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Open Source Software and the Path to EHR Heaven (Part 1 of 2)

Posted on September 19, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Do you feel your electronic health record (EHR) is heaven or hell? The vast majority of clinicians–and many patients, too, who interact with the EHR through a web portal–see it as the latter. In this article, I’ll describe an EHR heaven and how free and open source software can contribute to it. But first an old joke (which I have adapted slightly).

A salesman for an EHR vendor dies and goes before the Pearly Gates. Saint Peter asks him, “Would you like to go to heaven or hell?”

Surprised, the salesman says, “I didn’t know I had a choice.”

Saint Peter suggests, “How about this. We’ll show you heaven and hell, and then you can decide.”

“Sounds fair,” says the EHR salesman.

First they take him to heaven. People wearing white robes are strumming harps and singing hymns, and it goes on for a long time, till they take him away.

Next they take him to hell. And it’s really cool! People are clinking wine glasses together and chatting about amusing topics around the pool.

When the EHR salesman gets back to the Pearly Gates, he says to Saint Peter, “You know, this sounds really strange, but I choose hell.”

Immediately comes a clap of thunder. The salesman is in a fiery pit being prodded with pitchforks by dreadful demons.

“Wait!” he cries out. “This is not the hell I saw!”

One of the demons answers, “They must have shown you the demo.”

Most hospitals and clinicians are currently in EHR hell–one they have freely chosen, and one paid for partly by government Meaningful Use reimbursements. So we all know what EHR hell look like. What would EHR heaven be? And how does free and open source software enable it? The following sections of this article list the traits I think clinicians would like to see.

Interfaces could be easily replaced and customized

The greatest achievement of the open source movement, in my opinion, has been to strike an ideal balance between “let a hundred flowers bloom” experimentation and choosing the best option to advance the field. A healthy open source project encourages branching, which lets any individual or team with the required expertise change a product to their heart’s content. Users can then try out different versions, and a central committee vets the changes to decide which version is most robust.

Furthermore, modularization on various levels (programming modules, hooks, compile-time options, configuration tools) allows multiple versions to co-exist, each user choosing the options right for their environment. Open source software tends to be modular for several reasons, notably because it is developed by many different individuals and teams who want control over their small parts of the system.

With easy customization, a hospital or clinic can mandate that certain items be highlighted and that safe workflow rules be followed when entering or retrieving data. But the institution can also offer leeway for individual clinicians and patients to arrange a dashboard, color scheme, or other aspect of the environment to their liking.

Many of the enablers for this kind of agile, user-friendly programming are technical. Modularity is built into programming languages, while branching is standard in version control systems. So why can’t proprietary vendors do what open source communities routinely do? A few actually do, but most are constrained in ways that prevent such flexibility, especially in electronic health records:

  • Most vendors are dragging out the lifetime of nearly 40-year old technology, with brittle languages and tools that put insurmountable barriers in the way of agile work styles. They are also stuck with monolithic systems instead of modular ones.
  • The vendors’ business model depends on this monolithic control. To unbundle components, allow mix-and-match installations, and allow third parties to plug in new features would challenge the prices they charge.
  • The vendors are fundamentally unprepared for empowered users. They may vet features with clinically trained consultants and do market research, but handling power over the system to users is not in their DNA.

Data could be exchanged in a standard format without complex transformations

Data sharing is the lifeblood of modern computing; you can’t get much done on a single computer anymore. Data sharing lies behind new technologies ranging from the Internet of Things to real-time ad generation (the reason you’ll see a link to an article about “Fourteen celebrities who passed out drunk in public” when you’re trying to read a serious article about health IT). But it’s so rare in health care–where it’s uniquely known as “interoperability”–that every year, reformers call it the most critical goal for health IT, and the Office of the National Coordinator has repeatedly narrowed its Meaningful Use and related criteria to emphasize interoperability.

Open source software can share data with other systems as a matter of course. Data formats are simple, often text-based, and defined in the code in easy-to-find ways. Open source programmers, freed from the pressures on proprietary developers to reinvent wheels and set themselves apart from competitors, like to copy existing data formats. As a stark example of open source’s advantages, consider the most recent version of the Open Document Format, used by LibreOffice and other office suites. It defines an entire office suite in 104 pages. How big is the standards document for the Microsoft OOXML format, offering roughly equivalent functionality? Currently, 6,755 pages–and many observers say even that is incomplete. In short, open source is consistently the right choice for data exchange.

What would the adoption of open source do to improve health care, given that it would solve the interoperability problem? Records could be stored in the cloud–hopefully under patient control–and released to any facility treating the patient. Research would blossom, and researchers could share data as allowed by patients. Analytical services could be plugged in to produce new insights about disease and treatment from the records of millions of people. Perhaps interoperability could also contribute to solving the notorious patient matching problem–but that’s a complicated issue that I have discussed elsewhere, touching on privacy issues and user control outside the scope of this article.

The next segment of this article will list three more benefits of free and open source software, along with an assessment of its current and future prospects.

