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EMR Replacement & Migration Perspective: Tim Schoener, VP/CIO, UPMC Susquehanna

Posted on December 8, 2016 I Written By

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In the midst of a merger with a major Pennsylvania healthcare organization, Tim Schoener is wholly focused on EHR transition. He outlines Susquennaha’s plan for each aspect of transition, offering innovative and unique approaches to each. In addition, Schoener provides cogent insights regarding the intricacies involved with a multi-database system, the expenses associated with archival solutions, and the challenges associated with migrating records. This interview touches on many of the considerations necessary for a successful EHR transition as Schoener discusses minimizing surprises during a transition; why migrating a year’s worth of results is optimal; and how their document management system fulfills archival needs.

CHIME Fall CIO Forum provides valuable education programming, tailored specifically to meet the needs of CIOs and other healthcare IT executives. Justin Campbell, of Galen Healthcare Solutions, had the opportunity to attend this year’s forum and interview CIOs from all over the country. Looking for additional EMR replacement perspectives & lessons learned? View a recent panel where HCO leaders discussed their experiences with EHR transition, data migration & archival.

KEY INSIGHTS

Absolutely, we have problem lists that can’t be reconciled; there’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all.

We’re being told, if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.

Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

Let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move.

It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare.

CHIME is a great way to challenge yourself as a CIO and in your leadership. It pushes me in my leadership skills and helps to focus me back to what’s critical in the industry.
tim-schoener
Campbell: Tell me a little about yourself and your organization’s initiatives

Schoener: I’m Tim Schoener, the VP/CIO of, originally Susquehanna Health, which, as of October 1st, is now a part of the University of Pittsburgh Medical Center (UPMC) and re-named to UPMC Susquehanna. We’re located in central Pennsylvania, four hours away from Pittsburgh.

A major IT initiative for us is that we’re swapping out our EMR over the next couple of years. We are currently a Cerner Soarian customer. In fact, we were the initial Soarian beta site for Financials and second for Clinicals. We determined we eventually need to migrate to something else – that’s an Epic or Cerner decision for us at this point. UPMC’s enterprise model is Cerner and Epic, Cerner on the acute care side and Epic on the ambulatory side. As of this writing, we’ve made the decision to migrate to the UPMC blended model. Over the past nine months we’ve been focused on an EMR governance process, trying to get our team aligned on the journey that we’re about to take and by late next year we will likely be starting an implementation.

We currently leverage NextGen on the Ambulatory side, with approximately 300 providers that use that software product. We’re a four hospital system: two of which are critical access, one which is predominately outpatient, and the other a predominately inpatient facility. We were about a $600MM organization prior to our UPMC acquisition.

Campbell: Related to your current implementation, tell me a little bit about your data governance strategy and dictionary mapping that may occur between NextGen and Soarian.

Schoener: We definitely have a lot of interfaces, a lot of integration between the two core systems. From an integration perspective, we have context sharing, so physicians can contextually launch and interoperate from NextGen to Soarian, and vice-versa. We do pass some data back and forth—allergies and meds can be shared through a reconciliation process—but we certainly aren’t integrated. It’s the state of healthcare.

Campbell: That’s why you anticipate moving to a single platform, single database?

Schoener: Absolutely, we have problem lists that are not reconciled. There’s a problem list in the Soarian world and a problem list in the NextGen world, and they’re not the same thing right now, not at all. Meds and allergies are pretty much all we get in terms of outpatient to inpatient clinical data sharing today.

Campbell: Do you leverage an archival solution for any legacy data?

Schoener: We use EMC and have large data storage with them. I wouldn’t call it archival, but we have an electronic document management system – Soarian’s eHIM.

There’s a huge amount of data out there and I know you have some questions related to our thinking with respect to migration. I have some thoughts around that related to levering our document management system versus archiving into a separate system. I’m pretty certain we would be thinking ‘why not use eHIM as our archival process, and just put other data in that repository as necessary?’ For results data, for instance, what we’re thinking of migrating, or what our providers are requesting, is a years’ worth of results. ‘Give me a year’s worth of results, and then make sure everything else is available in eHIM.’

Campbell: As such, your default is to migrate a year’s worth of data?

Schoener: Yes. We would presume that the provider is probably not going to refer back to lab results or radiology results beyond a year, other than for health maintenance kind of things such as mammograms, pap smears, PSAs; those types of things.

Campbell: What expectations have you set with physicians when they go live on the new EMR?

