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Hospital Using AI To Handle Some Tasks Usually Done By Doctors And Nurses

Posted on May 30, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

One of the UK’s biggest facilities has announced plans to delegate some tasks usually performed by doctors and nurses to AI technology. Leaders there say these activities can range from diagnosing cancer to triaging patients.

University College London Hospitals (UCLH) has signed up for a three-year partnership with the Allen Turing Institute designed to bring machine learning to bear on care, a project which could ultimately spark additional AI projects across the entire National Health Service. The NHS is the body which governs all healthcare in the UK’s universal health system.

UCLH is making a big bet on artificial intelligence, investing what UK newspaper The Guardian describes as a “substantial” sum to develop the infrastructure for the effort.

UCLH officials believe — like other health organizations around the world — that machine learning algorithms may someday diagnose disease, identify people at risk for serious illness and more. Examples of related projects abound. Just one case in point is a project begun in 2016 by New York-based Mount Sinai Hospital, which launched an effort using AI to predict which patients might develop congestive heart failure and offer better care to those who have already done so.

Professor Bryan Williams, director of research at University College London Hospitals NHS Foundation Trust, said the move will be a “game changer” which could have a major impact on patient outcomes. “On the NHS, we are nowhere near sophisticated enough,” Williams told The Guardian. “We’re still sending letters out, which is extraordinary.”

UCLH’s first AI effort, which is already underway, is intended to identify patients likely to miss appointments. Using existing data, including demographic factors such as age and address plus outside factors like weather conditions, researchers there have been able to predict with 85% accuracy whether the patient will show up for outpatient visits and MRIs.

Another planned project includes improving the performance of the hospital’s emergency department, which, like many NHS hospitals, isn’t meeting government performance targets such as maximum four-hour wait times. “[This is] an indicator of some of the other things in the entire chain concerning the flow of acute patients in and out of the hospital,” UCLH chief executive Professor Marcel Levi told the newspaper.

The hospital envisions solving its wait-time problem with machine learning. Drawing on data taken from thousands of patients, machine learning algorithm might be able to determine whether a patient with abdominal pain suffers from severe problem like intestinal perforation or a systemic infection, then fast-track those patients. This kind of triage is generally performed by nurses in hospitals around the world.

That being said, the partners agree that machine learning performance must be incredibly accurate before it has any major role in care. At that point, it will be ready to support clinicians, not undercut them. According to Professor Chris Holmes of The Alan Turing Institute, the whole idea is to let doctors do what they do best: “We want to take out the more mundane stuff that’s purely information driven and allow time for things the human expert is best at.”

Origin Story: Mark McCloskey, President of Oneview Healthcare. Living Up to Commitments.

Posted on May 29, 2018 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 speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Right from the start I knew Mark McCloskey’s origin story was going to be special.

McCloskey, President and Founder of Oneview Healthcare, agreed to meet while we were both traveling through Chicago. We booked the meeting well in advance, but it turned out that we accidentally picked a date when Oneview was hosting several key customers at its US headquarters in Chicago. It would have been completely understandable if McCloskey postponed our meeting, but he and his team insisted keep it on the books. They had made a commitment and they wanted to make good on it.

Making commitments and living up to them is something that permeates McCloskey’s origin story and makes it special. In fact, this commitment is something that McCloskey has infused into the company he founded. Oneview has a strong reputation as a company that listens to its customers and delivers on promises made. This is partly why their customers are such strong advocates.

McCloskey’s story begins as many Irish tales do, as a young man leaving his beloved home to seek his fortune abroad. In McCloskey’s case, his journey began with a commitment made to a dress-maker friend of his. He took five dresses designed by his friend with a promise to sell them in London. Armed with nothing more than determination to succeed, he sold those dresses to a local London fashion retailer, Next PLC and convinced them to let him have space in one of their stores in return for a percentage of his dress sales.

With no experience in either fashion or retail, McCloskey focused on listening to what customers wanted and then tried it. Eventually he found a winning formula and in short order, he grew the business from one location to several dozen. He hired staff, took care of marketing and worked with his dressmaker friend to ensure a steady supply of dresses for the sprawling retail operation. By the tender age of 22, he had 84 people working for him and he was selling dresses all over England.

