The Business Case for AI

Jan 31, 2018

[...] AI can increasingly help to power essential business processes, and organizations look to harness this power, it's keep in mind that AI is fundamentally different from other technology trends that sweep the business world every few years. With AI, we are talking about the ability to exponentially accelerate cognitive powers of the human brain. This will have meaningful impacts across all of society, and specifically for businesses, across the entire value chain. Those impacts will be seen in back office operations like finance automation, improved customer insights and personalized marketing, and all the way up to the way customer interaction is handled.

Business applications of AI are already widespread. "Just look at your smartphone" has quickly become a cliché in the context of AI. Customer-facing or customer-oriented applications of AI are very common, with applications such as natural language processing and predictive marketing. In supply chain and distribution centers, we see the application of intelligent robots and demand forecasting. However, many experts agree that we're just at the beginning of an AI revolution -- currently at the stage of Artificial Narrow Intelligence (Think: Siri). As we move towards Artificial General Intelligence, leveraging deep learning and neural networks, AI will play a role in every business function and process: strategy, operations, marketing, finance, and so on.

When it comes to the benefits of adding AI to business processes, the most tangible wins are in terms of automation and efficiency, which in turn improve time to market and enable stronger financial results as businesses add value for their customers. Scratching beneath the surface, and depending on the application of AI, there are myriad other benefits that emerge from AI. For example, the ability to intelligently act upon volumes of data can unlock numerous opportunities, from identifying new customer segments to preventing fraud.

Of course, measurement and reporting are key when it comes to demonstrating the ROI of any new technology. To this end, it is crucial to have a clear understanding of the primary objectives of AI adoption. Much like any technological adoption or process improvement, these objectives need to be mapped to KPIs, and vigorously monitored. If anything, measuring the impact of AI is relatively easier than say, a major change management initiative. It is to be expected that some of the unexpected impacts, such as the business benefits discussed above, may not have clear KPIs established at the forefront, but should also be considered in terms of the overall AI platform.

[...] We're already in the AI-age, seeing applications in numerous ways. To stay competitive and maintain value, adoption is not really a question. However, there are many ways to do AI wrong. For example, if Elon Musk is correct, AI handled irresponsibly can lead to devastating effects. Therefore, skeptics and enthusiasts alike need to have honest and clear conversations on their organization's AI strategy moving forward.

Source: Information Week (View full article)

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CMS mandates that hospitals report EHR meaningful use data through secure portal

Jan 31, 2018

Source: Healthcare IT News

For 2018 and beyond, hospitals are required to submit their meaningful use data through the QualityNet Secure Portal, the Centers for Medicare and Medicaid Services affirmed this month.

Reporting began on Jan. 2 for hospitals and critical access hospitals eligible for Medicare and Medicaid EHR incentive programs.

CMS said its goal is to simplify reporting, as the hospitals can now report meaningful use using one portal, instead of two.

No other changes are needed. Eligible hospitals and CAHs can continue to collect data in the way they always have, CMS said.

CMS sent out a notice in October that eligible hospitals and critical access hospitals attesting to CMS for the EHR incentive program must use the QualityNet Secure Portal or QNet.

QNet streamlines data submission methods to make it easier for eligible hospitals and CAH's to report data.

The requirement covers eligible Medicare and Medicaid hospitals and critical access hospitals.

Medicaid-only hospitals and CAHs need to update their registration and coordinate with their respective state Medicaid agencies to for information on where to attest, according to CMS.

Hospitals dually-eligible and CAHs will need to register or update their registration with both QNet and the Medicare and Medicaid EHR incentive program registration and attestation system.

Medicare Part B clinicians eligible to participate in MIPS should visit app.cms.gov for more information on how to report.

The attestation period ends on Feb. 28.

Source: Healthcare IT News (View full article)

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Google Study Uses Entire Patient EHR for Predictive Analytics

Jan 31, 2018

A recent study by researchers from Google, University of California San Francisco (UCSF), Stanford University, and University of Chicago Medicine (UCM) found representations of a comprehensive patient EHR using Fast Healthcare Interoperability Resources (FHIR) can be used for more accurate predictive analytics.

