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Mobile Policy Enforcement Issues Could Expose Hospitals To Security Problems

Posted on June 15, 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.

Over the last several years, mobile device management has become a critical issue for hospital IT departments. As mobile use by both clinicians and patients has soared, hospitals have been scrambling to keep up. Now, a new study suggests that the policies hospitals develop to manage mobile devices are enforced inconsistently, a finding which should concern hospital leaders.

To perform the study, which was backed by mobile communications firm Spok, researchers collected responses from roughly 300 healthcare professionals from across the U.S. The survey reached not only IT leaders but also clinicians, who made up 44% of respondents. Another 40% included a wide range of professions, including pharmacists, medical technicians, business analysts, social workers and lab managers. IT respondents made up just 10% of those surveyed.

One of the results of the survey was that hospitals vary widely in the maturity of their mobile management strategies and their ability to execute them.

Certainly, the mobile management concerns have become a bigger deal over the last several years. Back in 2012, when Spok first asked survey participants about their mobile approach, only a third said that they had a formal strategy in place. By 2017, though, the number of respondents reporting that they had a mobile strategy had climbed to 65%. (That number actually fell to 57% in 2018, for reasons that are unclear.)

That being said, these strategies are relatively new. Forty-six percent of respondents said their organization had a mobile strategy in place for one to three years, and another 12% reported having a formal mobile management strategy for just one year.

The most common mobile strategy was focused on mobile management and security (56%), followed by mobile device selection, integration with the EMR (48%), infrastructure assessment (45%), clinical workflow evaluation (43%), device ownership strategy e.g. BYOD (34%), mobile app strategy (29%), mobile app catalog (16%), mobile strategy governance (14%) and business intelligence and reporting (12%).

Hospital leaders are continuing to rebuild their strategies as needed. Many hospitals have upgraded their mobile strategy over time, for reasons that included better meeting the needs of end users (39%), changes in clinical workflows (28%)  and addressing security and compliance requirements (25%).

Despite all of this effort, however, there seems to be a gap between mobile strategy development and the extent to which mobile strategies are enforced and understood by hospital staff. While 43% of hospitals have security teams, telecommunications teams or clinical informatics teams enforce mobile policies, many hospitals are struggling to give these rules some teeth.

True, 39% of respondents said that their hospital enforced mobile policies extremely well, and on a consistent basis, and another 33% said they were enforced well most of the time, and another 24% said they were not sure. This suggests that those institutions aren’t educating employees and clinicians about these issues, nor are they getting tough about enforcement. And of course, if hospital clinicians and staff don’t even know whether a strategy is in place, they’re probably not following it.

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.

What? In Some Cases, Additional IT Spending May Not Prevent Breaches

Posted on June 11, 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.

A new research study has come to a sobering conclusion – that investing more in IT security doesn’t necessarily reduce the number of breaches.

The research, which appeared in the MIS Quarterly, looked at how many breaches hospitals experienced relative to their IT security spending. The study authors started with the assumption that hospitals spending more on security would enjoy better protection from breaches.

The researchers assumed that looked at broadly, some security investments were “symbolic,” making superficial improvements that don’t get to the root of their problem, while others were substantive investments which met well-defined security needs.

After reviewing their data, researchers noted that many classes of hospitals turned out to be symbolic security investors, including members of smaller health systems, older hospitals, smaller hospitals and for-profit hospitals. They also noted that faith-based and less-entrepreneurial hospitals were prone to such investments. The only category of hospitals routinely making substantive security investments was teaching hospitals.

But that’s far from all. Their more controversial conclusions focused on the role of IT security investments in preventing security breaches. In short, their conclusion was pretty counterintuitive.

First, they found that larger IT security investments did not in and of themselves lower the likelihood of security breaches. Not only that, researchers concluded that the benefits of substantive adoption wouldn’t generate greater breach protection over time.

Researchers also concluded that the benefits of substantive IT security adoption by hospitals would take time to be realized. If I’m reading this correctly, mature IT security systems should offer more advantages over time, but not necessarily better breach protection.

Meanwhile, researchers concluded that the negative consequences of symbolic adoption would grow worse over time.

I don’t know about you, but I was pretty surprised by these results. Why wouldn’t substantively increasing security spending reduce the occurrence of breaches within hospitals? It’s something of a head-scratcher.

