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www.HealthcareITNews.com THE NEWS SOURCE FOR HEALTHCARE INFORMATION TECHNOLOGY n APRIL 2016 HIMSS Media / Vol. 13 No. 04 Out of the woods? During the long run-up to the ICD-10 compliance deadline, a feeling of nervous anticipation was palpable across the healthcare industry. The day itself came and went without incident, and six months later claims are still being processed smoothly. But are the sighs of relief premature? PAGE 4

Fighting alert fatigue EHR notification overload costs docs an hour per workday. PAGE 21 Get ready A new round of HIPAA audits is on the way from OCR. But will they do more harm than good? PAGE 8 See our ad on page 40 Incomplete information means incomplete care.

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mp-InterSystems Incomplete HITN March.indd 1 3/11/16 2:35 PM April 2016 | Healthcare IT News | www.HealthcareITNews.com CONNECT 3

BLOG FEATURED EVENT HIMSS Media’s Using telemedicine to Pop Health Forum kicks off May 19 at treat chronic disease the Westin Waterfront Despite the widely publicized successes of the ACA, many rural Americans were forgotten Hotel in Boston. by health care reform. Perpetuated by the inability to find and afford care, rural populations face higher incidences of chronic disease. Telemedicine has a crucial role to play. CALENDAR OF EVENTS http://bit.ly/1WIcnMS ------APRIL 14-15: HIMSS Media Big Data 16-19: CHIME Healthcare CIO & Healthcare Analytics Forum, SLIDESHOW BLOG Boot Camp, Chicago San Francisco 15-17: AHIP’s Institute & Expo MAY 2016, Las Vegas 8-11: WEDI Health Datapalooza, 28-30: AMIA’s Academic Forum Washington Annual Conference, Columbus 11-12: HIMSS Media Privacy & Security Forum, Los Angeles JULY 19-20: HIMSS Media Pop Health 23-27: AHIMA Faculty Forum, Boston Development Institute, Denver 23-26: WEDI 25th Annual National Conference, Salt Lake City AUGUST 1-2: AHIMA CDI Summit, JUNE Washington 13: MobiHealthNews 2016, San Francisco

VIDEO HIMSS16: Full Scenes from HIMSS16: Preventing EHR lava pits: Event Highlights While HIMSS16 has come to a Romney keynotes HX360, what healthcare can learn close, the value of the connec- education sessions thrive from the gaming industry tions made and the experienc- The show floor buzzed with anticipation surrounding Healthcare can learn a lot from the finance and retail sec- es gained from the annual Mitt Romney’s keynote speech at HX360 and educa- tors, but there’s another industry that hasn’t been men- conference will extend tion sessions continued to fill quickly with eager-to- tioned where healthcare, and particularly electronic health throughout the year. Hear from learn attendees. record systems, can take note: the gaming industry attendees themselves as they reflect on the week. bit.ly/himss16-scenes bit.ly/ehr-lava-pit bit.ly/himss16-vid

POLICY 8 BUSINESS 22 WHAT’S INSIDE Making IT work Big buy for Big Blue CMS’ Andy Slavitt calls out technology that IBM Watson acquires Truven Health Analytics for Critical decisions contributes to ongoing physician frustrations. $2.6 billion. “When you’re making decisions Long time coming Shopping on the mind and putting data in front of Interoperability incentives on the way for long- Pop health, patient engagement top of list patients, they are as important to term and post-acute care. for IT purchases. CDS as the doctor is – both parties have to be involved,” Dale INSIGHT 16 DATA 26 Sanders tells Healthcare IT News Contributing Editor John Andrews. What happened in Vegas HIE help “The decisions you make about Encouraging signs on interoperability, Michigan health information exchange pledges clinical care and strategy at the cybersecurity, pop health from HIMSS16. boost for Flint’s infrastructure. population level is a different skill set, different strategy and Ready to catch FHIR Cerner platform different method than at the CMS and ONC pledge to speed adoption of the Company launches open space to spur patient level,” he says. Sanders, interoperability spec, which shows pop health promise. development of SMART on FHIR apps. senior vice president of Salt Lake City-based Health Catalyst, advocates for a ‘Three Ps’ CLINICAL 18 Benchmarks �� 30 approach to clinical decision Trends...... 32 support: population, protocol and Acute step patient. As he sees it, each level eClinicalWorks enters hospital market with new New Products �� 34 has its own self-contained inpatient EHR. Jobspot...... 35 purpose, but together they make People...... 36 for an effective program. Preventative advantage Online records, alerts offer a boost for better care. Newsmaker �� 38 PAGE 32 4 COVER STORY www.HealthcareITNews.com | Healthcare IT News | April 2016

ICD-10: ASSESSING THE AFTERMATH JOHN ANDREWS, Contributing Editor April 2016 | Healthcare IT News | www.HealthcareITNews.com COVER STORY 5

N THE RUN-UP to the Oct. 1, 2015, claims that were held back for coding “It has to be classified as either of the Oct. 1 deadline, but also felt revenue stream hasn’t been affecte deadline for filing claims in reviews because certain physicians ‘with’ or ‘without’ normal finding it wane once crunch time actually and, despite “a handful of denials,” the ICD-10 format, the feeling took a little longer to choose the right and if you convert 9 to 10, it translates arrived. claims filing and cash flow has been I of dread within the healthcare ICD-10 codes, but within a month it as ‘without’ normal findings — and “Our anxiety level was huge, but “consistent overall,” she said. industry was palpable — much like was back to normal and overall it was that isn’t always the case,” she said. the closer the deadline got, I real- So for the time being, claims are it was prior to Jan. 1, 2000, when it a success,” he said. Rivera concedes that educating ized that the payers didn’t seem to being accepted, finances are stable was feared the Y2K computer glitch To be sure, the extra year made physicians on the higher level of spec- be stressing out nearly as much as and code cross-walks between ICD-9 could sow chaos. a diffe ence for a lot of healthcare ificity was “challenging,” but that I was,” said Dean, business office and ICD-10 are working fin . But for In both instances, fear of the organizations, said Pauline O’Dowd, progress is gradually being made. director for OrthoTexas Physicians how much longer? And what impact unknown and expectation of catas- senior director with Chicago-based and Surgeons in Carrollton, Texas. will it have when payers start requir- trophe caused sleepless nights for Huron Healthcare. BROADENING PERSPECTIVE “It was one of those things where ing more specificit ? many providers, payers and vendors “People woke up on Oct. 2 and In the acute care setting, concurrent we compared it to Y2K; we were on The transition took a minor toll across the U.S. found that all was well,” she said. documentation is “refocused” on the hamster wheel and freaking out,” on OrthoTexas, one of the largest, if Fortunately, both dates passed “From a clinical documentation per- clinical documentation improvement she said. “Yet it turned out to be a not the largest orthopedic groups in without incident and each event spective, we found that people were programs, O’Dowd said. non-event, and we handled it like the state. In the wake of the ICD-10 proved to be largely anticlimactic. Yet well prepared. We really haven’t seen The thrust of most CDI programs rock stars.” deadline, the organization contracted the situation that exists today may any revenue drops — there were the is on improving the quality of clinical The ordeal wasn’t without its frus- from nine office to seven and from hide more post-deadline pitfalls than usual denials, but nothing directly documentation, creating an accurate trations, however, as about one-quar- 28 physicians to 25. And while pay- Y2K did 16 years earlier, and every- related to ICD-10.” representation of services through ter of the clinic’s phy- ers are accepting claims one in the continuum, from CIOs to comprehensive reporting of diagno- sicians were skeptical without much static, physicians to coders, must maintain a ‘RELAXATION PERIOD’ ses and procedures. It affects qual- about ICD-10 ever Dean said she realizes heightened sense of vigilance. Other- All things considered, it appears ity measures, pay for performance, becoming reality, so that “eventually they wise, the fears of strangled cash flo that the healthcare industry pretty value-based purchasing and other they thought training will start denying even caused by waves of claims denials much aced the ICD-10 deadline, initiatives that require documenta- was a waste of time, though we’re not seeing could still come true, experts say. and those worries have been put to tion specificit . Dean said. it now.” But first things first: The mass rest. But have they? The one-year “Whether it’s looking at the broad- “No matter what I Cherry Westgate is a worrying about everything coming span between Oct. 1, 2015 and Oct. er spectrum, hospital-acquired con- said about it not going much smaller practice, to a grinding halt on Oct. 1 did not 1, 2016 is being called a “relaxation ditions or population health, people away, they didn’t comprising five fam- materialize. In fact, the transition period,” in which payers are offerin have the chance to refocus on these believe me until Sep- ily practitioners in a went so well that it even made some more latitude on claims details and issues now that they’ve worked their tember arrived,” she single offi . To handle Diane Rivers folks uneasy. eventually will start enforcing stricter way through ICD-10,” Huron Health- said. “So we were the scope of ICD-10, the Turns out, an extra year for imple- requirements. care’s O’Dowd said. “People were behind the eight ball.” organization turned to Carrollton, mentation helped a lot of the smaller “The bottom hasn’t been reached overwhelmed by what might happen Following a logical strategy of Texas-based Aprima for assistance hospitals and physician practices, yet because CMS came along and said — it’s a huge elephant to get your studying all ICD-10 codes related in mapping ICD-9 codes to ICD- even though larger hospital systems they wouldn’t be as hard on physi- arms around. They just focused on to orthopedics, Dean’s management 10 through a crosswalk program. saw it mostly as an inconvenience. In cians for 12 months after the dead- what they were supposed to know.” team attended a year’s worth of Though the conversions aren’t per- querying sources from various enti- line,” said Sage. “So we may not have On the coding side, productiv- training, and “took every orthopedic fect, they have worked well enough ties along the supply chain about why seen things we will see after Oct. 1, ity has gone down by 20 percent, ‘cheat sheet’ we could get our hands to make it beyond the deadline, “and things went better than expected, 2016. There haven’t been too many O’Dowd reasons, because the process on to create something that we could we’re still doing it that way,” Meikle they cited awareness, preparation denials yet, but that could change.” has become more convoluted. roll out to physicians.” said. and education while crediting dif- The physician sector is more “It takes longer to get through the The mission then progressed “If there is a 9 code, we have ferent technologies for facilitating vulnerable to revenue interruption process now,” she said. “If a coder into phasing out the doctors’ ICD-9 options with 10 — it isn’t exact … the transition. once payers start clamping down on could handle three ICD-9 charts an charge sheets, which had Dean won- sometimes we have to drill down There were hiccups, but for the code specification. So far the sector hour, it is a bit less than that with dering how it would be received. and sometimes we have trouble most part they were minor. Not sur- has managed to successfully convert ICD-10.” “We knew with ICD-10 we would with unspecified claims,” she said. prisingly, the physician sector expe- ICD-9 to comparable ICD-10 codes push our charges out of the EMR sys- “We realize that we are able to fil rienced the most difficult at crunch using crosswalk conversion programs INSIDE PHYSICIAN PRACTICES tem and prevent creating an ICD-9 unspecified, and that it will change time, with some practices struggling and by focusing on the code groups Hospitals — especially large health charge sheet,” she said. “We weren’t in October. But there are 69,000 to make the conversion. they use most often, she said. systems — have teams of support sure how it would come out, and unspecified codes in the book for Overall though, “it was not as hard “That is why they’ve done as well personnel to share the responsibility after nearly five months there have ICD-10 compared with 16,000 for as they thought,” said Mary Jean as they have so far. But they need to of ensuring that a major event like been a couple stragglers, but they are ICD-9. That is a huge diffe ence. The Sage, president of The Sage Associ- take the next step and start looking transitioning from ICD-9 to ICD-10 all pushing the codes out. They are other challenge is that we cannot ates, a billing and coding consulting at codes beyond their immediate succeeds without much difficul . with the program.” manipulate the verbiage, so we will agency. scope and adding more specificit ,” It is quite diffe ent at a physician At Cherry Westgate Family Prac- have to figu e that out.” For Jose Rivera, vice president of said Sage. practice, however, where the labor tice in Granville, Ohio, offic manager physician solutions development at For instance, Sage is conducting yoke is typically strapped to one Meikle admits everyone “was very THE CROSSWALK CHALLENGE Santa Rosa, Calif.-based VisiQuate, a coding audit for a large clinic that person. It is not an enviable position nervous” at the outset because “we For software developer Aprima, post- the key to success was two and a half regularly performs Well-Child exams to be in, say two clinic directors in were facing meaningful use and ICD- ICD-10 represents a very active time years of preparation. and converting the 9 code to 10 isn’t describing their ICD-10 experience. 10 at the same time, and it was one for the company. With more than “Initially we had a little diffic - always accurate because of a detail Both Tracy Dean and Lora Meikle thing after another.” 2,000 practices on the client roster ty, maybe a 15 percent increase in called “normal findings,” she said shared the same trepidation ahead But disaster didn’t happen, the ranging from single-physician practices to groups of more than 250, CEO Michael Nissenbaum says much of “THE BOTTOM HASN’T BEEN REACHED YET what Aprima does centers on evalu- ating each practice on its methods. BECAUSE CMS CAME ALONG AND SAID “I wish it could be one-size-fits-all, but all physicians practice diffe ent- THEY WOULDN’T BE AS HARD ON ly,” he said. “That means we have to listen to how they document, which allows us to modify the workflow PHYSICIANS FOR 12 MONTHS AFTER THE for their needs. We don’t see ICD-10 as a challenge, but an opportunity to DEADLINE. SO WE MAY NOT HAVE SEEN empower our customers.” One common theme among pro- THINGS WE WILL SEE AFTER OCT. 1, 2016. viders is that they will need to address the deeper granularity of THERE HAVEN’T BEEN TOO MANY DENIALS ICD-10 coding requirements going forward, specifically the addition of “right,” “left,” “upper” and “lower,” YET, BUT THAT COULD CHANGE.” body descriptions as well as “firs ” or “second” time on patient visits. Mary Jean Sage Ultimately the ICD-10 granularity 6 COVER STORY www.HealthcareITNews.com | Healthcare IT News | April 2016 is key to better care management, experience trying at first, but through As the “relaxation period” winds FRONT-END IMPACT ICD-10 claims is interpreted with Nissenbaum said, because “it puts arduous commitment she began to down, Ketterman concedes providers At first glance, front-end claims greater accuracy, Fetterolf said. together a mosaic in the physician’s “see it for what it is — a new lan- will have to get more specific with authorization isn’t directly related to “Half of what the physician does mind to be more creative than an guage and a way to keep my mind their codes, but at the same time he ICD-10 coding, but Jay Deady, CEO is interview the patient, and it assembly line worker.” sharp.” The effo t landed her at CSI is confident that the process will con- of Denver-based Recondo, says con- can’t be diagnosed properly with- Nissenbaum acknowledges that Healthcare IT, a third-party coding tinue unabated. flicts between 9 and 10 could cause out effective communication,” he multiple areas need to be contempo- firm, where she supervises a staff of “Providers understand that ICD- interruptions to the revenue cycle for said. “It leads to better specificit raneously updated for the crosswalk, 60. Among their biggest clients are 10 is life now,” he said. “There may providers. for coding while also preventing and that as modifications are made, hospitals where “Niners” have left. be some bumps and some issues “We’re hearing that payer by readmissions and leading to higher payer, they won’t accept unspeci- quality care.” “Denials are important – the data is fied codes for 9 or 10 and they want more discrete codes,” he said. “The LESSONS LEARNED complex and the providers struggle to impact from the front end means It is five months beyond the ICD-10 report. Denials are not always the same, most facilities won’t have clerks “go live” deadline, and the transition making determinations of which ordeal went better than anticipated so when trying to understand denial ICD-10 codes to use. for most providers. The fears of mas- “We’re starting to see our pro- sive claims rejections, crashing cash patterns, it’s a small percentage of claims, gressive clients adding in nursing flows and full-blown chaos were and the trends are smaller than that. It case managers and hospitalists to largely unfounded. the work groups and are looking But after a mounting pre-deadline takes complex analytics to get it right.” at how to provide a higher level of build-up and “sky is falling” admon- clinical specificity on the front end,” ishments — coupled with head-in- Allison Gilmore he said. “If that’s not done, the pro- the-sand physician denial — it’s jection is that in a year no wonder that those the company sends out bulletins. As auditor, coder and supervisor, with the system upgrades where or year-and-a-half, fears existed in the firs “We are the eyes and ears of the Rivers is overseeing a team made up no more ICD-9 codes are supported there will be a spike in place. regulatory process,” he said. of younger generation “Tenners,” by vendors, but those things can be claims denials due to Providers have more who she confirms “includes an influ worked out.” no prior authorization work ahead of them ‘NINERS’ & ‘TENNERS’ of young males who are grabbing the on the ICD-10 code.” during the next six or In the two years leading up to the job by the horns and showing more DISSECTING DENIALS With more than 900 12 months in order to ICD-10 deadline, industry figures confidence about the opportunities Claims are the lifeblood of pro- clients, Recondo’s ser- continue the relatively speculated rampantly about the that exist.” viders’ operations, and denials vices include patient smooth claims fil- make-up of coding staff for the new are the virus that threatens their estimation and eligibil- ing and revenue cycle format. Some predicted a mass exo- WATCHING PAYERS financial health. So understanding ity and authorization. experience they have dus of the ICD-9 coders (“Niners”) As a clearinghouse, Jacksonville, the reason why claims get rejected Its main focus is on enjoyed so far, but and an influx of people trained spe- Florida-based Availity is a claims — especially with the ultra-granu- automating authoriza- Jay Deady there is no discounting the fact cifically in ICD-10 (“Tenners”). While conduit for providers and payers, larity of ICD-10, is paramount, says tion in the area where there is “the that they endured and took away the Niners tended to be predomi- but the concentration is squarely on Allison Gilmore, principal data sci- biggest latent downstream effec ” — some valuable lessons. nantly composed of middle-aged the payer community, says Matthew entist for healthcare with Menlo business rule adoption tied to ICD-10 “The build-up and subsequent women unready or unwilling to learn Ketterman, director of product and Park, California-based Ayasdi. by payers. delay didn’t help matters,” Visi- the new code, the new generation portfolio analysis. An advanced analytics firm, Ayasdi “We heard from the Blues, who are Quate’s Rivera said. “A good portion was supposed to be younger, more So how complicated has ICD-10 develops machine learning applica- being more aggressive and stepping of us were ready the year before. We gender diverse and tech savvy. made their operations? tions for claims-denial management. out on their own ahead of CMS,” had a minor challenge within the Have those predictions come true “From a clearinghouse perspec- Its apps can extract denial and claim Deady said. physician population who didn’t so far? To a certain extent, yes — but tive, 5010 was a bigger issue,” he trends from extraordinarily large conduct their due diligence, but the evolution hasn’t been as clear-cut said. “The difference with ICD-10 datasets to recoup millions of dol- LANGUAGE BARRIER the majority wanted to do the right as expected. For one thing, the one- is that there is very little we can do lars in lost revenue. Getting the specifics of an ICD-10 thing and we got the right response. year delay caused some staffin con- with the claims — it requires some “Denials are important — the data code correct starts with a seemingly It is assuring to me that the doctors fusion within coding departments. sort of information for us to translate is complex and the providers struggle rudimentary process — examining wanted the best for their patients.” “We saw some Tenners hired the codes. Our role is to be the front to report,” Gilmore said. “Denials are a patient in order to determine a Huron Healthcare’s O’Dowd says a year ago before the delay was door of the payer, providing the least not always the same, so when trying diagnosis and set a course of treat- preparation, pragmatism, and priori- announced, so they also had to learn path of resistance so that the provider to understand denial patterns, it’s a ment. But with an increasingly tization helped a lot of organizations ICD-9, which was resource con- doesn’t have to worry about whether small percentage of claims and the non-English-speaking ethnic popu- withstand the storm: “The organiza- sumptive,” O’Dowd said. “Some of the payer has the setup they need to trends are smaller than that. It takes lation, simple communication can tions that succeeded built a strong the older coders delayed their retire- file the claims. complex analytics to get it right.” become a difficu and expensive relationship with their teams — spe- ment, while others left.” Because the payer doesn’t have ICD-10 presents a number of chal- proposition, says David Fetterolf, cifically the clinical documentation The diffe ence in volume between a one-to-one electronic relation- lenges, but they can be distilled down president of Clearwater, Florida- specialists, physicians and coding ICD-9 and ICD-10 is staggering: ship with the provider network, to two prominent ones, she said — based Stratus Video. professionals.” 69,368 diagnosis codes and 87,000 Availity scours the landscape to the speed with which new trends The language barrier can be over- Dean, meanwhile, contends that procedure codes under 10, com- solve any challenges that occur, arise and a negative cause-and-effec come with an interpreter either on- vigilance has been the key to manag- pared with 13,500 diagnosis codes Ketterman said. pattern within code analysis. site or by telephone, but the process ing the deadline transition as well as and 4,000 procedure codes under 9. “There are a few things that are spe- In addressing the first challenge, can be cumbersome. What’s more, staying on course for meeting future The rationale among many ICD-9 cific to 10, such as the need for end-to- Gilmore notes that “new trends come hiring an interpreter can be costly. challenges. coding veterans: Too much to learn, end testing, adjusting the system, and up fast and to identify them you While most of the non-English “We’ve been on guard, we know too late in life… might as well retire. mandates based on providers, payers only have a couple months of data patients speak only Spanish, waves when the changes are happening, A self-described “Niner,” Diane and states,” he said. “ICD-10 says prior to review so far — the data pool is of immigration in recent years have we are working the claims and Rivers, coding practice director for to Oct. 1, 2015, you need to use 10 cod- small.” On the second point, she increased the need for interpreters in looking at denials — nothing is too Jacksonville, Fla.-based CSI Health- ing schedule. For dates after that, the observed: “When you expand out Arabic and Mandarin, Fetterolf said. small not to have a conversation care IT, says if things progressed format must be ICD-10. How do you the number of codes, you decrease Stratus takes the best of both with the team,” she said. “We do according to that script, she would test that? We had to create a system the number of claims with any given face-to-face interpretation and the not assume a denial is a one-time, have followed many of her colleagues that accounted for diffe ent partners code. We call that sparsity and ICD- cost effectiveness of video confer- isolated thing. Each denial could out the door. Instead, she ended up with diffe ent states of readiness. We 10 just made things harder.” encing in its solution, which works be part of a larger pattern.” becoming an expert in ICD-10. had to build in a lot of capabilities that In the coming months, Gilmore on iPads and laptops. To arrange an And Sage makes one very impor- “I saw the handwriting on the wall providers could not have done.” expects to see “very fast change interpreter, the user presses a but- tant point: We made it. in 2012 and thought by the time ICD- Ultimately, payers were ready for as more adapt to the new envi- ton for the desired language, and “We all hate change, espe- 10 hit I’d retire and become an artist,” ICD-10 “because they stood to lose ronment.” For Ayasdi, that means a healthcare-certified interpreter cially when it’s something that is she said. “I reached a crossroads and I so much if they weren’t,” Ketterman a boost in workload so that new is supposed to join the conference administrative and not clinical in could either join my friends in retire- said. Provider claims, for the most trends can be detected quickly even within one second. nature,” she said. “The experience ment or take it seriously. I decided to part, were clean after the deadline, if there isn’t much data. By having a face-to-face conversa- has shown that we can make the buckle down and learn it.” he said, and claims payments have “There is a lot of change to come, tion, even with someone through a change, that in the long run the Admittedly, Rivers “begrudgingly” been consistent, with a less than 1 and we have yet to see the other shoe screen, it improves the communica- system will be better and reporting began learning ICD-10 and found the percent rejection rate. drop,” she said. tion so that specificity required for will improve dramatically.” n YOU CAN’T BUILD THE HOSPITAL OF TOMORROW ON THE NETWORK OF YESTERDAY.