Schoener: From an ambulatory perspective, we’re thinking that it would be nice to have the most recent note from the EMR available. All of the other notes for that patient would be consolidated into one note via a single pdf attachment. The note that’s the separate most recent note, we envision that being in a folder for that particular date. That note would reside in the appropriate folder location just like it would in the current EMR. Our goal is to bring the clinical data forward to the new EMR, taking all the other notes and placing them in a “previous notes” folder.

Campbell: Can you elaborate on your consideration of PAMI (Problems, Allergies, Medications, Immunizations) as part of the data migration?

Schoener: Sure. The disaster scenario would be the physician sits down with patient for first time with new EMR, and there are no meds, no allergies, and no problems! They’ll spend 25 minutes just gathering information, that would not work.

We’re thinking of deploying a group of nurses to assist with the data conversion and migration process. Our intent is to have them to retrieve CCDAs to populate those things I mentioned by consuming them right into the medical record, based on the physicians’ input. We expect there to be a reconciliation process to clean-up potential duplicates. Or, to be candid, we’ve talked about automating the CCDA process, consuming discrete clinical items from it by writing scripts and importing into the new EMR. I think we’re leaning towards having some staff involved in the process though.

Now if you share the same database between your acute and ambulatory EMR, and the patient was in ambulatory setting but now they’ve been admitted, it’s the same database: the meds are there, the problems are there, the allergies are there; it’s beautiful, right? If they weren’t, then the admission nurse is going to have to follow the same CCDA consume process that the ambulatory nurse followed. Or you start from scratch. On the acute side, we start from scratch a lot. Patients come in and we basically just start asking questions in the ER or in an acute care setting. We start asking for their meds, allergies, or problems – whatever they may have available.

Campbell: We’ve discussed notes, results and PAMI. Are there other clinical data elements that you’ve examined? How will you handle those?

Schoener: From an acute care perspective, our physicians are very interested in seeing the last H & P (History & Physical Examination) and the last operative note, so we’re going to consider two different ideas. One would be that all of that data would still reside in document management, which has the ability to be sorted. It’s currently very chart centric. For instance, you can easily pull the patient’s last acute care stay. There is the ability, however, to sort by H & P, operative note, or discharge summary—something along those lines for the separate buckets of information. Therefore, a physician could view the most recent H & P or view all sorted chronologically. In addition, they’ll be able to seamlessly launch directly from the new EMR to the old EMR, bypassing authentication, which is important to mitigate context switching.

One of the areas we’re struggling with is the growth chart. A physician would love the ability to see a child’s information from start to finish, not just from the time of the EMR transition. So that means some sort of birth height/weight data that we would want to retrieve and import into the new system so a growth chart could be generated. The other option is to somehow generate some sort of PDF of a growth chart up until the place where we transitioned to the new EMR. The latter however, would result in multiple growth charts, and a physician’s not going to be happy with that. So we’re trying to figure that one out.

Another area of concern is blood pressure data. We’re struggling with what to do with a patient we’re monitoring for blood pressure. We’d like to see more than one blood pressure reading and have some history on that.

Campbell: Thank you for elaborating on those items. What about data that is not migrated. How will that be addressed and persisted going forward?

Schoener: For the most part, everything else would be available in the document management system. We can generate that data from document our document management system and make it available to be queried by OIG or whoever else requires that data from a quality perspective. We are aware that an archival solution is very expensive. We’re being told, ‘if you think you’re going to migrate and move all this data to some sort of other archiving solution, get ready for a sticker shock.’ If that’s what the advisors and consultants are saying, then our thought is that probably isn’t going to be the direction we’re going to go. We’re likely going to stick with some type of document management system for archival.

Campbell: Very good. How are you gathering feedback from different specialties and departments? Do you have a governance process in place?

Schoener: So as you may have gathered, we’re getting ready. I don’t want surprises. I want physicians to be prepared and to set expectations for what’s going to be available. What I just described to you, we’ve vetted that out with our primary care docs. Now we’re going to take that to our cardiologists and ask them what they think. Then on to our urologists to allow them to weigh in. Our intent is to take it to each physician specialty to establish a good comfort level, so when the transition occurs, I don’t have physicians’ saying to me ‘no one ever asked me…’ or not be able to provide excellent patient care. It’s going to be critical to the success of our EMR transition to keep our physicians engaged and involved.

There will definitely be a learning curve with the new EMR, but we want to be clear and set expectations with respect to data migration and conversion, so that when the physician does use the new EMR they’re not saying ‘that darn Cerner or Epic.’  It’s more ‘that’s a part of the data migration process and we weren’t able to accomplish that.’

