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InterSystems partners with Coordinate My Care, an NHS clinical service, to create personalized urgent care plans for patients. Now all providers know their patients’ wishes and can access this information when and where they need it—leading to better, more comprehensive care experiences. Learn more at InterSystems.com/CMC
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¶´Áµ¸´É¼Ç´¿´¿¿Ì¼ÁÌÂÈÅ躻Ǵº´¼ÁÆǶ̵¸ÅƸ¶ÈżÇÌǻŸ´ÇÆ°¸Ô¿¿¶ÂÁÆÈ¿Ç The Affirm® prone breast biopsy system will not only increase clinician and ʼǻÌÂÈÇ´··Å¸ÆÆÌÂÈÅ»¼º»¸ÆÇƸ¶ÈżÇÌÁ¸¸·Æ´ÆƸÆÆÌÂÈÅżƾƴÁ·¶Å¸´Ç¸´ patient satisfaction, but it will also meet your IT initiatives. ¶ÈÆÇÂÀ¼Í¸·Ã¿´Á¹´¶Ç¼ÂÁÇ´¼¿ÂŸ·ÇÂÌÂÈÅƸ¶ÈżÇ̺´¿Æ
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** Medscape, Stolen EHR Charts Sell for $50 Each on Black Market, April 28, 2014 ADS-01846 © 2017 Hologic, Inc. All rights reserved. Hologic, Affirm, The Science of Sure, and associated logos are trademarks and/or registered trademarks of Hologic, Inc., and/or its subsidiaries in the United States and/or other countries. All other trademarks, registered trademarks, and product names are the property of their respective owners. Ñ #¢ÁǸ¿¿¸¶ÇÈ´¿©ÅÂøÅÇÌ¿¿Å¼º»ÇÆŸƸÅɸ·Ç»¸¿ÂºÂ´Á·´¿¿ÂÇ»¸ÅÀ´Å¾Æ¶ÂÁÇ´¼Á¸·»¸Å¸¼Á´Å¸ÇÅ´·¸À´Å¾Æ¹¢ÁǸ¿¿¸¶ÇÈ´¿©ÅÂøÅÇÌ´Á·ÂŴ´Ç¸·¶ÂÀôÁ¼¸Æ ¿¿ÂÇ»¸ÅÀ´Å¾Æ¶ÂÁÇ´¼Á¸·»¸Å¸¼Á´Å¸Ç»¸ÃÅÂøÅÇ̹ǻ¸¼ÅŸÆø¶Ç¼É¸ÂÊÁ¸ÅÆ»¼Æ·Â¶ÈÀ¸ÁǼÆÁÂÇ´ÁÂæ¸Å¶ÂÀÀ¼ÇÀ¸ÁǟßƸÁǴǼÂÁÂÅÊ´ÅÅ´ÁÇ̵̴Á·¼ÆÆȵ½¸¶ÇǶ»´Áº¸ BENCHMARKS: Predictive Analytics: Artificial intelligence and machine learning are fast accelerating the insights that can be gleaned from the granular descriptions enabled by ICD-10. PAGE 32
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www.HealthcareITNews.com THE NEWS SOURCE FOR HEALTHCARE INFORMATION TECHNOLOGY Q MAY 2017 HIMSS Media / Vol. 14 No. 5
BLOCKCHAIN IN HEALTHCARE Sifting through the hope and hype of a new way to manage data. PAGE 4
FHIR’s future Russell Leftwich, MD, of InterSystems and HL7, says the standard has big promise for interoperability, but should coexist with other specs for a while. AI takes off PAGE 38 “The rate of improvement happening in machine learning is way beyond what Moore’s Law is to chips.” PAGE 17 See our ad on page 40 RESPECTING A PATIENT’S WISHES MATTERS.
InterSystems partners with Coordinate My Care, an NHS clinical service, to create personalized urgent care plans for patients. Now all providers know their patients’ wishes and can access this information when and where they need it—leading to better, more comprehensive care experiences. Learn more at InterSystems.com/CMC
© 2017 InterSystems Corporation. All rights reserved. InterSystems is a registered trademark of InterSystems Corporation. All other trademarks are property of their respective owners 5-17 May 2017 | Healthcare IT News | www.HealthcareITNews.com CONNECT 3
BLOG FEATURED EVENT A challenge to healthcare )*.44.FEJBT#JH %BUB)FBMUIDBSF execs: Don’t hide your "OBMZUJDT'PSVN LJDLTPGGPO.BZ opinion about what’s JO4BO'SBODJTDP happening in Washington -ZHFJB3JDDJBSEJTBEWJDFGPSMFBEFSTIJQ BOETPDJBMNFEJB JOBUJNFPGQPMJUJDBM CALENDAR OF EVENTS ------VODFSUBJOUZBSPVOEUIF"GGPSEBCMF$BSF"DUBOEUIFGBUFPGIFBMUISFGPSNJO"NFSJDB MAY )*.44#SBOE)*5 )*.441SJWBDZ4FDVSJUZ .BSLFUJOH4VNNJU -BT7FHBT bit.ly/exec-challenge 'PSVN 4BO'SBODJTDP ".%*41IZTJDJBO )*.44.FEJB#JH%BUB $PNQVUFS$POOFDUJPO BLOG SLIDESHOW "OBMZUJDT'PSVN 4BO'SBODJTDP 4ZNQPTJVN 0KBJ $" 8&%* -PT"OHFMFT ")*."T-POH5FSN "$&)1*OEVTUSZ 1PTU"DVUF$BSFBOE)*5 4VNNJU 1IJMBEFMQIJB 4VNNJU #BMUJNPSF JUNE AUGUST )$$"3FTFBSDI$PNQMJBODF 8&%*4VNNFS $POGFSFODF #BMUJNPSF 'PSVN $IJDBHP ".*"*O4QJSF SEPTEMBER -B+PMMB $" )*.44.FEJBT1SJWBDZ ")*1*OTUJUVUFBOE&YQP 4FDVSJUZ'PSVN #PTUPO "VTUJO
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WHAT’S INSIDE GFC@:P 10 9LJ@E
WHAT BLOCKCHAIN NEEDS MOST TO SUCCEED:
For the distributed digital ledger technology to alleviate healthcare’s thorniest interoperability and security problems, technologists, clinicians, executives and regulators will need to overcome inertia and reconsider deep-rooted approaches. By Mike Miliard, Editor May 2017 | Healthcare IT News | www.HealthcareITNews.com COVER STORY 5
FI8K<:?EFCF>PK?8KN8J invented less than 10 years there would be no agreement to add it as a new block on the and then re-encrypt it back to meet that particular KPI? Pos- ago, and has only become more widely understood in chain,” writes Behlendorf, executive director of Hyperledger, sibly. And I’m sure there are smarter people than me working the past 24 months or so, blockchain has been getting an open-source collaborative launched by the Linux Foundation on that, and I wish them good luck.” F some pretty breathless attention recently. to advance the use of blockchain beyond bitcoin transactions. The larger issue affecting blockchain’s long-term prospects Indeed, the distributed digital ledger – touted by some as He also spotlighted the importance of so-called smart con- in healthcare has to do with a more essential question,” he a silver bullet to the cybersecurity and interoperability chal- tracts on the blockchain ledger: “simple software programs said. “In the end, follow the money: What money can it save, lenges across healthcare in addition to many other potential that run across all nodes in the network, and can extend the what money can it generate, what can it do for the patient? If use cases – currently sits atop Gartner’s famed Hype Cycle, validation logic at each node, in a way that is automatable and it doesn’t answer those questions, frankly, I think the broad just about to crest the perilous Peak of Inflated Expectations undeniable.” In healthcare, for example, such smart contracts use case doesn’t matter.” and plummet into the Trough of Disillusionment. could be deployed as an “authorization process and confir- Still, he said, the potential is undoubtedly there. That’s not to say, however, that the hype around blockchain mation step that notifies the patient – or even puts them in “I would say blockchain in healthcare right now is about is unwarranted. control – when their data is shared from one where AI was about four to five years ago. Some- Gartner notes that real-world deployments of the technology address to another.” one I was talking to described it as, ‘the Internet currently represent just 1 percent of its total potential audience, Behlendorf explained that because blockchain as it was supposed to be.’ We never quite got and says any widespread transformational use is still five or technology is distributed by design, storage there, because of the technology we had, but if even 10 years away. space is limited, so “small data or metadata is we were to go back and design the Internet today, But analysts also say that if blockchain finds a foothold in preferred.” The option is to store records or files it would be blockchain. The effect of blockchain, healthcare and other industries, its potential to “radically either “on-chain” or “off-chain,” he said. Large when it is finally real, could be as revolutionary transform” whole sectors of the economy could have profound healthcare files such as imaging scans or PDFs to healthcare as the Internet was.” implications “for society, governments and enterprises, for wouldn’t need to be stored entirely on the chain, In the meantime, “we’re definitely at the height which there are no clear answers today.” but could be linked to it with a “hash” (a crypto- of the hype curve,” said Natarajan. “I think there’s Whether blockchain lives up to the hype in healthcare – graphic numeric fingerprint) to ensure they hasn’t going to be about two or three years of disap- whether its new paradigm for storage and exchange of data been altered. pointment setting in once people figure out it’s Joe Guagliardo is as transformative as many say it will be – is very much an While one of the strengths of blockchain is its not the greatest thing since sliced bread. And then open question. And there are big hurdles to clear, related to visibility (and therefore accountability), not all blockchains are they’re going to have to figure out how to build a skilled staff, technology, regulation, workflow and more, if it’s to realize publicly available, he notes. “Just as you might have a private how to change the mindset and change the existing systems its potential. network at your house, or use a VPN to connect to the office, to be able to accept this.” But one thing is certain: Healthcare’s interest in blockchain there will be private or ‘consortium’ chains running between has been piqued in a big way over the past year or so, and specific organizations, perhaps with a legal or regulatory agree- USE CASES: SECURITY, INTEROPERABILITY AND MORE the industry is expected to continue innovating and invest- ment binding the participants.” Interest in blockchain is piqued enough that there was a day- ing in the technology in the near future. A recent report from A healthcare organization, for example, could “limit its long event focused on the topic at HIMSS17, hosted by IEEE Deloitte showed that, while blockchain is a hot topic in indus- network nodes to only HIPAA-covered entities, in addition Computer Society and the Personal Connected Health Alliance. tries from financial services to telecommunications, healthcare to encrypting some data and leaving other data off-chain to At the symposium, Tamara StClaire a health IT advisor who is planning the most aggressive deployments, with 35 percent provide multiple layers of security.” previously worked as chief innovation officer at Conduent of health and life sciences respondents saying their company Health, showed how blockchain could help with a wide array plans to deploy it within the next year. THE REAL ISSUE: COST of potential use cases in healthcare. And some organizations are putting big money behind the While the prospects of blockchain applications are exciting, “The current infrastructure is really inadequate to handle projects: 28 percent of respondents across all industries said and there are legions of talented technologists working on information exchange,” said StClaire. “Blockchain has the they’d already invested $5 million or more; 10 per- projects large and small to bring its potential for opportunity to impact those