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Next Steps In Making Healthcare AI Practical

Posted on November 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.

In recent times, AI has joined blockchain on the list of technologies that just sort of crept into the health IT toolkit.

After all, blockchain was borne out of the development of bitcoin, and not so long ago the idea that it was good for anything else wasn’t out there. I doubt its creators ever contemplated using it for secure medical data exchange, though the notion seems obvious in retrospect.

And until fairly recently, artificial intelligence was largely a plaything for advanced computing researchers. I’m sure some AI researchers gave thought to cyborg doctors that could diagnose patients while beating them at chess and serving them lunch, but few practical applications existed.

Today, blockchain is at the core of countless health IT initiatives, many by vendors but an increasing number by providers as well. Healthcare AI projects, for their part, seem likely to represent the next wave of “new stuff” adoption. It’s at the stage blockchain was a year or two ago.

Before AI becomes more widely adopted in healthcare circles, though, the industry needs to tackle some practical issues with AI, and the list of “to-dos” keeps expanding. Only a few months ago, I wrote an item citing a few obstacles to healthcare AI deployment, which included:

  • The need to make sure clinicians understand how the AI draws its conclusions
  • Integrating AI applications with existing clinical workflow
  • Selecting, cleaning and normalizing healthcare data used to “train” the AI

Since then, other tough challenges to the use of healthcare AI have emerged as the healthcare leaders think things over, such as:

Agreeing on best practices

Sure, hospitals would be interested in rolling out machine learning if they could, say, decrease the length of hospital stays for pneumonia and save millions. The thing is, how would they get going? At present, there’s no real playbook as to how these kinds of applications should be conceptualized, developed and maintained. Until healthcare leaders reach a consensus position on how healthcare AI projects should generally work, such projects may be too risky and/or prohibitively expensive for providers to consider.

Identifying use cases

As an editor, I see a few interesting healthcare AI case studies trickle into my email inbox every week, which keeps me intrigued. The thing is, if I were a healthcare CIO this probably wouldn’t be enough information to help me decide whether it’s time to take up the healthcare AI torch. Until we’ve identified some solid use cases for healthcare AI, almost anything providers do with it is likely to be highly experimental. Yes, there are some organizations that can afford to research new tech but many just don’t have the staff or resources to invest. Until some well-documented standard use cases for healthcare AI emerge, they’re likely to hang back.

The healthcare AI discussion is clearly at a relatively early stage, and more obstacles are likely to show up as providers grapple with the technology. In the meantime, getting these handled is certainly enough of a challenge.

Less Than Half of Healthcare Users Trust Critical Organizational Data

Posted on November 29, 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.

If you’re a healthcare CIO, you must hope that your users trust and feel they can leverage data to do their jobs better. However, some of your colleagues don’t seem to be so sure. A new study has concluded that less than half of users in responding healthcare organizations have a high degree of trust in their clinical, operational or financial data.

The study, which was conducted by Dimensional Insight, surveyed 85 chief information officers and other senior health IT leaders. It asked these leaders how they rated trust in the data leveraged by their various user communities, the percentage of user population they felt was self-service oriented and making data-driven decisions, and whether they planned to increase or decrease their investments in data trust and self-service analytics.

When rating the level of data trust on a 10-point scale, just 40% of respondents rated their trust in financial data at eight or above, followed by 40% of clinical data users and 36% of operational data users.

Perhaps, then, it follows that healthcare organizations responding to the survey had low levels of self-service data use. Clinical data users had a particularly low rate of self-service use, while financial users seemed fairly likely to be accessing and using data independently.

Given these low levels of trust and self-service data usage, it’s not surprising to find out that 76% of respondents said they plan to invest in increasing their investment in improving clinical data trust, 77% their investments in improving operational data trust and 70%  their investment in financial data trust.

Also, 78% said they plan to increase their spending on self-service analytics for clinical data and 73% expect to spend more on self-service analytics for operational data. Meanwhile, while 68% plan to increase spending on financial self-service analytics, 2% actually planned to decrease the spending in this area, suggesting that this category is perhaps a bit healthier.

