Subgroups will address compliance best practices for healthcare providers, health IT developers, and health information exchanges.
When it comes to information blocking, the devil's in the details, and The Sequoia Project is drilling down accordingly.
Distinct actors involved in the thorny issue are the focus of three new subgroups of the Interoperability Matters Information Blocking Workgroup of The Sequoia Project, a non-profit devoted to resolving health IT interoperability issues.
Federal regulations define distinct actors in the information blocking issue, and the new subgroups map to three of them: healthcare providers, health IT developers, and health information networks/health information exchanges.
In a press release, The Sequoia Project said it expects to add more subgroups over time.
"We're hoping these subgroups help communities address specific operational issues and best practices regarding information blocking regulatory compliance and implementation," said Mariann Yeager, CEO of The Sequoia Project.
The Interoperability Matters initiative brings together experts from healthcare and health IT to tackle the challenges of nationwide information sharing. As part of that initiative, the Information Blocking Workgroup tackles the practical implications and unintended consequences of the Office of the National Coordinator for Health Information Technology's final rule on interoperability and information blocking. The workgroup is also evaluating the proposed rule on information blocking enforcement by the Office of the Inspector General and any related future rulemaking from these bodies.
The Information Blocking Workgroup focuses on these proposed rules' broader implications, while the subgroups focus on more discrete issues and opportunities for each of the participants.
The Sequoia Project staff, workgroup co-chairs, and subgroup chairs will select subgroup participants, and keep each subgroup small to enable effective discussions. Subject-matter experts will be drawn from a variety of Sequoia Project communities, including participants in its initial Information Blocking Compliance Boot Camp.
These subgroups launch in January 2021 and final participants will be announced soon, The Sequoia Project said.
Enterprise resource planning modernization enables integration of systems from medical records to payroll.
As health systems finish modernizing their electronic health record (EHR) systems, attention is turning to renovating enterprise resource planning (ERP) software, and the benefits of tightly integrating the two.
Deb Muro, chief information officer of the nonprofit health system, El Camino Health, with hospitals in Mountain View and Los Gatos, California, says the process has improved productivity and enhanced access to data that proved vital during the current COVID-19-challenged times.
Speaking at the College of Healthcare Information Management Executives CHIME20 Digital Recharge event in November, Muro said the integrated system provides El Camino Health's top executives with a constantly updated view of such data as how many COVID-19 patients the health system has in its census, current supplies of personal protective equipment, and profitability of various service lines.
"This was one of the largest, most important projects that we were working on last year," Muro said. "Being able to determine what resources are needed is critical."
The business rationale for upgrading El Camino Health's ERP involved consolidating six existing ERP systems, and enabling better data flow between ERP and EHR systems. "We had several manual processes that had been in place for years," Muro said.
Additional benefits of the upgrade included improving data security and improving employee convenience, Morin said.
"It's so exciting to follow a model that will help bring success," Muro said. "El Camino Hospital has a rich heritage of technology. We were the first hospital in the nation to implement CPOE [Computerized Provider Order Entry] in 1972 with Lockheed Martin, and we've just continued this desire for innovation through the years."
Formulating the Right Partnerships and Stakeholder Participation Was Essential
A key element of getting to this point was partnering with a consultant and vendors who are aware of best practices when performing such an integration, Muro said.
In this case, the EHR vendor was Epic, the ERP vendor was Workday, and the consulting firm is Avaap.
Ben Morin, practice director at Avaap, led El Camino Health's deployment of Workday HCM [human capital management], payroll, and finance modules. Morin had led rollouts of Epic at other health systems, and Muro had led the rollout of Epic and Workday at El Camino Health during her four years there.
The transition to Workday was driven by the fragmented, incomplete nature of what preceded it.
"HR was challenged with multiple applications cobbled together [and] very little reporting capability," Muro said. "Supply chain was asking [for] a system that could meet [their] new business needs, [and] finance wanted to modernize the application platform. Bringing those three operational areas together [for] consensus on one system that can meet the needs of those three very disparate areas is quite the effort."
Morin said pitfalls await the health system that lacks involvement from operational owners of ERP and EHR systems. Involving those stakeholders, and taking a holistic view of how integrated data from each system can benefit the enterprise, is key, he said.
