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Prioritizing Nursing Sepsis Awareness and Compliance

Posted on September 17, 2018 I Written By

The following is a guest blog post by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Health Learning, Research & Practice, Wolters Kluwer.

September is Sepsis Awareness Month—an opportune time to reflect on the state of industry as it relates to reducing the impact of this potentially deadly condition. In terms of reach, the numbers are sobering: 1.5 million people in the U.S. contract sepsis each year, and a quarter of a million die annually from the condition.

In recent years, the healthcare industry has taken important steps to improve the sepsis outlook by keeping awareness and best-practice developments front and center. The Surviving Sepsis Campaign’s (SSC’s) 2018 release of the updated hour-1 bundle reflects this commitment by keeping care delivery in sync with the latest evidence—in this case the International Guidelines for Management of Sepsis and Septic Shock 2016.

The new bundle combines the SSC’s previously-released 3-hour and 6-hour bundles and prioritizes the need for early identification and more immediate response. Nurses play a critical role in this equation as the clinicians working on the frontlines of care. While sepsis is more likely to present in emergency departments and critical care environments, it is imperative that all nurses have the knowledge to quickly identify symptoms and begin appropriate treatment protocols.

The sepsis challenge is both mammoth and complicated, requiring a multi-pronged, multi-disciplinary approach that draws on the latest evidence and institutional accountability. There is much at stake for hospitals in terms of reputation as sepsis performance scores are now published on the Centers for Medicare and Medicaid Services’ Hospital Compare website, where patients can quickly and easily see how their facility of choice stacks up in terms of sepsis mortality.

Consequently, it is more important than ever for hospital clinical leaders to prioritize nursing education on the early signs of sepsis, especially when caring for at-risk patients. In addition, nurses need quick access to hour-1 bundle protocols at the point of care to ensure they are properly following the guidelines to optimize sepsis outcomes and save lives.

Sepsis Bundle Primer

The latest revision of the SSC bundles seeks immediate resuscitation and management of sepsis. In the update, SCC authors note: “We believe this reflects the clinical reality at the bedside of these seriously ill patients with sepsis and septic shock—that clinicians begin treatment immediately, especially in patients with hypotension, rather than waiting or extending resuscitation measures over a longer period.”

The guidelines detail five steps that should take place within one hour of identifying sepsis including:

  • Measure lactate level. Remeasure if initial lactate level > 2 mmol/L.
  • Obtain blood cultures before administering antibiotics.
  • Administer broad-spectrum antibiotics.
  • Begin rapid administration of 30mL/kg crystalloid for hypotension or lactate level ≥ 4 mmol/L.
  • Apply vasopressors if patient is hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.

The premise of the bundled elements is that the whole is better than the one. When implemented as a group, these protocols have the greatest impact on outcomes.

The Sepsis Knowledge Gap Challenge

Hospitals face nursing knowledge gaps related to sepsis on two fronts: 1) early identification; 2) adhering to best practice protocols. While nurses working in the ED or critical care are likely to have experience with sepsis and the hour-1 bundle, those working on the medical-surgical floor or in other specialty areas often lack a deep understanding of the complexities and urgency surrounding early identification and response.

To promote early identification, nurses need to first understand the symptoms that occur in patients who are septic. Key observations include:

  • Delirium
  • Extreme high or low temperatures
  • Shortness of breath
  • Extreme pain or discomfort
  • Elevated heart rate and/or low blood pressure
  • Cool and clammy skin

While the answers to these questions can provide a baseline, the reality is that sepsis is a complicated diagnosis that requires critical thinking. For instance, fever alone is not always the best indicator of the condition, as hypothermia and low temperatures are often more predictive of severity and death. In addition, nurses need awareness that certain patients are at higher risk of mortality, such as the very young and the elderly or those with certain co-morbidities like COPD, heart failure and diabetes.

The Quick Sepsis Related Organ Failure Assessment (qSOFA) provides an effective point-of-care prompt for identification of a suspected infection. The tool uses three criteria to determine sepsis mortality risk. These include one point for each of the following: low blood pressure (SBP≤100 mmHg); high respiratory rate (≥ 22 breaths per minute); or altered mentation. Nurses need to be educated to use this system and be made aware of alerts that point to these variables. For example, a positive score of 2 or higher would point to the need for intervention by a provider or initiation of rapid response protocols.

