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Partners Goes With $1.2B Epic Installation

Partners Goes With $1.2B Epic Installation | Healthcare and Technology news | Scoop.it

After living with varied EMRs across its network for some time, Boston-based Partners HealthCare has decided to take the massive Epic plunge, with plans to spend an estimated $1.2 billion on the new platform. That cost estimate is up from the initial quite conservative spending estimate from 3 years ago of $600M, according to the Boston Globe.


As is always the case with an EMR install of this size, Partners has invested heavily in staff to bring the Epic platform online, hiring 600 new employees and hundreds of consultants to collaborate with Epic on building this install. The new hires and consultants are also tasked with training thousands of clinicians to navigate the opaque Epic UI and use it to manage care.


The move comes at the tail end of about a decade of M&A spending by Partners, whose member hospitals now include Brigham & Women’s Hospital, Massachusetts General Hospital, the Dana-Farber Cancer Institute, McLean Hospital, Spaulding Rehabilitation Hospital and the North Shore Hospital.


The idea, of course, is to create a single bullet-proof record for patients that retains information no matter where the patient travels within the sprawling Partners network. Partners can hardly manage the value-based compensation it can expect to work with in the future if it doesn’t have a clear patient-level and population level data on the lives it manages.


Even under ideal circumstances, however, such a large and complex project is likely to create tremendous headaches for both clinical and IT staffers. (One might say that it’s the computing equivalent of Boston’s fabled “Big Dig,” a gigantic 15-year highway project smack in the middle of the city’s commuting corridor which created legendary traffic snarls and cost over $14.6 billion.)


According to a report in Fortune, the Epic integration and rollout project began over the weekend for three of its properties, Brigham & Women’s, Faulkner Hospital and Dana Farber. Partners expects to see more of its hospitals and affiliated physician practices jump on board every few months through 2017 — an extremely rapid pace to keep if other Epic installs are any indication. Ultimately, the Epic install will extend across 10 hospitals and 6,000 doctors, according to the Globe.


Of course, the new efforts aren’t entirely inward-facing. Partners will also leverage Epic to build a new patient portal allowing them to review their own medical information, schedule appointments and more. But with any luck, patients will hear little about the new system going forward, for if they do, it probably means trouble.

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What Patients Want: Flexible Access to Providers

What Patients Want: Flexible Access to Providers | Healthcare and Technology news | Scoop.it

One thing my organization is struggling with right now is urgent/acute/same-day care. Basically, the care provided to a patient for an urgent or acute need. Historically, this care can be found at the emergency department, a walk-in clinic, or your regular doctor's office. Nowadays, patients also have the option of getting virtual care over the Internet or visiting a retail clinic. Trying to figure out what patients need and what they most desire is challenging.

A couple of years ago, I was at a family dinner with relatives who were not in the medical profession. They were discussing their recent forays into obtaining acute care. What they said they wanted was care in a convenient location, at a convenient time, with someone who was clinically competent, and who knew all about them through access to their EHR. Seems like both a reasonable request and a tall order.

We, like many organizations, grapple with these same issues:

• When do patients most want to be seen, and is it different for pediatric and geriatric populations?

• Who is best able to provide urgent care?

• Where do patients prefer to be seen?

• Are patients comfortable with and willing to pay for virtual care?

• How important is it that the person providing acute care is the primary care clinician? Unfortunately, I suspect the answers to these questions are not "one size fits all" but rather reflect the diversity of our patients.

I believe that a patient's desire to be seen by their own primary-care clinician rises exponentially with the severity of the presenting concern. Of course, in our current practice environment, at a certain level, the primary-care clinician is no longer the right person to be caring for a surgical emergency, heart attack, or stroke. Similarly, most patients don't feel strongly about having minor issues — strep throat, urinary tract infection, or a sprained ankle — treated by whoever is available, as long as they are clinically competent. Yet, you will still have patients who eschew both more convenient care and more appropriate care, so that they can see their own physician for the strep throat and the heart attack. How do we build a schedule and a clinic that provides varied access?