Epic to Hold Startup Competition at App Orchard Conference

Posted on September 14, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I know it’s Friday and we usually do a Fun Friday post, but while this might look like a joke I assure you it’s not. Epic has recently announced to their App Orchard community that they’ll be doing a startup competition. The prize is $5k and “an opportunity to share their pitch with a senior Epic executive to get feedback and advice, and bragging rights.”

The startup competition is being held at the Epic App Orchard Conference happening Oct 24-26th at Epic’s headquarters in Verona. For those not familiar with App Orchard, it’s basically Epic’s partner program. The Founder or CEO of the startup is required to be there to be part of the Startup Pitch competition.

The contest is a little confusing because all tiers of App Orchard members are eligible to participate. However, companies don’t have to have to have an app in the app store yet. This would have been even more interesting if they opened it up outside the App Orchard community as well. However, given the short time frame to submit and then be on stage at the conference, I have a feeling this was a kind of last minute idea that they’re making happen and so they wanted to keep it simple.

Who would have thought that Epic would hold a startup competition? Is Epic finally seeing that there’s a lot of value to them and more importantly to their customers to have a more open approach to working with partners? Ok. A startup competition is a small step, but it feels like a huge one for Epic given past history.

The deadline to apply for the competition is Sep 28th, so it might be tight for companies that aren’t already a member of App Orchard to become a member and take part, but I’d be interested to hear if any company tries. I’ll be interested to hear what companies choose to take part in the competition and what ideas they pitch. Epic is currently displaying 111 apps in their App Orchard gallery.

Times are a changing at Epic. What’s next for Epic? They’re going to start acquiring companies? Let’s not get too crazy.

Are EHR Companies Difficult to Work With?

Posted on September 10, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

There is an entrenched myth that EHR companies are difficult to partner with – more interested in up-front partner fees and revenue sharing than actually collaborating with 3rd party companies. Two companies are working hard to be different.

Early in the spring, I had a lengthy conversation with a group of vendors at HIMSS18 about partnering with EHR companies. I had stopped at a booth and somehow we got onto the topic of collaborating with EHR companies as a way to accelerate product development and sales. The person I was speaking with was very frustrated at the lack of response from three of the larger EHR companies. I’m paraphrasing, but her statement was essentially this: “All they want is to charge me their 5K partnership fee and then take 10% of everything I sell to their customer base. It’s ridiculous.”

At that point, several representatives from surrounding booths joined in our conversation. All of them had similar frustrations and shared similar stories of being shunted to the partnership team – which in their opinion was just a sales team in disguise – where they were told about all the wonderful benefits they would receive in return for an upfront partnership fee. I’m sure many Healthcare Scene readers can identify with these vendors.

This conversation stuck with me and over the spring and summer, I decided to dive deeper into the world of EHR partnerships. I wanted to know if the myths were true and I wanted to see if there were any companies that were operating differently. Over the past several months at every conference I have attended, I have made it a point to find out as much as I could about the various partnership programs and spoke with dozens of vendors who were proudly displaying partnership badges on their booths.

The good news is that there are at least two companies working hard to build a thriving partner ecosystem. The bad news is that many EHR companies do not have a well-defined partnership strategy and many vendors do not feel they are getting full value for their participation in EHR ecosystems.

One of the key things I learned is that there is a distinct difference between working with an EHR company on interoperability vs being part of their partner ecosystem. There have been many articles over the past few years about the difficulty of extracting data from EHRs in order to share it with other organizations involved in the care for patients. Headlines like “How disparate EHR systems, lack of interoperability contribute to physician stress, burnout” are common.

Many of the EHR companies I spoke with separate their interoperability efforts from their partnership programs. The ability to share data with others, they said, was not related to how well/not well they worked with 3rd party companies. So while it may be true that EHR companies have a lot of work to do on interoperability, partnership for some is something a few companies are doing well.

One company is Allscripts.

After HIMSS18, I had the opportunity to drop in on the fourth annual Allscripts Developer Summit in Chicago. I honestly did not know what to expect and I was pleasantly surprised at how intimate the event was. The rooms were smaller and had people sitting at round tables listening to presenters and asking lots of questions. The level of interaction between the speakers and the developers at the tables was refreshing to see.

Most of the attendees at the Summit were developers and product managers from companies that were Allscripts partners. Most of the discussions in the sessions and in the hallways centered around the latest APIs and FHIR initiatives.

The Summit is part of Allscript’s Developer Program (ADP). Allscripts recently announced that its ADP partners have together processed more than 4 Billion API data exchange transactions since the company started tracking it in 2013. In the announcement Tina Joros, VP and General Manager, Open Business Unit at Allscripts had this to say:

“We are trying to create a new mentality of innovation for our clients so that they view innovation as a path to improve overall workflows and connect with patients. We have made our API platform easily accessible and cost-effective for developers to use so that they can develop and test their solutions. This includes the ability for developers to use our FHIR APIs to meet regulatory requirements for our shared clients at no cost.”

I had the chance to sit down with Joros during the Summit and she shared with me that Allscripts does more than just provide access to their APIs. “We help companies with sales and marketing as well,” said Joros. “We coach partners that are new to the space how to ‘talk healthcare’. We help them craft and tell their stories to their target buyers. We spend a lot of time on the phone and in the field with our ADP partners. Our goal is to reduce the risk for clients to adopt new technology.”