Campbell: What about legacy applications support. Will all of your staff be dedicated to the new project?

Schoener: I mean, let’s face it, no staff member has the desire to support the legacy application when all of their coworkers are learning the new application. That’s a career limiting move. We still haven’t decided what to do.

Campbell: I agree that no staff member wants to be left behind. I’ve talked to organizations where they use folks for both and it just doesn’t end well. You can’t expect them to do both, learning the new system while supporting the old one.

Schoener: I guess it depends on the capacity and the expectation of that particular project they’re working on. Maybe there is a person who has less involvement with the new EMR and they have availability where they can support both, although it’s unlikely. Sometimes you end up having someone who wants to retire within the time period. In that case, they can almost work their way to retirement and then not ever support the new EMR, although that situation is also unlikely.

It’s a great question, and one we’re going to have to have folks help us determine.

Campbell: Shifting gears a little bit, what are your thoughts on health data retention requirements? Too loose? Too stringent?  As you know, it varies state-to-state, from 7-10 years, but I feel like there’s a huge responsibility that is placed on organizations to be the custodians of that data. Do you agree?

Schoener: I think that’s just healthcare. A lot of it is legal considerations and our need to protect ourselves. That’s why do we do a lot of the things we do. We’re protecting ourselves from lawsuits and litigation. I think it’s expected; it’s just the nature of the business. Just think of what we had in a paper world. We used to have rooms and rooms full of charts and now that’s all gone. With our current process, any paper that comes in is scanned in within the first 24 hours. So it’s not something I worry about. My focus now is making sure our providers can perform excellent patient care on the new EMR.

Campbell: Could you provide some advice, insight or wisdom for healthcare organizations pursuing EMR/EHR replacement & transition?

Schoener: Get ready for some fun! Affiliations and acquisitions are greatly impacting these decisions. It used to be something that struggling organizations were forced to pursue, but now very successful organizations are starting to affiliate and merge with other organizations because it’s just the state of healthcare. One bit of wisdom for anyone is: if you’re not interested in that type of transition and change occurring, healthcare’s not for you. That’s the nature of the business we’re in.

I would say from an EHR transition process, I found that having an advisor is extremely beneficial to help me think outside of my day-to-day operations. They’re able to look outside of your organization and ask the right questions. If you pick the right advisor, they’ll protect you and protect your organization. I think it’s been very healthy for us to have someone from the outside give us counsel and advice because it’s a tough process. It’s extremely expensive, and extremely polarizing.

Campbell: Outside of the networking, what did you come to CHIME focused on this year?

Schoener: CHIME is a great way to challenge yourself as a CIO and in your leadership, it pushes me in my leadership skills and helps to focus me back to what’s critical in the industry. It helps me to think more strategic and broad, not to get too engaged in one particular topic. I think it’s just great for professional development. CHIMEs the best out there with respect to what I do.

This interview has been edited and condensed.

Evaluate options, define scope and formulate a strategy for EHR data migration by downloading Galen’s EHR Migration Whitepaper.

About Tim Schoener
Tim Schoener is the Vice President/Chief Information Officer for UPMC Susquehanna, a new partner of UPMC since October 1, 2016, which is a four-hospital integrated health system in northcentral Pennsylvania including Divine Providence Hospital, Muncy Valley Hospital, Soldiers + Sailors Memorial Hospital and Williamsport Regional Medical Center. UPMC Susquehanna has been Most Wired for 14 of the last 16 years and also HIMSS Level 6. Tim has worked at Susquehanna for over 24 years, 19 of those years in Information Technology.  He also has responsibilities for health records, management engineering and biomedical engineering. He is a CHCIO, HIMSS Fellow and CPHIMS certified. Tim received his undergraduate degree from The Pennsylvania State University with a BSIE in Industrial Engineering and his MBA from Liberty University. 

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell and LinkedIn.

About Galen Healthcare Solutions
Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Population Health 101: The One Where It All Starts

Posted on December 7, 2016 I Written By

The following is a guest blog post by Abhinav Shashank, CEO & Co-founder of Innovaccer.
population-health-101
Former US President Abraham Lincoln once said, “Give me six hours to chop down a tree and I’ll spend four hours sharpening the ax.”  After having a look at the efficiency of the US healthcare system, one cannot help but notice the irony. A country spending $10,345 per person on healthcare shouldn’t be on the last spot of OECD rankings for life expectancy at birth!

