Empower care teams to get more done. · DATA 26 Risky situation A Microsoft report shows that even...

A HealthShare Success Story: Rhode Island Quality Institute

“Aggregated and normalized patient data?”

Frank just feels better.

Using InterSystems HealthShare®, the Rhode Island Quality Institute’s health information exchange, CurrentCare, is helping everyone get the results they need. Patients are getting the safe quality care they need to feel better. Doctors and nurses are getting the information they need, when, where, and how they need it, to make the best care decisions.

“Aggregated and normalized patient data”? That’s one of many HealthShare capabilities for solving your toughest healthcare IT challenges.

Read a case study on Rhode Island Quality Institute and CurrentCare at InterSystems.com/Patient1Z

“The comprehensive patient recordwe’re building with HealthShare is giving providers across the state the information they need to deliver thebest care.”

Laura Adams, President & CEO

Rhode Island Quality Institute

HealthShare transforms care by sharing health information

© 2015 InterSystems Corporation. All rights reserved. InterSystems and HealthShare are registered trademarks of InterSystems Corporation. 11-15 Patient1HITN

Patient 1 HITN_Layout 1 10/5/15 2:49 PM

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BENCHMARKS: Hidden gems. These 18 health technologies are ready to help hospitals move beyond mere EHRs – but many are still surprisingly underused. PAGE 30

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The hospital would be nothing without its

IT DEPARTMENTMeet the winners of the

2015 Best Hospital IT Departments. See 21 of the best teams in the country, inside

and online at HealthcareITNews.com. PAGE 4

‘IT Bonanza Day’CMS and ONC go big, finalizing meaningful use requirements and the interoperability roadmap in a red-letter day for rulemaking. PAGE 10

No need for alarmOne hospital shows how it adjusts its EHR to fight back against alert fatigue.PAGE 20

http://www.HealthcareITNews.com

A HealthShare Success Story: Rhode Island Quality Institute

“Aggregated and normalized patient data?”

Frank just feels better.

Using InterSystems HealthShare®, the Rhode Island Quality Institute’s health information exchange, CurrentCare, is helping everyone get the results they need. Patients are getting the safe quality care they need to feel better. Doctors and nurses are getting the information they need, when, where, and how they need it, to make the best care decisions.

“Aggregated and normalized patient data”? That’s one of many HealthShare capabilities for solving your toughest healthcare IT challenges.

Read a case study on Rhode Island Quality Institute and CurrentCare at InterSystems.com/Patient1Z

“The comprehensive patient recordwe’re building with HealthShare is giving providers across the state the information they need to deliver thebest care.”

Laura Adams, President & CEO

Rhode Island Quality Institute

HealthShare transforms care by sharing health information

© 2015 InterSystems Corporation. All rights reserved. InterSystems and HealthShare are registered trademarks of InterSystems Corporation. 11-15 Patient1HITN

• • ••• • ••• •• •• • • • • • • • ••• ••• • •• •• • ••• •• • •• • ••• • • • ••

CONNECTNovember 2015 | Healthcare IT News | www.HealthcareITNews.com 3

Blog: Perhaps we don’t need interoperability as much as we think we doEHR vendors don’t really have a strong incentive to make

their products interoperable. But putting those standards in

the hands of the government also isn’t perfect.

http://bit.ly/nair-blog

CALENDAR OF EVENTS

NOVEMBER4-6: Healthcare IT News Big Data & Healthcare Analytics Forum, Boston8-11: mHealth Summit, Washington14-18: AMIA 2015 Annual Symposium, San Francisco

DECEMBER1-3: Healthcare IT News’ Privacy & Security Forum, Boston7-8: Healthcare Finance’s Revenue Cycle Solutions Summit, Atlanta

FEATURED EVENT

The mHealth Summit kicks off Nov. 8 at The Gaylord National Resort and Convention Center in Washington.

WHAT’S INSIDESeeing security risks in mobile imaging“Doctors tell me that PACS and radiological image sharing is common and that they could be viewed in public places like coffee shops,” Allan Ridings, senior risk management and patient safety specialist with the Cooperative of American Physicians, tells Healthcare IT News. Hackers love coffee shops, he says: “There could be a person sitting outside the shop in a car grabbing all that data.” Risk management specialists warn of potential HIPAA privacy violations for physicians accessing imaging data in public spaces. The level of risk has to do with how the images and data are accessed, experts say.PAGE 32

POLICY 10So much to read CMS and ONC publish combined 1,406 pages of final MU rules, interoperability roadmap.

Take 2 ONC’s Federal Health IT Strategic Plan gets a makeover.

CLINICAL 18Taking on Type 1 Philips connects EHR data, mobile app, online community to tackle diabetes.

Alerts that matter Turning off unimportant EHR alerts has clinicians at one hospital tuning in to better care.

BUSINESS 22Team effortVendor and client put their heads together to boost pop health.

Pressure is on Now that most hospitals have EHR systems, CIOs are pressed to show their value.

DATA 26Risky situation A Microsoft report shows that even encrypted data can be swiped from EMRs.

FBI alert Agency raises concerns over security of Internet-of-Things-enabled healthcare devices.

INSIGHT 16Data rulesPopulation health can’t happen without the capability to leverage lots of data.

Apple ability Apple Watch is starting to show its worth at three major health systems.

Benchmarks ........................... 30

Trends ................................... 32

JobSpot ................................. 33

People ................................... 36

Newsmaker ........................... 38

INFOGRAPHIC:

Top 10 biggest HIPAA breaches To date, nearly 143.8 million people have had their protected health information compromised in a HIPAA breach. Here’s a list of the 10 biggest in the U.S.

http://bit.ly/top10-breaches

VIDEO:

Clinical Spotlight Episode 21: Charles Macias, MD Charles Macias, MD, discusses the role of Chief Integration Officer and how it fits into the C-suite dynamic, as well as the impact of data analytics at Texas Children’s Hospital.

http://bit.ly/macias-video

VIDEO: Big Data Byte: Niall Brennan, Chief Data Officer of CMS Niall Brennan, chief data officer at the Centers for Medicare & Medicaid Services, talks about CMS’ initiatives in predic-tive modeling to identify fraud, real-time delivery system monitoring and increasing transparency in healthcare data.

http://bit.ly/brennan-video


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SUPER HOSPITALS

Meet the winners of Healthcare IT News’ 2015 Best Hospital IT Departments! This year’s top staffs demonstrate an incredible commitment to teamwork, collaborating every day to improve patient care. The winners span four categories:

SUPER (200+ IT STAFF) LARGE (76–199 STAFF) MEDIUM (26–75 STAFF) SMALL (1–25 STAFF)

To see more in-depth profiles of the winning departments, read Q&As with their CIOs and learn about what makes their workplace cultures tick, be sure to visit HealthcareITNews.com/best-hospitals-2015

1 | MERIDIAN HEALTH SYSTEM - NEW JERSEY

2 | WAKE FOREST BAPTIST MEDICAL CENTER - NORTH CAROLINA

November 2015 | Healthcare IT News | www.HealthcareITNews.comCOVER STORY www.HealthcareITNews.com | Healthcare IT News | November 20154


The new Office. Empower care teams to get more done.

Real-time editing for care teams to work together on critical patient documents and reduced risk of documentation errors.

Enhanced care team productivity with great new ways to collaborate with Skype for Business.

Data loss prevention across Word, Excel, PowerPoint and Outlook keeps your files safe when life pulls you away.

Simplified login with Windows Hello with facial recognition and biometrics.

Anytime-anywhere access with touch-first native Office apps on Windows 10, iOS and Android.

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POLICYwww.HealthcareITNews.com | Healthcare IT News | November 201510

CMS, ONC publish final meaningful use rules, interoperability roadmap‘We have a strong sense of urgency and want to see that we receive a return on the investment of establishing electronic health records’BY TOM SULLIVAN, Editor-in-Chief, and ERIN McCANN, Managing Editor

THE CENTERS for Medicare & Medicaid Services and the O ce of the National Coordi-nator for Health IT published

final rules for the federal EHR Incentive Programs and on Oct. 6, which they say will ease Stage 2 reporting requirements for providers. They also announced major news on Stage 3 of the program.

That same day, ONC also released the final version of its Shared Nationwide Interoperability Roadmap, charting a course toward a data-rich “learning health

system” within the next decade.The 2015 MU rule builds on 2011 and

2014 and is reflective of input from indus-try stakeholders, according to Karen DeSalvo, MD, national coordinator for health IT and acting assistant secretary for Health at HHS.

The final rules “make significant chang-es in current requirements,” o cials said. Chief among them are easing the reporting requirements for providers, according to Patrick Conway, MD, chief medical o cer of CMS. The rules also allow for a 90-day reporting period for providers in 2015 and

FDA launches new patient engagement task force

As healthcare enters an era in which “patients and their care partners participate actively in decision-making and priority-setting,” FDA has launched a Patient Engage-ment Advisory Committee. Officials say the group will

offer perspective to the FDA Commissioner on issues related to regu-lation of technology and medical devices and their use by patients. FDA will learn about patient-related topics and better integrate those patient perspectives into its regulatory process. The panel will inves-tigate how best to engage patients across the device development and assessment lifecycle as well as how FDA and sponsors should communicate patient preference information to patients.

ONC policy director Jodi Daniel steps down

A year since the Office of the Nation-al Coordinator for Health IT saw a spate of high-profi le departures, another longtime official has left. Policy director Jodi Daniel stepped down in October after more than a decade at ONC. Elise Anthony, cur-rently ONC’s deputy director of the office of policy, took over as acting director. Joining ONC in 2005 as a founding director, Daniel helped chart strategies for health IT for years before the HITECH Act turbo-

charged the industry with billions of dollars in stimulus, spurring huge increases in technology uptake.

HIMSS names NHIT Week leadership award winners

During a ceremony hosted by the American College of Surgeons, in Washington on Oct. 7, HIMSS gave awards to Sens. Lamar Alex-ander, R-Tenn., and Patty Murray, D-Wash., both leaders of the Sen-ate Committee on Health, Educa-tion, Pensions & Labor, which has been a heated battleground

for health IT over the past few months. Other award recipients included Military Health System CIO David Bowen and Defense Healthcare Man-agement System program Executive Officer Christopher Miller, as well as Republican Colorado State Rep. Perry Buck, who was instrumental in getting a law passed to reimburse physicians for telehealth services, as State Legislator of the Year.

ONC revamps Federal Health IT Strategic PlanPuts the person at the centerBY MIKE MILIARD, Editor

EMBRACING A long-term vision for nationwide health information technology that ‘puts the person at the center,’ the Office of the

National Coordinator for Health IT has finalized its strategy for the next five years.

The document represents an “action plan for federal partners, as they work to expedite high-quality, accurate, secure and relevant electronic health information for stakeholders across the nation,” writes National Coordinator for Health IT Karen DeSalvo on the ONC website.

“The Plan’s strategies for achieving this aim focus on making electronic information available so individuals can manage their health, providers can deliver high-quality care to their patients, public health entities

and long-term services and supports can improve community health, and scientists and innovators can advance cutting-edge research and solutions.”

Reflecting the recommendations from the Health IT Policy Committee, along with input from an array of some 35 federal partners and more than 400 public comments, the plan has four strategic goals:

1. Advance person-centered health and self-management;

2. Transform healthcare delivery and com-munity health;

3. Foster research, scientific knowledge and innovation; and

4. Enhance the U.S. health IT infrastructure.DeSalvo said it’s one “that puts the person

at the center and seeks to get to a place where everyone has quality care that’s at a lower cost, bringing a healthy and engaged population.Together, CMS and ONC’s rules for meaningful use, EHR certification and the

interoperability roadmap total 1,406 pages.

The Office of the National Coordinator for Health IT developed a strategy with a focus on making electronic information available to individuals to manage their own health.

REVAMPS SEE PAGE 14

ROADMAP SEE PAGE 12


When insights create great outcomes.

That sparks success.

An actionable insight is powerful. Uncovering the right one helps create better clinical and financial outcomes throughout your organization. It’s possible with Centricity™ Solutions for Integrated Care. From enhancing diagnostic speed and confidence to reducing rejected claims, our software and services help you connect productivity with care.

Visit gehealthcare.com/Centricity to see how you can spark success.

©2015 General Electric Company – All rights reserved. GE and GE Monogram are trademarks of General Electric Company. GE Healthcare, a division of General Electric Company.

ENTERPRISE IMAGING CARE DELIVERY MANAGEMENT POPULATION HEALTH FINANCIAL MANAGEMENT WORKFORCE MANAGEMENT

POLICY www.HealthcareITNews.com | Healthcare IT News | November 201512

OIG hits HealthCare.gov for poor oversightReport details lax management of contractors, missed deadlines, processes in disarrayBY BERNIE MONEGAIN, Editor-at-Large

IN A review of 20 of 62 con-tracts awarded for the devel-opment, implementation and operation of HealthCare.gov,

the HHS Office of the Inspector General found the supervision of contractors on the job to be sorely lacking.

HealthCare.gov opened for busi-ness on Oct. 1, 2013. It was plagued with website issues from Day 1. The report OIG released this week o�ers details of the lackadaisical contract oversight — and often the lack of supervision altogether.

Contracting officers and con-tracting officer’s representatives did not always manage and oversee contractor performance as required by federal requirements and con-tract terms, according to OIG.

Moreover, OIG found that the Centers for Medicare & Medicaid Services did not always comply with federal regulations regard-ing designation and certification requirements for contracting o -cer’s representatives. Also, con-tracting records did not always include all critical contract deliv-

erables and other management and oversight documentation. OIG con-cluded there were consequences to slack oversight:

� Contractor delays and per-formance issues were not always identified.

� A contractor incurred unau-thorized costs that increased the cost of the contract.

� Contracting o cers in all gov-ernment agencies did not have access to contractor past-perfor-mance evaluations when making contract awards.

� Critical deliverables and man-agement decisions were not prop-erly documented.

In addition, the HHS Acquisition Regulation and the Standards of Ethical Conduct for Employees of the Executive Branch may not have been complied with in connection with an employee who served as a member of the technical evaluation panel for one contract, OIG wrote in its report.

