Participating Carequality members will be able to subscribe to the CommonWell record locator service. A pilot test will begin in the first half of 2017.
Sometime before mid-2017, one of the greatest divides in health IT today will start to be bridged.
Communities supporting two of the leading HIT data exchange networks, managed by CommonWell Health Alliance and Carequality, will begin participating in pilot programs to bring each network's most compelling service to members of the opposite network, according to a joint announcement this month.
Participating Carequality members will be able to subscribe to the CommonWell record locator service, previously available only to members of CommonWell, or to its clients and customers. Access to the patient-matching technology returns a variety of results based on the patient name specified in the request.
Conversely, CommonWell participants will be able to begin sending directed health information exchange queries to systems supporting the Carequality Interoperability Framework, in order to receive relevant documents for a designated patient at a designated setting of care.
Full deployment of both services will arrive near the end of 2017 or in early 2018, officials say.
Company officials noted that each service is opt-in, but that once providers opt in, they will be obligated to "share and share alike" and respond to queries from other participating providers as they would expect those providers to respond to their own queries.
Previous Roadblocks Thwarted Interoperability
CommonWell, formed in 2012 by Cerner, athenahealth, and other EHR and HIT vendors—but with the notable exception of Epic—was followed by the activation in mid-2016 of Carequality.
The Carequality framework encompassed Epic, eClinicalWorks, athenahealth and a variety of other HIT vendors.
The technical terms of the agreement require CommonWell to build an equivalent version of its record locator service for Carequality, and to link the two into a single service capable of querying and retrieving those records. CommonWell will also add query and retrieve capabilities to enable it to do so against Carequality-affiliated data sources.
These new services will require little or no modification to EHR and other HIT software provided it is already connected to their respective networks, company officials say.
"In terms of this agreement, I don't see any kind of new work that our members will have to think about, from a policy or from a technology standpoint," says Jitan Asnaani, executive director of CommonWell.
Asnaani notes that Carequality members who opt to subscribe to CommonWell's record locator service will pay a fee, but he says these fees will be "fair and even costs to help us bear the burden of whatever load they bring as they subscribe to our record locator service."
In the case of EHR vendors who choose subscribe to the record locator service, Asnaani says CommonWell will pass whatever the cost of these subscriptions on to its customers.
Many Health Info Exchange Gaps to Persist
Due to the opt-in nature of services offered by those who are members of either group, just because the interconnected services begin in 2017 does not necessarily erase all gaps in connectivity between providers, Asnaani notes.
"If you are participating in the exchange via Carequality, you are expected to share with anyone else," says Dave Cassel, director of Carequality.
"So to the extent that participants of CommonWell opt to participate through CommonWell and Carequality activities, they will have access to all the other participants, and the other participants will have access to them."
"I have not seen any cases yet where a vendor can force their clients to opt in," he says.
In addition to the two services highlighted in the joint announcement, CommonWell and the Sequoia Project, the nonprofit parent under which Carequality operates, have agreed to explore additional collaboration opportunities in the future.
Behavioral health providers, in particular specialty addiction treatment organizations, often lack resources and infrastructure to implement technology tools that could improve care, survey data shows.
The use of health IT to advance behavioral health, in part by integrating it with general medical care is lagging.
Greater use would not only facilitate care coordination, but could fulfill the goals of MACRA and other value-based care initiatives, a survey of more than 8,000 commercial health plan products shows.
The survey, conducted in 2010 and published in the December 2016 issue of the American Journal of Managed Care, notes that behavioral health providers were not eligible for incentives under the Medicare Access and CHIP Reauthorization Act (MACRA), nor under the earlier 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act.
Moreover, behavioral health providers, in particular specialty addiction treatment organizations, often lack resources and infrastructure to implement health IT which could improve care.
Nevertheless, even in 2010, a significant minority (28%) of health insurance products allowed primary care providers to bill for e-mail communication with patients about behavioral health issues, the study concluded.