Unfortunately, it all came to abrupt end in 1988 when his dressmaker friend decided to retire from the business in order to start a family. McCloskey wound down the operation and returned to Ireland.

Back at home, McCloskey became a successful sales executive at a telecommunications company that was later acquired by British Telecom. He then went on to co-found a company that ran Ireland’s first independent ATM networks because he thought people should be able to conveniently access their own money from any ATM. That company was acquired by Ulster Bank in 2004. Two years after that acquisition, McCloskey found himself in hospital for knee surgery and it was his experience that ignited the flame that would become Oneview Healthcare.

“They put me in a ward room after my surgery,” recalled McCloskey. “The room held 4 people in total and had just 1 TV. The biggest guy in the room had the remote so no one was going to argue with him about what to watch. So for three days I watched what he wanted to watch.”

During those three days, McCloskey began to take note of the odd and inefficient processes at the hospital. “I noticed that everything was paper based,” recounted McCloskey. “Whenever a nurse or doctor came in the room, they asked the same questions over and over. It became very repetitive. On top of that, I got woken up every morning at 6am when a lady from food services came in the room to hand us slips of paper with that day’s menu on it. We had to check what we wanted for breakfast, lunch and dinner and then the lady would collect all the papers. I would come back after physio and the lunch that I ordered would be on the tray and it would be cold because it had been sitting there for an hour. They hospital delivered the meals according to the kitchen’s schedule and not the patient’s schedule. Then after almost 4 days in the hospital, they gave me an A4 sheet of paper with some instructions on it and said ‘there’s your physio’ now off you go.”

Following his hospital stay, McCloskey found himself on a plane to New York City with his wife. With the less-than-stellar healthcare experience still fresh in his mind, McCloskey was pleasantly surprised by much better experience he had as an airline passenger – especially with the in-flight entertainment system. [Editor’s Note: It is never a good sign when the customer experience in the AIRLINE industry is superior to your own].

During that trip, McCloskey committed himself to bringing that same airline experience to healthcare and Oneview Healthcare was born.

It was here that his early experience selling dresses helped him. Once again, McCloskey found himself in an unfamiliar industry (healthcare) attempting to sell a product he knew very little about (patient entertainment systems). Taking a cue from his past, he started by finding out what customers actually wanted and then incorporating that into his offering.

One of the first organizations he showed the product to was Epworth HealthCare, the largest private hospital group operator in Australia’s state of Victoria. They were impressed, but had numerous suggestions to improve the product which the small Oneview team added to the product. This virtuous cycle repeated itself over and over as McCloskey continued to show the product to healthcare organizations around the world including: UCSF Mission Bay, Chris O’Brian Lifehouse and  Maimonides Medical Center.

Fast forward to the end of 2012. At this point Oneview was a company of eight and without any customers, McCloskey had to make a tough decision. The company needed an infusion of cash in order to ensure it could make the Christmas payroll. McCloskey went to his wife and explained the situation. Together they decided to sell both their cars and put the money in the company. His wife had just one condition – that when the company “made it” that she would get the car of her dreams. McCloskey agreed and the cars were sold quickly.

And then the call came.

Alan Kincade, CEO of Epworth HealthCare called McCloskey to ask him to come to Australia to make a last presentation to the selection committee who was looking at new patient entertainment systems. McCloskey flew down to Australia and met with the Epworth team. The product’s vastly improved feature set, which went well beyond a simple entertainment system, impressed the committee. After the presentation, Kincade asked to meet privately with McCloskey.

“At that meeting Alan told me that we had the best product he’d ever seen,” said McCloskey. “But before we could move forward, he wanted me to answer a few questions from their financial controller. At that point he invited Liz into the room and she asked me three questions which I answered as honestly as I could.”

“How many employees do you have?”

“Eight”

“What’s your revenue?”

“Our revenue is zero right now.”

“What’s your balance sheet look like?”

“Not that good actually. Right now we’re $5 Million in debt.”

