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Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news |

Sometime in the not-so-distant future, getting a checkup will be very different.

When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.

This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.

But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”

Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.

In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.

Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.

Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.

And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.

“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.

For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.

Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.

“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.

And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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In The Grand Canyon State, Behavioral Health Data Exchange Gets Steeper

In The Grand Canyon State, Behavioral Health Data Exchange Gets Steeper | Healthcare and Technology news |

Last April, two health IT vendors—the Horsham, Pa.-based NextGen Healthcare Information Systems and its sister company, Mirth, based in Costa Mesa, Calif.—announced the launch of the Behavioral Health Information Network of Arizona (BHINAZ), publicized by its officials as the first statewide behavioral health information exchange (HIE) in the nation.

BHINAZ was the brainchild of a consortium of behavioral health providers who are customers of Topaz Information Solutions, an authorized NextGen reseller and outsource partner that specializes in behavioral health and social services. Topaz, in partnership with NextGen Healthcare, built specific content within the technology platform to meet specific needs of behavioral health and social services organizations.

Leveraging NextGen’s ambulatory electronic health record (EHR) and HIE, and Mirth Connect— an open source application used for healthcare data integrations—BHINAZ created the legal and operational framework necessary to protect confidentiality while helping to facilitate data exchange and streamline the process for behavioral health providers to obtain and manage patient consent, specifically as it relates to exchanging patient information, officials say. As a result, BHINAZ will provide clinicians throughout the state with a longitudinal patient history at the point of care, making information available when and where it's needed for medical care.

Shortly after the announcement, HCI Senior Contributing Editor David Raths interviewed Laura Young, the executive director of BHINAZ, about the network’s goals and progresses for HCI’s sister publication, Behavioral Healthcare. At that time, the organization was just getting off the ground, with some of the main challenges being around legal and privacy issues with patient consent, as well as connecting to the physical health HIE in Arizona, and of course, cost.

Operating under an “opt-in” consent management model, BHINAZ said that it will ensure that data protected under Federal Law 42 CFR Part 2 is not re-disclosed without proper consent. Within the NextGen EHR, customized behavioral health consent management templates were created by working collaboratively with BHINAZ to include required content management language and capture electronic signatures at the point of care. Using these templates, information is sent to the NextGen HIE, which then dictates specifically what data a given provider can access within the EHR. Patients and clients have the option to choose if they would like their data to be shared with the rest of the closed network at each BHINAZ location. Last year, Young told Raths that, “It really is all or nothing. We are treating all of the data within our HIE as protected 42 CFR Part 2 data. If the client isn’t comfortable sharing their Part 2 data, then we aren’t going to share anything else.”

A year later, HCI Associate Editor Rajiv Leventhal checked in with Young, and the challenges for BHINAZ remain similar to what they were in 2014. Below are excerpts of that recent interview.

Tell me about the logistics behind the creation of BHINAZ?

In Arizona and in other states, we have Regional Behavioral Health Authorities (RBHAs)and in Maricopa County, where I live, the RBHA contract of $7 billion over five years—for behavioral health services passed out from federal funds to the state and then out to designated behavioral health agencies— was up for bid. In the past, the challenge has been when those agencies lose those contracts, they pack up their data with them, so there are issues with continuity of care and being able to access information about patients and clients. There was a feeling that the way to go was start working on an HIE for behavioral health.

So the HIE is stakeholder-owned, comprised of seven nonprofit organizations.  It’s very much at the community level, driven by behavioral and community health providers. Our approach comes from the bottom up rather than top down, so we are able to be at provider level and insert the HIE directly into the practice and do workflow and training right at the organizational level.

How is it being funded?

Initially, the money didn’t come from the RHBAs, but that where it’s gone towards now. We do have a subscription model, and when we connect providers, there’s a connection fee with a sliding scale for monthly subscriptions. In working with the RHBAs, and there are now three of them in Arizona, their contracts obligate them to have some sort of HIE technology, and they’re also obligated to do integrated care, for both physical and behavioral health. So it’s turned into a critical thing for them to work with us. We’re contracting with them to connect providers, and they’re covering the cost of connection in exchange. We want providers to put some sort of money into it, otherwise they don’t own the technology and are less inclined to use it to be honest. We are also working on initiatives at the state level to get allocations that would go to our HIE and the physical health HIE in the state.

To what extent has your network grown, and how many organizations are exchanging data?