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Karen DeSalvo, MD Slavitt, DeSalvo at OCR unleashes new HIMSS16: Health IT wave of HIPAA audits TOM SULLIVAN, Editor-in-Chief approximately 200 audits – most of those HE OFFICE for Civil Rights has begun being “desk audits” – by the end of 2016. has to work better its second wave of HIPAA audits OCR added that it intends to use the sec- and already the question is arising: ond wave to identify best practices and, in T Will the program actually succeed turn, share that guidance with covered enti- in its effo t to improve privacy and security ties. The offi , however, still has to compile for physicians practices and, ultimately, protect patient and deliver that manner of guidance at some data? Or will it have the opposite impact? yet-to-be-specified point in the futu e. While touting tech “I think your speech comes across as Health attorneys aren’t expecting an answer Although the forthcoming best practices successes so far, CMS very negative,” DeSalvo told him. “Why in the short-term. What they are anticipating are won’t help those 200 covered entities that get don’t you re-read through that lens?” plenty of penalties in 2016 as the drum beat of audited this year, Fisher expects OCR to post and ONC recognize It was a light moment, but Slavitt had data breaches continues apace. “a checklist that everyone else should review a serious point to make: “She works with The initial rounds of audits under the and use for a self-assessment.” physician frustrations the technology community,” he said, new procedure “will result in a fair amount The problem for now, Harlow said, is that MIKE MILIARD, Editor which is making tons of progress and, of fines being levied since that money will healthcare organizations do not even have a draft N A CO-PRESENTATION with National to judge from HIMSS16 so far, “generally go right to OCR and probably help fund the audit protocol from OCR: “While OCR is certainly Coordinator Karen DeSalvo, MD, at pretty happy.” audit program going forward,” said Matthew fielding many complaints and taking action on HIMSS16, Acting Centers for Medi- On the other hand, “I’ve been spend- Fisher, an associate at Mirick O’Connell and cases before it, we have limited structural, systemic I care and Medicaid Services Admin- ing last months with physicians trying to chair of the fir ’s Health Law Group. improvements in privacy and security.” istrator Andy Slavitt said physicians use technology,” said Slavitt. “That may David Harlow, a health lawyer, consultant What’s more, earlier pilot audit waves showed “want better technology.” affect y mood just a bit.” and founder of The Harlow Group, explained that most healthcare organizations had a certain From both a policy and an innovation Indeed, health IT has made hugely that OCR is “consistent in saying that the degree of non-compliance with the HIPAA pri- perspective, it’s time to give it to them, impressive strides over the past five audit process is not a witch hunt.” vacy and security laws, Fisher explained. he said. years, said DeSalvo. U.S. providers have OCR described the audit program as an “an So even though OCR has yet to clearly outline Before their dual appearance, Slavitt tripled the adoption of EHRs, and the important tool to help assure compliance with what healthcare providers should expect exactly, said, he and DeSalvo read each other’s industry continues to build on those HIPAA protections, for the benefit of individu- one thing to anticipate is financial penalties. “Who speeches; the audience laughed when he early incentives. als,” as well as the opportunity to examine mech- loses out as a result? Patients,” Harlow said. “The said she took issue with the tone of his On one hand, healthcare is getting anisms for compliance and potentially discover breaches continue, free credit monitoring services

prepared remarks. HIMSS SEE PAGE 14 vulnerabilities it might not yet fully understand. are offe ed, and we all move forward with a dimin- To that end, the second wave will include ished expectation of privacy and security.” n

HHS gets to value-based ONC creates Tech Lab, will CIO says VA should rethink goal ahead of schedule sunset Standards Framework VistA, consider other EHRs Barely a year after announcing its The Office of the National Coordina- U.S. Department of Veterans’ Affairs ambitious plan to tie reimbursement tor for Health IT has established the CIO LaVerne Council said March 2 to quality of care, the U.S. Depart- ONC Tech Lab to both encourage that the VA needs to reconsider ment of Health and Human Services public input on standards devel- whether its proprietary Veterans announced March 3 that 30 percent opment and serve as a central Information Systems and Technolo- of Medicare payments are now tied connection point for the office’s gy Architecture is the best electronic to alternative payment models, such own work. The development of health record for its more than 1,200 as ACOs. The goal was reached standards through the lab will help healthcare sites. Council explained nearly a year ahead of schedule, ONC further develop interoperabil- during testimony to U.S. House according to HHS, which touts the ity standards and to advance work appropriators that changes in the fact that more than 10 million Medicare patients are now getting planned under the Federal Health IT Strategic Plan, which aims to VA’s healthcare delivery plan, such as emphasis on mobility, security higher-quality and more coordinated care. “Improving the quality and apply the effective use of information and technology to achieve and women’s health, as well as connections with private sector provid- affordability of care for all Americans has always been a pillar of the high-quality care. “We will be using the ONC Tech Lab’s organizing ers, are forcing the reconsideration of VistA. Specifically, Council said Affordable Care Act, alongside expanding access to healthcare,” said structure to help us focus on what we can uniquely contribute to it was time to “take a step back” from the planned modernization of HHS Secretary Sylvia Mathews Burwell in a statement. “The law gives improve existing standards and build consensus around those that the VistA health record and announced VA plans to review whether it us the tools to put patients at the center of their care, improve quality best serve specific interoperability needs,” said Steven Posnack, should continue upgrading VistA or turn to a commercial off-the-shelf and help make care more affordable over the long term.” director of ONC’s Office of Standards and Technology. product. “We have not made up our minds about VistA,” Council said. Medfusion® 4000 Wireless Syringe Infusion Pump and PharmGuard® Infusion Management Software

