http://www.informationweek.comInformationWeeken-usCopyright 2012, UBM LLC.2013-05-23T12:18:00ZHagel shoots down possibility of DOD adopting VA's Vista and sinks the joint iEHR. Epic Systems might win out.http://www.informationweek.com/healthcare/electronic-medical-records/dod-seeks-commercial-ehr/240155449?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_image_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /><div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div><!-- /KINDLE EXCLUDE -->Secretary of Defense Chuck Hagel has announced that the <a href="http://www.govexec.com/media/gbc/docs/pdfs_edit/052213bb1.pdf">Department of Defense (DOD) will shop for a commercial electronic health record</a> (EHR) system to replace its AHLTA. AHLTA stands for Armed Forces Health Longitudinal Technology Application. <P> The DOD will seek bids from a range of EHR vendors. Industry insiders give the edge to Epic Systems, which is currently the market leader. If it isn't Epic, however, the winner will instantly gain a competitive advantage against that giant vendor. <P> In Hagel's May 21 memo to subordinates, which was <a href= http://www.nextgov.com/health/2013/05/hagel-opts-commercial-electronic-health-record-software/63437/?oref=ng-HPtopstory">originally reported</a> by NextGov, he said the DOD would continue to develop interoperability with the VistA EHR of the Department of Veteran Affairs (VA). But his directive might well be the final blow for the departments' joint iEHR, an open-source project that was supposed to replace AHLTA and VistA with a new combined system. In February, the two departments announced they were <a href="http://www.fierceemr.com/story/va-dod-nix-plan-new-joint-ehr/2013-02-06">halting the iEHR initiative</a> to save money but would continue to work on interoperability. <P> <strong>[ Want more on the state of electronic health record integration? Read <a href="http://www.informationweek.com/healthcare/interoperability/interoperability-depends-on-ehr-vendors/240153698?itc=edit_in_body_cross">Interoperability Depends On EHR Vendors: AHA</a>. ]</strong> <P> It's not clear, though, how these interoperability efforts can go forward during the DOD's selection and implementation of a commercial EHR, or how such a system can be integrated with VistA. <P> Nearly two years ago, VA said that the two departments were going to use an <a href="http://www.informationweek.com/healthcare/electronic-medical-records/va-dod-choose-open-source-to-combine-ehr/231600819">open-source approach</a> to develop the iEHR's components. VA even created the <href="http://www.osehra.org">Open Source Electronic Health Record Agent</a> (OSEHRA) to manage an open-source community for this purpose. In a <a href="http://www.politico.com/story/2013/05/fixing-the-vas-health-system-fiasco-91336.html">recent op-ed piece</a>, Peter Levin, the VA's former chief technology officer, said he was still convinced that this is the best course, but Hagel sees it differently. <P> Based on a recent review of the iEHR program, the Defense Secretary said in his memo, he has concluded that putting the DOD's new system out for bid is "the optimal way to ensure we select the best value solution for DOD. A competitive process will allow DOD to consider commercial alternatives that may offer reduced cost, reduced schedule and technical risk, and access to increased current capability and future growth in capability by leveraging ongoing advances in the commercial marketplace." <P> Hagel added that the VA has good reasons to use VistA, but that "many of those reasons do not apply to DOD." The VA has suggested in the past that the DOD adopt its VistA system, according to <a href="http://ehrintelligence.com/2013/05/16/congress-we%E2%80%99ll-only-fund-a-single-joint-ehr-for-dod-va/">EHR Intelligence.</a> <P> An <a href="http://www.fiercegovernmentit.com/story/dod-and-va-should-complete-iehr-soon-possible-says-iom-task-force/2013-04-03">Institute of Medicine (IOM) task force</a> recently urged the DOD and VA to complete their work on iEHR. The report said that the lack of seamless records across the two departments was hampering physical and mental healthcare for wounded veterans. <P> Congress also has been getting into the act. Earlier this month, the House Appropriations Committee said it would allot $344 million to "jumpstart" an integrated DOD-VA EHR. But the committee decided it would release the money only if the departments moved forward with a joint, open-source EHR. Meanwhile, another bill in the House military construction subcommittee specified that only a quarter of that amount would be released until the departments could show that they had a plan for a unified EHR. Hagel's