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Applying AI Based Outlier Detection to Healthcare – Interview with Dr. Gidi Stein from MedAware

Posted on September 17, 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.

Most people who receive healthcare understand that healthcare is as much art as it is science. We don’t expect our doctors to be perfect or know everything because the human body is just too complex and there are so many factors that influence health. What’s hard for patients to understand is when obvious human errors occur. This is especially true when technology or multiple layers of humans should have caught the obvious.

This is exactly why I was excited to interview Dr. Gidi Stein, CEO and Co-founder of MedAware. As stated on their website, their goal is to eliminate prescription errors. In the interview below, you’ll learn more about what MedAware and Dr. Stein are doing to achieve this goal.

Tell us a little about yourself and MedAware.

Early in my career, I worked in the Israeli high-tech industry and served as CTO and Chief Architect of several algorithm-rich startups. However, after many years working in technology, I decided to return to school and study medicine. In 2002, I graduated from Tel Aviv University Medical School with a specialization in internal medicine, treating patients and teaching students and residents in one of Israel’s largest hospitals.

After working as a physician for several years, I heard a heartbreaking story, which ultimately served as my motivation and inspiration to found MedAware. A physician was treating a 9-year-old boy who suffered from Asthma. To treat the symptoms, the physician entered the electronic prescribing environment and selected Singulair from the drop-down menu, a standard treatment for asthma. However, unfortunately, he accidentally clicked Sintrom, an anticoagulant (blood thinner). Tragically, neither the physician, pharmacist nor parent caught this error, which resulted in the boys’ untimely death. This avoidable, medication-related complication and death was caused by a typo.

Having worked as a physician for many years, I had a difficult time understanding that with all the medical intervention and technological support we rely on, our healthcare system was not intelligent enough to prevent errors like this. This was a symptom of a greater challenge; how can we identify and prevent medication related complications before they occur? Given my combined background in technology and medicine, I knew that there must be a solution to eliminate these types of needless errors. I founded MedAware to transform patient safety and save lives.

Describe the problem with prescription-based medication errors that exists today.  What’s the cause of most of these errors?

Every year in the U.S. alone, there are 1.5 million preventable medication errors, which result in patient injury or death. In fact, medication errors are the third leading cause of death in the US, and errors related to incorrect prescription are a major part of these. Today’s prescription-related complications fall into two main categories: medication errors that occur at the point of order entry (like the example of the 9yr old boy) and errors that result from evolving adverse drug events (ADEs). Point of order entry errors are a consequence of medication reconciliation challenges, typos, incorrect dosage input and other clinical inconsistencies.

Evolving ADEs are, in fact, the bulk of the errors that occur – almost 2/3 of errors are those that happen after a medication was correctly prescribed. These are often the most catastrophic errors, as they are completely unforeseen, and don’t necessarily result from physician error. Rather, they occur when a patient’s health status has changed, and a previously safe medication becomes unsafe.

MedAware uses AI to detect outlier prescriptions.  It seems that everything is being labeled AI, so how does this work and how effective is it at detecting medication errors?

AI is best used to analyze large scale data to identify patterns and outliers to those patterns. The common theme in industries, such as aviation, cyber security and credit card fraud, is that they are rich with millions of transactions, 99.99% of which are okay. But, a small fraction of them are hazardous, and these dangers most often occur in new and unexpected ways. In these industries, AI is used to crunch millions of transactions, identify patterns, and most importantly, identify outliers to those patterns as potential hazards with high accuracy.

Medication safety is similar to these industries. Here too, millions of medications are prescribed and dispensed every day, and in 99.99% of cases, the right medication is prescribed and dispensed to the right patient. But, on rare occasions, an unexpected error or oversight may put patients at risk. MedAware analyzes millions of clinical records to identify errors and oversights as statistical outliers to the normal behavioral patterns of providers treating similar patients. Our data shows that this methodology, identifies errors and ADEs with high accuracy and clinical relevance and that most of the errors found by our system would not have been caught by any other existing system.

Are most of the errors you find obvious errors that a human could have detected but just missed or are you finding surprising errors as well?  Can you share some stories of what you’ve found?