Business operations need to be open to allowing and completing software upgrades, Muro said. "Thinking about a cloud-based solution was really optimal," she said. Going with cloud implementations such as Workday also allowed El Camino Health to meet modern regulatory and cybersecurity requirements of all its IT systems, she said.
The three touchpoints between the two systems were finance, supply chain, and business intelligence, Morin said. Everyone involved needed to agree how the systems would work together, he said.
The project involved a lot of work. El Camino Health needed 107 points of integration between the ERP and EHR, Morin said. "It was significant, but it was worth it," Muro said. "The more that you can automate those processes, then you're freeing up your staff and your operations employees to be able to focus on other things."
As an example of the integration taking place, general ledger integration has to pull transactions from where they originate in the EHR, and place them in the Workday ERP. But the integration ended up requiring mapping El Camino Health's legacy chart of accounts in Epic's GL modules to the best practices in Workday ERP, Morin said. These best practices allow important functions such as replacing inventory and charging supplies to the proper accounts to flow smoothly between systems.
The last of the Workday functions to be implemented will be supply chain, and it will benefit from El Camino's implementation of CISOM.
"CISOM looks at outcomes, the usage of your supply chain, and how it supports the patient and your providers," Morin said. "Moving up the CISOM ladder focuses on governance and interoperability. When you get to the highest levels, population health becomes important as well, [and] predictive analytics, so you can proactively support the needs that you're going to have."
Morin advises others performing ERP‒EHR integration to "push your teams to always be in collaboration.
Muro also suggests utilizing each technology to its full capabilities. "Many CIOs are in the same situation where we've implemented lots of technology, and we've probably used about 50% to 60% of the capability," she said. "All of us are trying to understand how we reduce technical debt," reflecting the additional rework caused by choosing a limited solution now, instead of using a better software approach that initially takes longer to implement.
"A key component is consolidating your applications to some really critical applications that are doing a lot of R&D," Muro said.
Push your software vendors to solve your pain points, she said. "Address that gap so you don't have to go buy more software. "I love to hear that Workday has been onsite at Epic discussing how they can work more efficiently together."
Visits in quarter ended May 2020 jump from 4.4K to 600K versus quarter in previous year.
Individuals enrolled in Anthem's affiliated Medicare Advantage (MA) plans during the early months of the COVID-19 pandemic used virtual care substantially more than before, according to a new report from Anthem's Public Policy Institute.
By the numbers, 136 times more affiliated MA members used virtual health from March through May 2020 than in the same months in 2019. That's an increase from 4,400 to 600,000.
In its response to the pandemic, Anthem increased access to virtual care for video and phone-only visits. Coupled with social distancing and stay-at-home orders, consumers are accessing care differently now, the company said in a statement.
Essentially all the virtual services provided—98%—were within existing patient-provider relationships, Anthem said. Even so, the number of new patient encounters in March through May 2020 was larger than the total of all virtual services in the same period in 2019.
The largest group of primary diagnoses treated remotely were mental conditions and substance abuse disorders, Anthem said. Year-over-year, such virtual treatment grew more than 5,000%. Cardiovascular diagnoses topped the list of most commonly addressed physical health conditions. Musculoskeletal maladies followed, as did conditions related to endocrine and metabolic systems.
Older Anthem members, though they used more virtual services than in 2019, actually utilized a smaller share of such services in 2020 than Anthem had expected, based on their utilization in-person in 2019.
“We believe that by examining and sharing how and when members were using virtual services, we can help to shape the healthcare system to better leverage digital technology to meet the needs of members and all Americans moving forward,” said Jennifer Kowalski, vice president of the Anthem Public Policy Institute.
Further information about the study is posted on the ThinkAnthem website, and downloadable copies of white papers from Anthem's Public Policy Institute also are available online.
Expanding telehealth and modernizing public health infrastructure are also high on the trade association's list of requests.
The Healthcare Information and Management Systems Society (HIMSS) is urging the incoming Biden/Harris administration to focus on health IT to advance a range of goals including developing a national COVID-19 pandemic strategy, and permanently expanding telehealth services.
