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UCSF Partners With Intel On Deep Learning Analytics For Health

Posted on January 30, 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.

UC San Francisco’s Center for Digital Health Innovation has agreed to work with Intel to deploy and validate a deep learning analytics platform. The new platform is designed to help clinicians make better treatment decisions, predict patient outcomes and respond quickly in acute situations.

The Center’s existing projects include CareWeb, a team-based collaborative care platform built on Salesforce.com social and mobile communications tech; Tidepool, which is building infrastructure for next-gen smart diabetes management apps; Health eHeart, a clinical trials platform using social media, mobile and realtime sensors to change heart disease treatment; and Trinity, which offers “precision team care” by integrating patient data with evidence and multi-disciplinary data.

These projects seem to be a good fit with Intel’s healthcare efforts, which are aimed at helping providers succeed at distributed care communication across desktop and mobile platforms.

As the two note in their joint press release, creating a deep learning platform for healthcare is extremely challenging, given that the relevant data is complex and stored in multiple incompatible systems. Intel and USCF say the next-generation platform will address these issues, allowing them to integrate not only data collected during clinical care but also inputs from genomic sequencing, monitors, sensors and wearables.

To support all of this activity obviously calls for a lot of computing power. The partners will run deep learning use cases in a distributed fashion based on a CPU-based cluster designed to crunch through very large datasets handily. Intel is rolling out the computing environment on its Xeon processor-based platform, which support data management and the algorithm development lifecycle.

As the deployment moves forward, Intel leaders plan to study how deep learning analytics and machine-driven workflows can optimize clinical care and patient outcomes, and leverage what they learn when they create new platforms for the healthcare industry. Both partners believe that this model will scale for future use case needs, such as larger convolutional neural network models, artificial networks patterned after living organizations and very large multidimensional datasets.

Once implemented, the platform will allow users to conduct advanced analytics on all of this disparate data, using machine learning and deep learning algorithms. And if all performs as expected, clinicians should be able to draw on these advanced capabilities on the fly.

This looks like a productive collaboration. If nothing else, it appears that in this case the technology platform UCSF and Intel are developing may be productized and made available to other providers, which could be very valuable. After all, while individual health systems (such as Geisinger) have the resources to kick off big data analytics projects on their own, it’s possible a standardized platform could make such technology available to smaller players. Let’s see how this goes.

An Effective Strategy for Long-term Epic Training

Posted on January 27, 2017 I Written By

The following is a guest blog post by Chris Cooley, Training Advisor at Pivot Point Consulting, a Vaco Company.

Ensuring that you have enough staff to cover day-to-day, new-hire, remedial, and monthly EHR update training is not an easy task. At the most recent Epic User Group Meetings and Spring Councils, sessions dedicated to building steady training teams were among the best attended. To be sure, Epic training is a hot topic in healthcare organizations—particularly as it relates to new hires. Here are some best-practice suggestions to help establish a long-term and successful Epic training program.

The Necessary Evils

eLearning
Many organizations are opting for eLearning in lieu of classroom training to reach multiple groups. The difficulty with this approach is the inability to truly know if the participant grasped the material. Most participants can pass a quick post-exam without completely understanding or retaining the information.

Timing is also an issue. Even a two-day lapse between an eLearning session and practicing the learned material can pose the risk of an 80 percent information loss, requiring retraining or additional support during the first shift following training. That said, when used correctly, eLearning can be quite effective when used in conjunction with traditional classroom training and immediate practice.

For those familiar with Epic, an interactive eLearning session that speaks to the specifics of your organization can easily be implemented in lieu of classroom training. When using eLearning, make sure to follow adult learning principles. Keep courses short, interactive, and challenging to keep end users engaged. To help participants retain information, include built-in exercises to prevent advancing without completing an action.

Classroom Training
In a preceptor-led training model, about four to eight hours of classroom training should be sufficient. Stick to the basics of navigation, terminology, and one or two main workflows to get comfortable working in the system.

For physicians, schedule a one-on-one follow-up with the trainer to set up preference lists and customizations within the same week. Avoid doing this day one or two, as the physician will need to be familiar with the existing orders and sets before customizing further.