In summing up, the report included recommendations on creating more trust in organizational data from George Dealy, Dimensional Insight’s vice president of healthcare applications. Dealy’s suggestions include making sure that subject matter experts help to design systems providing information critical to their decision-making process, especially when it comes to clinicians. He also points out that health IT leaders could benefit from keeping key users aware of what data exists and making it easy for them to access it.

Unfortunately, there are still far too many data silos protected by jealous guardians in one department or another. While subject matter experts can design the ideal data sharing platform for their needs, there’s still a lot of control issues to address before everyone gets what they need. In other words, increasing trust is well and good, but the real task is seeing to it that the data is rich and robust when users get it.

Fundamentals of Securing Reimbursement for Healthcare Technology

Posted on November 28, 2018 I Written By

The following is a guest blog post by Keith J. Saunders, Esq., Founder & CEO of FHAS.

The utilization of technology to enhance and improve the patient experience is among today’s leading topics in healthcare. Recent technological developments have permitted improved access to healthcare, high quality care delivered in the most cost effective manner possible, and patient data to be acquired and leveraged to furnish more effective services. Whether through an Apple watch, telemedicine to rural or underserved areas, electronic medical record systems, clinical informatics, or delivery of care through robotic technology, there are many amazing opportunities to improve and enhance the patient experience.

One area which is frequently overlooked for enhancement of the patient experience is the integration of these modalities into the reimbursement system. No matter how innovative and effective the technology may be, at the end of the day the services or items in question need to be paid for by the patient’s insurance coverage.

Whether you are involved in product design or make purchasing decisions, one crucial element you should take into account in the design and deployment of new technology is how to pay for it. The following reimbursement decision algorithm can help to expedite that decision.

1. Is this a covered item or service?

The answer to this initial question can be found in the scope of coverage issued by the respective third party payors, both government and private. If you are seeking to have an item paid for by the Medicare program, your first stop should be the Medicare Benefit Policy Manual. If you are seeking to have an item paid for by the Medicaid program, consult the guidelines of the respective Medicaid program offered by the state in which the beneficiary resides. A general listing of essential benefits required to be offered under the Medicaid program may be found at the CMS Medicaid/CHIP homepage.

Similarly, commercial insurers publish their own benefit policies on their corporate websites which set forth what services and products are covered by their various products. After you have determined that an item is a covered service, the next step is to ascertain under what circumstances it will be afforded coverage by the payor, and to what degree.

2. Under what circumstances will a payor cover an item?

The answer to this question is typically found within the coverage and payment guidelines issued by third-party payors. The good news is that these policies are usually quite detailed and subjective. The bad news is that you may have to conduct extensive research to determine how they are applied. A good place to start for the Medicare program is at the National Coverage Determinations manual (NCD). The NCD will provide a general scope of coverage for a device or service, but to find more comprehensive guidance regarding coverage, you should go to the websites of the Medicare Administrative Contractors (MACs). The MAC websites will furnish detailed guidance regarding coverage and payment guidelines for specific items and services covered under the Medicare program.

The process for Medicaid is similar in that each state program maintains coverage criteria either directly or through the entities selected for delivery of benefits, such as Medicaid managed care plans.

Commercial insurers, such a Blue Cross Blue Shield, likewise maintain their coverage and payment guidelines online for review, which set forth the scope and conditions for reimbursement for services or items.

3. What documentation or information do I need to capture to ensure coverage of an item or service?

The answers to this question can also be found in the coverage and payment guidelines referenced above. Typically the coverage and payment guidelines specify the type of information required by a payor to make a payment determination. This is a critical component of the payment determination process and represents perhaps the area of greatest peril for the deployment of new technology.

If you are deploying new technologies or procedures, I would strongly recommend that you familiarize yourself with the payment rules for the third party payors you are seeking to bill for your service. The greatest technology in the world is of little value if payment is impaired due to the failure to tailor your technology to the coverage and payment guidelines. Similarly, if you are seeking to purchase a new technology or service as a healthcare provider, you must likewise consider how you will pay for the device or service.

