-time job that requires a full team of security professionals who often command handsome salaries that many businesses can’t afford. By working with a reputable cloud-based company, you get to gain first class access to one of the best security any money can buy for your business.

Cloud storage offers security against both digital and physical attacks. Additionally, most of today’s tech providers have moved to the cloud meaning we are going to see more and more innovations happening in the cloud, and you don’t want your business left out.

One thing that most people who are so against the cloud don’t consider is the fact people are the greatest security weakness of all. Every security breach is instigated by a person, and the good thing about the cloud is that it uses the latest technological developments to eliminate the need for people to man the security system.

You won’t be able to monitor your data’s sovereignty once you move to the cloud

Legally speaking, the physical location of your company can command where your business data is going to be held. For example, all public companies in Europe are required by law to store their corporate data in the European Union. This is not something that you need to worry about concerning the cloud. Most cloud providers today offer a vast range of data locations meaning you can always access one no matter where your company is located. Though sovereignty shouldn’t be any problem for you, you need to do your due diligence to ensure you remain on the right side of the law.

Moving to the cloud means you are going to have to move everything which could be very disruptive

When you start seriously considering moving vast amounts of your company’s data to the cloud, it’s easy to see why you could see it as a challenge. However, as with any change you are ever going to make in your company, you should take it slow to ensure you understand how the cloud truly works. Additionally, you and your employees will still feel like you are in control especially if you are so used to network based storage.

Now that we’ve got the myths dispelled, it’s time to seriously consider moving to the cloud. While on-premise storage is still a common phenomenon in most business, it’s not easy to ignore the fact that it is labor intensive, costly, uses a lot of energy and there’ still a chance that an insider can breach your security.

Cloud storage spells out so many more benefits aside from security. Time for you to keep up with the trend and move to the cloud.  I love it when I hear the traditional IT leader defend the position on why they want to build infrastructure and a data center, I guess the key phrase for them is Career Is Over (AKA CIO).

If you’d like to receive future health care C-Level executive posts by David in your inbox, you can subscribe to future Health Care CXO Scene posts here.

VA (Veteran’s Administration) Chooses Cerner EHR

Posted on June 5, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Some really big news just dropped from the VA Secretary, Dr. David J. Shulkin, that the VA has selected Cerner as their EHR replacement to VistA. You can see the full press release at the bottom of this email which outlines the VA Secretary’s reasoning for going with Cerner and the expedited process.

Without getting too much into the details of government procurement, the VA secretary has decided to use a “Determination and Findings” or “D&F” that allows him to avoid the government requirement for a full and open EHR selection and instead be able to solicit the EHR from Cerner directly. I’m pretty sure this will have many of the VistA and even the Epic people up in arms. We may even see some lawsuits out of it, but I don’t expect they’ll go anywhere. Of course, I think most of the VistA people knew this was coming ever since the VA secretary said they’d be pursuing a commercial EHR.

I think most people in the industry thought that the VA would and should go with Cerner for their EHR once the DoD chose Cerner and has since started implementing the Cerner Millennium EHR in what is now known as MHS GENESIS. The only naysayers suggested that the VA might choose Epic over Cerner just because they wanted to be different. That always seemed like a bit of a stretch to me, but it is government and so you can never know what to expect.

You can read the full press release below, but the reasons for choosing Cerner are pretty clear. The release does say that the VA will have its own instance of Cerner. So, they’ll still have to build interoperability between the DoD implementation of Cerner and the VA implementation of Cerner. This isn’t really a surprise when you think about their unique needs and the size of their implementations. Watch for the Cerner interoperability chart to go through the roof once they start sharing records between the DoD and VA.

I also found it interesting to note that the VA has a lot of community partners who are on other EHR platforms. We’ll see how interoperability goes for them. I expect they’ll likely use the standard interoperability options that are out there today.

The VA Secretary did note the concern of many VistA users when he said that “In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work. And our work will help DoD in turn.” I know many VistA fans who suggested that Cerner and Epic were way behing VistA in many areas and so moving to either commercial EHR would be a frustrating thing for many VA VistA users. We’ll see how well the VA Secretary can incorporate their current IT innovation into Cerner. I expect this will be an extremely hard challenge.