Standardizing Sepsis Identification and Response

To eliminate variations in sepsis care and ensure best-practice protocols are followed, hospitals must implement comprehensive and ongoing education programs for nurses that address three areas: 1) identification of early signs of sepsis; 2) hour-1 treatment bundle protocol and 3) use of qSOFA scoring. Technology is an important part of any strategy and should be a priority consideration for both education and point of care guidance.

The best clinical decision support tools at point of care provide automated updating of new evidence as it is established. In the case of the hour-1 sepsis bundle, these solutions foster confidence that nurses have that right information when they are with the patient, and if they forget, a quick look-up can provide the needed guidance.

Access to the most up-to-date digital professional development education resources help nurses garner a deeper understanding of sepsis, the latest standards and practice application. Hospitals can draw on the latest advancements to quickly create customized programs and exams that allow students to progress and master skills at their own unique level.

Sepsis mortality rates sit at greater than 40 percent. In the era of value-based care which focuses on patient outcomes, that’s significant and problematic for hospitals on many levels. Improving sepsis outcomes necessitates that clinical leaders invoke strategies that promote adoption of the latest evidence to move the needle on performance.

About Anne Dabrow Woods
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN is the Chief Nurse of the Health Learning, Research and Practice business unit at Wolters Kluwer.  She is also a critical care nurse practitioner for Penn Medicine, Chester County Hospital, and she is adjunct faculty for Drexel University in the College of Nursing and Health Professions.

Clinicians Say They Need Specialized IT To Improve Patient Safety

Posted on July 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.

Hospitals are loaded down with the latest in health IT and have the bills to prove it. But according to a new survey, they need to invest in specialized technologies to meet patient safety goals, as well as providing more resources and greater organizational focus.

Health Catalyst recently conducted a national survey of physicians, nurses and health executives to gather their thoughts on patient safety issues. Among its main findings was that almost 90% of respondents said that their organizations were seeing success in improving patient safety. However, about the same percentage said there was room for improving patient safety in their organization.

The top obstacle they cited as holding them back from the patient safety goals was having effective information technology, as identified by 30% of respondents. The same number named a lack of technologies offering real-time warnings of possible patient harm.

These were followed by lack of staffing and budget resources (27%), organizational structure, culture priorities (19%), a lack of reimbursement for safety initiatives (10%) and changes in patient population practice setting (9%).

Part of the reason clinicians aren’t getting as much as they’d like from health IT is that many healthcare organizations rely largely on manual methods to track and report safety events.

The top sources of data for patient safety initiatives respondents used for safety initiatives voluntary reporting (82%). Hospital-acquired infection surveys (67%), manual audits (58%) and retrospective coding (29%). Such reporting is typically based on data sets which are at least 30 days old, and what’s more, collecting and analyzing the data can be time and resource-consuming.

Not surprisingly, Health Catalyst is launching new technology designed to address these problems. Its Patient Safety Monitor™ Suite: Surveillance Module uses protective and text analytics, along with concurrent critical reviews of data, to find and prevent patient safety threats before they result in harm.

The announcement also falls in line with the organization’s larger strategic plans, as Health Catalyst has applied to the AHRQ to be certified as a Patient Safety Organization.

The company said that he had spent more than $50 million to create the Surveillance module, whose technology includes the use of predictive analytics models and AI. It expects to add new AI and machine learning capabilities to its technology in the future which will be used to propose strategies to eliminate patient safety risks.

And more is on the way. Health Catalyst is working with its clients to add new features to the Suite including risk prediction, improvement tracking and decision support.

I’m not sure if it’s typical for PSOs to bringing their own specialized software to the job, but either way, it should give Health Catalyst a leg up. I have little doubt that doing better predictive analytics and offering process recommendations would be useful.

Near-Fatal Med Incident Leads Hospital To Redesign Alerts

Posted on June 13, 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.