As retail clinics advance from acute care to chronic disease management and preventive care, more traditional practices are left trying to decide how this will impact their own provision of medical care. While, it may be convenient for patients to get their diabetes managed at the local pharmacy, I suspect that many patients would opt for the relative inconvenience of going to a separate office for medical care if they feel aligned with their medical team and are confident that they get something extra from that interaction; whether it be the comfort of a familiar face, the kindness of the care team, or the confidence that their entire medical history is available to the treating clinician.

Finally, is predicting demand, which is done in a variety of fashions, essentially unreliable? In my neck of the woods, demand may be highly influenced by the weather, the football schedule, and whether influenza season coincides with the holidays. Two of those three are unpredictable.

I am curious what pearls of wisdom readers have learned as they and their practices try to best manage acute care.


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Why 2015 is the pivotal year for #digitalhealth

Why 2015 is the pivotal year for #digitalhealth | Healthcare and Technology news | Scoop.it

While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.

The mainstream healthcare consumer in 2014 embraced the ALS Ice Bucket challenge and panicked (rightfully so) about the staggering wake-up call of the Ebola outbreak. While the politicians in US played the Obamacare ping pong game, and Brussels accepted its first applications for eHealth projects as part of Horizon 2020, there was also a major undercurrent in how digital health and health IT have penetrated our everyday lives.

In the US alone, digital health funding more than doubled from 2013, according to RockHealth, and even almost tripled according to StartupHealth. While the delta is not a rounding error, the key point is the exponential trajectory that showcases the fact that smart money believes this industry is ripe for significant disruption.

There are still many companies and investors that are sitting on the sidelines and watching the show from the balcony. As an example, there are many critics of wearable devices and even some hesitations on the value of big data. But, I want to remind everyone that Rome was not built in a day and the first generation or even second generation of devices, big data platforms, and decision support tools will improve care mainly driven by healthcare entrepreneurs, healthcare consumers and passionate scientists and clinicians – the “stormchasers”.

On February 2nd, I attended a local Singularity University lecture with a keynote from Gerd Leonhard, who is a thinker, futurist and a digital heretic. One of the statements he made really resonated with me: “Technology is exponential, humans are not”. The keynote was all about ethics in the age of exponential technology. But, leaving privacy and ethical issues aside, 2015 will be a pivotal year for digital health in an era of exponential technology:

1. Precision medicine

During the State of the Union Address, President Obama announced the precision medicine initiative.  

"I want the country that eliminated polio and mapped the human genome to lead a new era of medicine — one that delivers the right treatment at the right time. In some patients with cystic fibrosis, this approach has reversed a disease once thought unstoppable. Tonight, I’m launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier."

Precision, or personalized medicine, (I use the term interchangeably) is an approach to using medical and genetics data, body-generated data, biotechnology, and science, to first and foremost understand the root causes of the disease—but also come up with personalized and individualized treatments and therapies.

Due to forthcoming government funding, but more importantly smart money and brilliant entrepreneurs, we will certainly see more activity this year. After all “Health IS Personal”.

2. Genomics

As DNADigest describes it:

"The techniques for researching and characterizing genomics diseases are available to both researchers (next generation DNA sequencing) and the general public (in the form of personal testing), so we should soon be able to diagnose any genetic disease by sequencing a patient’s DNA."

Indeed, this is the future but the future is almost here: Illumina with $1,000 per full genome sequencing, Tute Genomics which is now allowing researchers and clinicians to interpret the entire human genome, and a big announcement for 23andMe regarding their entrance into the UK market.

As an industry, there are still a lot of hurdles, but we will see some significant moves this year in this space—including ways to actually analyze 150 zetabytes (1021) of data per full genome, begin integrating this data into evolving and ancient EMR platforms, and provide genetic counseling to offset the lack of knowledge by the masses.

3. Smart Data and Data Science

Well actually, data itself is not smart, people are! And while there is huge promise in big data analysis, collecting and hoarding zetabytes (yes this term again) of data does not bring any value.