Researchers used de-identified EHR data from UCSF and UCM gathered from 2009-2016 during inpatient and outpatient encounters. Datasets included patient demographics, provider orders, diagnoses, procedures, medications, lab values, vital signs, and flowsheet data. In total, the study included data about 216,221 hospitalizations involving 114,003 patients.

Researchers then used a single data structure to predict health outcomes instead of requiring custom datasets for each new prediction.

"This approach represents the entire EHR in temporal order: data are organized by patient and by time," noted researchers in the report. "To represent events in a patient's timeline, we adopted the FHIR standard."

Ultimately, researchers determined deep learning could produce valid predictions across a variety of clinical problems and health outcomes. Researchers were able to predict outcomes ranging from mortality rates to readmissions, as well as length of stay and diagnoses. Additionally, the single predictive model could be used at different medical facilities.

"A deep learning approach that incorporated the entire electronic health record, including free-text notes, produced predictions for a wide range of clinical problems and outcomes that outperformed state-of-the-art traditional predictive models," wrote researchers.

The study showed the potential for advancements in the scalability of predictive analytics models in clinical care, researchers said.

"First, our study's approach uses a single data-representation of the entire EHR as a sequence of events, allowing this system to be used for any prediction that would be clinically or operationally useful with minimal additional data preparation," they stated.

[...]

Despite potential problems associated with predicting patient discharge diagnoses, researchers stated the study serves as a proof-of-concept for gaining a diagnosis from routine EHR data. The ability to predict health outcomes or diagnoses from routine EHR data could help to improve clinical decision support or clinical trial recruitment.

"Accurate predictive models can be built directly from EHR data for a variety of important clinical problems with explanations highlighting evidence in the patient's chart," researchers concluded.

Findings from this study could be used to encourage clinicians to leverage comprehensive patient EHRs for improved predictive analytics and health outcomes.

Another recent study published in the American Journal of Managed Care (AJMC) showed the value of utilizing diagnostic EHR data to lower patient mortality rates and improve health outcomes. Researchers found sharing diagnostic EHR data within health systems and hospitals is associated with lower rates of patient mortality and reduced hospital readmission rates for patients with heart failure and pneumonia.

The exchange of radiology images, lab results, and other kinds of diagnostic data allows for more accurate, informed patient care.

Source: EHR Intelligence (View full article)

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Coast Guard's abrupt termination of Epic EHR rollout prompts House hearing

Jan 30, 2018

The Government Accountability Office has hit the Coast Guard for failing to implement an electronic health record system and creating havoc by resorting to a paper process.

The House Transportation Committee has scheduled a hearing Jan. 30 to consider the Coast Guard's failure to implement an Epic electronic health record back in 2015.

The Coast Guard canceled the contract two years ago without explanation, according to Epic Systems, the EHR vendor who had won the contract.

[Also: How the Coast Guard's ugly, Epic EHR break-up played out]

Today, the Coast Guard is tangled in a web of paper processes, which is creating havoc, GAO found.

After canceling the project in October 2015, the Coast Guard could not return to using its electronic legacy system because the technology had been decommissioned in 2015, according to GAO findings.

The agency is recommending the Coast Guard "expeditiously and judiciously" pursue the acquisition of a new EHR, adding that, in doing so, the Coast Guard should ensure key processes are implemented. The government watchdog also called for the establishment of project governance boards to oversee the project.

As for Epic, it posted a project timeline of the abandoned Coast Guard work on its site prior to the GAO report. In the post, Epic noted its work on the project was repeatedly rated "exemplary" by the Coast Guard in formal documented reviews. "Epic was paid in full for the work done," the EHR vendor writes on its website. "The U.S. Government did not request any refund. The software was ready to go live."

GAO concluded the Coast Guard could not demonstrate effective management of the project, lacked governance and failed to document lessons learned from the project. Also, relevant documentation was often not available.

"Management told us documentation either did not exist or could not be located because several of the key project management team members were no longer employees of the Coast Guard," GAO said.

GAO noted that the Coast Guard also lacked governance mechanisms for its health information system and recommended the Coast Guard develop new performance goals or describe how existing goals are sufficient, publicly report its goals, assess the limitations in performance data are documented, document measurable corrective actions and implementation timeframes, as well as document efforts to monitor implementation of corrective actions.

The Department of Homeland Security concurred with all five recommendations.