Beyond the Classroom

Routine Training Integration
Standard training and orientation programs offer great opportunities to incorporate Epic-specific training elements where applicable. Nurses, for example, have a day or more of skill validation when starting a new position. For every skill they perform, an Epic training opportunity exists. Have participants find the order in Epic, perform the skill, then document the appropriate procedure and follow up. Collaborate with the education department and affected department leaders to add Epic workflows into routine training outlets.

Preceptorship
Learning happens best when on the floor, in the department, or repeatedly completing a task. Assign new hires a preceptor who is well versed in Epic and department workflows. Have them log in and perform the work while the preceptor guides them through their duties. After two to three days of side-by-side work, your new employee should be off and running.

Draw preceptors from within the new employee’s department and remove them from their daily duties when onboarding new hires. Choose your preceptors wisely. Just because Jane Doe is the resident Epic expert on your floor doesn’t mean she’ll be the best preceptor. Look for someone who embodies your organization’s culture, is a cheerleader for Epic, and has the patience to answer the same question multiple times.

Other Considerations

Materials
Materials must be well written, well organized, and—most important—accessible. Often, materials are outdated, in print form only, or not easily found by the end user. The use and regular maintenance of Learning Home Dashboards can ensure the latest materials are organized, intuitive, and available.

Consider turning tip sheets into two-minute-or-less video snippets. More often than not, watching and then repeating a process is preferable to deciphering a tip sheet and/or screen shots—especially for physicians and millennials looking for the quickest answer.

Remedial Training
While new hires account for about 30-50 percent of a trainer’s time, some individuals or departments will always need a little extra help. For example, evaluating a workflow to offer a faster/easier process, retraining, or providing additional one-on-one time with the end user can account for another 20 percent of a trainer’s time.

Update Training
Each month, a new set of Epic updates must be showcased to employees. This can be accomplished via monthly training or eLearning. In my experience, the time to coordinate and deliver monthly update training accounts for about 10 percent of the trainer’s time.

Rounding
End users often struggle in silence. When my trainers are not actively training, or working on materials, they are rounding in the departments they support looking for opportunities to strengthen knowledge. In addition to rounding, trainers attend huddles and meetings, offer help, and bring vital intel about updated or ill-working workflows to the principal trainer’s attention.

Help Desk
Trainers will also spend a good deal of time working “tickets” to assist end users (and often analysts) in identifying and communicating problems and resolutions.

Learning Management System (LMS) Administration
Hundreds of small details go into ensuring that Epic training is meeting the needs of an organization.  Who is expected in training? When and where can training be held? Who has completed training and can be activated in the system? It is imperative to dedicate at least one full time LMS administrator or coordinator to these ongoing Epic needs. Depending on the organization’s size, this may require up to four full-time resources.

Effective Coverage 
The number of Epic trainers needed will vary according to the organization’s size and hiring volume. Depending on the application and the hiring schedule, your principal trainer may be able to handle all training without the support of additional resources. However, I recommend having at least one credentialed trainer available for backup—to cover vacations, assist in remedial training, etc. Consider cross-training to make trainers versatile in related apps. Maintain expertise amongst your trainers by limiting cross-training to three areas of focus.

The example below includes enough trainers to cover the needs of a two hospital system and surrounding clinics in the same geographical location.

CT1: SBO, HB/PB
CT2 ClinDoc, Stork, Orders
CT3 ClinDoc, Beaker, Orders
CT4 Ambulatory, HOD, Cadence
CT5 Ambulatory, HOD, Cadence
CT6 Radiant, Cupid
CT7 Beacon, Willow
CT8 ASAP, OpTime, ANA
CT9 HIM, GC
CT10 HIM, GC

 

PT1 GC, Cadence
PT2 Ambulatory, HOD
PT3 ClinDoc, Stork
PT4 Orders, ASAP, Beaker
PT5 OpTime, ANA
PT6 Radiant, Cupid
PT7 Beacon, Willow
PT8 HIM, HB, PB, SBO

 
Creating partnerships throughout your organization, along with a steady, recurring training schedule, is the key to running an efficient, low-budget training team. With exceptional, easily accessible training materials and operational preceptors, training can be efficient, low-cost, and have employees in their positions with minimal classroom time.