OIG GAVE CMS SEVEN RECOMMENDATIONS:

1. Direct contracting o cers and contracting o cer’s representatives to comply with Federal regulations and contract terms by ensuring that all contract deliverables are received and are used in their management and oversight of the contract;

2. Direct acquisition personnel

not to authorize additional work on contracts until the work is approved by the contracting o cer and properly funded;

3. Direct contracting o cers to prepare contractor past-perfor-mance evaluations at least annu-ally and at the conclusion of the contract and electronically submit them to the Contractor Performance Assessment Reporting System;

4. Direct contracting o cers to designate and authorize contract-ing officer’s representatives in writing and identify their specific duties, responsibilities and limita-tions for each contract they manage and oversee;

5. Provide appropriate training for contracting o cer’s representa-tives to enable them to gain experi-ence and to achieve and maintain their appropriate level of acquisi-tion certification;

6. Maintain contracting files that adequately document contractor performance and CMS management and oversight of contracts; and

7. Require all acquisition person-nel to disclose their past-employ-ment relationships for purposes of determining their eligibility to par-ticipate in making contract award decisions.

OIG noted CMS concurred with its recommendations and described corrective actions it had taken or planned to take to address them.

new providers in 2016 and 2017.There were also big changes

to the number of objectives for eligible hospitals, which have been reduced from about 20 in prior stages to eight.

Clinical quality measures for both hospitals and providers will remain the same.

Stage 3, CMS officials also announced, will go on as planned and will not be delayed, but they will extend the public comment period for Stage 3.

After receiving some 2,500 comments from industry stake-holders on the two proposed rules, CMS made some big changes to the regulations:

� Give providers and state Medicaid agencies 27 months, until Jan. 1, 2018, to comply with the new requirements and pre-pare for the next set of system improvements.

� Give developers more time to create the next advancements in technology that CMS says will be easier to use and more appro-priate to new models of care and access to data by consumers.

� Support provider exchange of health information and interoperable infrastructure for data exchange between provid-ers and with patients.

� Give developers additional time to create the next advance-ments in technology that will be easier to use and more appropri-ate to new models of care and access to data by consumers.

� Address health information blocking and interoperability between providers.

STAGE 3 MAJOR PROVISIONSIn 2017, Stage 3 requirements are optional, but providers who opt to start Stage 3 that year will have a 90-day reporting period. Come 2018, all providers must comply with Stage 3 regulations using a certified EHR.

According to a CMS fact sheet detailing the final rules, major provisions pertaining to Stage 3 meaningful use include:

� 8 objectives for eligible docs, eligible hospitals and CAHs: In Stage 3, more than 60 percent of the proposed mea-sures require interoperability, up from 33 percent in Stage 2.

� Public health reporting with flexible options for mea-sure selection.

� CQM reporting aligned with the CMS quality reporting programs.

� Finalize the use of appli-cation program interfaces that enable the development of new functionalities to build bridges across systems.

DATA NEEDS TO BE FREEOct. 6 also saw the finaliza-

tion of ONC’s eagerly awaited interoperability roadmap. The three overarching themes of the report, “Connecting Health and Care for the Nation,” focus around giving consumers the ability to access and share their health data, ceasing all inten-tional or inadvertent informa-tion blocking and adopting federally-recognized national interoperability standards.

“Data needs to be free,” said DeSalvo. “If we’re going to change the care model, we need an information model to support it.”

“There is a significant focus on near-term activities,” said Erica Galvez, ONC’s interoper-ability and exchange portfolio manager, of the roadmap — the final version of which, as was the case with previous drafts, includes three-, six- and 10-year goals and milestones.

Between now and 2017 ONC intends to enable the sending, receiving, finding and using of health data domains with an eye on improving care quality and outcomes.

ONC’s next phase, slated to span 2018–2020, aims to expand data sources and increase the number of users to create health-ier populations at a lower cost.

The ultimate goal is to build a learning health system by 2024. That will require nationwide interoperability putting “the person at the center of a system that can continuously improve care, public health and science through real-time data access.”

Galvez added that the road-map is about action, not just talking over ways to get through pesky interoperability hurdles.

“The word action is used 107 times in the document,” she said.

Indeed, ONC’s roadmap is also a clarion call to private health-care providers, public organiza-tions and U.S. states — if only because the federal government cannot achieve a learning health system without them.

Such an ambitious goal is going to take incentives properly aligned to stimulate information exchange, policy components that move interoperability, patient matching, privacy and security and trust environment, DeSalvo said.

With those in place, the nation will have a platform on which to innovate and drive grand initiatives such as pop-ulation health and precision medicine.

“This is part of our work to build a system with better care, smarter spending and healthi-er people,” DeSalvo said. “We have a strong sense of urgency and want to see that we receive a return on the investment of establishing electronic health records.”

ROADMAPCONTINUED FROM PAGE 10


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POLICY www.HealthcareITNews.com | Healthcare IT News | November 201514

ONC launches health IT complaint formAims to help with challenges with interoperability, usability, safety and moreBY MIKE MILIARD, Editor

AS MORE and more reports pile up cataloging pro-vider frustrations with EHR functionality and

usability, the O ce of the National Coordinator has launched an online form where users can log com-plaints about certified products.

“If you have a problem with your health IT, you should start by con-tacting the developer or vendor,” writes Acting Deputy National

Coordinator for Health IT Jon White, MD, on the ONC website. “If that doesn’t work and you think the issue relates to the product’s certified capability, then you should contact the ONC-Authorized Certi-fication Body (ACB), which should be able to work with you and the developer to resolve most issues. But if the issue remains unresolved, please submit your issues to ONC.”

White says ONC wants to know about:

� Challenge related to data blocking (“when someone or an entity knowingly and unreasonably interferes with the exchange or use of health information”)

� Inability for EHRs to share or receive health information

� Usability issues � Failure for certified products

to perform as expected � Any concerns about health

IT safetyComment logged at HealthIT.gov/

healthitcomplaints will be reviewed and responded to by ONC sta�; the process will help the agency “bet-

ter triage, track, route and respond to your health IT concerns or chal-lenges,” White writes.

“While we may not always have the ability to step in and fix the problem, we may be able to help in others ways, such as begin-ning a dialogue between you and your vendor/developer,” he adds. “Submitting your concerns to us also helps us better understand the extent and nature of potential problems so we can more accu-rately represent them to Congress and our federal partners and work with them to develop solutions.”

“It is a shift from our prior strategic plan in just that: It puts the person at the center, with health IT as a support,” she added. “And aims to facilitate and enable the many important use cases including delivery system reform, scientific advancements such as precision medicine and improvements in public health and preparedness.”

“When we released the draft plan back in December, all along the goal was to make sure information was available when and where it matters,” said Gretchen Wyatt, senior strategy advisor in ONC’s O ce of Policy. “The idea was to make sure we look at engagement by the broader care team and for those who impact health for families and communities. The structure of the plan, we hope, reflects that.”

The public said loud and clear that “we were going in the right direction, but needed to offer more examples of what health IT would be used for,” she added.

That’s why — unlike the draft plan, which listed “expand adoption of health IT” as its top aim — in the final plan the technology is really only the focus of goal four.

“The infrastructure is support for goals one, two and three,” said Wyatt. “This is not a national plan for health, but for how health IT can improve health goals.”

REVAMPSCONTINUED FROM PAGE 10

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Palo Alto Medical Foundation, CaliforniaSteven Waldren, director, Center for Health IT,

American Academy of Family Physicians

www.HealthcareITNews.com

2013 JESSE NEAL AWARD WINNER

Challenges of pop health analytics BY SHEETAL SAWARDEKAR, CitiusTech

WITH THE increasing adoption of data analytics, providers, health plans and account-able care organizations are

quickly transitioning toward a coordi-nated, integrated and value-based care delivery ecosystem. We are seeing a gen-eral shift toward preventive care, along with a growing demand for accountable and coordinated care. With the Depart-ment of Health and Human Services’ recent decision to tie 90 percent of Medi-care payments to value-based models by 2018, we can expect organizations to move even faster over the next few years toward streamlining their population health man-agement processes.

POPULATION HEALTH ANALYTICS IS NOW A STRATEGIC IMPERATIVESince 2008, PHM processes and related reforms have been guided by the Institute

for Healthcare Improvement’s ‘Triple Aim’ — improving the health of populations, improv-ing experience of care and reducing per capita costs of health care. In 2015, IHI pub-lished a new report describing three core components that organizations need to execute to pursue the ‘Triple Aim’:

1. Creating the right foun-dation for population health management includes iden-tifying relevant populations, creating a strong governance mechanism and articulating purpose.

2. Managing services at scale for a pop-ulation includes defining subpopulations, analyzing care outcomes, designing or rede-signing services based on changing needs and even leveraging community organiza-tions (e.g. local fire department) for capac-ity expansion of care coordination.

3. Establishing a learning system to drive and sustain the work over time, using population level measures, applying analytics for itera-tive testing and continuous improvements and under-standing individual health-care needs.

Much of what IHI dis-cusses in the new report has analytics at its core, making population health analyt-ics tools and technologies

a strategic imperative for organizations that want to achieve the ‘Triple Aim.’ Advanced analytics tools and technolo-gies, such as big data and predictive ana-lytics will play an important role in the near future, helping providers drive effec-tive patient engagement and collaboration across care settings.

Meaningful use should work for providers – not vice versa T

HE REAMS of new meaningful use rules that landed with a thud on Oct. 6 (per usual, just before 5 p.m. Eastern Time) had been a long time in com-

ing – even by the molasses-slow standards of the federal bureaucracy.

Let’s take a trip back in time: Way back in August 2014, the U.S. Department of Health and Human Services touted the “flex-ibility” soon coming to the EHR incentive programs in the wake of severely disappointing Stage 2 attestation numbers from hospitals and providers.

It nonetheless held firm on a 365-day reporting period – even as industry groups implored that a shorter, 90-day window was critical for MU’s continued suc-cess. Without it, “the very future of meaningful use is in question,” o�cials from HIMSS, CHIME, MGMA, AHA, AMA and others wrote at the time.

By the following January, the Centers for Medi-care & Medicaid Services had relented, indicating its “intent to engage in rule-making” meant to “reduce the reporting burden on providers” and allow that three-month reporting period.

Months later, in April of this year, CMS finally published proposed rules allowing for the 90-day change, realigning the reporting period to fit the calendar year and suggesting a vastly reduced patient access requirement.

But by the dog days of summer, a full year after those first promises of flexibility, the MU modification process seemed to have stalled.

“We are urging and pleading with CMS to get the modification rules out there,” CHIME told Healthcare IT News in late July. “Where is the final rule?” asked MGMA in early September. In early October, as the calendar year began winding down, AMA called for an “automatic hardship

exemption” to protect its physician members from the the federal foot-dragging.

All of which is to say that the final meaning-ful use rules that happened to be published the very next day were a quite long time in coming.

In this issue, we salute our annual Best Hospital IT Departments — paying tribute to hardworking teams, large and small, that

are doing their darnedest, day in and day out, to help their health systems improve in the service of safer, more e�cient care.

Their commitment deserves appreciation. And it shouldn’t be taken for granted that, on top of their long daily to-do lists, they’ll work indefinitely to com-ply with a federal program some have begun to doubt.

Surely, many healthcare orga-nizations appreciate new Stage 2 regs that, in CMS speak, “simplify requirements and add new flexibilities” (see page 10 for details). But just as many are perplexed as to why this has all taken so long. Indeed, with the final rules so little changed from from the proposed rule, some have asked why well-meaning providers have had to wait until after the clock has already started ticking on the final 90-day period of 2015.

Even more participants and observers, as CMS surely knows, are loudly questioning just what all this is for at this point, more than five years since Stage 1 successfully set the ground rules for an unprecedented industry-wide digitization.

Some, such as Senate HELP Committee Chairman Lamar Alexander, R-Tenn., have repeatedly made the case that Stage 3 should be delayed. Others, such as Beth Israel Deacon-ess Medical Center CIO John Halamka, MD, have opined that we may be at a point where MU has outlived its usefulness.

Without arguing one way or the other, we’ll

simply say that the public comment period announced by CMS as it finalized Stage 3 is prob-ably a wise idea, if only as a chance to gather more voices that could help shape the timeline. (“It would not surprise me that the CMS final rules are not really final,” wrote Halamka on his blog.) A start date of 2018 — as far away as that may seem — is still not as far away as some might think.

As had been pointed out in this column many times, the federal government has asked a whole lot of U.S. healthcare providers and technology vendors these past few years.

Consider the fact, for instance, that the final rules were published just five days after the indus-try breathed a qualified sigh of relief that the Oct. 1 ICD-10 deadline had seemed to come and go without major incident.

Indeed, as one CIO we spoke with recently put it, when asked for an opinion on the 752 pages (!) of meaningful use rules handed down on Oct. 6, “I haven’t spent a lot of time focused on that. ... We’ve been so focused on ICD-10.”

This CIO wasn’t even ready to say the MU pro-gram had overstayed its welcome. But she did feel that, if CMS “wanted to make it easier” there were probably some ways to do it without requiring yet another round of detail-intensive hoop-jumping.

No one enjoys wading through hundreds of pages of dense and abstruse legalese. And that’s to say nothing of doing all the hard work of actu-ally complying with those voluminous rules. Many meaningful measures, this CIO said, feel like little more than “just checking a box so we can send the information in.”

Meaningful use has accomplished much since 2010, as the IT teams featured on page 4 and others liked them, have strived in ear-nest to make it work. As the program enters its final years, HHS owes it to them to listen to closely to their concerns and help them do their jobs: serving patients.

SHEETAL SAWARDEKAR

POPULATION SEE PAGE 17

MIKE MILIARD, Editor



mailto:[email protected]























INSIGHTNovember 2015 | Healthcare IT News | www.HealthcareITNews.com 17www.HealthcareITNews.com | Healthcare IT News | November 2015

Apple Watch in action We all hear plenty of speculation about Apple’s Watch not being particularly useful — but it’s already proving itself at three major hospitals. BY TOM SULLIVAN, Editor-in-Chief

IT SOUNDS almost shadowy and top-secret: An innovation wing in Louisiana is home to cutting-edge work undertaken by Apple, Epic and a tech-savvy provider.

That would be Ochsner Health System. Among the first-movers on Apple’s Health-

Kit and ResearchKit, Ochsner lays claim to having already linked HealthKit with the Epic EHR, including patient-generated data.