The errors that we find are obvious errors; any physician would agree that they are indeed erroneous. These include: prescribing chemotherapy to healthy individuals, not stopping anticoagulation to a bleeding patient, birth control pills to a 70-year-old male and prescribing Viagra to a 2-year-old baby. All of these are obvious errors, so why didn’t the prescribers pick these up? The answer is simple: they are human, and humans err, especially when they are less experienced and over worked. Our software is able to mirror back to the providers the crowdsourced behavioral patterns of their peers and identify outliers to these patterns as errors.

You recently announced a partnership with Allscripts and their dbMotion interoperability solution.  How does that work and what’s the impact of this partnership?

Today’s healthcare systems have created a reality where patient health information can be scattered across multiple health systems, infrastructures and EHRs. The dbMotion health information exchange platform aggregates and harmonizes that scattered patient data, delivering the information clinicians need in a usable and actionable format at the point of care, within the provider’s native and familiar workflow. With dbMotion, all of the patient’s records are in one place. MedAware sits on top of the bdMotion interoperability platform as a layer of safety, accurately looking at the thousands of clinical inputs in the system and warning with even greater accuracy. MedAware catches various medication errors that would have been missed due to a decentralized patient health record. In addition to identifying prescription-based medication errors, MedAware can also notify physicians of patients who are at risk of opioid addiction.

This partnership will allow any institution using Allscripts’ dbMotion to easily implement MedAware’s system in a streamlined manner, with each installation being quick and effortless.

Once MedAware identifies a prescription error, how do you communicate that information back to the provider? Do you integrate your solution with the EHR vendor?

Yes, MedAware is integrated with EHR platforms. This is necessary for error detection and communication of the warning to the provider. There are two intervention scenarios: 1) Synchronous – when errors are caught at the point of order entry, a popup alert appears within the EHR user interface, without disturbing the provider’s workflow, and the provider can choose to accept or reject the alert. 2) Asynchronous – the errors/ADE is caught following a change in the patient’s clinical record (i.e. new lab result or vital sign), long after the prescription was entered. These alerts are displayed as a physician’s task, within the physician’s workflow and the EHR’s user interface.

What’s next for MedAware?  Where are you planning to take this technology?

The next steps for us are:

  1. Scale our current technology to grow to 20 million lives analyzed by 2020
  2. Create additional patient safety centered solutions to providers, such as opioid dependency risk assessment, gaps in care and trend projection analysis.
  3. Share our life-saving insights directly to those who need it most – consumers.

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.

Origin Story: Paul M Black, CEO of Allscripts – Deep Roots and Optimism in Healthcare

Posted on May 24, 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.

This is first in a new series of articles. Over the coming weeks and months I will be publishing the origin stories of interesting, inspiring people in healthcare. These men and women come from all walks of life. Some are titans in the industry, others are leading grass-roots efforts. All are making an impact on healthcare.

As a self-professed comic-book geek, I am fascinated by origin stories – the account or back-story that reveals how someone became who they are today. Origin stories add to the overall narrative and give reasons for a person’s intentions. Knowing someone’s origin stories can give clues to their future actions.

Kicking off this series is the origin story of Allscripts CEO Paul Black. Allscripts, based in Chicago, serves over 45,000 physician practices and 2,500 hospitals around the world with their EHR systems and other Healthcare IT solutions. The company has a rich history of mergers. Early on they merged with Misys and Eclipsys. More recently, the company has acquired McKesson’s Health IT business and Practice Fusion.

It is common knowledge that Mr. Black has a long history in healthcare. Prior to becoming CEO of Allscripts in December 2012, he spent 13 years as Chief Operating Office at Cerner (an Allscripts rival). He has also served as an advisor to healthcare companies through his work at New Mountain Capital and Genstar Capital.

What is not common knowledge is how far back Black’s history with healthcare actually goes. When he was just 5 years old, Black accidentally consumed weed poison that was in an unlabeled vial. Luckily his father, who was the Director of the Pharmacy Department at the local hospital took him to the VA emergency room right away. As a healthcare professional his father knew that the VA had just purchased an artificial kidney machine – the very device needed to treat this type of poisoning. Spoiler Alert: Black made a full recovery thanks to his father’s quick actions and the knowledgeable staff at the VA.

To understand how lucky Paul Black was, you have to remember that back then, there were no toxicologists, no poison control centers, no detailed chemical labels and very little knowledge of poison treatments. In fact, it wasn’t until 1953 that the first poison hotline was established in Chicago by Louis Gdalman R.Ph and Edward Press MD [source: Forging a Poison Prevention and Control System 2004].