The survey found that in two areas, health plans excelled at digital capabilities. Ninety percent offered online provider directories, and 95% offered online self-assessment tools.
Seventy percent of respondents offered online personalized response to questions or problems, and 60% offered online counseling.
Only 25% of health plans, however, offered financial support for EHRs to behavioral health providers, and only 4.5% offered technical assistance for health IT needs, the survey found.
Behavioral Health Data Elements Often Still Lacking
The study noted that health IT overall still has many limitations, such as lack of standardization of data, interoperability between healthcare systems, and little or no inclusion of behavioral health data elements.
The study did highlight two large payers, Kaiser Permanente of Northern California and the Veteran's Health Administration, as leaders in using EHRs in primary care to address risky alcohol use by patients.
These organizations used a standardized EHR with recommended alcohol screening questions, tracked trends and employed decision support software and clinical alerts.
The study cautioned that data were self-reported by health plan executives, and may not fully reflect what was happening in practice.
Cigna has introduced a mobile feature that it hopes will lead consumers to raise their rates of engagement with their healthcare providers.
Like a stubborn virus, the necessity for logins and passwords clings to us all. But advances in mobile phone technology and the initiatives of healthcare payers are making headway.
Last month, Cigna became the latest payer to add authentication via fingerprint to its patient-facing mobile app. Now the MyCigna app can take advantage of the same biometric technology that banking apps, Dropbox, Amazon, and others have enabled through mobile platforms such as Apple's Touch ID.
With more than 30 million members in the U.S. alone, Cigna's goal was to decrease the number of those members who don't follow through on steps to seek preventative care, says Stephen Cassell, Cigna's global branding officer at the company's Bloomfield, CT headquarters.
Easier Responses, Lives Saved
"We see consumers go to their computers or phones to log in, but people just fall off. They just don't complete all the steps," says Cassell. "We thought, how could we make things even easier for our customers?"
Cigna was also looking for a way to allow consumers to easily respond to the different calls to action that the insurer was putting out there in the marketplace to get them to engage in their health.
"The reason we even started the fingerprint access is connected to a larger campaign to drive people to try to get their checkups. It's all around how do we help save a hundred thousand lives in the U.S. per year by getting people in for their preventive care services."
A consumer could be in a doctor's office, requesting a referral to a specialist, and would want to know on the spot, whether the specialist is in the Cigna network. By checking MyCigna, he could avoid any surprise out-of-network costs, or a delay in care by having to request a new referral later.
It also lets consumers receive care or provide proof of insurance even if they forget their Cigna ID cards, Cassell says.
Such convenience may vary depending upon provider, as some providers have a way to capture the member's ID via the Cigna app, but some do not. "Obviously we're looking to make things more efficient for the medical community as well," he says.
Provider Directory Accuracy Remains an Issue
I asked Cigna about a recent New York Times article highlighting the continuing inaccuracy of health insurance provider directories. The company replied that Cigna updates the myCigna directory every night to ensure the most up-to-date information is available to its customers.
The results from multiple focus groups convinced Cigna leaders that the public would respond well to fingerprint access. But the insurer lacks data on its actual use.
That's because of the way fingerprint access is implemented on mobile platforms.
"The feedback in the groups was just really positive," he says. "So we knew that we were on the right path. We are seeing definitely an uptick in overall engagement on preventive care, even from before the MyCigna app came out, and we continue to see those upticks."
Other Payers Also Use Biomterics
Cigna is also thinking about adding some contextual prompts to the app based on what members are searching for while using the app, Cassell says. For example, if the app determines that the user is searching for an urgent care clinic, it could prompt the user to input his fingerprint, and then, with location services enabled, direct them to the nearest urgent care clinic.
Cigna is hardly the first payer to enable features such as Apple's TouchID.
In early 2015, Aetna implemented it in its iTriage app. Apps such as MyCigna and iTriage are not as ambitious as apps from vendors such as LifeMedID, which help providers and payers go further to enable higher Level of Assurance (LOA) services, such as record matching and patient payment via mobile phone at check-in.