infrastructure challenges.” cent have invested $10 million or more. data security and interoperability to fruition, it’s Indeed, she cited a recent IBM report that found 16 percent Still, understanding of blockchain technology fair to say we’re probably still a good way off from of payer and provider executives saying they expect to have a is “uneven” according to Deloitte, which found seeing it widely and comprehensibly deployed. commercial blockchain application at scale in 2017. that while many executives say it’s among their Prashant Natarajan, author of the HIMSS book, “A lot of people believe there’s going to be momentum and company’s highest priorities, others knew little Demystifying Big Data and Machine Learning for acceleration,” said StClaire. Blockchain could “impact almost about it. Healthcare, describes blockchain as an entirely every healthcare transaction” and “has a global ability to change “It is fair to say that industry is still confused to new way to move health data – one that’s “just- the way we think.” She offered several potential use cases: a degree about the potential for blockchain,” said in-time, transient, approval-based, with lineage Master patient index. Blockchain “could solve the challenge David Schatsky, managing director with Deloitte, when needed.” (By lineage he means that “we health systems have when their data sets get mismatched, or in a statement. “More than a quarter of surveyed always have the option of creating an archival the problem of duplicate records,” said StClaire. For one thing, knowledgeable execs say their companies view record – for regulatory purposes, for instance.”) under the current system, there are “20 different ways you can Jon White blockchain as a critical, top-five priority. But about Natarajan says Blockchain has tremendous enter date-of-birth. Not a really great approach.” a third consider the technology overhyped.” value for the healthcare space because it essentially moves Another challenge is that “this information is centralized away from a mistake-prone documentation-centered approach with a single trusted source – to me that’s the downside of HOW IT WORKS to “a much more flexible process where the transaction is key.” the ways we’re approaching MPIs today. Even within organi- So what the heck is blockchain? It was first developed online in Still, he said, “I would say it’s not yet a revolution, until zations, error rates for being able to successfully identify or 2008 by Satoshi Nakamoto, a possibly pseudonymous person everybody starts using it.” integrate a file are 25 percent; outside the walls, they’re 50 or (or perhaps multiple people) who designed it as the underpin- That won’t be any time soon. 60 percent.” ning for the exchange of bitcoin, the digital cryptocurrency. “The potential value for healthcare is huge,” said Natarajan. But the very nature of blockchain “actually incorporates It was conceived as a distributed ledger where transactions “But the question is not whether it works, so much. The ques- MPI,” she said. “One way to think about it is the fact that are logged publicly and in chronological order. The database tion is who’s going to pay for it. And blockchain not your identification but your data is hashed to shows an ever-expanding list of ordered “blocks,” each of them is going to be expensive.” the ledger. It’s an address you’re looking for. And time-stamped and connected to the block that came before Not just financially expensive – in terms of there can be multiple addresses. And a patient it – a blockchain. updating or replacing IT systems to efficiently use can hold multiple keys to those addresses in their Crucially, each block cannot be changed, deleted or other- the technology, although there’s that. But also in electronic wallet.” wise modified: it’s an indelible record that a given transaction terms of the effort it will take to change ways of One thing that doesn’t quite jibe with that occurred. That verifiability is what has many in healthcare thinking and adjust long-ingrained workflows. approach, however, is when there’s an institution excited about blockchain’s potential for data security. Its open “Even for people who understand it, you have that actually owns that patient identification, said and decentralized nature could lend itself well to managing to change mindsets in healthcare from primarily StClaire. “If we’re going to move to blockchain, we health records and proving identity. a documentation and approval process,” he said. have to tip that philosophy on its head.” Rather than a central database, the blockchain record can “A lot of healthcare workflow is documentation- Claims adjudication. Automated adjudica- be distributed and shared across networks, with credentialed based: What was done for the patient, make an tion means being able to take a claim and decide Sharon Klein users able to add to – but not delete or alter – the transaction account of it so I can get paid properly. And that whether it’s going to be paid or denied without log. The transactions are encrypted, and must be verified by is going to have to change.” manual intervention. Eighty percent of claims are done this the network. There are other hurdles. There’s some dissonance about way. But claims are getting a lot more complex, said StClaire, “The software used to build a chain ensures that everyone how blockchain comports with existing HIPAA regulations, and more importantly there’s error and fraud already in that on the network sees, validates, and confirms each proposed for instance. Some say the huge processing power and special- 80 percent. next block of data in the chain,” Brian Behlendorf explains in ized technology it requires aren’t worth the benefits it could “There are a lot of processes that can be automated when a blog post for HIMSS. bring. And there are hurdles in trying to perform analytics for you think of blockchain that are just slightly peripheral to this,” “For example, if any node on the network tries to transfer value-based care on encrypted data. she said, such as “maintaining a benefits database, determining a particular asset twice, to two different parties, that trans- But those are mostly “technical challenges that smart people patient insurance.” action would not be validated by others on the network, and will resolve,” said Natarajan. “Can we do in-flight decryption Blockchain offers an opportunity for “disintermediation and 6 COVER STORY www.HealthcareITNews.com | Healthcare IT News | May 2017
trustless exchange,” said StClaire. “To me, this is when we that it would partner with IBM Watson Health on an initiative to industries, banking and healthcare, are looking at distributed think about the whole process of claims as an area that can be explore blockchain applications for scalable exchange of health ledger technology as something that’s a viable solution for a lot completely disintermediated. She pointed to the use of block- data, seeking new avenues for electronic health records, clinical of the problems in both of them,” he said. “But it also obviously chain’s smart contracts, where the network can agree upon the trials, genomics and health information from mobile devices, has technical, legal and regulatory challenges.” way the contract is executed. wearables and the Internet of Things. Healthcare especially has some well-entrenched and very “An easy win here is blockchain-like: Roughly 6 percent This past summer, the Office of the National Coordinator for complex ways of managing data, said Guagliardo’s Pepper of all claims are denied because of incomplete or incorrect Health IT sponsored a contest with NIST seeking innovative proj- Hamilton colleague Sharon Klein, who’s a partner in the firm’s information,” she said. Blockchain could help by enabling the ects for how it could be efficiently deployed in clinical settings health sciences department and chair of its privacy, security updating of information continuously and distributing it to – specifically how it might drive the data-exchange imperatives and data protection practice. the right network. outlined in ONC’s Nationwide Interoperability Roadmap, patient- An industry so infamously slow to adopt technology may not Interoperability. The ability of two or more systems to centered outcomes research and precision medicine. be ready – from either a workflow or regulatory point of view exchange information, and be able to use the information that’s The contest received more than 70 whitepaper submissions – for the changes some say blockchain could bring. exchanged, working together across organizations to improve a volume of response that agency officials said surprised them. “It’s a complicated web, in terms of the continuum of care. patient health, is “the very promise of health IT,” said StClaire. Among the winning entries: a peer-to-peer net- And it’s a regulated web, with business associates But as is widely known across the healthcare industry, it’s work that enables parties to jointly store and ana- and covered entities,” said Klein. “So the ques- much easier said than done. lyze data for precision medicine clinical trials; a tion is how does blockchain fit into the regulatory “Blockchain has the opportunity to help us with interoper- proposal for how, using smart contracts, block- scheme. Blockchain is great in terms of security ability,” she said. “If we think about a health chain, we can chain can be combined with other technologies – or could be. use industry standards related to APIs to exchange patient to enable big improvements to claims processing; “But HIPAA obviously has multiple subchapters,” information. The challenge with this is it really tips ownership a strategy for using of the Internet of Things in she added. “It has privacy rules, security rules, on its head, tips access on its head.” combination with blockchain for patient-reported interoperability stuff and healthcare clearinghouse Longitudinal health records. “A lot of these use cases stem outcome measures; a suggestion for how block- rules. And those are old – 1996 – but you still have from the way we think of healthcare now,” said StClaire. “But chain technology could help providers pursuing to comply, if you’re in the healthcare space, with if we