Black’s poisoning incident led his father to establish an Iowa poisoning hotline so that people in his home state could find out what to do in a poisoning situation. His work eventually led to the creation of the Iowa Poison Information Control Center – an entity that is still saving lives today.

“My father was always working on ways to improve healthcare,” recalls Black. “He built a machine that would help ensure that the right medication would be administered to the right patient at the right time. It was basically a precursor to a Pyxis machine. He got involved in computers in the early stages and was always looking for ways to use systems (whether physical or software) to solve problems in healthcare.”

Clearly the apple did not fall far from the tree.

Early in his career, Black worked at IBM where he learned “a lot about systems, software and hardware.” But more importantly, it was his time at IBM that ignited his passion for healthcare.

“I just felt good whenever I worked with hospitals and healthcare clients,” explains Black. “It was clear that working with them had a direct impact on care and on individuals in their care.”

Black moved on from IBM and joined Cerner, then an up-and-coming healthcare systems maker. There, he progressed steadily through the ranks until ultimately becoming Chief Operating Officer in 2005. Black retired from Cerner in 2007 and served in a number of advisory/board positions until he was named CEO of Allscripts in 2012.

I asked Black why he chooses to stay in healthcare.

“It’s pretty simple actually. We aren’t done yet,” states Black. “My grandfather was born in 1888 and during his lifetime we went from horse-and-buggy on dirt roads to a full interstate system with fast cars and a railroad system with fast trains. We also went from having to read your news in a newspaper to wireless radio. He even saw us land on the moon. That was an incredible amount of progress for a single lifetime. I would argue that in my lifetime we are going to see a similar leap with just as many innovations, discoveries, and life saving technologies. That’s why I stay. Healthcare is going to be a fascinating industry for the next 20+ years. Plus there aren’t many industries where you get to help the people that save lives.”

Black went on to say that this is a time in healthcare when strong leadership will be required to ensure we make the right decisions for the benefit of the many vs the few. He pointed at genomic testing as an example. Even though the cost of sequencing continues to drop, access to this type of technology and access to clinicians knowledgeable on how to interpret the results is not universal.

Access to care is a cornerstone of Black’s vision of a perfect healthcare system, something I asked him to describe during our conversation: “My perfect healthcare future is one where everyone has access to healthcare, not just people of means. It’s one where a payment mechanism has been figured out whereby a certain level of access is guaranteed as is a certain level of prevention.”

Black went on to say that this vision is not as far fetched as it may first sound: “My view is that there is enough money already in the healthcare system today to make this happen. If you add the dollars spent by every single player in the healthcare industry – governments, employers, patients, etc – it’s more than enough. We are at 18% GDP. It’s just not being spent efficiently.”

To reach his vision, Black feels we need to build a healthcare system where: “We get the diagnosis right the first time, there is no delay in treatment and there is active involvement from patients in their health.” The latter being the toughest challenge – motivating the average person to exercise more, eat better and make healthier lifestyle choices.

“We have to make it cool to be healthy,” says Black. “In fact we need the healthy equivalent of the Marlboro Man, which I know is an ironic and strange thing to say. But back in the day, EVERYONE wanted to be the Marlboro Man. He was what young men aspired to be like. We need the healthy equivalent to help motivate people to be more engaged in health.”

It is not surprising that Black sees Allscripts playing a significant role in making healthcare more efficient and effective. “Allscripts definitely has a role to play,” explained Black. “We will play that role by staying relevant in the healthcare industry. We have our core EHR products, but we also have four other product lines that are actually EHR-agnostic. We have our population health platform, dbMotion. We have our post-acute system, Netsmart. We have our precision medicine platform, 2bPrecise. And finally we have our consumer platform, FollowMyHealth. We will continue to push aggressively in these markets through innovation and acquisition to provide our clients with the solutions THEY NEED to deliver better care to patients.”

Allscript’s latest acquisition certainly fits with this acquire-functionality-that-clients-want strategy. On May 18th, the company acquired HealthGrid – a communication platform that delivers reminders, alerts and educational materials to patients via phone, text, and other electronic means. This functionality will be rolled into Allscript’s FollowMyHealth product line.

“I feel it’s our duty and obligation to automate the healthcare ‘shop floor’,” declares Black. “The groundwork had been laid with EHRs, but now it’s time to streamline workflows and leverage the data within these systems. We need to reduce the ‘shouting’ in healthcare (too many alarms). We need to improve User Interfaces so systems are easier to use. We need to reduce the documentation requirements on clinicians so they can go back to taking care of patients vs being data entry clerks. Computers should work for us, not the other way around.”