We have about eight providers, not necessarily the stakeholders which is ironic since it’s around the same number. We have also partnered with Quest Diagnostics, and now we have providers ordering in results and labs through the HIE. We’re right at that threshold where we'll connect more providers. There are about 200-300 behavioral health providers statewide, and of that, 40 or 50 of them touch 90 percent of the participants, so we are working on getting those providers on board first.

Has the lack of meaningful use incentive dollars hampered things at all?

One of the barriers is definitely lack of good EHR technology. In behavioral health, there are a lot of mom-and-pop applications. The other barrier is that a lot of these vendors charge a fortune for interfaces—thy either charge per interface or charge a lot at one time to give you an HL7 channel for instance. That makes it cost prohibitive for some of these providers, especially the smaller ones. The vendor cost for their EHR is sometimes the barrier to getting connected. The EHR companies are also trying to bite a piece off the HIE business, so they compete against HIEs, which I think slows everyone down. More collaboration is needed.

How has that experience been, connecting to the physical health HIE in the state?

We’re finishing up a connection from them so we will have all the hospital admits and discharges, and we can rout those in real time to our providers. A lot of the time these behavioral health patients get admitted in hospital or go to the ER, and they stay for 72 hours which is the requirement, but they don’t necessarily get a lot of treatment during that time. They might get discharged without addressing their concerns. Sometimes there are no follow-ups, and this way with alerts, intervention and coordination becomes critical.

Working with them has been a good partnership, I’d say. Our approaches are different, they have an opt-out model, we have an opt-in one. Their main focus has been around connections, getting big hospitals and payers on board and connected. They don’t spend much time at the community level doing workflow, so we do have different approaches. But we do also need each other, and we try to work together on things as the long-term goal is bi-directional exchange so the behavioral health data is getting back to the physical health providers. That will take some work.

How does your opt-in model work specifically with behavioral health patients?

We require explicit consent. For our model, the education piece is especially important. We spend time on educating the provider on educating the patient. We have about a 78 percent opt-in rate, but it does vary by type of provider, and when that consent is presented varies too. For example, if you’re coming into a detox center you won’t be presented with the consent right away. We have had good success with it though. If we convince the patients that the HIE is good for them, that they don’t have to repeat things every time they go to another provider, it will help them understand why it’s really best to opt-in. We want to improve that rate and do more education, but we are happy with our success so far.  

Consent has also taken up a big chunk of our time. We spent 18 months doing legal and technical work on consent. In fact, we have done so much work on it that we have become the de facto expert on it. We actually get calls on how we do it. A lot of groups see things that go into consent requirements for behavioral health and want to figure it out later. I mean it took us a year and a half, that’s all our organization was doing. Imagine if you had a lot of other priorities?  

Are there other HIEs in this space who you’re competing against?

We are the only standalone behavioral health HIE in the country. Other states are doing behavioral health as a component, but some of it is just using Direct exchange point-to-point, not a full blown repository. Colorado, Kansas, Rhode Island are states that do have behavioral health in their exchanges, but it’s hard for me to say what it looks like or what’s being exchanged. So there is no competition from that perspective.

Is behavioral health data exchange any different than physical health exchange?

One of the big areas of focus for us is crisis services. In a crisis, time is of the essence, so being able to have as much data as possible available about someone is critical. The type of data isn’t your standard data set, though. Rather than radiology and labs you’re looking for documents, assessments, and treatment plans. That’s where I see a bigger difference between physical health and behavioral health data exchange. And it’s not that they don’t exchange documents, but they are looking for diagnostic types of data versus these comprehensive documents. That’s where we insert ourselves and try to get people off paper. It’s such an old process, faxing and scanning compared to embedding right into the EHR.

What are some key goals for BHINAZ in the next year or so?

A lot of what we do is dictated by our participants; the RHBAs have a priority list, so we work that direction. We are also really focused on crisis services; it’s at the top of our list. We are working on a consolidated crisis viewer, which is different than what you’d see in a standard HIE, as there are very specific data elements that you need to see for crisis. Right now folks are looking in seven different systems, and in crisis, that’s not efficient as you can imagine.