With more than 8,000 registered developers in ADP, I asked Joros why so many companies had joined. “One of the key differentiators is the ADP Integrator tier of our program; most competitors have programs that make it easier to sign up for the FHIR APIs but they also have a vetting process in place to review companies for partnership,” said Joros. “In our ADP Integrator tier, however, companies can sign up immediately to access all our FHIR and proprietary API functionality – there is no wait or vetting by Allscripts and no fee to get started. The pricing model is designed so that companies only pay Allscripts when they are ready to go to market via a testing fee and usage-based fee. The ease of signing up and no fee to get started are unique in the industry.”

One company that has been very successful at working with Allscripts is Relaymed – a company that makes connectivity software that sends point-of-care test results directly into EHRs. RelayMed has been part of ADP for four years and had nothing but good things to say about the program.

“Many EHR companies have rigid cultures that actually bias them against partnerships – the ‘not invented here’ syndrome,” commented Neil Farish, CEO of Relaymed who spoke with me over the phone. “Allscripts isn’t like that. They had a vision of an open and vibrant ecosystem. That vision is ingrained into their culture and there is support right from the top. It’s become part of their DNA. If anything, senior management at Allscripts has been paying even more attention to partners this year. They are present. They interact with us. Help from their marketing & sales teams has been easy to get and really welcomed.”

The team at Relaymed has been working with the Allscripts team to tighten and improve the level of integration between their two systems. As well, the companies together are looking at ways to expand the breadth of devices that connect to Allscripts through Relaymed.

Another company that has invested in their partnership program is Cerner.

Cerner takes a different approach when working with partners. Although they have a centralized team that helps on-board partners (legal, contracting, etc), the ongoing relationship with partners is handled directly by the team/department that works most closely with that partner. Sometimes that is the Cerner sales team. Often times it is the product team. It just depends on where most of the interactions will occur.

“No partnership looks the same,” John Gresham, Senior Vice President, DeviceWorks & Interoperability at Cerner told Healthcare Scene. “So we have to ask the key question – How does that partnership bring differentiated value to the customer? We will work with partners the way that works best for our customers. That may mean embedding someone else’s solution within our solutions, co-market their solution as part of a bundle or we may simply go-to-market together.”

It was surprising to learn that a company as large as Cerner did not have a cookie-cutter approach to partnering with 3rd parties. It would have been easy for them to put in a rigid framework but instead they adapt themselves to best suit the partnership. DellEMC, Kofax and Nuance were cited by Gresham as examples of Cerner partnerships that were flourishing.

“Customers want something seamless and not just in terms of Cerner being a systems integrator for them,” continued Gresham. “They want everything to be smooth and simple – buying it, contracting it, deploying it, integrating it and supporting it. Cerner is willing to do all those things, something that isn’t common in the EHR space.”

During our conversation, Gresham repeatedly referenced Cerner’s laser focus on delivering better patient care and better outcomes – and how that focus guided their partnership decisions. In fact, that is key to attracting the attention of an internal champion at Cerner: a clear line from the product or service being offered to customer or patient benefit.

That is exactly what happened with Goliath Technologies, a provider of IT operations software that enables IT Teams to anticipate, troubleshoot and prevent infrastructure performance issues. The team at Goliath had successfully implemented their solution at a Cerner customer. That customer spoke about their experience at a Cerner event and Jay Savaiano, Senior Director of Business Development at Cerner took notice.

“It was because of Jay and his vision that Goliath got into the program,” explained Thomas Charlton, Chairman and CEO at Goliath Technologies. “He was the first person we had a conversation with and from there everything went smoothly. He was with us every step of the way and we’re still working with Jay today. But it all started because we were able to demonstrate a clear positive impact on a Cerner customer.”

“Once Cerner decided that Goliath would benefit their customers, the process of formalizing the relationship was very straightforward and smooth,” continued Charlton. “They moved really fast. They have a fantastic team of people, very competent and focused. Everyone from contracting to legal to sales was great to work with.”

Because of the success, they have enjoyed with Cerner, Goliath has begun to put a lot of focus on their partnership with Cerner. They have begun working with Cerner developers to refine and tune their combined solutions and Goliath recently hired a new VP of Corporate Development who had left Cerner a few years ago, to help strengthen the relationship [side note the VP was referred to Charlton by people at Cerner]

“Cerner brings healthcare knowledge to Goliath,” said Charlton. “They know patient care and healthcare systems management. That deep understanding of healthcare has helped us with product development. Cerner has really helped to reshape our thinking on healthcare, patient care and Healthcare IT Operations management.”

*****

It is interesting to note that neither Relaymed or Goliath were put forward by Allscripts or Cerner respectively as example partners to speak with. Both Relaymed and Goliath were referred to me by different people who are not affiliated with either EHR company.

So if you are a software provider that is looking to partner with an EHR company what can you do to attract their attention? All four individuals I spoke with offered sage advice.

Neil Farish (Relaymed): “Avoid the transactional models of partnership where it is just an exchange of $$$. Look to the value that you as a partner are getting, the value the EHR company is getting and the value you can provide together to their end-customers. If there is value all around then the fees should be dwarfed by the value. If not, then you seriously have to rethink that potential partnership.”