Reflecting on Black’s origin story you can see the thread of hope and optimism woven throughout. From his first (and positive) encounter with the healthcare system when he was 5 years old to watching his father use computers/machinery to try and improve patient care to the positive feelings he had while working with hospital clients at IBM – every experience brought him closer and closer to healthcare until he became part of the industry through his position at Cerner.

It gives me hope that an industry leader like Paul Black is optimistic about the future of healthcare. It’s exciting to learn that he is not just saying the right words, he is putting energy and investment behind them. It will be interesting to see how Allscripts will continue to “remain relevant” and be agile in the years ahead.

Why Should Patients Control Their Health Data? Here Are A Few Ideas.

Posted on September 29, 2017 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, healthcare organizations have begun working to give patients more access to their personal health data. They’ve concluded that the more control patients have, the more engaged they become in your care, which in turn leads to better outcomes.

But patient engagement isn’t the only reason for giving patients the keys to their PHI. In fact, organizational control of patient health data can cause problems for everyone in the healthcare data exchange chain.

An item found on the Allscripts blog does a nice job of articulating issues that can arise.  According to the blog item, those issues include the following:

  • The patient is in the best position to address inconsistencies in their medical record. For example, if one doctor diagnoses the patient with asthma, then another physician conclusively demonstrates the patient is not asthmatic, the patient can reconcile the two physicians’ conclusions.
  • Patients have a better overview of their care than most doctors. When a chronically ill patient sees multiple clinicians, their impressions may conflict with one another, but the patient can provide context on their overall conditions.
  • If a patient consents to multiple uses of their health data, and the consents seem to be in conflict, only the patient can articulate what their intentions were.
  • If the master patient indexing process generates a false match with someone else’s records, the patient will recognize this immediately, while physicians may not.
  • Giving patients control of the record allows them to decide how long those records should be maintained. Otherwise, HIEs — or other entities not bound by record retention laws — might destroy the data prematurely.
  • When patients have control of their data, they can make sure it gets to whomever they choose. On the other hand, patient data may not make it to other care settings if providers drop the ball.

To be sure, delegating control of their PHI to patients can go too far.

For example, if they’re transmitting most or all of their health data between providers, it could pose a significant administrative burden.  Patients may not have the time or energy to route the data files between their providers, assure that data has been received on the other end and make certain that the data was formatted in a way their clinicians can use.

Also, if the patient is chronically ill and sees multiple providers, they may end up having to manage a large body of data files, and not everyone can do so effectively. Ultimately, they may get too overwhelmed to send their records to anyone, or send the wrong records, which can create complications of its own.

Still, on the whole, healthcare organizations are giving patients more control of their health data for good reasons. When patients take responsibility for their health data, they’re far more likely to understand their condition and take steps to address problems. Establishing a balance between patient and provider control may be tricky, but it can and should be done.

IT Leaders Question Allscripts Acquisition of McKesson EIS

Posted on August 31, 2017 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, I shared the results of a poll featured on HISTalk on the potential benefits of the Allscripts acquisition of McKesson EIS. The poll asked readers “Who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?”

Roughly equal numbers of respondents said Allscripts customers would benefit (29%) and McKesson customers (27%). However, a new research report from Reaction Data suggests that many of their peers doubt that things will work out for McKesson customers or even do much to build Allscripts’ market position.

A number of health IT leaders quoted in the report say they’re fearful that McKesson solutions will get short shrift under Allscripts management. Others suggest that both vendors are behind the curve, especially McKesson, and that Allscripts is unlikely to spend enough money on it to catch up to current standards.

