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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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NYC Hospitals Face Massive Problems With Epic Install

NYC Hospitals Face Massive Problems With Epic Install | EHR and Health IT Consulting | Scoop.it

A municipal hospital system’s Epic EMR install has gone dramatically south over the past two years, with four top officials being forced out and a budget which has more than doubled.


In early 2013, New York City-based Health and Hospitals Corp. announced that it had signed a $302 million EMR contract with Epic. The system said that it planned to implement the Epic EMR at 11 HHC hospitals, four long term care facilities, six diagnostic treatment centers and more than 70 community-based clinics.


The 15-year contract, which was set to be covered by federal funding, was supposed to cover everything from soup to nuts, including software and database licenses, professional services, testing and technical training, software maintenance, and database support and upgrades.


Fast forward to the present, and the project has plunged into crisis. The budget has expanded to $764 million, and HHC’s CTO, CIO, the CIO’s interim deputy and the project’s head of training have been given the axe amidst charges of improper billing. Seven consultants — earning between $150 and $185 an hour — have also been kicked off of the payroll.


With HHC missing so many top leaders, the system has brought in a consulting firm to stabilize the Epic effort. Washington, DC-based Clinovations, which brought in an interim CMIO, CIO and other top managers to HHC, now has a $4 million, 15-month contract to provide project management.


The Epic launch date for the first two hospitals in the network was originally set for November 2014 but has been moved up to April 2016, according to the New York PostHHC leaders say that the full Epic launch should take place in 2018 if all now goes as planned. The final price tag for the system could end up being as high as $1.4 billion, the newspaper reports.


So how did the massive Epic install effort go astray? According to an audit by the city’s Technology Development Corp., the project has been horribly mismanaged. “At one point, there were 14 project managers — but there was no leadership,” the audit report said.


The HHC consultants didn’t help much either, according to an employee who spoke to the Post. The employee said that the consultants racked up travel, hotels and other expenses to train their own employees before they began training HHC staff.


HHC is now telling the public that things will be much better going forward. Spokeswoman Ana Marengo said that the chain has adopted a new oversight and governance structure that will prevent the implementation from falling apart again.”We terminated consultants, appointed new leadership, and adopted new timekeeping tools that will help strengthen the management of this project,” Marengo told the newspaper.


What I’d like to know is just what items in the budget expanded so much that a $300-odd million all-in contract turned into a $1B+ debacle. While nobody in the Post articles has suggested that Epic is at fault in any of this, it seems to me that it’s worth investigating whether the vendor managed to jack up its fees beyond the scope of the initial agreement. For example, if HHC was forced to pay for more Epic support than it had originally expected it wouldn’t come cheap. Then again, maybe the extra costs mostly come from paying for people with Epic experience. Epic has driven up the price of these people by not opening up the Epic certification opportunities.


On the surface, though, this appears to be a high-profile example of a very challenging IT project that went bad in a hurry. And the fact that city politics are part of the mix can’t have been helpful. What happened to HHC could conceivably happen to private health systems, but the massive budget overrun and billing questions have government stamped all over them. Regardless, for New York City patients’ sake I hope HHC gets the implementation right from here on in.

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Burke Autrey's curator insight, September 21, 2016 10:56 AM
Tracking companies who bring in Interim executive talent when it counts... Congratulations to Clinovations and HHC who clearly see the value of tapping into interim executives.
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Surescripts' New Tool Aims To Improve Interoperability, EHR Access

Surescripts' New Tool Aims To Improve Interoperability, EHR Access | EHR and Health IT Consulting | Scoop.it

On Monday, health information network Surescripts launched a new tool that aims to expand providers' access to electronic health records and simplify the data-sharing process, EHR Intelligence reports.

Details of Tool

According to EHR Intelligence, the National Record Locator Service will allow more than 480,000 providers to share EHRs housed in any medical center across the U.S.


Specifically, the tool implements a query and response system into providers' workflows. Providers using the tool will be able to access more than 230 million patient EHRs.


The NRLS tool will be integrated with the EHR systems of:

  • eClinicalWorks;
  • Epic; and
  • Greenway Health.


According to EHR Intelligence, the service will be implemented in accordance with legal agreements under CareQuality, which governs collaborations between health information exchanges.


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Can Apple, Others Bring PGHD to the EMR?