Source: Healthcare IT News (View full article)

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Value-based framework for EHR interoperability

Jan 30, 2018

Virtually all hospitals and providers, or at least the overwhelming majority, have adopted an EHR and that's a start. Next up: Harnessing EHRs to move to value-based care because of the data they house.

Specifically, said Weingarten, EHR data can help a provider avoid low-quality care, in which the harms of a test or treatment may outweigh the benefits, or there are no benefits at all. Weingarten sees this a lot with certain drug prescriptions for patients older than 65. Some ill-advised medications can increase the probability of falls resulting in hip fractures, for instance, and there are cost implications there: An otherwise healthy patient having a hip fracture requires additional treatment and is subjected to a potentially avoidable hospital admission.

"There are also tests where there is no value, or limited value," said Weingarten. "If you take an otherwise perfectly healthy person and do carotid ultrasounds, the data suggests that's not going to help an asymptomatic, otherwise healthy patient. And it's going to cost money without providing benefit.

"The EHR can provide benefits in real time in that it can share information with the provider," he said. "After the fact, data is available to see how many doctors have prescribed low-value tests or treatments in comparison to your peers. When you give providers comparative information ... they often respond by reducing their prescribing of low-value care."

Further elevating EHR's importance is increased interoperability, which enables different EHR systems to communicate with one another. This allows for a freer flow of information between providers, which is of prime importance when it comes to clinical quality and patient satisfaction.

"EHRs can all talk to each other, similar to ATMs," said Weingarten. "Anywhere in the world, I can withdraw money from an ATM ... because the ATM that I intend to withdraw money from is interoperable with my bank. There was one time I was in a remote area in Argentina, hiking, and I came across a small town and was able to withdraw money from my bank in Los Angeles. So there was that interoperability -- this ATM in Argentina knew I had money to withdraw from my bank. That's the benefit, when you can communicate patient information between different EHRs."

This is not just a rosy picture, of course, and there are differing degrees of interoperability, as each EHR system is slightly different. That makes communication between systems difficult at times, but Weingarten said that things have improved in this area in recent years.

"We haven't achieved an endpoint yet, but my sense is things are going in the right direction."

That end should encompass quality care, safer and more affordable care, and enabling provider satisfaction -- in other words, selecting a system that facilitates the day-to-day work of the provider rather than slowing them down.

The successful switch to a value-based framework depends on it.

"I think we'll continue to see a progression of value-based care," Weingarten said. "Providers who deliver the best care at the lowest cost and provide the best patient experience will grow and thrive, and those provider organizations that do not provide high-value care are going to struggle."

Source: Healthcare IT News (View full article)

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A Comprehensive Telehealth Experience

Jan 30, 2018

Today, organizations often focus on high-acuity programs like telestroke, which successfully serve some of the highest-needs populations. These programs often boast the greatest success rates--and help make the case for a more comprehensive, system-wide strategy. As a part of this, a growing number of hospitals also want to offer patients on-demand services: A 2015 survey from the Advisory Board Company indicates more than 80 percent of healthcare providers are interested in offering direct-to-consumer (DTC) telehealth (which, researchers note, is inclusive of remote monitoring and virtual visits).

However, not all vendors are alike in their ability to support a system-wide telehealth program that can support these and multiple other use scenarios, like behavioral health.

A handful of major vendors have the infrastructure to accommodate high-acuity telehealth situations, which requires a hospital to be able to quickly access experts who can remotely evaluate and treat patients displaying acute symptoms. However, these same vendors may lack the resources, such as a network of credentialed, high-quality providers for virtual visits, to help an organization expand into a lower-acuity use, like DTC.

Market research firm KLAS acknowledged this conundrum in its 2017 Telehealth Virtual Care Platforms report, which evaluated several of the leading telehealth platforms used by more than 100 healthcare organizations. According to KLAS researchers, leading vendors offer solid technology solutions to enable synchronous (i.e., live) visits between patients and providers or between providers and specialists. Yet very few are highly successful in offering both telespecialty services (initiated by providers from within the walls of a clinic or hospital for the purpose of consulting a specialist) and on-demand services (which are typically unscheduled, patient-initiated visits to address urgent or on-demand medical needs).

