healthcarereimagined

When you walk into the Arlington Women’s Center, you see a spacious waiting room with artwork on the wall, maroon chairs, and a friendly receptionist sitting at the front desk.

The obstetrics and gynecology practice serves a high-income suburb of Washington, DC. Framed photographs on the wall advertise the center’s physicians who’ve made lists of the city’s best doctors. It’s a modern, upscale doctor office.

Listen to the podcast version of this story: It’s time to face the fax

But when it needs to share patient records, it turns to an outdated technology: the fax machine. 

“The pages get jammed up so you end up with half-pages that come out at the other end,” says Amanda Rohn, an OB-GYN at Arlington Women’s Center, “or you get blank pages that don’t actually have the information you need.”

The clinic has digitized its own patient data. But its electronic system can’t connect with other clinics’ records. So when doctors want to retrieve records from another office — an ultrasound for a pregnant patient, for example — they have to turn to the fax.

Most women at the Arlington Women’s Center get their ultrasounds at a radiology office that is in the same building, just a floor below. It also has a digital record. But the two systems don’t connect. So they use a Rube Goldberg-esque analog method for sharing data: Print out pages of one record, fax it, and then scan those pages into the other digital system. 

“We have a medical records department who goes through all the incoming faxes, sorts them for which doctor they go to, and then I have a folder where they put my results in,” Rohn says, pointing to a pink file folder on her desk. “If we were all on the same system, I’d be able to see everybody’s results, but since we’re not, there has to be some way they get to me.”

Most industries abandoned the fax machine in the 1990s, and for good reason. Fax machines are terrible at sending data. Busy signals interfere. Printouts are blurry. And sometimes faxes go to the wrong place entirely.

One medical worker recalled a fax fiasco from the 1990s when he practically sent medical records to the moon. “The FBI called about a half-hour later and asked how I got the number,” he said. “I told them that I was faxing Minnesota. They told me I had faxed NASA.”

In the medical sector, the fax is as dominant as ever. It is the cockroach of American medicine: hated by doctors and medical professionals but able to survive — even thrive — in a hostile environment. By one private firm’s estimate, the fax accounts for about 75 percent of all medical communication. It frustrates doctors, nurses, researchers, and entire hospitals, but a solution is evasive.

At Rohn’s obstetrics practice, no one has contacted NASA by mistake, but they’ve had real problems. Lately, doctors have taken to hand-delivering the most important records. 

“We used to fax the labor and delivery records, but they didn’t get them or they were misplacing them,” says Hilda Moreno, who manages the office’s medical records. “We kept getting calls like, did you send this? And we’d say we did. So we started printing them out.”

Obama tried to force the health sector to go digital. But he didn’t make the systems talk. 

The story of the fax machine’s dominant role in medicine is also the story of a government incentive program that badly misread the economics of American health care. 

The Obama administration spent upward of $30 billion encouraging American hospitals and doctor offices to switch from paper to electronic records. The program was a wild success, in one respect. The number of hospitals using electronic records grew from 9 percent in 2008 to 83 percent in 2015, a huge change in less than a decade.

But the program didn’t account for a critical need: sharing. Hospital and doctor offices generally remain unable to transfer electronic information to other hospitals and doctor offices. Billions of dollars later, they are left printing out documents and faxing them. And so the fax machine remains medicine’s dominant method of communication.

“MEDICAL RECORDS GENERALLY COME BY FAX. SOMETIMES THEY’RE MAILED. THEY ALMOST NEVER COME BY ANY OTHER ROUTE.”

Obama officials believed competing health systems would volunteer to share patient data. They now admit that was naive.

“We don’t expect Amazon and Walmart to share background on their customers, but we do expect competing hospital system to do so,” says David Blumenthal, who coordinated health policy for the Obama administration from 2011 to 2013. “Those institutions consider that data proprietary and an important business asset. We should never have expected it to occur naturally, that these organizations would readily adopt information exchange.”

The stimulus package that President Obama signed into law in February 2009 included a 53-page section called the HITECH Act (an acronym for its much clunkier full name: the Health Information Technology for Economic and Clinical Health).

The small part of the massive stimulus bill included more than $30 billion to spend incentivizing doctors to adopt digital records. The law directed a small, little-known government agency — the Office of the National Coordinator for Health Information Technology (ONC) — to develop a program to distribute the money.