About Chris Cooley
Chris Cooley is a Subject Matter Expert for the LIVESite division of Pivot Point Consulting, a Vaco Company. Previously, she worked as a full-time training manager, with 14 EMR implementations under her belt. With a combined knowledge of adult learning principles, technical writing, project management and the healthcare world, Chris is known for her creative solutions.

Health IT Predictions for #HIMSS17

Posted on January 25, 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.

My fellow HIMSS Social Media Ambassador, Dr. Geeta Nayyar, has a great post up with various HIMSS 2017 social media ambassadors making predictions at the hot topics we’ll hear about at HIMSS 2017 and throughout the year. I was happy to take part and offered the following prediction:

“Actionable data and patient empowerment are two hot topics at HIMSS this year. We’re going to see a whole slew of applications that take data from clinical decision support at the point of care or real-time analytics that assesses a patients’ risk, and make it actionable. Patient empowerment is going to be enhanced with applications for self-scheduling, patient communication through text and telemedicine and possibly even the first healthcare chatbots.”

I also was quite interested in Rasu Shrestha‘s prediction:

“This is the year we see the emergence of the ‘learning health system.’ With the advent of machine learning and AI, and with the perfect storm of healthcare related needs and opportunities, we will see a true emergence of intelligent systems that will learn and get better over time.”

The idea of a learning health system is a lot to chew on. That’s a big concept that won’t happen over night. However, there’s so much potential in the concept. I’ll be interested to see what technologies are showcased at HIMSS which will help us get closer to a learning health system. What technologies have you seen are helping us get there?

Geeta has posted a bunch of other predictions from HIMSS social media ambassadors, so take a second to head over to her TopLine MD blog and check them out.

Do Health IT Certificate Of Need Requirements Make Sense?

Posted on January 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.

The other day, I read an interesting piece about the University of Vermont Medical Center’s plans to create an integrated EMR connecting its four network hospitals. The article noted that unlike its peers in some other states, UVMC was required to file a Certificate of Need (CON) application with the state before it proceeds with the work.  And that struck me as deserving some analysis.

According to a story appearing in Healthcare Informatics,  UVMC plans to invest an initial $112.4 million in the project, which includes an upgrade to informatics, billing and scheduling systems used by UVMC and network facilities Central Vermont Medical Center, Champlain Valley Physicians Hospital and Elizabethtown Community Hospital. The total costs of implementing and operating the integrated system should hit $151.6 million over the first six years. (For all of you vendor-watchers, UVMC is an Epic shop.)

In its CON application, UVMC noted that some of the systems maintained by network hospitals are 20 years old and in dire need of replacement. It also asserted that if the four hospitals made upgrades independently rather than in concert, it would cost $200 million and still leave the facilities without a connection to each other.

Given the broad outline provided in the article, these numbers seem reasonable, perhaps even modest given what execs are trying to accomplish. And that would be all most hospital executives would need to win the approval of their board and steam ahead with the project, particularly if they were gunning for value-based contracts.

But clearly, this doesn’t necessarily mean that such investments aren’t risky, or don’t stand a chance of triggering a financial meltdown. For example, there’s countless examples of health systems which have faced major financial problems (like this and this),  operational problems (particularly in this case) or have been forced to make difficult tradeoffs (such as this). And their health IT decisions can have a major impact on the rest of the marketplace, which sometimes bears the indirect costs of any mistakes they make.

Given these concerns, I think there’s an argument to be made for requiring hospitals to get CONs for major health IT investments. If there’s any case to be made for CON programs make any sense, I can’t see why it doesn’t apply here. After all, the idea behind them is to look at the big picture rather than incremental successes of one organization. If investment in, say, MRIs can increase costs needlessly, the big bucks dropped on health IT systems certainly could.

Part of the reason I sympathize with these requirements is I believe that healthcare IS fundamentally different than any other industry, and that as a public good, should face oversight that other industries do not. Simply put, healthcare costs are everybody’s costs, and that’s unique.