Their comments included the following observations:

  • I don’t see Allscripts as a major player in this space anymore and the acquisition will likely further stress the enterprise. Perhaps in combination they can cobble together a suite of tools, but integration will likely be clunky at best for some time.” – CIO
  • I do not see that McKesson brings anything beneficial to Allscripts, other than more users. McKesson’s products are very different from Allscripts’ current products and so will further dilute their efforts to bring quality product forward.” –CFO
  • McKesson is behind. Does not look like a smart choice moving forward.” –Director of IT
  • Just like Cerner buying Siemens, we were told they would support it and yada yada, here we are on Cerner after having to drop much more cash than we should have been required to.”—CIO

it’s worth noting, for the record, that all the feedback on the acquisition wasn’t negative. Positive comments included the following:

  • Combining Paragon, as the only true integrated, Microsoft SQL-based, hospital and ambulatory HIS on the market, with a solid vendor that focuses exclusively on HIT, is a win-win for the healthcare industry.” – CIO
  • “McKesson was losing and continues to lose ground on EHR systems to Epic and Cerner. They are withering on the vine. This acquisition will help them solidify their position in the market.”– Vice President of Finance

Still, most health IT leaders seemed to think the deal wouldn’t help either party that much. In particular, they were skeptical that McKesson’s high-profile Paragon solution was salvageable. “Paragon…is antiquated,” wrote one manager of information technology. “It will take a big bag of money and a lot of time to fix that.”

To summarize, while HIT execs conceded that the merger might buy Allscripts some customers and time, they felt it wasn’t likely to benefit their organizations. In fact, some argued that the deal could actually undercut the future of their McKesson systems: “Allscripts may focus on their own EMR and how those products I have with McKesson will interact with them rather than on McKesson products as a whole,” worried one director of information technology.

On top of everything else, the previous analysis by HISTalk doesn’t inspire much confidence that the acquisition will work on a corporate level. The analysis asserts that EMR vendors should be judged by the number of 250+ bed hospitals they have as customers, and points out that Allscripts controls only 6% of that market. (Epic, in contrast, has 20%, the article notes, citing HIMSS Analytics data.)

If I’m reading this right, it seems that Allscripts will take two mediocre and/or unfashionable solution sets and try to crossbreed them into a more popular set of tools, in the process scaring whatever loyal customers they have left. All sarcasm aside, I’d like to ask: Has this ever worked before?

Nurses Still Unhappy With EHRs

Posted on August 21, 2017 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 research report looking at nurses’ perceptions of EHRs suggests that despite countless iterations, many still don’t meet the needs of one of their key user groups. While the statistics included in the report are of some value, the open text responses nurses shared tell a particularly important story of what they’re facing of late.

The study, which was conducted by Reaction Data, draws on responses from 245 nurses and nurse leaders, 85% of whom work for a hospital and 15% a medical practice. Categories in which the participants fell broke out as follows:

* Nurses                                          49%
* CNOs                                            18%
* Nurse Managers                           14%
* Directors of Nursing                     12%
* Nurse Practitioners                       2%
* Informatics Nurse                         2%
* VP of Nursing                               2%
* Director, Clinical Informatics        1%

As with most other research houses, Reaction gets the party started by offering a list of vendors’ market share. I take all of these assessments with a grain of salt, but for what it’s worth their data ranks Epic and Meditech at the top, with a 20% market share each, followed by Cerner at 18%, Allscripts with 8% and McKesson with 6%.

The report summary I’ve used to write this item doesn’t share its stats on how the nurses’ ranked specific platforms and how likely they were to recommend those platforms. However, it does note that 63% of respondents said their organization wasn’t actively looking at replacing their EHR, while just 17% said that their employer was actively looking. (Twenty percent said they didn’t know.)

Where the rubber really hit the road, though, was in the comments section. When asked what the EHR needed to improve to support them, nurses had some serious complaints to air:

  • “Many aspects, too many to list. Unfortunately we ‘customized’ many programs, so they don’t necessarily speak to each other…” —Nurse Manager
  • “When we purchased this system 4 years ago, we were told that everything would be unified on one platform within 2 years, but this did not happen and will not happen.” –CNO
  • “Horrible and is a patient safety risk!” –RN
  • “Coordination of care. Very fragmented documentation.” –CNO

So let’s see: We’ve got incompatible modules, questionable execution, safety risks and basic patient care support problems. While the vendors aren’t responsible for customers’ integration problems, I’d find this report disheartening if I were on their team. It seems to me that they ought to step up and address issues like these. I wonder if they see these things as their responsibility?

In the meantime, I’d like to offer a quick postscript. The report’s introduction makes a point of noting – rightly, I think – that the inclusion of a high percentage of non-manager nurses makes the study results far more valuable. Apparently, not everyone agrees.

In fact, some of the vendors the firm met with said flat out that they only want to know what executives have to say – and that other users’ views didn’t matter to them.

Wow. I won’t respond any further than to promise that I’ll stomp all over that premise in a separate column. Stay tuned.