Nevertheless, MyCigna is a step forward, and as someone who uses TouchID to reduce my own dependence on logins and passwords, I can vouch for the technology's versatility, one that should be applied to healthcare as rapidly as education allows.
Rates of potentially unsafe medication prescribing were found to be significantly higher among veterans with dementia using more than one health system.
Using more than one health system can have a negative effect on patient safety, according to a study published Monday in the Annals of Internal Medicine.
Specifically, the study found that rates of potentially unsafe medication prescribing were significantly higher among veterans using more than one health provider.
Those rates were significantly higher among veterans with dementia using more than one health system compared to those using only the Department of Veterans Affairs providers.
According to the study, the average dementia patient has four co-morbid conditions and receives care from five different providers annually. Medication management is particularly challenging because the average patient takes five different drugs, and 16% of patients take nine or more.
Provision of highly coordinated care is fundamental to prescribing safety in dementia patients, the study suggests.
The research originated in the Center for Health Equity Research and Promotion at the Veterans Affairs' Pittsburgh Healthcare System, and the Center for Health Services Research in Primary Care at the Durham Veterans Affairs Medical Center, in Durham, NC.
"Recent federal policy changes to expand access to care may have unintended consequences that thwart the VA's efforts to enhance care coordination," the study states.
In 2006, the introduction of the Medicare Part D prescription drug program expanded veterans' access to medications through non-VA health care systems, in which eligibility for Part D is independent of VA benefits.
Subsequent legislation further expanded veterans' ability to seek care outside the VA system.
Although this study claims to be the first to focus on prescribing quality and safety with patients seeking care in both VA and non-VA systems, previous studies show such use to lead to duplication and overuse of other health services, and worse health outcomes.
"Successful co-management requires that health information exchange between systems—currently the responsibility of veterans and caregivers—needs to improve," the report states. Pilot programs, such as the VA Virtual Lifetime Electronic Record, show "great potential" to facilitate health information sharing between VA and non-VA providers.
Legislation on its way to the U.S. Senate offers a possible path toward solving the patient ID problem.
Last week's passage of the 21st Century Cures Act in the U.S. House of Representatives may result in reduced regulatory burdens for providers struggling to comply with meaningful use and other health IT-related requirements.
The bipartisan legislation is expected to pass the Senate this week and head to President Obama's desk for a promised approval.
It directs the Department of Health and Human Services to create a report outlining how the department could reduce regulatory and administrative burdens, says Leslie Krigstein, vice president of congressional affairs at College of Healthcare Information Management Executives (CHIME).
"It wasn't a direct relaxation [of regulations], but hopefully their findings could result in some harmonization across all of the different reporting programs, even just within CMS," Krigstein says. "That would be exceptionally helpful."
Effects on Patients
Then there is the patient ID aspect.
According to Krigstein, the 21st Century Cures legislation gives the U.S. Government Accountability Office two years to report back to Congress on a number of tech-related topics: the impact of IT on patient safety, on health IT security, and, of particular note, improvements in matching patient records, reducing errors, and duplicating records.
Each year since HIPAA passed in 1996, Congress has inserted language into the HHS appropriations bill (or its continuing resolution equivalent) that prohibits HHS from spending money on developing a unique health identifier for individuals. CHIME and other organizations have lobbied, with little effect until now, for Congress to relax this prohibition, which arose out of privacy concerns.
In preparing the report required by the 21st Century Cures bill, HHS's Office of the National Coordinator could define additional data elements that move toward a universal patient identifier, Krigstein says.
Krigstein cautions that the way previous Congressional language reads, such an identifier might not be created until a separate act of Congress authorizes it, essentially lifting the 20-year-old ban.
Infrastructure for Data Exchange
Yet another element of the bill defines a new federal advisory committee to replace the existing ONC Health IT Standards and Health IT Policy committees, Krigstein says.