Can Apple, Others Bring PGHD to the EMR? | EHR and Health IT Consulting | Scoop.it

Not settled with simply being the dominant device on which clinical data applications are hosted, Apple made another step towards becoming an even more ubiquitous presence at healthcare organizations last week when it launched ResearchKit.


ResearchKit is a platform that allows healthcare organizations to host apps that will get people to participate in clinical trials. During an event for the press, the company announced a few initial partnerships with major healthcare provider organizations to use ResearchKit, including Icahn School of Medicine at Mount Sinai, Penn Medicine, Dana-Farber Cancer Institute, Massachusetts General Hospital, Stanford Hospital, and more.


ResearchKit builds off HealthKit, which was a health platform Apple launched last year that aimed to connect personally-generated health data and clinical data. Since HealthKit’s launch, many notable healthcare organizations, including Stanford Medicine, Cleveland Clinic, and EHR vendors like Epic, have all partnered with Apple to work in their own patient-generated data applications.


The Cupertino, Calif.-based company is part of a wider movement in the industry to bring patient-generated health data (PGHD), from various portals and monitoring devices, into clinical data applications like the electronic medical record (EMR). The Office of the National Coordinator for Health IT (ONC), in its proposed rule for Stage 3 of meaningful use, made integrating PGHD into the EHR a requirement for eligible hospitals and providers.


Of course, this integration is easier said than done. Healthcare Informatics Senior Editor Gabriel Perna spoke with Rob Faix, principal advisor at the Naperville, Ill.-based consulting firm, Impact Advisors on the most recent edition of the Healthcare Informatics podcast. Faix discusses the challenges of bringing together patient and clinical data; why Apple has taken the lead in this category with many prominent healthcare organizations; and how ResearchKit can be a game changer.


“Integrating this data will be a significant challenge but I think it’s one that hardware device vendors, software developers, and EMR vendors are up for…it’s the next big opportunity,” Faix says. “


Faix talks about how this integration may happen. He predicts there will be a staging process, where PGHD is graded and reviewed. “Context will be important. The software and EMR vendors and the clinical community are really going have to think about that as we integrate PGHD into the EMR,” he says.


Sifting through a potential avalanche of data will present itself as a challenge, as will having to deal with potential issues of liability. “I have information in front of me that I chose to accept or discard, and therefore, it could be tied back to an adverse event,” Faix says.


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Connecting Behavioral Health EHR to HIT Community at Large

Connecting Behavioral Health EHR to HIT Community at Large | EHR and Health IT Consulting | Scoop.it

Behavioral health EHR adoption is on the radar of health IT developers already well position in acute and ambulatory settings. For behavioral health organizations and providers, the challenge of EHR integration centers of the difference in provider workflows and their use of health IT to document a patient’s care.

As value-based care programs extend the range of the care continuum, the ability to move a patient’s health data between primary and specialty providers becomes a necessity. The rise of accountable care, however, may be responsible for eroding differences between care settings and providers.

“As accountable care and the new healthcare environment that move forward in evolves, there will be less difference because one of the big things in behavioral health is that it is very much a team environment so that you have folks from all different specialties participating along with the patient,” says Melinda Wagner, General Manager of Behavioral Health for Cerner.

That being said, primary care and behavioral health are currently distinctly different animals. As health IT developers from traditional care settings to behavior health environments, they must come to appreciate what makes the two distinct.

“As we integrate mental and physical health together, there will be a lot of great lessons more learned by the physical side,” Wagner explains. “Your workflows are perhaps a little bit different, and the care planning coordination are definitely much different.”

For Cerner, this learning process has relied heavily on feedback from providers from both environments. ” We acquired a community solution a couple years back and that really thrust us into the environment quickly, so we have been gleaning information from the community clients as well as existing Cerner clientele who were primarily acute clients with behavioral health access about what was missing,” Wagner reveals.

As a result of the EHR selection of Cerner by Hazelden Betty Ford Foundation, the EHR developer also faced a unique challenge in the form of moving the behavioral health organization from its own homegrown system onto an EHR platform capable of performing the same functions.

“They did have their own system,” continues Wagner, “so they had been automated for some time and mature in their thinking about how IT supports their overall workflows and patient care. We have worked with them for a couple years in looking at how our Cerner functionality would fit their needs as well as our overall vision for where we’re taking our solution.”

While the transition from one electronic documentation platform to another presents challenges, the greatest test for behavioral health EHR adoption remains interoperability with the EHR technology of other providers involved in a patient’s healthcare experience.