EHR Replacement Roadmap to Success

Posted on July 29, 2014 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.

We’re just now starting down the road of the EHR replacement cycle. Meaningful use has driven many to adopt an EHR too quickly and now the buyer’s remorse is setting in and we’re going to see a wave of EHR replacements. Some organizations are going to wait until meaningful use runs it course, but many won’t even be able to wait.

With this prediction in mind, I was interested by this Allscripts whitepaper: Key Hidden Reasons Your EHR Is Not Sustainable and What To Do About It. I always learn a lot about a company when I read whitepapers like this one. It says a lot about the way the company thinks and where they’re taking their company.

For example, in the whitepaper, Allscripts provides a list of questions to consider when looking to replace your EHR:

  • How do you DEPLOY the right core IT systems to succeed with value-based care?
  • How do you CONNECT to coordinate care with key stakeholders and manage your population?
  • How do you better ENGAGE patients in their own health?
  • How do you analyze mountains of raw data to ADVANCE patient and financial outcomes?
  • How do you get everyone within your own organization to FOLLOW THE ROADMAP to EHR success?

You can see that these questions share a certain view of where healthcare IT and EHR is headed. Imagine how this criteria would compare with the criteria for EHR selection even five years ago. Although, I wonder how many doctors really share this type of approach to EHR selection. Do doctors really want their EHR to handle the above list? Should they be worrying about the above items?

I don’t doubt that doctors are going to be more involved in population health and they’re going to need to engage patients more. However, this list does seem to lack some of the practical realities that doctors still need from their EHR. In fact, as I write this, I wonder if it’s still too early to know what a next generation EHR will need to include. Of course, that won’t stop frustrated EHR users from replacing their EHR just the same.

Your EHR Vendor Isn’t Certified: Remove Barriers and Conquer Meaningful Use Stage 2

Posted on July 2, 2014 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 wrote previously about the “Triple Aim” of healthcare and even questioned if doctors really cared about the triple aim. For those not familiar with the triple aim, it includes: improving the health of our country, enabling less expensive care, and increasing patient engagement with their healthcare. All of these are noble goals and worthy of effort. Plus, even if providers aren’t moved by this goal, that doesn’t mean that much of the legislation and regulation that hits healthcare won’t be guided by this triple aim.

I was reading through this Allscripts whitepaper titled “Your EHR Vendor Isn’t Certified: Remove Barriers and Conquer Meaningful Use Stage 2” when I thought about how the triple aim is going to impact an organization’s decisions moving forward whether they like it or not.

The whitepaper underscores the shift towards more patient engagement, smart EHR tools, and population health. I think that generally summarizes meaningful use and is why it’s going to be really important that everyone in healthcare is involved in it.

Even if you don’t want to participate in the meaningful use program specifically, the overall trends that meaningful use represent are likely going to be with us for the foreseeable future. No doubt the government’s focus will continue this direction and I think payers are heading the same direction as well. They probably won’t adopt meaningful use entirely, but elements from it and other programs will likely be adopted by payers.

Check out the full whitepaper for more details on these trends and making sure your EHR is ready for them.

Your EHR Vendor Isn’t Certified – How Should You Approach MU Stage 2?

Posted on May 12, 2014 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.

A recent study conducted by Wells Fargo Securities stated “Over 700 EHR vendors had solutions certified for Stage 1, but at this point about 40 have been certified for Stage 2. While there is still time, we believe 300-500 vendors will ultimately disappear from the government program.”

We talked about the possibility of many EHR vendors not being 2014 certified in our interview with John Squire. This is a real possibility for many EHR vendors. It will be interesting to see which ones choose not to tell their customers that they won’t be ready until it’s too late to switch EHR. I think that will say something about the company.

Allscripts has put out a whitepaper that looks at some of the meaningful use stage 2 challenges and what you should do to make sure you’re ready.

  • Where to begin with Meaningful Use Stage 2
  • The new requirements for Stage 2 attestation
  • Technology upgrade and replacement considerations
  • Meaningful Use reporting
  • Transitioning to population health management

I find the idea of using MU stage 2 as a way to get ready for population health pretty interesting. I know this is a challenge when an organization is overwhelmed by the day to day life of someone in healthcare.