Increasing Troubles
report from Commonwealth Fund points out how massive the US health care budget is. Various US governments have left no stone unturned in becoming the highest spender on healthcare, but have equally managed to see most of its money going down the drain!

Here are some highlights from the report:

  1. The US is 3rd when it comes to public spending on health care. The figure is $4197 per capita, but it covers only 34% of its residents. On the other hand, the UK spends only $2,802 per capita and covers 100% of the population!
  2. With $1,074, US has the 2nd highest private spending on healthcare.
  3. In 2013, US allotted 17.1% of its GDP to healthcare, which was the highest of any OECD country.   In terms of money, this was almost 50% more than the country in the 2nd spot.
  4. In the year 2013, the number of practicing physicians in the US was 2.6 per 1000 persons, which is less than the OECD median (3.2).
  5. The infant mortality rate in the US was also higher than other OECD nations.
  6. 68 percent of the population above 65 in the US is suffering from two or more chronic conditions, which is again the highest among OECD nations.

The major cause of these problems is the lack of knowledge about the population trends. The strategies in place will vibrantly work with the law only if they are designed according to the needs of the people.

population-health-trends

What is Population Health Management?
Population health management (PHM) might have been mentioned in ACA (2010), but the meaning of it is lost on many. I feel, the definition of population health, given by Richard J. Gilfillan, President and CEO of Trinity Health, is the most suitable one.

Population health refers to addressing the health status of a defined population. A population can be defined in many different ways, including demographics, clinical diagnoses, geographic location, etc. Population health management is a clinical discipline that develops, implements and continually refines operational activities that improve the measures of health status for defined populations.

The true realization of Population Health Management  (PHM) is to design a care delivery model which provides quality coordinated care in an efficient manner. Efforts in the right direction are being made, but the tools required for it are much more advanced and most providers lack the resources to own them.

Countless Possibilities
If Population Health Management is in place, technology can be leveraged to find out proactive solutions to acute episodes. Based on past episodes and outcomes, a better decision could be made.

The concept of health coaches and care managers can actually be implemented. When a patient is being discharged, care managers can confirm the compliance with health care plans. They can mitigate the possibility of readmission by keeping up with the needs and appointments of patients. Patients could be reminded about their medications. The linked health coaches could be intimated to further reduce the possibility of readmission.

Let us consider Diabetes for instance. Many times Diabetes is hereditary and preventive measures like patient engagement would play an important role in mitigating risks. Remote Glucometers, could be useful in keeping a check on patient sugar levels at home. It could also send an alert to health coaches and at-risk population could be engaged in near real-time.

Population Health Management not only keeps track of population trends but also reduces the cost of quality care. The timely engagement of at-risk population reduces the possibility of extra expenditure in the future. It also reduces the readmission rates. The whole point of population health management is to be able to offer cost effective quality-care.

The best thing to do with the past is to learn from it. If providers implement in the way Population Health Management is meant to be, then the healthcare system would be far better and patient-centric.

Success Story
A Virginia based collaborative started a health information based project in mid-2010. Since then, 11 practices have been successful in earning recognition from NCQA (National Committee for Quality Assurance). The implemented technologies have had a profound impact on organization’s performance.

  1. For the medical home patients, the 30-day readmission rate is below 2%.
  2. The patient engagement scores are at 97th percentile.
  3. With the help of the patient outreach program almost 40,000 patients have been visited as a part of preventive measures.

All this has increased the revenue by $7 million.

Barriers in the journey of Population Health Management
Currently, population health management faces a lot of challenges. The internal management and leadership quality has to be top notch so that interests remain aligned. Afterall, Population Health Management is all about team effort.

The current reimbursement model is also a concern. It has been brought forward from the 50s and now it is obsolete. Fee-for-service is anything, but cost-effective.

Patient-centric care is the heart of Population Health Management. The transition to this brings us to the biggest challenge and opportunity. Data! There is a lot of unstructured Data. True HIE can be achieved only if data are made available in a proper format. A format which doesn’t require tiring efforts from providers to get patient information. Providers should be able to gain access to health data in seconds.

The Road Ahead
We believe, the basic requirement for Population Health Management is the patient data. Everything related to a patient, such as, the outcome reports, the conditions in which the patient was born, lives, works, age and others is golden. To accurately determine the cost, activity-based costing could come in handy.

Today, the EMRs aren’t capable enough to address population health. The most basic model of population health management demands engagement on a ‘per member basis’ which can track and inform the cost of care at any point. The EMRs haven’t been designed in such a way. They just focus on the fee-for-service model.