“It was quite small and had modest operational responsibilities,” says Blumenthal. 

The agency historically subsisted on a meager budget with a few dozen staffers. All of a sudden, it had a multibillion-dollar budget and pressure from the White House to spend that money quickly. The Obama administration hoped this infusion of money would help drag the country out of the 2008 recession. 

“The White House looked at these billions of dollars and they saw an opportunity to stimulate the economy,” Blumenthal says. “We did have pressure from the White House to get the money out the door.”

Blumenthal’s team had to move quickly, and decided to focus on getting doctors to adopt electronic records. Once doctors started using electronic records, the thinking at the time went, they would naturally start using more digital forms of communication like secure email. 

“Our philosophy was, you’ve got to have the information in bits and bytes before you can start sending those down the internet to someplace else,” Blumenthal says. 

Farzad Mostashari, who took over Blumenthal’s position in 2013, recalls the ambitions similarly. “The real goal at the time was, hey, let’s get folks off of paper and onto electronic health records,” he says. 

ONC came up with “meaningful use” standards, a checklist of benchmarks that doctor and hospital offices would need to hit in order to receive a small slice of that $30 billion incentive fund. If doctors and hospitals were able to meet these criteria, they’d get bonus payments from the federal government. 

All available data suggests that the meaningful use incentives hugely increased the adoption of electronic medical records. A recent paper in the journal Health Affairs compared the adoption of digital records among hospitals (which qualified for these incentive payments) and nursing homes (which didn’t get the bonuses).

It found that the facilities eligible for the bonus payments adopted digital records at a much faster pace than those without much incentive.

“We now have data to suggest the majority of electronic health record adoption was because of the HITECH Act,” says Julia Adler-Milstein, the lead author of that study and an associate professor at the University of California San Francisco School of Medicine. “We would not have seen those double-digit percentage point increases without it.”

If you can now log in to a patient portal at your doctors’ office to schedule a visit, see results of a test, or send a message to your physician, that is likely the result of the HITECH Act. 

But if you’ve ever become frustrated trying to get one doctor to talk to another, that is the Obama administration’s legacy too. 

“The fax machine is still a major part of medical communication”

Rohn works on that Virginia hospital campus I mentioned earlier. And for years, she’s had a front-row seat to the Obama administration’s struggle to digitize American medicine.

The 36-year-old received an undergraduate degree in engineering and initially planned to pursue a career in programming. “It turned out that I didn’t like spending all my time looking at a computer screen,” she said. “I really wanted to spend my time interacting more directly with people.”

Rohn went back to medical school and in 2013 completed a residency in obstetrics and gynecology at the University of Pennsylvania. She began cold-calling OB-GYN practices that had openings in the DC area, where her husband already had a job. 

Office after office told her the same thing: Stop calling us. Just fax us your résumé. 

“The fax machine is still a major part of medical communication,” she says. “It’s crazy that I was sending my CV by fax machine in 2013.”

Rohn began sending unsolicited faxes with her résumé to OB-GYN practices, and, amazingly, it worked. One of her faxes went to Arlington Women’s Center, where she works today.

When Rohn was a resident, she used a lot more paper records. When she saw patients in the hospital after surgery or a delivery, she would handwrite notes in a paper chart.

She started her job just as billions of federal incentive dollars were flowing to get doctors to switch to digital records. Her clinic digitized just before her arrival in 2013. Now, instead of scribbling patient notes in handwriting, she types them into her electronic record.

She can order most lab results through the electronic record, too, after a lengthy effort to connect her office’s digital system with the laboratory they work with most frequently.

“I can see each encounter the patient has had in our clinic, so I can look back and see when my colleague saw this patient last year, read her notes, know what they talk about,” Rohn says. 

It’s when she wants to communicate with other offices that things get tricky. The hospital where most of her patients deliver uses Epic, the medical records company with the largest market share in the United States. Rohn’s office uses a smaller company called NextGen.

Each day, Rohn comes into the office to a pink folder on her desk labeled “prenatal labs” that contains a stack of faxes from other offices she needs to enter into the electronic record.

When Rohn’s patients are close to giving birth, at 36 weeks pregnant, she or another doctor hand-delivers their medical records to the labor and delivery department. It’s not a great system.

