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From Fragmented to Coordinated: The Big Data Challenge

Posted on November 27, 2018 I Written By

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

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

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

Managing Complexity, Inside and Out

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

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

Improved Interoperability, Improved Outcomes

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

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

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

Leveraging Technology

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

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

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

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

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

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

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

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

AI May Be Less Skilled At Analyzing Images From Outside Organizations

Posted on November 26, 2018 I Written By

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

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

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

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

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

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

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

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

Top 10 Health Technology Hazards

Posted on November 23, 2018 I Written By

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

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

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

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

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

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

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

6. Unholstered Electrosurgical Active Electrodes Can Lead to Patient Burns

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

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

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

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

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

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

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

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

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

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

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

8. Injury Risk from Overhead Patient Lift Systems

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

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

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

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

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

Posted on November 20, 2018 I Written By

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

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


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


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


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


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

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

Posted on November 19, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

Five Things to Look for When Choosing a Professional Consultant

Posted on November 15, 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.

As a blogger, people always ask me if I run out of things to write about. It turns out that I never come close. Occasionally I’m not motivated to write or there are stories I don’t feel like writing that day, but there are always plenty of stories to write about. In fact, I have hundreds of draft blog post ideas sitting there waiting for me to write.

The problem with all these ideas sitting in my draft blog post folder is that many of them sink to the bottom as more ideas come in. So, every once in a while I like to go digging to see what blog ideas I never published and should have written.

That’s where today’s blog post came from. The team at Logicalis US sent me a great list of five things healthcare CIOs should look for when choosing a professional consultant. Check out the list below:

1. Have a Point of View: Having a point of view is very different from having technological expertise.  It’s about applying that expertise to develop an opinion about the best way to implement a particular technology or solution – and it’s about being so confident in that opinion that they’re willing to share their point of view with you. It does not, however, mean rigidly adhering to a single point of view when another option may work better. The key is to find a partner that has the expertise to advise you about what has worked well for other clients in similar scenarios, yet one who is open to what will work best in yours.

2. Eat their Own Cheerios: As clients move into the third platform and need help extending their capabilities, there are many consultants that can talk with them from a position of strength and experience.  But, if you want to limit the number of partners you have, look for solution providers that are deploying their own strategies and leveraging their own services where possible.  If they aren’t eating their own Cheerios, metaphorically speaking, then you shouldn’t either.

3. Promote Choice and Flexibility: If the partner you select offers its own cloud services, for example, that can be a plus.  But when your business needs dictate using another solution, the right professional consultant will lead the charge.  It’s critical, therefore, that the partner you select is objective enough to be truly vendor neutral, promoting choice and flexibility even when that means helping you select a solution or service that competes with its own.  Many partners are now adopting strategies to manage solutions beyond their own portfolio promoting a framework offering flexibility and choice all delivered with a high-quality, consistent end-user experience.  In the end, partnering with organizations like these will allow you to leverage volume and scale and achieve the best commercial economics while spending less time managing partner relationships.

4. Have a Wide Array of Experiences: A partner that has served clients across a number of industries will often have a wide array of experiences and best practices that can lead to creative solutions that a more linearly focused partner might not have in its toolbox.

5. Be Able to Solve Business Problems Outside of IT: If one of the CIO’s top priorities is to be seen as a more strategic partner to the business, it’s important to have a consultant behind you that can think outside the box – and sometimes that means outside of IT.  Savvy consultants can often leverage common IT processes and service management protocols and apply them to businessproblems beyond the traditional realm of IT.  Can well-oiled ITIL-oriented processes around incident, problem and change leveraged through an ITSM platform, for example, be applied to a manufacturer’s warranty returns process? IT consultants that get to know your business can offer creative ideas that will help you solve vexing business problems in new and creative ways leading to innovation and strategic value.