In a letter sent on December 15, HIMSS President & CEO Harold F. Wolf III identified eight priorities that require immediate action in 2021:
Develop and implement a nationwide COVID-19 strategy supported by health IT
Permanently expand telehealth and remote patient monitoring
Modernize public health data infrastructure
Heighten national focus on health equity
Develop a national patient identification strategy
Expand interoperability and health data exchange
Bolster cyber defenses for health infrastructure
Apply innovations to care delivery
The letter describes each of the eight priorities in detail.
HIMSS also pledged to help the incoming administration ensure equitable distribution of vaccines.
During a press briefing, when asked, HIMSS officials said they had just begun to define the organization's stance on immunity passports, potential tools for recording and sharing the immune status of an individual.
The HIMSS letter stated that the organization has developed clear evidence that virtual care offers equivalent quality to in-person care, as well as greater convenience to patients. "Telehealth also advances health equity by removing many barriers to care created by in-person visits and expands access to many underserved communities and individuals in ways never before envisioned."
In the letter, Wolf states that the initial investment of $550 million for the Data Modernization Initiative (DMI) through the Coronavirus Aid, Relief, and Economic Security Act will not be enough to modernize and maintain the U.S. public health surveillance system.
"The House of Representatives passed funding legislation that included an additional $450 million for DMI," the letter states. "We continue to urge Congressional leadership to include these resources in the final FY 2021 appropriations legislation and to continue sustained investments through regular appropriations."
"Netsmart customers report the most advanced capabilities when it comes to accessing and ingesting outside patient data," the report states. "Customers can automatically pull outside information (such as medications) into the EHR for reconciliation and use filtering tools to search ingested CCDs for relevant lab data and progress notes." CCDs are Continuity of Care Documents, based on HL7 standards.
A catalyst for moving outside data to these EHRs was the November 2018 connection between CommonWell and Carequality, the two most popular industry methods of exchanging medical records. So far, this connection has been utilized mostly by acute and ambulatory care organizations, KLAS says.
MatrixCare Homecare (Brightree) was among the first of these companies to connect to the CommonWell-Carequality connection. Approximately 100 customers have adopted the CommonWell connection, which requires little effort to set up, the KLAS report says.
More recently, MatrixCare has connected its long-term care solution to Carequality, and so far, about 30 customers are live.
According to KLAS, 88% of post-acute care and behavioral health organizations say they are getting value from their connections. The key benefit is being a few clicks away from getting this information, instead of waiting for faxes or chasing down other caregivers on the phone.
Although technical issues are few, nontechnical issues still present barriers to adoption, KLAS says. For instance, Homecare Homebase and Netsmart charge separate fees to set up connections.
At a time when physician burnout has reached alarming proportions, this virtual desktop solution improves the clinician experience and enhances workflow.
In a sweeping initiative to improve the clinician experience, Children’s National Hospital set its sights on designing a virtual desktop that follows staff around the health system and reduces logins from minutes to seconds. About one year later, despite the COVID-19 pandemic, that's exactly what the Washington, D.C.-based health system accomplished.
A key health information technology enabler for Children’s National is its Bear Institute, a unique 2013 partnership between the health system and EHR vendor Cerner Corporation. In 2018, innovation leaders at Children’s noticed some degradation of its clinician workflow environment, and decided to redesign it from the ground up, according to Matt MacVey, vice president and chief information officer at Children’s National.
Speaking at the College of Healthcare Information Management Executives CHIME20 Digital Recharge event, MacVey described the goal as being to improve the clinician experience at Children’s National. By that measure, mission accomplished—clinicians got back 12 minutes of each day previously spent logging into their Children’s National desktops.
The improvements also enabled those clinicians to access electronic health records (EHR) with maximum flexibility, thanks to a major infrastructure upgrade that replaced approximately 2,000 traditional PCs with "zero client" thin PCs, which access virtual desktops. Clinicians are now able to move from working on one such client to another in a fraction of the time it used to take. And during this year of the COVID-19 pandemic, this infrastructure also better supports remote work.
By leveraging Cerner’s resources, notably several system architects and project leaders who spearheaded the infrastructure upgrade, the Institute helped transform technology interactions.
"Physicians were logging into their systems, [and] it was taking up to two minutes for them to log into the system," says Darin Prill, a Cerner senior director who doubles as chief technology officer for Children’s National and technology leader for Bear Institute. "We had numerous back-end problems with applications and printing, and it was causing a huge amount of physician dissatisfaction, as well as potential patient safety issues with delay of care."
