Health IT Pulse


February 18, 2015  5:18 PM

Epic to open app store; meanwhile nemesis athenahealth already has one

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
Apple, athenahealth, Epic

While EHR market leader Epic Systems Corp. plans to open its own app store, modeled partly on Apple Corp.’s uber-successful App Store, one of its arch-rivals, athenahealth Inc, already has one.

Verona, Wisc.-based Epic confirmed the plan to the Wisconsin State Journal without elaborating. But the co-founder and former CEO of the biggest consulting firm that works with Epic customers told the paper that such a venture would be a huge stimulus for companies to develop apps for Epic users.

“Once they officially launch this, then it’ll be very, very easy. It will really open the floodgates for anyone that knows Epic to really get their product on the market quickly and in front of Epic’s customers. So the distribution channel is huge,” Marc Bakken, the former CEO of Nordic Consulting, told the Journal.

Beyond expanding its market, Epic’s apparent intentions also raise questions about whether the EHR giant’s move is in response to widespread criticism that its systems aren’t open to working with those from other vendors.

Ironically, in pursuing an app store, Epic may be following the lead of one of its most trenchant critics, athenahealth, whose executives have alleged that Epic’s platforms are not interoperable.

Last year, Watertown, Mass.-based athenahealth opened its “More Disruption Please” online marketplace for its customers.

While an athenahealth spokeswoman declined comment on the Epic strategy, athenahealth sees its marketplace as similar to Apple’s App Store in that customers don’t pay a fee to use the forum, although athenahealth does get a cut of each sale in a revenue-sharing arrangement.

And all of the marketplace companies’ products and services fit in with athenahealth’s cloud-based EHR and billing systems.

In a similar development a few months ago, Epic, which has long disavowed the cloud-based EHR approach that athenahealth is perhaps the most vocal exponent of, confirmed that it is building a cloud hosting data center.

February 17, 2015  2:02 PM

Patients want more options when scheduling medical appointments

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
EHR, mHealth, mHealth applications, mobile apps, telehealth

There is a distinct gap between how often patients in the United States are able to use digital technology to access their health information compared to how often they wish they could. If the next generation of patients gets its way, the difference between those two values will shrink considerably.

Just under three-quarters of patients from ages 18 to 34 that responded to Salesforce’s 2015 State of the Connected Patient report stated they value the ability to book appointments and pay bills online when they’re choosing a doctor. In comparison, of the 1,700 total respondents of various ages, 76% said they currently schedule medical appointments over the phone.

A combined 31% of all patients use the Web and email as means of reviewing healthcare information from their physicians. A greater percentage (39%) look at their health information during an in-person visit. Almost two-thirds said they rely on their physician to keep track of their health data, while only 36% use EHRs to do so. Nearly 10% of patients believe nobody is keeping tabs on their health information.

Millenials (those people in the 18-to-34-year-old range) want to take action and avoid feeling disconnected from their medical records. Of that age group, 71% expressed interest in receiving a mobile health application from their physician that would allow them to manage their own care, schedule appointments and view their health data. A slightly higher number would approve of their physician using a mobile device to share information with them during an appointment.

In addition, Millenials hope technology will do more than aid them in making appointments and accessing health data. For example, six out of 10 Millenials are interested in telehealth, in which a patient with questions or concerns about a minor illness could avoid traveling to an in-person doctor’s visit and instead discuss a condition with a medical professional through videoconference.


February 11, 2015  1:26 PM

Group representing ACOs asks for Shared Savings Program overhaul

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
accountable care organizations, ACO, AMA, Medicare Shared Savings Program

Changes proposed by CMS to the Medicare Shared Savings Program that could also alter the future of accountable care organizations (ACOs) aren’t significant enough to satisfy a collection of healthcare provider groups.

The opposing group comprises provider healthcare improvement alliance Premier, Inc., the National Association of ACOs and the American Medical Association (AMA). Group members made several major suggestions to CMS, including that the agency:
• Provide medical specialists with the flexibility to take part in more than one ACO,
• Reward ACOs for quality performance
• Provide ACOs with more timely data

“The future of the ACO program is important to the future of Medicare and the health system as a whole. In just three years, physician-led ACOs have made a major impact on improving care coordination and quality while also reducing costs,” Robert M. Wah, M.D., president of the AMA, said in a release.

An AMA release — linking the organization to the larger group — reports Medicare ACOs have created more than $705 million in savings and more than 50% of ACOs in the Shared Savings Program reported savings in the first year. However, the savings haven’t totaled enough to provide ACOs immediate financial justification for their decision to join up, as only 25% have started regaining the money lost in changing over to a different care delivery model.