The network is also in early stages of test-ing how it can make use of the Apple Watch and other wearables in a clinical capacity — as are Duke Medi-cine and Stanford University, though each in diªerent ways.

INNOVATION LABSOchsner is among the many hos-pitals operating technology labs to create and test new software, tools or medical devices. What’s unique about Ochsner, though, is the relationship with both Apple and Epic.

“This combination of having Apple and Epic developers allows us to try differ-ent things, they have carte blanche to go buy anything they want,” Ochsner CIO Patrick Anderson said. “They can fail, they can fail fast and early. And if they hit a home run one out of ten times, that’s a pretty big deal. That’s our innovative culture here.”

Count the Watch among those contend-ers. In a pilot program involving hundreds of people with hypertension, Ochsner has given patients a Watch via which they

receive reminders to take medications, weigh themselves, check their blood pres-sure and that data, in turn, is fed into their medical record. The software sends alerts on the case management side when it spots issues with a particular patient so Ochn-ser physicians can conduct an intervention and, ideally at least, avoid hospitalization or readmission.

Yet, that’s just a start. Based on the success of that program, Anderson said that Ochsner is “seriously considering giving physicians the

Watch,” and so it’s working with Apple and Epic to feed statistics into the device.

ALWAYS ON THE GOWhereas the physicians in Ochsner’s clinics, and this is the case at most hospitals, are typically close to a computer, the same does not hold as true for specialists.

There’s a cardiologist, for instance, who moves from the

catheterization lab to the emergency room, then to check on patients, perhaps visit another department, before heading back to an o�ce.

“We’re working to make those results go to the Watch so that a physician can literally see a patient and review those stats walking down the hall,” Anderson explained.

The emphasis, he added, is on keeping length-of-stay to a minimum.

“It’s in development now. The proto-type is working but not production-ready,”

Anderson said. “It’s in our innovation lab so that’s going to be coming.”

O BARModeling itself on Apple stores’ Genius Bar, where customers can walk up and ask employees anything, Ochsner built what it calls the O Bar.

Here’s how it works: A doctor recommends a partic-ular app to a patient, who goes to the O Bar, uses an Ochsner iPad to test out apps and then downloads those to their own phone.

NOT EXCLUSIVELest this appear to be an Apple, Epic and Ochsner ménage a trois, the relationship does not limit them from using other vendors’ technologies.

“We’re prototyping a non-Apple device that goes on the wrist to measure vitals, driving pulse, temperature and O2 statis-tics directly to Epic,” Anderson explained. “That’s in our innovation wing right now, and that seems to be working. So we’ll look to expand that.”

As noted, Apple and Epic are also working with hospitals including Duke and Stanford.

Stanford launched the MyHeart Counts app earlier this year to monitor heart rate as part of wide-ranging research into cardio-vascular disease by enabling participants to

download the software to their iPhone, answer questions about risk factors and track basic readings.

Duke, for its part, has armed providers with the Watch to use with Epic Haiku for several months now, according to Ricky Bloomfield, MD, director of Duke’s mobile technology strategy. Doctors have access to information including lab results, messages and appointments.

Bloomfield added that Duke has also made it available to its patients that use Epic MyChart.

The innovative work that is happening, in Anderson’s words: “Put simply: Nobody else is doing that in the world.”

TOM SULLIVAN

INNOVATION PULSE

DEPLOYING AN EFFECTIVE POPULATION HEALTH SOLUTIONPopulation health analytics is being increas-ingly used as tool for preventive care and overall wellness management rather than reactive localized care. According to recent reports, a few early adopters are using ana-lytics tools for risk stratification, targeted outreach, care plans, performance bench-marking, planning interventions and lever-aging registries for surveillance.

An eªective PHA solution must be able to perform a number of key tasks for the providers, including:

� Aggregating data across the continuum of care. This includes clinical applications, claims systems, administrative systems, health information exchange, remote mon-itoring devices, consumer mobile applica-tions, biometric sensors, etc.

� Tracking, aggregating and analyzing a vast spectrum of clinical and financial data, following a patient’s journey from progno-sis, prevention and treatment to mainte-nance and wellness management.

� Measuring performance scores and ana-lyzing clinical outcomes to help enhance quality, cost and e�ciency of care delivered at both an individual and population level.

� Applying risk stratification algorithms to patients in a given population to derive

better and more targeted health manage-ment programs.

� Delivering information to care team members and decision makers when and where they need it.

� Assessing cost and quality metrics of population health programs to deliver return on investment projections and scores.

KEY ADOPTION CHALLENGESAdvanced PHA solutions are still in the early stages of adoption, with most organizations largely relying on descriptive analytics exe-cuted monthly. Predictive analytics is on a rise and recent technologies are equipped with tools to facilitate predictive analytics. In the near future, we believe tools and tech-nologies will support predictive as well as prescriptive analytics. A small percentage of organizations have analytics operations that have a seamless integration of clinical, financial and operational data across the organization. Some of the key challenges for adopting these analytics programs include:

GETTING THE DATA IN ONE PLACEAlthough healthcare organizations’ IT teams have been planning for PHM tools for a while, providing a single source of truth data for analytics applications to use is far from reality. HIEs are yet to effectively develop and maintain continuum of care records. Healthcare organizations have a limited ability to

collate community indicators such as the impact of education, socioeconomic sta-tus, health disparity, ethnicity, place of stay, etc. Also, data needs to be aggregat-ed from diverse sources such as personal health records, personal health devices, mobile devices, consumer health appli-cations and de-identified databases without disrupting the care management workflow.

Additional data challenges include: � Need to standardize large unstructured

datasets. � Lack of clean, normalized data in EHRs. � Significant amount of eªort to address

issues like reconciliation, eliminating dupli-cates, determining message passage inter-face and patient matching.

BUILDING COLLABORATION ACROSS THE CARE CONTINUUMThis requires a robust health IT infrastruc-ture to collect, process and share informa-tion from diªerent parts of the ecosystem. Organizations need to build a framework that enables them to collaborate with pro-viders, patients, community employers, social service organizations, payers, public health agencies, home care, labs and other stakeholders. There are considerable chal-lenges in building data aggregators that are flexible enough to support diverse applications, file formats and standards across the population health ecosystem.

ADDRESSING TEAM CHALLENGES OF CARE DELIVERYThe e�ciency of any population health pro-gram relies on the ability of caregivers and stakeholders to leverage population data to make informed decisions. Healthcare orga-nizations are challenged with providing the right kind of technical assistance and train-ing to care providers to eªectively adopt and leverage PHA tools, along with ancillary sys-tems that support the PHM workflow (e.g. patient portals, remote patient monitoring, telemedicine, care coordination modules).

A part from the primary care physician or other designated care coordinators who are attached to the incentive plan, most care pro-viders involved in the ecosystem of care are often not compensated for their role in the care coor-dination process. To make population care man-agement a success, organizations need to rede-fine caregiver roles across the continuum and design cost eªective ways to manage resources and incentivize them for enhanced care delivery.

There is no one-size-fits-all approach to PHA with every organization defining its own priorities and quality objectives. However, for a successful population health story, every organization will need to lay a clear roadmap flexible enough to address fast changing regulatory needs and robust enough to mitigate adoption risks.

Sheetal Sawardekar is a healthcare consultant for CitiusTech.

POPULATIONCONTINUED FROM PAGE 16

Apple Watch in action being particularly

Anderson said. “It’s in our innovation lab so that’s going to be coming.”

Modeling itself on Apple stores’ Genius Bar, where customers can walk up and ask employees anything, Ochsner built what it calls the O Bar.

Here’s how it works: A doctor recommends a partic-ular app to a patient, who goes to the O Bar, uses an Ochsner iPad to test out apps and then downloads those to their own phone.

Ochsner Health System is testing Apple Watch in a clinical capacity.


CLINICALwww.HealthcareITNews.com | Healthcare IT News | November 201518

Philips launches new diabetes initiativeData, app and online community target Type 1BY BERNIE MONEGAIN, Editor-at-Large

ROYAL PHILIPS and Netherlands-based Radboud University Medical Center introduced a connected digital health pro-

totype designed to enable people with diabetes — and their healthcare provid-ers — to make more confident care deci-sions. In this first phase, they are focused on patients with Type 1 diabetes.

The system, which consists of a mobile pat ient app and online community, is the first to collect and connect data from electronic medi-cal records, multiple personal health devic-es — including wire-less glucose meters and activity monitors — and patient self-reported data, Philips executives say.

Via a smartphone or tablet, the app gives patients continu-ous information related to their condition, such as blood glucose levels, insulin use and nutrition. It also provides coaching guidance at home and on the go.

The secure online community pro-vides a place where enrolled patients and healthcare professionals can inter-act via private messaging or shared posts

within a healthcare organization’s clini-cal guidelines. The idea is for patients to get feedback from their care team using the combined data and also to provide a way to easily share experiences with fellow patients, clinicians and caregivers.

The collaborative prototype develop-ment among Philips, Radboudumc and Salesforce will be available in pilot release by the end of year, with plans to introduce similar connected care solutions address-ing other chronic conditions.

TAKING CONTROLDiabetes is a prevalent, chronic condition that is costly in terms of human su�er-ing and global healthcare spending with nearly 400 million people worldwide liv-ing with the disease. It is often associated with a variety of other chronic diseases.

On average, people with diabetes make up to 180 decisions about their health every day, collecting and evaluating valu-able information on personal and medical factors from blood sugar levels to exer-cise to food choices, research reveals. The care team of people living with diabe-tes can add up to more than 10 di�erent types of care providers.

“I am excited that we are providing

Hilo Medical Center lands Enterprise Davies Award

Hilo Medical Center in Hilo, Hawaii, has been named a 2015 HIMSS Enterprise Davies Award recipient, rec-ognizing its work in improv-ing patient care and out-comes. The Davies Awards

program promotes electronic health record-enabled improvement in patient outcomes through sharing of case studies and lessons learned across a wide range of efforts, including implementation strategies, workflow design, best practice development and adherence, and patient engagement that have improved both financial and care outcomes. HMC is a 276-bed facility with137 acute beds, 20-bed behavioral health facil-ity and 119-bed, long-term care facility. Overall, 72 percent of HMC’s patients have Medicare or Medicaid insurance.

Athenahealth tackles high blood pressure

About 9 percent of patients who are over the age of 50 may be candidates for more aggres-sive treatment of hypertension, according to cloud-based EHR company athenahealth. Athe-nahealth executives base the assertion on a National Institute of Health study. Inspired by the

findings, researchers at athenahealth analyzed the company’s cloud-based national network of more than 67,000 healthcare providers and 69 million patients to estimate the potential impact that a blood pressure guideline change could have on patients. The company is now developing tools that would allow physicians to identify these individuals and bring them in for further assessment.

Doc advises against overreliance on technology

Kyra Bobinet, MD, says a doctor can look at all the vital signs, test results, images and assorted other EMR data and still have no idea how to treat a patient. “That’s not how to care for people,” — it ’s

not engagement, says Bobinet, CEO of the behavior design firm engagedIN and a consulting faculty member on the neuroscience of behavior change at the Stanford School of Medicine. “The actual lived experience can’t be understood through technology,” she says. “The problem is the technology has not evolved enough to be anything more than an amplifier.”

From patient engagement to telehealth, what does it all mean?Seeking to draw clarity from health IT ambiguityBY MICHELLE RONAN NOTEBOOM, Contributing Writer

SEVERAL YEARS ago some girlfriends and I were enjoying a happy hour and noticed a group of guys wear-ing matching shirts. We were a

friendly bunch, so we asked what they did.In response, one guy handed me his card,

which displayed a title of “Transportation Coor-dinator.” Travel agent perhaps? Nope. Turned out that he and his comrades sold used cars.

More recently, I met an individual who said he loved his job as a “Commercial Con-sultant.” I know lots of consultants, but had never met a “commercial” consultant. I asked if he helped people create television commer-cials. Bad guess. Apparently his expertise is securing financing for companies when they acquire commercial vehicles.

Today, I quickly skimmed LinkedIn and discovered I’m connected to quite a few peo-ple with interesting titles, such as Futurist, Chief People O�cer, Wicked Problem Solver and Employee Engagement Game Changer. As fun as these titles are, I’m pretty sure I wouldn’t want a title that leaves people won-dering what I really do.

I prefer obvious titles like “salesperson”

and “programmer.” Unambiguous titles seem more appropriate for today’s world where everyone is urging more transparency from the government, providers and vendors.

Unfortunately our world is full of ambiguous titles and concepts. In health IT, the lingo is continuously evolving and stakeholders don’t necessarily agree on a single definition for each term. Sometimes we create new terms that real-ly aren’t that much di�erent from older, exist-ing concepts (anyone want clarify the nuances between a CHIN, RHIO and HIE?).

Ambiguity, of course, can create all sorts of problems. If you are a provider in a need of a patient portal, you can’t assume that the solu-tion from vendor A includes secure messaging and EHR integration just because that’s what is included in vendor B’s patient portal.

With so many similar concepts, it’s no won-der that providers are sometimes unsure what type of solution they really need. If, perhaps, you are running a small practice and need to exchange data with the hospital or other pro-viders, do you need an EMR that is interopera-ble? Do you need an interface? Or, do you need an option for electronic information exchange?

Obviously, many of these concepts are

“We want to encourage and support people to take full command of their disease by providing them with the right decision tools.” Cees Tack

PHILIPS SEE PAGE 20 ENGAGEMENT SEE PAGE 20


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November 2015 | Healthcare IT News | www.HealthcareITNews.comwww.HealthcareITNews.com | Healthcare IT News | November 201520 TELEHEALTH

How one hospital fights alert fatigue Each month, ‘we were seeing about 150,000 alerts’BY MIKE MILIARD, Editor

IN HEALTHCARE IT News’ July cover story, which explores new and innovative approaches to clinical decision support at

a time where it’s needed more than ever, one healthcare professional voiced a common complaint about electronic health records: the near-constant, often-annoying profusion of system alerts.

Too often, when clinicians think of CDS, “they think of a pop-up alert: something that, in the middle of what you’re doing, gives you a piece of information that the technol-ogy thinks is important and wants you to do something to fix,” said Gregory Paulson, deputy director of programs and operations at New Jersey-based Trenton Health Team.

But technology doesn’t always know best.

