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Intermountain Readies Tests For Hereditary Cancer Syndromes

Posted on February 23, 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.

Intermountain Healthcare has begun the process of validating and launching several tests designed to identify disease-causing hereditary genetic patterns. The work will be done through Intermountain Precision Genomics, which analyzes a patient’s genetic makeup. The data is then used by a team of molecular tumor specialists to plan a patient’s specialized course of treatment.

In a prepared statement, Intermountain notes that one area in which genetic testing can be particularly fruitful is in women with a history of breast and ovarian cancer. The statement cites a study noting that fewer than one in five individuals with a family history of breast cancer or ovarian cancer meeting certain guidelines have undergone genetic testing. Moreover, most have never discussed testing with a healthcare provider.

In its efforts, Intermountain hopes to find both individuals previously diagnosed with cancer and healthy individuals with hereditary cancer gene mutations. When these individuals get genetic counseling and testing, it sets the stage for them to get more frequent cancer screenings at younger ages, which in turn leads to critical early detection and treatment of many of these cancers.

In investing heavily in cancer prediction and treatment, Intermountain is hardly alone. What once was at best a specialty practice by cancer-specific hospitals is quickly becoming mainstream.

The practice of screening women for genetic triggers that might boost the risk of certain cancers has moved quickly from idea to action among hospitals. I don’t have a number to hand, but I remember reading that it can take decades before a scientific discovery in healthcare actually impacts patients.  Clearly, the growth of precision medicine is a dramatic exception.

Given the increasing benefits to be had from genetic testing and targeted treatment, we are seeing nothing less than an explosion in awareness and investment. Not surprisingly, hospitals are jumping into the market with both feet as, to be a bit crass, there’s a lot of money in effectively treating cancer.

Of course, some of the buzz around precision medicine may turn out to be just that, buzz. As my colleague has pointed out, EMR systems weren’t built to enable precision medicine, but rather, billing engines. He also notes that these systems aren’t built for real-time availability of data analytics, which makes it hard to use them for personalized medicine. As he puts it, “I’ve heard precision medicine defined as a puzzle with 3 billion pieces.”

Still, as a middle-aged lady with a history of cancer in her family, these developments give me hope. Someday, genetic testing like Intermountain’s will improve my care should I ever face breast or ovarian cancer. If nothing else, we are off to a good start.

Are Biometrics Tools Practical For Hospital Use?

Posted on February 21, 2018 I Written By

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

In theory, using biometrics tools could solve some of the hospitals’ biggest data management problems.

For example, if the patient had to register for treatment when seeking care at a hospital emergency department (something I saw in place at my local hospital), it would presumably cut down medical identity fraud substantially. Also, doing patient matching using biometric data could make the process far more precise and far less error-ridden. When implemented correct it can achieve these goals.

In addition, requiring hospital employees to use biometric data to access patient records would lock down those records more tightly, and would certainly make credential sharing between employees far more difficult.

Unfortunately, hospitals that want to use biometric technology have to overcome some major obstacles. According to an article by Dan Cidon, CTO of NextGate, those obstacles include the following:

  • Biometric solutions need to be integrated with primary hospital systems, and that process can be difficult.
  • Most biometric solutions can only manage a subset of patients, which makes it difficult to scale biometrics at an enterprise level.
  • Standard biometric solutions like palm vein and iris scanners demand highly-specialized standalone hardware.
  • Bringing biometrics in-house demands significant server-side hardware and internal infrastructure, bringing the total cost to one that even major health systems might balk at.

On the other hand, Cidon notes, some of these issues can be minimized.

Take the problem of acquiring and maintaining specialized devices. To bypass this issue, Cidon recommends that hospitals try using lower-impact solutions like facial recognition, commodity technology built into patient smartphones. By relying on patient smartphones, hospitals can offload enrollment and registration to patient-owned devices, which not only simplifies deployment but also increases user comfort levels.

He also notes that by using a cloud-based approach, hospitals can avoid allocating a high level of server-side hardware and infrastructure to biometrics, as well as getting added flexibility and affordability, especially if they leverage commodity hardware to do the job.