“It is the patient’s right to be able to expect that from healthcare and IT providers — that we will find ways to interoperate, that there won’t be one single system ever,” says Wagner. “That’s a driving force behind why Cerner got into behavioral health. Between interoperability and population health, we recognize to provide care for the whole person that behavioral health is integral to that.”

And the mental health environment likewise brings with it privacy concerns.

“We’re now trying to figure out how to make that compliant but still be able to share information,” Wagner observes. “We need to make sure that we protect the rights of those folks on the mental health side while also protecting their right to full and safe care by sharing information that needs to be given to other providers responsible for coordinating overall care.”

With patient’s road to recovery now taking a variety of routes, his health data must demonstrate the capacity for moving where it is needed.


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RNs are Choosing Where to Work Based on Hospital EHR

RNs are Choosing Where to Work Based on Hospital EHR | EHR and Health IT Consulting | Scoop.it

I came across this tweet and it made me stop and realize how important the selection and more important the implementation of your EHR will be for your organization. In many areas there’s already a nurse shortage, so it would become even more of an issue if your hospital comes to be known as the hospital with the cumbersome EHR.

Here’s some insight into the survey results from the article linked above:

79% of job seeking registered nurses reported that the reputation of the hospital’s EHR system is a top three consideration in their choice of where they will work. Nurses in the 22 largest metropolitan statistical areas are most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems. Those EHRs receiving the lowest satisfaction scores by nurses include Meditech, Allscripts, eClinicalWorks and HCare.

The article did also quote someone as saying that a well done EHR implementation can be a recruiting benefit. So, like most things it’s a double edge sword. A great EHR can be a benefit to you when recruiting nurses to your organization, but a poorly done, complex EHR could drive nurses away.

I’m pretty sure this side affect wasn’t discussed when evaluating how to implement the EHR and what kind of resources to commit to ensuring a successful and well done EHR implementation. They’re paying the price now.

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What Does Epic’s App Store Mean for EHR Interoperability?

What Does Epic’s App Store Mean for EHR Interoperability? | EHR and Health IT Consulting | Scoop.it

Epic Systems may be leaping to the top of yet another health IT category with a new app exchange, which would allow external developers to create products that would interface with Epic’s popular electronic health record system.  The Epic App Exchange would be the health IT version of Apple or Google’s app stores, and may first try to secure entries developed by Epic customers that would enhance the openness and interoperability of the famously tight-lipped infrastructure.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” said Nordic Consulting co-founder Mark Bakken in an interview with the Wisconsin State Journal.  “Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge.”

The app store mirrors a 2013 effort by athenahealth to connect innovative services to enhance interoperability, health information exchange, and data governance for users of their products.  The athenahealth Marketplace intends to bring “the best HIT solutions to the forefront,” athenahealth CEO and Chairman Jonathan Bush said at the time. “Similar to what Amazon.com is for consumers, our platform, with the immense support of our Marketplace partners, will serve as a one-stop ‘shop’ for high-value HIT solutions.”

A spokesperson from Epic confirmed the project, which Bakken says may launch within the next few weeks.  The Verona, Wisconsin company has faced criticisms in the past about its closed systems as the healthcare industry embraces the notion of EHR interoperability, data standards, and widespread health information exchange.

While it has made a few nods towards industry integration, Epic has secured such dominance in the hospital market that it has been able to largely ignore the complaints, but it has several big projects on its agenda that may make it more difficult to continue down its previous path.

In addition to bidding for an $11 billion contract from the Department of Defense that will likely value interoperability and open architecture above Epic’s monolithic culture, moving into the ambulatory market will require more flexibility than it has shown in the hospital sphere.

Primary care providers interested in population health management or joining the accountable care movement need EHR infrastructures that can easily speak to products from different vendors.  With the ambulatory EHR market so fragmented and the priorities of physician offices changing, Epic may need to expand its interoperability strategies if it wishes to continue its slow but steady gain in market share.

The app store might be a smart way to do this.  By encouraging third parties to develop connections between Epic products and other offerings, Epic gets to take credit for promoting EHR interoperability without having to do too much of the work itself.  The company will be providing interested developers with a “roadmap” about how to work with the company, Bakken says.  More details will no doubt be forthcoming, but until then, the healthcare industry will have to do what it always does: wait at Epic’s gates until it decides to open up.