According to McCloskey it was at that point that the controller turned to Kincade and said: “Honestly Alan you can’t sign a contract with a company from Ireland with eight people who are 5 million in debt.”

OOF.

But just when all hope seemed lost, Kincade said the magic words that would set Oneview on a path to success: “Mark, can you sort out your debt problem? If you can get back to me in 6 months and prove to me that you have the money and the balance sheet sorted out so that I can sign a contract for 5 years, I’ll do business with you.”

McCloskey committed to Kincade that he would.

The meeting happened on a Wednesday and by Friday McCloskey was home in Ireland getting ready with his wife for a dinner party with some friends. By cosmic coincidence, one of the other guests at the dinner party just happened to be a financier from Australia who helped companies raise capital. Over dinner, the two of them agreed to meet at the Oneview office on Monday.

During that meeting, McCloskey and his team impressed the financier who agreed to help Oneview raise money and restructure its debt. That financier was James Fitter, who is now Oneview’s Chief Executive Officer.

Together McCloskey and Fitter raised $8 Million from family, friends and angel investors. They bought back the company’s debt from the bank and in a few short months they got the balance sheet in order. A week after they completed the financing, the company inked its first deal – from Chris O’Brian Lifehouse in Australia. A week later, UCSF called to negotiate a deal.

“Joe Bengfort, CIO of UCSF Medical Center called me up and told me ‘You have a great product and you are one of two finalists’,” said McCloskey. “He then told us that the other company was installed in 40,000 beds compared to the zero that we had. Despite that, he let us know that we had won the contract because ‘UCSF has not gotten to where it is without making brave and bold decisions’”

To secure the deal, McCloskey had to make several commitments including: handing over Board of Director notes to Bengfort so that he could read about the technical direction and financial health of the company (something that Fitter had implemented as standard company practice earlier in the year) and to allowing a member of the UCSF team serve on the new customer advisory board for the Oneview product (which they did).

With these two new customers in the fold and having met the conditions outlined by Kincade at their last meeting, McCloskey returned to Epworth and signed the deal. In just a few months Oneview went from zero revenue to having three large hospital clients. It was just the boost the company needed.

Today, Oneview is a successful company with offices in Dublin (Global HQ), Chicago, Dubai, Melbourne and Sydney. The company recently announced a further global expansion with customers in Thailand and the rest of UAE.

As McCloskey told his story, I was struck by the number of times he was asked to make a commitment and was impressed by his effort to make good on those commitments. Whether it was a promise to sell a certain number of dresses, to address the company finances or to buy a car of his wife’s dreams, McCloskey never waivered in his commitment.

In this day and age, it is easy to make a verbal promise and even easier to break it. Verbal agreements simply do not have the heft they once did. To me it is rare and special to you hear a story like McCloskey’s – of promises made and kept.

Over this past year I have gotten to know a few members of the Oneview team and I can tell you firsthand that the company has a culture of living up to commitments. When they say they will do something, they do it. It’s not hard to trace this culture back to McCloskey. It is one of the reasons why the company is succeeding.

EPILOGUE: McCloskey did buy his wife the car of her dreams. He never did get around to replacing his vehicle and now uses Uber instead.

Memorial Day

Posted on May 28, 2018 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.

Thanks everyone for reading. I hope that each of you has a great Memorial Day. My thoughts today are with my brother who serves in the military, but also with all of the healthcare professionals that are still working on this day. While not the same sacrifice, it’s a sacrifice just the same to be working on a day when most are spending time with their families and friends. Thanks to everyone who sacrifices to make this world a little better.

“We’re Goin’ Live with Epic Now” – An EHR Go-live Parody Video

Posted on May 25, 2018 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.

Many of you may remember the Hamilton parody video that Mary Washington Healthcare did back when they selected Epic as their new EHR. Well, Mary Washington Healthcare’ CEO, Mike McDermott, and his Epic team are back again with another Hamilton parody video as they go live on Epic. Check out the video below:

I’m sure many people wonder why a healthcare leader would engage their employees in a video like this. Many underestimate the value of bringing a team together to create a project like this. It’s an extremely valuable team building experience. Plus, it’s nice to have a little fun together when dealing with something as grueling as an Epic EHR implementation.