The enhanced patient experience which we are all seeking through improved quality and efficiency can only be attained if reimbursement is on our radar. By doing so, we can ensure that our constituencies receive the benefit of innovative technology while maintaining financial peace of mind.

If you don’t have that peace of mind and the above steps seem too overwhelming, you can also reach out to a trusted claims review partner with expertise in reimbursement, like FHAS. Not getting paid because you’re using innovative technology is almost always an avoidable outcome.

About FHAS
FHAS, a URAC accredited IRO and ISO 9001 certified company, is one of the largest independent providers of “healthcare as a service” (HAAS) for government and commercial clients with a particular focus on adjudication services and medical claims’ review services. In 1996, FHAS began furnishing Medicare Fair Hearing Services to Durable Medical Equipment (DME) Administrative contractors located throughout the United States. Since that time, FHAS has expanded its scope of appeals services to include complex medical reviews for the following: Medicare Parts A, B, PDRC Appeals, and DME Appeals, internal and external health plan appeals, and the entire Pennsylvania Medicaid fair hearing process. FHAS utilizes a network of board certified physicians, legal professionals, and other healthcare professionals with diverse specialties, who have the expertise to render decisions for external review requests. In addition to professional services, FHAS provides enterprise-grade software solutions to healthcare and insurance industries. Their newest product Cogno-Solve is a comprehensive, RPA software platform that automates claims and appeals decision-making functions.

From Fragmented to Coordinated: The Big Data Challenge

Posted on November 27, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

When healthcare organizations have access to as much data as possible, that translates into improved coordination and quality of care, reduced costs for patients, payers and providers, and more efficient medical care. Yet, there is a void in the healthcare data landscape when it comes to securing the right information to make the right decision at the right time. It is becoming increasingly critical to ensure that providers understand data and are able to properly utilize it. Technologies are emerging today that can help deliver a full picture of a patient’s health data, which can lead to more consistent care and the development of improved therapies by helping providers derive better insights from clinical data.

Across the country, patient data resides across multiple systems, and in a variety of structured and unstructured formats. The lack of interoperability makes it difficult for organizations to have access to the data they need to run programs that are critical to patient care. Often, various departments within an organization seek the same information and request it separately and repeatedly, leading to a fragmented picture of a patient’s health status.

Managing Complexity, Inside and Out

While analytics tools work well within select facilities and research communities, these vast data sets and the useful information within them are very complex, especially when combined with data sets from outside organizations. The current state of data illiquidity even makes it challenging to seamlessly share and use data within an organization.

For example, in the life sciences arena, disease staging is often the foundation needed to identify a sample of patients and to link to other relevant data which is then abstracted and mined for real world use; yet clinical and patient reported data is rarely documented in a consistent manner in EHRs. Not only do providers often equivocate and contradict their own documentation, but EHR conventions also promote errors in the documentation of diagnostic findings. Much of the documentation can be found in unstructured EHR notes that require a combination of abstraction and clinician review to determine the data’s relevance.

Improved Interoperability, Improved Outcomes

Problems with EHR interoperability continue to obstruct care coordination, health data exchange and clinical efficiency. EHRs are designed and developed to support patient care delivery but, in today’s world of value-based care, the current state of EHR interoperability is insufficient at best.

Consider the difficulty in collecting a broad medical data set. The three largest EHRs combined still corner less than one-third of the market, and there are hundreds of active EHR vendors across the healthcare landscape, each bringing its own unique approach to the information transfer equation. Because many hospitals use more than one EHR, tracking down records for a single patient at a single hospital often requires connecting to multiple systems. To collect a broader population data set would require ubiquitous connection to all of the hundreds of EHR vendors across the country.

The quality integration of health data systems is essential for patients with chronic conditions, for example. Patients with more serious illnesses often require engagement with several specialists, which means it is particularly important that the findings and data from each specialist are succinctly and properly communicated to fellow doctors and care providers.

Leveraging Technology

As the industry matures in its use of data, emerging technologies are beginning to break down information road blocks. Retrieving, digitizing and delivering medical records is a complex endeavor, and technology must be layered within all operations to streamline data acquisition and make executable data available at scale, securing population-level data more quickly and affordably.