What’s more, I’m all too familiar with the bubble in which hospital execs and board members often live. Because they are compelled to generate the maximum profit (or excess) they can, there’s little room for analyzing how such investments impact their communities over the long term. Yes, the trend toward ACOs and population health may mitigate this effect to some degree, but probably not enough.

Of course, there’s lots of arguments against CONs, and ultimately against government intervention in the marketplace generally. If nothing else, it’s obvious that CON board members aren’t necessarily impartial arbiters of truth. (I once knew a consultant who pushed CONs through for a healthcare chain, who said that whichever competitor presented the last – not the best — statistics to the room almost always won.)

Regardless, I’d be interested in studying the results of health IT CON requirements in five or ten years and see if they had any measurable impact on healthcare competition and costs.  We’d learn a lot about health IT market dynamics, don’t you think?

Are Security Certifications Needed to Simplify the Acquisition Process?

Posted on January 20, 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’m generally someone who hates certifications. However, I hate them because they’re often implemented poorly and easily gamed. When they’re implemented effectively, they can be extremely helpful. Think about all the safety certifications that electronics have you go through. I’m sure they’ve saved our lives and saved our houses getting burnt down many times over.

I’ve wondered if a security certification would be useful for healthcare IT applications. Certainly it wouldn’t be perfect (security never is), but it could serve as a baseline security check that would help healthcare organizations with their acquisition process.

The reality is that many organizations don’t properly vet the healthcare IT applications they purchase for security. They aren’t consistent and they have limited resources. A security certification in theory would spread the costs of certifying a healthcare application’s security across a large number of organizations and thus save everyone money.

The key to this certification is not to have it as a kind of pass/fail certification. Sure, you want to say that it meets a certain standard of security, but more importantly it would also create a report on what type of security was implemented for that software.

Take encryption for example. Every healthcare organization looks for encryption. A security certification could ensure that the software system has implemented certification appropriately and also describe how the encryption was implemented. Is it end to end security encryption. Do they encrypt the data at rest? What about encryption of the data being stored on the customer’s device? etc etc etc

One challenge with this idea is that CIOs, health IT companies, and other technology professionals can become over reliant on certifications. It would have to be clear that the security certification was just a baseline and not a 100% foolproof way to secure your IT software. This is a challenge since health IT sales reps are going to position a security certification as such. It would take some effective marketing for people to know that the security certification could save them time in their security analysis of a new health IT software purchase, but wasn’t the end all be all.

I imagine some people would argue that this type of certification and details about how an organization or software company implements their security would be a treasure trove for hackers. Certainly you’d have to be careful with what you share and how you share it. However, most of the details are things that a good hacker could figure out anyway.

As it is today, health IT companies just say they’re HIPAA compliant (whatever that means) and many healthcare CIOs are floundering with limited resources for evaluating the security of the applications they buy. A security certification could help them make some headway on this I think.

Done the right way, a security certification could help set a new bar for how vendors approach security. That could be a very good thing. Of course, if not updated regularly and effectively, it could also require a bunch of hoop jumping that doesn’t provide real value. It’s a tricky challenge.

Searching for Disruptive Healthcare Innovation in 2017

Posted on January 17, 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

Disruptive Innovation has been the brass ring for technology companies ever since Clayton Christensen popularized the term in his seminal book The Innovator’s Dilemma in 1997. According to Christensen, disruptive innovation is:

“A process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.”

Disruption is more likely to occur, therefore, when you have a well established market with slow-moving large incumbents who are focused on incremental improvements rather than truly innovative offerings. Using this definition, healthcare has been ripe for innovation for a number of years. But where is the AirBNB/Uber/Google of healthcare?

On a recent #hcldr tweetchat we asked what disruptive healthcare technologies might emerge in 2017. By far the most popular response was Artificial Intelligence (AI) and Machine Learning.

Personally, I’m really excited about the potential of AI applied to diagnostics and decision support. There is just no way a single person can stay up to speed on all the latest clinical research while simultaneously remembering every symptom/diagnosis from the past. I believe that one day we will all be using AI assistance to guide our care – as common as we use a GPS today to help navigate unknown roads.