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SmithsMD_PPP_Aug2015_MedPhrmGrd.indd 1 7/14/15 2:13 PM 10 POLICY www.HealthcareITNews.com | Healthcare IT News | April 2016 CMS backs interoperability for long-term care facilities, behavioral health CMS acting administrator, and Karen between doctors and other clinicians when DeSalvo, the national coordinator for health needed, helping to create a more complete information technology and acting assistant care team to collaborate on the best treat- secretary for health, in an officia CMS blog ment plans and goals for Medicaid patients, post Wednesday. CMS added. “Technology, when widely distributed “Today’s announcement is another exam- and available, enables providers to improve ple of how Medicaid is leading change for patient care by distributing information and its beneficiaries and throughout the health- best practices and leading to better experi- care system,” Slavitt and DeSalvo said. “But ences of care for individuals in the healthcare this is more than a technology initiative. It is system. And technology can make a signifi- part of a comprehensive effo t to make sure cant diffe ence in the rapidly modernizing that the 72 million adults, children, seniors Medicaid program.” and people with disabilities served by the Slavitt alluded to the announcement Medicaid program have access to high qual- Tuesday night during a presentation with ity, coordinated care. Improving population DeSalvo at the 2016 Annual HIMSS Confer- health and addressing the needs of complex ence and Exhibition in Las Vegas, where he populations requires strong health informa- A new initiative permits states to request the 90 percent said, “We’re announcing funding to connect tion technology tools.” enhanced matching funds to connect a broader variety of many of the remaining parts of the system Slavitt and DeSalvo expect a variety of ben- that are not part of the EHR incentive pro- efits from the new initiative, benefits from Medicaid providers to a health information exchange. grams but serve our neediest patients every care coordination to medication reconcilia- BILL SIWICKI, Managing Editor connect a broader variety of Medicaid pro- day. Finally, we are going to wire up long- tion to public health reporting. For example, HE CENTERS FOR MEDICARE and viders to a health information exchange. term care, behavioral health and substance exchanging care data can support patients Medicaid Services on Wednesday This additional funding will help sustain abuse providers.” with multiple chronic conditions as they visit said it will permit states to request health information exchanges and lead to The free flow of information is hampered specialists, hospitals, primary care practices, T 90 percent enhanced matching increased connectivity among Medicaid pro- when not all doctors, facilities or other prac- home health care providers and pharmacies, funds to help other healthcare providers such viders, CMS said. tice areas are able to make a complete circuit, the two executives said. as long-term care facilities, behavioral health “The great promise of technology is to CMS said. Adding long-term care providers, “CMS and ONC look forward to partnering providers and substance abuse treatment bring information to our fin ertips, connect behavioral health providers and substance with and supporting states in these and other centers purchase interoperable technology. us to one another, improve our productiv- abuse treatment providers, for example, critical effo ts to modernize and connect the The initiative will help bridge an infor- ity and create a platform for the next gen- to statewide health information exchanges Medicaid program for the millions of benefi- mation sharing gap in Medicaid by CMS to eration of innovations,” said Andy Slavitt, will enable sharing of patients’ health data ciaries they serve,” Slavitt and DeSalvo said. n NQF to HHS: Align MIPS ICD-10 to get with other federal programs MIKE MILIARD, Editor 5,500 new codes HE NATIONAL Quality Forum said aligning measures should be a top CMS said it plans to add inpatient procedure codes to the ICD-10 priority for MIPS and alternative about 1,900 diagnosis coding system for healthcare claims in fi - T payment models across all federal codes and 3,651 hospital cal year 2017. programs and including U.S. states and the Of the 3,651 new hospital inpatient pro- private sector. inpatient procedure codes cedure codes, 97 percent will update the The National Quality Forum has published its SUSAN MORSE, Contributing Writer cardiovascular and lower joint body sys- guidance for the new Merit-Based Incentive Pay- N OCT. 1, the Centers for Medi- tems, CMS said. There will also be new ment System. NQF’s Measure Applications Part- care and Medicaid Services codes for a face transplant, hand transplant nership examined some five-dozen MIPS perfor- will add another 5,500 codes to and donor organ perfusion, CMS said. mance measures, proposed for implementation O the ICD-10 diagnostic library, The large number of new codes is due in 2017, from which data would be collected to official announced in a March 9 meeting. to a partial freeze on updates prior to the track eligible providers’ performance in 2019. notably in patient-centered areas such as The addition will come exactly one year original launch on October 1, 2015 accord- “As the U.S. healthcare system increasingly patient-reported outcomes, functional sta- ing to CMS. The 2016 update shifts to a performance-based payment sys- tus and care coordination. These measures will include the backlog of all tem, MAP’s role (is to serve) as an impar- should go beyond patients’ experience with proposals for changes to the tial advisor bringing stakeholders together the healthcare system to the impact of health- code set. from across the healthcare spectrum,” NQF’s care on patients’ health and well-being. The new and revised ICD- chief scientific office Helen Burstin said in Meanwhile, MAP urged continued explo- 10-CM (Clinical Modifica- a statement. ration of the impact of socioeconomic status tion) and ICD-10 PCS (Pro- To that end, MAP offe ed some suggestions and other demographic factors on measure cedure Coding System) codes to the U.S. Department of Health and Human results, noting that the program should be will be included in the hos- Services for better aligning with multiple fed- taking into account when providers are caring pital inpatient prospective eral healthcare programs, namely the Medi- for high-risk populations. payment system proposed care Shared Savings Program. NQF also weighed in on measures for pub- rule for fiscal 2017, which is Chief among those was that aligning of mea- lic reporting on CMS’ Physician Compare after ICD-10, with its nearly 70,000 bill- expected next month. Diagnostic Related sures should be a top priority, and not just for website. With regard to those most useful able codes, replaced the dated, and much Group changes will also launch on Oct. 1, MIPS programs and alternative payment mod- for consumers and patients, MAP expressed more compact, ICD-9 code set. according to CMS. els, but across all federal programs and with a preference for those focused on care coor- CMS said it plans to add about 1,900 Written comments on the codes will be states and the private sector where possible. dination, population health, appropriate care diagnosis codes and 3,651 hospital accepted until April 8. n Indeed, NQF found that gaps still exist and on outcomes – especially those that are across clinician-level programs – most patient-reported. n Clinical Lens

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ICIT’s report, “Assessing the FDA’s Cybersecurity Guidelines for Medical Device Manufacturers: Why Subtle ‘Suggestions’ May Not Be Enough,” knocks the agency for failing to implement enforceable regulations for manufacturers.

Institute for Critical Specificall , the study, “Assessing the FDA’s “Currently, healthcare device manufacturers medical device manufacturers could ignore Cybersecurity Guidelines for Medical Device and healthcare providers have the ability to the guidelines altogether.” Infrastructure Manufacturers: Why Subtle ‘Suggestions’ ignore the FDA’s recommendations,” they said This isn’t the first time FDA has been Technology says feds May Not Be Enough,” knocks the agency for in the report. “However, it is in the best inter- criticized for issuing public statements that failing to implement enforceable regulations est of each organization and the community at call attention to the severity of device secu- should do more than for manufacturers. large if the target audience pays attention to rity but do little to enforce safety practices just suggest safeguards “The argument against enforcing cyber- the FDA’s underlying message to adopt a com- by manufacturers. security standards typically centers on the prehensive risk-based cybersecurity program. In 2013, for instance, a so-called “safety MIKE MILIARD, Editor idea that a regulatory presence stifles inno- “Interested stakeholders have 90 days from communication” from the agency called on RECENT REPORT from the Institute vation,” they said. “Due to the industry’s manufacturers, clinical staff and hospital IT for Critical Infrastructure Tech- continuous lack of cybersecurity hygiene, “The FDA seems to be and security departments to safeguard against nology, a bipartisan collaborative malicious EHR exfiltration and exploiting in a constant state of cyberattacks but did little to enforce change. A meant to bridge the gap between vulnerabilities in healthcare’s IoT attack Noting that FDA “is at a critical point federal agencies and private-sector leaders in surface continue to be a profitable priority in this ecosystem to correct the path of the interest of protecting the nation’s technol- target for hackers.” offering subtle suggestions vendors, manufacturers and administra- ogy backbone, claims recent guidance from The FDA recently published its “Draft Guid- where regulatory tors,” information security expert Gunter U.S. Food and Drug Administration for device ance for Industry and Food and Drug Admin- Ollmann told Healthcare IT News at the time makers falls way short. istration Staff,” which underscores that cyber- enforcement is needed.” said the communication was “wishy-washy “In practically all matters of cybersecu- security for medical devices has emerged as a in its description of the threat and actions rity within the health sector, the FDA seems top priority for the healthcare industry. the January release of the guidelines to sub- to correct the threat. It’s as if it had to pass to be in a constant state of offering subtle But while it’s appropriate for FDA to be mit comments and suggestions to the FDA through multiple committees and each suggestions where regulatory enforcement doing more to highlight the nature of the about the guidelines,” they added. “It may be watered it down to become what it is today. is needed,” write ICIT Senior Fellow James threat, it’s also worth noting that the medical beneficial to healthcare providers, healthcare It should have been a call to arms, with a Scott and Drew Spaniel, a visiting scholar at device community is “compliance-oriented,” payers, and legislators to petition the FDA to clear communication of how serious the Carnegie Mellon University, in the report. Scott and Spaniel said. make the guidelines regulatory. Otherwise, problem is.” n HL7 MEMBERSHIP IS ON FHIR Health Level Seven® International is an ANSI- HL7’s family of standards includes: Fast accredited non-proﬁt that empowers global Healthcare Interoperability Resources (FHIR®), health data interoperability by developing Clinical Document Architecture (CDA®) and HL7 standards and enabling their adoption and Version 2 (V2) as well as standards for clinical implementation—for a world where everyone decision support and precision medicine. can securely access and use the right Actively participating in HL7 is your health data when and where they need it. opportunity to help shape the technical and policy environment of the future. Join today at bit.ly/JoinHL7

® Health Level Seven, HL7, CDA, FHIR and the FHIR [FLAME DESIGN] are registered trademarks of Health Level Seven International, registered in the US Patent and Trademark Oce. 14 POLICY www.HealthcareITNews.com | Healthcare IT News | April 2016 HHS to enact stricter rules to protect patient privacy of substance use disorder records Rule would bolster health information exchange of “This proposal will help patients with substance use disorders fully critical personal data while participate and benefit f om a healthcare delivery system that’s also addressing better, smarter and healthier, while protecting their privacy,” said HHS confidentiali y issues. Secretary Sylvia Burwell. JESSICA DAVIS, Associate Editor HE DEPARTMENT OF HEALTH and Human Services has proposed new rules on patient record disclosures T to ensure substance use disorder patients can participate in new integrated healthcare models without risk of having their records shared inappropriately. The revisions to the Confidentiality of Alcohol and Drug Abuse Patient Records regulation would also facilitate health information exchange and address legitimate privacy concerns of patients seeking treatment for substance use, HHS said. “This proposal will help patients with substance use disorders fully participate and benefit from a healthcare delivery system that’s better, smarter and healthier, while protecting their privacy,” HHS Secretary Sylvia Burwell said in a statement. The proposal reflects the changing healthcare landscape, including the development of an electronic infrastructure that focuses on managing and exchanging patient data and an increased focus on performance measurement and quality improvement. The current rules, sometimes referred to as “Part 2,” were created in 1975 amid concerns that potential substance use disorder treatment information used in crimi- stringent than other federal protections, “We’re moving Medicare and the health- of their care, and we’re modernizing our rules nal prosecutions would deter individuals including the Health Insurance Portability care system as a whole toward new integrat- to protect patients,” Burwell said. from seeking necessary treatment. It was and Accountability Act, due to its targeted ed care models that incentivize providers to The public comment session on this pro- last updated in 1987. Part 2 rules are more population. coordinate and put the patient at the center posal is open until 5 p.m. Eastern on April 11. n

start, said Slavitt. “But we’re still at the Second, he said CMS would hear phy- HIMSS stage where technology often hurts rather sicians’ requests to “stop measuring our CONTINUED FROM PAGE 8 than helps physicians providing better care.” clicks” and “give us more flexibility to better at spending smarter and having CMS is committed to taking a user- suit our practice needs and, ultimately, healthier patients. But there are chal- centered approach to designing policy, more control.” lenges, she said, emphasizing that data he said. Third, providers wherever possible needs to flow mo e freely. “I’m asking you to do the same. Step “favor a pull, versus a push for incentives” “On the supply side, we have built up an back and look at what you don’t think is that lets “outcomes, rather than activities, amazing amount of health information,” working, and make it work better.” drive the agenda,” said Slavitt, indicating said DeSalvo. “We have to set it free.” Slavitt said CMS has recently under- that CMS has received that message. HHS Secretary Sylvia Burwell Monday taken its most concerted effo t ever to lis- Meanwhile, he said the agency would evening announced that a who’s-who of ten to physician feedback, working with continue to use what levers it could to private-sector vendors, providers and those on the front lines to understand spread interoperability. health organizations have committed to their pain points. “We’re announcing funding to connect more open sharing of data, which DeSalvo He read a number of physician quotes many of the remaining parts of the sys- called a step in the right direction. that should sound familiar to many: Andy Slavitt tem that are not part of the EHR incentive “I couldn’t be more thankful,” said the Meaningful use has become “too much of programs but serve our neediest patients ONC chief. a burden,” said one doc. “Most of what are “not describing problems we don’t every day,” said Slavitt. “Finally, we are But Slavitt – who said he and DeSalvo I’m doing during the day is entering data know how to solve. That makes Karen and going to wire up long-term care, behavior- have “been working together for months” into the EHR,” said another. One joked me optimistic.” al health, and substance abuse providers.” on some of these new policy initiatives, to (or half-joked) that “to order aspirin takes CMS is “still a few months away from But in the private sector there are still the point where they can finish each other’s eight clicks; to order full-strength aspirin having details available on the proposed too many barriers to interoperability, he sentences – said still more was needed. takes 16.” MACRA rule,” said Slavitt. But he did said, from legal clauses to commercial “I’m certainly not bashful about what Physicians feel hampered and frustrated share some principles of the agency’s pol- impediments to intellectual property. we need to do better, and I’m not going to by lack of interoperability, said Slavitt. icy approach in the near future. That’s not an excuse, said Slavitt. be bashful here, even in the face of some They think federal regulations in their cur- “Job one is to bridge the gulf between “The companies that live up to their very good reasons for optimism, about rent form slow them down and distract our public policy work and what’s actu- commitments here will be recognized ways we need to take our game up across from care. They also find EHR technology ally happening with patient care,” he said. and applauded,” he said. “And I strong- the board – all of us,” he said. hard to use and cumbersome. “That has to become an integral part of ly encourage you to recognize those The health IT industry has made a great The good news, he said, is that doctors how we do things.” that don’t.” n OUR CLOUD. YOUR OPPORTUNITY.