think about what blockchain can do, these use cases alternative payment models develop IT platforms that structure. So I think the challenge with block- blend into each other. that would help link quality and value. chain, which might provide some interesting mecha- Steve Posnack “If we think about a longitudinal health record, one of the In March, ONC also held a blockchain code- nisms for security, is how does that satisfy the other reasons this is important: most of us go to our primary care a-thon, alongside the Chamber of Digital Commerce, that was requirements of data minimization, controls that are required, roughly 54 percent of the time we engage with care. The other billed as the he first-ever such event hosted by a U.S. gov- etc. There’s so many more rules if it’s in a designated record set.” 46 percent (of clinicians) doesn’t have a complete view of our ernment entity. Contestants were tasked with finding ways “That’s the most important point for everyone who’s talking health history. We need a clinical summary, view into what’s the technology could help address challenges such as iden- about blockchain to understand, whether you’re a regulator or a going on with that patient: labs, treatments, diagnoses.” tity management for APIs (for both provider-to-provider and healthcare institution or a technologist,” said Guagliardo. “We’re Blockchain methods could help speed the way toward the patient-mediated exchange), security metadata tagging for hearing that blockchain is going to revolutionize the way we inter- Holy Grail of a longitudinal view, including inpatient, ambula- access management, and more. Read about them all at Heal- act with and store data. But it’s not going to happen tomorrow. tory and wearable data, that could help with more innovative thIT.gov/blockchain. It may never happen that digital ledger technology is going to ways to deliver care, she said. Jon White, MD, then acting national coordinator for health replace current infrastructure, because of the regulations.” Supply chain. By leveraging blockchain-based smart con- IT, appeared at the IEEE blockchain event at HIMSS17, along- So a more practical approach may be to think about what tracts and the Internet of Things, healthcare organizations side his ONC colleague Steve Posnack, director of the Office can be accomplished in healthcare in the shorter term – “what can “monitor something through its entire life- of Standards and Technology. smaller projects can we do, that don’t have the regulatory cycle,” said StClaire. “Determine when some- “We are intensely interested in this,” said hurdles, and take some baby steps that don’t require breaking one gets paid, determine whether contracts or White. “There’s something here.” down all the walls. Let’s find smaller problems we can solve agreements are executed properly and on-time. He highlighted the inherent difference between as a starting point,” he said. I know several folks on the supply side of health- stewardship and ownership of healthcare infor- He points, for instance, to Healthcoin, which bills itself as care that are very interested in this application.” mation. ONC saw blockchain as a potential sea the first blockchain-enabled platform for diabetes prevention. Clinical Trials. “One of the things you can change in data stewardship: “How are you taking It aims to help payers and employers incentivize consumers to think about is having a layer where you have care of it, what are your responsibilities, what are manage lifestyle changes, using blockchain technology to track data and information, deidentified and avail- your rights?” biomarkers – actual lab work, rather than just step counters able,” she said. “As researcher in clinical trials, Nonetheless, both officials acknowledged that from a mobile app – to generate tokenized “prevention certifi- you can imagine having access to this wealth of there’s been more hype than with most new tech- cates” that patients can cash in for rewards. “By accumulating biomarkers on the blockchain, we also data that now is completely siloed to help you Tamara St. Claire nologies. The chrome-dome Posnack joked: “My recruit patients for clinical trials or help you to blockchain moment was when someone told me I create innovative data analytics: patient-owned health records do research. This is a platform that could actually get us there.” could regrow my hair.” with data visualization, population health management tools For all the excitement, however, “it’s really responsible for Still, ONC is committed to doing what it can to spur block- and a potentially vast longitudinal research trial,” according us to think about some of the challenges that are still ahead,” chain’s sustained success in healthcare, and plans to continue to the startup. said StClaire. As noted, for instance, blockchain’s very nature projects such as the contest and the code-a-thon, alongside As for those hospitals and health systems looking to get their makes it hard to do the data analytics so essential to popula- annual or semi-annual workshops on the topic and continued feet wet with more provider-focused clinical uses of block- tion health management. demonstrations and trial implementations. chain, Guagliardo’s advice is that “they should be talking with “People tried to take the information out of the blockchain to The philosophy is to usher along and enable incremental potential partners. What’s going to be critical with this tech- do analytics, but then you really destroy the whole reason you success wherever possible, said Posnack. But also not to push nology is interoperability. Without solving the interoperability have it on the blockchain, which is security and privacy,” she too hard, in recognition that blockchain technology represents issue, I don’t think we’re going to get any of this implemented. said. “But there are a lot of smart minds rallying around how a pretty substantial change in the way of doing things. The key – more so than with most new technologies – is not to do this. One is called homomorphic encryption.” “We’re in the listening and watching and learning mode, so much standards-setting but making sure that all the major The fact that blockchain gives patients more control over their where we can be helpful and stay out of the players are working together to look for a solution data is also something else to consider. “Think about transferring way,” said Posnack. “Providers already face hard- that would work for everyone involved,” he added. ownership of data to patients,” she said. “All of a sudden we have fought adoption challenges. We don’t want to Certainly, challenging inertia and changing a new paradigm about the way we think of privacy. We may need say, ‘Go out and do this.’ We want you to say, old ways of thinking will be among the biggest to set default levels for the people who are uncomfortable with ‘This is what we think we can do with it.’” obstacles on the road to more widespread adop- the magnitude of that responsibility. There’s a lot we need to dig tion of blockchain. into, and that conversation needs to start.” CHALLENGING OLD WAYS OF THINKING “We’re serving up potential answers to some As for regulation and oversight, “we need regulatory bodies In the near term, that may be just the right of the biggest challenges we’ve been facing in health- at the table,” she said. “One perspective is that we don’t want strategy to take. Rather than swinging for the care over the past couple decades,” said Tamara to get regulators involved yet because we don’t know what to fences with a wholesale rethinking of the way StClaire. “But if you think of the business models ask them to regulate at this juncture. And I think that’s prob- we store and exchange health data, it’s best to of some of the big incumbents: Owning this data, ably pretty right on. But at some point you want them at the focus on the low-hanging fruit: projects that keeping it siloed, not making it transparent to other Prashant Natarajan table so they’re comfortable with what we’re putting forth.” can be accomplished without too much heavy- people in the network, especially patients and users. lifting or change management, but still bring tangible results. That’s a really big hurdle.” FEDS HAVE INTENSE INTEREST “Digital ledger technology has applications across every But Prashant Natarajan thinks it’s a hurdle worth trying If regulators haven’t quite weighed in on blockchain in any industry, and especially in healthcare,” said Joe Guagliardo, to clear. significant way, policymakers and other federal officials are chair of the Blockchain Technology Group at Pepper Hamilton “A lot of the conversations today are happening from a silo- at least thinking about it – and encouraging smart people to LLP. (He says the firm has had a practice focused on blockchain within-an-enterprise perspective: ‘What can providers use make it work for healthcare. for a bit more than a year.) blockchain for?’” he said. “I would like to change that conver- The U.S. Food and Drug Administration announced in January “It’s interesting to see that two very heavily-regulated sation to: How can we use blockchain to benefit the patient?” Q Better Connectivity. Affirmed.
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ADS-01846 © 2017 Hologic, Inc. All rights reserved. Hologic, Affirm, The Science of Sure, and associated logos are trademarks and/or registered trademarks of Hologic, Inc., and/or its subsidiaries in the United States and/or other countries. All other trademarks, registered trademarks, and product names are the property of their respective owners. SPONSORED ADVERTORIAL Leveraging physicians to reduce cybersecurity risk
In 2016, the number of tracked data breaches in the U.S. reached an all-time high, with healthcare having the second- highest number.1 In addition, more than 75 percent of healthcare organizations have been infected with malware in 2016.2
The healthcare industry, guardian of the most personal data imaginable, recognizes the importance of having a robust security profi le. The industry’s secret weapon? Physicians. “Hospitals can partner with doctors to create a culture of security by taking simple steps,” said Jason Porter, vice president, AT&T Security Solutions.