What healthcare organizations must do, therefore, is seek vendor partners that can offer a more comprehensive, end-to-end solution instead of a "patchwork" solution. Specifically, organizations that want to offer system-wide telehealth need a platform that facilitates a seamless technology experience for patients anytime and anywhere -- whether they are experiencing a stroke, or simply need to call a doctor while on vacation.

Evaluating Telehealth Vendor Partners

Implementing a comprehensive telehealth program is a significant undertaking for any healthcare organization, especially organizations that are already using telehealth platforms that are several years old, and may not be aligned with the most up-to-date standards, or easily integrate with other technology such as Electronic Health Records (EHRs). Therefore, evaluating vendor partners on the front end is the most important part of expanding into new markets, such as DTC telehealth.

In addition to providing a secure, seamless, device-agnostic experience, a vendor must be able to address specific challenges, such as facilitating care coordination between providers at multiple locations who are involved in an Accountable Care Organization (ACO) or other population-healthcare models. Moving forward, healthcare organizations should consider the following:

• Experience. A technology partner should have a proven track record in working with healthcare organizations to help them accomplish their goals. Organizations that want to roll out DTC programs and outsource remote providers should make sure that their partners have established relationships with credentialed, board certified provider partners for virtual and onsite care coverage. As the KLAS report noted, DTC telehealth should ideally help boost healthcare organizations' access to vendor-employed urgent or specialty care providers when an organization does not have access to such clinicians through other means. The ideal telehealth platform should also allow providers to document the visit in the patient's record within the EHR, researchers added.
• Interoperability. As value-based care becomes more of a norm (and less of an alternative to fee for service), the need for tighter care coordination and information exchange will increase. If a vendor partner's platform isn't interoperable with all major EHRs, an organization will waste a lot of time and money in trying to coordinate care and record visits.
• Flexibility. An organization's needs, programs and partnerships are always evolving. A vendor partner must be flexible and able to accommodate today's needs and future plans to launch new telehealth programs. Technology cannot simply be great, powerful, and secure. It must also be able to adapt to multiple use cases. These may include providers who want to conduct secure DTC virtual visits between their mobile phone and patients' mobile phones, as well as remote specialists who conduct "virtual" visits with patients in remote exam rooms. Each of these use cases requires different tools, back-end technology, and expertise. A vendor should possess the technology to empower additional use cases with customizable technology solutions and quality providers, to ensure high-quality virtual care reaches patients in any location throughout the continuum.

Source: Health IT Outcomes (View full article)

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Diagnostic EHR Data Sharing in Health Systems Improves Outcomes

Jan 29, 2018

A recent study ties hospital and health system sharing of diagnostic EHR data to lower patient mortality rates and improve health outcomes.

Researchers studying CMS and AHA data published their findings in the American Journal of Managed Care. Specifically, Deyo et al. scrutinized information about patient mortality and readmission rates for heart failure and pneumonia in 2012 and 2013.

The AHA Annual Information Technology supplement gathered information from providers about their hospital's health data sharing behaviors. Providers submitted responses about how frequently their hospital exchanged data between providers in their own health system, as well as with providers at outside health systems. AHA collected separate responses from providers about hospital sharing of radiology reports and lab results.

Researchers linked AHA survey data from 3,113 distinct hospitals to each hospital's corresponding CMS Hospital Compare scores.

Ultimately, study results showed diagnostic EHR data sharing within health systems was associated with better health outcomes.

"Hospitals sharing diagnostic data through their EHRs with other hospitals and physicians within their system were associated with significant reductions in 30-day patient mortality scores," stated researchers in the report.

Comparatively, sharing diagnostic EHR data with hospitals part of other health systems was associated with higher patient mortality scores - particularly for patients with heart failure.

Several factors may contribute to the correlation between EHR data sharing between health systems and higher patient mortality scores, researchers wrote.

"It is possible that hospitals within a system share EHR data more effectively due to team dynamics," they suggested. "Further, as hospitals in different systems may have different EHR systems, there may be unique difficulties with sharing data across systems."

Furthermore, the exchange of radiology reports may be limited by the fact that many patient health records do not contain radiology images.

"This may partially account for the differential between sharing with providers within and outside of systems because physicians within the system may be able to access the source images through other means when necessary," wrote researchers. "Hospitals that solve the communication challenges associated with EHR data may be able to significantly reduce patient readmissions and mortality."