Also around crisis, we are improving our call centers. It’s a very old-fashioned process right now, so we are building a connection from the call center to the HIE that would rout a crisis call to the mobile team as a direct referral, and they would be able to pull that directly into the EHR. An added benefit of that is if there happens to be patient match, and in crisis that’s not easy because patients don’t always give their real names, we can pick up any other HIE data that we might have that they didn’t relay on the phone call. The team can then document that back in the EHR, and close that loop back to the call center. 

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Cedars-Sinai goes all-in on Apple HealthKit

Cedars-Sinai goes all-in on Apple HealthKit | Healthcare and Technology news |

Cedars-Sinai Medical Center in Los Angeles has become the latest provider organization to link its electronic medical records system to Apple's HealthKit software.

CIO Darren Dworkin, speaking to Bloomberg Business, said that information from HealthKit now will appear in health records for more than 80,000 patients. Several other hospitals, including the Mayo Clinic in Rochester, Minnesota, and New Orleans-based Ochsner Health System, as well as Stanford University Hospital and Duke University, also integrate with HealthKit.

"This is just another set of data that we're confident our physicians will take into account as they make clinical and medical judgments," Dworkin said, who added that use of HealthKit will be a learning experience.

"We don't really, fully know and understand how patients will want to use this," he said.

Dworkin added that HealthKit will be available for all patients throughout the system to use as they choose. 

"The opt-out is just don't use it," he said.

At the Healthcare Information and Management Systems Society's mHealth Summit in the District of Columbia last December, Ochsner Chief Clinical Transformation Officer Richard Milani and Duke Medicine Director of Mobile Technology Ricky Bloomfield shared insight into their respective organizations' HealthKit integrations. Both facilities use Epic's patient portal, MyChart.

Milani said the amount of data patients could generate that could then go into their records was pretty small; he said about 50 to 60 discreet elements such as weight, sodium intake and blood pressure could be entered. Bloomfield, however, said that based on conversations with Apple healthcare executives, he expects that number to grow.

Bloomfield added that HealthKit integration will help to transform the use of EHRs for providers.

"This was finally something we could give them that would live up to the promise of what EHRs can provide, and what having access to this kind of data can provide," Bloomfield said at the Summit.

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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 |

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 |

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 |

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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4 Ways Technology Will Dominate Healthcare in 2015

4 Ways Technology Will Dominate Healthcare in 2015 | Healthcare and Technology news |

Technology plays a major role in healthcare development around the world and we saw more proof of that in the past year. This year, we can expect to see technology dramatically change people’s entire healthcare experience. Here are 4 ways technology will dominate healthcare in 2015.

1. Investments in Technology

The Affordable Care Act (ACA), also known as Obamacare, is changing the healthcare industry by putting the focus on consumers. This will force health insurers to shift strategies from old business models using employer-sponsored products and services to more consumer-focused offerings.

In an article on, Joe Riley, a managing member of the healthcare investment firm Psilos, stated that he predicts a “surge in acquisitions in 2015 as the insurers add technologies, products and services that deliver a differentiated consumer experience on price, quality and service.  Significant investment will be required throughout the health insurers’ value chains, from research to product development, to operations and to marketing and sales”.

Among the technological solutions that Riley predicts companies will focus on this year include automated claims adjudication and payment software, population health management tools, mobile and telecommunication strategies such as online appointment scheduling, prescription ordering and direct payments, and a 24/7 customer service software.

2. Healthcare Data and the Cloud

In order for healthcare providers to improve the quality of their services and at the same time manage costs, they will have to create more comprehensive patient profiles. Cynthia Burghard, Research Director from the research firm IDC, in an article on, predicts that “15 percent of hospitals will create a comprehensive patient profile by 2016 that will allow them to deliver personalized treatment plans”. This calls for improvements in data collection and management, which will encourage more healthcare providers to make use of the cloud.

In the same article, Judy Hanover, Research Director at IDC, also stated that “by 2018, 80 percent of healthcare data will pass through the cloud at some point in its lifetime, as providers seek to leverage cloud based ecologies and infrastructure for data collection, aggregation and analytics and decision-making”.

3. Wearable Devices for Fitness and Healthcare

There has been huge growth in the wearable devices market in recent years. According to an article on the, Juniper Research estimates 19 million devices in the market last year, and this number is expected to reach 70 million by 2018.

Wearables are not only able to help users track their heart rates but also monitor other facets of their health. This year, though, we can expect to see wearable devices to expand from wrist devices to other products such as biometric shirts and headphones that track heart rate.