In recent years, there has been an increased focus on population health management. Advances in the software field have been prominent and they account for the lion’s share of the expenditure on population health. I think, this could be credited to Affordable Care Act of 2010, which mandated the use of population health management solutions.

Today, the Population Health Management market is worth $14 billion and according to a report by Tractica, in five years, this value will be $31.8 billion. This is a good sign because it shows that the focus is on value-based care. There is no doubt we have miles to go, but at least now we are on the right path!

Sutter Health Blends EHR, Patient-Reported Data For MS Treatment

Posted on December 5, 2016 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.

The Sutter Health network is launching a new research project which will blend patient-reported and EHR-based data to improve the precision of multiple sclerosis treatment. Sutter will fund the project with a $1.2 million award from the California Initiative to Advance Precision Medicine.

To conduct the project, Sutter Health researchers are partnering with colleagues at the University of California, San Francisco. Working together, the team is developing a neurology application dubbed MS-SHARE which will be used by patients and doctors during appointments, and by patients between appointments.

During the 18-month demonstration project, the team will build the app with input from the health system’s doctors as well as MS patients. Throughout the process of care, the app will organize both patient-reported data and EHR data, in a manner intended to let doctors and patients view the data together and work together on care planning.

Over the short term, researchers and developers are focusing on outcomes like patient and doctor use of the app and enhancing the patient experience. Its big picture goals, meanwhile, include the ability to improve patient outcomes, such as disease progression and symptom control. Ultimately, the team hopes the results of this project go beyond supporting multiple sclerosis patients to helping to improve care for other neurological diseases such as Parkinson’s Disease, seizure disorders and migraine headaches.

The Sacramento, Calif.-based health network pitches the project as potentially transformative. “MS-SHARE has the potential to change how doctors and patients spend their time during appointments,” the press release asserts. “Instead of ‘data finding and gathering,’ doctors and patients can devote more time to conversation about how the care is working and how it needs to be changed to meet patient needs.”

Time for an editorial aside here. As a patient with a neurological disorder (Parkinson’s), I’m here to say that while this sounds like an excellent start at collaborating with patients, at first glance it may be doomed to limited success at best.

What I mean is as follows. When I meet with the neurologist to discuss progression of my symptoms, he or she typically does little beyond the standard exam. In fact, my sense is that most seem quite satisfied that they know enough about my status to make decisions after doing that exam. In most cases, little or nothing about my functioning outside the office makes it into the chart.

What I’m trying to say here is that based on my experience, it will take more than a handy-dandy app to win neurologists over to collaborating over charts and data with any patient. (Honestly, I think that’s true of many doctors outside this specialty, too.) And I’m not suggesting that this is because they’re arrogant, although they may be in some cases. Rather, I’m suggesting that it’s a workflow issue. Integrating patients in the discussion isn’t just a change of pace, it could be seen as a distraction that could lead to worse care rather than better. It will be interesting to see if that’s how things turn out.

Bringing EHR Data to Radiologists

Posted on December 2, 2016 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.

One of the most interesting things I saw at RSNA 2016 in Chicago this week was Philips’ Illumeo. Beside being a really slick radiology interface that they’ve been doing forever, they created a kind of “war room” like dashboard for the patient that included a bunch of data that is brought in from the EHR using FHIR.

When I talked with Yair Briman, General Manager for Healthcare Informatics Solutions and Services at Philips, he talked about the various algorithms and machine learning that goes into the interface that a radiologist sees in Illumeo. As has become an issue in much of healthcare IT, the amount of health data that’s available for a patient is overwhelming. In Illumeo, Philips is working to only present the information that’s needed for the patient at the time that it’s needed.

For example, if I’m working on a head injury, do I want to see the old X-ray from a knee issue you had 20 years ago? Probably not, so that information can be hidden. I may be interested in the problem list from the EHR, but do I really need to know about a cold that happened 10 years ago? Probably not. Notice the probably. The radiologist can still drill down into that other medical history if they want, but this type of smart interface that understands context and hides irrelevant info is something we’re seeing across all of healthcare IT. It’s great to see Philips working on it for radiologists.

While creating a relevant, adaptive interface for radiologists is great, I was fascinated by Philips work pulling in EHR data for the radiologist to see in their native interface. Far too often we only talk about the exchange happening in the other direction. It’s great to see third party applications utilizing data from the EHR.