Not being an expert on government procurement, I’m interested to know how the VA will handle the rest of the procurement process. If you remember, the DoD’s massive EHR contract was really led by Leidos and not Cerner. Of the $9 billion contract, there were estimates that Cerner would only see $50-100 million per year of the $9 billion. The VA announcement only talks about a contract with Cerner for their EHR. Will they have to do an open bid process for all the services that Leidos and their rainbow of other partners are providing the Cerner DoD implementation?

Those are some initial high level views on this big announcement. What do you think of the announcement? Any other details I missed? Any other questions you have about it?

VA Press Release on Selection of Cerner EHR:

Today U.S. Secretary of Veterans Affairs Dr. David J. Shulkin announced his decision on the next-generation Electronic Health Record (EHR) system for the Department of Veterans Affairs (VA) at a news briefing at VA headquarters in Washington.

Secretary Shulkin’s full statement is below.

I am here today to announce my decision on the future of the VA’s Electronic Health Record system, otherwise known as EHR.

I wanted to say at the outset that from the day he selected me for this position, the President made clear that we’re going to do things differently for our Veterans, to include in the area of EHR.

I had said previously that I would be making a decision on our EHR by July 1st, and I am honoring that commitment today.

The health and safety of our Veterans is one of our highest national priorities.

Having a Veteran’s complete and accurate health record in a single common EHR system is critical to that care, and to improving patient safety.

Let me say at the outset that I am extremely proud of VA’s longstanding history in IT innovation and in leading the country in advancing the use of EHRs.

  • It was a group of courageous VA clinicians that began this groundbreaking work in the basements of VA’s in the 1970’s that led to the system that we have today, known as the Veterans Health Information Systems and Technology Architecture, or VistA.
  • It has been this system that led to the incredible achievements made by VA clinicians and researchers and resulted in VA’s ability to perform as well or better than the private sector in patient safety and quality of care.

That said, our current VistA system is in need of major modernization to keep pace with the improvements in health information technology and cybersecurity, and software development is not a core competency of VA.

I said recently to Congress that I was committed to getting VA out of the software business, that I didn’t see remaining in that business as benefitting Veterans.  And, because of that, we’re making a decision to move towards a commercial off-the-shelf product.

I have not come to this decision on EHR lightly.

I have reviewed numerous studies, reports and commissions, on this topic, including the recent commission on care report.

  • I’ve spent time talking with clinicians, and I use our legacy VistA system myself as a current practicing VA physician.
  • We have consulted with Chief Information Officers from around the country, and I’ve met personally with CEO’s from leading health systems to get their own thoughts on the best next-generation EHR for VA.
  • We’ve studied reports from management consulting companies and from the GAO and the IG on VA’s IT systems.
  • I can count no fewer than 7 Blue Ribbon Commissions, and a large number of congressional hearings that have called for VA to modernize its approach to IT.

At VA, we know where almost all of our Veteran patients is going to come from — from the DoD, and for this reason, Congress has been urging the VA and DoD for at least 17 years — from all the way back in 2000 — to work more closely on EHR issues.

To date, VA and DoD have not adopted the same EHR system. Instead, VA and DoD have worked together for many years to advance EHR interoperability between their many separate applications — at the cost of several hundred millions of dollars — in an attempt to create a consistent and accurate view of individual medical record information.

While we have established interoperability between VA and DOD for key aspects of the health record, seamless care is fundamentally constrained by ever-changing information sharing standards, separate chains of command, complex governance, separate implementation schedules that must be coordinated to accommodate those changes from separate program offices that have separate funding appropriations, and a host of related complexities requiring constant lifecycle maintenance.

And the bottom line is we still don’t have the ability to trade information seamlessly for our Veteran patients and seamlessly execute a share plan of acre with smooth handoffs.

Without improved and consistently implemented national interoperability standards, VA and DoD will continue to face significant challenges if the Departments remain on two different systems.

For these reasons, I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium.

VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems.

It’s time to move forward, and as Secretary I was not willing to put this decision off any longer.  When DoD went through this acquisition process in 2014 it took far too long.  The entire EHR acquisition process, starting from requirements generation until contract award, took approximately 26 months.