What is more interesting though is the movement to transition from just fitness to healthcare. One of the major goals now is for physicians to be able to monitor data coming from these wearable devices in order to make healthcare decisions.

4. Healthcare Apps

As more and more data are collected from wearable devices, there is also a corresponding increase in the development of healthcare apps that provide storage for and management of this data. Some of the apps available in the market now are the Apple Heath and Google Fit platforms. Since patients nowadays are also more empowered to take charge of their health, more healthcare apps are predicted to come out in the market soon.

Bob Lawson's curator insight, February 5, 2015 5:49 AM

Seeing some really clever stuff around clinical trial adherence where Mobile Apps are being used to keep participants in the medical trials on track and build a very short feedback loop!

MacPractice Enhances eRx Electronic Prescribing Option for Mac and iPad

MacPractice Enhances eRx Electronic Prescribing Option for Mac and iPad | Healthcare and Technology news |

MacPractice, the leader in the development of best-in-class practice management and clinical software for Macs, iPads and iPhones and associated services for physicians, dentists, chiropractors and eye care professionals, today announced enhancements to eRx, an ePrescribing option currently within MacPractice. eRx allows MacPractice users to securely prescribe all substances within the same efficient workflow on either a Mac with MacPractice MD, DDS, DC or 20/20 or using an iPad with MacPractice iEHR, utilizing robust patient safety features for drug reviews and managed care checks. eRx satisfies the certification requirement for New York State providers who all must ePrescribe by March 27, 2015.

“The development of eRx is truly a testament to strong communication with our customers, and our commitment to the delivery of solutions that fill all of their specific needs,” said Mark Hollis, MacPractice co-founder and CEO. “We are proud to launch solution options that demonstrate such a high level of performance.”

With eRx, MacPractice now supports electronic prescribing and controlled substance prescribing in conjunction with NewCrop. The eRx interface is tightly integrated within MacPractice and NewCrop, allowing users to safely and securely write prescriptions and transmit them to pharmacies directly from within MacPractice. Not only does this eliminate redundant data entry to create a prescription, it also reduces future work by mobilizing a prescription history in the patient’s clinical record for use in several other MacPractice Abilities and products.

MacPractice iEHR for iPad facilitates mobile electronic prescribing, allowing providers to prescribe during the patient encounter directly within the same clinical documentation form. Providers can view a history of all patient prescriptions sent from any device with a MacPractice product (iPad or desktop), with the same secure NewCrop interface integration and ePrescribe features found in MacPractice for desktop.

Beyond basic electronic prescription transmission, eRx also offers an all-doctor drug history with managed care connectivity, drug information and interaction reviews, managed care formularies, automated drug/allergy checks, patient education literature in 18 languages, and drug history reporting. Additional features include renewal requests, formulary checking, common drug and pharmacy lists, and drug sets.

eRx has achieved Drug Enforcement Agency (DEA) Electronic Prescriptions for Controlled Substances (EPCS) certification, allowing users to prescribe Schedule II-V controlled substances electronically, and transmit scheduled drugs through NewCrop. Pharmacies that accept controlled substance electronic prescriptions (more than 40% of pharmacies in 49 U.S. States and the District of Columbia) are highlighted in the commonly used pharmacy list.  Controlled substances are securely identity-verified, and each transmission is assigned a PIN through Verizon Universal Identity Services, an identity-proofing method that ensures each prescription sent meets federal regulations.

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Partners Goes With $1.2B Epic Installation

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

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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A Strive Towards “Meaningful” Data Exchange in the Midwest

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

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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What Patients Want: Flexible Access to Providers

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

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 |

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 |

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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5 Significant Health IT Trends for 2015

5 Significant Health IT Trends for 2015 | Healthcare and Technology news |

While I know meaningful use (stages 2 and 3), electronic health record (EHR) interoperability, ICD-10 readiness, patient safety and mobile health will all continue to trend upwards with great importance, the five areas that I strategically see growing rapidly in 2015 are focused on the consumerism of healthcare, personalization of medicine, consumer-facing mobile strategies, advancements in health information interoperability including consumer-directed data exchange and finally, innovation focused on tele-health and virtual care.

While all of these trends can be independent of each other and will respectively grow separately, I see the fastest growth occurring where they are combined or integrated because they improve each other. It’s like a great marriage where the spouses make each other better and usually more successful because of their unity. I see the same occurring in 2015 and why I am so bullish on these integrated opportunities and innovations.