Researchers also found communication between providers across EHR systems was generally lower than communication between providers using the same system. Seventy-two percent of hospitals shared radiology reports with hospitals within their system while only 36 percent shared radiology reports with hospitals outside their system.

Researchers observed a similar gap in the exchange of lab results within health systems as compared to between health systems.

Without significant improvements in EHR interoperability, the effectiveness of data sharing between hospitals will continue to lag behind data sharing within hospitals.

"If hospital sharing is limited by communication or compatibility among different EHR systems, the ability of EHRs to improve patient outcomes or access to care may be limited in the long run," wrote researchers.

A lack of effective health data exchange between health systems may pose a significant threat to patient safety.

"Our study found some evidence that when hospitals do share EHR data with hospitals outside their system, patient mortality has the potential to increase," researchers explained. "Therefore, although there may be benefits to sharing EHR data, it may be that hospitals are not yet able to effectively use EHR data from other hospitals as well as would be desired."

Given the low rate of diagnostic EHR data sharing between health systems, researchers suggested policymakers develop improved common standards for health data exchange between EHR systems.

"Thus, best approach for increasing patient outcomes through better provider communication of diagnostic information may not be simply expanding the degree of EHR data sharing among providers, but rather developing common standards when using different EHR systems to ensure that providers can share diagnostic information in ways that are easy for other providers to access and accurately interpret," they concluded.

Source: EHR Intelligence (View full article)

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The Potential of Blockchain in Healthcare

Jan 29, 2018

Marlin Finance details the potential they see for Blockchain technology in Healthcare, including:

• Patient health data - Using blockchain for health data exchanges would ensure health data interoperability, integrity and security. It would give providers easy access to historic and real-time data from disparate electronic medical records systems scattered across multiple facilities.
• Billing and claims management - Using blockchain to automate the claims resolution and payment processes could speed payments, reduce administrative costs and eliminate the need for intermediaries to resolve issues.
• Pharmaceuticals - Counterfeit drugs cost pharmaceutical companies $200 billion each year.[4] Blockchain could track the chain of custody for drugs through the supply chain and establish smart contracts to maintain drug integrity and veracity.
• Drug testing and development - Experts estimate 50% of clinical trials are not reported, creating knowledge gaps for patients, clinicians and policy makers.[5] Using blockchain for clinical trials would establish permanent records of testing protocols and results for use by all stakeholders.
• Health care internet of things (IoT) - Health care data breaches have increased and the growing use of health care IoT devices poses a looming threat. Analysts expect up to 30 billion health care IoT devices will be in use around the world by 2020.[6] Blockchain could securely bridge the interoperability gap between various devices and protect their data outputs.

Source: Marlin Finance (View full article)

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What to know about the SamSam ransomware hitting Allscripts, hospitals

Jan 29, 2018

For the last few weeks, SamSam ransomware attacks have steadily increased across all sectors. The virus took down the entire municipality of Farmington, New Mexico, and just last week two hospitals were hit -- Hancock Health and Adams Memorial.

Allscripts appears to have become the first EHR vendor brought down by ransomware, although officials have said the variant is slightly different than the strain impacting those other organizations.

Regardless, there's been an uptick in SamSam attacks since about Jan. 11, although some security experts saw the start Dec. 25. As these attacks show no signs of slowing down, it's important for healthcare security leaders to understand how the virus gets in to prevent falling victim.

[...]

There are a few different ways a hacker can use SamSam to get into a system, explained Kim. For example, those who use weak passwords, reuse passwords and fail to limit admin credentials. A brute force tool can break weak credentials to get in, especially if an organization has failed to limit the number of attempts allowed by a user to get into a system.

Organizations that also fail to monitor an abnormal amount of attempts are also at risk.

One of the things seen by CynergisTek Executive Vice President of Strategic Innovation David Finn is that often organizations put antivirus on laptops, desktops and other physical machines, but fail to keep servers locked up and safe with antivirus.

"It needs to be on all of your endpoints," said Finn. "We sometimes forget about those servers being endpoints."

While SamSam is highly effective, Finn said, "it isn't terribly sophisticated."

The virus is spread through the web and Java apps, as well as other web-based applications, explained Finn. And once it gets into the system, it spreads -- without a malicious email. SamSam can be stopped if detected before it gets into a system, but "once it's spread: it's over."