Even if hospitals act on Cidon’s recommendations, going biometric for patient matching, security and medical identity theft protection will be a major project. After all, hospitals’ existing IT infrastructure almost certainly wasn’t designed to support these solutions and putting them in place effectively will probably take a few iterations.

Still, if putting biometric solutions in place can address critical safety and operational issues, especially dangerous patient record mismatches, it’s probably worth a try.

Are You Still Doing the Happy Dance for Your EHR?

Posted on February 16, 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.

Today I stumbled upon this video from 6 years ago with Flagler Hospital celebrating the implementation and launch of the Allscripts EMR in their organization. Here’s the video in case you’ve never seen it:

We’ve written previously about the value of these videos bringing the team at your hospital together. Any big project such as an EHR implementation is a challenging thing and it’s important to get your whole team involved and to have some fun in the process.

At the end of the video they hold up a sign that says Good Bye Paper. 6 years later, I wonder how they feel about this video and their EHR implementation. Would they still be doing the happy dance? Could they make another video celebrating their EHR?

I know a few organizations where they could. They’ve implemented the EHR effectively and are happy with how it works. Sure, they still have things they’d like changed, updated, modified, etc. However, they’re generally happy to be on an EHR over paper charts. Plus, there’s a whole generation of doctors now that don’t know the paper charts world and know no difference.

Unfortunately, there are many other hospitals that are cursing their EHR software. They might do a video about their EHR, but it would be a satire video about the challenges they still face using an EHR.

Where are you at with your EHR? Are you doing a happy dance or are you disappointed, frustrated, or upset with having to use an EHR in your hospital? Share your thoughts in the comments.

Reasonable and Unreasonable Healthcare Interoperability Expectations

Posted on February 12, 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.

Other than EMR and EHR, I don’t think there’s any topic I’ve written about more than healthcare interoperability. It’s a challenging topic with a lot of nuances. Plus, it’s a subject which would benefit greatly if we could make it a reality. However, after all these years I’m coming to some simple conclusions that I think often get lost in most discussions. Especially those in the healthcare IT media.

First, we all know that it would be wonderful for all of your healthcare records to be available to anyone who needs them at any time and in any place and not available to those who shouldn’t have access to them. I believe that in the next 15 years, that’s not going to happen. Sure, it would be great if it did (we all see that), but I don’t see it happening.

The reasons why are simple. Our healthcare system doesn’t want it to happen and there aren’t enough benefits to the system to make it happen.

Does that mean we should give up on interoperability? Definitely not!

Just because we can’t have perfect healthcare interoperability doesn’t mean we shouldn’t create meaningful interoperability (Yes, I did use the word meaningful just to annoy you).

I think one of the major failures of most interoperability efforts is that they’re too ambitious. They try to do everything and since that’s not achievable, they end up doing nothing. There are plenty of reasonable interoperability efforts that make a big difference in healthcare. We can’t let the perfect be the enemy of better. That’s been exactly what’s happened with most of healthcare interoperability.

At the HIMSS conference next month, they’re going to once again have an intereroperability showcase full of vendors that can share data. If HIMSS were smart, they’d do away with the showcase and instead only allow those vendors to show dashboards of the amount of data that’s actually being transferred between organizations in real time. We’d learn a lot more from seeing interoperability that’s really happening as opposed to seeing interoperability that could happen but doesn’t because organizations don’t want that type of interoperability to happen.

Interoperability is a challenging topic, but we make it harder than it needs to be because we want to share everything with everyone. I’m looking for companies that are focused on slices of interoperability that practically solve a problem. If you have some of these, let us know about them in the comments.

Pilot Effort Improves EHR Documentation

Posted on February 9, 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.

Though EHRs were intended to improve medical documentation, in many cases they seem to have made documentation quality worse. Despite their best intentions, bogged-down physicians may resort to practices — notably excessive copy-and-paste usage — that turn patient records into bloated, unfocused data masses that don’t help their peers much.