The fi rst step is understanding how data and devices fi t into a A trusted partner helps hospitals physician’s workday. Gaining that understanding can be as simple assess risks and needs, and creates as making physicians part of the hospital’s security team or having customized plans for hospitals, hospital IT and security teams shadow physicians throughout their according to Porter. “Having an work day to see what challenges physicians face and what IT and unbiased partner identify the people, security workarounds they employ. processes and assets necessary to establish and maintain an active Another tactic is creating formal systems and structures for physician and fl exible security model is involvement in security decisions. A committee that brings together imperative to establishing the right IT and security team members with physicians gives these groups controls and culture associated an opportunity to understand needs and collaborate on creating with a best-in-class model,” he said. guidelines and solutions. A partner with experience establishing Jason Porter Bringing the message home through regular training sessions and and maintaining a culture of security AT&T Security Solutions simulated cyberattacks helps physicians understand how easy it is is a vital ally for hospitals. “Culture to fall victim to such attempts, reminds them why cybersecurity manages how the employees protocols are important and keeps their awareness raised. approach each eff ort,” said Porter. “Hospitals can “Without a culture, employees would Establishing a culture of security just default to trusting the tools to partner with Partnering with physicians following the simple steps outlined above detect and remediate any potential is a good place to start, but hospitals should resist the temptation of issue. As threats morph and adjust doctors to create cobbling together some sort of security plan, said Porter. to tools or security controls, the protection of the network again rests a culture of Sometimes a robust security plan must be rolled out in stages. All the on the culture of security to identify fi nancial resources may not be available in any given year, and it takes potential problems.” security by taking time to build a culture of security. Hospitals can make the most of available resources by partnering with experts, such as AT&T’s To learn more about what AT&T can do simple steps.” Security Consulting Services. “Don’t rely on homegrown tools to fi ght for your healthcare organization, go to an autonomous attacker,” Porter said. “Use the best technology and corp.att.com/healthcare. To learn more services you can fi nd to protect the lives of your patients and the about AT&T’s Cybersecurity Services, which can help you connect reputation of your organization.” and protect your healthcare assets, go to business.att.com/enterprise/ Portfolio/cybersecurity.
REFERENCES 1. Data Breaches Increase 40 Percent in 2016, Finds New Report from Identity Theft Resource Center and CyberScout, Jan. 19, 2017, http://www.idtheftcenter.org/Press-Releases/2016databreachespressrelease.html 2. A Cision Company Report, Oct 2016. *PR News Wire – A Cision Company Report, Oct 2016
About AT&T AT&T Enterprise Business provides networking, mobility, cloud, security, hosting, application management, unifi ed communications, VPN, VoIP, and conferencing solutions for medium to large businesses. Our extensive portfolio of integrated solutions that will help you adapt to the shifting demands of your business. OVER 75% OF HEALTHCARE ORGANIZATIONS HAVE BEEN INFECTED WITH MALWARE IN 2016*
That’s no surprise, a healthcare record may be 50 times more valuable to a cybercriminal than stolen credit card information.**
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* PR News Wire – A Cision Company Report, Oct 2016
** Medscape, Stolen EHR Charts Sell for $50 Each on Black Market, April 28, 2014
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AHIMA asks whether it’s keeping pace The law was enacted when the internet was in its infancy and healthcare was still paper-based. D@B<D@C@8I;#Editor of Privacy Practices filled out by patients when notifications – California in particular. I’m not in KÊJ9< CUSTOMIZE YOUR INSTITUTE & EXPO EXPERIENCE Beyond General Sessions, Mix and Match Concurrent and Breakfast Sessions from Eight Educational Tracks In a Year When You Really Need Answers, Institute & Expo Delivers. Register Today. www.ahip.org/InstituteExpo Connect with Us @AHIPCoverage, #AHIPInstitute | ® America’s Health Insurance Plans, AHIP Education Group | www.facebook.com/ahip Content and Design AHIP—All Rights Reserved: © AHIP 2017 14 BUSINESS www.HealthcareITNews.com | Healthcare IT News | May 2017 1SPWJEFSTTUJMMOPUSFBEZGPS ."$3" 4UPMUFOCFSHTVSWFZTBZT “Many felt MACRA would be delayed due “Success with MACRA requires a joint to its size and enormous financial impact effort of IT and departmental resources to on physician reimbursement in the transi- successfully combine clinical, financial and tion to value-based care,” Joncé Smith, vice operational data,” Smith said. “This effort president of revenue cycle management at commands not only a deep technical knowl- Stoltenberg Consulting, said in a statement. edge of how and where to extract and trans- “MACRA’s quality payment program, QPP, now streamlines and increases provider accountability for quality outcomes and cost “Many felt MACRA reduction, but success under the program will take far more than just passive submis- would be delayed due sion of claims data.” A majority – 68 percent of participants – to its size and indicated that preparation and compliance with MACRA should be a combined effort enormous financial Many practices expected, or at least hoped, that the initiative would be across clinical, financial and IT departments. impact on physician delayed. It’s still coming, and they need to prepare now. Additionally, revising data management mechanisms for new reporting requirements reimburse-ment in the 9 THE LATEST IN INTEROPERABILITY, HIE, AND CONNECTED CARE How can you make health data and HIE a public good? The answer to this and other questions challenging providers are at HIEWatch.com The news, perspectives and resources you need. 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WWWBRANDHEALTHITCOM June 15–16, 2017 | Las Vegas, NV 16 INSIGHT www.HealthcareITNews.com | Healthcare IT News | May 2017 Beyond politics and policy, www.HealthcareITNews.com 2 Monument Square, Suite 400 Portland, Maine 04101 pop health efforts push on T (207) 791-8700 F (207) 791-8794 John Whelan, Executive Vice President [email protected] PRODUCTION / TRAFFIC culture of patient engagement Karen Diekmann, Senior Manager [email protected] Three steps will begin to work toward enabling full With the rapid change of care interven- access to retain patients, ensure receipt tion, being multi-disciplined, multi-site AUDIENCE DATA AND DEVELOPMENT to getting Elizabeth Clancy, Senior Manager of maximum reimbursement, and reduce was no longer enough for Summit. Three [email protected] everyone, total cost of care. years ago, we decided that a patient including For Summit Medical Group, “patient portal would play a key component in a READER CUSTOMER SERVICE (847) 763-9618 F (847) 763-9541 engagement” not only refers to the engage- larger patient-centric strategy. This was employees, to own the patient [email protected] engagement experience. ment of the patient but also to everyone an opportunity to go beyond our estab- Reprints: The YGS Group who touches the patient. Though, if you lished EHR workflows to challenge our (800) 290-5460 x100, [email protected] G8LCJ? will finally acknowledge that engage- group that doesn’t work to instill a culture Second, we challenged all levels of the 2013 JESSE NEAL AWARD WINNER ment and convenience are now baseline around that patient engagement is hob- organization to become active participants expectations for patient consumers and bling itself. ENGAGEMENT SEE PAGE 17 May 2017 | Healthcare IT News | www.HealthcareITNews.com INSIGHT 17 AI and machine learning set to shatter Moore’s Law in rapid-fire pace of innovation The technologies are “AI and machine learning are exciting enabling early-adopter opportunities for us to accelerate,” Caroli- nas HealthCare Chief Information and Ana- hospitals to transition from lytics Officer Craig Richardville said. “To be the art of medicine to the successful you have to understand how that will fit within your market and your patient science of medicine. population, and you have to be knowledge- IK@=@:@8C @EK ENGAGEMENT CONTINUED FROM PAGE 16 in the overall success of the strategy. Mar- keting developed a plan to push content and information through relevant channels. Staff members were engaged to make sure they signed up every patient possible. Physi- cians were encouraged to communicate to patients that the best way to access results would be through the portal. And third, we incentivized every mem- ber of the organization to build in patients and build up satisfaction. Up and down the vertical chain, every executive, staff member and physician is accountable for the “satisfaction” score. In fact, bonuses are tied to this benchmark, ensuring everyone has skin in the game. As the shift in healthcare moves from volume to value, and medical practices place a greater importance on patient satisfaction and engagement to boost quality and efficiency, it will be critical that every last person in the healthcare organization owns the patient engage- ment experience. Being intentional about designing a cul- ture in support of the patient is a good place to start. Q 18 CLINICAL www.HealthcareITNews.com | Healthcare IT News | May 2017 &QJD /VBODFFNCFE Novartis, Cota Healthcare ink precision medicine "*JOUP&)3GPSDMJOJDBM collaboration deal EPDVNFOUBUJPO The multi-year research agreement will see the JNQSPWFNFOU pharmaceutical company By bringing deep learning and natural-language processing putting Cota's analytics capabilities to the electronic health record, Nuance's computer- platform to work for assisted physician documentation technology can help with quality improvement for value-based reimbursement, officials say. improved breast cancer treatment outcomes. 