The charter of the new advisory committee is "to articulate the infrastructure that will facilitate national and local electronic access exchange and use of information," she says. "That includes technology that can accurately match patient information to the correct patient and that avoids duplicate records. So that's huge."
Due to the bipartisan support the 21st Century Cures Act has received, Krigstein does not expect the Trump administration to overturn its elements in any sweeping health reform which may be in the cards.
"There are bits and pieces that were priorities of the Democrats as well as the Republicans both in the House and Senate," she says.
Several other provisions in the version of the House bill that passed are of interest to HIT leaders:
No enforcement of information blocking practices or conduct occurring prior to 30 days after the date of enactment can occur.
The new HHS Secretary is required to submit a report to the new advisory committee on attestations within six months of enactment.
The National Coordinator shall convene appropriate stakeholders to develop or support a trusted exchange framework for trust policies and practices and for a common agreement for exchange between health information networks.
This last point is particularly interesting, as it speaks to the shortcomings of MACRA's information blocking. Several sources report that the lack of common rules of the road among various health information networks is the main stumbling block keeping those networks from reaching agreements.
Perhaps the new administration can do what the present one failed to do: Get all these stakeholders in a room, and don't let them leave until they agree to open up their trust frameworks and health information silos and share data with each other.
Cedars-Sinai is improving nursing workflow by integrating devices around the hospital with its electronic health record.
This article first appeared in the December 2016 issue of HealthLeaders magazine.
At most hospitals, standalone devices capture such vital signs as pulse oximetry, weight, temperature, and blood pressure, but values from these devices must be reentered into the EHR manually, creating extra work for nurses and introducing data entry error possibilities.
Enter Cedars-Sinai, a nonprofit academic medical center in Los Angeles with 886 licensed beds, 2,100 physicians, 2,800 nurses, and thousands of other healthcare professionals and staff. At Cedars, device integration is already eliminating much manual work.
In a talk at the 2016 HIMSS conference, Jennifer Jackson, Cedars-Sinai director of clinical engineering and device integration, described the origins of the initiative, the outcomes of which she is now in the process of preparing for publication in a peer-reviewed journal. She is also preparing a paper about previous work integrating IV pump data into the health system's EHR.
In the case of pump integration at Cedars-Sinai, the Electronic Medication Administration Record (EMAR), which lives inside the EHR, pushes the medication order information to the pump. In that sense, the EHR programs the IV pump. The pump sends data back to the patient's EMAR. However, the EHR does not start and stop the IV pump itself. That still needs to be done by a nurse. The nurse reviews the settings prepopulated into the pump by the EHR before starting the pump.
"On both ends it saves us a lot of time and it also now removes a high degree of potential error when it comes to data entry and the timing of that data entry," she says. "We're now in the process of reviewing the data and seeing how significant the results are."
Cedars-Sinai first connected infusion pump systems to EHRs in June 2014, adding pulse oximetry integration in August 2016. Although she cannot yet disclose the outcomes of the infusion pump integration, Jackson says it involves significant avoidance of medication errors.
"Our approach to device integration is somewhat holistic," Jackson says. "We look very carefully at not just a movement of data points from one system to another system. In the case of pulse oximetry, a system that we just implemented, it wasn't enough for us just to export the SpO2 and pulse rate into the EHR. We also wanted to capture and be able to distribute the alarm settings. For us that was a single project."
Another aspect of the integration involves patient-controlled analgesia (PCA) pumps.
"When we say device integration, it's not just looking at how to get the data points into the EHR. It's also looking at what kind of alarms are more actionable information. Do we need to get to those caregivers in a meaningful time?"
"We measured their pulse oximetry, just to make sure, to monitor the patient's respiration, so that we can intervene should that patient start to have an adverse reaction to the opioid in their PCA pump," she says.