Of course, the answer to this question may lie in what type of substantive security investment hospitals make. The current set of results suggests, to me at least, that current technologies may not be as good at preventing breaches as they should be. Or maybe hospitals are investing in good technology but not hiring enough IT security experts to get the installation done right. Plus, purchasing security infrastructure can only do so much to stop bad user behavior. The issue deserves further research.

Regardless, this study offers food for thought. The industry can’t afford to do a bad job with preventing breaches.

New Mexico Hospital Battles Addiction with Health Information Technology Apps

Posted on June 8, 2018 I Written By

The following is a guest blog post by David Dellago, Former Chairman of McKinley County Commission

(This byline focuses on the efforts of David Conejo, CEO, RMCHCS Hospital who spoke on the Health IT Expo Data Integration Panel, May 31 at 2:30 pm.)

McKinley County, New Mexico, is the namesake of the assassinated 25th U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks.  Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”

For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness, and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.

McKinley County Is One of Poorest in U.S.

There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup, there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.

The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.

Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians was board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the 6th leading cause of death for New Mexicans and the 7th leading cause in the U.S.

RMCHCS Hospital Fights Addiction with Behavioral Health Apps

Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received $400,000.00 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grants out of which NCI was born.

The leader of that effort in the 80s and 90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) where he leads the fight against addiction with traditional tactics, but also behavioral healthcare innovations which have captured the attention of the healthcare industry.

Turing the Tables on Addiction

When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.

The center is operated by Ophelia Reeder, a long time health care advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the Behavioral Special Projects Director.  He opened “Bill’s Place”, an outdoors facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group which he founded and serves as president.  The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s casework, provide behavioral health services and are certified in peer support.

High Information Tech in High Gear

From this traditional form of behavioral health addiction treatment, Conejo has turned to health information technology in his pursuit of behavioral health care remedies while leveraging government insurance changes in Medicare and Medicaid Services (CMS), under the Obama Administration. Rather than traditional acute care services, CMS began to shift its focus on preventive care, identifying a 6:1 cost savings ratio.

Conejo recognized that RMCHCS would benefit by offering preventative care services which fit perfectly with his behavioral care plans while creating a new revenue center through reimbursements by CMS. To achieve this, he recognized the need for the convergence of hospital information across clinical, financial, and operational systems.

He began by integrating data from the hospital’s three clinics—the College Clinic for family and internal medicine, the Red Rock Clinic for general surgery and the Acute Clinic for emergencies and occupational health. He used a cloud suite application from Zoeticx which integrates and streamlines data from the Center for Medicaid and Medicare Services (CMS) including Annual Wellness Visits (AWV), Chronic Care Management and Care Transition between physical and behavioral health services.

Integrating Data and Patients

The cloud application streamlines data from Annual Wellness Visits (AWVs) and integrates it with the hospital’s Electronic Health Record (EHR) systems from Athena Health and MedTech. The app also allows for the management of tracking for patient wellness visits, provides a physical assessments guide through preventative exams and maps out the risk factors for potential diseases for patient follow-up visits.

In addition, the Zoeticx app includes other services that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurer requirements for organizations like Blue Cross/Blue Shield. The app’s time tracker capability automates invoices for faster billing.

RMCHS’ business is growing with full or near-full coverage compliance. And with its Accountable Care Organization (ACO) in startup mode, RMCHS is also receiving a bonus check from Medicare for containing costs, in addition to the new revenues being generated. During the first five months of using the Zoeticx app, the new revenue has matched the financial incentive from its ACO, with the outlook of at least doubling the bonus from the ACO. Furthermore, RMCHS does not increase its current operational cost to achieve this type of outcome.

Joe Wright, the hospital’s director of clinical services, has found the apps provide significant time savings for the nurses and medical assistants when disparate EHR data is integrated and streamlined. He also notes more patients can be seen. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day, that’s an extra 180 minutes. More minutes, more patients.

In addition, his chronic care patient practice has grown significantly since the recent implementation of Zoeticx’s Chronic Care Management where many patients suffer from diabetes. Patients participating in AWV visits have grown to 250, a 50 percent increase since the apps have been installed. The AWV appointments also mean less patient visits to the hospital. At the hospital’s Behavioral Health Services facility where addiction to alcohol and opioids are the main patient affliction, all 68 beds are full.

Telemedicine Next Step

Conejo’s next big technology push will be a telemedicine program enabling reservation patients to be seen by mobile healthcare physicians connected by satellite to the Internet to extend the hospital’s outreach to patients who can’t visit the hospital for various reasons.  This will enable patients to be treated as if they were at one of the hospital’s clinics with all their data entered into the appropriate systems and ready to be whisked off to the insurance organizations.