“Sometimes we can’t find the records because someone has misfiled it or someone never sent it,” Rohn says. “Or they’re not that far along yet in pregnancy if they deliver prematurely.”

Rohn is a highly trained professional. She spent four years at top-ranked medical school and more years after that as a resident learning how to deliver babies, perform surgeries, and help patients through pregnancy.

But because of America’s disconnected medical system, she spends a significant amount of time transcribing medical records and hand-delivering them around her hospital. This is time when she could be using her medical expertise to see more patients or have longer visits. Instead, she’s managing paperwork.

And this wastes her patients’ time too. Sometimes Rohn will have appointments to discuss an abnormal Pap smear but won’t be sent the actual results that show what is abnormal.

“So then I’m seeing someone in consultation for abnormal Pap smear and I don’t know what result was, and we have to decide do we do the test again today when you might not actually need it,” she says. 

There are financial incentives to keep using the fax machine 

It turns out there are strong economic incentives for doctors to keep patient information to themselves — and even stronger incentives for electronic medical records not to play nicely with each other. 

While patients might want one hospital to exchange information with another hospital, those institutions have little incentive to do so. A shared medical record, after all, makes it easier to see a different doctor. A walled garden — where records only get traded within one hospital system — can encourage patients to stick with those providers.

“When you want competing entities to share information, you have to realize that they’re sharing things that could help their competitors,” says Blumenthal. 

The program that Blumenthal helped build required hospitals to have the ability to share information, but it didn’t mandate that they do so frequently or make the process especially easy. Most hospitals made a rational business decision and did not invest in technologies that would make it easier for competitors to siphon off patients. 

Competitive pressure between the companies that sell electronic record makers themselves only made things worse. The electronic record makers don’t have much incentive to connect well with other records, when they’d rather just convert that hospital on a different electronic platform into one of their own customers.

“WHEN YOU WANT COMPETING ENTITIES TO SHARE INFORMATION, YOU HAVE TO REALIZE THAT THEY’RE SHARING THINGS THAT COULD HELP THEIR COMPETITORS”

“If [electronic record vendors] expended all that time and effort to make it so anyone could plug into any other system, it’s reducing the advantage of staying on your particular network,” Mostashari says. 

This is especially true for larger electronic medical record companies, which want to sell the advantages of joining a record that is used in lots of doctor offices. “You want to make it easier for people to say, ‘Hey, if you’re on [our electronic record], look how awesome it is! You can talk to any user, anywhere in the country,” he argues. 

In short, economics gave hospitals plenty of reasons not to connect their records with other hospitals — to stick with a clunky technology, like fax, that makes it hard to transmit information. And the government didn’t give any incentives to connect — it stopped at digitizing medicine, falling short of the interoperability that patients actually want. 

How do you actually kill the fax machine?

Mostashari came away from his time in Washington believing a fix would require more government intervention — namely, outlawing faxing in American medicine. He argues that doctors won’t leave the fax until there is an expiration date, a moment when the government forces them to use secure email instead. 

“I think if we want to kill the fax, we need to schedule a funeral,” he says. “I think you need a pull and you also need a push.”

The Trump administration, however, will take a different approach. Donald Rucker now runs the Office of the National Coordinator for Health Information Technology, and did not take kindly to the federal mandate proposal. 

“All of the thousands of regulations that have piled on have the net effect of preventing us as individuals from controlling our data, from shopping for care, or having vaguely cost-effective care to shop for,” Rucker said. 

He argues that better-designed electronic records will go a long way toward allowing data to transfer more freely. He also cited a new provision in a recent health care law, the 21st Century Cures Act, that requires electronic records to exchange data with other records in a way that requires “no special effort.” What “no special effort” means isn’t yet clear, and will likely be defined in future regulations.

“I THINK IF WE WANT TO KILL THE FAX, WE NEED TO SCHEDULE A FUNERAL”

The verdict is still out on whether the Trump administration’s approach can work — or whether, eventually, a more heavy-handed mandate will be needed to actually kill the fax.

But we do know this: As long as the fax sticks around, it is bad for doctors and bad for patients.

Article link: https://www.vox.com/health-care/2017/10/30/16228054/american-medical-system-fax-machines-why

https://www.nytimes.com/by/jennifer-steinhauer

WASHINGTON — The Department of Veterans Affairs is preparing to shift billions of dollars from government-run veterans’ hospitals to private health care providers, setting the stage for the biggest transformation of the veterans’ medical system in a generation.