"It speaks to effectiveness not sophistication," said Finn. "That's one of those things that makes it more insidious. It can traverse the network without human intervention. That's why the prevention piece becomes more critical."

Source: Healthcare IT News (View full article)

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Nursing Facility Improves Readmissions, Clinical Quality, and Finances

Jan 29, 2018

Skilled nursing facilities are moving into the digital age, and the impact is being felt in areas ranging from hospital readmissions to workforce efficiency and clinical quality. Increasingly, skilled nursing facilities are using new approaches to improve not only their own performance but the wellbeing of the healthcare system generally.

"The burden of paperwork in these buildings is absolutely astounding," said Paul Liistro, managing partner of Vernon Manor and Manchester Manor, both in Connecticut. "If you can find a technological answer, it'll save you a lot of frustration. It makes the quality of work, the experience they have when they come to work, more enjoyable. They just want to solve medical problems."

Rather than stay in the paper-based environment common to many skilled nursing facilities, Liistro's facilities are moving forward into what he sees as the future of long-term care.

For two years now, Liistro has been using a platform that sits on top of a facility's electronic medical record, analyzes 150 clinical data fields, provides recommended interventions and consolidates the data into a single report. [...] It gives the two Connecticut facilities a fresh report each day at 12:01.

Now, Liistro and his staff don't have to wait until the EMR's minimum data set pinpoints a trend that's happening. That has improved clinical quality, which in turn has resulted in fewer patients being readmitted to a local hospital.

"That is a metric that is problematic, because it's very expensive for the federal government," said Liistro. "It's problematic for us and the industry because the government is now creating a program where they penalize us for readmissions, and that starts in 2018. So you have to look for solutions that are going to help you avoid those things. If you're lowering the readmissions rate, you're starting to do things better."

The two facilities have also been able to improve their patients' lengths of stay. In Connecticut, the average length of stay for a patient in a skilled nursing facility is 30 days, and by Liistro's estimate, that translates into about $18,000 a stay -- the cost of episodic care. By contrast, Liistro's buildings average about 14 of 15 days per length of stay.

"Someone sees I'm responding to the mantra of shorter lengths of stay, lower readmission rates," he said. "So what hospitals and insurance companies are going to do is send us more patients. It's been driving volume."

Hospitals aren't complaining, either. The federal government levies financial penalties against hospitals for underperforming against their peers when it comes to 30-day readmission rates; Medicare financially penalizes about two-thirds of U.S. hospitals based on that metric. Harnessing technology to improve clinical quality and reduce that metric has benefitted not only Vernon and Manchester Manors, but hospitals that serve those communities.

It's part of a broader technological approach that has helped in other areas, as well. The Connecticut facilities have been using Providigm's Abaqis tool, a quality management system distributed by Medline that helps reduce survey deficiencies, to help prepare for surveyors who come in and determine skilled nursing facilities' competencies in several key areas. When CMS announced the facility assessment requirement, Providigm decided to add an assessment tool to abaqis to provide nursing home operators with an efficient means fulfilling the requirement.

It's already paying off. By the time the surveyors come in, Vernon and Manchester Manors have typically already identified any issues that might be found, and taken steps to correct them. The two buildings routinely score a full five stars on nursinghomecompare.gov, one of several federal websites that rank healthcare facilities on quality.

"If you can intercept that assessment, if you can know it before you complete that form, it doesn't become data," said Liistro. "You can fix it. The software technology gathers that information every night in our building. It will tell us specifically which patients have triggered something that will affect our five-star (rating)."

The efforts to bolster care and quality through technology is part of the two skilled nursing facilities' drive to follow the so-called triple aim: better outcomes, lower cost, and better patient satisfaction. There's an upfront investment required to overhaul systems and processes in a 21st century framework, but it pays off down the road.

"We spend about $325,000 on IT-related software," said Liistro. "When I tell people that, they stare at me and ask, 'Why do you have this?' The theory is, every department, and in some cases specific people, need to have a sharp tool in their shed. The software makes them do their job much better. If you're a paper-driven nursing home, you're not going to be as attractive to a new graduate nurse, because they are attracted to technology."

Source: Healthcare Finance (View full article)

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