move seems to fly in the face of both these bills. <P> "Hagel's problem is going to be with Congress," commented Mike Corrigan, VP of consulting firm Warren Suss Associates, in an interview with <em>InformationWeek Healthcare</em>. "They're scratching their heads about why there shouldn't be a common record across the two departments. And if he's going with a commercial system independent of VA, I think there's going to be a couple more rounds of this match." <P> The iEHR is not necessarily dead, Corrigan added. But even if the iEHR went forward, he noted, it would address only part of the problem of creating a unified record for veterans. Because non-VA physicians and hospitals provide much of veterans' care, the iEHR "would be of limited utility," he said. For that reason, he commended the government's Virtual Lifetime Electronic Record (VLER) project, which is testing interoperability among military, VA and private-sector systems. <P> The <a href="http://www.healthcareitnews.com/news/bill-holds-iehr-money-hostage">original estimates</a> for the cost of the iEHR were $4 billion to $6 billion. That has since ballooned to an estimated $8 billion to $12 billion. Besides the lack of cost control, Congress is also concerned about VA's slow processing of claims for disability benefits. <P> Addressing the latter issue in his memo, Hagel wrote, "I recognize that only 4% of the current VA backlog is associated with the transfer or completeness of DOD records -- and that these EHR efforts should be not conflated with the present VA disability claim backlog...Nevertheless, improvements in interoperability and EHR modernization will impact the timely processing of future claims and will provide better continuity of care to our people."2013-05-22T09:06:00ZProfessional network will give continuing medical education points to doctors for care-related literature searches and discussions with colleagues.http://www.informationweek.com/healthcare/policy/doximity-branches-into-cme-with-clevelan/240155272?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_image_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /><div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div><!-- /KINDLE EXCLUDE -->Doximity, an online professional network that includes 170,000 U.S. physicians, <a href="http://www.prnewswire.com/news-releases/doximity-to-launch-new-physician-education-platform-with-cleveland-clinic-208175241.html">has struck a deal</a> with the Cleveland Clinic to offer a novel kind of continuing medical education (CME) based on social networking. <P> Instead of participating in webinars or reading journal articles and answering questions about them, physicians who choose Doximity's program, <a href="http://www.clevelandclinicmeded.com">accredited by Cleveland Clinic</a>, will participate in online discussions with other physicians to earn their CME credits. Moreover, they'll be able to do so on their iPhones, iPads or other mobile devices, a feature that Cleveland Clinic's CME program currently lacks. And the CME will be free for doctors. <P> Doximity tracks users' CME credits, both from its own program and from other programs if physicians forward their CME certificates to the network. <P> <strong>[ Is time on the side of the United States' effort to institute electronic health records? Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/canada-doctors-reap-roi-from-ehrs/240153789?itc=edit_in_body_cross">Canada Doctors Reap ROI From EHRs</a>. ]</strong> <P> "Doximity's new CME offering has tremendous potential to save physicians precious time and reduce the burden of paperwork and tracking of credits that typically accompany CME activities," said Doximity CEO Jeff Tangney in a news release. "In addition to facilitating vigorous online discussion, Doximity's digital platform for CME also automatically handles logging and maintenance of education credits for its physician members." <P> In an interview with <em>InformationWeek Healthcare</em>, Tangney explained how the new social CME system will work. Doximity already offers its members the ability to search medical journals for articles relevant to patient care. Under the CME arrangement with Cleveland Clinic, they will get credit for the time spent doing those searches without having to answer questions about them afterward. This is similar to the "taxi-meter" approach at <a href="http://www.uptodate.com/home">UpToDate,</a> a major player in the point-of-care CME field, he pointed out. <P> "Part of the idea is giving doctors credit for what they're doing already that we want them to do more of -- which is using the Internet to find the right answer for the patient," Tangney noted. Under the Cleveland Clinic