When planning to take advantage of new advanced technologies, seek a vendor partner that provides a mix of traditional and emerging technologies, including robotic process automation (RPA), computer vision, natural language processing (NLP) and machine learning. All of these technologies serve vital functions:

  • RPA can be used to streamline manually intensive and repetitive systematic tasks, increasing the speed and quality at which clinical and administrative data are retrieved from the various end-point EHRs and specialty systems.
  • NLP and neural networks can analyze the large volume of images and text received to extract, organize and provide context to coded content, dealing with ambiguous data and packaging the information in an agreed-upon standard.
  • With machine learning, an augmented workforce can be equipped to increase the quality of records digitization and the continuous learning across the ecosystem, where every touchpoint is a learning opportunity.

Smarter, faster and more qualitative systems of information exchange will soon be the catalysts that lead paradigm-shifting improvements in the U.S. care ecosystem, such as:

  • Arming doctors with relevant information about patients
  • Increasing claims accuracy and accelerating providers’ payments
  • Empowering universities and research organizations with timely, accurate and clinically relevant data sets
  • Correlating epidemics with the preparedness of field teams
  • Alerting pharmacists with counter-interaction warnings

Ultimately, improving information exchange will enable healthcare industry professionals to elevate patient safety and quality, reduce medical and coding errors tenfold and enhance operational efficiencies by providing the relevant data needed to quickly define treatment.

Achieving this paradigm shift depends almost entirely on taking the necessary steps to adopt these emerging technologies and drive a systematic redesign of many of our operations and systems. Only then will we access the insights necessary to truly impact the quality of care across the healthcare landscape.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

AI May Be Less Skilled At Analyzing Images From Outside Organizations

Posted on November 26, 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 AI technologies to analyze medical images is looking more and more promising by the day. However, new research suggests that when AI tools have to cope with images from multiple health systems, they have a harder time than when they stick to just one.

According to a new study published in PLOS Medicine, interest is growing in analyzing medical images using convolutional neural networks, a class of deep neural networks often dedicated to this purpose. To date, CNNs have made progress in analyzing X-rays to diagnose disease, but it’s not clear whether CNNs trained on X-rays from one hospital or system will work just as well in other hospitals and health systems.

To look into this issue, the authors trained pneumonia screening CNNs on 158,323 chest X-rays, including 112,120 X-rays from the NIH Clinical Center, 42,396 X-rays from Mount Sinai Hospital and 3,807 images from the Indiana University Network for Patient Care.

In their analysis, the researchers examined the effect of pooling data from sites with a different prevalence of pneumonia. One of their key findings was that when two training data sites had the same pneumonia prevalence, the CNNs performed consistently, but when a 10-fold different in pneumonia rates were introduced between sites, their performance diverged. In that instance, the CNN performed better on internal data than that supplied by an external organization.

The research team found that in 3 out of 5 natural comparisons, the CNNs’ performance on chest X-rays from outside hospitals was significantly lower than on held-out X-rays from the original hospital system. This may point to future problems when health systems try to use AI for imaging on partners’ data. This is not great to learn given the benefits AI-supported diagnosis might offer across, say, an ACO.

On the other hand, it’s worth noting that the CNNs were able to determine which organization originally created the images at an extremely high rate of accuracy and calibrate its diagnostic predictions accurately. In other words, it sounds as though over time, CNNs might be able to adjust to different sets of data on the fly. (The researchers didn’t dig into how this might affect their computing performance.)

Of course, it’s possible that we’ll develop a method for normalizing imaging data that works in the age of AI, in which case the need to adjust for different data attributes may not be needed.  However, we’re at the very early stages of training AIs for image sharing, so it’s anyone’s guess as to what form that normalization will take.

Top 10 Health Technology Hazards

Posted on November 23, 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.

Over the years, it’s always been interesting to take a look at the Top 10 Health Technology Hazards reports that the ECRI Institute puts out each year. Healthcare IT always seems to show up on the list which is interesting since I hear very few healthcare IT salespeople talk about the risks of their systems vs the benefits.