I think these are some great ideas to think about. What’s been fascinating from my perspective has been the evolution of the term consultant in healthcare IT. During the golden era of EHR adoption, the term consultant largely became synonymous with temp staff. I think they preferred the term consultant because it was easier to justify the high temp staff rates if you called them consultants.

Now that EHR software is implemented, I’m interested to see if we see the return of the true consultant. I think we will. I’m just not sure how many of the “Temp Staff” consulting companies will be able to truly make the transition to consultant.

What else would you add to the list of things you look for when choosing a consultant? Are there red flags you watch for as well? Let us know in the comments and on Twitter with @HealthcareScene.

Will Remote Medical Coders Ever Return to the Hospital? – HIM Scene

Posted on November 14, 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.

This week on the Journal of AHIMA blog, Elena Miller, Director of Coding Audit and Education at a healthcare system, posted this really fascinating question:

Will Coders Ever Return to the Office?

Elena does a good job of explaining how quickly remote work has become part of the medical coder’s life and the benefits it provides. However, she looks at large companies like IBM that are eschewing remote work and bringing their employees back to the office. It’s fair to wonder if the same thing will happen with medical coders who are requested to work from the hospital as opposed to their home.

I’d suggest that this is extremely unlikely to happen. First, I think it’s a mistake for IBM to bring everyone back to the office. Second, the reasons that IBM wants to bring everyone back to the office don’t apply to medical coders as much as it does IBM employees.

While IBM made a big splash with their announcement of bringing everyone back to their office, I think they’re going to regret this decision. They’re going to lose some of their best people who want to work remotely and that’s going to leave them in a bad place. Finding and keeping high quality people is the hardest thing to do at any company. The problem is that the most skilled people in your workforce can find a job anywhere at any time and your competitors are still offering remote work. It’s such a bad idea to lose all of these quality people by getting rid of remote work across the board.

I’m sure IBM needed to change the culture of the company where many remote workers weren’t being efficient in their work. That needs to be addressed, but banishing remote work across the board has all sorts of bad consequences. Don’t be surprised if IBM has made a bunch of exceptions for their highest performing people and if they go back on such a broad policy. A hospital or health system that does this will find the same problem and most can’t afford to lose their best medical coders who can certainly find remote coding work elsewhere if needed.

All of this said, the bigger issue is that remote coding work is quite different than most of the IBM jobs. Most IBM jobs benefit from collaboration and they’re hard to track as far as results. This is why they benefit from being in the same office with their colleagues with whom they need to collaborate and that can hold them accountable.

While medical coders certainly run into challenging cases where they benefit from collaboration, for the most part, medical coding is an individual sport. Plus, there are good ways to track coders productivity, accuracy, etc so you can hold them accountable for their work regardless of whether they’re at home or in the office. This is why I think it’s pretty unlikely that medical coders will return to the office.

Sure, there may be some edge cases where certain healthcare leaders who bring all their coders back as a way to send a message to staff. I think that’s what happened in the IBM case. However, much like I think will happen with IBM, those leaders will backtrack to remote coding soon enough. No doubt there will also be some edge cases where it makes sense to bring a specific coder back on site for training or other remediation for poor performance. Some medical coders may even request to be on site based on their own needs. However, if you can’t trust them to code remotely, my feeling is that you probably shouldn’t trust them to code at all.

Elena does make a great point in her article about remote coders not having the same opportunities to advance in their organization. Being present definitely matters if you are aspiring into leadership positions. What’s not clear to me is how many remote coders really aspire to leadership positions. Those that do seem to be doing remote coding on the side to supplement their income as they rise through the HIM leadership ranks. Maybe I’m wrong and there are a lot of remote medical coders that aspire to leadership in their organizations.

Let us know what you think in the comments and on social media @HealthcareScene. Will remote medical coders return to the office? Will remote coding hurt HIM professionals’ leadership opportunities?

Interoperability Problems Undercut Conclusions of CHIME Most Wired Survey

Posted on November 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.

Most of you have probably already seen the topline results from CHIME’s  “Healthcare’s Most Wired: National Trends 2018” study, which was released last month.