People need to ask the right questions of the data. We are at an age where collecting data is easy with body-generated data, environmental data, and traditional medical data—but it is the data scientist combined with sharp business and clinical skills that will empower the healthcare system to make all this data actionable, with the healthcare consumer at the center.

"If you torture the data long enough, it will confess to anything" - Ronald Coase
4. Next Generation EMR is personal

Let’s face it—and this is not news to anybody—core medical data is already becoming a small percentage of the overall personal health record. Existing EMR platforms are over two decades old and some are struggling to keep up with archaic architectures, millions of lines of code, and minimal-to-no differentiation to their client base today.

The smart ones are looking to open up their APIs, integrate body-generated and genomics data, and even combine that with environmental data at a personalized level to be able to provide that precision medicine at point of care.

5. Design and Aesthetics

Our bodies are complex, and therefore the medical profession is complex. Once again, an unprecedented amount of content is generated daily—and for both consumers and clinicians alike, dealing with this information overload is becoming yet another full time job.

The aforementioned smart data discussion is only one piece of the puzzle. User experience is another.

At the core of our health is human behavior. Hence, incentivizing healthcare consumers (patients), making their treatment pathways clear, and presenting stupid data in a smart and actionable way are all key to improving our healthcare system.

Global health care transformation is still in its infancy. While we don’t truly know what the future holds, we all know that health is personal—and will need to be handled accordingly to optimize the progress that is possible with digital health.


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Why Medical ID Fraud Is Rapidly Growing

Why Medical ID Fraud Is Rapidly Growing | Healthcare and Technology news | Scoop.it

As the healthcare industry continues to digitize patient records, that data is a growing target for cybercriminals intent on committing medical identity theft and fraud, says Ann Patterson of the Medical Identity Fraud Alliance.

In fact, the number of individuals affected by medical identity theft in the U.S. increased 22 percent in 2014 vs. the previous year - an increase of nearly half a million victims, according to The 2014 Fifth Annual Study on Medical Identity Theft. The study, conducted last November by the Ponemon Institute, was co-sponsored by the alliance.


Ponemon Institute estimates that medical identity theft incidents affected 2 million victims in 2014, nearly double the number of victims affected when the survey was first conducted five years ago.


"As the health industry creates more and more electronic health records and becomes fully digitized ... it just creates more cyber data for hackers to try to attack," Patterson says in an interview with Information Security Media Group.

"Medical records are highly lucrative on the black market," even more so than credit card data, she notes.

It's not just the data stored by healthcare providers and health plans that is being targeted, she warns. Consumers also need to safeguard their medical information, whether it's by shredding paper-based "explanation of benefits" documents they receive in the mail from insurers, or being more mindful of the information they share on social media.

"Cybercriminals are really good at aggregating and data mining all kinds of data that's available on online platforms, like social media, to create really rich, robust medical identity about you, Patterson says. "It's not just your date of birth, Social Security number, and health plan ID number ... that need to be protected. All other health information can be aggregated to create a really rich identity that can be exploited."

In its 2013 study, Ponemon found that about third of medical ID fraud victims were faced with various out-of-pocket expenses, such as legal fees. But in 2014, about 65 percent of medical ID fraud victims dug into their pockets, paying, on average, about $13,000 to clean up the mess left by medical ID fraudsters, Patterson says. "However, what we're finding is that oftentimes, even after spending all of that money, the problem doesn't get solved. Your medical record is still not correct." That's because false information can become part of an individual's medical record when someone fraudulently receives treatment as a result of identity theft.


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A Strive Towards “Meaningful” Data Exchange in the Midwest

A Strive Towards “Meaningful” Data Exchange in the Midwest | Healthcare and Technology news | Scoop.it

Although the successful exchange of health data has been a struggle in most U.S. regions, a commitment to the free flowing of information on a patient’s history—regardless of what local healthcare facility they have been at—has helped spur health information exchange (HIE) in the Midwest.