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By leveraging nursing informatics, Caroli- cracks, she continued. The health system "If you make things better for your nurse, nas Healthcare reduced documentation time We used a lot of analytics to drive design, drastically reduced you make things better for your patient," said for head-to-toe assessment by 20 percent, Fox said. We also had a great partnership documentation time Becky Fox, RN, Carolinas HealthCare assis- which is equivalent to about 35,000 work- with bedside nurses, nursing managers, IT ing hours returned to nurses directed back and our vendors. It was a significant change within its Cerner EHR to patient care. for clinicians. after a three-year "That's Additionally, CHS saw a 14 percent "That's what's valuable to us: The nurses optimization project. improvement in on-time medication admin- feel the computer has their back," explained istration, equal to about 400,000 eliminated Fox. "Nurses now feel part of the care team A The AnywhereCare app is actually is still expected to relieve a considerable amount of emergency rooms and allows doctors to spend venture arm called UPMC Enterprises that invests intended for non-emergency strain on patients, clinicians and emergency rooms. more time with patients who suffer from chronic in health technology companies developed under ailments such as sore throats and "The platform allows patients to use technology conditions. Nearly 90 percent of patient issues are the Pittsburgh Health Data Alliance. Last year, it respiratory illnesses. to be seen by doctors more quickly," said Jacobs. resolved during the AnywhereCare virtual visit invested in six health tech projects within the state "AnywhereCare also helps to free the backlog in and do not require follow-up care." as well as San Francisco-based Lantern, which offers ?<8K??D<;@:8CCenter Health Plan has launched an app-based, 24/7 telemedicine service for its mem- Ubers across Pennsylvania, offering video visits from UPMC emergency room clinicians. First launched as a desktop service for UPMC Health Plan employees in November 2016, the new app version of AnywhereCare is now avail- able to all patients within the state. Even though emergency room professionals are providing the service, the AnywhereCare app is actually intended for non-emergency ailments that nonetheless require urgent care, such as sore throats and respiratory illnesses. Powered by American Well and white-labeled under UPMC, the video-visit app is available for free on smartphones, tablets or desk- top computers, and users can expect to wait for a JUNE 12-13, 2017 little over six minutes, on average, to see a clinician. "Consumers are seeking convenient and high- THE WESTIN BOSTON WATERFRONT BOSTON, MA "Consumers are seeking convenient and high-quality care, when and where they need it. Using AnywhereCare, patients can initiate a visit with a UPMC physician without ACCELERATING THE VISION traveling to an office or taking time off of work.” ENHANCING CARE o,JN+BDPCT quality care, when and where they need it. Using 3UHFLVLRQPHGLFLQHLVRQƓUH,QIDFWLWōVJRWWHQ FEATURED SPEAKERS AnywhereCare, patients can initiate a visit with VRELJWKDWDQDO\VWVH[SHFWWKHPDUNHWWR a UPMC physician without traveling to an office VN\URFNHWSDVWELOOLRQZRUOGZLGHE\ -2+1+$/$0.$&,2%(7+,65$(/ or taking time off of work,” Kim Jacobs, UPMC’s '($&21(66 vice president of consumer innovation, said in $VPRUHKHDOWKFDUHRUJDQL]DWLRQVQDWLRQZLGH Realizing the Promise of Precision a statement. “AnywhereCare visits are low-cost, SXWSUHFLVLRQPHGLFLQHLQWRSUDFWLFHWKH Medicine: Obstacles and Opportunities typically about half the cost of a healthcare plan co-pay, and they allow patients within Pennsyl- RSSRUWXQLWLHVLWEULQJVIRUGLVHDVHWUHDWPHQW vania to be cared for by UPMC clinicians in their DQGSUHYHQWLRQDUHHQRUPRXV homes, at work or on the road.” /<1'$&+,1',5(&725,167,787()25 UPMC is one of the largest health systems and The HIMSS Precision Medicine Summit was designed +($/7+75$16)250$7,217+( insurers in the state, counting 3,600 physicians 81,9(56,7<2)7(;$66<67(0 across 25 hospitals and 600 offices and outpatient to provide attendees with the insights and tools they Personalizing Precision Medicine and clinics. There are more than 3 million members need to address those challenges head on – and take Improving Lives under UPMC Health Plan, but AnywhereCare is available to anyone in the state regardless of their the next steps. plan. Depending on coverage, the video consulta- tions range from $10 to $49 per visit. Healthcare 52%(57*5((10'03+352)(6625 professionals conducting a visit can also send 2)0(',&,1(+$59$5'',5(&725 prescriptions directly to the patient’s pharmacy, REGISTER NOW *(120(63(23/(5(6($5&+352*5$0 if need be, saving the patient even more time. Genetic Testing in Healthy Populations A spokesperson for UPMC said the organization theprecisionmedicinesummit.com/boston/2017 eventually plans to expand the applications on Any- whereCare, bringing in other departments besides the non-emergency basics, but there are currently no official plans in the works. For now, the service 22 BUSINESS www.HealthcareITNews.com | Healthcare IT News | May 2017 )FBMUI$BUBMZTUMBVODIFT #MPPNCFSHMJLFTVQQPSU TZTUFNBJNFEBU$TVJUF The new Leading Wisely tool combines data analytics from IT systems enterprise-wide to help hospital leaders develop more informed strategies. 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REQUEST A DEMO AT IGAdvisors.com/Contact-Us IGAdvisors.com Q (844) 554-4447 Q [email protected] 414.17 24 BUSINESS www.HealthcareITNews.com | Healthcare IT News | May 2017 Managing business associates and 3rd-party privacy risk isn’t so easy, says CIO With about 200 business associates, keeping apprised of their status is imperative. through the analysis: Are they a business asso- Some companies want to doctor it up a bit, so “Our biggest challenge was just making sure ciate or not?” there’s some back and forth on that. We make ‘that’s a lot of people we’re trusting to do we knew who was really a business associate,” A dashboard to keep IT teams posted about sure we get the right elements in the BAA.” the right thing with our patients’ data.’ said Ricks. “People struggle with that.” the status of dozens or hundreds of BAAs is a The technology has helped free up enough Ricks uses software to track business associates valuable tool in an era where OCR enforcement time, said Ricks, that he and his team are able D@B<D@C@8I;# Editor status across the organization. The Partner Risk is both more widespread and more pointed. to focus on more robust risk prevention. G<8B@E>8K?@DJJ(.@Emid-February, Manager tool from Iat- “We set the soft- “Now what we’re actually talking about doing – security consultant Kevin Johnson ric System helps with ware up, so we knew I don’t know if we’ll be able to pull off, but we may made the point that far too many due diligence, he said, who the business get someone to help us – is doing audits: doing real, S health organizations still “don’t truly offering capabilities associates were, who technical audits, which is something (our business understand” the array of security threats they such as vendor track- we were working associates) agreed to. We can go in and treat them face. It’s not just nefarious hackers, he said, but ing and screening to with, who all our like we treat ourselves, hold them to the highest also the privacy risk posed by negligence from spot potential risks, contacts were,” said standards of technology and process. We want to trusted third-parties such as vendors and other and the ability to send Ricks. “We need to go in and at least do a tabletop exercise. business associates is “astronomical.” alerts if contractors have that informa- “Iatric always understands that there are all Ed Ricks, chief information officer of Beaufort associated with termi- tion now. So if we do these small niches that people don’t really fill Memorial Hospital in Beaufort, South Carolina, nated BAA access ePHI. get audited – before, for you that make sense,” he said. “Whether is one IT leader who does appreciate the threat That, combined with without it, we would it’s around security or just making you a little that third-parties pose to patient data. rigorous internal access have been lost, even more efficient.” That’s not to say, however, that it’s an easy audits, gives him and though we felt like Ricks also uses the company’s Security Audit threat to manage. his team visibility into we had the right docu- Manager, for instance – a machine learning technol- Beaufort Memorial deals with about 200 where and when elec- ments somewhere on ogy that helps manage privacy by homing in when business associates, Ricks said. “And we’re not tronic protected health file — this makes it inappropriate activity is detected with patient data. gigantic. We’re a 200-bed community hospital. information is accessed, much easier to get the Its tracking tool enables easier data collection, anal- But that’s a lot of people we’re trusting to do whether inside the hos- Ed Ricks information together. ysis, breach risk assessment and incident response. the right thing with our patients’ data. That is pital or out of it. “There’s sometimes “It takes a lot of the complexity out of just a lot, and we want to stay on top of it.” “For lack of a bet- a lot of mystery around doing the easy audits,” said Ricks. “We have The HIPAA Omnibus Final Rule of 2013 broad- ter way to say it, it’s an electronic filing cabi- that: Are they a business associate, or are they a small staff – I have just one engineer who’s ened the definition of “business associates” and net with a good tickler system,” said Ricks. a covered entity? Are they really going to have cybersecurity-focused, and he’s got to do a lot of upped the stakes for potential financial penalties “Things don’t fall through the cracks ;things ePHI of ours? So we go through that algorithm,” things. So if we can just have this stuff running in when they mishandle patient data. That means don’t expire. Any time we contract with any he added. “Some people are good with what our the background, bringing the appropriate alerts managing business associate agreements and vendor on any of the relationships, then we go attorneys have drawn up to be a sort of standard. forward to us, we can manage those.” Q Measuring Your Technology’s Success Across Healthcare & Health HIMSS Health IT Value Suite Meaningful Use ACO Navigator Pathways to Value Value STEPS Fact Finder Delivers easily accessible A starting point toward health IT A collection of plans focused A health IT value optimization information on Meaningful Use capabilities in an organization’s on key areas with high potential for framework for stakeholders measures and reporting timelines. pursuit of accountable care. value realization. formulating their value strategies ( 15,000+ Standard value statements Find out your value today: ( 1,775 himss.org/valuesuitenow Cases ( 1,500 International examples May 2017 | Healthcare IT News | www.HealthcareITNews.com BUSINESS 25 Covenant Health bends its own cost curve with analytics in population health program It transformed itself to tap into