Furthermore, one of the keys to effectively implementing an EHR is creating a deep relationship with your EHR vendor. There are always problems that come up where you need your EHR vendors support to solve the problems. What better way to get noticed and appreciated by your EHR vendor than to create a video like the one above?

Nice work to the team at Mary Washington Healthcare for creating such a great video. I especially like the drone shots and the shout out to the Epic employees not dressed in the period clothes like everyone else.

In The Aftermath Of Sutter Health EMR Crash, Nurses Raise Safety Questions

Posted on May 24, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In mid-May, Sutter Health’s Epic EMR crashed, accompanied by other technical problems. Officials said the system failures were caused by the activation of the fire suppression system in one of their IT buildings.

As you might expect, employees at locations affected by the downtime weren’t able to access patient medical records. On top of that, they didn’t have access to email or even use their phones. In addition, the system had to contact some patients to reschedule appointments.

On the whole, this sounds like the kind of routine issue which, though embarrassing, can be brought to heel if an organization does the disaster planning and employee training on how to react to the situations.

According to some nurses, however, Sutter Medical Center may not have handled things so well. The nurses, who spoke on condition of anonymity with The Sacrament Bee, told the newspaper that the hospital moved ahead with some forms of care before the outage was completely resolved.

The nurses told that when some patients were admitted after the systems failure, clinicians still didn’t have access to critical patient information. For example, a surgical nurse noted that the surgical team relies upon EMR access to review patient histories and physicals performed within the previous 30 days. According to Sutter protocols, these results need to be certified by the physician as still being valid on the date of surgery.

Instead, patients were arriving with their histories and physical exam records on paper, and those documents didn’t include the doctor’s certification that the patient’s condition hadn’t changed. If something went wrong during elective surgery, the team would’ve had to rely on paper documents to determine the cause, the nurses said.

They argue that Sutter Medical Center shouldn’t have taken those cases until the EMR was fully online. “Other Sutter hospitals canceled elective surgeries,” one nurse told a reporter. “Why did Sutter Medical Center feel like they needed to do elective surgeries?”

Also, they say that at least one surgical procedure was affected by the outage, when a surgeon needed a particular instrument to proceed. Normally, they said, operating room telephones display a directory of numbers to supply rooms or nurse stations, but these weren’t available and it forced the surgical team to break its process. Under standard conditions, the team tries not to leave the operating room because a patient’s condition can deteriorate in seconds. In this case, however, a nurse had to hurry out of the room to get instruments the surgeon needed.

While it’s hard to tell from the outside, this sounds a bit, well, unseemly at best. Let’s hope Sutter’s decision-making in this case was based on thoughtful decisions rather than a need to maintain cash flow.

Let this also be an important reminder to every healthcare organization to make sure you have well thought out disaster plans that have been communicated to everyone in your organization. You don’t want to be caught liable when disaster strikes and your staff start free wheeling without having thought through all of the potential consequences.

Enterprise Resource Planning: Critical Factors for Increasing End-User Adoption

Posted on May 23, 2018 I Written By

The following is a guest blog post by Mark Muddiman, Sallie Parkhurst & Maureen Tellefson from Atos.

Healthcare organizations continue to be bombarded with technology implementations that span every critical path in healthcare, from clinical applications to business processes.  EHR implementations alone increased over 75 percent from 2009 to 2015 (NCHS, 2015).  The change continues at a pace that makes adoption of these systems a difficult journey for IT leadership, administrators, clinicians, and the teams who support them.  Mergers and acquisitions within healthcare are at an all-time high.  Acquiring or being acquired requires system consolidation, new technologies, and decisions about workflow and training.  Sharing the lessons learned from successful implementations will drive improved outcomes and create a better understanding of the factors that contribute to successful adoption.