Indeed, the Lewis and Clark Information Exchange (LACIE) is one of the first fully operational, multiple-state HIEs in the country, providing patient information to healthcare systems and providers in Kansas and Missouri. Getting the HIE up and running to a point where it could successfully exchange data required a few key elements, starting with getting hospitals on board that were willing to share data. To this end, in the last 18 months, LACIE announced two major connections: first with the Kansas Health Information Network (KHIN), another major HIE in Kansas. This was a significant moment for data exchange in the Midwest, as in the past, the two organizations had failed to reach an agreement on sharing data.

A few months after that, LACIE announced that patients' electronic medical records (EMRs) were being securely shared with Tiger Institute Health Alliance (TIHA) in Columbia, Mo. In total, LACIE is now connected to 17 hospitals in two states in addition to three accountable care organizations (ACOs), the two aforementioned regional HIEs, multiple private HIEs, and the Kansas City Metropolitan Physician Association (KCMPA), a large independent physician group with 80 clinics and 350 providers. The 24 different EMRs those organizations use have been connected via a hub that has been put in place from Cerner, says Mike Dittemore, the executive director for LACIE. Dittemore says that LACIE connects to that hub so it doesn’t have to do all of the independent connections, leading to greater efficiencies and cost savings.

However, getting different provider organizations on board has not been easy, Dittemore admits. “There are always challenges with provider participation, and one of reasons we had the strategy to work with hospitals and get them on first is that we felt if we did a good job with them, that would spur participation from others. The best marketing out there as far as HIEs go is word of mouth by providers who actually use it,” he says. What’s more, LACIE’s board of directors consists of several physicians, including multiple CMIOs of organizations in the Kansas City area. “That’s really helped us, having these physicians have conversations with other providers or their clinics and talk to them about why it’s important to share this information and participate,” says Dittemore. “They can show other [providers] the value by being able to not tie up so much staff in administrative time in tracking information down that already exists in the HIE.”

Still, there are additional challenges for independent providers who have all kinds of mandates and rules they are struggling with, in addition to low reimbursement rates, Dittemore notes. “So we try to have a price point that works for them, and we also have found some grant funds through the Office of the National Coordinator for Health Information Technology (ONC). In Kansas, we used some of those funds to help folks to connect, but it’s always an uphill climb to get individual providers on board. We do think that if we can get in and meet with clinic managers, maybe not the providers themselves, but a trusted person they go to, and show them the value, getting these smaller providers on board might not be as hard,” he says.

One of these physicians on LACIE’s board is board chair, Gregory Ator, M.D. CMIO and practicing physician at the University of Kansas Hospital. Ator says that as of late, LACIE has become much more focused in getting smaller practices on board. “It’s been a great experience, it’s very refreshing to see all of these large organizations that are not competing around the ‘this is my data and you can’t have it’ concept, but rather the ‘let’s compete around quality of care and let information freely flow’ concept. That’s been quite refreshing, and moving forward we’re looking at the next tier of smaller physician practices,” Ator says.

LACIE further attempts to make the exchange process more doable by not charging organizations a fee to connect. “We have always believed in connecting to other HIEs, be it community, regional, or state. But we don’t pay other organizations to connect nor do we charge others to connect to us,” Dittemore says. “LACIE is a public type of entity. We think that’s why it’s here, for the spirit of moving information regardless of where they reside. We have been adamant about that, but not all facilities feel the same way. So that’s been a barrier,” Dittemore notes.

Making HIE Valuable

Currently, LACIE is consistently seeing 100,000 queries per month going through the HIE, and according to Dittemore, one of the things that really helps provide value to its providers is getting robust information trading rather than just checking a box. “If checking a box is what you want, our HIE won’t be for you. We’re about the meaningful trading of information,” he says.

To this end, all of LACIE’s connected providers are encouraged to share radiology reports, discharge reports, clinic visits, and any summaries, Dittemore adds. “What we have found is that when you have that type of information above and beyond the continuity of care document (CCD) or consolidated-clinical document architecture (C-CDA), it really provides a great platform for providers to go in and look at the information and find out what is really going on with patients in those last visits,” he says. “We want to try to get rid of the fax machine, or reduce its use by as much as possible. Having this robust information available does help providers to move onto other duties like taking care of patients. They become valuators rather than investigators,” says Dittemore.”