Paulson o�ered an analogy. “To me, it’s the equivalent of going online to shop on a website or pay your bill and getting these pop-up ads,” he says. “If you’re shopping on Amazon and you do it frequently, obviously you know where to click. You’re familiar with that website you know how to interface with it in a way that is seamless. So if I then institute a pop-up alert — one that interrupts your process when you’re not expecting it and you don’t want to stop — you’re not going to want to shop at Amazon.”

WEIGHING THE BENEFITSSame goes for physicians: The more they’re irritated by unneces-sary alerts, the less they like using their EHRs. While alerts can be lifesaving — flagging dangerous

drug-allergy interactions or sound-ing the alarm about inappropriate doses — too many are unneeded, telling docs and pharmacists things they already know.

“Alerts are only modestly e�ec-tive at best,” according to a report from AHRQ. “A systematic review of computerized reminders found only minor improvements in tar-geted processes of care, and, while CPOE systems have been shown to markedly decrease pre-scribing errors, this can largely be ascribed to their ability to stan-dardize drug doses, provide deci-sion support and eliminate errors from poor handwriting or incorrect transcriptions.”

As such, clinicians “generally override the vast majority of CPOE warnings, even ‘critical’ alerts that warn of potentially severe harm,” AHRQ points out. Meanwhile, “alert fatigue increases with grow-ing exposure to alerts and heavier use of CPOE systems. This find-ing is intuitive, but also raises the important implication that without system redesign, the safety conse-quences of alert fatigue will likely become more serious over time.”

At University of Vermont Medical

Center, clinicians have been using a new CDS technology to customize its EHRs, tailoring type and num-ber of interaction alerts to a more manageable level.

“We transitioned from a home-grown EHR system five or six years ago,” says Larry Lamb, clinical application analyst in the pharma-cy at UVMC. In that self-developed system, “we built all the interac-tions tables so we had total control of how many interactions were fir-

ing,” he says.But when UVMC finally went live

on Epic, “we did not understand just how many alerts were going to fire.” For roughly 200–250,000 orders per month, “we were seeing about 150,000 alerts,” says Lamb — sometimes as many as 175,000.

At first, “we did the sledgeham-mer approach,” says Wes McMil-lan, UVMC’s clinical pharmacy manager.

PROVIDING CONTROLAlerts generally have four levels, and the three most serious — severe, moderate and contraindi-cated — were the ones UVMC was most concerned about.

“When we saw how many were firing, we turned o� moderate and severe for physicians in the begin-ning, and we left them all on for pharmacists,” says Lamb.

“We tried to use some of the Epic tools and set the alerts for the di�er-ent provider types. For the inpatient side, the physicians were only seeing contraindicated alerts; nursing sta� too,” says McMillan. “On the outpa-tient side we also allowed providers to set the systems to allow providers to see alerts as well.”

UVMC also implemented a CDS tool called AlertSpace. Developed by First Databank, the technol-ogy enables hospitals a much wider latitude for enabling and disabling alerts, letting them customize how — and how often — they fire, according to its own needs and informed by its own institutional expertise.

Whether it’s for drug-drug, drug-allergy or drug-disease reactions; precautions or dosage ranges, the Web-based tool allows fine-tuned modification of medication alerts, with clinicians able to edit or turn off specific prompts — tracking those customizations to gauge their e�ectiveness.

“We developed a three-pronged approach to managing alerts,” says Lauren Hertel, AlertSpace Product

Manager. “The first piece is actu-ally fine-tuning existing content by critically evaluating the evidence and considering the appropriate-ness of alert. The second is intro-ducing more parameters and filters into the data — for example being able to adjust an alert based on a patient’s lab value.”

The third was to focus on the ability of a provider to “locally cus-tomize for their needs,” she says. “Di�erent institutions have di�er-ent clinical perspectives and patient populations and care environments. It doesn’t really work to have one-size-fits-all alerts.”

As for UVMC, “Our first step with AlertSpace was to try to deal with all the alerts pharmacy was seeing,” says Lamb.

The tool o�ered the opportunity to “go into specific alerts and really fine-tune them,” he says. “One example: There are some alerts that are kind of generic for cardiac meds. But they would also include ophthal-mic meds that are in the same class. Those alerts really weren’t signifi-cant, and we were able to go in and turn those products o�.

“We log into FDB, go into the alert we’re looking to modify, and then there are options about what to do,” says Lamb. “Sometimes we change the severity level. We may turn certain products on or o� within that alert. We’ve probably tweaked about 300 alerts.”

That’s enabled UVMC to reduce the number of alerts per order from .77 down to “probably around .5,” he says.

Moreover, says Lamb, “by turn-ing o� the unimportant alerts, peo-ple are seeing ones that are much more clinically significant and probably not blowing by them quite as often as they have in the past.”

“By turning o� the unimportant alerts, people are seeing ones that are much more clinically signi�cant and probably not blowing by them quite as o�en as they have in the past.” Larry Lamb

relatively new and the definitions are still evolving. The definitions seem to get muddled even further when the concepts are tied to some sort of government incentive or penalty. For example:

PATIENT ENGAGEMENT Broadly speaking, patient engage-ment is defined as getting patients involved in their own care. And then there are more specific definitions, such as this one from HIMSS Ana-lytics: “An organization’s strategy to get patients involved in actively and knowledgeably managing their own health and wellness and that of family members and others for whom they have responsibility. This includes reviewing and managing care records, learning about con-ditions, adopting healthy behav-iors, making informed healthcare

purchases and interacting with care providers as a partner.”

Compare the HIMSS Analytics definition to the Stage 2 meaningful use objective for patient engagement, which requires providers to give patients secure online access to their health information. To qualify for meaningful use, all a provider must do is prove that one single patient has the ability to view, download and transmit their health informa-tion. What’s “engaging” about that?

TELEMEDICINE/TELEHEALTHA Center for Connected Health Policy notes that some states use the terms telemedicine and telehealth inter-changeably, while other states use telehealth to reflect a broader defi-nition. In addition, the CCHP found that “no two states are alike in how telehealth is defined or regulated.”

Similarly, on the Medicaid.gov website, the telemedicine is defined

as medical care that permits two-way, real-time interactive commu-nication between the patient and clinician at a distant site.

In comparison, The World Health Organization’s telemedicine defini-tion includes interactions between patients and providers, as well as the continuing education of health-care providers. I doubt many Med-icaid carriers are willing to reim-burse providers for continuing education via telemedicine or any other method.

I prefer clarity over ambiguity, though I realize it’s impossible to eliminate all of life’s obscure titles and concepts, especially in a dynamic environment like health IT that must continually adjust to new payment models and emerging technologies.

Rather than just rant about all these abstruse terms, I wonder if I should also designate myself “Seek-er of Lucidity”?

people with diabetes the tools to connect all of their relevant health data and devices,” Jeroen Tas, CEO, healthcare informatics solutions and ser-vices at Philips, said in a news release. “Our system allows sharing of data and experiences in one community, where they can collaborate with fellow patients and their care teams in a secure environment.”

“We want to encourage and support people to take full command of their disease by providing them with the right decision tools,” added Cees Tack, professor of internal medicine at Radboudumc. “This fits in our mission towards patient-centered participatory healthcare at Radboudumc.”

Philips executives describe the system as built on the Philips HealthSuite digital platform and its new CareCat-alyst. The platform securely connects devices and collects, integrates and analyzes patient data from connected consumer and medical devices, electronic medical records and personal health data. Via this open digi-tal platform, self-measurement sources and overall functional-ity can easily be extended as new digital health consumer measurement technologies become available.

CareCatalyst is a digital tool-kit aimed at making it easy for health systems, institutions and care providers to utilize the power of the HealthSuite digital platform in localized platforms.

PHILIPSCONTINUED FROM PAGE 18

ENGAGEMENTCONTINUED FROM PAGE 18

At University of Vermont Medical Center, clinicians have been using new CDS technology to customize its EHRs, tailoring the type and number of interaction alerts.


CLINICALNovember 2015 | Healthcare IT News | www.HealthcareITNews.com 21www.HealthcareITNews.com | Healthcare IT News | November 2015

Banner Health to switch Tucson hospitals to Cerner EHR

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Goal is to have all hospitals on one platformBERNIE MONEGAIN, Editor-at-Large

IT MAY seem counter-intuitive to pull the plug on a new and expensive — reportedly $115 million — EHR system that was

recently rolled out at two hospitals in favor of another brand. But that’s exactly what Banner Health has decided to do in the case of the two hospitals they recently acquired from the University of Arizona.

Banner, a 28-hospital integrated healthcare system with a Cerner EHR, will by 2018 migrate the two UA hospitals from their Epic EHRs to the Cerner platform.

To Banner executives, it makes perfect sense. As they figure it, the move will, in the end, save them money. But most important it will ensure better quality of care, said Banner Chief Information Officer Ryan Smith.

“There’s significant cost savings by consolidating these two systems down to our single system,” Smith said. “Even taking into account the sizable investment that the former organization had made in that Epic environment, the structure of our relationship with Cerner is actually very cost e�ective for us to make this migration.”

He pointed out there would be significant operating cost around system support and disparate sta� to support a system like that’s di�erent from what the rest of the organization is using.

“From the cost side of the equation, it makes really good business sense for us to do this migration,” he said. Having all hospitals on the same EHR will also benefit a key component of Banner Health’s approach to care, he added.

“Part of our operating success really entails driving as much standardization as possible to operate most e�ciently, safely with the highest quality possible,” Smith explained. “You can’t do that if you’re doing things in a lot of di�erent ways across your various care sites.

“In essence, our whole IT organization is built around support of a highly centralized, highly consolidated, highly integrated business and clinical operations of the company,” he said.

EASY IMPLEMENTATIONWhen Banner acquired the two Tucson hospitals, they had been operating with their Epic system for about two years. There had been reports of cost overruns mostly attributed to delays in implementation. The UA board of directors reported in April 2014 $6.8 million loss, which it attributed to physicians devoting time learning how to use the new system and also a decrease in patient volumes.

Steve Lynn, former chair of the UA Health Network board of directors

was quoted in the Arizona Daily Star as saying the migration to Cerner would be easier than installing the Epic EHR had been.

“Obviously there was pain and su�ering. But the good news is that there’s enough similarity between the two,” Lynn told the newspaper. “It is much more difficult to go from non-electronic to electronic than from one electronic system to another.”

But, the decision for Banner did

not boil down to whether Epic was better than Cerner or vice-versa. As Smith put it, it was all about standardization. It was vital for the organization to have everyone on the same platform.

Another critical factor is clinical decision support: “We have implemented within our server system vast decision support rules that assist our clinicians and physicians in providing really highest quality care,” said Smith.

But ultimately, the choice to move the two Tucson hospitals to the Cerner EHR was a C-suite decision, he said – even if there was a lot of early discussion and debate around it, since the former organization had made significant investment in that Epic implementation.

“As we went through and really did the analysis and challenged ourselves around what would it mean to have significant variance in what had historically been a very strong

operating model in Banner, we pretty quickly concluded conceptually and philosophically that this migration would make sense,” said Smith.

Even after thorough discussion and analysis, Banner execs took several months to do due diligence, he said, to really build the case of why exactly it made sense: “We’ve largely concluded that analysis,” Smith said, “and all arrows point in the same direction — that it does make sense.”


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Partners, Health Catalyst partner to take on pop healthGoal is to forge new tools to transform careBY BERNIE MONEGAIN, Editor-at-Large

IN AN UNPRECEDENTED al l iance between client and vendor, Boston-based Partners HealthCare, the client, and Salt Lake City-based Health Cata-

lyst, the vendor, have agreed to share best practices, intellectual property, technol-ogy and training in an e�ort to take popu-lation health management to new heights.

Money is involved — at least $30 mil-lion. Partners, which is already invested in Health Catalyst, raised its equity own-ership stake in the growing health data warehousing and analytics company. Health Catalyst, meanwhile, is investing in money, time and e�ort in the initiative.

Neither party is saying much about the financial piece of the deal. Nor are they unraveling how much capital either part-

ner is contributing to which aspect of the collaboration. Both, however, are eager to emphasize the goals and the expected gains from their unique collaboration.

As Timothy G. Ferris, MD, Partners’ senior vice president of population health management, sees it, the health system’s agreement with Health Catalyst will tur-bocharge its care management program and improve outcomes for its patients.

Ferris, a practicing internist, pediatri-cian and Harvard professor, who has spent more than two decades focused on health policy and care coordination, is vice presi-dent of population health management at Partners HealthCare. Ferris will lead the new population health management cen-

ter at Partners. Both Partners HealthCare and Health Catalyst teams will train there in population health management.

The goal, says Ferris, is to provide the infrastructure and knowledge base for broader outcomes transformation, not just for Partners HealthCare, but also for health-care organizations across the country.

FOCUS ON COMMERCIALIZATIONOne key element of the deal between Partners and Health Catalyst is an agree-ment not only to create new technology, which Partners HealthCare has already done supported by its Health Catalyst platform, but also to make the new tech-nology available to other health systems by commercializing it.

“We saw some of the innovations they had developed, specifically in the area of care management and population health management, as being very, very impres-sive,” Health Catalyst CEO Dan Burton told Healthcare IT News.

“As we talked about what they had

Revenue cycle outsourcing in growth mode

More and more hospitals are outsourcing their revenue cycle management processes as ICD-10 looms, value-based reimbursement remains clouded in uncertainty and many tech-nology vendors under-deliver on their promises. A new report from Black Book Research finds

that many RCM platforms are missing the advanced functionality needed to meet the demands of new reimbursement models, and that 79 percent of chief financial officers are looking to cut ties with vendors that are not producing a return on investment in 2016. More than half of them (54 percent) believe outsourcing RCM processes will allow them to become more efficient and better positioned financially.

Accenture buys EHR consulting firm Sagacious

Global health IT, management and outsourcing company Accen-ture has finalized its agreement to acquire Sagacious Consultants, an EHR consulting practice, executives announced Sept. 23. The acquisi-tion enables Accenture, which helps

healthcare organizations across the country with massive EHR rollouts to expand capabilities for helping clients to better manage healthcare quality, efficiency and costs, Accenture execs said. Financial terms of the transaction were not disclosed. Closing is subject to customary conditions, including required regulatory approvals. Approximately 250 employees from Sagacious Consultants will join Accenture, bring-ing specialized skills in implementation, systems integration, upgrades and optimization of EHR solutions from Epic Systems.