I’m not exactly sure when ECRI puts out these annual reports, but the 2019 report is already out. However, before we look at the Top 10 Health Hazards for 2019, I like to look back at what was on their list from 2018:
1. Ransomware and Other Cybersecurity Threats to Healthcare Delivery Can Endanger Patients

2. Endoscope Reprocessing Failures Continue to Expose Patients to Infection Risk

3. Mattresses and Covers May Be Infected by Body Fluids and Microbiological Contaminants

4. Missed Alarms May Result from Inappropriately Configured Secondary Notification Devices and Systems

5. Improper Cleaning May Cause Device Malfunctions, Equipment Failures, and Potential for Patient Injury

6. Unholstered Electrosurgical Active Electrodes Can Lead to Patient Burns

7. Inadequate Use of Digital Imaging Tools May Lead to Unnecessary Radiation Exposure

8. Workarounds Can Negate the Safety Advantages of Bar-Coded Medication Administration Systems

9. Flaws in Medical Device Networking Can Lead to Delayed or Inappropriate Care

10. Slow Adoption of Safer Enteral Feeding Connectors Leaves Patients at Risk

And now a look at the list of healthcare technology hazards for 2019:
1. Hackers Can Exploit Remote Access to Systems, Disrupting Healthcare Operations

2. “Clean” Mattresses Can Ooze Body Fluids onto Patients

3. Retained Sponges Persist as a Surgical Complication Despite Manual Counts

4. Improperly Set Ventilator Alarms Put Patients at Risk for Hypoxic Brain Injury or Death

5. Mishandling Flexible Endoscopes after Disinfection Can Lead to Patient Infections

6. Confusing Dose Rate with Flow Rate Can Lead to Infusion Pump Medication Errors

7. Improper Customization of Physiologic Monitor Alarm Settings May Result in Missed Alarms

8. Injury Risk from Overhead Patient Lift Systems

9. Cleaning Fluid Seeping into Electrical Components Can Lead to Equipment Damage and Fires

10. Flawed Battery Charging Systems and Practices Can Affect Device Operation

In a bit of a surprising result to me, the only thing on the list that qualifies as healthcare IT to me is the first one focused on hackers accessing health IT systems and disrupting the healthcare operations. It’s no surprise that hackers are on the list, but I’d have thought more health IT components would be on there. Even something like inappropriate alerts or incorrect information in the EHR or even health IT system downtime.

I’m not sure if we should applaud healthcare IT for not really making the list or whether it’s more of an indication of the other things being more hazardous. What is an important takeaway from these lists is that healthcare organizations have a lot of different hazards to deal with in their environment. Poorly implemented health IT is only one of them.

Cybersecurity, Telehealth and Big Tech Entrants are Top of Mind

Posted on November 22, 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.

Unease over cybersecurity, optimism for the future of telehealth, and worries about the entry of big tech companies (like Apple, Amazon and Google) are the top three concerns for 2019 according to a recent survey of healthcare leaders released by the Center for Connected Medicine.

The Center for Connected Medicine (CCM), which is jointly operated by GE Healthcare, Nokia and UPMC, partnered with The Health Management Academy for the Top of Mind 2019 survey. Conducted in three parts, the research started with a survey of health system information officers in May 2018 to determine the top areas of health IT for 2019.

According to the CCM, key findings include:

  • Hackers and other cyber-criminals are stepping up their attacks on the health care industry, leading 87 percent of respondents to say they expect to increase spending on cybersecurity in 2019; no health system was expecting to decrease spending.
  • Health information technology (IT) leaders overwhelmingly expect government and commercial reimbursement to provide the majority of funding for telehealth services by 2022; internal funding and patient payments are expected to provide the majority of funding for telehealth in 2019.
  • 70 percent of responding executives said they were “somewhat concerned” about big tech companies, such as Apple, Amazon and Google, disrupting the health care market; 10 percent were “very concerned.”

Cybersecurity

Cybersecurity was the top concern from the 2018 survey so it is not surprising to see it on top of the list for 2019 – especially as the number of cyberattacks continues to increase each year. What is surprising is the level of confidence that executives have in their ability to recover from an attack.