Expanding on the notion of meaningful data exchange, Ator notes that fax machines are how providers are doing HIE right now, and what’s more is that Direct also has issues with people’s addresses as well as its own technological problems. “I am an Epic customer at KU, so we have a number of Cerner operations in town as well as Epic operations, and when you log into Epic for instance, we can go out to the HIE and search for a patient, at which point a very robust matching algorithm kicks in and we get textual documents presented in reverse chronological order. Operative notes, progress notes and discharge summaries are all within Epic without a separate log-in,” Ator explains. “Our providers don’t have to dig through exchange formats such as CCDs and CCDAs to see it in a meaningful manner. And that’s Cerner shop looking at Epic and vice versa,” he says.

Value to providers is further seen in the form of impacting patient outcomes. According to Ator, the strongest use case now is in the ER. “The patients here in a big city circulate around the EDs, and it’s fabulous to have the notes as it was was signed from an organization right down the street that a person might have checked into,” he says. “So we have seen improved outcomes around the ED, and the literature backs that up. I think that it is clear there is benefit in ED world, but rest is bit too soon to call,” Ator says.

Dittemore also says that value has been seen on the care management side. Kansas City has multiple medical facilities and acute care facilities, but even more non-acute facilities, he says. Just because a patient happens to go to a provider or an urgent care clinic that they have affiliation with, they might not go there for all care, and that’s something that needs to be seen in the HIE, he says. Also with specialists, making sure to ensure patients have done the appropriate follow up and have been to specialists allows care managers to see if that has happened and if not, find out why, Dittemore says. “Was it a transportation problem, an illness or what? It gives them something to go off of when they reach back out to the patient. Care managers have seen great value in this to manage that care between multiple facilities that might not be financially related to one other. That’s been rewarding,” he says.


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The Apple Watch will Bolster the iPhone’s Place in Medicine

The Apple Watch will Bolster the iPhone’s Place in Medicine | Healthcare and Technology news | Scoop.it

One of the single biggest complaints that we hear from Physicians when referring to their EHR system is how computers take away from the personal side of patient care. All too often docs are now forced to dig through various screens, and drop down menus while they type in copious amounts of data during patient encounters. Traditionally, doctors could easily maintain eye contact with their patient while they jotted notes into a medical record using a pen and paper, but EHR interfaces have complicated that process.

In the last couple of years we’ve seen mobile apps and smart phones bring many efficiencies to the medical exam room. For example, an app that we built on behalf of the American College of Physicians, ACP Immunization Advisor, helps clinicians get up-to-date vaccine information quickly and efficiently. The free iPhone app, which provides several ways to filter the CDC Immunization Schedule for specific patient needs, can help a physician save valuable time in a patient visit by providing a comprehensive, up-to-date list of vaccine recommendations in seconds. Not only is this far more efficient then trying to navigate through the paper-based CDC schedule, but it provides the clinician with piece-of-mind as the app is updated frequently to stay on top of changes in the guidelines that won’t be reflected in a paper copy unless they download, and reprint them frequently.

Apps like the ACP Immunization Advisor are great examples of ways we can bring new efficiencies to medicine, but there is still plenty of room for improvement. One of the great advantages that Apple Watch will bring to the table is the ability for a clinician to access all of that great functionality in their smart phone, without ever having to remove it from their pocket. With the release yesterday of iOS 8.2, newer iPhones (Apple Watch is compatible with iPhone 5, iPhone 5c, iPhone 5s, iPhone 6 or iPhone 6 Plus) will now have the capability to tether with Apple Watch. Developers can now build watch based interfaces to allow for easy access to information that’s literally at arm’s length. Bringing data to the physicians wrist will help to reduce the need to stare into a screen, and it helps free up both hands from having to physically hold a device.