Some #hcldr participants, however, were skeptical of AI.

While I don’t think @IBMWatson is on the same trajectory as Theranos, there is merit to being wary of “over-hype” when it comes to new technologies. When a shining star like Theranos falls, it can set an entire industry back and stifle innovation in an area that may warrant investment. Can you imagine seeking funding for a technology that uses small amounts of blood to detect diseases right now? Too much hype can prematurely kill innovation.

Other potentially disruptive technologies that were raised during the chat included: #telehealth, #wearables, patient generated health data (#PDHD), combining #HealthIT with consumer services and #patientengagement.

The funniest and perhaps most thoughtful tweet came from @YinkaVidal, who warned us that innovations have a window of usefulness. What was once ground-breaking can be rendered junk by the next generation.

What do you believe will be the disruptive healthcare technology to emerge in 2017?

Rumor Control: These are the Facts

Posted on January 16, 2017 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

Why is it that one of the largest challenges on any project is miscommunication and out of control rumors? While many projects need and would benefit from more communication, even with the best of communication plans, project teams can spend more time dispelling false information than proactively communicating.

I believe in strong communication plans for EHR and ERP projects that include a wide range of communication including town halls, newsletters, emails, signage, internet sites, and other methods of sharing correct information. But on every project, no matter how much we communicate, certain hospital staff will find other sources of information.

I can see the rumor coming when an email or conversation starts with “I heard that…” or “Is it true that…”. These are telltale signs that I am about to hear a rumor. Rumors can range from minor details to far-reaching implications such as a perceived change in project scope or even the live date. While most rumors are just annoyances, responding to them and controlling them can be a significant strain on the project team’s time.

I believe that hospitals have a unique challenge in that proactive communication is more challenging than in many traditional businesses because it is common for a large portion of the staff, including nurses and physicians, to rarely check email. As a result, they are often in a position where “hallway conversation” is how they first hear information and are more likely to give it credibility.

While I admit that I have personally never been able to fully eliminate the rumor challenge, I’d like to share several ideas about what I have seen as an effective way to keep the rumor mill under control:

1) Establish a clear Source of Truth – From the very beginning of the project, communicate to every possible audience how decision and communications will be distributed and who they should contact with questions and information. If it doesn’t come from one of the accepted Sources of Truth, its not true. When I lead a project, I prefer to be the Source of Truth – if it doesn’t come from me verbally or in writing, it isn’t true.

2) Encourage questions and respond to all of them timely – When I am running a project, my motto is “Ask me anything, anytime”. At times, I will get dozens or even hundreds of questions a day through meetings, phone calls, texts, and emails. I respond to every question, providing the truth if I have it, or getting them to the person who can provide the truth. Rumors often start because staff members are not getting answers or don’t feel their questions are welcomed. How do I respond to so many requests? I do it immediately so they can’t accumulate – which also helps inspire confidence and a feeling that they can ask rather than assume.

3) Town Halls – I strongly believe that a change management and communication strategy must include town halls. During town halls, project teams should provide an overview of what is occurring that is relevant to the staff, do occasional software demonstrations, and most importantly – field questions. Creating those proactive communication channels is a powerful way to avoid people creating their own truths.

4) Provide the complete truth – Sometimes the answer to a question is not known because it has not been determined, or has not been considered. Sometimes it is not what the person wants to hear. Regardless, provide the truth – and the complete truth. There is nothing wrong with saying that you don’t know – but can find out. Or that a decision has not been made, but now that they have raised the concern we will make it and get back to them. Responding immediately doesn’t always mean providing an answer immediately, as long as the follow-up is done once the answer is available.

5) Communicate Everywhere – A communication plan must be extensive and include many different points of contact. Intranet sites can look impressive and have lots of great information on them – but usually only a small percentage of the staff will check them. Consideration must be given as to how to communicate with contracted employees, physicians, and traveling nurses. This is particularly challenging during an EHR roll-out when all of these parties must be enrolled in training classes and kept up-to-date on the go-live. Find and use every possible communication challenge. There are always questions about how much communication is too much – but they apply to the volume of communication you push through a particular communication channel – not the number of different communication channels you use.