It only took a couple of mistakes – but they nearly led to tragedy.

Not long ago, a patient with a deadly allergy to a common pain reliever was admitted to Brockton, Mass.-based Good Samaritan Medical Center. The patient’s allergy was recorded in the EMR. But somehow, despite the warning generated by the system, a nurse practitioner ordered the medication and a pharmacist approved it. The patient recovered but was forced to spend time in the ICU, according to a story in the Boston Globe.

When state and federal regulators descended upon the hospital, its leaders said that they felt alert fatigue was a factor in the error. Of course, this forced the hospital to address some complex issues and the path wasn’t simple. CMS almost booted Good Samaritan from the Medicare program over the issue, in part because it didn’t address the problem quickly enough.

Since then, parent company Steward Health Care has made changes to the EMRs at all of the facilities to cut the chances of patients being harmed by alert fatigue.

Today, if a new patient at any of the Steward hospitals has a serious drug to allergy, they must follow a new procedure. Under new rules, a pharmacist cannot place an order for any of the potentially harmful drugs until they speak with the doctor or nurse to discuss alternative treatments.

Dr. Joseph Weinstein, chief medical officer at the health system, told the newspaper that the new procedure forces staff who are “moving through screens at a rapid pace” to stop. “The two people have to sign off on [the prescription] together,” he said. “This is one of the safest ways to reduce alert fatigue.”

Steward also cut back the list of reasons providers can override analogy alert from 14 to 7 of the most important, giving them a shorter list of items to read through and check off as part of the process.

It’s good to see that Steward was able to learn from the medication error and improve the alarm systems across its entire hospital network. These changes are likely to make a difference in day-to-day patient care and reduce the odds of patient harm.

That being said, clinicians are still besieged by alerts generated for other reasons, and simplifying one process, however vital, can only shave off points of the larger problem.

It seems to me that vendors ought to be more involved in the process of refining alerts rather than making individual hospitals figure out how to do this. Sure, hospitals need to address their individual circumstances but vendors need to take more responsibility the problem. There’s no getting away from this issue.

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.

Yale New Haven Hospital Partners With Epic On Centralized Operations Center

Posted on February 5, 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.

Info, info, all around, and not a place to manage it all. That’s the dilemma faced by most hospitals as they work to leverage the massive data stores they’re accumulating in their health IT systems.

Yale New Haven Hospital’s solution to the problem is to create a centralized operations center which connects the right people to real-time data analytics. Its Capacity Command Center (nifty alliteration, folks!) was created by YNHH, Epic and the YNHH Clinical Redesign Initiative.

The Command Center project comes five years into YNHH’s long-term High Reliability project, which is designed to prepare the institution for future challenges. These efforts are focused not only on care quality and patient safety but also managing what YNHH says are the highest patient volumes in Connecticut. Its statement also notes that with transfers from other hospitals increasing, the hospital is seeing a growth in patient acuity, which is obviously another challenge it must address.

The Capacity Command Center’s functions are fairly straightforward, though they have to have been a beast to develop.

On the one hand, the Center offers technology which sorts through the flood of operational data generated by and stored in its Epic system, generating dashboards which change in real time and drive process changes. These dashboards present real-time metrics such as bed capacity, delays for procedures and tests and ambulatory utilization, which are made available on Center screens as well as within Epic.

In addition, YNHH has brought representatives from all of the relevant operational areas into a single physical location, including bed management, the Emergency Department, nursing staffing, environmental services and patient transport. Not only is this a good approach overall, it’s particularly helpful when patient admissions levels climb precipitously, the hospital notes.

This model is already having a positive impact on the care process, according to YNHH’s statement. For example, it notes, infection prevention staffers can now identify all patients with Foley catheters and review their charts. With this knowledge in hand, these staffers can discuss whether the patient is ready to have the catheter removed and avoid related urinary tract infections associated with prolonged use.

I don’t know about you, but I was excited to read about this initiative. It sounds like YNHH is doing exactly what it should do to get more out of patient data. For example, I was glad to read that the dashboard offered real-time analytics options rather than one-off projections from old data. Bringing key operational players together in one place makes great sense as well.