Surgery Partners, a leading operator of surgical facilities and ancillary services, continues to grow both organically and through acquisitions.  With financial systems at end of life, Surgery Partners worked in partnership with Atos to select a new ERP to help manage their business.  ERP systems play a critical role in the transition to value-based care.  About 69 percent of IT leaders said they will prioritize healthcare supply chain in 2017 as “the most valuable asset for actionable data mining” rather than population health and data analytics tools (Black Book, 2016).  Surgery Partners engaged Atos as a consultant to assist with a thorough system selection that would best meet their needs.  The resulting strategic decision was to implement Infor Lawson to replace all legacy systems for Finance and Supply Chain.

The multitude of challenges that arise during large technology implementations are rarely captured, but can provide significant value when shared.  The leadership team at Surgery Partners was highly engaged and disciplined in how they managed and measured adoption of Infor Lawson.  They utilized a research-based methodology, The Breakaway Methodology, published in a book titled Beyond Implementation: A Prescription for the Adoption of Healthcare Technology.  As their partner, Atos provided expert guidance in navigating the adoption process and measuring the work outcomes according to the methodology.

Surgery Partners understood that their business had to overcome a few unique challenges during their implementation.  With hundreds of users spanning 20 locations in 12 states, their geographic footprint made it challenging to educate their employees on the new Infor Lawson solution.  Traditional classroom training is expensive and time-consuming when users are spread across multiple locations. And, without proper training, many ERP system implementations fail.  Instead, Surgery Partners used a novel approach based on The Breakaway Methodology to educate their employees on Infor Lawson.  Atos developed “simulators” which allowed every user to practice relevant tasks and workflows in a realistic environment that mimicked the actual system without compromising real application data.

Atos and Surgery Partners measured the effectiveness of this novel approach throughout their implementation and continue to measure these factors post-implementation.  Eighty-seven percent of employees assigned to the supply chain learning completed their education and 69% of employees assigned to the accounts payable learning completed their education.  In comparison, less than 60% of employees typically complete traditional e-learning.  More importantly, the employees who completed the supply chain learning achieved an average proficiency score of 94% on challenging, workflow-based assessments in a simulated environment.  Employees who completed the finance learning achieved an average proficiency score of 89%.  In addition, users were asked to rate the quality and effectiveness of every simulation.  Based on 656 responses, 94% believed the simulator courses were valuable to their role.  Eighty-eight percent indicated that the simulations provided the knowledge they needed to perform key tasks in the new system, and 90% would recommend the simulations to colleagues going through similar implementations.

A key component of Surgery Partners strategy for managing change involved engaged leadership.  Executive leadership communicated messages to learners that were jointly developed with Atos.  Varying levels of leadership, from Senior Directors through local leaders, were selected as adoption coaches to assist learners with questions and direct them to the appropriate resources.  This approach that was defined as leading by example, set a tone throughout the organization that the adoption of Infor Lawson was imperative and that leaders were there to ensure success.

Achieving ERP adoption also requires continued investment long after go-live.  Surgery Partners developed standard processes to re-examine workflows and continue to educate users on changes or modifications due to system upgrades.  Adoption of technology often erodes over time due to employee turnover, so they put programs in place to teach new users how to use Lawson Infor and develop the same high levels of proficiency in the system achieved during the initial implementation.

Technology adoption creates significant changes in workflow, resource needs and overall governance.  Surgery Partners knew that simply installing a new ERP wouldn’t be enough; to realize the value they expected from the purchase, they had to ensure that every user across their organization successfully adopted the system.  The results Surgery Partners experienced provide important insight for other organizations going through similar technology implementations.

Recommendations and Best Practices:

  • Align business needs and vendor capabilities using a disciplined vendor selection process. Surgery Partners understood the value of selecting the right system and following a disciplined process for achieving adoption.
  • Executive engagement is a significant predictor of implementation success: prioritize the effort across the entire organization, remove organizational barriers, and develop a communication strategy.
  • Lack of training can cause failure. Provide role-based education that is relevant to user roles and allow users to practice realistic workflows. Simulation learning saves time and results in higher user proficiency.
  • Customize your policy and procedure learning. Implement best practices for specific procedures consistently across all locations, and ensure that the simulator training reflects best practices.
  • Develop a plan to sustain high levels of adoption after go-live. Surgery Partners updates their learning regularly and educates new employees to prevent erosion of adoption over time.