Some of the more interesting numbers coming out of the survey, at least for me, included the following:

  • Just 60% of responding physicians could access a hospital network’s virtual patient visit technology from outside its network, which kinda defeats the purpose of decentralizing care delivery.
  • The number of clinical alerts sent from a surveillance system integrated with an EHR topped out at 58% (alerts to critical care units), with 35% of respondents reporting that they had no surveillance system in place. This seems like quite a lost opportunity.
  • Virtually all (94%) participating organizations said that their organization’s EHR could consume discrete data, and 64% said they could incorporate CCDs and CCRs from physician-office EHRs as discrete data.

What really stands out for me, though, is that if CHIME’s overall analysis is correct, many aspects of our data analytics and patient engagement progress still hang in the balance.

Perhaps by design, the hospital industry comes out looking like it’s doing well in most of the technology strategy areas that it has questions about in the survey, but leaves out some important areas of weakness.

Specifically, in the introduction to its survey report, the group lists “integration and interoperability” as one of two groups of foundational technologies that must be in place before population health management/value-based care,  patient engagement and telehealth programs can proceed.

If that’s true, and it probably is, it throws up a red flag, which is probably why the report glossed over the fact that overall interoperability between hospitals is still very much in question. (If nothing else, it’s high time the hospitals adjust their interoperability expectations.) While it did cite numbers regarding what can be done with CCDs, it didn’t address the much bigger problems the industry faces in sharing data more fluidly.

Look, I don’t mean to be too literal here. Even if CHIME didn’t say so specifically, hospitals and health systems can make some progress on population health, patient engagement, and telehealth strategies even if they’re forced to stick to using their own internal data. Failing to establish fluid health data sharing between facility A and facility B may lead to less-than-ideal results, but it doesn’t stop either of them from marching towards goals like PHM or value-based care individually.

On the other hand, there certainly is an extent to which a lack of interoperability drags down the quality of our results. Perhaps the data sets we have are good enough even if they’re incomplete, but I think we’ve already got a pretty good sense that no amount of CCD exchange will get the results we ultimately hope to see. In other words, I’m suggesting that we take the CHIME survey’s data points in context.

MRI Installation Slip Disables Hospital iOS Devices

Posted on November 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.

The following is the story of an MRI installation which took a surprising turn. According to a recent post on Reddit which has since gone viral in the IT press, a problem with the installation managed to shut down and completely disable every iOS-based device in the facility.

A few weeks ago, Erik Wooldridge of  Chicago’s Morris Hospital, a perplexed member of the r/sysadmin subreddit, posted the following:

This is probably the most bizarre issue I’ve had in my career in IT. One of our multi-practice facilities is having a new MRI installed and apparently something went wrong when testing the new machine. We received a call near the end of the day from the campus that none of their cell phones work after testing [the] MRI… After going out there we discovered that this issue only impacted iOS devices. iPads, iPhones, and Apple Watches were all completely disabled.

According to Wooldridge, the outage affected about 40 users. Many of the affected devices were completely dead. Others that could power on seemed to have issues with the cellular radio, though the Wi-Fi connections continued to work. Over time, the affected devices began to recover, but one iPhone had severe service issues after the incident, and while some of the Apple Watches remained on, the touchscreens hadn’t begun working after several days.

At first, Morris and his colleagues feared that the outage could be due to an electromagnetic pulse, a terrifying possibility which could’ve meant very bad things for its data center. Fortunately, that didn’t turn out to be the problem.

Later the vendor, GE, told the poster and his colleagues that the problem was a leakage of liquid helium used for the MRI’s superconducting magnets. GE engineers turned out to be right that the leak was the source of the problems, but couldn’t explain why Android devices were untouched by the phenomenon.

Eventually, a blogger named Kyle Wiens with iFixit.org seems to found an explanation for why iOS devices were hit so hard by the helium leak. Apparently, even Apple admits that exposing iPhones to evaporating liquefied gases such as helium could take them offline.