Huron to acquire Cloud 62, extending Salesforce reach

Huron Consult ing Group has acquired Buffalo, N.Y.-based Cloud62, a fast-grow-ing firm specializing in complex Salesforce.com implementations

and related cloud-based applications. The addition of Cloud62 would expand Huron’s Salesforce.com offerings to clients across multiple indus-tries, including healthcare, higher education, manufacturing, retail and financial services. Terms of the acquisition, which was expected to close in October 2015, were not disclosed. “Cloud62 is an innovative partner in the Salesforce ecosystem,” Jay Laabs, managing director and practice leader of Huron Consulting Group’s Enterprise Performance Management & Analytics practice, said in announcing the deal.

“We saw some of the innovations they had developed, specically in the area of care management and population health management, as being very, very impressive.” Dan Burton

IBM builds its Watson businessCambridge headquarters to serve as hub for new health system partnershipsBY ERIC WICKLUND, Contributing Editor

IBM RECENTLY appointed a general manager for its Watson Health unit, revealed two new prod-ucts, established a global

headquarters for its supercom-puter and announced several partnerships.

Former Philips Healthcare CEO Deborah DiSanzo steps into the new role of Watson Health general manager and is charged with growing the cognitive computing unit that IBM established in April. DiS-anzo joins IBM amid a flurry of activity around Watson.

IBM’s initially surprising partnership with Apple integrates Watson Health with both ResearchKit and HealthKit platforms for Care Manager to enable personalized patient engagement tools.

The company also unveiled IBM Watson Health Cloud for Life Sciences Compliance, a service designed to enable biomed cus-tomers to move more of the drug life cycle into the cloud.

A HOME OF ITS OWNDiSanzo will work at the new Cambridge, Mass., global headquarters for IBM Watson Health, which will serve as a hub for many of the new partnerships IBM also detailed on Thursday.

IBM will be working with Boston Chil-dren’s Hospital, Columbia University, Sage Bionetworks, Teva Pharmaceuticals and ICON plc on a number of initiatives rang-ing from chronic disease management and pediatrics to clinical research and popula-tion health.

Boston Children’s Hospital, for instance, will be integrating Watson in its OPENPe-diatrics program, which seeks to incorpo-rate big data and analytics for personalized medicine, critical care and heart health. BCH researchers will also use Watson Genomic Analytics in research on rare

pediatric diseases.At Columbia University Medical Cen-

ter, IBM Watson will be used by oncol-ogists at the Columbia Herbert Irving Comprehensive Cancer Center to develop personalized cancer care treatment pro-grams based on DNA analysis. Columbia becomes the 16th cancer center to use

Watson Genomic Analytics to develop precision medicine platforms.

IBM Watson Health’s work with ICON, Sage Bionetworks and Teva Pharmaceuticals focuses on the company’s IBM Watson Health Cloud for Life Sciences Compliance, which is designed to advance and improve clinical and research trials. Officials said an estimated 80 percent of all clinical trials are delayed or

ultimately fail because of patient enroll-ment issues, and only 2 percent of eligible patients actually become trial subjects.

END GOAL: ANALYTICS AND POPULATION HEALTHThere’s a pattern to be gleaned from IBM’s initiatives ratcheting Watson up for health-care providers: Big Blue tends to cluster sev-eral major announcements together.

The partners announced joining a grow-ing list of healthcare and pharma companies working with IBM Watson Health, includ-ing CVS Health, MD Anderson, Medtronic, Memorial Sloan Kettering, Yale University and others.

Back in mid-April IBM also bought two companies, Explorys for its cloud-based data analytics technology and population health vendor Phytel, announcing both of those on the same day.

All of these moves, taken together, advance the strategy that IBM senior vice president Mike Rhodin described in a prepared statement as “driving a new era of health, enabling entrepreneurs and industry leaders to address diverse needs, spanning the earliest stages of research all the way through to clinical care and population health through to consumer wellness.” PARTNERS SEE PAGE 25

Deborah DiSanzo


November 2015 | Healthcare IT News | www.HealthcareITNews.comBUSINESS www.HealthcareITNews.com | Healthcare IT News | November 201524

Why hospitals should buy IT startupsExecs must ‘avoid the trap of viewing deals as one-o� opportunities’JACK MCCARTHY, Contributing Writer

LOTS OF hospitals are snap-ping up clinics and physi-cian practices. One major consultancy recommends

they also consider acquiring digital health startups and other vertically integrated companies.

The advice comes amid a record timespan in healthcare mergers and acquisitions.

Healthcare M&A in the U.S., in fact, totaled $241 billion by May 2015, the highest year-to-date fig-ure ever, according to a new report from Accenture. And such changes in the healthcare landscape should prompt executives to look at asset accumulation di�erently.

“Provider executives must avoid the trap of viewing deals as one-o� opportunities to create a new rev-enue stream or add market share,” Accenture said. “The best prepared executives will systematically and rigorously manage M&A opportu-nities as a portfolio and evaluate how a potential deal will influence the whole.”

So-called “horizontal” healthcare M&A represents the traditional ‘land grab’ of hospitals purchas-ing other hospitals to develop an

i n c r e a s i n g l y larger market presence. Hori-zontal acquisi-tions, however, have generally failed to gener-ate the desired synergies, and some have actu-a l l y re su l t ed in diminished operating per-formance of the combined entities. The expecta-tion of quickly realizing benefits of scale often results in deals being closed quickly, without planning to achieve benefits in both the near- and long-term. Accenture estimated that at least 10 percent of the antici-pated cost savings are not realized.

In contrast, “vertical” healthcare

M&A, such as the acquisition of a payer or a non-acute care provider is increasing as its value is better understood. Accenture said the share of non-acute acquisitions as a portion of total provider acquisi-tion volume increased from 64 per-cent in 2006–2010 to 74 percent in 2011–2014, while horizontal acqui-sitions decreased from 32 percent to 21 percent in the same periods.

Also increasingly popular as M&A targets are digital health start-ups, typically those o�ering health-related

products or services in ehealth, tele-medicine, population health man-agement, health analytics, remote monitoring, wearable technology and other areas, the report said.

That’s likely to ramp up in the months ahead. According to Accen-ture, acquisitions of non-acute pro-viders will reach 84 percent of the total provider acquisition volume by 2018 while purchases of payers will double. Digital health acquisi-tions will increase by a multiple of 8 — from 1 percent of overall acqui-sition volume in 2014 to 8 percent by 2018. Meanwhile, the share of traditional horizontal acquisitions is expected to shrink from 21 per-cent in 2014 to 6 percent by 2018.

While the potential is real for digital business acquisitions to transform and disrupt the business models, such investments may be “daunting” for healthcare execu-tives to manage, the report said.

“A portfolio approach will improve the chances that the broader business survives and grows and a transaction generates the value that was intend-ed,” the report explained.

“The best prepared executives will systematically and rigorously manage M&A opportunities as a portfolio and evaluate how a potential deal will in�uence the whole.”

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Horizontal acquisitions have often failed to have the desired level of synergy and performance.

Pressure on CIOs to pull value from EHRs Optimization means ‘significant efforts to leverage your IT investment in a programmatic way’BERNIE MONEGAIN, Editor-at-Large

HEALTHCARE CIOS across the country are, more than ever before, intent on getting the

most value from their hospital and health system EHRs.

“Now that most hospitals and health systems have implemented an enterprise EHR, there is also growing internal pressure to real-ize value from that investment,” concludes a report from Impact Advisors, which conducted an online survey of CHIME mem-bers. The trade group has more than 1,400 members, all CIOs and health IT professionals.

Four key findings put the spot-light on EHR optimization:

� More than 70 percent of responding CHIME members agreed — 36 percent strongly — that the top IT priorities for their organization in the next 12 months are projects that help them realize more value from their EHR investment.

� Only 8 percent said they are not focused on EHR optimization right now.

� Almost three quarters cited “too many competing priorities” as one of the biggest challenges to getting more value out of their EHR; only 30 percent cited “bud-get concerns.”

� Almost three quarters plan to seek outside assistance from a services firm and/or their EHR vendor in addition to leveraging internal project teams.

As Impact Advisors put it, “optimization” means “significant e�orts to leverage your IT invest-ment in a programmatic way” — or, “outcomes-based improvement to meet a defined set of objectives.”

IT DOESN’T COME EASYWhile CIOs surveyed indicated they were willing — eager even — to pull the optimal value from EHRs, they also pointed to dif-ficulties. Almost three-quarters of respondents said there are too many other competing pri-orities. The results also suggest respondents feel more opera-tional ownership needs to occur in order for optimization to be successful, as 73 percent cited either “lack of process improve-ment resources to augment IT redesign” or a “lack of opera-tional focus” as a challenge.

However, “budget con-straints” was only mentioned by 30 percent of CHIME members as a barrier to getting more value from their EHRs.

When asked which business units have most successfully leveraged the EHR investment in partnership with IT, the most frequently mentioned unit was finance/revenue cycle. The least mentioned were quality and medical group, at 26 percent and 29 percent respectively.

Almost three-quarters of respon-dents said they plan to rely on out-side help (in addition to internal project teams) as they approach optimization over the next two years. More than two thirds said they plan to seek assistance from their EHR vendor in some capac-ity, while roughly 40 percent plan to turn to an outside services firm.


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developed,” Burton said, “our assessment was that these are relevant to the broader market. They were interested in the opportunity to commercialize. I think they were intrigued at the possibility of using Health Catalyst as the commercialization partner or agent. And we were interested in and excited about being the commercialization partner.”

“We’re not disclosing the price tag,” Burton added, “but the terms include cash and equity. So Partners is deepening its equity stake as part of this commercialization process.”

For its part, Health Catalyst is granting Partners HealthCare “an enterprise-wide, complete subscription to our entire library of everything we have built, everything we are building, everything we will build in the future,” Burton said. “The best way to further Partners Healthcare’s objectives — and to further the commercialization of care management and broader health population management IT, was this expansion of our technology and professional services relationship.”

“It’s similar to discussions that we had with Allina Health, where they developed some IT that we felt was compelling; it was tested in the field, and it had produced real outcomes, improvements,” Burton said. “We were interested in and excited about being the commercialization partner.”

The collaboration with Partners HealthCare is not the first partnership Health Catalyst has crafted with its clients. Besides the collaboration with Allina Health, its first customer, which had developed information technology that tested well in the field and produced outcomes and improvements, Health Catalyst also has partnership agreements with a few of its other clients.

The Health Catalyst relationship with Partners HealthCare calls for the former to purchase meaningful care management and population health IP from the latter, so the two can jointly commercialize the technology by using Health Catalyst as the commercialization engine.

“We very much look forward to working with Health Catalyst to enable greater use of analytics within our system,” Ferris said. “So, that’s one piece of it.” The second piece, he said, is about the collaboration around Partners’ population health information management programs.

“We’re excited about working with them in further development,” Ferris said. “Despite our successes in population health management, we are nowhere near done innovating, demonstrating our ability to move the needle on quality and cost. Partnering with Health Catalyst allows us an opportunity to share those practices much more widely as we continue to innovate.”

PARTNERSCONTINUED FROM PAGE 22

SUMMARY OF THE AGREEMENTThe expanded agreement between Partners HealthCare and Health Catalyst includes four major elements:

� Health Catalyst and Partners HealthCare will collaborate through the creation of a new Partners HealthCare Center for Population Health. The Center will train Health Catalyst and Partners HealthCare clinical and administrative teams in best practices for care management and population health, building on

the knowledge base that enabled Partners HealthCare to save $40 million in providing care to the seniors as part of the federal government’s Pioneer accountable care organization from 2012 to 2014. Health Catalyst graduates of the program will disseminate these best practices to client healthcare organizations across the country.

� Health Catalyst is licensing technology, content and analytics innovations that Partners HealthCare, the Massachusetts General Physician Organization and the Brigham and

Women’s Physician Organization developed as part of its decade-long, nationally recognized care management and population health management programs. Health Catalyst intends to commercialize these innovations to further enhance Partners HealthCare’s population health and care management programs and to benefit other health systems in their care management and population health initiatives.

� Partners HealthCare has signed an expanded enterprise-wide technology subscription agreement,

giving it access to Health Catalyst’s full suite of technology solutions to accelerate outcomes improvement. In keeping with Health Catalyst’s mission to improve outcomes, a portion of the company’s revenue from the subscription will be tied to the attainment of measureable improvements in Par tners HealthCare’s clinical and financial performance.

� Par tners Heal thCare is increasing its equity ownership stake in Health Catalyst, after first investing in the company in 2013.

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Hospitals making inroads with analyticsBut C&BI approach too often ‘fragmented, with limited coordination at the enterprise level’BY MIKE MILIARD, Editor

USE OF ANALYTICS by large hospitals and health systems is on the rise, and should continue to grow — although “perhaps not as dra-

matically or rapidly” as some might hope, according to a new Deloitte survey of CIOs and CMIOs.

The 2015 U.S. Hospital and Health System Analytics Survey, from the Deloitte Center for Health Solutions, polled chief information o�cers, chief medical informatics o�cers and other senior IT leaders in health systems, academic medical centers and large hospitals (revenue greater than $500 million).

INVESTMENT IS KEYOne of the biggest and most gratifying takeaways? Spending on clinical and busi-ness intelligence capabilities does correlate with analytics success, and those surveyed

agreed that investments in these tools is key to e�ective participation in value-based care initiatives.

But many organizations are still working to develop their analytics strategies, accord-ing to Deloitte, especially with regard to data governance and budgeting.

In fact, “respondents at several organiza-tions” — about one in three, in fact — “indi-cated they lack clarity on their current analyt-ics spending, so it is di�cult to determine their future spending,” according to the report. “Explanations for this pattern may lie in challenges such as culture, operating models and fragmented oversight. More than half of the respondents mentioned these fac-tors as top barriers for analytics adoption.”

Other factors clouding the waters include tight budgets, a confusing array of product o�erings and a lack of clarity on just what analytics means. Nonetheless, more than three in five health systems reported their organizations plan increased investments in advanced analytics tools for clinical and pop-ulation health functions. Part of that is likely due to the successes that are already being

Encryption has long been looked to as an underused solution that could solve some of healthcare’s most vexing security challenges.