A drawback and annoyance of standalone devices' alarm systems is that, often, the only person hearing that alarm initially may be the patient, as nurses attend to other patients in their care. Alarms can be routed to a nurse's workstation or portable communication device to speed intervention, Jackson says.
"The expectation that the nurse or someone will always be available to intervene the moment that device starts to alarm is a large expectation," she says. "Actually, we're asking too much of our care workers to always be waiting for the next alarm. And when we say device integration, it's not just looking at how to get the data points into the EHR. It's also looking at what kind of alarms are more actionable information. Do we need to get to those caregivers in a meaningful time?"
Therefore, at Cedars, data such as pulse oximetry not only integrates with the EHR, it also integrates with Cedars' alarm management system. "We're often shocked at how few medical device manufacturers have actually thought through this kind of integration," Jackson says. Once these integrations were in place, "we know that we've been able to intervene and possibly save lives.
"It could be something as simple as the patient just dislodged their nasal cannula, but that caused their SpO2 to go down," Jackson says. Nurses could then reenter the patient's room and ask the patient to reinsert the cannula to receive the proper amount of oxygen.
Jackson describes the device integration initiative as "my career. I've been very passionate about it." At Cedars, the initiative's executive champion has been Linda Burnes Bolton, RN, vice president of nursing and chief nursing officer. "She did a lot of the precursor work to identify device integration and some technologies that we actually leverage for the alarm notification process," Jackson says. "She and some of her fellow CNOs got together and said nursing care should be at the highest level that it should be in terms of quality of care in the era of EHRs and newer technologies that are impacting the workflow."
Over time, vendors themselves are filling in some of the device integration gaps. For instance, San Antonio, Texas-based AirStrip Technologies has been building and offering a vendor- and data source-agnostic enterprisewide clinical mobile interoperability solution incorporating devices such as fetal monitors into dashboards viewable on iPads and other information-viewing devices. AirStrip investors include Dignity Health, Hospital Corporation of America, St. Joseph Health, and the Gary and Mary West Health Investment Fund.
There is also an effort underway at the national policy level to help with device interoperability issues, including draft guidance from the Food and Drug Administration in January 2016, "Design Considerations and Premarket Submission Recommendations for Interoperable Medical Devices," intended to be a nonbinding set of guidelines to interoperability of medical devices with each other and other health information systems. "There's a lot of different agencies that are looking at interoperability and each agency has its own hammer, and the FDA's hammer is safety," says Matt Patterson, MD, president of AirStrip.
The draft FDA guidance has broad industry support, and may help extend the work of trailblazers such as Cedars-Sinai to all of healthcare.
But a Harvard professor who leads a startup supplying machine learning technology to Senior Whole Health, a Medicaid managed care organization active in New York state and Massachusetts, says that machine learning will eventually power all technologies we know today as predictive analytics and population health.
Leonard D'Avolio is that professor, and his background in healthcare makes him someone to watch on this front. His startup, Cyft, specializes in creating proactive care models with all available data from EHRs, unstructured notes, pharmacy info, and more to identify and better treat patients who will be soon experiencing some kind of trauma or risk of readmission.
D'Avolio's background includes collaboration with Atul Gawande, MD, at Ariadne Labs, an innovation lab startup where Gawande serves as executive director.
"I came up as a researcher and so I knew from trying to solve medical data problems that more than 50% of what is considered clinically relevant is unstructured free text in the medical record," D'Avolio says.
Highly Inaccurate Claims Data
"Claims data can be, depending on the disease, up to 80% inaccurate, and yet when we're doing analytics in healthcare, we are relying on rules and traditional statistics, all of which have at their base assumption the idea that the data will all be in one place, well-structured, and reliable."
D'Avolio says 20 years of research shows that machine learning and natural language processing (NLP) are capable of making sense of healthcare data that traditional business intelligence analytics technology cannot.
But after publishing more than 20 papers on the topic, speaking publicly, and releasing some machine learning and NLP technology as open source for healthcare to use, D'Avolio was disappointed by the results.