Here are the 5 top trends:

  1. Treating the patient as a consumer: This is due to numerous factors but a significant driver is the shift in various CMS regulations and incentives that have care providers and healthcare organizations focused on increased patient engagement as well as patient empowerment to improve communication, care coordination, patient satisfaction and even discharge management with hospitals. As a result of an increased focus on improving the patient/consumer experience, 65 percent of consumer transactions with healthcare organizations will be mobile by 2018, thus requiring healthcare organizations to develop omni-channel strategies to provide a consistent experience across the web, mobile and telephonic channels. I have already begun to see this in hundreds of area hospitals and practices in Georgia and know it is occurring across the country.
  2. Personalized medicine: While this concept is not new, the actual care plan implementation as well as technology and services innovations supporting this implementation is being driven quickly by the increased pressure for all care providers to improve quality and manage costs. You will see this increase dramatically once Congress passes SGR Reform that received bipartisan and bicameral support last Congressional Session and Congressional leaders are poised to take up this legislation again in the next month. The latest statistics show that 15 percent of hospitals will create a comprehensive patient profile by 2016 that will allow them to deliver personalized treatment plans.
  3. Consumer-facing mobile strategies: To control spiraling healthcare costs related to managing patients with chronic conditions as well as to navigate new policy regulations, 70 percent of healthcare organizations worldwide will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018. This will create more demand for big data and analytics capability to support population health management initiatives. And to further my earlier points, the personalization of medicine relies on additional quality and population health management initiatives so these innovations and trends will fuel each other at faster rates as they become more integrated and mature.
  4. Consumer-directed interoperability: Along with the evolution of the consumerism of healthcare, you will see the convergence of health information exchange with consumer-directed data exchange. While this has been on the proverbial roadmap for many years, consumers are getting savvier as they engage their healthcare and look to manage their increasing healthcare costs better along with their families’ costs. Meaningful use regulations for stage 3 will drive this strategy this year but also just the shear demand by consumers will be a force as well. I am personally seeing a lot of exciting innovation in this area today.
  5. Virtual care: Last but certainly not least, tele-health, tele-medicine and virtual care will be top-of-mind in 2015. The progression of tele-health in recent years is perhaps best demonstrated by a recent report finding that the number of patients worldwide using tele-health services is expected to grow from 350,000 in 2013 to approximately 7 million by 2018. Moreover, three-fourths of the 100 million electronic visits expected to occur in 2015 will occur in North America. We are seeing progress not only on the innovation and provider adoption side but slowly public policy is starting to evolve. While the policy evolution should have occurred much sooner, last Congressional session we saw 57 bills introduced and as of June 2013, 40 out of 50 states had introduced legislation addressing tele-health policy. I see in every corner of the country that care providers want to use this type of technology and innovation to improve care coordination, increase access and efficiency, increase quality and decrease costs. Patients do as well so let’s keep pushing policy and regulation to catch up with reality.

While the headlines this year will be dominated by meaningful use (good and bad stories), ICD-10, interoperability (or data-blocking), and other sensational as well as eye-catching topics, I am extremely encouraged by the innovations emerging across this country. We are starting to bend the cost curve by implementing advanced payment and care delivery models. While change and evolution aer never easy, we are surrounded by clinicians, patients, consumers, administrators, innovators and even legislators and regulators who are all thinking and acting in similar directions with respects to healthcare. This is fueling these changes “on the ground” in all of our communities. This year will be as tough as ever in the industry but also, a great opportunity to be a part of history.

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Ingredients for streamlining care management | Healthcare IT News

Ingredients for streamlining care management | Healthcare IT News | Healthcare and Technology news |

In an era where medicine is highly specialized and different specialties are involved in the care of a patient, intelligent use of information technology is essential to help providers, payers and patients achieve better care management outcomes while simultaneously improving cost and quality of care.

While some entities, such as the Department of Veterans Affairs, have implemented solutions where patients have the ability to view their personal health records online and offline, the majority of the healthcare industry continues to face multiple challenges while implementing care management processes. Care management for large, diverse populations is highly complex and subjective, largely because needs vary for each patient and encounters may span across multiple care settings and plans.

Although a large proportion of health information today is captured electronically, integrated data around patients and their underlying disorders is often not available to providers at the point of care. However, efforts to code clinical content with standard terminology has, to some extent, helped streamline information across applications. There is also a lack of alignment between payers and providers in regards to cost of care management services and shared risk arrangements, leading to sub-optimal care quality.