Finally, accept that no matter what you do, rumors will form and will need to be dispelled. Its part of project management and change management that always had existed, and always will. Properly controlled, the rumors can be a minor distraction at worst – entertainment at best.

Please share any ideas you have found to be successful in keeping rumors under control.

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Healthcare’s Not Good At Mining Health Data

Posted on January 13, 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 really blown away by this quote from an interview with Rebecca Quammen.

The buzz around data analytics promotes the need for data scientists and data analysts as among the most sought-after roles, and that is problematic in and of itself. It’s creating a huge demand, but it’s also a demand that many healthcare organizations don’t know how to deal with right now. I see the buzz around data analytics increasing the pressure to “do something” with data, but many organizations across the nation, both large and small and in every setting of care, simply don’t have the foundational knowledge to manage the data to their benefit, and to know the database structure and how to get it the data out and what the data tells them when they get it. We are not an industry historically good at mining good, rich data out of products and doing something meaningful with it. We do traditional reporting and we may do a little bit of historical reporting, but we’re not good at looking at data to predict and promote and to work toward the future, or to see trends and do analysis across the organization.

Rebecca nailed this one on the head. I’ve seen a bunch of organizations go running towards healthcare informatics with no idea of what they wanted to accomplish or any sort of methodology for how they’re going to analyze the data to find useful insights. It kind of reminds me of the herd mentality that happens at conferences. If any sort of crowd starts to build at a conference, then the crowd quickly grows exponentially as people think that something interesting must be going on. The same seems to happen as healthcare organizations have run towards data analytics.

While I think there’s so much potential in health data analytics, I think that most organizations are afraid to fail. The culture in healthcare is “do no harm.” There are some very good reasons for this and some real fears when it comes to medical liability. There’s a lot more at stake when using data in healthcare than say Netflix trying to predict which shows you might be interested in watching. If Netflix gets it wrong, you just keep scrolling after some minor frustration which you quickly forget. In healthcare, if we get it wrong, people can die or be harmed in some major way.

I understand why this healthcare culture exists, but I also think that inactivity is killing as many or more people than would be damaged by our data mistakes. It’s a challenging balance. However, it’s a balance that we must figure out. We need to enable more innovation and thoughtful experimentation into how we can better use health data. Yes, I’m talking beyond the traditional reporting and historical reporting which doesn’t move the needle on care. I’m talking using data to really impact care. That’s a brave place to be, but I applaud all of those brave people who are exploring this new world.

“Learning Health System” Pilot Cuts Care Costs While Improving Quality

Posted on January 11, 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.

As some of you will know, the ONC’s Shared Nationwide Interoperability Roadmap’s goal is to create a “nationwide learning health system.”  In this system, individuals, providers and organizations will freely share health information, but more importantly, will share that information in “closed loops” which allow for continuous learning and care improvement.

When I read about this model – which is backed by the Institute of Medicine — I thought it sounded interesting, but didn’t think it terribly practical. Recently, though, I stumbled upon an experiment which attempts to bring this approach to life. And it’s more than just unusual — it seems to be successful.

What I’m talking about is a pilot study, done by a team from Nationwide Children’s Hospital and The Ohio State University, which involved implementing a “local” learning health system. During the pilot, team members used EHR data to create personalized treatments for patients based on data from others with similar conditions and risk factors.

To date, building a learning health system has been very difficult indeed, largely because integrating EHRs between multiple hospital systems is very difficult. For that reason, researchers with the two organizations decided to implement a “local” learning health system, according to a press statement from Nationwide Children’s.

To build the local learning health system, the team from Nationwide Children’s and Ohio State optimized the EHR to support their efforts. They also relied on a “robust” care coordination system which sat at the core of the EHR. The pilot subjects were a group of 131 children treated through the hospital’s cerebral palsy program.

Children treated in the 12-month program, named “Learn From Every Patient,” experienced a 43% reduction in total inpatient days, a 27% reduction in inpatient admissions, a 30% reduction in emergency department visits and a 29% reduction in urgent care visits.