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Epic Systems Squeaks to Top of Physician EHR Adoption List

Epic Systems Squeaks to Top of Physician EHR Adoption List | EHR and Health IT Consulting | Scoop.it

Epic Systems is the number one vendor when it comes to physician EHR adoption, but it only barely beats out some of its close competitors for the top spot, according to a report from SK&A.  While the mega-vendor is a frequent choice for large hospitals and health systems, taking best-in-show honors from KLAS Research for nine out of the past ten years, Epic has not yet secured total dominance on the physician side.  The highly fragmented market has left a number of other vendors nipping at Epic’s heels, including eClinicalworks, Allscripts, and Practice Fusion, which have secured similar shares of the top 35% of physician customers.

In contrast to last year’s report, where the top ten vendors made up 53% of the physician EHR adoption market, this year’s research shows that just eight vendors have now scooped up the same proportion of providers.  Epic, now at 11.6 percent of the overall market, has grown by more than 1 percent over last year’s numbers, while eClinicalworks has stayed steady at 10.2 percent, and Allscripts follows at 8.7 percent.

The next few vendors, including Practice Fusion, NextGen, GE, and Cerner, drop off from 6.7 percent to 3.5 percent, while other companies, including athenahealth, McKesson, Greenway, and MEDITECH, hover between one and two percent of market share.  Overall adoption has increased from 61 percent to 62.8 percent of all responding providers, the report shows.

Quite notably, the top twenty vendors make up less than three-quarters of the physician EHR market.  Twenty-seven percent of providers are using close to 500 different products that may be proprietary, specialty-specific, or small newcomers in the industry.  Providers with one to three physicians were significantly more likely to be using one of these unknowns than larger organizations, with close to 30% of these small organizations adopting a product outside of the mainstream.

The fragmentation of the EHR landscape is a boon for startup developers and smaller companies looking to cash in on the few remaining paperbound providers, or those seeking to become an unhappy organization’s choice for a replacement EHR.  But it is also bad news for health IT interoperability, as small vendors who may or may not be certified by the ONC for meaningful use attestation, are built upon a wide array of proprietary technologies that do not foster data exchange.


While a 2013 survey found that small EHR vendors were more likely than larger ones to produce happy customers, likely due to better customer support and more individualized attention for training and technical glitches, these vendors may also be more likely to fold suddenly under financial pressures, leaving physician organizations in the lurch.

But financial disasters are not the provenance of small vendors alone.  Epic has made more headlines than most other vendors for its role in several spectacular EHR implementation failures, though it is most frequently cited for its success in larger hospitals, and continues to expand its footprint into major health systems.  The Mayo Clinic recently announced that the vendor would be replacing Mayo’s trio of EHR systems with a single, integrated platform, while Epic remains in contention for the $11 billion Department of Defense EHR modernization contract.  The company’s suite of offerings, including business intelligence software, ambulatory practice management, health information exchange, and patient portals provides physician practices with an attractive toolkit to fuel expansion into the physician EHR world.

Other companies are seeking a similar crossover between the ambulatory and hospital markets as adoption reaches its saturation point.  athenahealth, ranked eighth in physician EHR market share by SK&A, is moving into the hospital sphere by offering its cloud-based services to the rural and critical access hospital (CAH) market.

“Rural and CAH organizations may not receive the same attention as academic medical centers and large, clinically-integrated health systems, but they make up approximately 1/3 of the hospital market,” explained Jeremy Delinsky, Chief Technology Officer at athenahealth.  “They’re also innovative, important pillars of their communities, providing tremendous value and quality at generally lower costs. These providers have been unable to afford the steep price tags of legacy software installations. Our revenue model is closely tied to that of our customers; we don’t make money unless they succeed.  We think this message will gain a lot of traction in the CAH market.  From there, we will have room to climb upmarket.”

EHR vendors looking to achieve a foothold in both worlds will need to tailor their offerings appropriately for customers no longer satisfied with basic data entry interfaces.  While some companies tout the standardization of their user experiences as a selling point, products that will continue to gain traction in either segment of the marketplace will need to meet the specific needs of choosy providers looking to make the most of their costly EHR investments.


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75% of Hospitals Had a Basic EHR System in 2014, ONC Data Show

75% of Hospitals Had a Basic EHR System in 2014, ONC Data Show | EHR and Health IT Consulting | Scoop.it

The percentage of hospitals with electronic health record systems increased eightfold between 2008 and 2014, according a data brief from the Office of the National Coordinator for Health IT, FierceHealthIT reports.

The report was based on an American Hospital Association survey of non-federal acute-care hospitals.