timely to look at prioritizing people, and we worked middle 70 percent is where we could make an “Getting information when you can do some- information to make care services more with sophisticated analytics to see where our impact. Keep people in the middle 70 percent thing about it is key,” Boehler said. “When we attractive to its own employees – and time would best be spent,” Williams explained. from moving up to the highest spend category.” know someone was in the ER this afternoon, and positively impact patient outcomes. “The high utilizers were on dialysis or had an And a major key to all of this is the timeli- have the ability to intercede and help them not organ transplant or an acute burn; those were ness of receiving information meant to help a be readmitted, that knowledge and the ability to 9@CCJ@N@:B@# Managing Ed itor not things we could make an impact on. But that population health management effort. act on it, makes all the difference in the world.”Q FM )FBMUIDBSFEBUBBUUBDLT ESPQQFEJO CVUNPSF HL7 publishes a new version of its FHIR specification DZCFSDSJNJOBMTBSFUBSHFUJOH Release 3 of the interoperability standard touts more utility for decision support and quality measures and better VOTUSVDUVSFEEBUB functionality for clinical workflows. Email archives, business documents, 80 million records being accessed. But while healthcare saw declines, the D@B<D@C@8I;# Ed itor it defines an RDF (resource description intellectual property and source total number of records compromised in E Updated Cerber ransomware can Cybercriminals targeting FTP Ransomware attack may have hide from machine learning tools servers to compromise health data exposed 279,000+ patient records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o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tion and personally identifi XJMMSFDFJWFPOFZFBSPGGSFFDSFEJUNPOJUPSJOHBOEDBODBMMUIFPSHBOJ[BUJPOTDBMM BCMFJOGPSNBUJPOTIPVMEOPUCFTUPSFEPOUIBUTZTUFN DFOUFSXJUIBOZRVFTUJPOT CYBERSECURITY HUB Discover IT security solutions in an ! interactive exhibit. See unique and targeted health IT Host a meeting in this solutions that result in better, state-of-the-art space that safer, more cost-effective care. TECHNOLOGY CONFERENCE holds up to 150 attendees. CENTER SHOWCASE COLLABORATORS: LEARNING ZONE HOT TOPICS Examine the continuously shifting healthcare landscape through Discover HIMSS’ interactive videos. next steps to Learn about the latest TRANSFORMATION GALLERY improving health health IT initiatives through IT. like interoperability, IMMERSION connected health, Health IT ConCert by Innovator privacy & security Trends HIMSS™ Profiles THEATER and more. Explore the past, HEALTH IT present and future TIMELINE of health IT. Discover books, HIMSS podcasts and other RESOURCES health IT resources. WELCOME Receive a headset and AREA begin your interactive health journey on your mobile device. HIMSS Innovation Center Advance the delivery of care. Connect. Engage. Collaborate. Become an active participant in the transformation of health and healthcare through IT at the HIMSS Innovation Center. To learn more, visit www.himssinnovationcenter.org #EmpowerHIT 28 DATA www.HealthcareITNews.com | Healthcare IT News | May 2017 Frustrated by Big Data? One Harvard prof says that’s justifiable The excitement that Big Data industry, should be looking at the dot-com brings is matched by the bust and boom for lessons learned about capi- talizing on new technologies quickly. confusion about exactly what “What we learned from that, after the neces- the technologies can do, sary growing pains of wasting billions of dol- according to Leonard lars trying to jam what is in effect new ways of D’Avolio. And that is as true in doing business into existing companies without a very exact focus on the problem you are trying healthcare as anywhere else. to solve and careful consideration of the existing 9@CCJ@N@:B@# Manag ing Edi tor constraints and workflows, is that you are very ?<8D PRESENTS SPONSORED BY Gain Instant Insights Analytics can help unlock the potential of your data and optimize your revenue cycle performance. Learn what metrics CFOs are using, how patient portals can increase revenue, and more. Your solutions for analytics, patient engagement, claims life cycle, and more at RevenueCycleInsights.com May 2017 | Healthcare IT News | www.HealthcareITNews.com DATA 29 Big data is actually ‘Bigger Data’ now for healthcare, Berkeley professor says As the amount of available health better than others, puts health systems in a “But to the extent that we are increasingly Bertozzi will deliver a keynote address data explodes, executives must much stronger position to intervene.” able to correct for other factors that create dif- on Big Data at the HIMSS and Healthcare It’s easy when differences are identified ferences, Big Data can reveal what the differ- IT News Big Data & Healthcare Analytics learn how to dig through it to get to assume they can be attributed to varia- ences in performance really are,” he said. “And Forum, May 15-16, 2017, in San Francisco, to the key performance indicators. tions in resources or populations rather than as a result, what are the interventions that during a session titled “Using Bigger Data performance, Bertozzi said. are effective for improving the performance.” to Improve Population Health.” Q 9@CCJ@N@:B@# Managing Editor K<=8EF9 AF?E8E;I ate sting of a readmission penalty, but the social media for photo posting, messaging and medical records.” “transition coaches” or “care coordinators,” process takes its toll across the continuum. and real-time interaction. Because it is emblematic of the past, Sul- they said. So the low-hanging fruit in care transi- livan and Zynx Health’s Hou dislike the Narke, of West Corporation, advocates tion is ensuring that patients comply with MENTALITY SHIFT NEEDED term “discharge” and suggest it be retired a greater emphasis on communication physician orders – especially for patients The healthcare industry’s progress toward for “transition.” best practices. with chronic conditions like diabetes, a seamless transition of care is “slower “I don’t like the word ‘discharge’ because “In healthcare, we talk about laying the COPD and CHF. With its history in call than we would like, but there is progress,” it has the connotation of getting rid of a groundwork before discharge, and there centers and acquisitions of 30 communi- DrFirst’s Sullivan said. The reason for the patient,” Sullivan said. are materials that talk about communica- cations technology companies, Omaha, lethargy, he said, is that “appropriate tran- Hou agreed, saying that “‘discharge’ sends tion between providers and patients as Nebraska-based West Corporation is tak- sition of care really does require a change a message that after patients leave the hos- the key elements to drive success,” she ing a holistic view across the provider care in workflow and mindsets among clini- pital, they are someone else’s problem. The said. “The discharge process is a cognitive spectrum to provide a continuity that bet- cians and stakeholders. Patients them- transition is a step in the health journey, not assessment. By asking patients the right ter enables transitions of care. selves are also responsible because they just for patients but also for their caregivers.” questions, it can map out the care plan that West Corporation uses a multitude of are not used to looking at their portals Discharge planners could be re-titled is right for them.” Q[ communications platforms to connect patients with providers, including mobile phones, landlines, automated voice calls, text messaging and e-mails. Through these means, providers can make assessments and look for red flags in the patient’s condi- tion. They can also facilitate appointments IMMUNIZATION and medications. “The big risk for INTEGRATION errors is from PROGRAM acute care to where the patient goes next – rehab, In collaboration with: home or nursing home.” 5PN4VMMJWBO .% “Our primary focal point is to augment processes – the intake, insurance capture and appointments,” said Fonda Narke, vice president of client services. “But what comes into transition is staying in contact with the patient outside the four walls, a strategy to ensure patients take medica- tions and follow their care plan. In transi- tion, the entire point is to keep patients from being readmitted.” Company case studies show a success. Reminders have boosted participation up The Immunization Integration Program (IIP) – a collaborative effort between HIMSS, Chickasaw Nation to 50 percent, while a readmission study Industries, Inc and ICSA Labs – takes immunization workflow mainstream, streamlining and improving the shows rehospitalizations down by 16 per- vaccine process. cent, Narke said. The IIP allows healthcare providers to provide better patient care by managing immunizations more HOME MONITORING effectively and efficiently by: Non-clinical caregivers in the home are a constant and necessary presence for elderly • Making it easier to administer appropriate vaccines and disabled patients who need help dress- ing, bathing and with other daily activi- • Increasing knowledge and acceptance of vaccines among patients, resulting in higher immunization rates ties. Through a subscription service, Tulsa, • Improving vaccine safety Oklahoma-based SAFE HOMECARE gives remote monitoring capabilities to family • Providing vaccination histories and information to patients more efficiently members who are separated by geography • Improving workflow and reducing the burden associated with related administrative tasks to ensure that their loved ones are being cared for properly, said COO Adam Krueger. • Transmitting immunization data to local registries “This is a way for families who live in dif- ferent cities and states to keep tabs on their • Improving vaccine tracking to help manage costs and inventory parents,” he said. “It is a way for them to stay connected.” Through a portal called the Family Room, IMPROVED IMMUNIZATION RATES ARE LINKED TO: relatives can access relevant information related to care giving, such as which care- Better health outcomesReductions in healthcare costs Higher levels of productivity giver is there at any given moment and when they clock in and out; they can view and update medications and read a message board from clinicians, family members and Learn more at himssinnovationcenter.org/immunizationhit caregivers. Also, an invoicing option is avail- able that allows payments to be split among different family members. The system incorporates elements of 32 BENCHMARKS www.HealthcareITNews.com | Healthcare IT News | May 2017 As AI evolves, predictive analytics is about finding patterns: riding a ‘geek