Fortunately, the patient safety issues never materialized, but Prill says the health system never wanted to be in that situation. "Within the hospital, the physician is hopping from computer to computer, and they need instantaneous access to the medical record," he says. Prior to the infrastructure upgrade, such logins took two to three minutes for each initial login, and a minute or two for subsequent logins. Due to some earlier design compromises, the remote-hosted Cerner servers had introduced even more delays in application response.
As part of the upgrade process, project leaders convened a user experience governance committee, which included a variety of departmental directors and managers, medical staff, the chief medical information officer, and the chief nursing information officer, Prill says.
Imprivata single sign-on technology allows clinicians to roam from client to client and be recognized and authenticated merely by their badges being in proximity to that workstation.
"We set some pretty aggressive goals," Prill says. "The first, and most important of which was, 30-second login time with 10-second resumption time." To achieve this, the team specified a multisite active server design utilizing a so-called "active-active" data center—continuously-available compute clusters at two different data centers, which could still serve up virtual desktops even if one data center were to go offline.
The upgrade ultimately "shattered" the design goals, now serving up the initial login in less than 15 seconds, and no more than three-and-a-half seconds for subsequent logins, Prill says. "When we talk about initial login, that’s [going] to the terminal, swiping their badge, and being able to get into the Cerner EHR, so that’s [the] full workflow, getting them to the EHR."
Upgrade Delivers Additional Benefits
Faster logins were only one of the improvements Children's National experienced.
Another benefit of going to zero client hardware is lowering administrative burdens and reducing the health system’s security attack surface, Prill says.
Other server-side infrastructure upgraded during the project includes Citrix virtual desktop technology and the Cerner EHR software itself. "The hyperconverged infrastructure from Cisco really lets us scale," says Keith Haag, senior architect of server and desktop virtualization at Cerner, who also worked on the upgrade. "If additional compute or memory resources are needed, [or] storage, that can be added in a modular fashion."
Children’s National also had some clinicians with more demanding workstation tasks – higher video performance for cardiologists and radiologists who needed snappy performance as they called up videos for their respective practices. "We did do NVIDIA GRID hardware-enhanced performance for some advanced desktops," Haag says.
Deployment: "We Didn't Want a Global Pandemic to Stop Us"
The team was one day away from starting the production pilot in its 7-East non-critical care hospital unit when the 2020 COVID-19 pandemic hit. "[It’s] our favorite place for pilots," says Ben Abramovitz, managing architect for Cerner at the Bear Institute.
Then, the health system told all non-essential workers to get out of the hospital, including the IT staff. "We had to rethink how we were going to pilot this," Abramovitz says. "We had just spent nine months building it. The general feeling was, we didn’t want a global pandemic to stop us."
The team switched the pilot to virtual, and deployed at the clinics first, since all nonessential visits had been stopped, Abramovitz says. Because there were still critical appointments going on, "we wore proper PPE and face masks, [and] had a large supply of hand sanitizer," he says.
Each clinic took two to three days to convert to the new infrastructure, and then the transition team would spend a day in between clinics doing rounding, making sure the deployment went well, Abramovitz says. Because on-site deployment staff were limited due to the pandemic, remote assistance from Haag’s team was essential to the rollout.
"We deployed to the entire hospital and all our ambulatory clinics in three months," Abramovitz says. "The net effect is every clinician at Children’s National got 12 minutes of their day back" due to the number of times clinicians log in each day.
One final benefit of the virtual desktop deployment: Faster, simpler logins for staff working from home during the pandemic. "It’s no longer a chore to get into the system," Prill says.
[Editor's note: This article has been modified to correct the spelling of Matt MacVey's name]
The report identifies the strengths and weaknesses of options in the market and predicts how the market will develop in the future.
Jody Ranck, co-author of the report, said that leaders involved understand that the healthcare system needs to address SDoH better.
“The pandemic has proven to be an additional, critical driver for continued expansion of [value-based care], which requires understanding all of the factors that can influence a member’s health status … to engage resources beyond the clinic,” he said in a news release.
The need for community partners is a new one for healthcare organizations, which traditionally try to keep all care within their own walls to maximize fee-for-service revenues. Key barriers to integrating with such partners include data management, legal issues, and internal engagement, according to the report.