While no one’s suggesting that liquefied helium is good for any type of microelectronic device, the bottom line seems to be that the iOS devices are more sensitive to this effect than the Android devices. Let’s hope most readers never need to test this solution out.

The Leadership Demands of Value Based Care

Posted on November 8, 2018 I Written By

The following is a guest blog post by Mary Sirois and Heather Haugen PhD from Atos Digital Health Solutions.

The topics of Population Health and Value Based Care continue to swirl through nearly every healthcare conversation.  Leaders across the healthcare provider and payer industries are looking for strategies to reduce costs and improve quality in hopes of improving the bottom line and increasing the viability of the organization within the community; and every vendor has a solution. We recently formed an expert panel to study and better understand the current state of work being done across healthcare provider organizations.  We explored the topics of leadership strategy and commitment, data aggregation, data analytics, and consumer engagement.  Our conversations reinforced the importance of developing a research-based approach to help healthcare leaders navigate the breadth and depth of this critical initiative: value based care.  Our findings continue to drive our work in defining solutions that meet healthcare leaders’ needs to better serve their organizational missions as care providers and employers in their communities.

The expert panelists included Zach Goodling, Director, Population Health and Care Coordination at Multicare; Randy Osteen, VP Applications, Information Management at CHRISTUS Health; and Ruth Krystopolski, SVP of Population Health at Atrium Health.

The panel discussion gave attendees the opportunity to:

  1. Understand experiences and lessons learned from industry population health and informatics leaders in preparing for value-based care opportunities to improve care quality and reduce costs in their communities
  2. Learn about approaches to data aggregation and analytics to support population health’s strategic and operational priorities
  3. Gain an understanding of various care models deployed by different organizations to manage high risk populations
  4. Appreciate the organizational culture and leadership challenges faced within each of the value-based care journeys of three different dynamic organizations

The discussion began by recognizing that the current state of healthcare is isolated and disconnected; it has interoperability challenges, misaligned incentives for employers, payers, providers, and community services; it tends to focus on sickness for an uninformed and confused user population; and it places accountability on providers that often results in duplication or even scarcity of services.

The opportunity here is tremendous!  We can find ways to:

  • Enhance the ability to improve care quality and consumer (patient, member, employee) quality of life and reduce the cost of care.
  • Come together in consumer-centric manner, using interoperable, technology-enabled, data-driven, innovative business models that cross stakeholder boundaries and focus on quality of life across the continuum of care and services, acknowledging shared risk and creating a more accountable consumer population.

Key messages from the group were enlightening and reflected the progression of the entire healthcare industry.

We heard from all three panelists about the arduous work required to make even small amounts of progress. “We have been on a five-year journey to create capabilities in population health management, managing plans to assist members, identify care gaps, and develop care plans.”  The topic of data arose throughout our interviews.  The panel discussed various concerns around data aggregation. “The biggest hurdle is aggregating data from non-affiliated places and various systems.”  “Data is vital to supporting a broad view of each patient; without it, it is very difficult.” And they cautioned organizations about relying on too much data. “When it comes to analytics, being more actionable is better than gathering more data.”

Many leaders find the array of solutions and systems available to healthcare organizations overwhelming. Our experts provided some insight on platform strategy. “Must identify consistent, reliable, scalable solutions.  It is difficult when you have too many solutions/platforms. If you can get users onto the same system, even if it is not the best of class, using the same governance model and tools creates important consistency and scale.”

The panelists had some ideas about other success factors beyond the tool set.  “Social determinants are often the biggest impact when managing a population. We joke that we are all social workers. We are putting these resources in place and able to monitor 400-450 patients with some of the highest risk patient populations.” They encouraged a paradigm shift for those setting strategy for value based care. “I am often impressed by the level of expertise in healthcare, but surprised by the lack of awareness about the macro environment.  We need to ensure we help our people understand the “why” behind the need for change. The organizational work pales in comparison to the cultural changes required to make progress.” Several panelists also reinforced the long-term focus required for value based care programs to succeed. “This is an iterative process that will evolve over time, not a program with a beginning and end.”