Only 300 institutions downloaded it and used it as a teaching tool. "It never jumped the fence and really made a difference in the care of patients."
So D'Avolio found investors and formed Cyft, which commercialized this work for organizations such as Senior Whole Health.
"One of the things we're doing right now is not just identifying folks that are going to be readmitted, which is sort of where predictive analytics stops in most of health care today. They've got to figure out which people in my population are most likely to end up in the emergency department in the near future, and not just anyone, because again, the high risk pregnancy is very different than the geriatric patient."
Cyft is focusing on the top five condition classes faced by organizations such as this—heart disease and diabetes are two—to try to target preventable admissions. It does this by scrutinizing nontraditional data such as nurses' impressions on notes, call center transcripts, Medicaid surveys on activities of daily living, and Likert scale functional status data.
Start with the Outcome
Cyft predictions get funneled to the appropriate person who specializes in that area, and who can now justify the cost of a $150 home visit. The results of such decisions increasingly can be shown to be more cost effective than an emergency room admission, which can cost more than $12,000 a day, D'Avolio says.
The same technology can even predict which patients are most likely to disenroll from a care plan, D'Avolio says.
"What makes machine learning so different is that you start with the outcome," he says. "You're taking a group of patients that were readmitted and a group of patients that looks a lot like them except they were not readmitted, and you're letting the math learn what makes group A different than group B."
While recognizing such patterns can be done by people, computers prove to be superior in recognizing more patterns faster than humans can.
So get ready for the next wave of analytics, one that may not rely so much on those analysts as today's analytics solutions. As companies such as Cyft gain traction, the economics, as usual, favor ever more automation.
Whether the practice of reasonable or unreasonable data blocking yields to government or market forces in 2017 remains to be seen.
As we await stronger signals about where the Trump administration will take health IT from here, keep in mind that the Republican contribution to the MACRA legislation talked tough about information blocking by healthcare providers and HIT vendors.
This tough talk, which originated in Senate hearings in 2014 and 2015, pegged information blocking as a key factor inhibiting the growth of value-based care and was echoed in a 2015 ONC report commissioned by the Republican-controlled Congress as well as ranking committee Democrats in the House and the Senate..
As a refresher, ONC's report states that information blocking occurs "when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information."
MACRA spells out just how ONC would enforce its new power to combat information blocking. On or after April 16, healthcare providers will submit attestations to CMS which require the provider to affirm they did not knowingly and unreasonably interfere with the exchange or use of electronic health information.
Following such attestations, providers who feel that information blocking is continuing to occur are free to complain about it to ONC, and CMS is empowered by MACRA to audit these providers. If the audit reveals that the complaint is warranted, CMS is further empowered to take appropriate action.
Comments on this part of the MACRA file rule ranged from concerns that it was too vague to concerns that it was too prescriptive.
"The majority of commenters, whether they supported or opposed the proposal, stressed that certain factors that prevent interoperability and the ability to successfully exchange and use electronic health information are beyond the ability of a healthcare provider to control," CMS wrote in the final rule.
EHR Vendor Perspective
To me, however, it appears that there is so much room in the phrases "knowingly and unreasonably interfere" that it remains to be seen whether the information-blocking provisions of MACRA will result in fewer reported or unreported instances of information blocking.
For some perspective, immediately prior to the Presidential election, I spoke with the two leading EHR vendors who were attending the CHIME conference.
One of those vendors, Epic, declined to update its comments after the election, but I sketched a scenario for the company that it seemed all too familiar with.
In cases I've had described for me more than one, a given provider says it is happy to share information with another provider, provided that the information is accessed through the first provider's health information exchange. The exchange may be of its own creation, or one the provider has contracted with to provide outside data access.
But the provider requesting the information may very well want to use its own HIE, or an emerging national network such as Epic's CareEverywhere, the CommonWell Health Alliance, or the Sequoia Group's CareQuality network.