Considering the abysmal meaningful use stage 2 numbers that were released, it seems that many organizations could benefit from some meaningful use stage 2 help this whitepaper provides. I’d be interested to hear if people think that MU stage 2 does help their organization move towards population health management. Is that a reasonable goal you can work on as you work on MU stage 2? Reminds me of those who are doing CDI (clinical documentation improvement) projects alongside their ICD-10 work.

#HIMSS14 Day 2 – Future of EMR and EHR Market

Posted on February 25, 2014 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 is probably going to forever be the case, much of my experience at HIMSS gets to benefit from the beauty of social media. Today was no different as their was the #HITsm chat where we played #HITsm account bingo. Somehow I ended up on stage competing against my fellow EMR and EHR writer, Jennifer Dennard, for one of the prizes. Happily she won. I cheered for her over me too. All in all it was a fun time hearing about the various people in the HITsm social media community.

The evening of day 2 was also highlighted by the New Media Meetup event. This is our 5th year organizing the event and I believe we can call it a great success. A big thanks to Stericycle Communication Solutions for sponsoring the event, and for everyone that attended. For those I didn’t really get a chance to see and talk with, let’s make up for it tomorrow. Although, as I always tell people, the best part of the event is that there are hundreds of amazing people you can meet.

Here were two comments attendees made to me about the event, “That conversation right there was more valuable to me than any of the sessions at HIMSS.” And then this one from someone who’s been to at least four of the meetups, “This is always my favorite event.” What a blessing for me to take part in such a tremendous HIMSS social media community.

Enough with my social media experience at HIMSS. Today I had a number of really interesting conversations. Some of them I’ll be saving for future posts. However, one thing stood out to me today in my discussions with a new EHR vendor called Viztek and the multiple EHR vendor, Allscripts.

When I decided to meet with Viztek, I was intrigued by the fact that they were just launching a new EHR software. I wanted to see who wave brave (or crazy depending on perspective) enough to launch a new EHR software at this point in the game. Are 300+ EHR vendors not enough? Plus, I thought the market was suppose to be contracting and not growing.

I was actually impressed by what I found at Viztek. No doubt, in the short time I had during HIMSS, I didn’t have time to dig in really deep to evaluate the breadth of the EHR they’ve created, it’s usability and feature set. Instead, with our short time I wanted to understand the why and EMR market conditions that prompted them to build and launch another EHR software.

What’s particularly interesting about Viztek is that they have a full PACS and RIS software system that they’ve already been selling for a long time. They saw offering an EHR software as a natural extension to this offering. Considering there’s still some growth available in the ambulatory market, and in specialties where they have deep PACS needs (like ortho) I could see an opportunity. One of the most compelling reasons for a practice to go with the fully integrated PACs and EHR software is that it leaves only one vendor to look to when there are issues. Don’t underestimate the value of this. I’m not sure of the pricing of their EHR, but I won’t be surprised if like many other vendors the EHR is just a way to get access to and solidify their main revenue stream (in this case PACS).

On the other end of the spectrum was my meeting with Allscripts. In my discussion, I almost got the feeling (although, they certainly didn’t state this specifically), that EHR has become almost a commodity. The idea being that everyone is going to have an EHR and that the EHR market is going to be a heterogeneous environment. I assure you that the later is true and will be for the forseeable future. So, it makes a lot of sense why much of the focus of our conversation was around Allscripts efforts with DBMotion to provide a platform that brings together all the data from the heterogeneous EHR systems.

I was really intrigued by each of these companies and how far apart they are in their approach to EHR. At the one side of the spectrum I see a new EHR that’s still trying to provide the right EHR software for the physician. On the other hand, you have a vendor that’s always been known as an EHR vendor (and quite frankly still is with so many EHR software under one roof) is now shifting much of their focus to population health and ACO technology.

I’ve previously written that the Golden Age of EHR adoption is over. We’re entering into a much bumpier and brutal period of EHR transition. We’ll see if doctors get some relief from ONC on Thursday. Word at HIMSS is that on Thursday they’ll be announcing something important in regards to meaningful use (likely during one of the ONC/CMS keynotes). At the CHIME event they said something to the effect of, “we’ve heard you and we’re going to help.” I’ll be on a plane home, but no doubt the details will be tweeted live.

There you have it. A few of my thoughts from day 2 of HIMSS. Tomorrow’s my last day at the event. I have too many things scheduled, but we’ll do what we can to discover interesting content and share more with you tomorrow.

Also, be sure to check out my #HIMSS14 Twitter Roundup – Take Two