surfboard’ in a data tsunami Artificial intelligence and to riding “a geek surfboard” in his plates to repair a joint along with sources of extraction, with Beaulah using job of probing healthcare’s data specific drugs, there is a profile ejection fraction as an example. machine learning are fast tsunami. But his job is the equiva- that can be created,” Bradley said. “If ejection fraction is less than 45 percent accelerating the insights that lent of finding meaningful drop- The more granular descrip- in the left ventricle of a poorly performing lets within that tidal wave. The tions within ICD-10 have also heart, that is a really important measurable can be gleaned from the scope of that task is intimidating, helped zero in on missed rev- value that indicates a serious disorder and is granular descriptions but it is within these microscopic enue opportunities, he said. in the clinical notes,” he said. “The reference segments that meaningful discov- “Missing just 1 percent to 2 to the ejection fraction needs to be identi- enabled by ICD-10. eries are made. percent of charges on claims in fied – EF or Multiple EF. Once found, it can AF?E8E;I :KDWV+DSSHQLQJ1RZ :KDWV+DSSHQLQJ1H[W $QG:K\,W0DWWHUV *HW PRELKHDOWKQHZVFRP May 2017 | Healthcare IT News | www.HealthcareITNews.com BENCHMARKS 33 is and overestimates where it will be.” number of fast food places is higher. Health- layer it onto the data creates value in measur- once we learn more.” What it will be, said Singh, CEO of Palo Alto, care needs to realize the value of the zip code.” ing patient risk and propensity to consume,” For Beaulah of Linguamatics, the future California-based Ayasdi, is a technology that Zip codes are rich sources of information Hom said. “For physicians being paid for out- represents “more opportunities to improve accelerates data cultivation without human about their residents – income level, educa- comes, getting that data helps them under- care,” pointing to behavioral health and its interference. (Where it won’t be, he added, is tion level, number of dependents, spending stand the viability of the patient.” co-morbidities as an unexplored frontier of the worst-case scenario of machine self-aware- habits and other factors that can be critical unstructured data. ness in “The Terminator” film series.) to understanding a patient’s ability to com- JUST GETTING STARTED Ultimately, analytics needs to reach a point Already in use by the world’s biggest ply with physician orders, Hom said, adding The analytics movement in healthcare is “at where “systems are built for physicians to banks, Ayasdi’s machine intelligence platform that other social determinants like unemploy- the beginning of the beginning,” and Singh is give care their way without the need to ingests and processes large volumes of inter- ment and crime — even weather patterns — “super excited about its potential,” he said. explain it,” ZirMed’s Bradley added. “It’s a nal or third party data, then applies multiple can impact behavior. Moreover, he said the ”There are some things we can attack right tall order, but the forces out there around the machine learning, statistical and geometric four-digit zip code extensions can create even away, but there is so much more. Hospitals escalating costs of care and a boomer popula- algorithms to gain insight and predict the more finely detailed micro-profiles. have barely started collecting genetic infor- tion that increasingly needs it will enable the future. It got its start at Stanford University “Understanding the zip code and how to mation, and it will become super impactful right technology to be developed.” Q with the Human Genome Project, which through a $10 billion investment mapped out the first seven genomes in detail. “The challenge started with how to handle large data sets,” Singh said. “We didn’t know what we’d find. What we realized was that people weren’t asking the right questions in a complex data set.” Patient-provider interactions are complex data sets, but for defragging the massive cyber- lump, “analytics aren’t that useful,” Singh said. “It’s about building apps that go to the dash- board. The problem with analytics is that the people who do it are not the ones who use it on a day-to-day basis. We need to build apps for the professionals who can use it themselves.” In explaining machine intelligence’s role “The problem with analytics is that the people who do it are not the ones who use it on a day-to- day basis. We need to build apps for the professionals who can use it Require sound financial investments to become interoperable. Require a trusted, ConCert by HIMSS™ themselves.” simplified solution for connectivity. Certified Products o(VSKFFU4JOHI ConCert by HIMSS™ EHR and HIE certification mandates commitment to these needs at the highest level. in healthcare, Singh refers to four “notions”: discovery, prediction, justification and action. “Any intelligence system that embodies these four concepts will use data efficiently,” he said. ConCert by HIMSS offers a one-of-a-kind, vendor-independent The artificial intelligence advantage is the removal of human subjectivity from the seal of approval for electronic health record (EHR) and health equation, though machine logic alone is not information exchange (HIE) systems. Setting a bar higher than enough – “it needs to go hand in hand with Meaningful Use, products that pass this robust, highly automated human guidance as well,” Singh said. testing and certification program will verify that, once certified, ZIP CODE MINING a health IT system is capable of exchanging health information Quantifying healthcare has one thing in com- mon with real estate: location, location, loca- securely and reliably with other certified systems. tion, said Dave Hom, chief evangelist for SCIO Health Analytics in West Hartford, Conn. Take action at Specifically, it comes down to the zip code www.himssinnovationcenter.org/certify. as a fertile source of demographic information Introducing about patients, he said. Medical Device Certification “The zip code is the greatest predictor of health status than genetics or education,” ConCert by HIMSS™ | Certified Connectivity. Finely Tuned Simplicity. Hom said. “Zip codes show income levels for www.himssinnovationcenter.org/certify towns that have a vulnerability to diabetes. Zip codes with lower incomes typically have lower education. The number of physicians is much lower in low-income areas, and the 34 JOBSPOT www.HealthcareITNews.com | Healthcare IT News | May 2017 5 focuses for the healthcare C-suite under the Trump administration Healthcare leaders are zeroing in on population health, patient engagement and analytics, according to a new Premier study. A MOST INFLUENTIAL WOMEN IN HEALTH IT: the 2017 HIMSS award. They see it not just as a badge Meet of honor, the winners but a callof to action to change culture, norms and expectations. 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Just visit: Himsslearn.org/easy 36 PEOPLE www.HealthcareITNews.com | Healthcare IT News | May 2017 ON THE MOVE ,FJUI;JNNFSNBOOBNFE$&0 Jack Kalavritinos, a longtime industry lobbyist, was tapped as the FDA’s associate commissioner for external affairs. Cerner added former PG.FEJDBM$JUZ"SMJOHUPO CDC Director Julie Gerberding, MD to its board of directors. She’s cur- ,FJUI;JNNFSNBO became CEO of rently the executive vice president for strategic communications, global Medical City Arlington on April 1. He public policy and population health at Merck & Co. Former FDA Com- succeeded Winston Borland, who retired missioner 9VILY[*HSPɈwill head the newly-created People-Centered on March 31. Medical City Arlington is a Research Foundation, which was formed by National Patient-Centered 366-bed full-service hospital located in +BDL,BMBWSJUJOPT Clinical Research Network investigators. Kenneth H. Paulus, an execu- Arlington, Texas. Zimmerman has served tive advisor at the private investment firm Water Street Healthcare Partners, joined Tela- doc’s board of directors. Paulus formerly served as president and CEO as CEO at Medical City Children’s Hospi- of Allina Health. Intermountain Healthcare promoted Robert Allen to tal since 2013, where he guided women COO and senior vice president. Bill Kloes was appointed vice presi- and children’s services for the entire ,FJUI;JNNFSNBO dent of operations integration of Leidos. CRM data analytics platform Medical City Healthcare division. He also Evariant named Clay Ritchey as CEO. NYC Health and Hospitals/Jacobi oversaw development of a $125 million women’s hospital scheduled named three interim executives: Christopher Mastromano became to open in 2018, as well as a 156,000-square-foot expansion of a new acting CEO, Michael Zinaman, MD became acting CMO, and Ellen hospital tower, which opened in May 2016. Barlis, associate executive director of NYC Health and Hospitals/Jacobi %BOJFM#SB[FMM took over senior finance responsibilities after the departure of CFO Kathy Garramone. MITRE appointed LaVerne H. Council as senior vice president and general manager of the Center for Connected Government. The American Medical Association hired Todd +VMJF"OO'SFJTDIMBHOBNFE$&0 Unger as chief experience officer. The University of Texas Health System tappedMarshall PG8BLF'PSFTU#BQUJTU.FEJDBM$FOUFS E. Hicks, MD as interim president, following the resignation of Ronald DePinho, MD +VMJF"OO'SFJTDIMBH .