Under proposed guidelines, it would be easier for veterans to receive care in privately run hospitals and have the government pay for it. Veterans would also be allowed access to a system of proposed walk-in clinics, which would serve as a bridge between V.A. emergency rooms and private providers, and would require co-pays for treatment.

Veterans’ hospitals, which treat seven million patients annually, have struggled to see patients on time in recent years, hit by a double crush of returning Iraq and Afghanistan veterans and aging Vietnam veterans. A scandal over hidden waiting lists in 2014 sent Congress searching for fixes, and in the years since, Republicans have pushed to send veterans to the private sector, while Democrats have favored increasing the number of doctors in the V.A.

If put into effect, the proposed rules — many of whose details remain unclear as they are negotiated within the Trump administration — would be a win for the once-obscure Concerned Veterans for America, an advocacy group funded by the network founded by the billionaire industrialists Charles G. and David H. Koch, which has long championed increasing the use of private sector health care for veterans

Report link: https://healthcarereimagined.net/wp-content/uploads/2019/01/leading-agile-transformation.pdf

By Aaron De Smet, Michael Lurie, and Andrew St. George 

Written by Juli Dixon, Andrew Mason, and Ben Marglin

Managing change means understanding what it is—and isn’t

Successful IT modernization initiatives are often more dependent on an organization’s culture and ability to absorb change than they are on the selection and implementation of the right technology. Yet, some federal organizations think of change management initiatives almost as an afterthought to technical delivery. A comprehensive change management strategy should be an integral part of any IT modernization effort—it’s a critical part of the overall culture and vision of any modernization plan.
Here are five key myths about organizational change management in IT modernization efforts—and the reality.

Myth No. 1: We focus all our change management efforts on the end users. They’re the ones who need it most.
The Reality: Change management efforts should address the entire stakeholder community. From your delivery teams and business units to your IT group, anyone who’s helping execute the work should be part of your change management strategy. They all need to work together to ensure proper adoption of new technology and ultimate success of the IT modernization initiative.
Myth No. 2: We don’t need executive leadership to help drive our IT modernization initiatives. We can handle this on our own.
The Reality: A change champion gives your IT modernization initiative the vital authority and support it needs to succeed. From communicating a vision to connecting the IT modernization efforts to the mission, an executive sponsor should be actively engaged—articulating just how important the initiative is to the greater stakeholder community. Without an executive champion, your change management initiatives may not be prioritized effectively, resulting in implementation breakdown.
Myth No. 3: Change management means communications and training, plain and simple.
The Reality: Change management involves a variety of activities—including training and communications—but also many others. Stakeholder analysis, performance management, policy development, business process reengineering, marketing efforts, workforce impacts, and organization analysis are all vital capabilities to ensure the IT modernization effort is successful.
Myth No. 4: We engage once the technical team is ready to deploy, and once we’ve completed that, our job is done. External agencies now own it and are responsible for their own activities associated with the new application.
The Reality: Change management starts with initial planning of an IT modernization initiative and goes throughout (and likely beyond) the full lifecycle of technical delivery—it takes a sustained effort over time. For IT modernization efforts that affect a large stakeholder community, you should engage with change management workstreams all along the way, from initial planning to post-implementation.
Myth No. 5: It’s difficult to measure the success of your change management activities during an IT modernization effort. It’s a lot of “soft” stuff that’s hard to measure and understand if it has been helpful.
The Reality: Leaders and teams are quick to claim victory in the deployment of solutions without taking the time to find out what’s working and what’s not. There are lots of ways to approach performance management to identify how and where the change efforts are impacting an IT modernization initiative, and ultimately the mission or business of the agency itself. Measures and metrics should be established and used to help with data-driven decision making around the success of change management. Common examples are user adoption of new technology, but other examples include measuring the success of communications, business process and/or workforce adjustments, stakeholder feedback, and many others.

The Bottom Line
As federal agencies look to move forward with IT modernization initiatives, they should build in change management as a key component to their plans. All too often, it’s an overlooked piece of the puzzle, or agencies feel that they don’t need to invest in change management (or the first to get cut when budgets are tight). Agencies are making large investments in new technology to drive their missions forward, and they should also look to invest (a relatively small amount) in change management to drive to successful outcomes.