In my discussion with Yair Briman, he pointed out some interesting data. He commented that Philips manages 135 billion images. For those keeping track at home, that amounts to more than 25 petabytes of data. I don’t think most reading this understand how large a petabyte of data really is. Check out this article to get an idea. Long story short: that’s a lot of data.

How much data is in every EHR? Maybe one petabyte? This is just a guess, but it’s significantly smaller than imaging since most EHR data is text. Ok, so the EHR data is probably 100 terabytes of text and 900 terabytes of scanned faxes. (Sorry, I couldn’t help but take a swipe at faxes) Regardless, this pales in comparison to the size of radiology data. With this difference in mind, should we stop thinking about trying to pull the radiology data into the EHR and start spending more time on how to pull the EHR data into a PACS viewer?

What was also great about the Philips product I saw was that it had a really slick browser based HTML 5 viewer for radiology images. Certainly this is a great way to send radiology images to a referring physician, but it also pointed to the opportunity to link all of these radiology images from the EHR. The reality is that most doctors don’t need all the radiology images in the EHR. However, if they had an easy link to access the radiology images in a browser when they did need it, that would be a powerful thing. In fact, I think many of the advanced EHR implementations have or are working on this type of integration.

Of course, we shouldn’t just stop with physicians. How about linking all your radiology images from the patient portal as well? It’s nice when they hand you a DVD of your radiology images. It would be much nicer to be able to easily access them anytime and from anywhere through the patient portal. The great part is, the technology to make this happen is there. Now we just need to implement it and open the kimono to patients.

All in all, I love that Philips is bringing the EHR data to the radiologists. That context can really improve healthcare. I also love that they’re working to make the interface smarter by removing data that’s irrelevant to the specific context being worked on. I also can’t wait until they make all of this imaging data available to patients.

HIM’s Role in Healthcare Security and Privacy – HIM Scene

Posted on November 30, 2016 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 go-to experts on healthcare privacy and security is Mac McMillan, CEO and Co-Founder of CynergisTek. He’s built a really great company that focuses on privacy and security in healthcare and he’s a true expert.

While at AHIMA 2016, I talked with Mac about the role that HIM plays in healthcare privacy and security. We also talk about where healthcare privacy is heading and which part of healthcare privacy and security doesn’t get enough attention. I also asked Mac to make a big 20 year prediction on what will happen with privacy and security in healthcare.

Check out our interview with Mac McMillan, CEO and Co-Founder of CynergisTek:

We shot a number of other videos at AHIMA 2016 which we’ll be posting shortly. If you enjoyed this video, be sure to Subscribe to Healthcare Scene on YouTube and watch our full archive of Healthcare Scene interviews.

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

Hospital Program Uses Connected Health Monitoring To Admit Patients “To Home”

Posted on November 28, 2016 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.

A Boston-based hospital has kicked off a program in which it will evaluate whether a mix of continuous connected patient monitoring and clinicians is able to reduce hospitalizations for common medical admissions.

The Home Hospital pilot, which will take place at Partners HealthCare Brigham and Women’s Hospital, is being led by David Levine, MD, MA, a physician who practices at the hospital. The hospital team is working with two vendors to implement the program, Vital Connect and physIQ. Vital Connect is supplying a biosensor that will continuously stream patient vital signs; those vital signs, in turn, will be analyzed and viewable through physIQ’s physiology analytics platform.

The Home Hospital pilot is one of two efforts planned by the team to analyze how technology in home-based care can treat patients who might otherwise have been admitted to the hospital. For this initiative, a randomized controlled trial, patients diagnosed at the BWH Emergency Department with exacerbation of heart failure, pneumonia, COPD, cellulitis or complicated urinary tract infection are being placed at home with the Vital Connect/physIQ solution and receive daily clinician visits.

The primary aim of this program, according to participants, is to demonstrate that the in-home model they’ve proposed can provide appropriate care at a lower cost at home, as well as improving outcomes measures such as health related quality of life, patient safety and quality and overall patient experience.

According to a written statement, the first phase of the initiative began in September of this year involves roughly 60 patients, half of whom are receiving traditional in-hospital care, while the other half are being treated at home. With the early phase looking at the success, the hospital will probably scale up to including 500 patients in the pilot in early 2017.

Expect to see more hospital-based connected care options like these emerge over the next year or two, as they’re just too promising to ignore at this point.

Perhaps the most advanced I’ve written about to date must be the Chesterfield, Mo-based Mercy Virtual Care Center, which describes itself as a “hospital without beds.” The $54M Virtual Care Center, which launched in October 2015, employs 330 staffers providing a variety of telehealth services, including virtual hospitalists, telestroke and perhaps most relevant to this story, the “home monitoring” service, which provides continuous monitoring for more than 3,800 patients.