Thomas Charlton (Goliath): “Have a very clear understanding of how your product or service helps deliver better care to patients. Can you show a direct line to customer or patient benefit? If you can’t then you need to figure that out before approaching an EHR company looking for a partnership. Also, joint customers are important. The more joint customers you have the more momentum you will get behind the initiative.”

John Gresham (Cerner): “The key to making partnerships work is mutual respect. That’s the starting point. Next comes a key question – do you have a ‘what’s best for customers’ mindset. If you have that then we have a foundation for conversation. I would strongly encourage companies to build solutions for the highest possible reliability, scalability and security.  Cerner customers expect that. Oh, and you have to have proof points to back that up.”

Tina Joros (Allscripts): “Be persistent. Come talk to us at conferences. Connect with us online. I would encourage any company signed up for the program and does not feel like it is providing value, to speak with a member of our team and let us know.  In some cases, we can find a tier that is a better fit for the company or make introductions to other associates at Allscripts, so additional areas of the business can evaluate their solution.”

Myth busted.

Does NLP Deserve To Be The New Hotness In Healthcare?

Posted on August 30, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Lately, I’ve been seeing a lot more talk about the benefits of using natural language processing technology in healthcare. In fact, when I Googled the topic, I turned up a number of articles on the subject published over the last several weeks. Clearly, something is afoot here.

What’s driving the happy talk? One case in point is a new report from health IT industry analyst firm Chilmark Research laying out 12 possible use cases for NLP in healthcare.

According to Chilmark, some of the most compelling options include speech recognition, clinical documentation improvement, data mining research, computer-assisted coding and automated registry reporting. Its researchers also seem to be fans of clinical trial matching, prior authorization, clinical decision support and risk adjustment and hierarchical condition categories, approaches it labels “emerging.”

From what I can see, the highest profile application of NLP in healthcare is using it to dig through unstructured data and text. For example, a recent article describes how Intermountain Healthcare has begun identifying heart failure patients by reading data from 25 different free text documents stored in the EHR. Clearly, exercises like these can have an immediate impact on patient health.

However, stories like the above are actually pretty unusual. Yes, healthcare organizations have been working to use NLP to mine text for some time, and it seems like a very logical way to filter out critical information. But is there a reason that NLP use even for this purpose isn’t as widespread as one might think? According to one critic, the answer is yes.

In a recent piece, Dale Sanders, president of technology at HealthCatalyst, goes after the use of comparative data, predictive analytics and NLP in healthcare, arguing that their benefits to healthcare organizations have been oversold.

Sanders, who says he came to healthcare with a deep understanding of NLP and predictive analytics, contends that NLP has had ”essentially no impact” on healthcare. ”We’ve made incremental progress, but there are fundamental gaps in our industry’s data ecosystem– missing pieces of the data puzzle– that inherently limit what we can achieve with NLP,” Sanders argues.

He doesn’t seem to see this changing in the near future either. Given how much money has already been sunk in the existing generation of EMRs, vendors have no incentive to improve their capacity for indexing information, Sanders says.

“In today’s EMRs, we have little more than expensive word processors,” he writes. “I keep hoping that the Googles, Facebooks and Amazons of the world will quietly build a new generation EMR.” He’s not the only one, though that’s a topic for another article.

I wish I could say that I side with researchers like Chilmark that see a bright near-term future for NLP in healthcare. After all, part of why I love doing what I do is exploring and getting excited about emerging technologies with high potential for improving healthcare, and I’d be happy to wave the NLP flag too.

Unfortunately, my guess is that Sanders is right about the obstacles that stand in the way of widespread NLP use in our industry. Until we have a more robust way of categorizing healthcare data and text, searching through it for value can only go so far. In other words, it may be a little too soon to pitch NLP’s benefits to providers.

Report Says EHR Usability Tests Should Focus On Common Safety Threats

Posted on August 29, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The American Medical Association and health system operator MedStar Health have published a report laying out a set of proposals designed to improve EHR safety. The report, which is also backed by The Pew Charitable Trusts, looks at ways that use of EHR usability can fail to prevent or even lead to patient harm.

As readers will know, to meet certification criteria EHRs currently need to conform with EHR usability requirements established in 2015. Developers need to document how they meet clinician needs and conduct formal usability testing addressing clinicians’ efficiency, effectiveness and satisfaction in using the system.

Unfortunately, the current generation of certification standards don’t focus specifically on high-prevalence safety hazards, which may mean that the process doesn’t address how usable some important EHR features are, the report says. Plus, even the earlier versions didn’t do much in regards to usability.

Over time, of course, both EHR developers and providers have begun to take these issues more seriously, and as the paper points out, are moving beyond the minimum required to meet certification standards.

For example, developers have agreed to review safety incidents with patient safety officers and product users, along with sharing such information across healthcare facilities. Also, providers have taken their own steps in this direction, such as protecting EHR safety surveys or establishing safety teams tasked with identifying EHR-related problems. As we all know, however, there’s a lot more to be done.