Of course, not all hospitals will have the resources to pull something off something like this. YNHH is a 1,541-bed giant which had the cash to take on a command center project. Few community hospitals would have the staff or money to make such a thing happen. Still, it’s good to see somebody at the cutting edge.

Texas Hospital Association Dashboard Offers Risk, Cost Data

Posted on January 22, 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.

The Texas Hospital Association has agreed to a joint venture with health IT vendor IllumiCare to roll out a new tool for physicians. The new dashboard offers an unusual but powerful mix of risk data and real-time cost information.

According to THA, physician orders represent 87% of hospital expenses, but most know little about the cost of items they order. The new dashboard, Smart Ribbon, gives doctors information on treatment costs and risk of patient harm at the point of care. THA’s assumption is that the data will cause them to order fewer and less costly tests and meds, the group says.

To my mind, the tool sounds neat. IllumiCare’s Smart Ribbon technology doesn’t need to be integrated with the hospital’s EMR. Instead, it works with existing HL-7 feeds and piggybacks onto existing user authorization schemes. In other words, it eliminates the need for creating costly interfaces to EMR data. The dashboard includes patient identification, a timer if the patient is on observational status, a tool for looking up costs and tabs providing wholesale costs for meds, labs and radiology. It also estimates iatrogenic risks resulting from physician decisions.

Unlike some clinical tools I’ve seen, Smart Ribbon doesn’t generate alerts or alarms, which makes it a different beast than many other clinical decision support tools. That doesn’t mean tools that do generate alerts are bad, but that feature does set it apart from others.

We’ve covered many other tools designed to support physicians, and as you’d probably guess, those technologies come in all sizes. For example, last year contributor Andy Oram wrote about a different type of dashboard, PeraHealth, a surveillance system targeting at-risk patients in hospitals.

PeraHealth identifies at-risk patients through analytics and displays them on a dashboard that doctors and nurses can pull up, including trends over several shifts. Its analytical processes pull in nursing assessments in addition to vital signs and other standard data sets. This approach sounds promising.

Ultimately, though, dashboard vendors are still figuring out what physicians need, and it’s hard to tell whether their market will stay alive. In fact, according to one take from Kalorama Information, this year technologies like dashboarding, blockchain and even advanced big data analytics will be integrated into EMRs.

As for me, I think Kalorama’s prediction is too aggressive. While I agree that many freestanding tools will be integrated into the EMR, I don’t think it will happen this or even next year. In the meantime, there’s certainly a place for creating dashboards that accommodate physician workflow and aren’t too intrusive. For the time being, they aren’t going away.

Predictive Analytics Will Save Hospitals, Not IT Investment

Posted on October 27, 2017 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.

Most hospitals run on very slim operating margins. In fact, not-for-profit hospitals’ mean operating margins fell from 3.4% in fiscal year 2015 to 2.7% in fiscal year 2016, according to Moody’s Investors Service.

To turn this around, many seem to be pinning their hopes on better technology, spending between 25% and 35% of their capital budget on IT infrastructure investment. But that strategy might backfire, suggests an article appearing in the Harvard Business Review.

Author Sanjeev Agrawal, who serves as president of healthcare and chief marketing officer at healthcare predictive analytics company LeanTaaS, argues that throwing more money at IT won’t help hospitals become more profitable. “Healthcare providers can’t keep spending their way out of trouble by investing in more and more infrastructure,” he writes. “Instead, they must optimize the use of the assets currently in place.”

Instead, he suggests, hospitals need to go the way of retail, transportation and airlines, industries which also manage complex operations and work on narrow margins. Those industries have improved their performance by improving their data science capabilities.

“[Hospitals] need to create an operational ‘air traffic control’ for their hospitals — a centralized command-and-control capability that is predictive, learns continually, and uses optimization algorithms and artificial intelligence to deliver prescriptive recommendations throughout the system,” Agrawal says.

Agrawal predicts that hospitals will use predictive analytics to refine their key care-delivery processes, including resource utilization, staff schedules, and patient admits and discharges. If they get it right, they’ll meet many of their goals, including better patient throughput, lower costs and more efficient asset utilization.