Bias In Medical Records Can Affect Patient Care

Posted on June 4, 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 the past, doctors wrote whatever they wanted in their notes, including sarcastic and derogatory comments about the patient, assuming that the comments were no big deal. And largely, they were right, as in prior times, few patients would have asked for those records.

Today, however, such records are becoming increasingly public, particularly through the efforts of the Open Notes project. Not only that, when an EMR connects the health system, such notes may be viewed by many types of professionals, ranging from hospital-based doctors to outpatient physicians, residents to outpatient specialists and more.

But how important is this? Doctors need to reduce tension with a bit of gallows humor, don’t they? Is it worth making the effort to discourage such comments and criticism in the notes? A recent study of physicians in training suggests that it is.

The study, which appears in the Journal of General Internal Medicine, was designed to measure whether patient records serve as a means of transmitting bias from one clinician to another. Specifically, the study was intended to assess whether stigmatizing language written in a patient medical record had an effect on students’ clinical decision-making and attitudes toward the patient.

To tease out this information, the researchers created chart notes, one of which used stigmatizing language in the other neutral language to describe hypothetical patient, a 28-year-old man with sickle-cell disease.

Researchers then surveyed medical students and residents in internal and emergency medicine programs at an urban academic medical center to see how their subjects related to the vignette.

The conclusions drawn by this study should concern everyone in the healthcare business. Researchers found that when the medical students and residents were exposed to stigmatizing language in the notes, the exposure was associated with more negative attitudes toward the patient. Even more concerning, the note using stigmatizing language was associated with less aggressive management of the patient’s pain level.

Addressing this problem is not just an ethical issue, as important as that is on its own. If stigma and bias affect how medical students and residents care for patients, it undermines larger goals of the health system, particularly the need to manage populations effectively, promote patient-centered care and reduce healthcare disparities, it’s a clinical and operational issue as well.

No one is suggesting that it’s possible to squeeze all bias out of the healthcare process. However, it seems reasonable to limit how much of this bias makes it into the chart and influences other providers.

Mayo Clinic EMR Install Goes Poorly For Nurses

Posted on June 1, 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.

Ordinarily, snagging a contract to help with an Epic install is a prized opportunity. Anyone involved with this kind of project makes very good money, and the experience burnishes their resume too.

In this case, though, a group of nurse contractors says that the assignment was a nightmare. After being recruited and traveling across the US to work, they say, they were treated horribly by the contractor overseeing the Mayo Clinic’s go-live of its Epic EMR.

According to a recent news story, the Clinic hired a team of seven nurses to help with the final stages of the rollout. The nurses, all of whom were familiar with Epic, were recruited by Mayo vendor the HCI Group. One nurse, Angela Coffaro, was offered $15,000 for her work. However, she found the way she was treated to be so offensive that she quit after only days on the job. Working conditions were “horrendous,” she told the reporter.

Nurse.org reported that another nurse said the contract nurses were verbally abused, intimidated, and even threatened that they would lose their jobs on an “hourly” basis. They also noted being assigned to positions well outside the skill set. For example, Coffaro said, she was sent to the outpatient eye clinic instead of the OR, and an OR nurse to radiology.

What’s more, the HCI Group executives apparently treated the nurses brutally during training sessions. According to some, they were not permitted to leave the training room even to use the restroom during 6 to 8-hour orientation sessions.

Adding insult to injury, the contractor allegedly failed to provide adequate housing. For example, Nurse.org tells the story of Cleveland-based nurse practitioner Kumbi Madiye, who arrived at 9 AM the day before her training was scheduled to begin and found only chaos. Madiye told the publication that she waited 14 hours without a room, only to find out at 11 PM that her assigned room was an hour and a half away.

The story stresses that while the nurses said they were astonished by HCI Group’s attitude and performance, they had no problem with the way they were treated by Mayo Clinic personnel.

That being said, if even half of the allegations are true, Mayo would certainly bear some responsibility for failing to supervise their vendor adequately. Also, my instinct is that one or more of the nurses must have told Mayo what was going on and if the Clinic’s leaders did anything about the problem the nurses never mentioned it.

I’m also very surprised any vendor might have abused IT-savvy nurses with precious Epic experience. As sprawling as the health IT world is, word gets around, and I doubt anyone can afford to alienate a bunch of Epic experts.

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.”

“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.

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.