The group’s major theme of greater flexibility was exemplified by its assertion that ACO participants should receive waivers from some Medicare regulations that served as barriers to quality care. The group also said ACOs should be allowed to pick from a wider selection of payment models. It publicly disclosed its recommendations on Feb. 6 — the same day the 60-day public comment period on CMS’ proposal closed.

On Dec. 1, 2014, CMS released the proposed rule that aims to change some of the policies of the Shared Savings Program. The rule presented a few adjustments to encourage more providers to join an ACO, including removing a stipulation that required an ACO’s medical director to also be an ACO supplier/provider or someone who bills for Medicare services under an ACO participant taxpayer identification number.


February 4, 2015  5:20 PM

ONC’s interoperability roadmap points the way, federal health IT officials say

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
DeSalvo, Interoperability, ONC

At 13 pages, it reads a lot longer.

Even officials of the Office of the National Coordinator (ONC) of Health IT at their annual meeting in Washington, D.C., earlier this week sometimes sheepishly acknowledged that their new “10-year Vision to Achieve an Interoperable Health IT Infrastructure” is a somewhat dense document.

But a lot of folks are taking the so-called interoperability roadmap seriously as a spur to action on the part of EHR vendors, health IT software and standards developers, health information exchanges and even patients.

The immediate goal is to start moving past the relatively easy data collection parts of meaningful use and toward the hardest parts: making the data flow and squeezing dramatically better health outcomes out of that interoperability.

The ultimate objective, a decade from now, is the “learning health system,” ONC officials’ and other health IT thinkers’ vision of an interconnected national healthcare network in which all hospitals can absorb and freely use health data from other providers and from individual patients.

It is a world, too, for empowered patients, because they will possess their own health data and share it with whomever they want.

“The evolution of standards, policies, and data infrastructure over the next 10 years will enable more standardized data collection, sharing, and aggregation for patient-centered outcomes research,” the roadmap reads in the concluding section. “Continuous learning and improvement will be feasible through analysis of aggregated data from a variety of sources. Health IT systems will enable both analysis of aggregated data and use of local data at the point of care through targeted clinical decision support (CDS).

“CDS will improve care by taking into account information such as an individual’s genetic profile, local trends in disease prevalence, antibiotic resistance, occupational hazards, and other factors,” the roadmap continues.

By the way, don’t confuse the interoperability roadmap with the Federal Health IT Strategic Plan for several dozen federal agencies. However, the latter plan, which is also stimulating much discussion, was coordinated by ONC and covers the next five years, until 2020.

As for the roadmap, it describes a U.S. health IT “ecosystem” in which:

  • Patients access and share health information
  • The health IT industry values quality and safety in care deliver
  • Population health management efforts and regional information exchanges are widespread and work effectively
  • People within the ecosystem use big data and analytics

In drafting the plan, which will remain open to public discussion and changes until April, ONC “spent 2014 on a path to unlock data so we can put it to use,” ONC chief Karen DeSalvo, M.D., said at the annual meeting.


February 3, 2015  2:20 PM

Cerner Corp. closes purchase of Siemens Health Services

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
Cerner, EHR, Siemens Health Services, Soarian

Closing the books on a deal that was at least six months in the making, Cerner Corp. announced it has finalized its purchase of Siemens Health Services, an EHR and business unit of Siemens AG.

Cerner made the acquisition for $1.3 billion, and now projects its revenues to sit somewhere in the range of $4.8 to $5 billion in 2015. An official release announcing the move also included details on a health IT alliance between Cerner and Siemens AG. The two companies first plan to work together on “integrating diagnostics and therapeutics into the electronic health record,” with each investing $50 million over the first three years of the agreement.

Cerner will continue support for existing Siemens platforms, including the Soarian EHR system — which the company plans to further develop over the next 10 years. Soarian users that previously spoke to SearchHealthIT about their experiences with the EHR expressed hope that Cerner’s association with the product would benefit both the functions of the system and their organizations.

“Cerner remains focused on . . . population health, physician experience, open platforms, revenue cycle and mobility. We see these as critical areas of investment to ensure providers can meet growing regulatory demands and control cost,” said Neal Patterson, Cerner chairman, CEO and co-founder, in the company’s release.

The buildup of Cerner’s acquisition of Siemens Health Services caught the attention of people from across the health IT spectrum. Analysis from health IT market research firm KLAS Enterprises, LLC showed Cerner was catching up to Epic Systems Corp. by making deals with new hospitals, but its purchase of Siemens Health Services would only nominally place it ahead of Epic. Even Carl Dvorak, president of Epic, weighed in last August when he said the still-in-the-works deal would make Epic an “underdog” in the market.