My general impression is that few hospitals are ready to make the kind of commitment Mercy did, but that most are curious and some quite interested in actively implementing connected care and monitoring as a significant part of their service line. It’s my guess that it won’t take many more successful tests to convince wide swath of hospitals to get off the fence and join them.

6 Things EHRs Should Be Thankful For

Posted on November 25, 2016 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

Tis’ the season for being thankful for the friends, family and bounty we have in our lives. It is a time to celebrate the end of the season with copious amounts of food and reflect upon the good things that have happened in our lives this year.

In the spirit of Thanksgiving, I thought it would be fun to give voice to what an EHR would be thankful for this year. So if I put my mind into that of an EHR here are the top 6 things I’d be thankful for.

  1. Meaningful Use. Thank you for five great years. It was only through the infusion of $35B that thousands of my brethren were adopted/implemented across the United States. Without MU, we EHRs would not have proliferated to the degree that we have. #forevergrateful
  2. Doctors. Absolute thankful for all the doctors who use us everyday. We love how much time and attention you are giving us in 2016. It’s almost embarrassing how you stare at our screens and don’t get distracted by the other people in the exam room with you (I think you call them patients…and I think I have a field for that). We look forward to more of the same next year. Thank you!
  3. Nurses. Thank you to all the nurses out there. Your constant clicking on our drop-down boxes and check boxes are like a daily “tickle”. We hope you aren’t too mad at us for making it difficult to get the information you want. It’s only because we want to spend more time with you. #love
  4. EHR Consultants. I am grateful this year for the army of EHR consultants that are out there. Without you, we EHRs would have been relegated to the scrap heap long ago. Thank you for working hard to optimize us, customizing us to better suit user needs and to teaching people how to use us effectively. We owe our longevity to you.
  5. Health IT Media. Thank you to the Health IT media for keeping the spotlight on EHRs in 2016 – despite it being the last year of the Meaningful Use program. Whether you like us or not, we EHRs have become the backbone of healthcare and there are a lot of things that can be improved – but only if people stay focused on their EHR journeys. Installation was just the first step. So all you columnists, writers, bloggers and Tweeters out there, please keep EHRs on the radar.
  6. EHR Vendors. I shudder to think of where we would be without our creators in 2016. It was exciting to watch you build “partner ecosystems” around us. These add-ons really helped to unlock the usefulness of the data we’ve been keeping safe. I know we wanted to work on something called “usability” but I’m sure we’ll get to it next year.

Happy Thanksgiving!

Thanksgiving Gratitude

Posted on November 24, 2016 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.

In the US, today is Thanksgiving and so I thought it would be fun to show a bit of gratitude to each of my children on each of my blogs. Feel free to skip this post if you’re looking for Healthcare IT content on Thanksgiving. We’ll be back with our regularly scheduled content on Monday.

This probably says a lot about me, but I decided to put my oldest child on my oldest blog and so forth down the line based on age of the child and blog. With that alignment, HospitalEMRandEHR.com is host to my third child. Most of you don’t know, that my brother and I have casually been writing a daddy blog called Crash Dad where I refer to my kids as Crash Kids. So, on this blog I want to show some gratitude for Crash Kid #3.
crash-kid-3-4
Crash Kid #3 is an incredible child. In some ways, he’s the black sheep of the family since all of the others got the blonde hair and light skin that you’d expect from my children. Instead, Crash Kid #3 got all the Italian blood from my wife. Yes, that means he’s short and has incredible olive skin, dark hair, and a really amazing personality. He’s also well known for having incredible eyelashes. We actually have a contest on airplanes to see how many people will comment on them. They really are that long and dark and the envy of every woman he meets. He of course wants to shave them off since so many people comment on them. He’s an incredible boy that’s thoughtful, smart, and extremely caring.

I’m so grateful for this sweet boy. He comes home from school almost every day and stops by my home office to give me a hug and tell me that he missed me. There really is nothing sweeter than this in my life. It’s often nice to have that perspective during a challenging day.

Happy Thanksgiving! Who are you grateful for this day?

Longitudinal Patient Record Needed To Advance Care?

Posted on November 23, 2016 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.

In most day to day settings, a clinician only needs a small (if precisely focused) amount of data to make clinical decisions. Both in ambulatory and acute settings, they rely on immediate and near-term information, some collected during the visit, and a handful of historical factors likely to influence or even govern what plan of care is appropriate.