Key Themes from Panelists

  1. A clearly defined leadership strategy and commitment are imperative.
  2. Most organizations are still in the early stages of defining their value based care processes. They are working to improve their understanding of consumer engagement and activities that potentially influence consumers. They are exploring new ways of leveraging technologies to engage consumers and provide new models of care.
  3. The lack of interoperability makes data aggregation difficult and the application of meaningful analytics even more challenging.

A Value Based Care Model

Understanding these key themes provides healthcare leaders with a better understanding of where to focus their efforts, but they still need a model to navigate the various domains of value based care.  The model below includes five areas of consideration for healthcare leaders to use as they continue to define their value based care efforts.

  1. Leadership Strategy & Commitment: Define, refine, and commit to a strategy that allows the organization to realize the benefits of value based care. Leadership engagement is imperative and has the power to accelerate or limit the amount of progress in every domain.
  2. Data Aggregation: Compilation of disparate clinical, financial, social, supply chain, administrative, public, and consumer data is vital for supporting clinical and business decisions.
  3. Data Analytics and Business Intelligence: The ability to utilize aggregated data to make informed clinical and business decisions that improve quality, reduce costs, and offer value to consumers
  4. Models of Care: Leveraging digital technology as appropriate, selection of a care delivery model based on collaboration and communication among all health care providers, payers, consumers, and community resources that contribute to individual consumers’ health and well-being
  5. Consumer Engagement: Connection and engagement between external stakeholders (consumers) and organizations (company or brand) through various channels of correspondence. This connection can be a reaction, interaction, effect, or overall customer experience that takes place online and offline.

Maturity and Organizational Evaluation

An example of the progression in organizational competency within each dimension is shown below, focusing on the most important dimension: Leadership Strategy and Commitment.

Value based care domains establish a critical foundation for assessing progress.  Organizations can then begin to evaluate their maturity within each domain. Atos is developing an innovative algorithm to rank organizational maturity within each domain, as seen in the following chart:

This type of insight helps healthcare leaders to think more strategically about where they invest and how they prioritize the many competing initiatives that impact value based care. This strategic view often results in new operating models and elucidates new ideas, innovative approaches, and ultimately better outcomes for consumers, both inside and outside of the healthcare system.

Atos believes that the digital transformation in healthcare is facing three shockwaves:

  1. Shockwave 1: Requires leaders to rationalize and streamline existing systems, notably through real-time clinical delivery and an EHR, in addition to the integration of financial, revenue cycle, and clinical data to fully understand care quality and costs that impact overall revenue and the organization’s financial viability
  2. Shockwave 2: Interconnect and increase collaboration between all ecosystem players, notably through collaboration and digital solutions. Deeply analyze and optimize treatments with new big data and cognitive technologies for population health (achieve early detection of epidemics, discover new risk factors, uncover new treatments, etc.). This is also at the heart of the research in which Atos is participating.
  3. Shockwave 3: Leverage the latest advances in artificial intelligence, machine learning, and genomics analysis. Leverage high performance computing solutions to enable precision medicine. This is probably the most striking advance on the healthcare horizon.

It will be no small feat for organizations to navigate these shockwaves, respond to ongoing payment reform, and address a changing consumer population; it will require discipline and focus. A complete, thoughtful approach will enable healthcare organizations to move from systems of reactive, disconnected care to a global health system that supports individuals throughout their lives.

About the Authors:

  • Mary Sirois is the Vice President of Integrated Solutions Delivery, focused on population health and value-based care services and technology delivery across all of Atos’ solutions. In addition, Ms. Sirois is a member of the Atos Scientific Community.
  • Heather Haugen is the Chief Science Officer for Digital Health Solutions for Atos.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

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