deal, CME-accredited content will come from about 200 journals, including those of the New England Journal of Medicine, the Lancet, and the Annals of Internal Medicine, as well as from Cleveland Clinic's own extensive educational resources. <P> Beyond doing the literature search, he said, physicians can get CME for participating in an online discussion with colleagues who have read the same article. "These articles become a launching-off point for doctors to have a discussion about how they might use [the research] in their practice. It's a discussion like the kind you might have on Grand Rounds. And your CME credit reflects the amount of time you spent participating in that." <P> Tangney, a founder of <a href="http://www.epocrates.com">Epocrates</a> who spent 10 years at that company, said that Doximity's approach is fundamentally different from his old firm's methodology. Epocrates, he said, takes a traditional approach to CME, including quizzes on articles read, and it lacks the search and social networking features of Doximity. <P> Currently, Tangney observed, the social networking aspect of Doximity is relatively little-used compared to its secure messaging functions, which let physicians message each other online or receive images or lab results via e-fax. Based on this experience, he doesn't expect much more than a fifth of the network's members to use the social media feature of the new program. <P> William Carey, MD, director of the Center for Continuing Education at Cleveland Clinic, is more optimistic about the possibility that Doximity's social media-driven CME will draw a big audience. Noting that the Cleveland Clinic's own CME website has been an "engine for growth," he said, "The lesson I've learned is that technology, harnessed in the right way, provides a tremendous opportunity for physicians and other providers to get education." <P> To make social media work with CME, he said, a CME provider must offer a platform with plenty of material and that is easy to use, cost effective, and based on "self-directed learning," such as online literature searches to answer care questions. In addition, the online content must be available on mobile devices. <P> "If you keep in mind the four things necessary for getting it right, there's no reason why CME through social media should not grow explosively in the next few years," he said.2013-05-21T12:34:00ZSocial networking site PatientsLikeMe loans its 200,000-member community to academic and pharma researchers to validate online questionnaires.http://www.informationweek.com/healthcare/patient/patientslikeme-launches-open-research-ex/240155263?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href=" http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137"><img src="http://twimgs.com/informationweek/galleries/automated/943/Cerner-patient-portal_tn.png" alt=" 7 Portals Powering Patient Engagement" title="1 7 Portals Powering Patient Engagement" class="img175" /></a><br /><div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->PatientsLikeMe, a social network that lets patients share health information with each other online, has announced it is piloting a medical research platform that lets researchers test new methods for measuring patient outcomes. <P> Funded by the Robert Wood Johnson Foundation, PatientsLikeMe's <a href="http://www.openresearchexchange.com">Open Research Exchange</a> allows researchers "to pilot, deploy, share, and validate new ways to measure diseases within PatientsLikeMe&#8217;s community of more than 200,000 members," according to a <a href="http://news.patientslikeme.com/press-release/patientslikeme-calls-researcher-participation-new-open-research-exchange-platform">news release.</a> The researchers might be from academia or pharmaceutical companies, said Paul Wicks, PatientsLikeMe's research and development director, in an interview with <em>InformationWeek Healthcare</em>. <P> Founded in 2004, <a href="http://www.patientslikeme.com">PatientsLikeMe</a> initially focused on about 10 conditions, including multiple sclerosis and Lou Gehrig's Disease (ALS). It developed online questionnaires, known as "instruments," to measure the outcomes of patients with some of these diseases. Two years ago, Wicks explained, the company decided to expand its site to encompass patients with all kinds of conditions. Today, the network's database includes data, treatments and symptoms for about 1,500 conditions. <P> <strong>[ Online medical records are a success, says survey. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/patients-like-online-health-records-acce/240152164?itc=edit_in_body_cross">Patients Like Online Health Records Access, Study Says</a>. ]</strong> <P> "It doesn't make sense for us, as a tiny research team, to try to build instruments for a disease a day -- particularly if there are experts out there and academic researchers who can get grants for this," he said. "So we're building a platform that allows other experts to come to our site and build new instruments." <P> What's in it for the researchers? If they were trying to do this kind of study in an academic medical center, Wicks said, it could take them years to organize the study, recruit patients through their doctors and hospitals, and analyze the data before they found out whether their instrument worked. <P> "With PatientsLikeMe, they come into a live situation, and with the first 10 to 20 patients, they can find out basic things about their instrument, such as that nobody is using the most severe ratings on the site, or that the questionnaire is too long. The patients are already here and they're willing to take part. So you can reduce the time from several years to several months." <P> Although interest in patient-reported outcomes is growing for several reasons, academic and pharma researchers are interested in it because many clinical trials include functional outcomes and quality of life as secondary foci, Wicks noted. This is especially true in studies of conditions such as cancer and HIV, where the therapy can have worse effects than the disease does. <P> This kind of outcomes research is a subset of a larger body of medical research that PatientsLikeMe has been engaged in for some time. Pharmaceutical companies and universities use PatientsLikeMe to recruit subjects for clinical trials. PatientsLikeMe, which doesn't charge membership fees or permit advertising, is financially dependent on the fees from these activities. <P> When patients sign up with the network, Wicks explained, they are informed that researchers might contact them. But they don't have to participate in studies if they don't want to. In some cases, such as PatientsLikeMe's recent deals with drug makers Sanofi and Merck, the network itself contacts patients who fit the study criteria and tells them about upcoming clinical trials involving those companies' products, he said. It also has developed a user-friendly interface to clinicaltrials.gov, which lists all ongoing clinical trials. <P> "We try to be as transparent as possible about who we work with," he added. "So in the case of the pharmaceutical research, we always want to mention by the name the companies we're working for. We don't do secret research. Patients are giving us their trust, and we have to honor that and be transparent with them." <P> PatientsLikeMe requires that measurement instruments validated on its Open Research Exchange be made available for free to anyone who wants to use them. However, Wicks added, a researcher could sell consulting services or imbed the instrument in a commercial app without violating the terms of the open license.2013-05-20T09:06:00ZDeloitte survey contrasts with other data that finds near-universal adoption, reports EHR resisters tend to be older and solo practitioners.http://www.informationweek.com/healthcare/electronic-medical-records/15-of-physicians-declining-ehrs-deloitte/240155154?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ 9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_i mage_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div> <!-- /KINDLE EXCLUDE --> Nearly all U.S. doctors responding to a <a href="http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture-Digital-Doctor-Is-In-UK.pdf">recent Accenture survey</a> said they use electronic health records (EHRs). But a new <a href="http://www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/Health%20Care%20Provider/us_dchs_2013PhysicianSurveyHIT_051313%20(2).pdf">report from Deloitte</a> shows a somewhat different picture: Just two-thirds of physicians said they have an EHR capable of showing Meaningful Use (MU), and 45% of the remaining third, or about 15% of all respondents, said they have no plans to purchase an EHR that meets MU criteria. <P> Both surveys were done at the same time, and both included about the same number of American physicians. Accenture polled 3,700 physicians in eight countries, including 500 U.S. doctors; Deloitte's survey involved just over 500 randomly selected, responding physicians from the AMA Masterfile. But Deloitte asked about EHRs that were qualified for Meaningful Use -- i.e., systems that had basic capabilities -- whereas Accenture asked about any kind of EHR. <P> Deloitte found that only half of physicians aged 60 or older had MU-ready EHRs. In comparison, 71% of doctors who were 25-39 years old had such EHRs; so did 71% of those aged 40-49 and 67% of those