However, a pilot program conducted by a group of academic medical centers suggests using a set of best practice guidelines and templates for progress notes can improve note quality dramatically. The pilot involved intern physicians on inpatient internal medicine rotations at UCLA, the University of California San Francisco, the University of California San Diego and the University of Iowa.

According to a related story in HealthData Management, researchers rated the quality of the notes created by the participating interns using a competency questionnaire, a general impression score and the validated Physician Documentation Quality Instrument 9-item version (PDQI-9).

The researchers behind the study, which was published in the Journal of Hospital Medicine, found that the interns’ documentation quality improved substantially over the course of the pilot. “Significant improvements were seen in the general impression score, all domains of the PDQI-9, and multiple competency items, including documentation of only relevant data, discussion of a discharge plan, and being concise while adequately complete,” the authors reported. Even better, researchers said notes generated by the participating interns had about 25% fewer lines and were signed 1.3 hours earlier in the day on average.

One side note: despite the encouragement provided by the pilot, the extent to which interns used templates varied dramatically between institutions. For example, 92% of interns at UCSF used the templates, compared to 90% at UCLA, 79% at Iowa and only 21% at UCSD. Nonetheless, UCSD intern notes still seemed to improve during the study period, the research report concluded. (All four institutions were using an Epic EHR.)

It’s hard to tell how generalizable these results are. After all, it’s one thing to try and train interns in a certain manner, and another entirely to try and bring experienced clinicians into the fold. It’s just common sense that physicians in training are more likely to absorb guidance on how they should document care than active clinicians with existing habits in place. And unfortunately, to make a real dent in documentation improvement we’ll need to bring those experienced clinicians on board with schemes such as this.

Regardless, it’s certainly a good idea to look at ways to standardize documentation improvement. Let’s hope more research and experimentation in this area is underway.

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.

Apple Trials Tech Offering Patient Access To Their Health Records

Posted on January 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.

In recent times, tech giants have been falling over themselves in a race to offer consumers the best access to their health data, including even dark horses like Amazon. And it’s little wonder – it’s become increasingly obvious that he who controls patient health data access controls a critical sector of the entire healthcare industry.

The most recent stake in the ground comes from Apple, whose latest update to its Health app allows customers to see their medical records on their iPhone. The Health Records section of the Health app, which comes with the release of the iOS 11.3 beta, collects FHIR-based records from multiple sources and makes them available through its Health Records section.

The patient data display will pull together patient data from various healthcare organizations into a single view. The data will include lists of allergies, conditions and medications taken, immunizations records, lab results on procedures and vital sign information. When providers published new information, iPhone users will be notified.

To conduct its Health Records beta test, Apple has partnered with a number of high-profile health systems and hospitals, including Johns Hopkins Medicine; Cedars-Sinai; Penn Medicine; Geisinger Health System; UC San Diego Health; UNC Health Care; Rush University Medical Center; Dignity Health; Ochsner Health System; MedStar Health and OhioHealth.

As part of its launch, Apple told the New York Times that unless consumers specifically choose to share it with the company, it will never see the data, which will be encrypted and stored locally on the iPhone.  A recent (if unscientific) poll suggests that consumers trust Apple with their health data more than other top tech vendors, so this reassurance may be enough to ease their fears.

But security is hardly Apple’s biggest concern. How does the tech colossus expect to profit from its health data investments?  When I break the issues down, it looks like this:

  • Unlike hospitals and clinics, which can expect medium- to long-term ROI when patients manage their health better, Apple doesn’t deliver care.
  • Apple might want to sell anonymized aggregated patient data, but as far as I know, the company would still have to get patient permission, and that would be an administrative and legal nightmare.
  • If Apple or its competitors have some vision of selling access to the patient, good luck with that. Providers have a hard time attracting and keeping patients with nifty technology even if those patients live in their backyard.

While I could be missing something major, from what I see, Apple, Google, Samsung, Amazon and the rest are engaging in a series of preemptive patient data land grabs. My sense is that none of them know exactly what to do with this data, they’ll be damned if they’re going to let their competitors get there first.