“We were highly committed to adopting Infor Lawson and we appreciated the guidance, leadership, responsiveness, and  expertise of the Atos team.” – Cathy Borst, Senior Vice President, IT.

“The learning has gone very smoothly.  I think this has been extremely valuable.”  – Rick Daniel, Senior Director of Supply Chain and Materials Management at Surgery Partners.

Acknowledgements:
Thank you to the leadership at Surgery Partners for their dedication to this project: Cathy Borst (SVP of IT), Chris Vandercook (Director, Technical Services Hospital Division), Sallie Parkhurst-PM, Carol Mortimer (SME), John Hart (CFO), Kara Baker (VP Finance/Corporate Controller), and Doug Watkins (VP of Supply Chain Management).

About the Authors
Mark Muddiman is an Engagement Manager for Breakaway Adoption Solutions, Atos
Sallie Parkhurst is a Project Manager for Digital Health Solutions Consulting, Atos
Maureen Tellefson is an Engagement Manager for Digital Health Solutions Consulting, Atos

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

5 Ways Allscripts Will Help Fight Opioid Abuse In 2018

Posted on May 22, 2018 I Written By

The following is a guest blog post by Paul Black, CEO of Allscripts, a proud sponsor of Health IT Expo.

Prescription opioid misuse and overdoses are on the rise. The Centers for Disease Control and Prevention (CDC) reports that more than 40 Americans die every day from prescription opioid overdose. It also estimates that the economic impact in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment and criminal justice involvement.

The opioid crisis has taken a devastating toll on our communities, families and loved ones. It is a complex problem that will require a lot of hard work from stakeholders across the healthcare continuum.

We all have a part to play. At Allscripts, we feel it is our responsibility to continuously improve our solutions to help providers address public health concerns. Our mission is to design technology that enables smarter care, delivered with greater precision, for better outcomes.

Here are five ways Allscripts plans to help clinicians combat the opioid crisis in 2018:

1) Establish a baseline. Does your patient population have a problem with opioids?

Before healthcare organizations can start addressing opioid abuse, they need to understand how the crisis is affecting their patient population. We are all familiar with the national statistics, but how does the crisis manifest in each community? What are the specific prescribing practices or overdose patterns that need the most attention?

Now that healthcare is on a fully digital platform, we can gain insights from the data. Organizations can more precisely manage the needs of each patient population. We are working with clients to uncover some of these patterns. For example, one client is using Sunrise™ Clinical Performance Manager (CPM) reports to more closely examine opioid prescribing patterns in emergency rooms.

2) Secure the prescribing process. Is your prescribing process safe and secure?

Electronic prescribing of controlled substances (EPCS) can help reduce fraud. Unfortunately, even though the technology is widely available, it is not widely adopted. Areas where clinicians regularly use EPCS have seen significantly less prescription fraud and abuse.

EPCS functionality is already in place across our EHRs. While more than 90% of all pharmacies are EPCS-enabled, only 14% of controlled substances are prescribed electronically. We’re making EPCS adoption one of our top priorities at Allscripts, and we continue to discuss the benefits with policymakers.

3) Provide clinical decision support. Are you current with evidence-based best practices?

We are actively pursuing partnerships with health plans, pharmaceutical companies and third-party content providers to collaborate on evidence-based prescribing guidelines. These guidelines may suggest quantity limits, recommendations for fast-acting versus extended-release medications, protocols for additional and alternative therapies, and expanded educational material and content.

We’ll use the clinical decision support technologies we already have in place to present these assessment tools and guidelines at the time needed within clinical workflows. Our goal is to provide the information to providers at the right time, so that they can engage in productive conversations with patients, make informed decisions and create optimal treatment plans.

4) Simplify access to Prescription Drug Monitoring Programs (PDMPs). Are you avoiding prescribing because it’s too hard to check PDMPs?