For example, he notes, hospitals can optimize OR utilization, which brings in 65% of revenue at most hospitals. Rather than relying on current block-scheduling techniques, which have been proven to be inefficient, hospitals can use predictive analytics and mobile apps to give surgeons more control of OR scheduling.

Another area ripe for process improvements is the emergency department. As Agrawal notes, hospitals can avoid bottlenecks by using analytics to define the most efficient order for ED activities. Not only can this improve hospital finances, it can improve patient satisfaction, he says.

Of course, Agrawal works for a predictive analytics vendor, which makes him more than a little bit biased. But on the other hand, I doubt any of us would disagree that adopting predictive analytics strategies is the next frontier for hospitals.

After all, having spent many billions collectively to implement EMRs, hospitals have created enormous data stores, and few would argue that it’s high time to leverage them. For example, if they want to adopt population health management – and it’s a question of when, not if — they’ve got to use these tools to reduce outcome variations and improve quality of cost across populations. Also, while the deep-pocketed hospitals are doing it first, it seems likely that over time, virtually every hospital will use EMR data to streamline operations as well.

The question is, will vendors like LeanTaaS take a leading role in this transition, or will hospital IT leaders know what they want to do?  At this stage, it’s anyone’s guess.

A New Hospital Risk-Adjustment Model

Posted on August 23, 2017 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.

Virtually all of the risk adjustment models with which I’m familiar are based on retrospective data. This data clearly has some predictive benefits – maybe it’s too cliché to say the past is prologue – and is already in our hands.

To look at just one example of what existing data archives can do, we need go no further than the pages of this blog. Late last year, I shared the story of a group of French hospitals which are working to predict admission rates as much as 15 days in advance by mining a store of historical data. Not surprisingly, the group’s key data includes 10 years’ worth of admission records.

The thing is, using historical data may not be as helpful when you’re trying to develop risk-adjustment models. After all, among other problems, the metrics by which evaluate care shift over time, and our understanding of disease states changes as well, so using such models to improve care and outcomes has its limitations.

I’ve been thinking about these issues since John shared some information on a risk-adjustment tool which leverages relevant patient care data collected almost in real time.

The Midas Hospital Risk Adjustment Model, which is created specifically for single organizations, samples anywhere from 20 to 600 metrics, which can include data on mortality, hospital-acquired complications, unplanned readmission, lengths of stay and charges. It’s built using the Midas Health Analytics Platform, which comes from a group within healthcare services company Conduent. The platform captures data across hospital functional areas and aggregates it for use in care management

The Midas team chooses what metrics to include using its in-house tools, which include a data warehouse populated with records on more than 100 million claims as well as data from more than 800 hospitals.

What makes the Midas model special, Conduent says, is that it incorporates a near-time feed of health data from hospital information systems. One of the key advantages to doing so is that rather than basing its analysis on ICD-9 data, which was in use until relatively recently, it can leverage clinically-detailed ICD-10 data, the company says.

The result of this process is a model which is far more capable of isolating small but meaningful differences between individual patients, Conduent says. Then, using this model, hospitals risk-adjust clinical and financial outcomes data by provider for hospitalized patients, and hopefully, have a better basis for making future decisions.

This approach sounds desirable (though I don’t know if it’s actually new). We probably need to move in the direction of using fresh data when analyzing care trends. I suspect few hospitals or health system would have the resources to take this on today, but it’s something to consider.

Still, I’d want to know two things before digging into Midas further. First, while the idea sounds good, is there evidence to suggest that collecting recent data offers superior clinical results? And in that vein, how much of an improvement does it offer relative to analysis of historical data? Until we know these things, it’s hard to tell what we’ve got here.

2 Core Healthcare IT Principles

Posted on May 10, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of my favorite bloggers I found when I first starting blogging about Healthcare IT was a hospital CIO named Will Weider who blogged on a site he called Candid CIO. At the time he was CIO of Ministry Health Care and he always offered exceptional insights from his perspective as a hospital CIO. A little over a month ago, Will decided to move on as CIO after 22 years. That was great news for me since it meant he’d probably have more time to blog. The good news is that he has been posting more.

