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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!

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.

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.

Rush University Medical Center Rolls Out OpenNotes

Posted on November 18, 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.

Back in 2010, a group of primary care doctors from three different healthcare organizations across the US came together to launch a project in which they’d begin sharing their clinical notes directly with their patients. The doctors involved were part of a 12-month study designed to explore how such sharing would affect healthcare. The project was a success, and today, 10 million patients have access to their clinicians’ notes via OpenNotes.

Now, Rush University Medical Center has joined the party. The 664-bed academic hospital, which is based in Chicago, now allows patients to see all of their doctor’s notes through a secure web link which is part of Epic’s MyChart portal. According to Internet Health Management, Rush has been piloting OpenNotes since February and rolled it out across the system last month.  Patients could already use MyChart to review physician instructions, prescriptions and test orders online.

If past research is any indication, the new service is likely to be hit with patients. According to a study from a few years ago, which looked at 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center, 99% of study participants wanted continued access to clinician notes after having it for one year. This was true despite the fact that almost 37% of patients reported being concerned about privacy after using the portal during that time.

Dr. Allison Weathers, Rush associate chief medical information officer, told the site that having access to the notes can help individuals with complex health needs and under the care of multiple providers. “Research shows that when patients can access their physicians’ notes, they better understand the medical issues and treatment plan as active partners in their care,” she said. “When a patient is sick, tired or stressed during a doctor’s visit, they may forget what the doctors said or prescribed.”

I think it’s also apparent that giving patients access to clinician notes helps them engage further with the process of care. Ordinarily, for many patients, medical notes from their doctor are just something that they hand along to another doctor. However, when they have easy access to their notes, alongside of the test results, appointment scheduling, physician email access and other portal functions, it helps them become accustomed to wading through these reports.

Of course, some doctors still aren’t OpenNotes-friendly. It’s easy to see why. For many, the idea of such sharing private notes — and perhaps some unflattering conclusions — has been out of the question. Many have suggested that if patients read the notes, they can’t feel free to share their real opinion on matters of patient care and prognosis. But the growth of the OpenNotes program suggests to me that the effect of sharing notes has largely been beneficial, giving patients the opportunity not only to correct any factual mistakes but to better understand their provider’s perspective. As I see it, only good can come from this over the long run.

Healthcare Security is Scaring Hospital CIOs

Posted on November 16, 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 sponsored by Samsung Business. All thoughts and opinions are my own.

Coming out of the CHIME CIO Forum, I had a chance to mix and mingle with hundreds of hospital CIOs. There was one major theme at the conference: security. If you asked these hospital CIOs what was keeping them up at night, I’m sure that almost every one of them would say security. They see it as a major challenge and the job is never done.

I had more than one CIO tell me that breaches of their healthcare system are going to happen. That’s why it’s extremely important to have a 2 prong security strategy in healthcare that includes both creating security barriers and also a mitigation and response strategy.

One of the most challenging pieces of security identified by these healthcare CIOs was the proliferation of endpoints. That includes the proliferation of devices including mobile devices and the increase in the number of users using these technologies. There was far less concern about the mobile devices since there are some really deeply embedded software and hardware security built into mobile devices like Samsung’s Knox which has made mobile device security a lot easier to implement. The same can’t be said for the number of people using these devices. One hospital CIO described it as 21,000 points of vulnerability when he talked about the 21,000 people who worked at his organization. Sadly, there’s no one software solution to prevent human error.

This is why we see so much investment in security awareness programs and breach detection. Your own staff are often your biggest vulnerability. Training them is a good start and can prevent some disasters, but the malware has gotten so sophisticated that it’s really impossible to completely stop. That’s why you need great software that can detect when a breach has occurred so you can deal with it quickly.

On the one hand, it’s one of the most exciting times to be in healthcare IT. We have so much more data available to us that we can use to improve care. However, with all that data and technology comes an increased need to make sure that data and technology is kept secure. The good news is that many hospital boards have woken up to this fact and are finally funding security efforts as a priority for their organization. Is your organization prepared?

For more content like this, follow Samsung on Insights, Twitter, LinkedIn , YouTube and SlideShare.

Hospital CIOs Say Better Data Security Is Key Goal

Posted on November 9, 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 new study has concluded that while they obviously have other goals, an overwhelming majority of healthcare CIOs see data protection as their key objective for the near future. The study, which was sponsored by Spok and administered by CHIME, more than 100 IT leaders were polled on their perspective on communications and healthcare.

In addition to underscoring the importance of data security efforts, the study also highlighted the extent to which CIOs are being asked to add new functions and wear new hats (notably patient satisfaction management).