Findings

Overall, the data show 97% of hospitals in 2014 had certified EHR technology, an increase of 35% since 2011

.

Meanwhile, 75.5% of hospitals in 2014 had a basic EHR system, up from 59.4% in 2013 and 9.4% in 2008.

The report showed that in every state at least half of hospitals had adopted a basic EHR in 2014.

The states with the highest adoption rates of basic EHR systems included:

  • Delaware, with 100% of hospitals;
  • South Dakota, with 95.1% of hospitals; and
  • Virginia, with 93.2% of hospitals.

Those with the lowest adoption rates included:

  • West Virginia, with 49.6% of hospitals;
  • Hawaii, with 54.8% of hospitals; and
  • Kansas, with 60% of hospitals.

Meanwhile, 34.4% of hospitals in 2014 had adopted comprehensive EHR systems.

In a blog post, Matthew Swain -- a program analyst in ONC's Office of Planning, Evaluation and Analysis -- and ONC Interoperability and Exchange Portfolio Manager Erica Galvez wrote that that about 60% of hospitals in 2014 exchanged data electronically, marking a 55% increase from 2013.

However, Swain and Galvez said, "While these survey results are promising, there is plenty of room for progress." They added, "These results capture exchange activity among hospitals; however, these results do not assess exchange volume, whether the exchange is interoperable, and if information is available to providers at the point of care".

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Epic Systems’ Open Platform Will Bring U.S. Health Care Delivery Into the 21st Century | The Health Care Blog

Epic Systems’ Open Platform Will Bring U.S. Health Care Delivery Into the 21st Century | The Health Care Blog | EHR and Health IT Consulting | Scoop.it

Epic Systems, the market leader in electronic health record software (EHR), recently made a quiet but potentially transformative announcement that may finally shake the healthcare industry out of its technological doldrums.


Epic said it is prepared to support the creation of a more open interoperability platform for integration with other diversified healthcare applications. This will attract substantial investment to create software that operates, hopefully seamlessly, within the Epic EHR infrastructure.  Expect Epic’s competitors to follow suit, eventually opening up the marketplace of installed EHRs to third-party software developers and the efficiencies of modern, post-EHR technology ecosystem.

Epic’s critics have often denounced the company for selling a mostly closed technology, dampening hopes for the creation of an ecosystem of best-of-breed applications that work together with the EHR to automate much of the care delivery infrastructure beyond patient intake and billing.  The value of such an infrastructure is extremely compelling and so the company is under enormous pressure from its customers to become more open.


An open-architecture environment, with published Application Programming Interfaces (APIs) and open standards, will improve the functionality of EHRs in myriad ways.  Consider innovations such as full-service, secure, HIPAA compliant mobile care networks within and around hospitals, integrated delivery systems and ambulatory care providers. These networks would facilitate powerful point-of-care mobile automation, such as the delivery of interactive care checklists to doctors, nurses and patients; the sharing of patient medical histories to create a comprehensive care record; and automating the patient hospital discharge process with care plans developed digitally by physicians and nurses for their individual patients.  These networks integrated to the data available through the EHR will also enable advanced workflow applications.  Imagine providers interacting with one another and their patients in real-time, independent of care settings when care considerations and treatments get logged as part of a living patient record and, ultimately, when real-time software and cognitive analytics can aid in the development of patient care options.


The move toward open-standards, cloud-based, mobile-enabled EHR applications will be the biggest development in the healthcare software industry in many years.  The passage in 2009 of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) stimulated the adoption of EHRs, but these systems were largely built on older technology and struggle to incorporate the benefits of internet-based architectures, enabling cloud and mobile computing, and as such, today the EHR value proposition still remains uncertain.  However, open standards for interoperability is the key to opening up the EHR infrastructure to all facets of the provider value chain.

One of Psilos’ investments, PatientSafe Solutions, developer of a smart point-of-care mobile communications network, is already working on adapting their product for to Epic’s open source standards.  As the CEO of PatientSafe Solutions, Joe Condurso, recently mentioned, “All of our customers are now seeking to optimize their EHR investments through interoperability in order to liberate and activate data with mobile tools for clinicians and patients. It’s an important part of our operations today. Being able to leverage OpenEpic to interoperate and connect with the Epic allows us to deliver more capabilities for our customers to prepare for quality and value-based reimbursement.”