Even with encryption, EMR data at riskWhile encryption could o�er some protections ... it also has serious limitationsBY MIKE MILIARD, Editor

A RECENT SECURITY REPORT by Microsoft finds that, even when cloaked in encryption technol-ogy, “an alarming amount of

sensitive information can be recovered” from electronic medical record databases.

For the report, “Inference Attacks on Property-Preserving Encrypted Data-bases,” which included 200 hospitals, researchers from Microsoft, University

of Illinois and Portland State University examined four types of cyberattacks tar-geted at EMRs.

Specifically, they probed the response of relational databases using the CryptDB design, which enables SQL queries on scrambled data.

“Many encrypted database systems have been proposed in the last few years as cloud computing has grown in popularity and data breaches have increased,” write the researchers, Seny Kamara, Muham-mad Naveed and Charles V. Wright. Such systems, most based on CryptDB, make use of “property-preserving encryption

Claims company under scrutiny after data breach

An insurance claims man-agement company that reportedly failed to encrypt its data is in hot water after an IT professional uncovered detailed medical records of some 1.5 million people from its online database. Texas IT

specialist Chris Vickery discovered the medical records from Systema Software on Amazon’s cloud computing platform after following up on reports of massive data dumps on the platform. Vickery said the Larkspur, Calif.-based software company did not encrypt its data, and it could be accessed without a password. Among the data were health insurance information, medical diagnoses, plans to defend against claims, Social Security numbers, names, addresses, phone numbers and dates of birth.

AHIMA ready with answers to ICD-10 questions

AHIMA executives say the organization is able and ready to roll up its sleeves and provide help with ICD-10 coding where it is needed. “AHIMA Code-Check doesn’t just provide answers to questions but will show all the key steps

for using the correct code. It can be an important and ongoing source of continuing education,” said AHIMA CEO Lynne Thomas Gordon in announcing the service. AHIMA’s credentialed members will be available to answer questions related to coding in ICD-10-CM and ICD-10-PCS, CPT and HCPCS. The service can be purchased on a subscription or as-needed basis.

CommonWell Health Alliance membership jumps to 33

The newest health IT companies to join the CommonWell Health Alliance brings the interoperability group’s total membership to

33 — quadruple the number at this time last year. The new mem-bers are: ESO Solutions, which develops technology for connecting pre-hospital emergency medicine to the rest of the care continuum; Beyond Lucid, which develops software aimed at emergency medical services and medical transportation; MYidealDOCTOR, which offers a telehealth platform providing patients 24/7 direct links to physi-cian consults and diagnosis; and Varian Medical Systems, which manufactures medical devices and software for treating cancer and other medical conditions with radiation.

ANALYTICS SEE PAGE 27

ENCRYPTION SEE PAGE 27

Microsoft reports that even using encryption technology doesn’t necessarily stop sensitive information from being recovered from EMRs.


DATANovember 2015 | Healthcare IT News | www.HealthcareITNews.com 27www.HealthcareITNews.com | Healthcare IT News | November 2015

recognized by health systems with more mature C&BI capabilities.

“Health systems using analytics for more mature applications (i.e., advance analytics and forecasting) report greater success with analyt-ics for their business functions,” according to Deloitte. “Like a virtu-ous cycle, the more success organiza-tions achieve, the more likely they are to invest in additional advanced ana-lytics solutions and benefit further.”

SORTING THROUGH THE ISSUESEven at health systems that have embraced analytics in earnest, however, some nuts and bolts aspects remain problematic. Data governance can be especially tricky. The report finds that models are often “fragmented, inconsistent and varied.”

Indeed, just 20 organizations surveyed say they have a “clear, integrated strategy for analytics deployment across various business functions,” according to Deloitte.

Meanwhile, 21 respondents “report that they do not have a for-mal enterprise-level data governance process and only six have a chief analytics o�cer,” the report finds. Three-quarters of health organiza-tions polled do have “a department dedicated to delivering analytics to the enterprise,” however.

One health system that is find-ing some success on that front is Harvard-a�liated Beth Israel Dea-coness Medical Center, in Boston.

“At Beth Israel Deaconess, we have engaged governance,” CIO

John Halamka, MD, told Deloitte.With a centralized analytics

model, regular board committee meetings to hash out analytics strategy and a commitment to communicating that strategy to all leadership, BIDMC aims for a much deeper understanding of variations in cost and care and looks to drive big improvements in quality and e�ciency.

“An EHR is fine for a single doc-tor to do analytics, but it is not enough for population health or care management,” said Halamka.

schemes such as determin-istic (DTE) and order-pre-serving encryption (OPE).”

The researchers modeled “a series of attacks that recover the plaintext from DTE- and OPE-encrypted database columns using only the encrypted column and publicly available auxiliary information.”

Such cyberassaults — “including frequency analy-sis and sorting, as well as new attacks based on com-binatorial optimization” — proved more damaging to encrypted EMR data than might have been expected.

The study gauged the e�ectiveness of four types of attacks: “two are well-known and two are new.” The researchers “evaluate(d) these attacks empirically in an electronic medical records scenario using real patient data from 200 U.S. hospitals.”

Their findings? “When the encrypted database is operating in a steady-state, where enough encryption layers have been peeled to permit the application to run its queries, our experimental results show that an alarm-ing amount of sensitive infor-mation can be recovered.”

Specifically, and scar-ily, these attacks correctly recovered OPE-encrypted attributes, such as age and disease severity, for more than 80 percent of the patient records from 95 percent of the hospitals “and certain DTE- encrypted attributes (e.g., sex, race, and mortality risk) for more than 60 per-cent of the patient records from more than 60 percent of the hospitals.”

Encryption has long been looked to as an underused solution that could solve some of healthcare’s most vexing security challenges.

But as the study suggests, “While encryption could o�er some protections — par-ticularly when the database is exfiltrated from disk — it also has serious limitations.”

Most notably, “since an encrypted database can-not be queried, it has to be decrypted in memory, which means the secret key and the database are vulnerable to adversaries with memory access,” Kamara et al. write. “In cloud settings, where a customer outsources the storage and management of its database, encryption breaks any service offered by the provider.”

ANALYTICSCONTINUED FROM PAGE 26

ENCRYPTIONCONTINUED FROM PAGE 26

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DATA www.HealthcareITNews.com | Healthcare IT News | November 201528

Sutter Health says data on 2,500 patients involved in potential breachFormer employee emailed the records of 2,582 patients to a personal account without authorizationBY HENRY POWDERLY, Contributing Editor

HOSPITAL OPERATOR SUTTER

Health recently reported that personal information on more than 2,500 patients were

improperly emailed by a former employee in 2013, representing a possible breach of patient data. The possible breach is the latest privacy violation for the major California-based health system.

According to a notice posted on Sut-ter’s website on Sept. 11, the former employee at Sutter Physician Services emailed the records of 2,582 patients to a personal account without authoriza-

tion. They included name, date of birth, insurance identification number, date of service and billing code. In two cases a driver’s license number was accessed, and in one case the patient’s Social Secu-rity number was included. The company said no financial information was leaked.

Sutter said the event occurred in April 2013, and was recently discovered through a review of the former employ-ee’s email and computer use. Sutter began its investigation on Aug. 27.

“Our patients trust us to provide their care and protect their privacy,” Sutter Health chief medical officer Stephen Lockhart said in the announcement. “We believe protecting patients’ health information is the responsibility of every employee. We require employees to sign confidentiality agreements. In addition, we train them to follow privacy and information security policies and regu-lations. We deeply regret this incident occurred.”

While this potential breach is relative-ly small, Sutter is no stranger to security issues. In one of the largest breaches, the

system, in 2011, saw the records of more than 4 million patients breached after an unencrypted company desktop computer was stolen. The company faced billions in payments in a consolidated class action suit that was later dismissed.

As for 2015, this is third breach for Sutter. In January and again in March, hundreds of patients’ charts were stolen from Sutter hospitals. Sutter said it will pay for free credit monitoring services for one year for all a�ected patients.

FBI issues alert for IoT device securityBy 2020, a staggering 26 billion IoT-enabled devices will be installed worldwideBY ERIN McCANN, Managing Editor

WHEN THE FEDERAL Bureau of Investigation issues an alert to healthcare organizations and others warning of the serious

cyber risks the Internet of Things presents, it’s probably best to pay attention.

For healthcare security folks, this means paying closer attention to the myriad IoT devices within their organizations. And they’re not necessarily all the devices you might think of. They also include things such as HVAC remotes, Wi-Fi cameras, insulin dis-pensers, thermostats and any type of wear-able and other medical devices.

These devices, FBI o�cials said, are notori-ous for having serious security deficiencies. This, combined with patching vulnerabilities, make these IoT devices an attractive target for cybercriminals.

So what are the most pressing IoT risks, according to the FBI? The first is exploiting the Universal Plug and Play protocol to gain access to these devices. The next involves tak-ing advantage of those default passwords to transmit malicious and spam emails or swipe personal and financial data. There’s also the risk of cybercriminals overloading these devices, e�ectively rendering them inoper-able, which could have serious consequences in the realm of healthcare.

FBI o�cials specifically underlined the risk of criminals gaining access to unprotected devices used for remote patient monitoring

medication dispensing.“Once criminals have breached such devic-

es, they have access to any personal or medi-cal information stored on the devices and can possibly change the coding controlling the dispensing of medicines or health data col-lection,” they wrote in the alert.

So what can you actually do about all this? The FBI o�ered a list of recommendations.

1. Keep up-to-date with security patches for these devices.

2. Ditch any default passwords you may still have, and make them stronger: “Do not use the default password determined by the device manufacturer,” since many can be found online.

3. Disable UPnP on routers.4. Isolate IoT devices on their own pro-

tected networks.How big exactly is IoT? One Gartner report

concluded that by 2020, a staggering 26 bil-lion devices will be installed worldwide and connecting with each other.

For healthcare, specifically, the IoT repre-sents an economic impact ranging from $170 billion to a whopping $1.6 trillion each year by 2025, according to a report by McKinsey & Company.

This is not the first time FBI o�cials have issued a cybersecurity alert to healthcare groups and others. In April 2014, it warned healthcare providers specifically that they needed to shape up their security readiness.

“The healthcare industry is not as resil-ient to cyber intrusions compared to the financial and retail sectors, therefore the possibility of increased cyber intrusions is likely,” according the FBI notice, which was obtained by Reuters.

Sutter Health began an investigation in August into a breach of patient information — the third such breach for the organization in 2015.

“Our patients trust us to provide their care and protect their privacy.” Stephen Lockhart


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BENCHMARKS www.HealthcareITNews.com | Healthcare IT News | November 201530

EMERGING TECHNOLOGY

18 health technologies poised for big growth‘Now that you have all this data, what do you do with it?’BY MIKE MILIARD, Editor

BY NOW, everyone’s got an EMR. And most providers are also mak-ing use of ancillary technologies to help harness patient data toward

more e�cient care and better outcomes. But many species of health IT are still surprisingly underused in the U.S. hospital market.

“While the EMR market itself is pretty sat-urated, and usage has really improved since the HITECH Act, the challenge for hospitals and health systems is, now that you have all this data, what do you do with it?” says Matt Schuchardt, director of market intelligence solutions sales at HIMSS Analytics.

One HA report tracks technologies that have seen growth of 4–10 percent since 2010, but have yet to be adopted by more than 70 percent of hospitals. In many cases, the per-centage of potential customers far exceeds those that have a given product installed.

“I think the opportunity for vendors to provide solutions is now,” he says. “There are technologies in place now that can real-ly help, and hospitals need to be aware of them.”

BED MANAGEMENTRemaining first-time buyers: 49.7 percent“This is one technology that “has big growth potential.” New software programs “are so much more sophisticated in terms of the data they’re tracking,” he says. “Knowing how many beds are empty, most hospitals probably do that on a spreadsheet. But really knowing how they’re utilized — and which beds are the most expensive — is going to be incredibly helpful, in terms of the cost-cutting and savings people are hoping to get from these structural changes.”

BUSINESS INTELLIGENCERemaining first-time buyers: 40.3 percent“You need the data, but once you have it, what do you do with it?” says Schuchardt. “You’re going to need a tool to really ana-lyze it. BI connects really well to population health, too. Population health is a series of components — it’s integrating all those dis-parate data sets together to make the right decisions for patient care and from a business perspective.”

DATA WAREHOUSERemaining first-time buyers: 39.7 percentAn EMR, too, is a series of components, “with a clinical data repository being the hub of that spoke,” he says. But in its most basic form that only means the data inside that system — “it’s not all of the external data that’s avail-able — pay data, etc. You need all of that to really start doing BI.”

DICTATION WITH SPEECH RECOGNITIONRemaining first-time buyers: 44.4 percentThe capabilities exist: “You can have Drag-on at your house now. Everyone has Siri on their phone, although she’s not very smart. You think about the kinds of words people use in healthcare it just increases

the complexity. It’s not, ‘Hey, how do I get to here…’ It’s very technical and jar-gony — you need to make sure there aren’t translation errors.”

ENTERPRISE MASTER PERSON INDEXR e m a i n i n g f i r s t - t i m e b u y e r s : 39.6 percent“EMPI is sort of like the next level of CDR,” says Schuchardt. “It’s like putting patient data in an easily sharable manner. The data sets in di�erent EHRs aren’t even necessar-ily correlatable. One may have your birthday as three fields and another might have it as an eight-digit code. Those two data sets are never going to talk.”

ENTERPRISE RESOURCE PLANNINGRemaining first-time buyers: 65 percent“If you don’t know that’s going on, it makes it very hard to cut costs — which is the first step in reducing expense,” says Schuchardt. “As these health systems get larger and larger, knowing where your spend, knowing where you’re ine�cient is really the first step in any sort of merger. It’s important to have that understanding.”

EXECUTIVE INFORMATION SYSTEMSRemaining first-time buyers: 30.7 percentExecutive information systems may be a bit of an outmoded term at this point — “cost/utili-zation analytics is how vendors are position-ing that, as opposed to EIS, which is an older HIMSS Analytics name,” says Schuchardt — but both names boil down to the same con-cept: dashboards, primarily aimed at C-suite decision-makers. “It’s a dashboard, to say, ‘Where’s our spend, how many beds are full right now, what’s patient throughput, what’s days in receivable?’ It puts all of that into an easily consumable format for high-level consumption.”