PDMPs are state-level databases that collect, monitor and analyze e-prescribing data from pharmacies and prescribers. The CDC Guidelines recommend clinicians should review the patient’s history of controlled substance prescriptions by checking PDMPs.

PDMPs, however, are not a unified source of information, which can make it challenging for providers to check them at the point of care. The College of Healthcare Information Management Executives (CHIME) has called for better EHR-PDMP integration, combined with data-driven reports to identify physician prescribing patterns.

In 2018, we’re working on integrating the PDMP into the clinician’s workflow for every patient. The EHR will take PDMP data and provide real-time alert scores that can make it easier to discern problems at the point of care.

5) Predict risk. Can big data help you predict risk for addiction?

Allscripts has a team of data scientists dedicated to transforming data into information and actionable insights. These analysts combine vast amounts of information from within the EHR, our Clinical Data Warehouse – data that represents millions of patients – and public health mechanisms (such as PDMPs).

We use this “data lake” to develop algorithms to identify at-risk patients and reveal prescription patterns that most often lead to abuse, overdose and death. Our research on this is nascent, and early insights are compelling.

The opioid epidemic cannot be solved overnight, nor is it something any of us can address alone. But we are enthusiastic about the teamwork and efforts of our entire industry to address this complex, multi-faceted epidemic.

Hear Paul Black discuss the future of health IT beyond the EHR at this year’s HIT Expo.

Geisinger Integrates Precision Medicine Into Care

Posted on May 21, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Lately, it seems like we read about new advances in precision medicine every day. Increasingly, physicians are able to adjust drug therapies and predict conditions like cancer and heart disease before they blossom, particularly in the case of some cancers. However, many health organizations are still focused on research rather than delivering genomic medicine results to consumers.

The process of basing medical decisions on genomic data has certainly begun, with a number of health systems jumping on board. For example, a few months ago Intermountain Healthcare begin the process of validating and launching several tests designed to identify hereditary genetic patterns that might lead to disease. Intermountain expects this work to be particularly fruitful for individuals with a family history of breast cancer or ovarian cancer. The test should identify both those previously diagnosed with cancer and healthy individuals with hereditary cancer gene mutations.

Now, at least one health system is taking things even further. Geisinger Health says it has announced that it plans to expand its genomics program beyond its research phase and into everyday care for all patients. The new program will not only target patients who have obvious symptoms, but instead, all patients Geisinger treats. The health systems clinical DNA sequencing efforts will begin with a 1000-patient pilot program taking place in mid-to-late 2018.

According to David Ledbetter, Ph.D., Geisinger executive vice president and chief scientific officer, the program will not only help current patients but also amass data that will help future patients. “As we sequence the exomes of our patients and learn even more about particular genome variants and their impact on different health conditions, we predict that as many as 10 to 15 percent of our patients will benefit,” he said.

The new strategy follows on the success of its MyCode Community Health Initiative, which it launched in 2014 in collaboration with Regeneron Pharmaceuticals. Since then, Geisinger has been analyzing the DNA of patients participating in the program, which has attracted more than 190,000 patient sign-ups to date. To date, more than 500 MyCode participants have been notified that they have a genomic variant which increases the chance that they’ll develop cancer or heart disease.

Geisinger’s effort sounds exciting, there’s little doubt. However, programs like these face some obstacles which the health system wouldn’t call attention to a press release. For example, as my colleague John Lynn notes, integrating genomic data with other clinical information could be quite difficult, and sharing it even more so.

“Healthcare organizations have problems even sharing something as standard and simple as a PDF,” he wrote last year. “Once we have real genomic data and the markers behind them, EHRs won’t have any idea how to handle them. We’ll need a whole new model and approach or our current interoperability problems will look like child’s play.” Let’s hope the industry develops this new approach soon.

Hospitals Still Grappling With RCM Tech Infrastructure

Posted on May 18, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While revenue cycle management isn’t the sexiest topic on the block, hospitals need to get it right or they won’t be able to pay their bills. One key element needed to accomplish this goal is a robust tech infrastructure that helps RCM specialists get their job done.