aged 50-59. <P> Physicians in small and solo practices were also less likely to have EHRs than those in larger groups and healthcare systems. Only 31% of soloists had EHRs, vs. 62% in practices of two to nine physicians and 82% of those employing 10 or more doctors. Among solo practitioners who do not have EHRs, 71% do not plan to acquire one; that was also true for 32% of doctors in midsized practices and 28% of those in large groups that do not yet have an EHR. <P> <strong>[ Not everyone sees innovation as a positive. Read about <a href="http://www.informationweek.com/healthcare/leadership/20-health-it-leaders-who-are-driving-cha/240154651?itc=edit_in_body_cross">20 Health IT Leaders Who Are Driving Change</a>. ]</strong> <P> The biggest reasons for not getting an EHR, the survey found, were the upfront investment, ongoing maintenance costs and the increased complexity of delivering care with an EHR. <P> Ken Bowden, a practice management consultant in Pittsfield, Mass., said that the EHR resisters fall into one of two camps. "One group hides their heads and says, 'Go away.' And then there are the ones who don't think it's worth it. Because even though the government is reimbursing them up to $60,000, most systems cost at least that much, and they lose a year's worth of income in the implementation of it. If they have less than 10 years left to retirement, I tell them, 'don't do it.'" <P> Some experts, Bowden noted, recommend that doctors cut their patient schedules in half for the first six months after they introduce an EHR. "None of my clients went to half a schedule, but they did a lot less visits than they did in the past [after getting an EHR]. And it takes a year-and-a-half to two years to get back to where you were, if you ever get back. Some of those systems slow you down so much that you never regain the productivity." <P> <a href="http://www.americanehr.com/blog/2013/03/himss13-ehr-satisfaction-diminishing/">Another physician survey</a> by AmericanEHR and the American College of Physicians supports Bowden's point. According to that 2012 poll, 32% of doctors who used EHRs said that they hadn't recovered their productivity. Only 20% said that in a similar survey in 2010. <P> Bowden admitted that if physicians were better trained on EHRs and had tech-savvy support staff, "they'd cut their downtime in half." That's proved by the primary care doctors who received help from the regional extension center in Massachusetts. "I'm not hearing any horror stories from them," he said. But the usability of EHRs also matters, and many of his clients "go on the cheap" when they buy EHRs, he added. <P> The Deloitte survey also had these notable findings: <P> -- 73% of physicians believe that health IT will improve the quality of care in the long term. Younger doctors and those in larger practices were more likely to say that. <P> -- 71% of physicians believe that the promise of health IT reducing costs is inflated and that the technology will drive up, not cut, costs. That position was held more widely among solo physicians and those not employed in practices belonging to accountable care organizations. <P> -- A third of doctors communicate with consumers using e-mail or texts. <P> -- 15% of physicians use telemedicine for follow-up or diagnostic visits with patients. <P> -- 14% of respondents allow consumers to schedule visits and access test results and medical records via mobile devices. <P> -- Nearly six in 10 physicians don't employ mobile health technologies -- tablets or smartphones -- for clinical purposes. <P> Of the non-users of mobile technology, 44% attribute their reluctance to the lack of cooperation in their workplace, 29% to concerns about patient privacy, and 26% to a lack of suitable apps and programs.2013-05-17T08:48:00ZBoston Children's Hospital's pioneering approach would bar parents from seeing sensitive portions of their children's personal health records.http://www.informationweek.com/healthcare/security-privacy/boston-childrens-hospital-tackles-teen-r/240155087?