To make more progress, the groups suggest, EHR developers need to design more rigorous, safety-focused test cases. While they already need to run such real-world-oriented test cases, which are required for certification, but these studies might not be looking for the right things, the report says.

To be truly useful, these test cases should represent the expected uses of the technology; should represent a clinically-oriented goal with clear measures of success and failure; test known areas of risk and efficiency; and address a defined audience.

The paper also includes a list of criteria developers and providers can use to boost EHR usability and safety across the system’s entire lifecycle. For providers, this includes establishing a culture of safety which will support EHR-based safety efforts; seeing that user needs and product capabilities are aligned; customizing and configuring the system to meet those needs; implementing and maintaining the EHR carefully; and training clinicians to use the product safely and effectively.

Not surprisingly, research on these topics is ongoing, but some providers are more engaged than others. I was interested to see that MedStar Health’s National Center for Human Factors  in Healthcare continues to work with the AMA on these issues. For example, about two years ago the partners released a joint framework designed to rank EHR usability. (The partners also use the framework to rank the usability of several widely-implemented systems, including that Allscripts and McKesson were doing the best job at the time. That was fun.)

I hope to see more work on the links between EHR usability and safety in the future, as well, of course, as feedback on how to address both. We simply don’t spend enough time on this subject.

More Than 3 Million Patient Records Breached During Q2 2018

Posted on August 15, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study by data security vendor Protenus has concluded that more than 3 million patient records were breached during the second quarter of 2018, in a sharp swing upward from the previous quarter with no obvious explanation.

The Protenus Breach Barometer study, which drew on both reports to HHS and media disclosures, found that there were 143 data breach incidents between April and June 2018, affecting 3,143,642 million patient records. The number of affected records has almost tripled from Q1 of this year, when 1.13 million records were breached.

During this quarter, roughly 30% of privacy violations were by healthcare organizations that had previously reported a data breach. The report suggests that it is because they might not have identified existing threats or improved security training for employees either. (It could also be because cyberattackers smell blood in the water.)

Protenus concluded that among hospital teams, an investigator monitors around 4,000 EHR users, and that each was responsible for an average of 2.5 hospitals and 25 cases each. The average case took about 11 days to resolve, which sounds reasonable until you consider how much can happen while systems remain exposed.

With investigators being stretched so thin, not only external attackers but also internal threats become harder to manage. The research found that on average, 9.21 per 1,000 healthcare employees breached patient privacy during the second quarter of this year. This is up from 5.08 employee threats found during Q1 of this year, which the study attributes to better detection methods rather than an increase in events.

All told, Protenus said, insiders were responsible for 31% of the total number of reported breaches for this period. Among incidents where details were disclosed, 422,180 records were breached, or 13.4% of total breached patient records during Q2 2018. The top cause of data breaches was hacking, which accounted for 36.62% of disclosed incidents. A total of 16.2% of incidents involved loss or theft of data, with another 16.2% due to unknown causes.

In tackling insider events, the study sorted such incidents into two groups, “insider error” or “insider wrongdoing.” Its definition for insider error included incidents which had no malicious intent or could otherwise be qualified as human error, while it described the theft of information, snooping in patient files and other cases where employees knowingly violated the law as insider wrongdoing.

Protenus found 25 publicly-disclosed incidents of insider error between April and June 2018. The 14 of which for which details were disclosed affected 343,036 patient records.

Meanwhile, the researchers found 18 incidents involving insider wrongdoing, with 13 events for which data was disclosed. The number of patient records breached as a result of insider wrongdoing climbed substantially over the past two quarters, from 4,597 during Q1 to 70,562 during Q2 of 2018.

As in the first quarter, the largest category of insider-related breaches (71.4%) between April and June 2018 was healthcare employees taking a look at family members’ health records. Other insider wrongdoing incidents including phishing attacks, insider credential sharing, downloading records for sale and identity theft.

Healthcare CIOs Focused On Patient Experience And Innovation

Posted on August 2, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Not long ago, 22 healthcare CIOs had a sit-down to discuss their CEOs’ top IT-related priorities. At the meeting, which took place during the 2018 Scottsdale Institute Annual Conference, the participants found that they were largely on the same page, according to researchers that followed the conversation.

Impact Advisors, which co-sponsored the research, found that improving patient experiences was priority number one. More than 80% of CIOs said patient engagement and better patient experiences were critical, and that deploying digital health strategies could get the job done.

The technologies they cited included patient-facing options like wearables, mobile apps and self-service tools. They also said they were looking at a number of provider-facing solutions which could streamline transitions of care and improve patient flow, including care coordination apps and tools and next-generation decision support technologies such as predictive analytics.

Another issue near the top of the list was controlling IT costs and/or increasing IT value, which was cited by more than 60% of CIOs at the meeting. They noted that in the past, their organizations had invested large amounts of money to purchase, implement and upgrade enterprise EHRs, in an effort to capture Meaningful Use incentive payments, but that things were different now.

Specifically, as their organizations are still recovering from such investments, CIOs said they now need to stretch their IT budgets, They also said that they were being asked to prove that their organization’s existing infrastructure investments, especially their enterprise EHR, continue to demonstrate value. Many said that they are under pressure to prove that IT spending keeps offering a defined return on investment.