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What happened in Vegas 2 Monument Square, Suite 400 Portland, Maine 04101 T (207) 791-8700 F (207) 791-8794 Encouraging signs at HIMSS16 of the biggest EHR vendors (Epic, Cerner, some teeth to the well-meaning words, certi- FTER SPENDING a week at the MEDITECH, Allscripts athenahealth et al.) fying technology directly to ensure IT systems John Whelan, Executive Vice President [email protected] Sands Expo and Convention Cen- and largest health systems signed on to HHS’ “speak and listen in the same language.” Dan Dinsmore, VP, Operations ter this past month with 41,885 of pledge for better patient data access, more There were plenty of buzzwords, of [email protected] my closest friends, it took a few transparency and standards for interoperabil- course – “population health,” “cybersecu- Gus Venditto, VP, Content A [email protected] days to sort through and put into perspective ity. You could hear it when CMS chief Andy rity” – heard all over a sprawling exhibit some of the big thematic takeaways of health Slavitt reemphasized the agency’s commit- floor crowded with 1,300 vendors of all EDITORIAL IT’s biggest event. ment to physicians, calling out technology stripes. But there was also the feeling that Tom Sullivan, Editor-in-Chief [email protected] Perhaps appropriately for a city that loves its that still “often hurts rather than helps” and they were starting to really mean something Mike Miliard, Editor lucky 7s, this was my seventh trip to the HIMSS pledging to take a “user-centered approach” for healthcare providers large and small [email protected] Annual Conference & Exhibition, to designing policy. across the country. Bill Siwicki, Managing Editor and it’s pretty remarkable to com- There was a sense that maybe I talked with many healthcare chief infor- [email protected] pare how diffe ent things are from (just maybe!) the forthcoming mation officer at HIMSS16, and they offe ed Jessica Davis, Associate Editor my first isit in 2010. Merit-based Incentive Payment all sorts of anecdotal evidence that their orga- [email protected] Back then, with meaningful use System rules – alluded to often nizations were starting to notch some real Bernie Monegain, Editor-at-Large just coming into focus, this still at HIMSS16 but still a ways off pop health wins using targeted data analytics [email protected] paper-heavy industry was trying from taking final shape – might and patient engagement strategies. ADVERTISING / LEAD GEN / to figu e out how to put those bil- offer a more manageable and less On the privacy and security front, clearly MARKETING OPPORTUNITIES lions of newfound dollars to use. onerous path toward account- the stakes are higher than ever. The good NATIONAL SALES DIRECTOR It’s amazing to contemplate how able and technology-enabled news is that more CIOs than I can remember Jane Bogue MIKE MILIARD, Editor [email protected] far things have progressed in less care than the meaningful use told me data security has become their top (207) 337-4313 than a decade. program, which did so much to spur tech priority, and many are using new and enve- SENIOR DIRECTOR, CUSTOM SOLUTIONS & STRATEGIC ACCOUNTS The technology has evolved, of course. But uptake early on but caused so much con- lope-pushing tools to keep their data secure Betsy Kominsky so has healthcare providers’ willingness to sternation (while also arguably stifling from snoops and cyber crooks. [email protected] embrace it and put it to work, their readi- innovation) in its latter years. All told, the feeling at HIMSS16 was one of (312) 502-2773 EVENTS ness to really accomplish some substantial There was encouraging news on several maturity, if not yet critical mass. The sense Roz Burke successes with health IT. fronts with regard to interoperability – was that the many various stakeholders in [email protected] this transformative enterprise – the hospitals (773) 318-9710 and physician practices, the technology ven- SALES ADMINISTRATOR “The technology has evolved, of course. But Mary Taylor dors, the federal rule-makers – are coming [email protected] so has healthcare providers’ willingness to closer together in alignment and agreement (207) 791-8716 on the way forward. NEW ENGLAND embrace it and put it to use, their readiness Regina Dexter The technology is already is there. Even [email protected] to really accomplish some substantial as it continues to advance and evolve, the (603) 204-0709 existing tools are enough to get us where we SOUTH/SOUTHEAST Cathleen Martindale successes with health IT.” need to go: smarter, safer, more effective and [email protected] And not just providers. Vendors and policy whether it was the continued evolution and affo dable care. Now what’s needed is the (727) 376-2900 makers seemed to be energized by this new innovation around HL7’s FHIR protocol (see will to put it work, and to innovate together MIDWEST Randy Knotts data-rich era and committed to driving inno- Tom Sullivan’s “Innovation Pulse” column on on those achievable goals. Amid the loudly [email protected] vation on the road to value-based care. page 17) or, potentially, the rule floated by flashing lights of Las Vegas, that seemed to (630) 790-0737 n You could see it, for instance, when most the Offic of the National Coordinator to add be happening more than ever. MIDWEST/WEST Kelly Laidler [email protected] (312) 867-1473 systems back to service. A decision only he Other hospital leadership teams need to ask WEST and the leadership of that hospital could these questions because ― to dispel one of those Jen LaFlam Ransomware: make and one I’m sure not easily arrived at. fears above ― others will follow suit. Additional [email protected] In most instances the majority of security and attacks are already happening. It’s not a matter (312 )515-6956 law enforcement professionals would advise of if, but when. NORTHEAST/MIDATLANTIC TERRITORY What will it Deborah Crimmings against paying the hackers, because, 1) there is There needs to be a fundamental shift in [email protected] no guarantee you will get the decryption key, our thinking about security today. More prior- (207) 233-5242 and 2) there is the fear that it will ity needs to be given to detection take to be PRODUCTION / TRAFFIC encourage others to follow suit. I and response, but detection and Karen Diekmann, Production Manager would argue that is easy advice to response without protection will be [email protected] prepared? give if you are not the one looking less effective and can fail. Systems AUDIENCE DEVELOPMENT Elizabeth Clancy, Senior Manager Much of the ransomware seen in down the barrel of the ransom note. that look for anomalous behavior or [email protected] Until you have walked in those traffi first have to understand what READER CUSTOMER SERVICE attacks like the one at Hollywood shoes you don’t really know what is normal or correct. And response- (847) 763-9618 F (847) 763-9541 Presbyterian is well-known, and you will do. approaches need sound architectures [email protected] detectable with the right tools and The hospital in this case applied and systems to enable identification, Reprints: The YGS Group practical triage logic to the patient isolation and containment of infect- (800) 290-5460 x100, [email protected] strategies in place List rentals: Information Refinery and took the hand to save the arm. I ed or affected information assets MAC McMILLAN (800) 529-9020 x25, [email protected] MAC MCMILLAN, CynergisTek think it is basically unfair to second Things that undermine this are: EDITORIAL BOARD AST WEEK we all read another sobering guess its decision, after it was faced with more lack of proper and real segmentation; weak John Glaser, SVP, Cerner, Kansas City, Mo. account of the disruption that cyber than a week of downtime, and was facing poten- access controls and protections of credentials, Denni McColm, CIO, Citizens Memorial incidents can cause. The ransomware tially longer disruption and mounting costs. particularly elevated privileges; lack of disci- Healthcare, Bolivar, Mo. attack at Hollywood Presbyterian But what is not unfair to ask is how ready was pline in hardening, patching and change con- Jane Olds, COO, Louisiana L Health Network, New Orleans Medical Center was despicable in its nature and it for this situation? What level of protection was trol processes; lagging refresh cycles and end of Wes Rishel, vice president, Gartner, Inc. alarming in it what it says about the overall pre- in place? What detection capabilities were pres- life equipment; shadow IT and rogue applica- Paul Tang, vice president, CMIO, paredness of healthcare to deflect these threats. ent to identify this situation earlier? And how tions; inadequate user education and awareness; Palo Alto Medical Foundation, California Healthcare is one of our most critical infra- ready were its contingency plans? Many of the not adhering to a recognized standards-based Steven Waldren, director, Center for Health IT, American Academy of Family Physicians structures and important to every American. ransomware programs we see in these attacks approach to controls; irregular testing and 2013 JESSE NEAL The CEO for this institution eventually opted are well-known and detectable with the right assessment; lack of external review; and inad- AWARD WINNER to pay the ransom to return his institution’s solutions in place ― but were they? SECURITY SEE PAGE 25

HITN 0416-masthead.indd 1 3/22/16 4:29 PM April 2016 | Healthcare IT News | www.HealthcareITNews.com INSIGHT 17 FHIR setting the stage for population health At HIMSS16, CMS and ONC DeSalvo described the developer challenges as an opportunity for the federal promise to not only accelerate government to engage private sector entre- adoption of the interoperability preneurs in building technologies that make more effective use of health data for spec but also have some patient-centric care. providers looking ahead at “It’s time for us to see some digital divi- dends,” DeSalvo said, “to really make that ways they can put it to use. data sing.” That’s going to require much more than HE EMERGING PROTOCOL known as these developer challenges. In fact, DeSal- FHIR has been most closely asso- vo’s announcement came just days after ciated with interoperability so far. ONC unveiled the Interoperability Prov- FHIR was a hot topic The acronym, after all, stands for ing Ground, which the director of ONC’s T at HIMSS16, with big Fast Healthcare Interoperabil- INNOVATION PULSE office of standards and tech- excitement for its pop ity Resources. But if the stan- nology, Steve Posnack, called health potential. dard succeeds in its mission a “Match.com for FHIR.” of enabling widespread data As of March 10, there are exchange, FHIR might soon currently 61 projects in the NASCENT PROGRESS ON POP HEALTH alone won’t get the nation to ubiquitous popu- have a higher calling to serve as a Interoperability Proving Among the early success stories of FHIR in lation health management, of course. No single foundation for population health Ground. While those are not action is the work Duke School of Medicine technology or specification existing today can management. limited to FHIR, the idea is is doing with FHIR and Apple’s HealthKit to manage that. “FHIR is a better-designed to build a central hub that integrate standards-based apps such that it Many in the industry, rather, maintain Lego,” said Doug Dietzman, connects the community of can, in the words of Duke’s director of mobile that technology is not the hardest obstacle. executive director of Great people working on interoper- technology strategy Ricky Bloomfield, MD, Healthcare organizations haven’t received Lakes Health Connect, a self- TOM SULLIVAN ability projects to share les- “liberate electronic health records data.” strong guidance from the government, Waller sustaining health information exchange in sons learned, best practices and, indeed, Another perhaps less-covered initial FHIR said, while Dietzman added that issues such Grand Rapids, Michigan. “I’m looking for- to prove the progress already being made. success is the rheumatology app that Geising- as informed consent and compliance with ward to having it in my toolbox.” The MITRE Corp., meanwhile, also er Health System’s innovation unit xG Health federal mandates are also inhibiting infor- used the occasion HIMSS16 to post an Solutions built with FHIR to communicate mation exchange. FEDS BACK FHIR, BIG-TIME open source tool, a web UI called Cru- between Epic and Cerner EHRs basically That said, what FHIR at least has the prom- There is certainly no lack of public support cible. Available at ProjectCrucible.org, it straight out-of-the-box. ise of enabling is something akin to a reliable for FHIR right about now. National coordi- enables developers to run 228 test suites Duke and Geisinger’s work offers a glimpse pathway into data about patient populations. nator Karen DeSalvo, MD, started the fi e at comprising some 2,000 tests of the FHIR into the much larger potential FHIR holds. Waller said he can envision looking at HIMSS16 by launching a $625,000 triptych specification. Entrants are classified as API, Indeed, at Great Lakes Health Connect, patient records relative to a particular geog- of developer challenges. One focuses on resources or administrative, displayed in a Dietzman is already thinking about the big raphy to know in which neighborhood to set patient-facing apps, the second on software graphical map to pinpoint bugs and, ulti- picture — as is Corey Waller, MD, medical up, say, an addiction clinic. And that’s just geared toward providers and for the third mately, given a pass or fail grade. director at the Spectrum Center for Integra- one example. ONC is hoping the funding and recognition MITRE lead systems engineer Andre tive Medicine, which participates in the Great “I can only imagine what we’ll be able inspire someone to create what essentially Quina cut to the chase: “Having a standard Lakes HIE. to do when we have that data,” Waller would be an app store for housing these alone isn’t enough to achieve interoperabil- said. “I know I have the keys to a health- FHIR-based apps and making them availity,” he said. “Ambiguities in the standard HURDLES AHEAD ier community. I just can’t use that data able for download. can be disastrous.” Dietzman and Waller acknowledged that FHIR effectively yet.” n

organizations now called “Locky.” use and the mandate to digitize patient infor- industry just what this experience meant to SECURITY Locky was first reported a little more than a mation in the electronic health record, making his or her institution, how it affected them, CONTINUED FROM PAGE 16 week ago, and immediately researchers began to healthcare more susceptible to hacking and and just how it felt to be at the helm during equate oversight or governance. see instances ― upwards of 100,000 per day ― of electronic extortion. such a trying situation. Executive teams need Organizations with a good defense-in- infected systems. It took some period of time Symantec, a leading provider of security to understand the cyber risks they face. Mean- depth strategy, advanced detection capabili- for A/V vendors to acquire the new signature solutions and threat monitoring, published an while, here are eight areas to think about when ties and solid response/contingency plans will and update their software to detect and block excellent report in 2012, “Ransomware: A Grow- building a resistance to these threats: fare far better when attacked. Make no mis- this threat. Depending on how long it took orga- ing Menace,” which provides a brief history of 1.Education. Ensure users know now to take about it: Protecting information assets is nizations to update its system or how well its ransomware, some examples of diffe ent types identify anomalous behavior and avoid com- a business issue, and organizations that don’t environment was covered, it gave Locky more of ransomware attacks known at that time, mon threats though practical training and recognize this will pay for it. time to operate undetected. and strategies for mitigation. While a bit dated realistic exercises. The ransomware threat is particularly rel- Locky is reportedly spread through a today, it no less will bring two things home to 2. Vigilance. Maintain currency in the IT envi- evant for healthcare today and a real threat as Microsoft Word attachment containing mali- those you share it with. ronment, refresh systems, keep patches up to we are seeing. That threat continues to evolve cious macros that, when the recipient clicks First, this is not something new, but rath- date, and harden according to recognized stan- as well, and new ransomware variants continue on them, downloads the Locky malware and er just the electronic version of an old crime: dards, mind configu ations and change control. to appear like the one thought to be affectin executes it. These ransomware tools are creat- extortion. Second, any and every organization 3. Layer defenses. Use multiple layers in ing serious problems, as the folks in Califor- is susceptible to this threat, and it is definitel protective technologies and controls at the end It’s unfair to second nia experienced. And for healthcare they are persistent. I recommend sharing this with non- points, on the network, at the host level, etc. particularly scary because they represent the technical leadership. 4. Compliment controls. Deploy both sig- guess Hollywood worst scenario possible ― a serious disruption What is especially frustrating about this nature based and heuristic based detection to the ability to deliver care services. crime is that most of the ransomware types are solutions. Presbyterian’s Ransomware attacks in healthcare affect the well known and there are solutions out there if 5. Enhance detection. Deploy next generation reputation of the institution, undermine the acquired, implemented properly and allowed fi ewalls, malware filters, A/V filters, automate decision to pay confidence of patients and staff, and represent to be enforced that would stop this threat dead log management, IDS/IPS, etc. ransom to hackers. real financial costs in its tracks. We have seen disciplined organi- 6. Plan smartly. Update contingency plans, Right now there is a clamoring for more infor- zations achieve this, but it takes enlightened back up everything (offline), and think of the What is not unfair mation on the threat. This always happens right leadership and investment. worst case in exercises. after an event like this, and then fades with time, We may never know the specifics of the Hol- 7. Be ready. Establish external support rela- to ask is: How ready as does the attention to the problem, but the lywood Presbyterian Medical Center incident tionships, acquire tools, conduct simulations threat doesn’t go away. This is a persistent issue, ― organizations, for good reason, are reluctant and practice for a real event. was it for this requiring a persistent solution. Ransomware is to discuss those things. What I do hope is 8. Be objective. Use independent third par- not new ― it has been around since at least 2009, that the CEO of that hospital will find a way ties to perform regular readiness audits, test- situation? which just happens to coincide with meaningful to share with his or her counterparts in our ing of controls and assessments. n 18 www.HealthcareITNews.com | Healthcare IT News | April 2016

CLINICAL "By creating a customized and personalized communication to patients about their care needs, healthcare providers can directly engage patients and close important gaps in care.”