Article link: https://www.boozallen.com/s/insight/blog/5-myths-of-change-management-for-it-modernization.html

During a discussion of virtual health and the Military Health System (MHS VH) at #AMSUS2018, current virtual health activities in federal health were mapped out to show where duplication of efforts make the MHS VH non-standardized and less efficient.

AMSUS link: https://twitter.com/AMSUS/status/1080466651018158080/photo/1

Executives from Epic, Allscripts, athenahealth, eClinicalWorks and Greenway reveal what business decision makers should expect from their forthcoming software and cloud-based services.

By Bill Siwicki December 17, 2018

Electronic health record systems are the backbone of ambulatory practices today and need to be designed and tailored to meet the specific needs of physicians. Ambulatory EHRs are tasked with streamlining workflows, improving care and helping to trim costs. And like every technology, ambulatory EHRs are evolving, changing in different ways to meet the constantly transforming healthcare marketplace.

It’s up to physician group practices, health systems that own numerous group practices, and other ambulatory healthcare organizations to stay abreast of change to make sure they are getting the most out of their EHRs, and to make sure that they don’t fall behind technologically in a highly competitive industry.

Ambulatory EHR experts at both provider and vendor organizations have a wide variety of informed opinions and helpful insights as to where the technology is headed next so that ambulatory healthcare provider organizations can best prepare for where they need to be in the years ahead. And they share their expertise here, as well as in a checklist of both evolutionary changes coming soon and ways organizations can future-proof in advance of such changes and in a case study of an ambulatory EHR in action.

Connectivity backbone

But to understand where ambulatory EHRs are headed, it’s important to first understand where things stand today. EHR experts have lists of components that they believe make up a high-quality ambulatory EHR now.

Among ambulatory provider organizations in the top 5 percent that have attested for meaningful use, Epic, Allscripts and athenahealth are the top EHRs for solo practitioners and for group practices with 2 to 25 physicians, according to research from HIMSS Analytics. Epic, Allscripts and Cerner come out on top for group practices with 26 or more physicians.

[Case study: How one medical group uses its EHR to tackle three big goals and here’s a checklist:10 steps for future-proofing your ambulatory EHR investment] 

An ambulatory EHR should have the power to connect communities, providing clinicians immediate analysis and insights to initiate meaningful change, said Allscripts CEO Paul Black.

“Think of it as a practice’s backbone technology that significantly and positively impacts patient care delivery and outcomes,” Black said. “To achieve these results, it is critical for the EHR to have the capability to customize workflows, and coordinate and deliver primary and specialized care.”

Clinicians want to take great care of patients while staying independent and financially viable. They do not need complicated systems that create as many headaches as they solve.

“Clinical and financial functionality is important,” Black said. “Fundamental components such as e-prescribing, mobile access and robust, flexible clinical features will help practices deliver quality patient care, combined with powerful financial and administrative support.”

Optimizing decision-making

A comprehensive chart is critical to an ambulatory EHR, one that provides enough information to optimize clinical decision making and care planning and prevents the need to repeat tests or the risk of potentially doing harm, for example, administering a medication for which the patient has a severe allergy.

“EHRs need to employ effective clinical documentation tools that allow clinicians to capture patients’ current condition/disease states, both delivered and planned care, and satisfy regulatory requirements seamlessly,” said athenahealth Director of Ambulatory Services Jasmine Gee. “This frees up clinicians to do less administrative work and spend quality time with more patients.”

Another must-have for ambulatory EHRs is computerized physician order entry – effective CPOE tools enable easy order entry (for instance, labs, imaging, referrals, etc.) and present information to physicians that drives more effective ordering decisions, Gee added.

“And EHRs must be offering, embracing and actively improving interoperability,” she said. “The ability for the clinician to construct a 360-degree view of a patient’s clinical information, regardless of where care has been delivered, is only possible if the EHR proactively searches for and consolidates information across both traditional and non-traditional data repositories.”

“Today’s EHR must offer doctors methods to connect with patients outside of the walls of the office to help them stay healthy.”

Girish Navani, eClinicalWorks

And fundamental to any ambulatory EHR are tools that help providers better understand each patient’s needs, more accurately gauge risk, and promote more effective treatment and improved outcomes, said Girish Navani, CEO and co-founder of eClinicalWorks.