Open architecture EHR as the standard, rather than the exception, should set the stage for a much brighter future for participants at all levels in the healthcare arena. Let’s hope it meets its promise and makes the delivery of U.S. healthcare — not just our medical technology — the envy of the world.


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EHR Systems Lack Adequate Lab Data Graphing Functions

EHR Systems Lack Adequate Lab Data Graphing Functions | EHR and Health IT Consulting | Scoop.it

Current electronic health record systems lack adequate laboratory data graphing capabilities, according to a study published in the Journal of the American Medical Informatics Association, Modern Healthcare reports.

Study Details

For the study -- which sought to determine the abilities of various EHR systems to display test results -- researchers analyzed eight EHR systems based on 11 criteria.

Of the eight EHR systems included in the study, six had been certified by the Office of the National Coordinator for Health IT, including those from:

  • Allscripts;
  • Cerner;
  • eClinicalWorks;
  • Epic;
  • Meditech; and
  • Partners Longitudinal Medical Record.

The other systems were the Department of Veterans Affairs' Computerized Patient Record System and Glassomics, an EHR prototype designed to work with Google Glass.

The study did not rate the EHR systems by name.

Findings

Overall, the researchers found none of the systems met all 11 criteria.

According to the study, the highest-rated system achieved 10 of 11 criteria, while the lowest-rated system achieved five.

The most common problem among EHR systems was the failure to label the vertical, or Y-axis.

Other flaws included:

  • An EHR system that labeled data in reverse order with the most recent data on left instead of the right;
  • An EHR system that did not equally space out data points on graphs, which could result in an erroneous slope when measuring rates; and
  • Three systems that did not include patient identification directly on the graphs.

According to EHR Intelligence, the results showed a lack of standardized workflows among EHR systems, which could lead to an increase in medical errors and a decline in patient safety.


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UCLA Health to integrate genomic data into EHR in pilot

UCLA Health to integrate genomic data into EHR in pilot | EHR and Health IT Consulting | Scoop.it

UCLA Health will soon begin a pilot project with Seattle-based startup ActX that will integrate genomic patient data into its Epic EHR system, with the eventual intent of applying precision medicineto a large-scale patient base.

ActX, founded in 2012 and just out of stealth mode six months ago, collects a patient’s genetic information by way of a saliva sample, and then analyzes the information in real time. The data is integrated into an EHR – already, ActX is working with Allscripts and Greenway Health – and physicians will receive an alert about a medication and possible side effects, or warn of potentially serious risks for cancer.

Think of it as a 23andMe that is integrated into an EHR and available to the patient.

Molly Coye, chief innovation officer at UCLA Health, which operates four hospitals, said that’s precisely what intrigued the academic health system.

“Our goal is to try to bring precision medicine to a much larger proportion of patients,” she told MedCity News. “Right now it tends to be focused particularly on people with cancer, and even then on a low number of patients.”

She added that genomic data combined with an EHR could have “real clinical meaning for a larger number of patients than we could have known about five or 10 years ago.”

The pilot will begin in the coming weeks on 50 patients that the health system thinks will be a good fit, Coye said. Depending on initial success, it will be expanded to a greater number.

“If successful, and our physicians are enthusiastic about it, we’ll rapidly make it available more widely,” she said, adding that most UCLA Health pilots range from three-to-six months.

ActX co-founder and CEO Andrew Ury, a physician who has worked extensively in the EHR space, said up until now, few if any genomic data collectors have been integrated into an EHR. Dr. Ury previously worked for Practice Partner, which was acquired by McKesson in 2007.

As he sees it, EHR integration is the only way to harness genomic data on a large scale while at the same time providing the results for patient.

“We believe the way to do that is to build it into the everyday tool, the EHR,” he said. “The consumer factor is because we have to get the patient’s genomic data in order to make it work, so we offer access to affordable DNA sequencing. In order to that, we involve the patient.”

Given that UCLA Health uses an Epic system, which dominates the hospital market, Coye said the potential to reach a mass of patients is significant, and that such an EHR add-on could someday be a standard feature if it proves successful.

“They’re actually working with Epic, so decision support means a lot more if it pops up in the EHR,” Coye said. “This is going to be a game changer, I think. That’s the real promise that everyone recognizes about genetic testing,  that this will become a standard. It’s just a question of how you do it early on.”

Importantly, Coye cited the autonomous nature of ActX in how it’s available to both patient and physician.

Dr. Ury elaborated on the potential of precision medicine and EHR integration from a clinical standpoint.