Kaiser: Online tools increase likelihood Girish Navani patients will get preventative care Rates of preventive health eClinicalWorks more likely to visit providers for mammogram screenings, vaccinations remain screenings, while 6.1 percent were more likely low, according to the study than non-users to receive a Pap smear. Howev- makes big move into JESSICA DAVIS, Associate Editor er, there was no noticeable diffe ence between ATIENTS WITH ACCESS to their online online and non-registered members when it health information who received came to receiving vaccinations. acute care EHRs timely alerts about gaps in care Researchers analyzed the EHRs of 838,638 were more inclined to receive pre- Kaiser Permanente members in Southern Cali- The electronic health record vendor debuted early ventative tests and screenings compared with fornia. Around 40 percent of these members Ppatients who didn’t use the service, according use the online Patient Action Plan, or oPAP, components of new cloud-based technology at HIMSS16 to a Kaiser Permanente study published in the a Web-based system launched in 2012 that BILL SIWICKI, Managing Editor cloud computing health records is lack- American Journal of Preventative Medicine. provides access to personalized health data. CLINICALWORKS IS into the acute ing on the inpatient side,” said Girish Rates of preventive health screenings, chronic It also sends emails to members if they’re care EHR space, and it show- Navani, CEO and co-founder of eClini- disease management tasks and vaccinations in need of preventative care based on their cased early work on the new calWorks. “They also say the current around the country remain low, according to last appointments for preventative screen- technology at HIMSS16. state of acute care technology is very the study. More than 20 to 80 percent of adults ings and specific health conditions, such as Expanding on some international effo ts different from ambulatory, and that it fail to obtain the health services they need. smoking and diabetes. Edipping its toe into the acute care market, costs too much. Client/server is a very “Making sure patients receive appropriate “Our study demonstrates that by creating eClinicalWorks has entered a joint devel- rigid system that does not cater to a tests and screenings is a critical part of provid- a customized and personalized communi- opment agreement with South Carolina’s model of care delivery that requires ing high-quality healthcare, but it can be chal- cation to patients about their care needs, Tidelands Health, a three-hospital health both agility and speed. And usability is lenging and time-consuming to get patients to healthcare providers can directly engage system with more than 40 outpatient loca- a question, with many acute care prod- follow through due to a variety of reasons,” the patients and close important gaps in care, tions, to bring an acute care EHR to market. ucts looking like they were developed study’s lead author Shayna L. Henry, Kaiser particularly for preventive screenings for Named eClinicalWorks 10i, the cloud- 30 years ago.” Permanente Southern California Department cancer,” Henry said. based EHR platform will enable provider Navani said eClinicalWorks has met of Research & Evaluation, said in a statement. “Although the findings represent only a small organizations to connect care within with success on the acute care front over- The study found that 8.8 percent of patients segment of the overall KPSC membership, and inpatient, outpatient and allied health set- seas, where it launched an inpatient EHR who used an online portal were more likely to the effect sizes are modest,” the study’s authors tings, and is slated to launch in early 2017. system at 80 hospitals. receive colorectal cancer screenings than those said, “the results of the present study indicate “We’ve got a lot of ambulatory cli- “For the U.S., we’re taking an approach members who didn’t, and online users were 11.9 the oPAP has considerable potential to be a ents who use our product that believe that is very collaborative,” Navani said of percent more likely to complete their HbA1c model for cost- and resource-effective patient the way we’ve worked with them with ECW SEE PAGE 20 testing than non-users. engagement in health maintenance and disease Additionally, 9.1 percent of online users were prevention.” n

Cerner, xG Health ink population HIMSS, SIIM join to ensure com- Mass General teams with health pact, will share platforms plete electronic health records Cogito on behavioral health Cerner has announced that The Healthcare Information and Massachusetts General Hospital Geisinger Health System Management Systems Society and and MIT spin-off Cogito have subsidiary xG Health Solutions will the Society for Imaging Informatics partnered on a National Institute use Cerner’s HealtheIntent in Medicine are making progress of Mental Health-funded project population health management tackling the issues associated with aimed at addressing depression platform and, in turn, Cerner will incomplete data in patients’ digital and bipolar disorder. MGH is the use xG Health’s clinical content. health records. Founded a year ago, largest hospital in the Bay State, xG Health’s care management the HIMSS-SIIM Enterprise Imaging and serves as the teaching clinical content automates the Workgroup is focused on unmanaged hospital for Harvard Medical assessment of a variety of hereditary, socio-economic, physical, — and sometimes missing — imaging data in patients’ electronic health School. Cogito, a startup spinoff from the Massachusetts behavioral and environmental risk factors, as well as warning signs history. The group offers a platform for sharing enterprise imaging strate- Institute of Technology, specializes in behavioral analytics. “We and symptoms associated with specific conditions. Cerner clients gies, creating awareness that images are an essential part of the electronic focus on automatically measuring behavior and understanding will be able to use xG Health’s clinical content within HealtheCare, health record, inclusive of, yet broader than the more pervasive radiology behavior,” said Cogito CEO Joshua Feast. “We’re interested in Cerner’s community care management solution that provides or cardiology domains. The joint effort “provides timely resources that offer the way people move and react. On the healthcare front, Cogito algorithms with the ability to identify, stratify and prioritize organizations insights on how to manage and share imaging data across technologies are aimed at helping organizations understand, individuals for assignment to aligned care managers. the enterprise,” said Joyce Sensmeier, HIMSS vice president of informatics. manage and care for patients. VISIT US AT AAMI 2016 Conference & Expo BOOTH #606 20 CLINICAL www.HealthcareITNews.com | Healthcare IT News | April 2016 EHRs trim odds of hospital-acquired infections, adverse events: AHRQ But of more than 45,000 patients at risk for nearly 350,000 adverse events in the study sample, only 13 percent had fully electronic records

MIKE MILIARD, Editor RECENT STUDY FUNDED by Agency for Healthcare Research and Qual- ity suggests that patients with fully electronic health records experienced fewer adverse events such as hospital- acquiredA infections. In order to be considered a fully electronic EHR, “physician notes, nursing assessments, problem lists, medication lists, discharge summaries and provider orders are electroni- cally generated,” according to researchers. Using 2012 and 2013 Medicare Patient Safe- ty Monitoring System data, AHRQ examined outcomes for cardiovascular, pneumonia and surgery patients ― specifically with regard to occurrence rates of 21 adverse events in four clinical domains: hospital-acquired infections, Patients hospitalized for pneumonia and adverse drug events, general events (falls or exposed to a fully electronic EHR had 35 pressure ulcers, for instance) and post-pro- percent lower odds of adverse drug events, cedural events. 34 percent lower odds of hospital-acquired “To assess the role of EHRs in preventing infections, and 25 percent lower odds of adverse events, the researchers measured to general events, according to AHRQ. what extent care received by patients in the 1,351 hospitals was captured by a fully electronic EHR,” said Amy Helwig, MD, depu- EHRs, meanwhile, had 17 to 30 percent lower Adverse Events” suggest hospitals with EHRs percent fewer general events,” they wrote. ty director of AHRQ’s Center for Quality odds of any adverse event. can offer more coordinated care from admis- Helwig and Lomotan caution that the Improvement and Patient Safety, and Edwin Helwig and Lomotan said that health IT has sion to discharge to reduce the risk of patient AHRQ study raises a few questions. Lomotan, MD, medical office and chief of shown patient safety gains, but research to harm. “The findings showed a significant rela- clinical informatics at AHRQ’s Center for prove it has often looked at just one healthcare They note, however, that adverse event tionship between fully electronic EHRs and Evidence and Practice Improvement, in a provider at a time. odds varied by medical condition and type adverse drug event rates for patients hospital- blog post. “A question that remains unanswered is of event. ized with pneumonia, but not for those with The findings of the study, published in the impact of fully installed electronic health “For example, patients hospitalized for cardiovascular disease or needing surgery,” the Journal of Patient Safety, show that, of records systems used in multiple organiza- pneumonia and exposed to a fully electronic they wrote. “This may be due to the fact that more than 45,000 patients at risk for nearly tions,” they wrote. “Another big question: Can EHR had 35 percent lower odds of adverse certain high-alert medications, such as opi- 350,000 adverse events in the study sample, EHRs go beyond improving safety-related pro- drug events, 34 percent lower odds of hospi- oids, which are often associated with adverse 13 percent were exposed to fully electronic cesses to actually preventing adverse events, tal-acquired infections, and 25 percent lower drug events, were not included in the MPSMS health records. such as potentially deadly hospital-acquired odds of general events. Among patients hos- measures.” Among all patients examined in the study, infections, from reaching patients?” pitalized for cardiovascular surgery, a fully Still, the authors said as more hospitals the occurrence rate of adverse events was 2.3 The findings from “Electronic Health electronic EHR was associated with 31 percent mature in their use of EHRs, those systems can percent, or 7,820 adverse events. Patients with Record Adoption and Rates of In-hospital lower odds of post-procedural events and 21 play a key role in preventing adverse events. n

ECW product that is in the works at HIMSS.” which will provide one continuous patient enhances patient care.” CONTINUED FROM PAGE 18 For its part, Tidelands Health, an ambu- record for inpatient and outpatient, in 2017. IDC Health Insights research director the agreement with Tidelands Health before latory EHR client of eClinicalWorks since For example, under OneCare, our internal Judy Hanover said that eClinicalWorks HIMSS16 took place. “We’re engaging with 2009, is excited to be able to have such name for the system, an emergency room innovation in the ambulatory fray signals staff throughout the entire ecosystem, from input into the creation of an acute care EHR. physician calling up a patient record will see potential to offer those technologies in the every inpatient department, from OR to ER “We’ve seen the prototypes and are very the most comprehensive and current medical acute care space. to rehab ― everyone is participating in the pleased,” Tidelands CIO Todd Rowland, MD, record from that patient’s primary care and “It is quite clear from IDC’s research that design sessions with us. We’ll showcase the added. “We’ll be going live with the system, specialist physicians ― in contrast to what there is opportunity for innovation in acute an ER physician has today, which maybe is care EHR, particularly as existing products information on the last time the patient was do not deliver on the need for flexible eClinicalWorks co-founder and in the ER, which is not very helpful.” mobile workflows, do not offer significant On another front, Rowland added that 50 improvements to provider productivity or CEO Girish Navani said the percent of Medicare payments by 2018 will operational efficiency, and fail to deliver be made using performance-based mecha- value for cost,” Hanover said. company has met with success on nisms, and that many other payers are fol- EHR vendors that are able to leverage lowing suit. “Our current IT systems are not the cloud to deliver resilient applications the acute care front overseas, capable of dealing with this,” Rowland said. with superior fl xibility, usability, mobil- where it launched an inpatient “eClinicalWorks has shown a shared com- ity, performance and cost of ownership will mitment to the OneCare approach, which certainly find opportunity in acute care, EHR system at 80 hospitals. will cost-effectively deliver a solution that Hanover added. n April 2016 | Healthcare IT News | www.HealthcareITNews.com CLINICAL 21 EHR notification overload is costing doctors an hour each workday, JAMA says Primary care doctors amounts of notifications in EHR- "Information overload is of concern are subject to twice as based inboxes such because new types of notifications and ‘FYI as Epic’s In-Basket messages can be easily created in the EHR," according to Baylor University researchers. many notifications as and General Elec- tric Centricity’s specialists, Documents. The messages include researchers found, but test results, both are facing responses to refer- rals, requests for information overload medication refills, and messages from JACK MCCARTHY, Contributing Writer physicians and RIMARY CARE doctors now lose other healthcare more than an hour a day to sort- professionals. ing through approximately 77 elec- The system is cry- P tronic health record notifications ing out for change researchers at Baylor University found. the researchers "Information overload is of concern wrote. "Strategies because new types of notifications and to help filter mes- ‘FYI’ (for your information) messages can sages relevant to be easily created in the EHR (vs in a paper- high-quality care, EHR designs that support unintended consequences of EHRs," Joseph unnecessary burden on physicians. based system)," the researchers wrote in team-based care, and staffing models that Ross, MD wrote in an editorial accompany- In addition, doctors should be reim- the Journal of the American Medical Asso- assist physicians in managing this influx of ing the research. bursed for time spent reviewing EHR ciation Internal Medicine. information are needed." In fact, electronic "paperwork" has bur- notifications. Making the workload harder to endure, What’s more, optimistic predictions that dened doctors and reduced the time for "Although many of these notifications are reading and processing these messages EHRs would improve patient care through patient care. in the service of patients," Ross wrote, "we is uncompensated in an environment of better doctor-patient communications have Ross advocated that inbox notification need to be sure that physicians’ reimburse- reduced reimbursements for office-based not ubiquitously materialized. capabilities be periodically reviewed to be ment, particularly for primary care physi- care, according to the study. "Unfortunately, we are far from this sure EHRs are working in the best inter- cians, is taking into account the full time Physicians are receiving these increasing promise and now also grapple with the ests of patient care and not creating an needed to manage patients’ care." n

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Members of the fast-growing CommonWell Health Alliance gathered at HIMSS16 in March.

IBM Watson buys Truven Health Analytics

COURTESY, COMMONWELL HEALTH ALLIANCE COMMONWELL HEALTH COURTESY, for $2.6 billion Execs say the purchase adds and government agencies. eClinicalWorks, HIMSS “With this acquisition, IBM will be one a massive repository of data of the world’s leading health data, analyt- to the Watson Health Cloud, ics and insights companies, and the only among 7 new organizations and an extensive client roster one that can deliver the unique cognitive capabilities of the Watson platform,” Debo- joining CommonWell BERNIE MONEGAIN, Editor-at-Large rah DiSanzo, general manager for Watson BM ANNOUNCED in February that it will Health, said in a press statement announcing MIKE MILIARD, Editor practices and ambulatory sites. pay $2.6 billion to acquire Truven Health the pending deal. HE COMMONWELL HEALTH Alli- Other general members include Imag- Analytics for its Watson Health unit. She added that Truven’s offerings would ance has signed on one of the eTrend, maker of Web-based emergen- I The buy will mark IBM’s fourth major complement Watson Health’s broad-based biggest ambulatory electronic cy response and health information acquisition for Watson Health, a strategic team, capabilities and offerings and would T health record vendors, the top exchange technology, and Mana Health, move designed to boost IBM’s capabilities help Watson Health to scale globally to help healthcare IT advocacy organization, an a platform-as-a-service that links patient in the emerging field of value-based ca e. clients apply cognitive insights in a value- image-sharing network and others to the data from EHRs, apps and devices. IBM executives say the purchase adds not based care environment. private-sector interoperability group. “The diversity in our membership is only a massive repository of health data to the Today, Truven provides cloud-based health- eClinicalWorks, a cloud-based EHR representative of our commitment to Watson Health Cloud, but also an extensive care data, analytics and insights to more than used by more than 115,000 physicians, reach the full continuum of care and to client roster to IBM’s Watson Health unit. 8,500 clients, including U.S. federal and state

has joined CommonWell as a contributor help ensure pertinent patient informa- The deal is projected to close later this government agencies, employers, health plans, ALLIANCE COMMONWELL HEALTH COURTESY, member and will commit to offering its tion is available to patients and caregiv- year, subject to satisfaction of customary hospitals, clinicians and life sciences compa- interoperability services to its customers. ers regardless of where care occurred,” closing conditions and applicable regula- nies. Data and insights from Truven inform HIMSS, the global nonprofit organiza- said Jitin Asnaani, executive director of tory reviews. benefit decisions for 1 in 3 Americans tion focused on improving health through CommonWell Health Alliance. Truven brings hundreds of types of cost, Just about a year ago, at HIMSS15, IBM information technology, will also join Com- The addition of Westborough, Massa- claims, and quality and outcomes data. Once acquired population health company Phytel, monWell as a general member. chusetts-based eClinicalWorks – with some integrated into the Watson Health Cloud, cloud-based intelligence company Explo- Other new contributor members include 70,000 facilities running its technology is per- that information can be leveraged to deliver rys and medical imaging company Merge lifeIMAGE, a medical image sharing net- haps the biggest EHR get for CommonWell insights-as-a-service based on IBM’s data Healthcare. IBM has also compiled a roster work with 150,000 users and 1.5 billion since MEDITECH signed on in April 2015. repository that will now top approximately of partners and clients that include Apple, exams exchanged; MediPortal, a developer CommonWell official say alliance mem- 300 million patients. Medtronic, Johnson & Johnson, Teva Phar- of patient engagement tools; and Modern- bers represent 72 percent of the hospital The deal nearly doubles Watson Health’s maceuticals, Novo Nordisk, and CVS Health. izing Medicine, whose clinical and fina - EHR market and 34 percent of the ambula- worldwide footprint and brings to IBM With the acquisition of Truven, the cial technology is geared toward physician tory EHR market. n Watson Truven’s marquee roster of clients – employee number for the Watson Health unit which spans life sciences, providers, payers will total more than 5,000. n