Yet another important item on their to-do list was to foster innovation, which was cited by almost 60% of CIOs present. To address this need, some CIOs are launching pilots focused on machine learning and AI, while others are forming partnerships with large employers and influential tech firms. Others are looking into establishing dedicated innovation centers within their organization. Regardless of their approach, the CIOs said, innovation efforts will only work if innovation efforts are structured and governed in a way that helps them meet their organization’s broad strategic goals.

In addition, almost 60% said that they were expected to support their organization’s growth. The CIOs noted that given the constant changes in the industry, they needed to support initiatives such as expansion of service lines or building out new ones, as well as strategic partnerships and acquisitions.

Last, but by no means least, more than half of the CIOs said cybersecurity was important. On the one hand, the participants at the roundtable said, it’s important to be proactive in defending their organization. At the same time, they emphasized that defending their organization involves having the right policies, processes, governance structure and culture.

2018 Practical Innovation Award Winner: ENGINUITY

Posted on July 25, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As the vision for the Health IT Expo came into view, we realized how valuable it was for the Health IT Expo community to learn about and share practical innovations that were happening in healthcare IT. As part of that effort, we announced the 2018 Practical Innovation Awards. Being the first year, we only had a short time to promote it and get the word out about it. With that said, we’re extremely pleased with the practical innovations that the 2018 Practical Innovation Award Winner has brought to the healthcare IT community and we’re excited to share those with you.

So, without further ado, we’re excited to announce the 2018 Practical Innovation Award Winner is ENGINUITY run by Kelly Del Gaudio, Principal Consultant, Galen Healthcare Solutions and was implemented at Freeman Health System, Valley Health System, and Canton – Potsdam Hospital System. This is a well-deserved honor for Kelly Del Gaudio and the team that worked on this project. Congratulations!

While awards and recognition are great, they don’t mean much if we don’t share the details of the practical innovations that won the award. In order to share more details about ENGINUITY (originally named Project Claire[IT]), we thought an interview with Kelly Del Gaudio would be a great way to share what they accomplished and hopefully help to spread their experiences, insights, and innovations.

Tell us about Project Claire[IT].  How was it started and who was involved?

Project Claire[IT] was what we originally called ENGINUITY. It was a project in honor and memory of my friend and Rule writing mentor at MEDITECH, Claire Riemer. Claire was the original pioneer of the MEDITECH rules engine and led the Clinical Content group there for many years.

The idea for this project started about a few months after I came on as the Principal Consultant for MEDITECH at Galen Healthcare Solutions. Since I had a lot of experience with the MEDITECH Rules engine from people like Claire, and working on a Clinical Optimization Performance Team during my 10 years at the “Tech”, I decided to host a free “Rule Writing 101” webinar that would give users a basic understanding of the MEDITECH Rules engine and offer tips and tricks on how to write some basic rules. We were surprised when we saw the signup list the day of the webinar (which ended up being our highest attended to date), and soon after, the flood gates opened with questions from MEDITECH users asking for help with Rules they’ve been stuck on for weeks, months and sometimes years!

Many of the questions we received were similar (people needing help with calculations, VTE compliance, Problem List Management etc) so we thought maybe we could streamline the process and write the complex rules that everyone seems to need for them; or as we call it: Doing their NerdyWork. Galen was no stranger to this as we have been successful in creating and delivering a similar solution to our Allscripts clients called eCalcs.

I knew I had the unique skill set to write the Rules that these customers needed, but not being a nurse or clinician by trade (although I can occasionally fake it til’ I make it) I knew I needed their help to understand exactly what their frustrations were from both a clinical and IT perspective. The only logical conclusion was to host a focus group, and so our first Galen Focus Group: Operation NerdyWork was born.

Operation NerdyWork was a group of nine MEDITECH hospitals all running MEDITECH’s 6.x/6.1 or higher platform. They represented various areas of the country, from cities to rural/remote, from large Health Systems to small Critical Access satellites. It seems that no matter how big (or small) your IT staff was, the Rules Engine was a bit of a black box for everyone.

Here is our elite nine:

  • Catholic Health Initiatives
  • Salinas Valley Medical Center
  • Randolph Hospital
  • Uvalde Memorial Medical Center
  • Freeman Health System
  • Canton-Potsdam Hospital
  • Peterson Reginal Medical Center
  • Calvert Memorial Hospital
  • Parkview Medical Center

These groups offered their time on Thursdays during the winter of 2016 and provided us with valuable insights into the world of a MEDITECH doctor, nurse, care provider, or pharmacist. From their list of frustrations, we got to work building better, rule driven workflows that will save time, reduce clicks, increase compliance and patient safely and present users with much needed clinical decision support.

We decided to call our platform ENGINUITY because we use the MEDITECH Rules Engine to code a lot of our custom content. It’s also a derivative of the word ingenuity which is the quality of being inventive, clever, resourceful; thinking outside of the box. We pride ourselves on coming up with really clever ways to achieve something that may otherwise be “Working as Designed”. ENGINUITY continues to be crowdsourced and we receive suggestions every day from users of our content. MEDITECH customers drive the future direction of this product because hey, they’re the one that have to use it right?