In a recent post, Will offered two guiding principles that I thought were very applicable to any company working to take part in the hospital health IT space:

1. Embed everything in the EHR
2. Don’t hijack the physician workflow

Go and read Will’s post to get his insights, but I agree with both of these principles.

I would add one clarification to his first point. I think there is a space for an outside provider to work outside of the EHR. Think of someone like a care manager. EHR software doesn’t do care management well and so I think there’s a space for a third party care management platform. However, if you want the doctor to access it, then it has to be embedded in the EHR. It’s amazing how much of a barrier a second system is for a doctor.

Ironically, we’ve seen the opposite is also true for people like radiologists. If it’s not in their PACS interface, then it takes a nearly herculean effort for them to leave their PACS system to look something up in the EHR. That’s why I was excited to see some PACS interfaces at RSNA last year which had the EHR data integrated into the radiologists’ interface. The same is true for doctors working in an EHR.

Will’s second point is a really strong one. In his description of this principle, he even suggests that alerts should all but be done away within an EHR except for “the most critical safety situations. He’s right that alert blindness is real and I haven’t seen anyone nail the alerts so well that doctors aren’t happy to see the alerts. That’s the bar we should place on alerts that hijack the physician workflow. Will the doctor be happy you hijacked their workflow and gave them the alert? If the answer is no, then you probably shouldn’t send it.

Welcome back to the blogosphere Will! I look forward to many more posts from you in the future.

Cleveland Clinic Works To Eliminate Tech Redundancies

Posted on March 1, 2017 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.

The Cleveland Clinic has relied on its EMR for quite some time. In fact, it adopted Epic in the 1990s, long before most healthcare organizations were ready to make a bet on EMRs. Today, decades later, the Epic EMR is the “central data hub” for the medical center and is central to both its clinical and operational efforts, according to William Morris, MD, the Clinic’s associate chief information officer.

But Morris, who spoke about the Clinic’s health IT with Health Data Management, also knows its limitations. In an interview with the magazine’s Greg Slabodkin, he notes that while the EMR may be necessary, it isn’t sufficient. The Epic EMR is “just a digital repository,” he told Slabodkin. “Ultimately, it’s what you do with the technology in your ecosystem.”

These days, IT leaders at the Clinic are working to streamline the layers of additional technology which have accreted on top of the EMR over the years. “As an early adopter of Epic, we have accumulated quite a bit of what I’ll call technical debt,” said Doug Smith, interim chief information officer. “What I mean by that is multiple enhancements, bolt-ons, or revisions to the core application. We have to unburden ourselves of that.”

It’s not that Clinic leaders are unhappy with their EMR. In fact, they’re finding ways to tap its power to improve care. For example, to better leverage its EMR data, the Cleveland Clinic has developed data-driven “risk scores” designed to let doctors know if patients need intervention. The models, developed by the Clinic’s Quantitative Health Sciences group, offer outcome risk calculators for several conditions, including cancer, cardiovascular disease and diabetes.

(By the way, if predictive analytics interest you, you might want to check out our coverage of such efforts at New York’s Mount Sinai Hospital, which is developing a platform to predict which patients might develop congestive heart failure and care for patients already diagnosed with the condition more effectively. I’ve also taken a look at a related product being developed by Google’s DeepMind, an app named Streams which will ping clinicians if a patient needs extra attention.)

Ultimately, though, the organization hopes to simplify its larger health IT infrastructure substantially, to the point where 85% of the HIT functionality comes from the core Epic system. This includes keeping a wary eye on Epic upgrades, and implementing new features selectively. “When you take an upgrade in Epic, they are always turning on more features and functions,” Smith notes. “Most are optional.”

Not only will such improvements streamline IT operations, they will make clinicians more efficient, Smith says. “They are adopting standard workflows that also exist in many other organizations—and, we’re more efficient in supporting it because we don’t take as long to validate or support an upgrade.”

As an aside, I’m interested to read that Epic is tossing more features at Cleveland Clinic than it cares to adopt. I wonder if those are what engineers think customers want, or what they’re demanding today?