% was named who left the organization in early March. University of Pennsylvania Health System/Penn CEO of Wake Forest Baptist Medical Cen- Medicine named three new executives following the departure of COO Gary Scheib: ter in Winston Salem, North Carolina. Freis- Chief Nursing Executive Regina Cunningham will become Hospital of the University chlag, who joined the medical center on of Pennsylvania’s CEO, Phil Okala will serve as COO of the Philadelphia region, and May 1, succeeded CEO John D. McConnell, Lori Gustave will succeed Okala as senior vice president of business development. Mary Norine Walsh, MD was appointed president of the MD, who announced last year he would American College of Cardiology. Boston Medical Center tapped Michael move to a new position at the medical cen- Botticelli to serve as head of the new Grayken Center for Addiction ter, after being at the helm since 2008. As Medicine. Botticelli is the former director of the White House Office of CEO, Freischlag will oversee Wake Forest +VMJF"OO'SFJTDIMBH National Drug Control Policy under the Obama administration. Daniel Baptist’s academic health system, which Brazell Sam was appointed CEO of La Peer Health. AMC Health named includes Wake Forest School of Medicine, Wake Forest Baptist Health, Karam as chief technology officer. Health Partners Plans appointed "OUIPOZ.BSJOP Wake Forest Innovations, Wake Forest Innovation Quarter, and a network Anthony Marino as vice president of IT infrastructure and operations. of hospitals, physician practices and medical/surgical services. Find your next career opportunity on The #1 Source for advancing your Healthcare IT career • Create free and easy-to-use online accounts • Post an anonymous CV or resume for employers to view • Get advanced access to posted jobs • Find out immediately through job alerts when a job that meets your criteria is posted Visit http://jobmine.himss.org to get started The number of new resources 537 we released last year thanks to our members. Our members make a difference. JOIN TODAY. www.himss.org/537 38 NEWSMAKER www.HealthcareITNews.com | Healthcare IT News | May 2017 Q&A: Russell Leftwich of HL7 talks FHIR’s interoperability future of a previous era. Really, interoperability in the But what will happen, I think, is that FHIR Q. What are some areas where FHIR is ‘80s, when those standards were first developed, will serve as a translation layer, as is the case being deployed that you’re particularly meant connecting two systems together. And with the InterSystems health informatics plat- excited about? then we managed to extend those standards to form, which has now become enabled so data A. I’m really excited in general that there are connect one system to multiple systems. But the can come in, in existing standards like V2 or CDA so many people who have developed something reality of today is that there’s data across many documents, and can be transformed into FHIR with FHIR. I heard there were more than 60 FHIR systems, for an individual or a population – and and take advantage of the technology FHIR is presentations at HIMSS17, where at the previous that’s happened steadily over the past decades. based on to do things with that data. And then annual conference there were fewer than 10. That The amount of data has grown, and so has the can be exported from that platform as any one of reflects how fast it’s growing. number of places where it exists. those standards, including FHIR, back to systems I think some of the most exciting aspects The inspiration for FHIR was to be able to see that may only understand some of the existing of FHIR are when it’s used in areas that don’t that data from one point in real time, the way standards. have existing standards, like genomics. There’s we do in other industries: The way e-commerce Q. Practically speaking, what should IT no older genomics standard because genom- works, the way Google and social media work, teams at hospitals and other providers be ics hasn’t been around that long. So that was where you’re connecting across the entire inter- thinking about in the years ahead, as FHIR an ideal place for FHIR to become the standard net network from one place and seeing the data continues to evolve? from the beginning. And truthfully it’s the only Russell Leftwich, MD, that’s out there. Not necessarily downloading it A. Vendors, and the organizations that use health standard that could meet the needs of that senior clinical advisor because that’s becoming harder and harder to IT systems, need to think about a strategy to domain because when someone has their whole do, based on the amount of data, but to see the live in this hybrid environment. You’re certainly genome sequenced, it creates terabytes of data, of interoperability at data you’re interested in. That’s the technology not going to replace or abandon your existing and you’re not going to be able to move that data InterSystems and member that FHIR is based on. system – the average hospital today has in excess around easily. You need to be able to access it, Q. When a vendor touts FHIR capabili- of 80 systems within their walls – so many of get the important pieces of that data – genomic of the HL7 board of ties, what does that mean? Should it be those systems may operate very well with older variant or the tumor mutation – that’s reflected in directors, says the spec taken with a grain of salt, or should we standards, but you want to be able to get that that huge amount of data, and that’s what FHIR holds big promise for temper our enthusiasms? Or is FHIR as data and aggregate it with data that comes in is ideal for doing. exciting as everyone says it is? other forms and from other systems – some of it The other thing that’s great about FHIR is it’s interoperability but will A. Well, it is exciting. And I think what you should in FHIR, some of it in existing standards – and ideal for mobile devices and mobile applications need to coexist with other take from that is they’re excited about it. And they aggregate that data. because it’s the type of technology that most of understand that. I don’t know what “FHIR-com- I think FHIR is the ideal standard to create a those apps were already built on. FHIR is just standards. patible” means to any one vendor; there’s not a representation of that data as FHIR resources, the healthcare version of that, so a lot of the uses D@B<D@C@8I;# Editor good definition of that. But that said, there are a and then you can operate on that data with the of it we’re seeing are those mobile applications, E:<8>8@EK?@JP<8I#HL7’s FHIR number of apps that have been developed around technology that FHIR represents and do a lot web apps that leverage the technology FHIR is specification was a hot topic at FHIR and are actually in use and production. with it that you couldn’t previously. made from along with its healthcare structure to HIMSS17, a burning issue discussed There was recently an event at Duke called the Q. Do you see a time where FHIR will do things you couldn’t do before. O ardently across the show floor. (Our FHIR Applications Roundtable where something win out as a standard and be the only Q. In the meantime, as it runs alongside apologies, but heat- and flame-related puns seem like 35 different FHIR apps were demonstrated game in town? And if so, how far off existing standards in clinical settings, to be required when writing about FHIR. Thank- by the developers. Now, most of those early would that be, and what would have to what are some of the technical chal- fully, we’ve gotten them out of the way early.) apps are not about connecting across systems happen between now and then? lenges of managing that? But while many vendors were touting their but about accessing the data in your own systems A. I think before that happens there would be A. You do need a strategy. Connecting to each embrace of the interoperability spec, and while – or your own closely held systems – to more something new after FHIR. Because of all the of those many systems individually with some the promise it holds for enabling faster and easier easily access it in the flow of particular user, of systems that exist, the economic argument just sort of FHIR translation interface probably isn’t exchange of data is very real, the open API isn’t particular clinical domains, where they would can’t be made for replacing all of them. And many practical. Having a platform that can connect to going to supplant existing HL7 standards such like to see the data and see it in a way that they of them have quite a long lifecycle. So by the time those systems, or maybe is already connected as Version 2 and CDA any time soon. That means can easily use it, as opposed to having a huge pile they are replaced, there will be something better to those systems and can take in data in differ- the industry will be taking a hybrid approach of data they have to sort through. FHIR makes it than FHIR. But I think that day is probably 20 ent formats and standards and transform it into to interoperability standards for the foreseeable easy to access just the data you need, which was years off. Some people think longer. FHIR is, I think, the only workable strategy. Ret- future. not the case with previous standards. That said, I think FHIR will be essential in rofitting systems with FHIR or connecting them We recently spoke with HL7 board member Q. At HIMSS17, Micky Tripathi made a the next few years as it evolves. I would com- with some sort of individual translator probably Russell Leftwich, MD, senior clinical advisor of very compelling case about how benefi- pare the way FHIR is now to an early version isn’t a good long-term strategy. It’s going to be interoperability at InterSystems and co-chair of cial FHIR can be, and how much prog- of a smartphone: We have the iPhone 3G; and it exciting to see what happens with FHIR even both HL7’s Learning Health Systems Workgroup ress has been made in a relatively short can do things phones could never do; and we’re within the next year. We’re about a month away, and its Clinical Interoperability Council, for his time. But in the near term, how do you excited about it. But it doesn’t do nearly what probably, from the publication of the next ver- perspective on FHIR’s place in healthcare now see it coexisting with other standards in the iPhone 7 will do. But it’s still useful even in sion of FHIR STU3 – it stands for a standard for and prospects for the future. actual practice? its current form. And it sort of confounds the trial use three – which will be another quantum Q. How do you see FHIR’s place right A. It definitely will coexist for the foreseeable concept of a draft standard because people are leap for FHIR and will enable a broader range of now in the larger ecosystem of interop- future; there is no compelling economic argu- actually using it. So I think it’s more the concept applications to use it. Because of how fast the erability standards? ment to replace the uncounted billions of dollars I suggest: It’s a new reality of maturity where applications can develop – even recreating an app A. No. 1, it will be the preferred technology for worth of existing systems that use existing stan- standards evolve; and you use the current version for the new version of FHIR shouldn’t be much new development, particularly when it involves dards and do what they do perfectly well with because it’s useful and the F in FHIR stands for of an obstacle, so organizations can go along and accessing data across many servers. That’s one them. The change in technology is such that you fast; and it is fast to develop applications with take their existing applications and start to build of the driving forces for developing FHIR – that probably couldn’t retrofit most of those systems FHIR and implement them; and they operate in new ones that leverage the increased capability the existing standards are based on technology with FHIR. this technology world that the older standards of this next version of FHIR. Q can’t take advantage of. 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