What have been the practical benefits of this project?

Practical Innovation is all about solutions that can be implemented now that bring value to an organization. We think we are doing just that.

By streamlining the lengthy design process that many of these rules take to write and creating a plug and play solution that has been tested, validated, and thoroughly researched, we can confidently help hospitals achieve optimal compliance, increased patient and provider satisfaction, EMR confidence, realize revenue gains and so much more. If you wanted to implement some of these complex tools outside of ENGINUITY, not only would you need at least one full time dedicated FTE on these projects, but that person would need to have an advanced Rule writing skill set which is not easy to find. You would also need to keep those people on staff to troubleshoot Rules that are subject to change during much needed updates or future workflow changes.

I actually spoke with a client at last year’s MUSE conference who told me that their resident “Rules” person was about to retire so they stopped optimizing their system because she was the only one who could support it. I used this anecdote the next day at our official launch presentation and realized that this was more common than I thought. Rules are complex and there are a lot of unknowns but they are far and away the most efficient way to optimize the your MEDITECH system which is why everyone should have them!

ENGINUITY makes these options an affordable reality for many organizations that simply don’t have the time, capital or resources. The Galen team supports all of our content post-implementation, so our clients can worry about daily system support and education.  ENGINUITY customers also determine “what’s next” in our dev cycle and are always receiving the fruit of our development efforts keeping their system optimized, refreshed and functional for years to come.

What were the keys to success with this project? 

I attribute the success of this project to 5 main things.

  1. First, having a deep understanding of the technical underpinnings of the MEDITECH Rules Engine is crucial to the success of ENGINUITY. I have always been fascinated with trying to figure out this puzzle and I continue to learn more about it daily. For me, it’s fun; for most, its frustrating. Thank you Claire Riemer, Ginny Jacques and Nancy McGowan for teaching me this craft.
  2. Second, having the support of the Galen Healthcare Solutions team. They let me run with this idea to design, develop and mass deliver content to clients who need it and they’ve fully supported it through its infancy to now. We are KLAS ranked and on Modern HealthCare’s Best Places to Work for a reason and I know working at Galen was one of the best decisions I have ever made. I firmly believe that autonomy, support and confidence is really what helps innovation to thrive.
  3. Third, our focus group. They are the ones who brought the ideas to the table and got the ball rolling. Thank you Operation NerdyWork!
  4. Fourth, our ENGINUITY clients who push us and challenge us with new puzzles every day. Their challenges (though sometimes daunting) make us better in the long run.
  5. Finally, getting the word out in major healthcare IT publications! Having published articles that recognize our unique approach to customer collaboration and feature our MU3: Measure 3 content really help to spread the word about what we’re doing.

How does this project impact patients?

We put a lot of effort in the design process of a workflow to make it easy for the doctor/user to use. Many of our tools are “single-click” meaning that as soon as I “click” on something (a query or order) then the algorithm will “fetch” necessary data and bring that to the providers attention immediately. We can suggest, require, suppress or automate responses based on preexisting information which makes ENGINUITY very patient centric. This added clinical decision support is embedded directly into the MEDITECH system (not 3rd party) which significantly increases the confidence that users have in the messages they are receiving. We can then use a combination of hard stops, soft stops, alerts and audit trails to increase patient safety across the board.

We’re currently working on a case study of before and after Implementation of our VTE Compliance protocol, which was designed using the AHRQ’s Best Practice recommendations for VTE Prophylaxis compliance. It is estimated at increasing organizational compliance to over 90% which will significantly impact the lives of many surgical inpatients.

I also worked with some of our product development folks from our VitalCenter Online Archival team to create a way to have Rules evaluate patient Problems and drive care off the Problem List. From my research, this is not just a MEDITECH problem, (pun intended) but it spans across all EMRs leaving most Problem Lists “static”. We are changing that for our MEDITECH clients by driving and automating care off the Problem List making it a truly “dynamic” list.

You call the effort “Operation NerdyWork”.  What’s been your experience getting “nerds” together to collaborate on a solution like this?

Operation NerdyWork was all about bringing a diverse group of people together with some commonalities (trades, users of MEDITECH) and working together toward a common goal. Listening to each other’s pain points and sometimes even solving each other’s problems without my help at all (which was really fun to see). Everyone brought a unique voice to the table. As innovators, the best we can do is shut up and listen, hear what people want and develop what they need.

What practical advice would you give health IT professionals that will help them be more successful in their work?

Find something you’re good at, something you’re passionate about, something that keeps you up at night but also helps you rest easy knowing you could be a part of the solution. When you’ve found it then surround yourself with supportive people and get busy on the Nerdywork.