ONC proposes direct review UPMC invests in Vivify CPSI launches EHR financin of health IT certification population health technology program for hospitals, nursing Health IT products will be certified UPMC Enterprises, the commercial arm Newly expanded health IT vendor directly by the Office of the National of the Pittsburgh-based UPMC health CPSI has introduced nTrust, a program Coordinator under a proposed rule system, has become both a customer designed to help community hospitals change, officials announced in the and an investor of Vivify Health, a Plano, and skilled nursing facilities improve National Coordinator Spotlight ses- Texas-based company that promises to financial operations while moving into sion March 1 at HIMSS16. Senior break down the walls when it comes an electronic health records system with members of the ONC described to delivering care. Neither UPMC nor no upfront costs. Through nTrust, hospi- the change as necessary to make Vivify would disclose how much UPMC tals and senior care facilities outsource sure that medical record sharing invested in the company. Vivify Health’s revenue cycle management operations to TruBridge business services, which becomes a reality. The proposed rules will enable ONC to “directly technology is in play at some of the largest health systems in the country. The recently has been strengthened by the addition of revenue cycle management review certified health IT products, including certified electronic health technology is deployed by 500 hospitals and payer organizations to manage, tools from Rycan Technologies, CPSI officials said. “There are many providers records systems, and take necessary action to address circumstances monitor and engage patient populations of all sizes and risk levels, execu- that are unhappy with their EHR, but they don’t have the financial capability to such as potential risks to public health and safety.” Comments are due tives said. “Health plans and providers are laser focused on population health make a switch,” said Boyd Douglas, CPSI president and CEO. “With nTrust, we by May 2, 2016. Medical records should be able “to speak and listen in management right now, but they’re struggling to take the vital step of engaging help providers in acute and post-acute settings improve business operations” the same language,” said Elise Adams, acting director of policy at ONC. patients in a way that makes it easy for patients,” said Eric Rock, CEO of Vivify. while “funding the purchase of their EHR with no advance payment required.” T:10.625" S:9.625" © 2016 Optum, Inc. Inc. Optum, © 2016 © 2016 Optum, Inc. Inc. Optum, © 2016

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optum.com/healthier 24 BUSINESS www.HealthcareITNews.com | Healthcare IT News | April 2016 Population health, patient engagement top healthcare purchasing plans in 2016 Jensen in the report. “It’s really no surprise Report also claims 23 these two segments continue to lead the way among hospital IT upgrades considering their percent of healthcare impact on successful migration to value-based organizations are care and value-based purchasing.” As for pop health, peer60 sees some stabi- planning to look for new lization in contracting plans. In 2015, roughly 25 percent of providers were certain they’d EHR vendors in 2016 keep their population health vendor; in 2016, that amount has doubled. MIKE MILIARD, Editor “The pressure is on for vendors that have not EALTHCARE ORGANIZATIONS are already made their mark in this market because making big investments in popu- they’re about to be squeezed by increasing lation health and patient engage- renewal rates and a declining pool of hospitals H ment platforms as they prepare to that have not already adopted,” said Jensen. move past meaningful use and toward value- But when it comes to patient engagement, based reimbursement, according to “The Big authors see the opposite. “More enterprise Mega HIT Purchasing Report,” released Feb. vendors are capturing more of the minds of 22 by market research firm peer6 . providers, while interest in the best of breed Electronic health records remain core to crowd is beginning to dwindle,” Jensen said. healthcare IT, according to the report, which Other big purchasing trends are also unsur- gathered 567 responses from CEOs, CIOs, prising. Data security, enterprise analytics nursing and financial leaders and others with and revenue cycle management are all in play. purchasing authority at hospitals and medical Security technology, especially, has seen a big practices. However, many customers are still jump in provider interest. dissatisfied ith their products. “In 2015 it was at the bottom of the list of Projected EHR replacement rates for 2016 top IT priorities and placed third this year,” Electronic health records remain core to show 23 percent of health providers (inpa- said Jensen. “Since this is not a growth mar- tient and outpatient combined) planning to ket with 90 percent of hospitals already healthcare, according to “The Big Mega HIT look for new vendors, according to peer60. employing a true data security solution, the Still, “population health and patient engage- jump in interest in this area likely means the Purchasing Report.” But many customers are ment are the hottest areas by a wide margin,” replacement market for more robust solutions wrote peer60 executive vice president Chris in this very critical segment is heating up.” n still dissatisfied with their products Mount Sinai Health forms ACO with Aetna

The New York provider aggressively toward population health,” already has ACO Niyum Gandhi, chief population health officer, Mount Sinai Health System, said. “Our arrangements with the strategy is toward moving into savings for all. When the opportunity came about, that CMS, Healthfirst and aligned incentives around keeping patients healthier – we jumped on it.” Empire Blue Cross Currently, Mount Sinai has ACO arrange- Blue Shield ments with the Centers for Medicare and Medicaid Services, Healthfirst and Empire, JESSICA DAVIS, Associate Editor as well as similar contracts in the works OUNT SINAI HEALTH PARTNERS – a that will be made official throughout the network made up of the Mount coming year. Mount Sinai hopes to have Sinai Health System and a vol- these arrangements with every insurer in its M untary provider group – has cre- system. ated an accountable care organization with “Our goal here is align our incentives Aetna, the companies announced Feb. 16. across all payers,” Gandhi said. “We’re The three-year agreement will allow Aetna arranging resources to keep patients healthy commercial plan members who receive care and out of the hospital. This allows us to at Mount Sinai to benefit from quality and align the reward model to reap the benefits. cost efficienc improvements from the pro- The agreement includes the more than gram and establishes a new payment model 3,100 Mount Sinai employees and affiliat that will reward physicians for meeting physicians. Aetna provides benefits to more established quality measures. than 1.1 million members in New York. The partnership is just another step in “Our new agreement with Mount Sinai Mount Sinai’s strategy to improve care puts consumers at the center of a health care delivery from traditional fee-for-service system that promotes wellness, provides bet- models into population health management, ter care for chronic conditions and uses eco- by working with health plans like Aetna to nomic incentives to reward positive health improve care value for both the patients and outcomes,” David Kobus, Aetna senior vice providers. president, New York market, said in a state- “As a health system, we’re moving ment. n EXAMINE THE HEALTH OF YOUR DATA CENTER TRUST PC CONNECTION, INC. FOR CONVERGED DATA CENTER SOLUTIONS

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©2015 PC Connection, Inc. All rights reserved. PC Connection, GovConnection and MoreDirect are trademarks of PC Connection, Inc. or its subsidiaries. All copyrights and trademarks remain the property of their respective owners. C291008 1115 26 www.HealthcareITNews.com | Healthcare IT News | April 2016 DATA “Encouraging innovators to develop apps that work across existing health records can help the industry advance the way care is delivered through improved interoperability capabilities,” said Cerner’s David McCallie, MD.

Michigan HIE gives $250K to Cerner launches open buoy healthcare infrastructure platform to spur around Flint for water crisis Collaboration with Greater Flint who will require intensive treatments dur- development for SMART ing the course of their lives. The United Way Health Coalition hopes to improve of Genesee County has already launched a on FHIR apps health IT infrastructure, long-term $100 million fundraising campaign for medical treatments for up to 15 years. Launches its new Cerner Open Developer Experience to spur care coordination goals in the area GLHC believes data exchange among all JESSICA DAVIS, Associate Editor providers will improve communication for wider collaboration with third-party and client developers ICHIGAN HEALTH INFORMATION more accurate, secure and timely care. Addi- MIKE MILIARD, Editor opers and help further health information exchange Great Lakes Health tionally, the partnership with Greater Flint ERNER HAS LAUNCHED its new technology,” said David McCallie, MD, Connect is investing $250,000 Health Coalition will facilitate better care Cerner Open Developer Expe- senior vice president, medical informat- M to lay the groundwork for better response for tracking lead exposure. rience ― known as “code_” ― in ics, at Cerner, in a statement. care coordination among healthcare provid- “This integrated network of providers C a bid to spur wider collabora- “Encouraging innovators to develop ers across Genesee County to better prepare holds the potential for establishing the great- tion with third-party and client develop- apps that work across existing health them for the long-term health effects likely er Flint region as the benchmark model for ers for SMART on FHIR applications. records can help the industry advance the to stem from the ongoing Flint water crisis. a care-connected community in the United SMART on FHIR tools run on top of way care is delivered through improved GLHC will partner with Greater Flint States ― a virtual environment where informa- electronic health records, giving physi- interoperability capabilities,” he added. Health Coalition to connect dozens of medi- tion can be shared quickly among healthcare cians access to the apps from within their Fifteen new SMART on FHIR apps are cal practices and improve analytics capa- providers, leading to more effectiv , efficien workflo , enabling them to more easily in development or in production and were bilities to address some of the looming care healthcare services,” Bres said. interact with health data. showcased in Cerner booth at HIMSS16, requirements for those patients contaminated $100,000 will be earmarked to create the Developers who visit code.cerner.com can which took place Feb. 29 to March 4, at by lead in the water supply. Community Interface Grant to pay for the infra- begin coding immediately with the SMART Sands Expo Center in Las Vegas. The organization hopes to “give those structure necessary to connect 40 physician on FHIR tools and browse current apps that “Fostering new ideas from the developer responding to the healthcare needs of Flint’s office across the county, say GLHC official are available or in development. Cerner offi- community enables us to reach a broader residents the tools needed to coordinate care while $90,000 is set for a dedicated implemen- cials say code_ is designed with open com- market of potential users,” said Bob Robke, and positively impact the health and well-being tation consultant to coordinate the program. munications and robust API documentation Cerner’s vice president of interoperability, of Flint’s citizens over the long term,” said Tom Another $50,000 will back an analyt- in mind, meant to offer access to tools that noting that the platform “has potential to Bres, GLHC board chair, in a statement. ics engine for improved communications enable innovative app development. unlock the next cutting-edge solution that More than 420,000 Flint residents have and data analysis for the coming years, and “Cerner is committed to taking a lead- could benefit not only our entire client been exposed to water contaminated by $10,000 will establish a grant to train all ership role to support third-party devel- base, but the industry as well.” n lead, including 6,000 to 12,000 children ― involved with the program. n

Providers protect wrong data, CSF certification could reduce Oracle debuts next-gen putting patient health at risk cyber insurance costs analytics suite at HIMSS16 Too many healthcare organizations The Health Information Trust Alli- IT giant Oracle unveiled its Oracle are focused on securing the wrong ance has joined with insurance Healthcare Foundation March 1 at assets, leaving them vulnerable to broker Willis Towers Watson for HIMSS16, a next-generation ver- cyberattacks and putting patients a new program that could enable sion of Oracle Enterprise Healthcare at risk, a new report from Indepen- providers and vendors certified Analytics, which provides healthcare dent Survey Evaluators claims. When under HITRUST Common Security organizations with a consistent and healthcare leaders focus primarily on Framework to save on insurance complete patient-centric view of their protecting patient data, they often fail premiums. The two groups have clinical, financial and genomics data to address actual cybersecurity threats worked together to educate cyber across an enterprise. The modular that directly affect patient health, the report said. ISE studied 12 healthcare insurers about HITRUST CSF, and data integration and analytics system is designed to help various types organizations, two healthcare data facilities, two active medical devices, to encourage them to consider it of professionals throughout an organization study clinical care, per- two Web applications and other devices found on healthcare networks during the cyber risk underwriting process. They said that CSF’s form financial analyses, streamline administrative services and support over the course of two years to determine the possibility of remote attacks comprehensive controls framework, which aims to accurately and research efforts. The aim of Oracle Healthcare Foundation is to enable an and the readiness of these institutions to keep data secure. “We found consistently measure residual cyber risk, has shown some appeal entire healthcare organization to treat each patient with a personal touch hospitals were antiquated in their network designs and unsure about the to insurers looking to cover healthcare organizations operating in a while achieving high-quality, value-based care in an operationally effi- technologies that could effectively help them,” the study’s authors said. fraught cybersecurity threat environment. cient environment, the vendor said.help them,” the study’s authors said. ADVANCED SOLUTIONS for Healthcare

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“The big surprise for us in this survey IT managers are hacking is that the gatekeepers are really the gatecrashers,” said Stephen Midgley, vice president of global marketing for their own systems, even in Absolute. healthcare, survey finds A high percentage of IT also be worthwhile to consider third-party workers admit to not following audits to ensure adherence with corporate the same security protocols security policies.” IT decision-makers bear the brunt of they are expected to enforce responsibility. Of those surveyed, 78 percent BERNIE MONEGAIN, Editor-at-Large said the organization’s security is primarily HIGH PERCENTAGE OF IT workers IT’s responsibility. The report also showed admit to not following the same that 65 percent of IT decision makers believe security protocols they are expect- they would likely lose their job in the event A ed to enforce, according to a new of a security breach. survey conducted across the United States by “The gaps in current data breach response Absolute, a Canadian security firm plans and in upholding general best practice In fact, 33 percent admitted to successfully policies must be addressed,” Midgley said. hacking their own or another organization, As he sees it, when it comes to security and 45 percent admitted to knowingly cir- ― especially in healthcare, but also in other cumventing their own organization’s secu- sectors ― there’s an accountability divide. rity policies. “That is a very precarious space for IT to “The big surprise for us in this survey is be in,” Midgley said. “They are tasked with that the gatekeepers are really the gatecrash- data security, but aren’t actually responsible ers,” said Stephen Midgley, vice president for the device that contains that data.” of global marketing for Absolute. Moreover, “I think in healthcare it’s magnified,” he he said, while the survey of IT department added, “because of HIPAA, HITECH, PHI. managers included several industries, the So, you can have all the security in place, findings apply across the board, with health- but at the end of the day, IT is reliant on the care no exception. employee to ensure security is implemented gives them complete visibility and control said. “It’s mitigating the risk of a data breach.” “Given that IT is the security gatekeeper correctly. Yet, what we find is those very same of the devices. The survey ― which polled 501 U.S. adults for an organization, it was alarming to see employees try to find ways to circumvent the Midgley mentioned the example of one who work in information security manage- such high incidents of noncompliant behav- security policies that have been put in place.” healthcare entity that has a policy of auto- ment roles in companies or organizations ior by IT personnel,” he said. “Even if these There’s a lot of work for IT in terms of matically wiping data from any device ― lap- with 50 or more employees ― found that secu- actions are being performed to validate exist- bridging that gap, he said, and recommend- top, tablet or phone ― that goes beyond a rity remains at the top of the IT spending ing infrastructure, senior leadership should ed that organizations implement technology certain location. list, with 87 percent of respondents expecting be aware that this activity is occurring. It may that is adapted to their environment that “They assume that device has PHI on it,” he increased investment in security this year. n & PRESENT Continuum of Care News