“Specifically, tools for interoperability to improve outcomes and the transmission of data, population health to analyze critical health information, and patient engagement services to virtually connect the patient and providers,” Navani said. “These tools are crucial to establishing expanded intelligence and creating inferences that improve care outcomes.”

State of the art

Ambulatory EHRs today are marked by a variety of top features and functions, the state of the art from which the technology will grow into the future.

“Capabilities enabled by technology are emerging with most EHRs able to provide some level of access to patients and providers to participate and collaborate during the care cycle,” said Robert Van Tuyl, CIO of Easter Seals of the Bay Area, which uses athenahealth’s ambulatory EHR. “Patient portals for access to at least a subset of their electronic medical record, scheduling appointments, and participation at a beginning level of remote care, is possible today.”

On another note, standards like FHIR are emerging for the exchange of electronic medical records between providers, but a lack of adoption and/or willingness to share this data efficiently and effectively with outpatient healthcare providers still is creating challenges to implementing fully integrated care.

Elsewhere, today’s EHRs should offer not just methods and tools to make a doctor’s office more efficient, but ways for doctors to connect with patients more meaningfully, said Navani of eClinicalWorks.

“Providers are moving from the traditional fee-for-service to more of a value-based care, forcing EHRs to cater to the evolving needs and changes with modules to better manage quality programs,” he said. “Today’s EHR must offer doctors methods to connect with patients outside of the walls of the office to help them stay healthy. The connection will allow providers to be successful at the different quality programs they participate in, such as reminder services, portals, and other patient engagement tools that are directly integrated into the EHR.”

How doctor’s work

Today’s ambulatory EHRs should work the way physicians work, said Richard Atkin, CEO of health IT vendor Greenway Health. If EHRs give physicians time back and improve their quality of life, they can focus on providing the best quality care to patients; EHRs today should provide added value to ambulatory practices and serve as a one-stop-shop system, Atkin added.

“The collective data recorded in the EHR should be in a discrete format and suggest preventative steps that can be taken – additional office visits, exams, tests – to give the patient the best chance of achieving the highest quality of care,” he said. “While business intelligence and automation features like this are common in other industries, they’re only now becoming mainstream in healthcare.”

In addition, EHRs that support patient portals and messaging systems are a must-have today in the age of healthcare consumerism, he added.

Allscripts CEO Paul Black said the state of the art in ambulatory EHRs today includes four components: mobility, the cloud, comprehensiveness and data sharing.

“Mobility gives you what you need, when and where you need it,” he said. “The cloud reduces total cost of ownership while improving scalability and security. A comprehensive solution integrates practice management and patient engagement. And data sharing delivers a single, shared patient record.”

The future of ambulatory EHRs

So where are ambulatory EHRs evolving toward? What will be the features and functions of tomorrow that group practice physicians can’t live without? Ambulatory EHR experts point in many directions, from artificial intelligence to genomics and more.

“Ambulatory service providers are in the unique position to provide comprehensive integrated care management and care coordination across a spectrum of services,” said Van Tuyl of Easter Seals of the Bay Area. “The ability for cloud-based ambulatory EHRs to ingest data from multiple data sources including medical devices and consumer health activity devices and provide a longitudinal view of services provided and care-team interactions will be key to integrating more advanced technologies like artificial intelligence and machine learning to reach better outcomes and efficiencies across the healthcare system.”

Patient engagement through mobile apps for managing health and wellness could be the driving force to making personal medical records a reality with which EHRs will need to exchange data, he added. Consumer-facing apps like Apple Health Records could provide availability of near-real-time data from a variety of trusted devices to augment and enrich medical records that reside within traditional electronic medical records, he said.

“It is critical for the EHR to have the capability to customize workflows, and coordinate and deliver primary and specialized care.”

Allscripts CEO Paul Black

In the future, EHRs will not just track a patient’s adherence to his or her care plan but also alert providers when a patient is missing certain elements or when specific steps of the plan have not been completed, said Atkin of Greenway Health. Machine learning will be more commonplace in EHRs, guiding the provider and suggesting medications or care plans based on additional patient data and information stored in the system, he added.