Community partners are some of the best resources providers can utilize to address the social factors impacting patients’ health status, but this is a new need for, healthcare organizations, which under FFS, tried to keep all care within the clinic to maximize revenues. Data management and liquidity make effective integration with external partners a key barrier to implementation, while legal and internal engagement issues continue to slow adoption.
Within two years, healthcare IT products and services will slowly grow new capabilities, as the market determines key functions and performance expectations. The Chilmark report profiles key technology IT vendors and their plans to impact community health.
Use of innovative technology also reduced hospital admissions, as well as ER and outpatient visits.
A study of patients at high risk of developing diabetic foot complications saw major amputations completely eliminated and all-cause hospital admissions drop by 52% due to virtual care management provided by Podimetrics.
The research was published in BMJ Open Diabetes Research & Care, a journal published in partnership with the American Diabetes Association.
The researchers examined the impact of once-daily foot temperature monitoring with Podimetrics for patients with recently healed diabetic foot ulcers and found that for every three study participants using Podimetrics over the yearlong study, one hospital admission was avoided.
They also noted a 40% reduction in emergency department visits, and more than 25% reduction in outpatient visits.
Diabetic amputations are some of the costliest complications of diabetes. The research was conducted across four outpatient centers within Kaiser Permanente’s Mid-Atlantic States Region.
Seventy-seven eligible participants were provided the Podimetrics SmartMat for once-daily foot temperature monitoring and were followed for one year.
The researchers evaluated diabetic foot-related outcomes and associated resource utilization for each participant during three distinct and non-overlapping phases: the two years before study participation, the one year during the foot temperature monitoring intervention, and the period after the intervention ended through the date of the analysis.
After placing their feet on the cellular-connected SmartMat for just 20 seconds a day, patients’ data are automatically sent to the Podimetrics care management team, which helps address any concerning findings.
As a national telehealth provider, Amwell supports urgent care, acute care, chronic care, and wellness patient needs.
The Amwell platform is in use by more than 2,000 hospitals, 55 health plans, and 36,000 employers. The TytoHome Medical Exam Kit will now be used by Amwell to monitor adherence to treatment plans, as well as use with primary care and urgent care patients.
The TytoHome Medical Exam Kit has the potential to reach one-quarter of the U.S. population, subsequent to the Amwell partnership.
According to the HealthTech Insider newsletter, once the current pandemic is under control and people are less hesitant to leave their homes to make office visits, it will be interesting to see if the wider reach of home telehealth programs will cause a lasting change in how primary care medicine is practiced.
Faster, more sensitive testing method uses technology 'smaller than a quarter' to diagnose disease.
Diseases of the blood, like sickle cell disease, have traditionally taken a full day and tedious lab work and expensive equipment to diagnose, but researchers at the University of Colorado Boulder and the University of Colorado Anschutzhave developed a way to diagnose these conditions with greater sensitivity and precision in only one minute. According to Medical Product Outsourcing (MPO), "their technology is smaller than a quarter and requires only a small droplet of blood to assess protein interactions, dysfunction, or mutations."
Oxygen gets to cells throughout the body via red blood cells. Hemoglobin, the molecule that delivers that oxygen, can be affected by sickle cell disease. Crescent or sickle-shaped red blood cells can appear in hemoglobin where malaria is present in different parts of the world.
Traditionally, Thermal Shift Assays were used to determine how stable proteins were under different conditions. New Acousto Thermal Shift Assays allow two teams at the University of Colorado to do the same assessment faster and with greater sensitivity.
The new method heats a protein sample, while concentrating the proteins that do not dissolve, by using high-amplitude sound waves. This method employs a channel where protein samples get deposited, while two electrodes on each side generate the wave to heat and concentrate the proteins.
"The traditional methods for thermal profiling require specialized equipment such as calorimeters, polymerase chain reaction machines, and plate readers that require at least some technical expertise to operate," said University of Colorado researcher Kerri Ball. "These instruments are also not very portable, requiring samples to be transported to the instruments for analysis."
Acousto Thermal Shift Assays require a power source, a microscope, and a simple camera, such as those found on smart phones. There is no need to apply a florescent dye, which is sometimes required to highlight protein changes in a traditional thermal shift assay.