That may be changing, though, according to Cheryl McKay of Orion Health. In a recent blog item, McKay argues that as the industry shifts from fee-for-service payment models to value-based reimbursement, we’ll need new types of medical records to support this model. Today, the longitudinal patient record and community care plan are emerging as substitutes to old EMR models, McKay says. These new entities will be built from varied data sources including payer claims, provider EMRs, patient health devices and the patients themselves.

As these new forms of patient medical record emerge, effective population health management is becoming more feasible, she argues. Longitudinal patient records and community care plans are “essential as we steer away from FFS…The way records are delivered to healthcare providers– with an utter lack of visibility and a lot of noise from various data sources– creates unnecessary risks for everyone involved.”

She contends that putting these types of documentation in place, which summarize patient-based clinical experiences versus episodic clinical experiences, close big gaps in patient history which would otherwise generate mistakes. Longitudinal record-keeping also makes it easier for physicians to aggragate information, do predictive modeling and intervene proactively in patient care at both the patient and population level.

She also predicts that with both a longitudinal patient record and community care plan in place, getting from the providers of all stripes a “panoramic” look at patients, costs will fall as providers stop performing needless tests and procedures. Not only that, these new entities would ideally offer real-time information as well, including event notifications, keeping all the providers involved in sync in providing the patient’s care.

To be sure, this blog item is a pitch for Orion’s technology. While the notion of a community-care plan isn’t owned by anyone in particular, Orion is pitching a specific model which rides upon its population health technology. That being said, I’m betting most of us would agree that the idea (regardless of which vendor you work with) of establishing a community-wide care plan does make sense. And certainly, putting a rich longitudinal patient record in place could be valuable too.

However, given the sad state of interoperability today, I doubt it’s possible to build this model today unless you choose a single vendor-centric solution. At present think it’s more of a dream than a reality for most of us.

Health System Sees Big Dividends From Sharing Data

Posted on November 21, 2016 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.

For some health organizations, the biggest obstacle to data sharing isn’t technical. Many a health IT pundit has argued — I think convincingly — that while health organizations understand the benefits of data sharing, they still see it as against their financial interests, as patients with access to data everywhere aren’t bound to them.

But recently, I read an intriguing story by Healthcare IT News about a major exception to the rule. The story laid out how one healthcare system has been sharing its data with community researchers in an effort to promote innovation. According to writer Mike Miliard, the project was able to proceed because the institution was able to first eliminate many data silos, giving it a disciplined view of the data it shared.

At Sioux Falls, South Dakota-based Sanford Health, one health leader has departed from standard health system practices and shared a substantial amount of proprietary data with research organizations in his community, including certain clinical, claims, financial and operational data. Sanford is working with researchers at South Dakota State University on mathematics issues, University of South Dakota business researchers, Dakota State University on computer science/informatics and University of North Dakota on public health.

The effort is led by Benson Hsu, MD, vice president of enterprise data and analytics for the system. Hsu tells the magazine that the researchers have been developing analytical apps which are helping the health system with key issues like cost efficiencies, patient engagement and quality improvement. And more radically, Hsu plans to share what he discovers with competitors in the community.

Hsu laid the groundwork for the program, HIN reports, by integrating far-flung data across the sprawling health system, including multiple custom versions of the Epic EHR, multiple financial accounts and a variety of HR systems; analytics silos cutting across areas from clinical decision support and IT reports to HR/health plan analytics; and data barriers which included a lack of common data terms, benchmarking tools and common analytic calculator. But after spending a year pulling these areas into a functioning analytics foundation, Sanford was ready to share data with outside entities.

At first, Hsu’s managers weren’t fond of the idea of sharing masses of clinical data with anyone, but he sold them on the idea. “It’s the right thing to do. More importantly, it’s the right thing to do for the community — and the community is going to recognize that Sanford health is here for the community,” he argued. “Secondly, it’s innovation. Innovation in our backyard, based on our population, our social determinants, our disparities.”

According to HIN, this “crowdsourced” approach to analytics has helped Sanford make progress with predicting risk, chronic disease management, diagnostic testing and technology utilization, among other things. And there’s no reason to think that the effort won’t keep generating progress.

Many institutions would have shot down an effort like this immediately, before it could accomplish results. But it seems that Sanford’s creative approach to big data and analytics is paying off. While it might not work everywhere, I’m betting there are many other institutions that could benefit from tapping the intellect of researchers in their community. After all, no matter how smart people are, some answers always lie outside your walls.