“Genomics will also unlock new possibilities for personalization and wellness in healthcare, allowing provider organizations to design transformational experiences for patients,” Atkin said. “Additionally, behavioral health and socioeconomic factors will become important elements. For example, a patient may not be coming to doctor appointments as recommended because he or she lives in an underprivileged area without transportation. This ultimately tells providers that overall community changes need to be made in order for patient outcomes to improve.”

Offering different choices

Looking ahead, EHRs will also be capable of evaluating the financial implications of clinical decisions and giving a set of different choices – such as various treatment options and drug prices – to improve the patient experience, meet their rising expectations and reduce costs even more, Atkin said.

And next-generation EHRs should be more advanced in the way they receive information, leveraging voice recognition to cut down the administrative process of entering data even more, he added. This will have even bigger benefits as providers work to spend more time with patients and less on documentation, he said.

Artificial intelligence will be a critical element in the evolution of ambulatory EHRs. Incorporating machine learning capabilities to learn physician treatment patterns, for example.

“It can pre-populate information based on these patterns and deliver preference reminders,” said Allscripts’ Black. “It’s constantly surveilling trends by user, organization and region to create opportunities for more efficiency. Plus, the power of artificial intelligence surfaces information relevant to the encounter in real time, which helps improve quality and immediate interaction with the patient.”

Ultimately, this reduces the amount of time spent on documentation, helping address the problems of EHR fatigue and physician burnout, he added.

In addition, more and more vendors will have open IT systems. Open architecture makes it easy to create apps, share data and upgrade individual components of a platform.

“When we add true vendor-agnostic interoperability, we enable providers to seamlessly communicate and exchange data with any trusted system and use that data to make better informed decisions at the point of care and beyond,” Black said.

On the horizon, EHR makers will incorporate EHR-agnostic precision medicine and genomic capabilities within their workflow, Black said.

“These types of capabilities,” he added, “should capture and store genomic data from a range of sources, harmonize clinical knowledge and genomic research to identify relevant information, and then push the resulting insights to the point of care to better determine the most effective regimen for the patient.”

Article link: https://www.healthcareitnews.com/news/what-know-purchasing-next-gen-ambulatory-ehr

With EHR frustrations at a boiling point and physician burnout at epidemic levels, it’s time to rethink the way IT is designed, developed and deployed to better enable a human touch, says one clinician.

By Mike MiliardDecember 07, 2018

“At its core, technology would seem to be the antithesis of humanity,” said Dr. Chris Derienzo, chief quality officer at Asheville, North Carolina-based Mission Health System. “It doesn’t feel, it doesn’t think and it can’t see the humanity of the person in front of it,” he explained.”
Ask physicians how the feel about electronic health records, or read Atul Gawande’s recent New Yorker feature, “Why Doctors Hate Their Computers,” and it’s apparent that most healthcare professionals’ relationship with technology is ambivalent at best.
“It’s tempting to say there’s no way we can build or leverage technology in order to restore some humanity to the practice of medicine,” said Derienzo. “But I think that’s fundamentally a wrong assumption.”
At HIMSS19 in Orlando, in one of the new TED Talk-style SPARK Sessions, titled “Humanity and Technology in Medicine: Antithetic or Symbiotic?” Derienzo will explain why.
The reason technology seems to pull us away from people, rather than bring us together, mostly boils down to “how we’ve designed it and what we’ve designed,” Derienzo said. But rethinking both of those, IT could be repositioned in a way where it enhances, rather than detracts, from the clinician and patient experience.
With funny personal anecdotes and real-life case studies, he’ll show how technology, properly deployed, can restore joy to healthcare – helping burnt-out physicians better engage person to person, enabling them to practice at the top of their license and use their skills to solve complex challenges
“If we focus on the right types of technology, and we build it right, then we can actually use it to empower people to do more of the things that only people can do in healthcare,” said Derienzo.
How technology is designed, and what it’s used for, plays a big role in how well it is liked by its end-users. Consider tech that’s intentionally created connect people, such as telemedicine. “We see much more positive reaction to it.”
EHRs, on the other hand, were not designed with joy in mind. They were developed under certain conditions, with necessary check-the-box functionalities related to regulatory compliance and billing capture.
And they were “based on a world where we took what we did on paper then did the same thing on computers,” said Derienzo. They effectively ignored a lot of the human factor elements for how to design a way to document and record care electronically.”
But EHRs are only one challenge, he said. “Our monitors are another. How we use algorithms is another very important one.”
Derienzo predicts that “our electronic documentation will evolve drastically over the next few years as we move away from this built environment and toward a world where human factors matter a whole lot more.”
In the meantime, he sees one technology doing a lot to return humanity to healthcare. One that may seem ironic, to say the least, given the trepidations many have about its potential to disrupt and displace: artificial intelligence.
“AI stands positioned to be one of the core technological advances that allows us to return humanity to healthcare,” he said.
For example, he explained, “we’ve built a machine learning model at Mission Health and we’ve now gotten it fully up and running. Its purpose is to help risk-stratify patient who are case managers need to focus on. To serve them, not only by a ranked-ordered list but a concept as to why our model thinks they may be at a high risk of being readmitted.”
That’s a fairly AI application, “but its purpose is to pull out things that people don’t have to be doing so now my care manager team can spend less time wondering who to focus on and more time actually focusing on people,” said Derienzo.
Ditto with radiology, he said: “I don’t think that reading a thousand normal chest X-rays brings radiologist a ton of joy. But doing the really complex work – is it this, is it that? – is what they enjoy. How do we bring the expertise and brains of these terrific musculoskeletal and neuroradiologists tp the things we actually need them to be doing? That is how something like AI can actually empower humans.
The practice of medicine is an ancient art, and one that’s long depended on the power of human interaction, he explained.
“At one point that was all we had – other than leeches and bloodletting, all we had was the ability to interact with our patients one on one and be human with them,” said Derienzo.
“We’ve vastly improved our ability to care since then, but in some ways we’ve lost an appreciate for that aspect of a clinician patient relationship,” he explained. “My fervent hope is that once we get this right, we’ll actually be returning, somewhat, to a place where it’s that person to person relationship that’s the most valuable part of our day.”
Chris Derienzo’s HIMSS19 SPARK session, “Humanity and Technology in Medicine: Antithetic or Symbiotic?” is scheduled for Tuesday, February 12, from 3-3:30 p.m. in room W300.