January 29, 2015  2:34 PM

Responding to industry pressure, CMS plans to shorten meaningful use reporting to 90 days

Scott Wallask Scott Wallask Profile: Scott Wallask
CHIME, CMS, EHR, electronic health record, meaningful use attestation, meaningful use stage 3, stage 2

Relief is coming for thousands of providers who worried about gathering and reporting EHR data for 365 days as part of stage 2 of the government’s meaningful use program.

CMS announced on its blog this morning that it intends to relax its meaningful use reporting period to 90 days for stage 2 in 2015, a move that industry groups such as the College of Healthcare Information Management Executives (CHIME) and the American Medical Association pushed hard for.

“The agencies have listened,” said Russell Branzell, FCHIME, CHCIO, president and CEO of CHIME. “CMS and the ONC have been nothing but supportive.”

The time and money required to attest for a 365-day reporting period gave heartburn to many hospitals and physicians.

Specifically, CMS proposed today to update its Medicare and Medicaid EHR Incentive Programs to accomplish the following goals:

  • Adjust hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to install and implement 2014 edition software
  • Modify other aspects of the program to match long-term goals, reduce complexity, and lessen provider reporting burdens
  • Shorten the EHR reporting period in 2015 to 90 days to accommodate these changes

These actions will be part of a proposed rule from the agency, and as such, related public comment and deliberation will take time, Branzell said.

However, CMS’ announcement allow providers who had become pessimistic about the 365-day reporting period — and dropped out of the incentive program — to reconsider with the 90-day timeline, he added.

“For many that were giving up … now they can go back and say, ‘Let’s start collecting data,’ because now they can collect data without incurring penalties and participate,” he said.

The stage 2 announcement is separate from CMS’ upcoming stage 3 rule, which it expects to publish in March, Patrick Conway, M.D., wrote in the agency’s blog post.

“CMS intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years,” wrote Conway, who is deputy administrator for innovation and quality and CMS’ chief medical officer.

At the end of 2014, a coalition of healthcare industry groups attempted unsuccessfully to insert a 90-day clause into a federal government spending package.

The point of the government’s reporting mandates is to increase the adoption and meaningful use of EHRs.

Scott Wallask is news director at SearchHealthIT. Follow him on Twitter @Scott_HighTech.


January 28, 2015  2:47 PM

HL7 International starts user group for payers

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
FHIR, HL7, payers

Unlike in European countries with single-payer or similar health insurance systems, the U.S. healthcare market is fragmented among a large number of individual private payer companies and groups.

That setup brings technological problems when it comes to exchanging information between payers and providers, and between payers and members, or customers.

Enter HL7 International.

The influential non-profit standards and interoperability organization — the steward of HL7 health data exchange standards and the popular emerging new health IT standard, (FHIR) Fast Healthcare Interoperability Resources) – has decided to try to bring more order to the payer world.

In furtherance of that goal, HL7 has launched a payer user group to support insurers that use HL7 standards and protocols to better manage member care, promote better medical outcomes and work toward the long-term objective of more affordable healthcare, according to a release.

The main areas of focus for the HL7 Payer User Group are to:

  • Educate and train the payer community on how to put into action HL7 standards
  • Share lessons learned during implementations
  • Provide feedback to HL7 work groups that are responsible for creation of the standards that affect the payer community
  • Be a collaborative resource for other stakeholders at HL7 from the payer perspective

“Over the past year, HL7 has become increasingly active within the payer community. These efforts have provided critical support through the introduction of the payer summit program, and now enabled the launch of the HL7 Payer User Group,” Charles Jaffe, M.D., CEO of HL7, said in the release.

The payer user group is the second user group HL7 has started recently.

Last year, HL7 created an immunization user group in collaboration with the American Immunization Registry Association.

Similarly, HL7 is working on the payer group initiative with insurers such as BlueCross BlueShield, Cambia Health Solutions, Inc., Cigna Health and Life Insurance Company, Humana Inc., and other payers, according to HL7 spokeswoman Andrea Ribick.


January 27, 2015  1:46 PM

In Massachusetts, medical marijuana alerts get a second look

Scott Wallask Scott Wallask Profile: Scott Wallask
Healthcare, patient privacy, PHI, prescriptions

Imagine checking a personal email at work or at the public library and seeing this subject line show up in the alert box: “Confirmation of Patient Certification in the Medical Use of Marijuana Online System.”