“What this means is that if a patient’s genetic data is on file, because we’ve analyzed it, each time the physician writes a prescription in the EHR, it’s going to see if a drug is going to work, or if there’s an adverse reaction,” he said. “If there is an issue, the physician will get an alert.”

The data, and its use within an EHR, can also help physicians better determine if a patient is at higher risk of a genetic disease or a certain type of cancer. With that knowledge, more effective medications and treatments can be determined far earlier than before.

Coye said UCLA Health hopes the pilot can bring precision medicine to primary care and a further breadth of specialists “across a wide variety of clinical conditions.”

ActX is so far privately funded and has about 25 employees and independent contractors, including scientists, pharmacists, genetic counselors, physicians and software developers, according to Dr. Ury.

Dr. Ury noted that it’s “the dawn of precision medicine,” referring to the $235 million initiative championed by President Obama and overseen largely by the NIH.

“While genetics can’t predict everything, genetics can predict more and more and whether a patient has a side effect,” he said. “We think this is the future.”


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Top 10 EHR vendors in physician offices

Top 10 EHR vendors in physician offices | EHR and Health IT Consulting | Scoop.it

There's little question that Cerner and Epic are the giants in the EHR field. Epic is dominant not only in the scope of its market share but also in the depth of its client base. Mayo Clinic announced last month that it would be abandoning its three current EHR systems in favor of a new contract with Epic, which will now be the healthcare icon's sole EHR provider and strategic partner. Jilted in the deal were GE and Cerner, who were the providers of Mayo's current systemsalthough if you tallied the figures when Cerner acquired Siemens' EHR unit for $1.3 billion, it still had the largest US market share of any vendor, with 1,132 acute care hospitals. 

But a more granular look at market share amongst physician offices shows a slightly different market picture.



Epic is still on top, but only by a percentage point (eClinicalworks is close on its heels). And as you might expect, Epic's client base skews heavily towards larger practices, dominating the 41+ practice market at 54%. On the lower end of the scale (1 - 3), Epic, eClinicalworks, Allscripts and Practice Fusion are all within a percentage point or two of one another. 

Cerner, notably, is way down the list across the board in the physician practice world, taking just 3.5% of the overall market. So is athenahealth, at 3.3% overall and just 0.4% and 0.8% in the 26 to 40 and 41 and up segments. This tallies with the cloud-based vendor's ongoing investments in the inpatient market, however: In January, the cloud-based provider purchased start-up RazorInsights to move into the 50-bed and under sector, a niche that accounts for one-third of all hospitals in the US; and last week the company announced that it has purchased WebOMR, Beth Israel Deaconess' cloud-based, stage 2-certified EHR, for commercial development in the hospital setting.


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Epic Systems to open its own app exchange

Epic Systems to open its own app exchange | EHR and Health IT Consulting | Scoop.it

Epic Systems Corp. is about to launch its own app store — much like Apple’s App Store — opening the door for outside companies to create applications that will work with Epic’s widely used electronic health records systems.

Mark Bakken, co-founder and former chief executive of Nordic Consulting, the largest consultant firm working with customers of Verona-based Epic, stirred up excitement about the plan Tuesday at a luncheon meeting of the Wisconsin Innovation Network.

Bakken said the app store will launch in a few weeks and it will “open the floodgates” for all sorts of companies to develop and market their apps, especially those in the Madison area populated by former Epic employees.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” Bakken said later in an interview.

Epic spokesman Shawn Kiesau confirmed the plans but could not provide immediate details. It will be called the App Exchange, he said.

Bakken said Epic’s App Exchange will work similarly to Apple’s App Store.

“Let’s say you want to create an app for the iPhone. Apple has automated that online. As long as you play by all the rules, they’ll publish it,” said Bakken. Epic will be “publishing a road map about how to work with Epic,” he said.

Bakken said there are all sorts of potential uses for the Epic App Exchange, both for health care organizations and for consumers. He said he expects the first apps to come from Epic’s customers, so that one health care organization can offer other hospitals and clinics the specialized programs it has developed to work along with Epic’s software.

“Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge,” Bakken said.

Politically, he said, the App Exchange should squelch some of the criticism Epic has drawn from those who say its system is too closed, and that it is too hard to share medical records between health care groups that use Epic’s systems and those that don’t.

That may be particularly important as the U.S. Defense Department considers which team should receive a contract worth up to $11 billion over five years to install an electronic health records system for the U.S. military. Epic and IBM have submitted a joint application for that contract, which is expected to be awarded later this year.