Because the provider receiving the request is wedded to its own network or HIE, the resulting situation appears to be a standoff. But is it a standoff that meets the condition of "knowingly or unreasonably interfere"?
"And let's multiply this a little bit," says Epic chief executive officer Judy Faulkner. "That organization doesn't get one request to do it their way. It gets 25 requests, [to do it] in all different ways, and they don't even have the staff to do it."
No 'Willful' Blocking
All of which, Faulkner says, is that the incidence of willful blocking "doesn't occur." Instead, it falls into the category of reasonable lack of interoperability.
CareQuality connects Epic and other EHR vendors together, including athenahealth, which is also a member of CommonWell. But as of yet, CareQuality and CommonWell have no announced intention or timeframe to connect to each other.
And those state-based HIEs which still exist, by-and-large do not yet connect to each other, although HIE Texas is now a CareQuality member, notes Dave Fuhrmann, a software developer who leads Epic's interoperability team.
"I still think data blocking exists, and it's more subversive and below the surface," says Zane Burke, president of Cerner. "It's going to be very challenging to implement, and we don't have a lot of guidance on what CMS and ONC are saying behind that."
A quick check with Cerner officials after the election basically echoed Burke's remarks.
So will the practice of reasonable or unreasonable information blocking yield to government or market forces in 2017? Without progress on this front, it will be difficult for either the current or future administration to call MACRA a success.
Making patients the stewards of their own health data could result in better access, despite a business environment where health systems do not make sharing a patient's data with each other a top priority.
The barest outlines of the Trump Administration's healthcare policy were not yet clear on the morning after Donald Trump's upset presidential victory, but the CIO of a New York City health system was already looking forward to resolving issues unresolved by the election.
"If we were all on a common shared data platform and could easily access one another's patient data, I think we would do a much better job of keeping people healthy," said Daniel Barchi, senior vice president and chief information officer of New York Presbyterian Hospital in New York.
Speaking at the inaugural Techonomy Health conference last week in Half Moon Bay, CA, Barchi expressed hopes that the industry can agree to make patients the stewards of their own data moving forward.
In this way, he believes, patients can be at the center of sharing data in a business environment where health systems still do not make sharing a patient's data with each other a top priority.
"The standard [in the 2009 American Recovery and Reinvestment Act] was so low," he said.
"I can send a couple of packets of data. You can send me a couple of packets of data and check the box. That's it. It's not really interoperable in any way. And the EMR vendor was really not incented in any way. They were just helping everybody get live on all these new systems."
No Incentive to Share Data
As a result, healthcare CIOs find themselves having built "really great complex systems within our own health systems, but aren't incented to share data in any way, and so we're doing it through a lot of back-door work," Barchi said.
He equated continuity of care (CCD) documents to "electronic faxes, a couple-of-page PDF version of somebody's care. Sure you can shoot it back and forth electronically, but you're not going to interact with it."
Barchi said he forward to accelerating innovation on the care coordination front.
"There's an expectation in the technology industry that we have absolute huge airplane hangars full of people at desks making phone calls and checking up on people at home," he said.
"Even in a $7 billion health system, I might be able to introduce you to our 17 care coordinators individually by name, so we're not at the level where large health systems have these workforces that are incented to keep people healthy."
Rooting Out Inefficiencies
Speaking at the same event, another speaker said technology is showing promise to squeeze inefficiencies out of back-office work.
"The provider is the main deliverer of healthcare," said Jim Dougherty, who serves as CEO and co-founder at Madaket Health, a cloud-based service startup, which automates provider enrollment in payer plans.
"We've said we're going to focus on making their lives better," said Dougherty, a former member of the board of directors of Beth Israel Deaconess Medical Center in Boston.
Such enrollment still relies too often on laborious fax-based workflows. Via Madaket, a process that used to take a provider and payer 45 days "now takes two days, which benefits everybody," he said.
Such cloud-based technology platforms can also be extended to accelerate other workflows.