According to the report:

  • Only 20% of respondents reported being “very confident” in their organization’s IT recovery and business continuity plans
  • 70% of respondents said they were “somewhat confident” in those plans

I’m not sure I would want to be at a healthcare organization that was only “somewhat confident” it could recover from a cyber attack.

For me, the survey highlights how much work we still have to do around cybersecurity in healthcare. It’s not just a matter of hardening HealthIT systems, that is only part of the solution. Healthcare organizations also need to implement robust security processes and ensure staff are properly educated.  The latter is particularly important as Phishing and spear-phishing were cited by 80% of Top-of-Mind survey respondents as the most common types of cyberattacks.

My colleague John Lynn recently wrote an article that dives deeper into cybersecurity.

Telehealth

One of the most interesting findings in the survey was the optimism healthcare executives have for telehealth.

“Telehealth represents a low percentage of total care delivery at all responding health systems, yet executives unanimously anticipate growth in the next three years as reimbursement increases and consumer demand picks up. All responding health systems report 10% or less of their organization’s total care delivery is currently provided through telehealth. However, all health systems expect an increase over the next three years, with 45% expecting a significant increase of 10% or more.”

According to the survey the biggest barrier to telehealth adoption is not the technology, but rather the lack of reimbursement.

Part of the optimism executives feel toward telehealth may have to do with the final 2019 Physician Fee Schedule and Quality Payment Program issued early in November 2019 by The Centers for Medicare & Medicaid Services (CMS). As of 1 January 2010, CMS will reimburse a number of telehealth and communication-technology based services:

  • Brief communication technology-based service, e.g. using phone or other telecommunications device to decide whether an office visit is needed
  • Remote evaluation of recorded video and/or images submitted by an established patient
  • Remote patient monitoring (CPT codes 99453, 99454, 99457)
  • Interprofessional Internet consultations (CPT codes 99451, 99452, 99446, 99447, 99448, 99449)

It is widely expected that CMS will continue to expand the reimbursement for communication technology enabled services in future years.

Entry of Big Tech Companies

Companies like Apple, Amazon, Google and Microsoft have each made significant healthcare-related announcements this past year and continue to push into the healthcare space. Their entry has executives concerned, according to the Top-of-Mind survey results.

“The biggest threat is if these companies get between us and the end consumer,” said one CEO in a written survey comment. “If there is a platform regulated and controlled by someone other than us – that makes us nervous. There are many places where some of these new platforms and conveniences can and will likely succeed – we haven’t been good in this space.”

What this CEO is referring to is the consumer-focus that these Big Tech companies have and how relentless they are at providing superior consumer experiences based on data as well as deep analytics. That is something traditional healthcare organizations have only just woken up to realize – that patients want the consumer-friendly conveniences they have become accustomed to from other industries like retail and banking.

Top-of-Mind Conference

In a few weeks CCM will be hosting healthcare leaders from around the country at their annual Top-of-Mind conference. I’m really excited to attend the event and learn first-hand how leaders plan to address their concerns in 2019. Stay tuned.

Sharing Records with Patients is the Right Thing to Do – OpenNotes

Posted on November 21, 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.

I’ve been a big fan of the OpenNotes effort for a long time. While I’ve heard every excuse in the business for why patients shouldn’t have access to their chart, all of those reasons have fallen flat. Much of that is thanks to the good work of the people at OpenNotes.

If your organization has not embraced opening up your chart notes to patients, what’s holding you back? The case for opening your notes to patients is clear.

If you want a more humorous look at this, check out this video featuring e-Patient Dave and clip’s from Seinfeld.

I’m not sure how I missed this video when it first came out, but it’s timeless. Plus, there’s no one better to share this message than e-Patient Dave whose life was literally saved because he demanded access to his chart.

No doubt, a lot of things have changed in the 20 years since the above episode aired. One of those things is patients desire to access their chart and technology’s ability to deliver the chart to the patient at basically no cost.