That said, many in the industry are suggesting that this move is just another effort by Apple to sell more iPhones. The question I ask is how valuable will the information be to the patients? Certainly the beta hospitals and health systems are large and have a lot of data, but how is this going to scale down to the smaller providers? If you don’t have these smaller providers, then you’re going to be missing some of the most important health data.

Deep Learning System Triages Terminally Ill Hospital Patients

Posted on January 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.

Researchers at Stanford have developed a new tool designed to coordinate end-of-life care for critically ill patients. While the pilot study has generated screaming newspaper headlines (“AI tool predicts when people will die!”) researchers say that the system is best thought of as a triage option which helps hospitals and hospices provide timely palliative care to those who need it. It can also help terminally ill patients — most of whom would prefer to die at home — make plans for their passing and avoid dying in their hospital bed.

According to an article in tech publication Gizmodo, the Stanford set-up combines EHR data with other sources of information such disease type, disease state and severity of admission. The information is then processed by a form of AI known as deep learning, in which a neural network “learns” by digesting large amounts of data.

To conduct the study, researchers fed 2 million records from adult and child patients admitted to either Stanford Hospital or Lucile Packard Children’s Hospital. The system then identified 200,000 patients who met the study’s criteria. In addition to clinical criteria, the system also reviewed associated case reports diagnoses, number of scans ordered, number of procedures performed and other data.

After reviewing 160,000 case reports, the deep learning system was instructed to predict the mortality of a given patient within three to 12 months of a particular date using EHR data from the previous year. The algorithm included a requirement to ignore patients who appeared to have less than three months to live, as this window was too short for providers to make preparations to offer palliative care.

Then, the AI algorithm calculated the odds of patient death in the 3 to 12-month timespan extending from the original date. Its predictions turned out to be quite accurate. For one thing, it predicted patient mortality within the 3 to 12-month window accurately in nine out of 10 cases, a performance that few clinicians could match. Meanwhile, roughly 95% of patients considered to have a low probability of dying within 12 months actually lived beyond that point.

It’s worth noting that while the deep learning tool made fairly accurate predictions of patient mortality, the system doesn’t let healthcare providers know what treatment patients need or even how it makes its predictions. Luckily, researchers say, the system allows them to get a look at individual cases to better understand its deductions.

For example, in one case the system predicted accurately that a patient with bladder and prostate cancer would die within a few months. While there were many clues that he was near death, the system weighted the fact the scans were made of his spine and a catheter used in his spinal cord heavily in its calculations. Only later did the researchers realize that an MRI of the spinal cord most likely suggested a deadly cancer of the spinal cord which was likely to metastasize.

It’s worth remembering these results were produced as part of a pilot project, and that the predictions the system makes might not be as accurate for other data sets. However, these results are an intriguing reminder of the possibilities AI offers for hospitals.

An EHR Vendor’s Efforts to Address Physician Burnout with Corinne Proctor Boudreau from MEDITECH

Posted on January 24, 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.

Physician burnout is a major problem in healthcare. While there are a lot of things that are contributing to physician burnout, many like to point to the EHR as a major reason why so many physicians are getting burnt out. So, while the EHR can’t completely solve physician burnout, a well designed EHR can help to alleviate some of the stress a physician experiences.

With this idea in mind, we jumped at the chance to sit down with Corinne Proctor Boudreau, Senior Manager, Physician Experience at MEDITECH, to learn about what MEDITECH is hearing from their customers about physician burnout and what they’ve been doing and plan to do to alleviate this challenging problem.

Check out our full physician burnout interview with Corinne Proctor Boudreau embedded below or on YouTube.

You can find all of Healthcare Scene’s interviews on the Healthcare Scene YouTube channel. Also, at the start of the video, I mentioned our new conference, Health IT Expo happening at the end of May in New Orleans. We hope you’ll all be able to join us in New Orleans to learn about practical innovations that can benefit your organization.

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.