How organizations manage their healthcare data, and what they use this data for, therefore becomes extremely critical to the success of these programs. While technology plays a very important role in areas like decision support, care coordination and population health management, providers and payers are still faced with the challenge of managing both complex people and process challenges.

Effective use of patient data

Patient data adds value across multiple areas such as decision support, planned interventions and medical reconciliation. Such examples include:

  • Using CPOE Based Order Sets: Effective clinical decision support tools contained within an order set can help enforce the use of quality measures or meaningful use criteria by providers. An example would be the use of a venous thromboembolism (VTE) risk assessment and subsequent prophylaxis for high risk patients embedded within an order set. Monitoring the prophylaxis regimen based on the VTE risk score can help reduce incidence of venous thrombosis.
  • Clinical Information Exchange: Effective care coordination requires healthcare data to flow seamlessly across all parts of the healthcare ecosystem, including providers, payers and consumers. By aligning incentives, all parties can reduce costs and improve quality of care. By leveraging health information exchanges across radiology, laboratory, perioperative, inpatient and outpatient applications, healthcare organizations have the ability to access patient data in a timely and secure fashion.
  • Medical Reconciliation: This feature is commonly available in electronic health records (EHRs) and can play a very important role in preventing adverse drug reactions. For example, the use of over-the-counter (OTC) medications like acetaminophen may not get recorded in an EHR, but can be retrieved from the pharmacy or the medication management application. This is extremely critical information for a physician, given the hepatotoxic profile of the drug.
  • Patient Registries: A patient registry fed with data from EHR applications can show the treatment prescribed to patients and identify care gaps, based on evidence-based guidelines. Care management programs can use this kind of analysis to highlight areas of improvement, thus positively impacting cost and quality of care.

Promoting patient engagement

Patient education plays a very important role in effective care management. Patients who are actively focused on learning more about their conditions are more likely to participate in initiatives that promote preventive steps and healthy behaviour. The use of patient portals, for instance, allow patients to have anytime, anywhere access to their medical records, and the ability to schedule appointments, request medication reconciliation, etc.

Processes such as discharge management and preventive care can also provide strong opportunities to increase patient participation. Such processes play a crucial role in keeping readmissions and acute care costs to a minimum. Automated alerts informing patients to make appointments or follow up on lab visits can help prevent potential acute and chronic conditions.

Patients today are increasingly using consumer devices and mobile apps to store and monitor their health parameters. Wearable devices have the ability to change the way health data is collected and managed, and care management processes will soon need to incorporate consumer technology to enhance patient engagement and self management.

Managing Stakeholder Expectations

To drive a sustainable care management program, it is important to demonstrate value to key stakeholders including providers, payers and patients. However, the definition of value differs from one entity to another. For instance, providers and payers often do not see eye to eye on issues such as risk sharing and care management goals. It is essential to build consensus on many of these issues and agree on clearly defined goals around care objectives, processes and costs.

Addressing issues around provider and payer expectations could lead to significant advantages for the healthcare industry as a whole. According to the Center for Disease Control and Prevention, the government spends nearly three-fourths of its total healthcare expenditure on chronic disease, an area where care management programs can make a large impact. A concerted effort from all major stakeholders to streamline care management objectives and processes would have a very large impact on healthcare cost and quality.

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Hospitals want Congress to keep ICD-10 on track

Hospitals want Congress to keep ICD-10 on track | Healthcare and Technology news |

Any attempts to delay, again, ICD-10 compliance would be a waste of time and money, and should be opposed, eight healthcare organizations--including the American Hospital Association and the Premier healthcare alliance--stressed to members of Congress in a recent letter.

ICD-9 is "outdated" the organizations said, and ICD-10 would enable providers to keep up with medical advances.

"The [most recent] delay added billions of dollars in extra costs," the organizations said. "Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9. Newly trained coders who graduated from ICD-10 focused programs were unprepared for use of the older code set and needed to be retrained back to using ICD-9. ... This results in a doubling of costs that are not productive."

An ICD-10 delay was not included in the proposed "Consolidated and Further Continuing Appropriations Act, 2015" to fund the government, which is also being referred to as the "cromnibus" bill. The proposal is expected to be voted on by Congress later today.

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