FINANCIAL MODELINGRemaining first-time buyers: 51.6 percent“This connects really nicely with executive information systems,” says Schuchardt. In this new value-based world, this world of ACOs and risk stratification, you have to be able to model. “When you’re making an agreement with Anthem or Blue Cross about risk, you have to be able to see what the risks actually are, and you need to start think-ing about them across a variety of possible outcomes.”

INFECTION SURVEILLANCE SYSTEMRemaining first-time buyers: 49.3 percentMost hospitals at this point have a “core,” EMR-centric IT system, says Schuchardt. “But it’s the surrounding applications, that allow you to gain e�ciencies around all that electronic data that are very, very lightly adopted.” Technology that can help keep tabs on healthcare-associated infections can lead to big gains — or at least prevent unnecessary losses. He points to a recent article showing that “more than 50 percent of hospitals in Florida are simply taking the readmissions hit” — acceding to CMS pay-ment reductions rather than staving them o�. “That’s a massive hit.”

LABORATORY (MOLECULAR DIAGNOSTICS) AND LABORATORY (OUTREACH SERVICES)Remaining first-time buyers: 48.2 percent and 41.8 percent, respectively“These are interesting too,” he says. “If you look at the number (of hospitals) that has acquired them, it’s really high. The bigger hospitals have acquired a lot of this. But it’s not universal by any means.” Molecular diagnostics is clearly on the rise. And lab outreach — ensuring diabetics take their insulin, for instance — is critically impor-tant. “You could say it’s lab technology, it’s boring,” says Schuchardt. “But it’s about patient compliance, really.”

MEDICAL NECESSITY CHECKINGRemaining first-time buyers: 32 percent“Should that test be ordered? Have you already had one?” Think of this one as “next-level clinical decision support,” he says. “Not only just that the doctor orders a medicine for you but someone else says, ‘Hey, that person shouldn’t take that because they’re on this,’ or ‘Hey, there’s a cheaper one.’ The medical necessity checking is diving deeper into the data repository to say, ‘This person has had an MRI in the last six months. Do not do another one.’”

NURSE COMMUNICATION SYSTEMRemaining first-time buyers: 30.3 percentThis one represents a big change in work-flow for some hospitals — but could lead to big gains. “A nurse call system, everybody used to have to have them,” says Schucha-rdt. “But it was a wire in the wall that called down to an intercom in the nurse station. We have the technology now for that not to be a wire: for the nurse to wear that around her neck. For it to go to the next available person if someone doesn’t answer. And then to log all of those calls. It gives you much more data to use, and helps create efficiencies in staffing as well as in quality of care.”

NURSE STAFFING/SCHEDULINGRemaining first-time buyers: 30.7 percent“Down here in Florida there’s an interesting anecdote,” says Schuchardt, who lives in the Miami area. “There are places here where, in the winter, the population doubles. But the number of nurses doesn’t. And keeping them scheduled and rested is important. As nurses play a much larger role in care now, keeping them where they’re supposed to be is important.”

PATIENT AND PHYSICIAN PORTALSRemaining first-time buyers: 30.9 percent and 38 percent, respectively“I think the interesting challenge for the patient portal now is the rural communities that don’t have Internet,” says Schuchardt. From a physician portal perspective, right now the use is around retrieving diagnostic results, entering orders and electronic sig-natures. In both instances, “even in places where they’re installed, the usage is much lighter than what people who understand the technology capabilities would imagine.”

SINGLE SIGN-ONRemaining first-time buyers: 43.2 percent“Single sign-on is a big deal,” says Schuchardt. “For people who have the same EHR system across the continuity of care, it’s not that big of a deal. But that’s not a lot of places. And I think that as we think about accountable care and population health, and the network leakage that people talk about from the hospital side, and about keeping people in your ACO, having the ability to access that stu� very quickly is important for provider engagement.”

STAFF SCHEDULINGRemaining first-time buyers: 42.2 percentTo some degree, this one speaks to the size of the U.S. hospital market, says Schuchardt: “There are a lot of hospitals and the major-ity of them have fewer than 100 beds. That is something that you may not need until you’re a larger organization or you’re scheduling people at multiple places — a campus with multiple buildings.”


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Imaging files at risk on mobile devices‘Doctors tell me that PACS and radiological image sharing is common and that they could be viewed in public places like coffee shops’BY JOHN ANDREWS, Contributing Editor

THE PROLIFERATION of mobile device technol-ogy has given physicians the freedom to assess

and diagnose disease from wher-ever they may be, but they also need to be cognizant of potential security breaches while viewing images in public, risk management specialists say.

Bandwidth advancements and greater device capacity have enabled the sharing of high-density files like PACS and other diagnostic images, so physicians can join in on con-sults even from remote locations. Yet despite the convenience and immediate response capabilities, there are various security issues that must be addressed before confiden-tial patient image files are viewed in public, says Allan Ridings, senior

risk management and patient safety specialist with the Cooperative of American Physicians.

“Any time a mobile device is used to share personal health informa-tion, it triggers a number of poten-tial HIPAA privacy violations,” he said. “Doctors tell me that PACS and radiological image sharing is com-mon, and that they could be viewed in public places like co�ee shops. That is very unsecure. Hackers love to surf co�ee shops. There could be a person sitting outside the shop in a car grabbing all that data.”

Ironically, while mobile devices routinely have encryption capabili-ties built into them, “no one knows how to turn on the encryption because manufacturers aren’t good at informing users that this option is available,” Ridings said. “This is a serious issue. While technology brings information to our finger-tips, not much has been done to

protect PHI.”Public Wi-Fi in places like co�ee

shops and airports should be avoid-ed at all costs when sharing sensi-tive images, and even safe networks are sensitive to data theft if a user ID and password is intercepted, Ridings said.

“If there is public Wi-Fi in wait-ing rooms, patients could be put-ting their own data at risk,” he said. “We need to educate care-givers across the country about sharing only what you need. Pro-tect health information on mobile and wired systems. Not enough people have jumped aboard this bandwagon yet.”

IMAGE SECURITYMobile device functionality has improved so dramatically in recent years that detailed, sophisticated PACS images can be displayed with sufficient clarity and char-

acteristics to make an appropri-ate diagnosis. So it is natural that busy physicians would want to use the devices when they are “on the go,” said Pierre Lemire, chief tech-nology o�cer and executive vice president for Calgary Scientific.

Lemire acknowledges that secu-rity is a delicate issue and that how the images are viewed make a di�erence.

“It comes down to accessing the images — some call for downloading, but when you do that the IT depart-ment is at risk because it has to be controlled,” he said. “Our solution allows for access but images are not loaded onto the device. It is a remote access system, deployed through an on-premises method that provides access without being downloaded.”

Calgary Scientific’s diagnostic medical imaging software Reso-lutionMD enables physicians to securely view patient images from

a wide variety of devices. It can handle tens of thousands of users and can access any EMR from any storage system, Lemire said.

“Some IT departments have remote desktop solutions to con-trol security, but they are not usable for devices when trying to present detailed images from a desktop onto a smaller screen,” he said. “With ResolutionMD, those details are tailored for smaller screens so they can be viewed with clarity.”

3G DELIVERS 3DEven regions like the Great Plains that are known for rural isolation now have the infrastructure to transmit highly detailed images over the landscape. Sharing diag-nostic images over wide swaths of countryside is more a necessity than luxury for Academic Health System in Omaha, Neb., says tele-health coordinator Kyle Hall.

For instance, neurological scans can now be shared over the 3G net-work using the Calgary Scientific sys-tem, which greatly reduces the need for rural patients to travel, he said.

“Three years ago we were able to help neurosurgeons get access to CT scans through the image exchange,” he said. “Before that every patient had to travel to the medical center and a large percentage didn’t need to come.”

Now the neurosurgeons can see the images remotely and make their diagnosis, Hall said. The cloud-based system transmits the images with impressive speed, he said, accessing a CT head exam on an iPad in less than 60 seconds.

“Using other systems could take 20 to 30 minutes to calculate this data,” Hall said. “The plat-form renders the graphics card at the source of the data center and streams compressed pixel informa-tion at 100 percent of the original resolution. When the processing power is at the source, you can have 3D capability.”

Risk management specialists warn of potential HIPAA privacy violations for physicians accessing patient imaging data in public spaces where hackers have easy access.

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Could Austin be the next health IT hub?‘Access to capital is always a hot issue’BY MICHELLE RONAN NOTEBOOM,Contributing Writer

HEALTHCARE IT enthusiasts in Austin, Texas are bullish on their city’s prospects for becoming one of the country’s next major hubs for

healthcare technology and innovation. Thanks to a new medical school, an established high-tech community and support from a couple of strong flagship IT companies, Austin’s healthcare technology community appears poised for solid growth.

“In the last five years we have seen a huge growth in the technology community,” said Jason Bornhorst, CEO and co-founder of the Austin start-up PatientIO, which o�ers a col-laborative care platform for providers. “The health IT ecosystem is also up and coming, particularly in the last year. Austin has been a great place to build a business, particu-larly from a recruiting standpoint, and all our employees have been sourced from our network here.”

Kyle Cox, an investor and mentor with the non-profit AustinHealthTech.org, believes the city’s health technology ecosystem is “still in very early innings,” yet has “the ability to play a bigger role nationally and internationally in support of health technology startups.

“There is still an issue of scale and having a truly massive set of resources with tons of entrepreneurial experience in health technology,” said Cox. “But that situation is changing. We now have two major anchor tenants, athenahealth and The Advisory Board, that have set up shop and are providing resources to help the next generation of startups.”

Athenahealth, which invested $13 million to convert a defunct power plant to 110,000

square feet of office space, opened its new downtown Austin facility in February of this year. “We believe Austin is at an inflection point,” said Mandira Singh, director of the company’s More Disruption Please initiative, which includes an accelerator program for early stage companies.

“We see Austin as an early version of both Boston and the Silicon Valley. The Dell Medical School is a huge addition to healthcare innovation, there are great schools in the area, the cost of living is lower, there is a lot of untapped talent and the energy there is infectious.”

The Dell Medical School at the University of Texas, which is scheduled to welcome its inaugural class of students next summer, is the first medical school in almost 50 years to be built at a top tier research institute in North America. Maninder Kahlon, MD, Dell Medical’s vice dean for strategy and partnership, believes the school’s mission to redesign care at the population level and measurably improve health in the region requires technology that is innovative.

“To create Austin as a model healthy city requires a very di�erent approach to data technology,” said Kahlon. “If we want to lead in making Austin a demonstration in population health, we have to lead in advancing what health IT and data infrastructure look like to support population health goals.”

The medical school intends to lend both financial support and domain expertise to

advance local technology innovation. “We are designing a new kind of accelerator,” explain Kahlon. “We will make an investment to push the development of the right kinds of startups and bring the right partners together. As new opportunities arise we want to open the doors so that startups can pitch in and participate.”

eClinicalworks is the most recent health IT company to open an Austin o�ce, announcing its new location there in late September.

“eClinicalWorks has been growing at a rapid pace in all areas of the country,” said Girish Navani, CEO and co-founder of the ambulatory-focused developer. “Before this opening, we had o�ces on both coasts and Chicago. With a large number of customers in Texas, we felt it was beneficial to have a local o�ce. Austin has a strong technology culture that lends itself well as a new location for our company and will provide the opportunity to for us become more involved with healthcare providers located in this region.”

Despite the growing network of supporters, Austin-based health tech startups may struggle to secure local funding sources. “The weakest aspect of our community is the lack of deep

pockets when it comes to funding,” noted Zac Jiwa, CEO of MI7, a start-up that provides connectivity between healthcare apps and patient data. “We can find angels and seed money locally, but to raise more money than that you have to go to the east or west coast.”

Cox agrees. “Access to capital is always a hot issue,” said Cox. “For the early entrepreneurs just getting started there are plenty of viable funding sources. The biggest gap in the market right now is for the slightly more established companies that could benefit from experienced venture capitalists or disciplined investors.”

Despite the possible shortage of local funding options, members of the health IT community appear enthusiastic about Austin and its potential for continued health IT growth.

“It is a super exciting to be an entrepreneur in this space,” said Bornhorst. “People want to live here and it is creating an ecosystem of people that will ultimately want to create new start-ups like ours.

“In short, it is a really awesome time for Austin as a health IT community.”

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PAID/OR REQUESTED CIRCULATION THRU DEALERS, ETC (NOT MAILED) - -

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PERCENT PAID AND/OR REQUESTED CIRCULATION 83.1% 87.4%

ACTUAL NO. COPIES PUBLISHED NEAREST TO FILING DATE

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www.HealthcareITNews.com | Healthcare IT News | November 201534 TECHNOLOGY

NEW PRODUCTSInDemand Interpreting launches Vidyo-powered appSEATTLE – InDemand Interpreting, a leading provider of healthcare-focused language services management, has launched InDemand Clarity, an application powered by the Vidyo platform that delivers high-quality, high-definition video and audio. InDemand Interpreting connects health care professionals to medically trained and quali-fied interpreters 24 hours a day, seven days a week, in more than 200 languages. InDemand Clarity includes clear video and sound, dashboard analytics with vital usage data, higher definition video, improved stability, enhanced call routing and third-party videocon-ferencing systemsand third-party videoconferencing systems.

GE Healthcare’s DenialsIQ helps with claims denialsNEW YORK – DenialsIQ is a

predictive analytics solution

created by GE Healthcare to

help administrators identify and act on trends that lead to medi-

cal claim denials, before those denials negatively impact financial

performance. Leveraging patent-pending statistical algorithms

developed by the GE Global Research Center, DenialsIQ includes

tools that help identify hidden trends in denied claims, uncover

root-cause factors and show the dollar value of the potential

impact. GE Healthcare developed the software with input from

healthcare providers.

personalized healthcare via Health-Tap, which leverages more than 70,000 doctors around the world.

Box makes content easier to access, shareLOS ALTOS, CA – Box introduced support for content preview and collaboration of three new content types in Box — HD video, DICOM images and interactive 3D. The nature of content on the web has transitioned from static text and images to a more immersive, inter-active and dynamic experience for a number of industries including healthcare, media & entertainment and retail, Box executives note. Box also introduced Box Capture, its first mobile-only app for the enterprise. In healthcare, medical professionals can use Box Capture to share patient images, videos and documents with another care pro-vider in a HIPAA-compliant setting.

customize the learning modules to their specific course outcomes. Instructors will now have real-time, learning analytics to monitor their programs against accrediting body standards and student success towards licensure.