Although the interface may be small, the Apple Watch is fully voice control enabled with Siri, meaning apps can be controlled hands free. From the looks of the interface, this watch seems to have reinvented usability for such a small screen (another forward-thinking move by Apple). When looked at as an extension of the iPhone, the Apple Watch has great potential to help clinicians have more face-to-face interaction with their patients while they are leveraging technology. It also opens the door for apps to enter other areas of medicine, like surgery, where a doctor is unable to physically interact with a smart phone due to the physical constraints of surgical gloves, and of course sanitary reasons. An Apple Watch would allow a surgeon to access powerful apps in their smartphone without ever having to touch it.

In 2013 AmericanEHR conducted a report titled “Mobile Usage in the Medical Space” which set out to better understand health practitioners usage of technology in the medical space. Some key findings included:

  • 77% of physicians who’s adopted an EHR use a smartphone
  • On average, physicians who have adopted an EHR conduct 11.2 activities per week on their smartphone in a clinical setting
  • 51% of doctors with smartphones use apps on a daily basis for clinical purposes
  • Nearly 7 in 10 (69%) of iPhone users are very likely to recommend their iPhone compared to just 26% of non-iPhone users


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67 percent of seniors want to access healthcare at home

67 percent of seniors want to access healthcare at home | Healthcare and Technology news | Scoop.it

Sixty seven percent of seniors want to access healthcare service from home, although 66 percent of seniors do not think current available technology is sufficient for them to do so, according to an Accenture survey of 354 US seniors, aged 65 and over who are receiving Medicare benefits. The survey was fielded between May and June 2014.

Accenture pointed out that according to data from the US Census Bureau, 3.9 million Americans are turning 65 this year.

“Just as seniors are turning to digital tools for banking, shopping, entertainment and communications, they also expect to handle certain aspects of their healthcare services online,” Kaveh Safavi, global managing director of Accenture’s health business said in a statement. “What this means for healthcare systems is that they need to consider the role that digital technology can play in making healthcare more convenient for patients of all ages at every touch point.”

The survey found that more than 66 percent of seniors prefer to use self-care technology to manage their health rather than managing health independently. The survey also found that more than 60 percent of seniors are willing to wear a health tracking device to monitor certain vital signs, like heart rate and blood pressure. Another 60 percent of seniors are somewhat or very likely to use online health communities, including PatientsLikeMe, to research a doctor’s recommendation before they act on it.

Twenty five percent of seniors use electronic health records portals regularly to manage their health. According to projections from Accenture, the percentage of seniors that use EHR portals will grow to 42 percent in five years, as consumer-facing tools increase. Of those that currently use these portals regularly, 57 percent use them to access lab results.

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Cerner big data platform gets new client

Cerner big data platform gets new client | Healthcare and Technology news | Scoop.it

Truman Medical Centers and the University of Missouri-Kansas City's Center for Health Insights have teamed up on a new initiative that will harness data from electronic medical records, de-identifying it and digesting it into a database that can help inform better care decisions.

Both organizations will partner with EMR giant Cerner to leverage its Health Facts data warehouse platform to drive the analytics initiative. Health Facts extracts data from both clinical and financial IT systems, de-identifies the data, standardizes terms through mapping to common nomenclature and has the ability to create adverse drug events and outcomes reports.

The platform, as Cerner officials described, will allow the two-hospital TMC to use its current clinical and financial data and transform it into a usable form that can be leveraged to improve patient safety and care outcomes. What's more, TMC officials anticipate the data analysis can also be used to reduce specific health disparities and reduce costs for certain procedures.

Specifically, with the platform TMC officials will be able to use the generated reports and compare one's organization's performance with other clients who use the warehouse. The warehouse already includes millions of EMR records from inpatient, ED and outpatient visits from patients nationwide.

"The centerpiece of this partnership provides tools to accelerate clinical and translational research and ultimately provide better health outcomes," said Lawrence Dreyfus, UMKC vice chancellor for Research and Economic Development, in a Feb. 18 press statement. "We couldn't be more excited about the prospects that this partnership holds for healthcare decisions that ultimately improve care and reduce costs."

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