However, it seems that many hospitals are struggling to manage RCM data and pick out the right vendors to support their efforts, according to a report published by Dimensional Insight in collaboration with HIMSS Analytics. To conduct the research, the two organizations reached out to 117 senior-level decision-makers in hospitals and health systems.

According to the survey, more than two-thirds of health systems use more than one vendor for RCM. But that might be a bad idea. The research also found that organizations using more than one RCM vendor seem to face bigger issues with denials than those using only one RCM solution. Regardless, the execs said that denials were the biggest RCM challenge for health systems today.

Pulling together RCM data is a struggle too, respondents said. More than 95% of health systems reported that the way data is collected is a challenge. Also, nearly all respondents said that collecting RCM data from disparate sources is also difficult.

One reason why it’s tough for hospitals to put effective RCM technology in place may be that health information management directors and managers aren’t at the top of the influencer list when it comes to making these decisions.

When asked who the key stakeholders were in RCM. 91.5% said that the CFO was the most important, followed by the head of revenue cycle, who was ranked as important by 62.4% of respondents. Meanwhile, only 48.7% of respondents saw the health IT leaders as key stakeholders in the RCM environment. In other words, it looks like tech leaders aren’t given much clout.

When it came to technical infrastructure for RCM, respondents were all over the map. For example, 34.5% were working with an EMR and 3+ vendors. Another 12.1% used in EMR with one vendor, followed by 11.2% with 3+ vendor solutions, 6.9% using an EMR plus two vendors and 4.3% using two to vendor solutions. Clearly, there’s no single best practice for managing RCM technology in hospitals.

Not only that, some hospitals aren’t doing much to analyze the RCM data they’ve got. According to the survey, 23.9% said that 51 to 75% of the RCM process was automated, which isn’t too bad. However, 36.8% of hospitals reported that less than 25% of the revenue cycle process was driven by analytics. Also, roughly a third of respondents said that collecting data from diverse sources was extremely challenging, which can cripple an analytics initiative.

Taken as a whole, the report data suggests that hospitals need to improve their RCM game dramatically, which includes getting a lot smarter about RCM technology. Unfortunately, it looks like it could be a long time before this happens.

Effort Focuses On Better Ways For Hospitals To Detect Drug Diversion

Posted on May 17, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Using a combination of machine learning technology and advanced analytics, a healthcare vendor has been working to find better ways to spot drug diversion in U.S. hospitals. The work done by the firm, Invistics, is funded by an NIH research grant.

The project has taken aim at a ripe target. According to a 2017 study by Porter Research, 96% of healthcare professionals who responded said that drug diversion happened often in their business. Also, sixty-five percent of respondents said that most diversion never gets detected. Clearly, there’s a hole you could drive a truck through in the drug dispensing process.

During the first stage of the research, Invistics worked with a pilot hospital to find opioid and drug theft across the entire facility. To get the job done, the vendor aggregated data from across the pilot hospital’s systems, including medical records, employee time clocks, wholesale purchasing, inventory and dispensing cabinets.

By leveraging data across several departments, Invistics got a much clearer view of potential problems than other efforts have in the past. The initiative was completely successful, with the technology picking out 100% of drug diversion happening within the project’s parameters, the company said. Since the completion of Phase I of the grant, Invistics has rolled out the solution at several other hospitals.

When it comes to avoiding opioid abuse, far morer attention has been focused on patterns of opioid prescribing, with the assumption that the opioid addiction epidemic can be stemmed at the source. For example, we recently covered a study looking at post hospital-discharge opioid use which centered on predicting which patients would be on chronic opioid therapy after discharge and planning for that discharge appropriately.

There’s no question that such research has a place in the battle against opioid misuse and abuse. After all, it seems likely that at least some needless addictive patterns stem from physician prescribing habits. It also makes sense that states are revising their guidelines for opioid prescribing, though to my knowledge these changes are being based more on ideology than rigorous research.

On the other hand, drug diversion creates a pipeline between drug supplies and drug abusers which must be addressed directly if the opioid abuse war is to be won. I for one was interested to learn about a solution that addresses this piece of the puzzle.