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BY MIKE MILIARD, Editor for Medicare and Medicaid Services Admin- Rakesh Mathew, program manager at T HIMSS16 this past month, “interop- istrator Andy Slavitt said patience is wear- HealthShare Exchange of Southeastern erability” was a word heard once ing thin. There are too many excuses thrown Pennsylvania, explains how the HIE set or twice. From policy makers to IT around for lack of interoperability, he said. up an international exchange with Italy during the Pope’s visit to Pbiladelphia. professionals, doctors to vendors, “The companies that live up to their the term was repeated like a mantra. But how commitments here will be recognized and close,A after all this time and talk, are we to applauded,” he said. “And I strongly encour- really getting there? age you to recognize those that don’t.” There was some encouraging news out of Las National Coordinator Karen DeSalvo, MD, Vegas. HHS Secretary Sylvia Burwell announced echoed the call: “The most recurring themes I that health IT heavy-hitters representing hear from consumers is they want their data some 90 percent of electronic health records to be free,” she said. (Cerner, Epic and MEDITECH among them) had pledged – along with some of the largest STANDARDS ON DISPLAY health systems in the country – to commit to One of the most encouraging demonstra- using standardized APIs, forswearing informa- tions of that data liberation was the HIMSS tion blocking and making patient access easier. Interoperability Showcase, which for years And on both the private and public-sector has offe ed technology vendors, HIEs and As Robert is transported to the emergency technician Zach McQuiston. sides, there were promising advancements others the chance to show secure and stan- department, paramedics stabilize him and The journey starts in St. Louis, where Rob- announced at HIMSS16. For instance, CHIME dards-based interoperability in real-time, in gather clinical data that’s communicated to the ert is treated for diabetes at a MEDITECH- Board Chair Marc Probst, chief informa- the real world. ED. Clinicians at the hospital are also able to equipped community hospital. “We see that his tion officer at Intermountain Healthcare, This years’s showcase featured more than a gain access to his historical medical data once condition is a bit more serious than expected, so announced that CHIME’s the $1 million dozen use case scenarios simulating continuity he arrives. A summary of his care is shared with we eventually admit him,” explains MEDITECH National Patient ID Challenge, launched in of care in multiple diffe ent settings: ambulatory, his care providers in St. Louis and also in Italy. Senior Project Coordinator Joe Wall. “Eventu- January, has already signed on more than 170 hospital, emergency, chronic care, public health EHR vendors Epic and MEDITECH took part ally when the patient is discharged, we generate innovators to solve the “vexing problem” of and more. One demo, called “911 Continuity of in the demonstration. So did Surescripts, Zoll the continuity of care document,” using HL7’s cross-system patient matching. Care,” showed how IHE and HL7 specification (developer of emergency medical services tech- Consolidated CDA standard. The Offic of the National Coordinator for could enable IT systems of all types to talk to nology) and HealthShare Exchange of South- It’s an example, he said, of “leveraging work Health IT, meanwhile launched an Interoper- each other – across the U.S. and even abroad. eastern Pennsylvania, or HSX, the region’s we’ve been doing with the Argonaut Project” – a ability Proving Ground for FHIR, Consolidated The imaginary scenario concerned one health information exchange. collaborative of major EHR vendors and health CDA, eHealth Exchange, Direct, the Semantic “Robert Hartman,” a 40-year-old male who’s It showed the promise of seamless data systems to speed the development and adop- Interoperability Framework and more, and an Italian citizen visiting the U.S. In St. Louis, exchange – from the ambulance to the ED, from tion of HL7’s FHIR framework – “with all of us proposed direct review of IT certification with he receives care at a community hospital for one the primary care offi , to the HIE and back. playing in the same sandbox.” an eye toward improved interoperability. of his chronic conditions. Later, while visiting “At every place along the way, you can use All the discharge packet information gets Still, there’s much more work to be done. Philadelphia to see the Pope this past Septem- interoperability standards to get the outside put into the continuity of care document on the And in a prime time keynote, Acting Centers ber, he is in a car accident. data and take care of Robert better,” said Epic MEDITECH side. Since everything is structured,

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“we’re able to display right on the Epic side,” lookup and the PLQ patient location query, McQuiston. “Now Robert’s data followed said Wall. “On the ambulance side, they’ll cap- onto other IHE-connected participants. These you can see all the him everywhere he went ture additional information so that will be avail- might be other hospitals, clinics or technology external data I’ve on his trip to the U.S. able for the ED as well.” vendors who are connected to our network. received. I have During transport, paramedics interview Rob- Second, we’re going to take a look at our own the MEDITECH ert and learn he has hypertension, for which he master patient index, which contains 140 mil- information that takes medication. They assess his head lacera- lion patients and that number is ever-increasing. Surescripts told tion and examine him for neurological symp- “By doing this we’ve identified two instances me about. I can see toms and take his vitals. They document the where Robert has received care during his trav- the information treatment rendered: oxygen, lead monitoring, els across the U.S.,” he said. “We’re able to com- returned to me by fluids, wound care. At the end of the ambulance pile those locations into a patient care CDA that the HIE, the Italian ride, they document that he was transferred to we then send back to Epic via the IHE profil system. Because this an emergency department. so that can be presented at the point of care. is standards-based When the record is complete, it’s packaged “Lastly, with the IHE profiles, we’re adapt- structured data I into an HL7 CDA patient care report. When ing them to the HL7 FHIR resources so we can also interact Robert arrives in the hospital ED – which uses can communicate with Robert’s hometown with it – so as I go Epic – care providers there already have the pre- of St. Louis, where he receives primary care through and review liminary information they need. for his chronic disease management. So we’re the information I “I open this chart and can see I don’t know translating the IHE transactions into the FHIR can see that Robert anything about this patient,” said Epic’s resources so we can query the MEDITECH sys- is allergic to morphine and penicillin; he’s also walls of a demonstration pavilion. McQuiston. “He’s never been here before, he’s tem and pull the CCD that was compiled at diabetic and suffers f om hypertension.” “It all looks great here,” said DePalo. from out of state. But what I do have is this the outset of this demo from the urgent care Thanks to all of this outside information, “I’m “But the uptake of some of this stuff is not information here that Zoll has captured. All visit. We’re then taking that CCD and adapt- able to take really good care of Robert,” he as large scale as we make it appear. If you the information that they documented I have ing it back into the IHE profiles to send back said. “I can avoid aggravating his allergies went to 10 different places, maybe three right in my normal workflow in Epic: I can see to Epic at the point of care so the provider can and I can release him in just a couple days. would have this technology. Or one has the concussion, can see my patient is diabetic, make the most important clinical devisions.” He makes a really quick recovery.” it, but the next part your healthcare sys- and a lot of other things.” Meanwhile, Rakesh Mathew, program man- During the discharge process, “the docu- tem doesn’t, so you really can’t exchange As Robert is being cared for, the ED staff is ager at Philadelphia’s HealthShare Exchange, mentation I’ve done in the ED is going to be anything. also able to query Surescripts’ record locator explains how, during the the papal visit, the packaged up in a CDA discharge summary “It isn’t about the technology, it’s the service in an effort to learn more about him; HIE set up an international exchange with – standards-based, with discrete data – and uptake of that technology,” he added. “The meanwhile, they can also check in with Philadel- Italy – one of the first times an HIE in the sent back to the his primary care provider and technology is growing, for sure – how could phia’s health information exchange to see what U.S. has set up an international exchange to to the HIE so it might be available to other it not? But they’re creating more than peo- else they might find out receive clinical data from other countries. people who might treat Robert in the future.” ple are actually using.” “All of these transactions are standards-based “We’ve received a CCDA document from It’s all very impressive, to be sure. And Thankfully, we appear to be at an pivot IHE transactions; they are all being piloted or Robert, and we share that with Epic.” encouraging. The key now, said Philip point that could see these advances pro- are live,” said McQuiston. Back in the emergency department, a look DePalo, who oversaw the HIMSS16 Interop- liferate faster than ever, said DePalo: “The “We’re going to do three diffe ent things at Robert’s chart shows that it’s now popu- erability Showcase as senior technical proj- strides we’re making on restful APIs, such with those queries,” said Surescripts’ Bryan lated with much more critical data than it ect manager, its to take these real-world as FHIR, are making it a little easier for Nelson. “First, we’re going to pass along the otherwise might have been. accomplishments and see them spread people to incorporate and to use this tech- IHE standards, the XCPD patient demographic “Before, we didn’t have anything,” said more broadly in the real-world, beyond the nology on a cheaper budget.” n

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Visit www.HIEWatch.com 32 TRENDS www.HealthcareITNews.com | Healthcare IT News | April 2016 Better clinical decision support one to 10, I’d give it a three or four. But there “When you’re making decisions and putting data in is great movement around improving it, so front of patients, they are as we’re optimistic.” important to CDS as doctor The keys to optimizing clinical decision is – both parties have to be support are three levels that Sanders calls involved,” says Dale Sanders the “Three P’s – population, protocol and of Health Catalyst. patient.” Each level has its own self-contained purpose, but together they coalesce into an effective p ogram. “When you’re making decisions and putting data in front of patients, they are as important to CDS as doctor is – both parties have to be involved,” Sanders said. “The decisions you make about clinical care and strategy at the population level is a diffe - ent skill set, diffe ent strategy and diffe ent method than at the patient level. “The next level down is the protocol level, where you narrow the number of patients affected. Within the population, it is about developing specifics for clinical protocols of a certain type – the temporal dimension of decision making, measured in months and ‘THREE PS’ NEEDED FOR – namely, when a critical care decision has “The traditional definition of CDS is what weeks. The final tip is delivering to the per- to be made. It is not a new concept, and you can do within the electronic health sonalized level for the patient.” CDS IMPROVEMENT. the healthcare industry certainly has the record to support better decisions,” said In grading the industry based on his “three JOHN ANDREWS, Contributing Editor technology available to make it work at an Dale Sanders, senior vice president of Salt p’s” benchmark, Sanders says effo ts at the LINICAL DECISION support is optimal level. Lake City-based Health Catalyst. protocol and population levels get “pass- designed to deliver the most rel- Still, there is room for improvement on “You have spots of innovation in some ing grades” due to increased emphasis on evant patient data to the physi- both the provider and vendor ends, say spe- areas, but as an industry CDS at the EHR making them better. However, he imposes C cian at the time it is most needed cialists in the CDS field level is really bad,” he said. “On a scale of “a failing grade” at the patient level due to HIMSS Media 2016 Spring Events Solutions. Innovation. Insight.

Playing to Win Patient Engagement • Care Patient Generated Health Data From Big Data to in the Cyber Era Coordination • Data & Analytics Smarter Care The MobiHealthNews 2016 There’s no sugarcoating Dig deeper than ever into data event will feature a Translate data into it – In healthcare privacy and analytics, care coordination, series of presentations real dollars and make and security, if you don’t and patient engagement – the and panels focused a measurable impact have the fundamentals cornerstones of a successful on patient generated on clinical care. Through covered, you’re not doing population health strategy. Come health data and remote healthcare-focused your job. Join us for two hear case studies, thought care initiatives from insights, successes action-packed days, leadership and best practices from innovative healthcare and lessons learned, and learn the fundamental leading healthcare institutions who providers, payers, discover the most effective best practices you’ll need have worked through some of pop and pharmaceutical paths forward to conquer to protect your health’s biggest challenges and walk companies. the transition to organization’s data assets away with actionable strategies you value-based care. and intellectual property. can carry back to your organization.

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HIMSSMedia.com/2016Events April 2016 | Healthcare IT News | www.HealthcareITNews.com TRENDS 33 needed for value-based care “a lack of vision, priority and leadership” “A patient can show signs of something to HITECH Act requirements. ous entries. “They might be used to examine a around the topic. wrong, but that is very diffe ent than a tan- Allan Ridings, senior risk management patient’s medical history in conjunction with gible outcome,” he said. “What we do is and patient safety specialist with the Coop- reliable clinical research,” Ridings said. EXTRACTING ACTIONABLE DATA combine various symptoms and vital signs, erative of American Physicians concedes that Whichever system they decide upon, The machinery is in place for deploying CDS, and through analysis correlate the historical there have been “trust issues” with CDS in physicians need to make reducing risk and but the industry has faced various obstacles value and combine it into a single decision.” the physician community, which is why the maximizing patient safety their highest pri- in getting it up to speed, says Foad Dabiri, Technology has advanced to the point sector is not as proficient in its utilization as ority, he said. chief technology office at San Francisco- where CDS should be readily utilized, but it should be. Moreover, he says EHRs evolved based Wanda. Principally, he Dabiri maintains in a backwards REPLACING THE ‘GUT’ says, the challenge has been that many provid- fashion, starting As a physician himself, David with extracting actionable er organizations with the claims Delaney, MD, chief medical offi- information from the various are still overly and financial data cer for the SAP Public Services system silos. reliant on propri- and moving to and Health Care Industries “It is getting actionable etary legacy sys- clinical diagnos- team in Newtown Square, Pa., information – what you can tems that prevent tics instead of the understands the traditional collect and record,” Dabiri said. mobile access. other way around. medical process of “using your “The question is, what informa- “The industry In looking at gut, intuition and experience” tion is the physician looking for recognizes the CDS systems, in decision making. And while and how can it be seen?” need to upgrade – physicians will some old-school docs might Having instant access to providers need to find two kinds: a still prefer that method, Del- actionable data is paramount Allan Ridings move from an in- David Delaney, MD knowledge-based Foad Dabiri aney realizes the tremendous when making decisions to keep chronic dis- network system to a cloud-based system,” he system and a data mining system. It is essential clinical advantages of CDS. ease patients from costly hospital readmis- said. “That would provide more scalability, they know the diffe ence, Ridings said. “The ability to leverage organizational sions, Dabiri said. Diagnosing the symptoms reliability and access to electronic records.” A knowledge-based system obtains patient knowledge to bring better decisions has of a homebound patient with congestive data from a result engine and “reveals all dis- been lacking in the industry,” he said. “The heart failure, for instance, requires enough SEEKING ‘KNOWLEDGE’ coveries based upon the data being enquired data also includes claims and financial data granular information so that the physician For physicians contemplating implement- upon,” he said. “This type of system is also that are needed to understand the ‘value’ in can determine if an episode such as flui ing a CDS system in their practices, there known as ITTT – ‘if this-then that’ and could value-based care. I believe we are ready to retention can be handled with a remote are some considerations they need to be used for determining drug interactions.” pivot into an era where if there is informa- intervention or if the situation is more make, such as determining what type of Data mining is based on algorithms, artificia tion available that can impact a decision, it urgent in nature. CDS is most suitable as well as adhering intelligence and machine learning from previ- must be brought to bear.” n