Bakken’s comments about Epic’s App Exchange came as the Madison tech entrepreneur spelled out plans for HealthX Ventures, a fund Bakken is forming to invest in very early-stage health information technology companies, many of which are being created in the Madison area by former Epic employees.

Currently at $5 million, Bakken hopes to raise $10 million to $20 million for the fund. He said Nordic’s clients include some of Epic’s most prestigious customers, such as Kaiser Permanente, Johns Hopkins and the M.D. Anderson Cancer Center at the University of Texas, and he plans to introduce some of the local start-ups to them.

A goal of HealthX Ventures is “helping startups get to the next level,” said Bakken. If they can snag $1 million in revenue within a year, other venture firms will want to invest, he said.

“And hopefully, we have five more Epics,” Bakken said.

Epic has about 8,000 employees and its preliminary 2014 revenues were $1.8 billion, spokesman Kiesau said.

About 135 people attended the luncheon at the Sheraton Madison Hotel held by Wisconsin Innovation Network, a tech-oriented group that’s part of the Wisconsin Technology Council. Among them was Niko Skievaski, co-founder of Redox, a new business aimed at helping health care applications connect with electronic health records companies such as Epic.

Redox grew out of 100health, initially meant to incubate health IT startups. “We were missing the capital and therefore couldn’t get them going fast enough. That’s why we focused on Redox,” Skievaski said.

He said Bakken was Redox’s lead investor in a $350,000 funding round in December. “He sat other investors down and said, ‘Guys, this is a good deal,’” Skievaski said. He said Bakken’s HealthX fund is “exactly what Madison needs right now.”


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EHR Quality Reporting Rewarded through $36.3M in HHS Funding | EHRintelligence.com

EHR Quality Reporting Rewarded through $36.3M in HHS Funding | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
EHR quality reporting led to $4.9 million in ACA awards to 332 health centers.

The Department of Health & Human Services (HHS) has rewarded the quality improvement efforts of health centers with $36.3 million in Affordable Care Act (ACA) funding.

“This funding rewards health centers that have a proven track record in clinical quality improvement, which translates to better patient care, and it allows them to expand and improve their systems and infrastructure to bring the highest quality primary care services to the communities they serve,” HHS Secretary Sylvia M. Burwell said in an official statement.

The rewards spans four distinct kinds of quality improvement achievements.

The first award went to 361 health centers and totaled $11.2 million for health center quality leaders, those clinical settings scoring in the top 30 percent of all health centers based on best overall clinical outcomes.

The second award of $2.5 million rewarded 57 national quality leaders for surpassing national clinical standards for chronic disease, preventive care, and perinatal/prenatal care.

Clinical quality improvers — demonstrated at least a 10-percent improvement in clinical quality measures between 2012 and 2013 — were recipients of largest sum of awards, $17.7 million. The award goes to 1,058 health centers.

The last category of awards recognized 332 EHR reporters which received $4.9 million for reporting clinical quality measures (CQMs) for their entire patient population.

According to the Health Resources and Services Administration (HRSA), ACA-established Health Center Program comprises close to 1,300 health centers operating in more than 9,200 delivery sites in all 50 states, the District of Columbia, and US territories and treating approximately 21.7 million patients.

The ACA earmarked $11 billion to be disbursed over a five-year period to support the creation, expansion, and operation of health centers.

In the past year alone, 43 Health Center Controlled Networks received $21 million in rewards specifically for EHR adoption and meaningful use with requirements to “include at least 10 Health Center Program grantees and overall will provide support to more 700 health centers nationwide.”

In a recent brief, the Office of the National Coordinator for Health Information Technology (ONC) demonstrated that incentive dollars and looming financial penalties are driving EHR adoption and meaningful use.

The chance to benefit from tens of thousands of dollars from the EHR Incentive Programs was cited as a major influence for 62% of physician providers participating in the 2013 National Ambulatory Medical Care Survey Physician Workflow Survey. Another major factor were the ONC-funded regional extension centers whose availability during Stage 1 Meaningful Use and beyond influenced 35 percent of respondents to adopt a certified EHR technology and demonstrate meaningful use as part of the EHR Incentive Programs.

The major takeaway from the HHS and ONC announcements is the integral role health IT-related funding in the form of incentives or awards plays in transforming the care delivery and coordination through the innovative use of technology.



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