The two institutions spent $225,000 to implement the pilot during the first year. However, the return on this investment was dramatic.  Researchers concluded that the program cut healthcare costs by $1.36 million. This represented a savings of about $6 for each dollar invested.

An added benefit from the program was that the clinicians working in the CP clinic found that this approach to care simplified documentation, which saved time and made it possible for them to see more patients during each session, the team found.

Not surprisingly, the research team thinks this approach has a lot of potential. “This method has the potential to be an effective complementary or alternative strategy to the top-down approach of learning health systems,” the release said. In other words, maybe bottom-up, incremental efforts are worth a try.

Given these results, it’d be nice to think that we’ll have full interoperability someday, and that we’ll be able to scale up the learning health system approach to the whole US. In the mean time, it’s good to see at least a single health system make some headway with it.

McKesson and Infor Go-To-Market Partnership – What Happens Now?

Posted on January 9, 2017 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

A couple weeks ago, McKesson and Infor announced a partnership that will have McKesson EIS (Enterprise Information Solutions) offering Infor Cloudsuite as their cloud-based ERP (Enterprise Resource Planning) solution for human resources, supply chain, and financials. What does each party have to gain from this partnership and what does this mean for existing customers of McKesson ERP solutions?

Infor continues to be the dominant player in the ERP space for healthcare providers. Its healthcare applications, previously known as Lawson (and probably always known as Lawson to many of us), have the largest market share with the majority of larger hospitals and healthcare systems. Its closest competitor in the past, Peoplesoft, is now owned by Oracle which is focused on developing and promoting its Fusion product and has released the final version of the Peoplesoft product. Workday, the cloud-only solution that is publicly traded and making significant strives in many industries, has won deals in human resources and financials implementations but lacks a supply chain solution, critical to any integrated ERP deployment. SAP, the largest ERP provider in the world, has a strong presence in healthcare manufacturers but does not provide a supply chain solution well suited for the unique needs of healthcare providers, and therefore has a very small market share.

McKesson, once a strong player in this space, has faded over the years in ERP as they have with EHR solutions. The majority of the McKesson ERP customer base, using the products commonly referred to as Pathways, have been long-time legacy customers. Pathways has not been kept up with modern ERP needs, and it has been many years since I have seen a hospital consider Pathways as a potential solution, but rather it is typically the solution being replaced.

Infor has invested significantly in creating a cloud-based solution, referred to as CloudSuite. However, the existing healthcare customer base typically has an on-premise installation and therefore cloud adoption has been focused on new customers as well as those that are specifically looking to transition away from on-premise. McKesson has not had a cloud offering, therefore it would make sense for them to partner with someone to offer it as an alternative to Pathways.

Infor will gain access to the Mckesson customer base, many of whom are likely considering leaving Pathways for other solutions anyway. In addition, Infor will be able to provide Mckesson’s Strategic Sourcing solution for their customers.

However, it is unclear what that means for Pathways. While McKesson press releases state that CloudSuite is an alternative to Pathways, one has to wonder why Infor would want to expose their solution to someone who is actively selling a competitive solution, and why McKesson would continue to invest in Pathways when it has access to a much more mature and robust solution as a go-forward path for its Pathways customers.

Therefore while it is likely that McKesson will keep Pathways supported and up-to-date with regulatory improvements for the time being, it seems very unlikely that they would continue to enhance it – and inevitable that it will eventually be sunset in favor of transitioning those customers to Infor Cloudsuite. If history is indeed an appropriate predictor of the future, consider that McKesson announced its BetterHealth 2020 plan – in which they announced a focus on Paragon as their EHR but continued support of the older Horizon EHR product. Shortly after that they went back on that commitment and announced they would sunset Horizon in 2018.

Meaningful Use has led to a focus of resources on Electronic Health Records implementations which have led many customers to hold onto their older ERP solutions past their useful life. I suspect that the next two years will see a re-focus to ERP solutions with customers with more modern solutions focusing on upgrades and new feature deployment while customers with older solutions making a change.

Those customers who stayed on Horizon for too long are currently in a rush to implement replacements before the March 2018 sunset date.Customers on Pathways products should likely start the conversation now about their long-term ERP plans and consider if they want to get ahead of any sunset announcement.

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