Goals and investments
When asked what business goals they expected to be focused on for the next 18 months, the top goal of 12 possible options was “strengthening data security,” which was chosen by 81%. “Increasing patient satisfaction” followed relatively closely at 70%, and “improving physician satisfaction” was selected by 65% of respondents.

When asked which factors were most important in making investments in communications-related technologies for their hospital, the top factor of 11 possible options was “best meets clinician/organizational needs” with 82% selecting that choice, followed by “ease of use for end users (e.g. physician/nurse) at 80% and “ability to integrate with current systems (e.g. EHR) at 75%.

When it came to worfklows they hoped to support with better tools, “care coordination for treatment planning” was the clear leader, chosen by 67% of respondents, followed by patient discharge (48%), “patient handoffs within hospital” (46%) and “patient handoffs between health services and facilities” chosen by 40% of respondents selected.

Mobile developments
Turning to mobile, Spok asked healthcare CIOs which of nine technology use cases were driving the selection and deployment of mobile apps. The top choices, by far, were “secure messaging in communications among care team” at 84% and “EHR access/integrations” with 83%.

A significant number of respondents (68%) said they were currently in the process of rolling out a secure texting solution. Respondents said their biggest challenges in doing so were “physician adoption/stakeholder buy-in” at 60% and “technical setup and provisioning” at 40%. A substantial majority (78%) said they’d judge the success of their rollout by the rate the solution was adopted by by physicians.

Finally, when Spok asked the CIOs to take a look at the future and predict which issues will be most important to them three years from now, the top-rated choice was “patient centered care,” which was chosen by 29% of respondents,” “EHR integrations” and “business intelligence.”

A couple of surprises
While much of this is predictable, I was surprised by a couple things.

First, the study doesn’t seem to have been designed for statistical significance, it’s still worth noting that so many CIOs said improving patient satisfaction was one of their top three goals for the next 18 months. I’m not sure what they can do to achieve this end, but clearly they’re trying. (Exactly what steps they should take is a subject for another article.)

Also, I didn’t expect to see so many CIOs engaged in rolling out secure texting, partly because I would’ve expected such rollouts to already have been in place at this point, and partly because I assume that more CIOs would be more focused on higher-level mobile apps (such as EHR interfaces). I guess that while mobile clinical integration efforts are maturing, many healthcare facilities aren’t ready to take them on yet.

Health System Pays Docs To Use Cerner EHR

Posted on November 7, 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.

Typically, we cover US-based stories in this blog, but the following is just too intriguing to miss. According to a Vancouver newspaper, an area hospital system agreed to pay physicians a daily fee to use its unpopular Cerner EHR, positioning the payments as compensation for unpaid overtime spent learning the system.

The Times Colonist is reporting that local hospital system Island Health has offered on-call physicians at its Nanaimo Regional General Hospital $260 a day, and emergency department physicians up to $780 a day, to use its unpopular Cerner system.

The newspaper cites a memo from hospital chief medical officer and executive vice president Dr. Jeremy Etherington, which says that the payment was in recognition of “the extra burden the new electronic health record has placed on many physicians during the rollout phase” of the new EHR.

In 2013, Island Health (which is based in British Columbia, Canada) signed a 10 year, $50 million deal with Cerner to implement its platform across its three hospitals. More recently, in March of this year, Island Health’s three facilities went live on the Cerner platform.

Within weeks, physicians at Nanaimo Regional Hospital were flooding executives with complaints about the new platform, which they claimed we randomly lost, buried or changed orders for drugs and diagnostic tests. Some physicians at the hospital reverted to using pen and paper to complete orders.

Not long after, physicians signed a petition asking the health system to stop further implementation, citing safety and workability concerns, but executives still moved forward with the rollout.

Neither the newspaper article nor other reports could identify how many physicians accepted the offer from Island Health. Also, the health systems management hasn’t shared how it picked doctors who were eligible for the payout, and what criteria it used to determine the size of the higher emergency department physician payouts. However, according to a Nanaimo physician and medical staff member quoted by Becker’s Health IT & CIO Review quotes, execs structured the payments to reflect the unpaid overtime doctors put in to learn the system.

As for the claims that the Cerner system was causing clinical problems and even perhaps endangering patients, that issue is still seemingly unresolved. In late July, British Columbia Minister of Health Terry Lake apparently ordered a review of the Cerner system, but results of that review do not appear to be available just yet.

It’s not clear whether the payments bought Island Health enough goodwill to mollify the bad feelings of doctors who didn’t receive one of these payments, nor whether those who are being paid will stay bought. And that’s the real question here. Call the payments a publicity stunt, an attempt at fairness or cynical political strategy, they may not be enough to get physicians onto the system if they are convinced it doesn’t work. I guess we’ll have to wait and see what happens.