If your organization hasn’t embraced OpenNotes, I encourage you all to do so now. They can answer all your questions and address all your doubts. Join the Movement and improve the care you provide patients.

Apple Health, Opioid Challenge, Safety Risk Heat Maps, and athenahealth Acquisition

Posted on November 20, 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.

We’re back again with a quick roll around Twitter in a round up of some of the interesting tweets we’ve seen shared. This was quite a diverse set of tweets, so I think there will be something of interest for everyone in this Twitter Round Up.


This tweet is a little annoying for me. I know Matthew has the best of intentions, but there’s no way I’d call and ask my provider or hospital to take part in this. I’m an Android user. This type of access does nothing for me. Apple users seem to forget that. Plus, it’s worth mentioning that there are more Android users out there than Apple users. It’s great that Apple is doing this, but it’s not the game changing thing that so many make it out to be.


Numbers like this always take me back. I just have to keep reminding myself that the opioid crisis wasn’t created over night and it won’t be fixed over night either.


Love this type of collaboration and creativity. One of the big things missing in healthcare is getting doctors off the reimbursement treadmill so they can take part in these types of creative activities. Also, a heat map of patient safety risk is pretty interesting to consider.


No doubt, we’ll hear a lot more about this acquisition in the future. As soon as Jonathan Bush was out as CEO, this company and people’s perception of this company changed. He was the heart and soul of the company and it’s going to be much different going forward. As far as the hospital piece of this tweet. I’ll be really interested to see if private equity is brave enough to continue Jonathan Bush’s ambitious hospital EHR strategy. I won’t be surprised if they pull the plug on it, but time will tell.

What’s the Future of Open Source EHR, Vista?

Posted on November 19, 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.

I was going through some old draft posts (as I mentioned yesterday) and found a post that was started by Nate DiNiro which said “Will the VA and DoD help tip the scales on VistA adoption with OSEHRA?” Granted, this post was first started back in 2011. It’s amazing how much has changed since then.

We all know about the DoD’s selection of Cerner and Leidos to replace their EHR. In a more surprising move was the VA’s decision to sole-source their EHR selection of Cerner based on the idea that it was essential they go with Cerner after the DoD selected Cerner. Certainly a topic for another blog post.

We’ve certainly heard many complaints from those in the VA community that are going to have a really hard time giving up Vista which was basically tailored for many of their unique needs. However, there seems to be nothing stopping that ship now.

Given these events, it brings up an interesting question about the future of Vista as the VA replaces their version of Vista with Cerner. The good news for those healthcare organizations on Vista is that it’s now open source. So, the software can persist as long as there is a community of developers behind it. The core question is how much of Vista’s ongoing development came from the VA versus the community.

The two players I’ve seen using the open source Vista EHR platform are MedSphere and WorldVista. I’ll admit that I haven’t seen too much news from either of them lately, but they both seem to be humming along.

I took a look at the ONC’s latest Health IT Dashboard stats for hospitals. In 2017 (their latest data), it reported 11 “providers with certified technology” for Medsphere and 1 for WorldVistA. Of course, this is just those who have taken part in the meaningful use government program. It’s reasonable to assume that some open source EHR customers probably didn’t want to take part in meaningful use. Plus, these numbers don’t include international Vista installs which obviously can’t take part in meaningful use.

Given these numbers and the VA pulling Vista out, I have a feeling it’s going to be a hard road ahead for Vista.

I’ll never forget when it was first announced that the VA was open sourcing Vista and that anyone that wanted a free EHR could have it. What was amazing is that the HIM manager I was working with found an article talking about this announcement and brought it to me. She wondered why we were paying for an EHR if Vista was available for free. It gave me a chance to explain to her that “free software” doesn’t mean it’s free to implement and manage. Not to mention the fact that this was a small ambulatory clinic that was likely not a good fit for the hospital focused Vista software.

What have you heard or seen with Vista? Has more been happening with the open source versions of Vista that I just haven’t seen? As a big open source user myself (my blogs run on pretty much all open source software), I’d love to see an open source EHR succeed. Unfortunately, it just hasn’t seen near the adoption it needs to really create that momentum yet.