Article link: https://www.healthcareitnews.com/news/can-technology-restore-humanity-healthcare
Topics: Artificial Intelligence, Clinical, Electronic Health Records (EHR, EMR)

Artificial intelligence is booming in Europe, China, and the US, but it’s still a very male industry.

by Will Knight  December 12, 2018

With so much hype surrounding artificial intelligence today, it can be difficult to know where things actually stand. Fortunately, a report (.pdf) issued by a group of AI policy researchers today collates a range of data that helps capture the state of the AI boom.
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The authors, from MIT, Stanford, and Harvard as well as nonprofits including OpenAI, look at investments, hiring, papers and patents, and even mentions of AI at government meetings. Here are some take-aways.

1. AI is being commercialized at a dizzying pace.

The amount of money being poured into AI startups is remarkable. The number of AI startups (top) is shown on the left, compared with total startups on the right. AI investment (below) is shown on the left, compared with total investments on the right. This speaks to huge opportunities to use machine learning in different industries, but also to a market that is hyped and overheated.

2. The focal points are China and the US, but also Europe.

Much has been made of China’s rising AI prowess (see “China’s AI awakening”) and its growing rivalry with the US. As the data shows, Europe is also a huge hub of AI activity. But it seems that three main centers of power are emerging.

3. There are still far more men in the field than women.

Many researchers have pointed to the inadequate number of women and racial minorities in AI research. The new report offers some data to back that up, showing a shortage of women among applicants for AI-related jobs (top) and as a percentage of people in AI teaching roles (bottom).

4. The state of the art is improving fast.

The report includes several measures of technical progress, including the accuracy of object recognition in images, measured against average human performance (top), and the accuracy of machine translations of news articles, measured using a score assigned by human judges (bottom). These don’t mean that the field is getting closer to developing a human-level AI, but they show how key techniques have been honed in recent years.

5. Artificial intelligence is a political issue.

Mentions of artificial intelligence and machine learning in the US Congress (above) and the UK Parliament (below) have exploded in the past few years. This reflects a growing awareness of the technology’s economic and strategic importance (see “Canada and France propose an international panel on AI”).

For more info, and to find the data itself, check out the AI Index site.

Article link: https://www.technologyreview.com/s/612582/data-that-illuminates-the-ai-boom/