"We at New York Presbyterian have this issue," Barchi said, commenting on Madaket's technology. "Mass General has this issue. Mayo has this issue. We all have this credentialing and payer issue with vendors. This is the kind of solution that will get in and solve a problem that occupies anywhere from 10 to 30 full-time employees on this kind of issue."
One concern is whether to implement such point solutions in a piecemeal fashion, or to looking "to change the way that we're running the healthcare system."
Barchi said part of the answer will come from the next generation of electronic medical records.
"There are always upgrades that are happening to get better and better at sharing data," Barchi said.
Healthcare CIOs describe their wishes for the incoming president. Among them: National data standards, stronger data security, and continuing efforts to advance technology.
Scuttling meaningful use for hospitals, continuing with value-based payment efforts, and using the most advanced technology available are some of the nuggets of advice some healthcare CIOs have for President-Elect Donald Trump.
"Stop MU and redirect resources focused on the program," advises Marc Probst, CIO of Intermountain Healthcare in Salt Lake City. "Any value that potentially came from MU is now over."
Probst, an original member of the Health IT Policy Committee of the Office of the National Coordinator, adds that "the check-the-box approach to HIT is severely limiting innovation, frustrating caregivers and increasing costs. [It's] time to let providers and other HIT organizations figure out for themselves how to best utilize the EMR technology and get value from their investments."
Probst adds that the Trump administration should focus government health IT spending on "issues they can help with, such as national data standards and information security strategies."
Other items on his priority list for the Trump Administration include passing a bill through Congress to create true semantic interoperability of EHR systems and data. Probst, the current chair of the College of Healthcare Information Management Executives, says the organization has developed a draft bill focused on this issue.
Probst also wants to see less regulation of digital healthcare technologies such as telehealth. "Regulation inhibiting expansion of tele-health use or payment for tele-health services is hurting healthcare," he says.
Regardless of political events in Washington, healthcare leaders must focus on already-identified high priorities – improving quality, safety, and efficiency, says John Halamka, CIO at Beth Israel Deaconness Medical Center in Boston.
"In my conversations with Washington DC career staff (not political appointees), there is a sense that the Quality Payment Program will go forward as written," Halamka says.
Halamka's advice to healthcare CIOs is to ready themselves for care management and payment based on quality and outcomes. To Halamka, that means:
Social – groupware applications for clinicians to coordinate care including secure messaging integrated into the EHR workflow
Mobile – move everything provider and patient facing to mobile platforms
Analytics – provide population health and CRM tools based on a cross-organizational aggregation of data from inpatient, outpatient, urgent care, emergency and skilled nursing settings
Cloud – make all solutions available from cloud-hosted providers anywhere at any time
Privacy – invest heavily in security, respecting patient privacy preferences when sharing data
"Such an approach works for Obama's agenda and should work for Trump's," Halamka says.
"My initial reaction is one of shock," says Randy McCleese, vice president of IS and CIO of St. Claire Regional Medical Center in Morehead, Kentucky.
"Based on what I have heard and seen in the media, rural America carried Trump to the presidency. Hard-working people that live in rural areas and small towns have become very irritated with Washington inasmuch as the government seems to have forgotten that we are here.
McCleese says St. Claire has spent millions of dollars during the past few years implementing technology to overhaul the delivery of healthcare "and cannot go back to the pen and paper days of the past. My advice for the new administration is to continue the advancement of safe, effective, and efficient delivery of healthcare utilizing the most advanced technology."
The consumerization of healthcare was on the minds of another CIO.
"President-elect Trump's populist message around advancing the retail orientation of healthcare delivery, including price transparency will probably accelerate the current trends and pressures we have already seen in this direction," says Darren Dworkin, senior vice president of enterprise IS and CIO of Cedars-Sinai Health System in Los Angeles.
"In health IT, I would expect that we will see even more rapid innovation in digital health as consumer-friendly applications continue to be demanded to be connected to our existing enterprise systems," Dworkin says.