We simply can’t afford to wait that long when it comes to the health of our Veterans.

Because of the urgency and the critical nature of this decision, I have decided that there is a public interest exception to the requirement for full and open competition in this technology acquisition.

Accordingly, under my authority as Secretary of Veterans Affairs, I have signed what is known as a “Determination and Findings,” or D&F, that is a special form of written approval by an authorized official that is required by statute or regulation as a prerequisite to taking certain contract actions.

The D&F notes that there is a public interest exception to the requirement for full and open competition, and determines that the VA may issue a solicitation directly to Cerner Corporation for the acquisition of the EHR system currently being deployed by DoD, for deployment and transition across the VA enterprise in a manner that meets VA needs, and which will enable seamless healthcare to Veterans and qualified beneficiaries.

Additionally we have looked at the need for VA to adopt significant cybersecurity enhancements, and we intend to leverage the architecture, tools and processes that have already been put in place to protect DoD data, to include both physical and virtual separation from commercial clients.

This D&F action is only done in particular circumstances when the public interest demands it, and that’s clearly the case here.  Once again, for the reasons of the health and protection of our Veterans, I have decided that we can’t wait years, as DoD did in its EHR acquisition process, to get our next generation EHR in place.

Let me say what lies ahead, as this is just the beginning of the process.

  • VA has unique needs and many of those are different from the DoD.
  • For this reason, VA will not simply be adopting the identical EHR that DoD uses, but we intend to be on a similar Cerner platform.
  • VA clinicians will be very involved in how this process moves forward and in the implementation of the system.
  • In many ways VA is well ahead of DoD in clinical IT innovations and we will not discard our past work.  And our work will help DoD in turn.
  • Furthermore VA must obtain interoperability with DoD but also with our academic affiliates and community partners, many of whom are on different IT platforms.
  • Therefore we are embarking on creating something that has not been done before — that is an integrated product that, while utilizing the DoD platform, will require a meaningful integration with other vendors to create a system that serves Veterans in the best possible way.
  • This is going to take the cooperation and involvement of many companies and thought leaders, and can serve as a model for the federal government and all of healthcare.

Once again, I want to thank the President for his incredible commitment to helping our Veterans and his support for our team here at the VA as we undertake this important work.

This is an exciting new phase for VA, DOD, and for the country.  Our mission is too important not to get this right and we will.

How Many Platforms Does Each Hospital Own?

Posted on June 2, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently thinking about how nearly every healthcare IT company I talk to today has some sort of platform. Yes, even our beloved EHR vendors (or not so beloved) often talk about their EHR system as an EHR platform. Is there anything that’s implemented in healthcare IT today that’s not a platform? Everything seems to be a platform these days.

If they have hundreds of health IT systems, then they have hundreds of platforms.

Given this is the case, are they really all platforms? Do we need all of these platforms? Has the word platform just been corrupted and really doesn’t have any meaning any more?

I wonder if hospital CIOs now would be interested in purchasing a piece of healthcare IT software that wasn’t a platform. Would it be better to market a healthcare IT software product as a solution rather than a platform? I’m guessing that most hospital CIOs probably feel like they have plenty of platforms. Am I wrong?

I should be clear. I think the idea of creating a platform with something is a good thing. At least it’s a good thing if you define a platform as something that connects and integrates with other systems and software. This would be a good trend in healthcare since so many so called platforms were at best very closed platforms and at worst not platforms at all. If platform would be defined as being open and interoperable, then I would welcome all these platforms with open arms.

The problem is that I think many healthcare IT vendors (EHR vendors leading this charge) look at their platform as a way to entrench the customer with them. They want to create the end all be all platform that all of a hospital’s future healthcare IT purchases need to integrate with the hospital. This is where the platform idea can fall flat when it comes to health IT customers and patients.

I love a good platform as much as the next person. It’s a powerful way to do business and can really do amazing things to improve the care a patient receives and how efficient a healthcare organization can operate. However, once everything says their a platform it loses meaning. I think we’ve reached that point with the word platform.