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PCC_116-tab 1.2h.indd 1 1/11/16 11:33 AM 34 NEW PRODUCTS www.HealthcareITNews.com | Healthcare IT News | April 2016 NEW PRODUCTS Wolters Kluwer releases which provides users access to evidence- address the need for organizations to control nected health technologies for consumers. based, peer-reviewed clinical information. costs and improve care with a centralized infor- The program provides plan participants with management platform Clinicians can access the largest collection mation management system. Clinical Archive wearable devices at no extra cost and enables of clinical resources on their mobile device, breaks down data silos, reduces storage costs them to earn up to $1,460 per year by meeting DENVER – Wolters Kluwer launched its including data from medical, surgical and and complexity, enables better data-sharing certain health goals. enterprise terminology platform to improve nursing specialties. The app boasts an intui- and eliminates costs of legacy systems’ main- health system integration, interoperability tive search function with auto suggest, search tenance and support. and analytics. Health Language Enterprise history and filters, access to full-book texts and drchrono platform now Terminology Management Platform stan- journals, guidelines, images and more, and can dardizes and normalizes clinical, claims be synced with the web application. Clinicians ZeOmega releases value- captures insurance, and administrative data to maximize stored can even earn and track continuing medical data, analytics and population health man- education credits. ClinicalKey is available in based care performance credit cards agement tools. The software includes the both Android and iOS formats. management system MOUNTAIN VIEW, LEAP Map Manager module, which sup- CA – drchrono, Inc., ports advanced clinical decisions, predictive LAS VEGAS – ZeOmega, population health man- an electronic health analytics and quality reporting to accurately New analytics platform agement technology vendor, introduced Jiva for record and practice leverage clinical and claims data. LEAP con- Performance Management, a software-as-a- management plat- tains top search algorithms, over 1 million from Iatric Systems, Inc. service system that enables healthcare organi- form, released a new clinically-curated synonyms and an updat- BOXFORD, MA – Healthcare IT company Iatric zations to quickly manage the clinical and fina - version of the software to include the electronic ed content library of 180 standard and pro- Systems, Inc. launched its new analytics solu- cial performance of their pay-for-performance photo capture and storage of patient insurance prietary terminologies to improve analytics. tion, Analytics on Demand. The platform is and readmission reduction programs across cards and credit cards, which is compatible designed to meet the needs of healthcare orga- multiple payers, including Medicare, Medicaid with the iPad, iPhone app and web portal. Phy- nizations transitioning into value-based care and commercial contracts. Jiva integrates with sicians can take a photo of the paper insurance with rapidly delivered clinical and financial data. about three dozen disparate health data sys- card with the app and move it into the drchrono MDLIVE, Zenith American The new software will help providers achieve tems, and healthcare organizations can use this platform, while patients can also complete this Solutions collaborate incentives and avoid penalties with crucial single platform to measure and manage per- process and send the data to their providers. decision-making data for both ambulatory formance across multiple populations, multiple The company executives say it’s the first and for telehealth and hospi- payers and different types of value-based care only EHR to provide fully integrated electronic TAMPA – Zenith American Solutions, Inc., a third- tal settings. contracts. The system can be deployed in just photo capture and storage of insurance cards. party benefits administrator, has signed an agree- The pre-built a few weeks and can quickly integrate claims ment with MDLIVE, a provider of integrated tele- dashboard and electronic health records data. health, medical and behavioral health services, maps data American HealthTech, to expand its capabilities to include telehealth targeted by services. The partnership will allow patients providers to track and analyze data, including UnitedHealthcare, Medtelligent launch senior round-the-clock access to board certified doctors modules for quality measures management and and therapists through MDLIVE’s Virtual Medi- reporting, meaningful use compliance, sepsis Qualcomm partner for care management system cal Office platform for medical consultations and management and readmission management. LAS VEGAS – American HealthTech joined forces treatments via phone, video conference or email. mobile wellness app with Medtelligent to offer owners and managers Through the platform, patients can have access to LAS VEGAS – UnitedHealthcare and Qualcomm, of senior care facilities a new care and manage- providers within 16 minutes of a call and can also Commvault launches clinical a 3G, 4G and next-generation wireless tech- ment system, dubbed Assisted Living Solution. be prescribed medications, as needed. nologies provider, released UnitedHealthcare The platform helps providers navigate the tech- data sharing platform Motion, a mobile health program designed to nology challenges of caring for seniors who LAS VEGAS – Commvault, an enterprise data boost wellness by linking financial incentives move across the care spectrum from assisted Elsevier launches mobile protection and information management tech- with the use of wearable devices that run on living to skilled nursing facilities and other pro- app for clinician research nology provider, through its integration with the Qualcomm Life’s 2net Platform. The idea is for vider organizations. Post-acute organization vendor Laitek, unveiled Commvault Clinical UnitedHealthcare plan participants enrolled in owners and managers can use the platform PHILADELPHIA – Elsevier, an information solu- Archive — a system designed to modernize the high-deductible health plans to improve their to provide accurate, detailed electronic care tions provider, released its mobile app version way healthcare organizations manage, migrate health and save money by encouraging daily records for seniors; the system also tackles of ClinicalKey and ClinicalKey for Nursing, and share clinical data. The platform seeks to walking, while testing and building new con- financial management and workflow tool

BENCHMARKS: Big ideas for 2016. The great EHR buying spree may be over, but hundreds of hospitals are making huge investments in new technologies for quality and efficienc . PAGE 50

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n MARCH 2016 www.HealthcareITNews.com HIMSS Media / Vol. SHOWCASE 13 No. 03 WELCOME NEW CORPORATE MEMBERS The evolution of population health Creating balance between DIAMOND YOUR patient wellness and cost savings, forward-thinking organizations are leading the Avankia Fusion PPT way with innovative management programs that are paying off. www.avankia.com www.fusionppt.com FEATURED PAGE 6 Credible Behavioral Health Next steps for MU Meaningful use is “still in Running a clean ship effect,” say CMS and With hacking attempts now www.credibleinc.com ONC, while also pointing commonplace, an FDA security toward a new program expert offers advice for basic with “flexibility” for “cyber hygiene” to keep medical innovation. PAGE 16 Bitglass Hc1.com devices safe. EDITORIAL PAGE 44 www.bitglass.com www.hc1.com

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BILL SIWICKI, Managing Editor DVANCED DEGREES and credentials literally pay off for health IT professionals. Additional credentials A such as certifications, in fact, roughly double the chances professionals have of earning an annual salary greater than $130,000, according to a new survey from the University of South Florida Morsani College of Medicine, Bisk Education and HIMSS. While 29 percent of survey respondents said they make more than $130,000 annually, only 12 percent without credentials rank in that category. Women lead in the realm of furthering education, with 232 reporting additional credentials compared with 150 male survey respondents, the survey said. The majority of health IT professionals earn salaries greater than $80,000 per year, the study found, and 140 survey respondents said they were very satisfied with their career in health informatics compared with only 18 describing themselves as very dissatisfied The survey included 404 health IT professionals from seven countries and 42 U.S. fied (55) with their career choice, compared cover how the diffe ent categories correlate wide range of skills and backgrounds. states. There is a correlation between the with people who are very dissatisfied (4), the with income and education, the University Health IT professionals overwhelmingly level of education and job satisfaction: Profes- survey determined. of South Florida Morsani College of Medi- see career growth during the next five years: sionals with advanced degrees (master’s and Of the 404 survey respondents, 303 report- cine said; however, there is a larger narra- 337 survey respondents believe their career doctorates) are more likely to be very satisfie ed unique job titles. The potential exists to tive here concerning the profession’s many will continue to grow, compared with only (89 respondents) or at least somewhat satis- categorically break down job titles and dis- Theniches, which require professionalsbest with a 41 who doway not. n to predictThe best the way futureto predictis to the create future it is to create it

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SUPPORTED BY 36 PEOPLE www.HealthcareITNews.com | Healthcare IT News | April 2016 ON THE MOVE Pam Ballou-Nelson was appointed senior consultant of Medi- ONC elects Chartese Day office directo , cal Group Management Association’s Health Care Consulting Office of the Chief Operating Offic Group. Orion Health appointed Wayne Oxenham president, Chartese Day was named office director North America; he most recently served as executive vice of the Office of the Chief Operating Offi- cer, ONC Deputy National Coordinator for president of Orion’s Europe, Middle East and Africa region. Operations, to support the ethics function Divurgent, a healthcare IT consulting firm, has named Ste- recently transitioned into the office Day phen Eckert president and chief operating officer he has 20 will provide senior leadership and program years of industry experience and most recently served as the direction for the Executive Secretariat and Freedom of Information Act, which the partner for Encore’s National Client Services. Keith Fernandez, Doug Cusick OCOO will now handle. She’ll be supported MD, was named senior physician executive of Privia Health, LLC, by Acheeria Walters and Carolyn Holden. a national physician practice management and population health technology Day most recently served as the director of the Office of Public Affairs and Com- company. MedyMatch, an artificial intelligence healthcare startup, has hired Chartese Day munications, which will now be filled by former Philips’ CEO Gene Saragnese as chairman and chief executive office Megan Roh. Roh joined the ONC from Senator Tammy Baldwin’s office Kathy Kaminsky was appointed chief population health offic where she was the deputy communications director. of Englewood Hospital. Bellevue-based Atigeo, a technology company and developer, has named Doug Cusick chief growth VisualDx hires William Bria, MD, officer Brad Boyd was promoted to president of Culbert as chief medical information office Healthcare Solutions, a healthcare management consulting William Bria, MD, was appointed chief med- firm; he previously served as the company’s vice president ical information officer of VisualDx, a diagnos- of sales and marketing. Thrive 4-7, a mobile health company, tic decision support system. Bria is a critical care physician and pulmonologist with more appointed Deborah Hylton president and CEO. Melinda D. Whit- than 30 years of clinical and medical infor- tington joined Allscripts Healthcare Solutions, Inc. as senior Drew Hamilton matics experience and currently serves as the vice president finance and chief financial officer Singular Advisory Board chairman of the Association Medical Technologies, a single- and multi-PACS designer and developer, named of Medical Directors of Information Systems. He most recently served as CMIO of Shriners Gregory Burnell as CEO and David Logan as vice president of strategy; both will join Hospitals for Children and the University of Michigan. the company’s board of directors. CTG, an IT solutions and services provider, appointed Laura Momplet as chief operations office and chief clinical officer Marie Jeff Brown named permanent CIO, Murphy as delivery director, optimization and implementation; Scott Gildea as SVP of Seattle Children’s Hospital delivery director, strategic programs; and Amy White quality analyst lead. Drew Seattle Children’s Hospital appointed Jeff Brown Hamilton was named chief sales officer of Kareo, a cloud-based medical office as senior vice president and permanent chief software and services platform. entrotech life sciences has appointed former information office . He had been the acting interim U.S. Surgeon General Kenneth Moritsugu, MD, to its board of directors. Christopher CIO since April 2015. Before joining Seattle Chil- dren’s, Brown served as chief information office Libby, a third-year student at the University of Massachusetts Medical School, at Lawrence General Hospital in Massachusetts. was elected to represent all U.S. medical students at the American Medical He previously served in senior management Association Medical Student Section. positions in organizations that include Partners HealthCare and Steward Health Care Network.

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*Healthcare IT News’ Women in Health IT Survey 2015 38 NEWSMAKER www.HealthcareITNews.com | Healthcare IT News | April 2016 Q&A: Judy Faulkner on Epic’s early years and future plans CEO discusses company’s roots, interoperability, need for patient ID and more

SKIP SNOW, Contributing Writer on my own to figu e out how to build this. UDY FAULKNER, founder and CEO of Neil Pappalardo, the CEO of MEDITECH, Epic Systems, is one of the most pow- was the guy who invented MEDITECH Inter- erful leaders in the healthcare industry. pretive Information System (MISS), and Mas- J In an interview, she explains how she sachusetts General Hospital Utility Multi-Pro- grew the company, founded as Human Services gramming System, or MUMPS – he has said that Computing in 1979 with a small pool of inves- if he had understood how important it would tor customers, to its current dominant position, be in healthcare computing, he would not have with annual revenues of nearly $2 billion. given it such a silly name. When Faulkner spoke with Healthcare IT What Neil Pappalardo developed was writ- News, her affect was down-to-earth, candid and ten specifically for healthcare data, so the sharp, with an engineer’s attention to detail. She underlying infrastructure of MIIS was won- spoke about her computer science beginnings, derful for dealing with healthcare because you discussed Epic’s long history and addressed the have sparse arrays. Back then you had Fortran future of software in healthcare. She touched and you had COBOL. Neither of them could upon familiar issues with interoperability, deal with sparse arrays. The ability of MIIS to patient identifi ation and more. Here’s what deal with sparse arrays was terrific because else she had to say. you might have 100,000 data elements but only some would be filled ith data. Computer science education was key Some things never change, like your birth what they are doing.” They’d call me up and say, each group could understand each other. to her success. So was an early clini- date. Some things occasionally change – your “Start a company,” and I would laugh and say, “No.” Let’s examine gender. I may have one for cal mentor. address, your insurance, your primary care This went on for about two years. Finally I male, two for female, and then two other Starting at the beginning, I was a math undergradu- physician, your surgeries – and you don’t want said yes. You have to realize I wore blue jeans. kinds of genders, ambiguous and something ate major, and then I went to the University of Wis- to have to store them every single time. There’s In the summer I wore T-shirts; in the winter I else. On the other hand, they may have one consin for computer science. Originally I applied in a look-back capability that lets you get to the wore sweatshirts. I cut my hair with scissors, for female and a range of other values. How math, and UW and Stanford both switched me to last one right away. Then some things, like no makeup. I was a normal programmer and I do you move that over when different groups computer science, all by themselves, and I thought, your vital signs, change all the time, so built had no idea how you start a company. have different ways of doing that? You need “Hey, that’s cool. I like that idea.” into Chronicles was a sense of how to handle So I went to somebody who had spun off from standards. There’s a limited number of stan- I took courses in computers and medicine. time, which was really important. The other the university, and he said three things: One, dards that we have to be able to transmit the The professors were physicians. Warner Slack, thing that was built into it was a sense of what get permission from the university, get a good data. I use such a simple example as gender, MD, asked me to work with him, so I then went you might call the joins. You might have three lawyer, get a good accountant. I did all three. but as you go into the drug and other data- to Beth Israel (Deaconess Medical Center, in problems, three diagnoses, three treatments, It was great advice. bases, there is even greater complexity. Boston). This was at a time when the vendors three outcomes; how do you keep everything I started the company, valued it at $70,000, Within your organization you want to share. were just selling systems for billing and lab. together? How do you understand what goes and I invited my customers to join in and be It’s critically important to also get informa- No vendors I’m aware of were doing clinical with what? That was built into MIIS too. part of the original shareholders. There are tion back and forth from other groups who systems. This was in the early ‘70s. I took the Both MIIS and Chronicles were built for a lot of people then who helped start Epic. aren’t yours. class in the late ‘60s, but this was asked of me healthcare. The other vendors were hardcoding We divided it up, so if you had 5 percent of in the very early ‘70s. After a while, I got called everything. Line by line, everything was hard- the company, you paid $3,500, and that got Unique patient ID has to happen. in by some of the other physicians and (was) coded, and if you wanted to change anything, us started. We started with one and a half I think each person should have a medical iden- asked to create a system that would keep track you didn’t have a database management system people. I had a morning assistant and an after- tity. I don’t care whether it’s federal or not. How- of clinical information. underneath it to allow you to make those changes. noon assistant. We were in a basement of an ever, the lack of this is not an excuse. You can apartment house. do a lot of patient matching based on other attri- The foundation of Epic predates com- ‘I was a normal programmer and I had That was it. We signed a bunch of contracts bute checking and so the identity would make it mercial relational database manage- no idea how you start a company.’ and never took outside money from venture easier, but it is not an absolutely critical thing. ment systems. After I built it, I went around to a lot of diffe - capital or went public or anything like that. This was before dBase. I think Oracle was build- ent departments in UW and worked with them. Remote care is the future. ing its system at this time, but we didn’t know I remember one department had money for six Semantic standards are key Healthcare going to stay local to a great extent. the words “database management system.” There months for a programmer to do something. There If you’re going to do interoperability between I think it’s going to also move to telemedicine was a little system in use that was a little tiny were only 20 data elements, and I remember charg- organizations, which I think is critical, it’s much more than it is right now because we have database management system that was pretty ing them for 45 minutes of time. You can see why limited because you have to define and no - to reduce the resources that we’re using and the nifty and I took a look at that, but mostly I was customers all around the country told people, “Look malize and harmonize the data so that that expense that we have in healthcare. n

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