Healthtap aims health management tech at employersPALO ALTO, CA – Healthtap is expanding beyond the consumer space with the launch of a health-management platform aimed at employers. The platform allows companies to offer their employees the convenience of easily finding the right healthcare professional within their insurance plan. The first enterprise company to sign up for HealthTap’s service is the “sketch to scale” solution-provider Flex (formerly known as Flextronics). More than 200,000 workers will be able to receive 24/7 access to

accurate and expert coding, billing, documentation, case management and regulatory support. “Precyse Expert offers a second set of eyes and in-depth research that results in assurance that billing cases are compliant and that optimum reim-bursement is achieved. This can have a huge impact on the bottom line,” said Thomas Ormondroyd, vice president and general manager of Precyse Learning Solutions.

Elsevier launches personalized learning toolPHILADELPHIA – Elsevier, a provider of scientific, technical and medical information products and services, has introduced Sherpath, its per-sonalized learning solution. The first of its kind for nursing educa-tion, Sherpath uses data, analytics and adaptive techniques to track students’ interactions with content, assessments and simulations while providing a highly focused learn-ing path for each student. Sher-path empowers faculty to easily

Panasonic are extending the avail-ability of the NetMotion Mobility and Diagnostics software bundle for Panasonic Toughbook and Tough-pad tablet devices into the U.S. and Latin America markets. Launched in Europe earlier this year, the NetMo-tion software bundle for Panasonic improves productivity for enterprise mobile workers through better con-nectivity and security. NetMotion’s Mobility and Diagnostics products offer the protection mobile users need to stay securely connected to mission-critical corporate applica-tions and data, Panasonic execu-tives say.

Precyse creates Precyse Expert for coding, billingWAYNE, PA – Pre-cyse, unveiled Precyse Expert, a HIPAA-compliant online solution connecting healthcare professionals with industry experts to receive fast,

Nuance launches Dragon Medical AdvisorBURLINGTON, MA – Nuance Com-munications launched Dragon Medical Advisor, a next genera-tion computer-assisted physician documentation solution that auto-matically provides real-time qual-ity feedback to physicians while they are documenting patient encounters. The technology, say Nuance executives, improves the completeness of clinical notes and helps provider organizations meet ICD-10 requirements, justify medi-cal necessity of care decisions and support better patient care.

NetMotion, Panasonic extend software bundleSEATTLE – NetMotion Wireless and

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THE NEWS SOURCE FOR HEALTHCARE INFORMATION TECHNOLOGY � OCTOBER 2015 www.HealthcareITNews.comHIMSS Media / Vol. 12 No. 10

BENCHMARKS: Telehealth. As distance-based care gains traction nationwide, it’s still very much a regional affair, with states having different populations to serve — and different ideas about how to regulate it. PAGE 28


CISOs:The new rock starsAs cyber threats crowd in on healthcare from all sides, chief information security offi cers are in the spotlight. A risky new era means they’re more in-demand than ever. PAGE 04

Seeking meaningProviders gear up for quality reporting, decision support and security analysis for Stage 3 MU, while vendors air concerns about ONC certifi cation. PAGE 14

Numbers gameWant to get population health right? Plan to get deep in the weeds with data. PAGE 30

S P E C I A L P R I VA C Y & S E C U R I T Y I S S U E

SHOWCASE YOUR FEATURED EDITORIAL

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THE NEWS SOURCE FOR HEALTHCARE INFORMATION TECHNOLOGY � OCTOBER 2015 www.HealthcareITNews.comHIMSS Media / Vol. 12 No. 10

BENCHMARKS: Telehealth. As distance-based care gains traction nationwide, it’s still very much a regional affair, with states having different populations to serve — and different ideas about how to regulate it. PAGE 28


CISOs:The new rock stars As cyber threats crowd in on healthcare from all sides, chief information security officers are in the spotlight. A risky new era means they’re more in-demand than ever. PAGE 04

Seeking meaningProviders gear up for quality reporting, decision support and security analysis for Stage 3 MU,while vendors air concerns about ONC certification. PAGE 14

Numbers gameWant to get population health right? Plan to get deep in the weeds with data.PAGE 30

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PEOPLE www.HealthcareITNews.com | Healthcare IT News | November 201536

ON THE MOVEInova named James Wade, MD, deputy director for

quality and network development at the Inova Dwight

and Martha Schar Cancer Institute. Wade is a medical

oncologist with additional board certification in

infectious diseases, and he holds a master’s of public

health from Johns Hopkins University and an MBA

from Marquette University. Mark

Dill, director of information security at Cleveland

Clinic, leaves the clinic to join tw-Security, a boutique

healthcare security firm. Deborah Golden, formerly

principal at Deloitte, has been appointed as lead of

the company’s federal cyber risk services. Golden also

serves as the lead principal for a federal government

healthcare provider in addition to her role at Deloitte.

Mari Savickis, formerly the AMA’s point person on meaningful use and

EHRs, has moved to CHIME as vice president of federal a�airs. CHIME

also named Matthew Weinstock director of communications and public

relations. Weinstock succeeds Stephanie Fraser, who takes on the

title of Senior Media Relations and Social Media Director at Amendola

Communications. Nuevolution appointed Keith Nolop, MD, to as chief

medical officer in a consultancy role. RemitDATA

appointed Patrick Kennedy, founder of PJ Consulting,

to its board of directors. Quartet Health, a digital health

start up in New York City, named David Wennberg,

MD, to their executive sta�. The company focuses on

behavioral health. Voalte, a healthcare communications

firm, has hired Sean Friel as senior vice president of

sales and marketing. Friel most recently worked for Siemens Healthcare’s

healthcare information technology division.

Mark Dill

Sean Friel

Deborah Golden

Freeman named ONC chief nursing officerRebecca Freeman, RN, has joined the Office of the

National Coordinator for Health IT. As Chief Nursing Offi-

cer, Freeman spearheads the agency’s nursing outreach

and help shape its clinical informatics activities. Working

in ONC’s Office of Clinical Quality and Safety, Freeman

will lead initiatives focused on health IT enabled nursing

practice and research. As a liaison offering support to providers, vendors and healthcare agen-

cies, she’ll help her fellow RNs keep up with the fast-changing field of nursing informatics. Prior

to joining ONC, Freeman was assistant vice president and Epic national nurse champion at the

Hospital Corporation of America. There, she led the planning and coordination of enterprise-wide

Epic deployment, working to ensure the technology’s alignment with HCA’s safety, compliance,

efficiency and care improvement goals.

Rebecca Freeman

Briggs to head precision med researchNational Institutes of Health Direc-

tor Francis Collins named Josephine Briggs, MD, interim director of a

study for President Barack Obama’s

Precision Medicine Initiative. Briggs

is director of the National Center

for Complementary and Integrative

Health. She is also co-leader of the

NIH Common Fund Health Care

Systems Research Collaboratory, a

five-year e�ort to conduct pragmat-

ic clinical trials in the U.S. She is a

member of the NIH Steering Com-

mittee, the

most senior

g o v e r n i n g

board at NIH,

and she serves

as a member

of the NIH

S c i e n t i f i c

Management

Review Board. The study, announced

in January by Obama, aims to enroll 1

million volunteers in the next three

to four years to gather data on people

in the United States of all ages, racial

and socioeconomic groups. Collins

said he would begin a nationwide

search for a distinguished scientist

to direct the study.

Josephine Briggs

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NEWSMAKER www.HealthcareITNews.com | Healthcare IT News | November 201538

3M / ICD10 Watch ...................................24ACT.md ....................................................34athenahealth............................................40Athenahealth / Continuum of Care News .29Cox Business .............................................9Epson ......................................................25Fuji Medical Systems ...............................13Fujitsu Components America ...................19GCX Mounting Solutions ..........................23

GE Healthcare ..........................................11Healthcare Finance News ........................32Healthcare IT News Statement of Ownership ..........................33HIMSS Learning Center ............................39HIMSS New Members ..............................33HID Global ...............................................27IBM Future Care ......................................31InterSystems .............................................2

InterSystems / HIE Watch .........................14Microsoft Corporation ................................7Northern Virginia Community College .......33PC Connection .........................................21PC Connection - We Solve IT ...................36Privacy & Security Boston ........................35Revenue Cycle Solutions Summit Atlanta .37Time Warner Cable Business Class ..........15

AD INDEX

Q&A: Population health guru Timothy FerrisHe’s been working on cost and quality issues in healthcare for more than two decadesBY BERNIE MONEGAIN, Editor-at-Large

TIMOTHY G. Ferris, MD, is senior vice president for population health manage-ment at Partners Health-

Care in Boston. He is trained in both internal medicine and pediatrics. He is a practicing primary care physician and also an associate professor at Harvard Medical School. Ferris holds degrees from Middlebury College, Oxford University, Harvard Medi-cal School and the Harvard School of Public Health.

We talked with him recently about the new Population Health Management Center he will oversee at Partners HealthCare, the partner-ship the healthcare organization has with data warehouse and analytics company Health Catalyst and how population health management has changed over the past 20 years or so.

Q: It sounds like you were in popula-tion health management before it was the buzz term that it is today.A: Yes. I never called it that. I just called it cost and quality. I’ve been focused on this set of issues for two decades, and it’s very fortu-itous that the current imperative for bending the cost curve and improving quality came along when it did.

Q: Was population health manage-ment considered before now? It sounds like you certainly were consid-ering it — you just didn’t call it that.A: I think people have been thinking about cost and quality for a long time, and so, every decade had to have its phrase. The phrase was ‘managed care’ in the 1990s, and it was pay-for-performance in the 2000s, and now it’s population health management. There are some significant themes that tie those decades together. Some people focus on the discontinuities between them and what’s di�erent. Other people focus on the switch theme. What’s really different this time between population health and managed care in the ‘90s is there are really three dif-ferences. One is we have much better IT and analytics. In the ‘90s we thought we were electronic, but we really weren’t.

Now everything is electronic, and so we have access to huge amounts of data. The data is real time. That really makes things better. In the ’90s we were largely using claims to do management and that was just untenable.

The other thing that’s di�erent is we actually know more about what we need to make care better. We know that 50 percent of costs are constituted in 5 percent of patients — that if you want to do something about bending the cost curve, you better focus on that 5 percent of really sick, complex patients and do a bet-ter job of coordinating their care. I’m not sure we knew that in the ‘90s. It certainly wasn’t appreciated widely.

The third thing that’s di�erent this time around is the federal government is in the game in a way that they weren’t in the ‘90s. Secretary Burwell said in the New England Journal in January that we are moving to value-based care. It’s not clear exactly what the mechanism is and what the timetable is. But you providers should get ready for this and be planning for this, because this is coming. That has provided great motiva-tion to this e�ort between the ‘90s and now. Those statements make me optimistic that, you know, third time’s a charm.

Q: How will this Partners HealthCare partnership with Health Catalyst ben-efit Partners’ population health man-agement initiatives?A: I think it’s going to benefit us in a few ways. First of all, going to Health Catalyst’s core com-petency around analytics, we’ve been work-ing with them for three years. We have a very good relationship, and we want to expand that relationship around analytics. There’s so much more we could be doing with the data that we have, and we very much look forward to work-ing with Health Catalyst to enable greater use of analytics within our system.

So, that’s one piece of it. The second piece is really the collaboration around our popu-

lation health information management programs. We’re excited about work-ing with them in further development. Despite our successes in population health management, we are nowhere near done innovating and demonstrating our ability to move the needle on quality and cost. Partnering with Health Cata-lyst allows us an opportunity to share those practices much more widely as we continue to innovate — in a way that we don’t have the core competency to do.

Q: Tell me about the population health center you will be manag-ing. Did it come from the part-nership with Health Catalyst?A: Yes. Our e�orts on population health management have become more and

more organized. The center is just the next step for us in organizing our population health management activities, giving them a corpo-rate home and spreading the participation in that center all across hospitals and physician practices and post-acute and nursing home — all of the di�erent parts of our organization at Partners HealthCare. So the center is a next step for us to observe our commitment to this set of issues and how well organized we are to execute on improving healthcare.

Q: When you speak about outcomes transformation, what do you envision?A: This is what we’re all shooting for. I’ll give you an example. In our priority of care coordination program, we demonstrated through a national demonstration project that we reduced mortality in our sickest patients by adding care coordinators, iden-tifying them statistically, working with their primary care physicians with care coordi-nators, and we had a 4 percent mortality reduction. That is improving outcomes. No one can argue that’s not the best possible thing that we could be doing. We want to spread that to other areas. Another example of how we’re focused on improving outcome is we are collecting from our patients — patient-reported outcomes. It’s another hot area right now. We’re asking our patients, when they come in, a series of questions.

Q: What would be the best outcome from your expanded collaboration with Health Catalyst?A: I think it’s pretty simple — that our abil-ity to improve care and lower cost at our own organization improves, and through this collaboration Health Catalyst’s ability

to spread the things that they’re learning at Partners to their other partnerships. We also enjoy learning from Health Catalyst’s other partners. Basically, Health Catalyst becomes a vehicle for sharing best practices.

HEALTHCARE IT NEWS (ISSN 1547-3139) is published monthly by HIMSS Media, P.O. Box 2016, Skokie, Illinois, 60676-2016. Phone: 207-791-8700; FAX: 207-791-8794. Periodicals postage paid at Portland, ME and additional mailing offices. Qualified subscribers receive HEALTHCARE IT NEWS free of charge. Non-qualified subscribers in the U.S. are charged $72/year. Canadian subscriptions $96/year. Foreign subscriptions $150/year, includes airmail delivery. Single copy, $8. POSTMASTER: Please send address changes to HIMSS Media, P.O. Box 2016, Skokie, Illinois, 60676-2016. ©2015 by HIMSS Media. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without permission in writing from the publisher.

“People have been thinking about cost and quality for a long time, and so every decade had to have its phrase. The phrase was ‘managed care’ in the 1990s, and it was pay-for-performance in the 2000s, and now it’s population health management.”Timothy G. Ferris, MD

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