That’s what happened to more than 6,800 patients in Massachusetts who have been approved for marijuana use as part of medical treatment, although after questioning by The Boston Globe, the state’s Department of Health has changed its ways. New emails will feature a softened subject line and no longer include the patients’ full names in the body of the message, The Globe reported earlier this month.

subject line

Patient privacy experts expressed surprise at the state’s original email wording, saying it failed to safeguard protected health information.

“They are supposed to protect the privacy of medical information,” David Szabo, a healthcare lawyer with Locke Lord Edwards LLP in Boston, told The Globe.

Massachusetts requires patients who can use marijuana, along with their prescribing physicians, to register with a state database.

In comparison, IT officials at a pair of Boston hospitals contacted by The Globe outlined more conservative approaches to emailing medical marijuana patients:

  • Beth Israel Deaconess Medical Center’s emails to patients include a subject line that simply says “Important Information from Your Doctor.”
  • Electronic messages from Partners HealthCare don’t include a patient’s personal information, instead prompting patients to log in to a Partners’ hospital’s website to view sensitive material.

Regardless of whether you agree with the medical marijuana movement, mentioning that information in an email subject line is a poor practice. It’s no different than getting an email from your provider saying a Rogaine prescription or birth control pills are ready. It’s protected health information, and mentioning it in the subject line of an email that a passerby could see raises questions about protection efforts.

 Scott Wallask is news director at SearchHealthIT. Follow him on Twitter @Scott_HighTech.


January 27, 2015  1:29 PM

State Innovation Models Initiative to fund telehealth, EHRs

Alex Delvecchio Alex Delvecchio Profile: Alex Delvecchio
CMS, EHR, State Innovation Models Initiative, telehealth

A portion of an investment approaching $1 billion, made by the Centers for Medicare and Medicaid Services, will go toward stimulating the practice of telehealth and increasing patient access to EHRs.

An Accenture report analyzes how states that created State Health Innovation Plans as part of CMS’ State Innovation Models Initiative are planning to assign the funds supplied to them and where they stand in the development process. CMS doled out money in two stages. First, in 2013, they awarded nearly $300 million to 25 states for plotting and developing an innovation plan. In 2014, 28 states, three territories and Washington D.C. received a sum of $660 million to design and test their plans.

The Accenture report examined the 25 states that were part of the first round of the State Innovation Models Initiative and found that 19 intend to increase use of virtual care technology, including remote patient monitoring and telehealth. Nearly two-thirds of the states will attempt to involve a larger number of patients in their care by offering them patient portals and increasing their ability to view their EHRs. For example, patients in Delaware will be able to use mobile applications to view their EHRs and assess care options.

More than half (14) of the participating states are going to deploy analytics to increase their knowledge of population health, reduce care redundancy and combine analysis of health data and human services data. Analyzing both of those data sets will help create more opportunities for preventive care, such as wellness programs, and may reduce the long-term cost of patient treatment.

Each of the 25 states will invest in patient-centered medical homes, with a focus on improving primary care integration with specialists. All 25 will also devote some of their funds to hire lower-cost community health workers in an effort to place more of the cost of care on more specialized caregivers.


January 21, 2015  12:55 PM

CHIME and AHA launch Most Wired 2015 survey

Shaun Sutner Shaun Sutner Profile: Shaun Sutner
AHA, CHIME, Meaningful use

CMS may be the source of the definitive numbers about which hospitals, healthcare systems and physicians are attesting to meaningful use, but the College of Health Information Management Executives (CHIME) knows which providers are “most wired.”

CHIME, in conjunction with the American Hospital Association’s (AHA) Health Forum, has opened the two groups’ “2015 Most Wired” survey and benchmarking study.

Last year, 1,901 hospitals were represented among 680 people who responded to the survey – roughly 33% of U.S. hospitals.

This industry barometer looks at how well hospitals use IT to improve performance for value-based healthcare and helps survey participants map strategic IT plans.

Participating providers answer questions about their progress in adoption, rollout and use in four key areas: infrastructure; business and administrative management; clinical quality and safety in inpatient and outpatient settings; and clinical integration.

In October, CHIME and the AHA announced that they would work together to further develop the survey, begin recognizing IT use in hospitals, and encourage IT use and performance improvements with results from the survey.

As a result, the groups say they have made changes, including:

  • Stricter verification and checks of whether organizations have successfully met meaningful use criteria
  • New questions about security measures
  • Additions to the survey involving patient engagement, telemedicine and integrated networks

Hospitals and healthcare systems taking part in the survey can be named among the Most Wired, Most Improved, or Most Wired among small or rural hospitals. Hospitals with unusual IT projects can compete for the Innovator Award.

A panel of hospital and IT Ieaders will evaluate the submissions, which are due March 15.

The annual survey link and Innovator award application can be found here.


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