A big Congratulations to the 2018 Practical Innovation Award Winner: ENGINUITY

EMR Integration Paying Dividends For All Types of Healthcare Practitioners

Posted on July 17, 2018 I Written By

The following is a guest blog post from the team at Fullscript, a proud sponsor of Healthcare Scene. Follow and engage with them on Twitter: @FullscriptHQ

It would not be a stretch to say that EMRs have been both a blessing and curse for healthcare practitioners. There is no doubt that EMRs have improved the safety of care and the mountain of data that has been collected is now powering the renaissance of Artificial Intelligence in healthcare. However, EMRs have also increased the workload on clinicians which in turn has negatively impacted the overall patient experience and has contributed to burnout. It would not be a stretch to say that EMRs have been both a blessing and curse for healthcare practitioners. There is no doubt that EMRs have improved the safety of care and the mountain of data that has been collected is now powering the renaissance of Artificial Intelligence in healthcare. However, EMRs have also increased the workload on clinicians which in turn has negatively impacted the overall patient experience and has contributed to burnout.

To help practitioners, HealthIT vendors need to ensure their products can be:

  • Tightly integrated with EMRs so that data can be shared easily
  • Seamlessly incorporated into existing workflows
  • Tuned to fit the specific needs of the practice

Fullscript, an online e-prescribing platform helps integrative medical practitioners dispense supplements without the need for physical inventory. This saves valuable office space and improves the overall safety of practices. The company offers over 20,000 professional-grade supplements. Key to the company’s success has been the integration of their platform with existing EMRs coupled with their user-friendly workflow features.

Dr. J. E. Williams, a highly respected integrative medicine clinician who treats and revitalizes patients across a spectrum of illness, implemented Fullscript in order to provide his patients with a streamlined experience and to improve the performance of his practice.

Prior to Fullscript, Dr. Williams, used a non-integrated e-prescribing system. That system was difficult to use and his patients frequently complained at how confusing it was. The result was that patients were not filling their scripts and were not following the prescribed regimen. After switching to Fullscript, Dr. Williams could seamlessly e-prescribe what his patients need, directly from within his EMR. In addition, the easy-to-use nature of the system has made it less confusing for patients. The net result is that Dr. Williams has experienced 100% patient compliance by using Fullscript through his EMR.

“I can write a recommendation when a patient is in front of me, or immediately afterwards. ​Patients want to see their recommendation in their inbox right away, and that’s what Fullscript provides. My patients love it.” – Dr. J.E. Williams

Dr Williams is on a mission to bridge complementary as well as alternative therapies with evidence-based clinical science. Although some would see this as controversial, Dr. Williams firmly believes that there is growing evidence of improved patient outcomes when melding ancient wisdom with modern science. The ultimate goal is to use the most efficient therapies with the least side effects for patients.

The success of Dr Williams demonstrates the power of tight integration with EMRs for all types of clinicians. Gone are the days when clinicians had to tolerate clunky stand-alone systems. Today, they can and should expect their HealthIT partners to provide systems that seamlessly integrate with their existing applications.

Fullscript embraces this vision and has worked with over a thousand practitioners just like Dr Williams to provide the ability to e-prescribe nutraceuticals in as little as 4 weeks.

To learn more about Fullscript’s EMR integration or to read more about Dr. Williams, click here.

Healthcare Execs Investing In Intelligent Technologies Face Roadbumps

Posted on July 16, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A recent report from Accenture concludes that healthcare executives are enthusiastic about “intelligence technologies” such as AI and IoT. It also suggests, however, that health organizations will need to add new capabilities to be sure they can manage these technologies responsibly.

The report, based on a survey of 100 health executives, found that 77% of respondents expect to invest in IoT and smart sensors and that 53% expect to invest in AI systems.  Presumably, they expect these technologies to offer benefits more quickly.

Why the gap in adoption? The truth is that healthcare leaders haven’t yet gotten their arms around AI just yet. While IoT and smart sensor technology can boost the flexibility and “judgment” of enterprise systems, AI arguably has the potential to be far more flexible and wide-reaching — and ultimately less than predictable.

This unpredictability makes AI investment a bit trickier to implement than other emerging technologies. Just over four-fifths of health leaders said they were not prepared to explain AI-based conclusions to their internal stakeholders nor outsiders.

To address this deficit, 73% said they plan to develop internal ethical standards for AI to make sure these systems can act responsibly. Before that, they’ll need to determine what “acting responsibly” actually means — and as far as I know there are no accepted guidelines for developing such standards. (They might want to start off by reviewing Google’s ethical principles for AI use here.)

Adding AI to the enterprise IT mix could also wreak havoc. I for one was surprised to read that almost one-fourth of respondents said that they had been the target of adversarial AI behaviors, including falsified location data or bot fraud. (This stat blew my mind. Why haven’t we heard more about these “adversarial behaviors” and what are they?)

This certainly adds another element of uncertainty for CIOs interested in AI investments. While AI technologies can’t “think” in the traditional sense, they can create a range of problems previous-gen technology couldn’t.

This is part of a larger picture in which health organizations aren’t sure if their data has been corrupted. In fact, 86% of health execs said they hadn’t yet invested in technologies which could verify their data sources. Adding AI to the mix could potentially compound these problems, as it might create a cascade in which the AI then draws false inferences and takes inappropriate actions.

Meanwhile, respondents were excited about blockchain and smart contracts technology, with 91% reporting that they believed it would be a critical tool for supporting frictionless businesses over the next three years. All told, expect to see IoT and blockchain investments right away, with AI lagging until health IT leaders can teach it to play nicely.