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/mobile-wireless/ss01081310mobilehealthappsunclesam/240145790"><img src="http://twimgs.com/informationweek/galleries/automated/937/01_Opening_Image_tn.jpg" alt="10 Mobile Health Apps From Uncle Sam" title="10 Mobile Health Apps From Uncle Sam" class="img175" /></a><br /><div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->The increase in the use of personal health records <a href="http://geekdoctor.blogspot.com/2013/05/personal-health-record-use-by.html">raises important questions about adolescents' access to their own PHRs</a> and who can view their sensitive personal health information, noted Fabienne Bourgeois, a pediatric hospitalist at Boston Children's Hospital (BCH), in a recent blog post. <P> Writing on the blog of John Halamka, CIO of Beth Israel Deaconess Medical Center, Bourgeois pointed out that children's and adolescents' PHRs are generally controlled by their parents. However, <a href="http://geekdoctor.blogspot.com">teenagers have a right to privacy when they share confidential information with their physicians</a>, she noted. Often, this includes data about reproductive health, sexually transmitted diseases, substance abuse and mental health that adolescents might not want to share with their parents. <P> "As it turns out, this type of confidential information is pervasive throughout most EHRs," noted Bourgeois, who is also the clinical lead on applications at BCH. And it is EHRs that are the main source for the PHRs that reside on patient portals. <P> <strong>[ Bill Clinton spoke out against kids' obesity at recent health conference. Read <a href="http://www.informationweek.com/healthcare/leadership/bill-clinton-stumps-for-health-it-at-him/240150379?itc=edit_in_body_cross">Bill Clinton Stumps For Health IT At HIMSS</a>. ]</strong> <P> To address these issues, BCH has developed a custom-built PHR with separate accounts for patients and parents. Bourgeois wrote, "The parent has sole access to the patient's portal until the patient turns 13, at which point both the parent and the patient can have access. &#8230; At 18 years, the patient becomes the sole owner of the portal account, and we deactivate the parent's link (unless we receive court documents stating that the parent remains the medical guardian)." <P> The federal HIPAA law dictates that the patient have sole control over his or her PHR at age 18, because an 18-year-old is defined as an adult with full privacy rights under HIPAA, Bourgeois told <em>InformationWeek Healthcare</em>. But soon, BCH will give adolescents over 18 the ability to share their information with "select individuals," including parents. They also will be able to choose which categories of information they want to share. <P> BCH has identified and tagged sensitive information from the EHR, including labs related to pregnancy, sexually transmitted illnesses (STIs), genetic results, select confidential appointments, and potentially sensitive problems and medications. <P> "This information is currently filtered from both parent and adolescent accounts, but in the near future the sensitive information will flow to the adolescent account, but not to the parent account," Bourgois said in the article. "So, even if a patient is less than 13 years, the parent would not have access to this information." <P> Asked why BCH would prevent parents from obtaining such information for children under 13 years old, she said every family is different and has a different relationship with its physician. "In one family, we'll disclose information around STIs in a 10-year-old, if we feel that the patient is at risk and it's appropriate to give that information to the family," she said. <P> However, she added, sending that information to a patient portal that includes a PHR might not be the best way to communicate it. "Some of this information is best handled in a person-to-person conversation with a provider," she said. <P> In her post, Bourgeois offered a couple of alternative ways to handle adolescent PHRs. One method would be to provide shared access for patient and parent, but filter out all sensitive information. Another approach would be to provide access only to the adolescent and include sensitive data. <P> Why would a healthcare organization want to cut off parents' access to their children's health records before they turned 18? "Some practices have found that hiding sensitive information is something that's more complicated than they can manage," Bourgeois replied in the interview. "They don't have the ability to tag information and filter the sensitive information, which is just littered throughout the EHR. Therefore, they allow access to the adolescent only." <P> BCH is also trying to deal with the problem of sensitive data hidden in unstructured parts of the EHR, such as clinical notes. "The approach we're taking with clinical notes is that we're going to create a particular type of note called confidential notes," Bourgeois said. "In addition, we're allowing providers to decide whom the note can go to. If they're going to push the note to the portal, they can choose whether it should go to the parent, the adolescent patient, or both." <P> This is not an ideal solution, because it puts the onus for protecting the privacy of this information on the physician, she acknowledged. But it's the best mechanism her institution could come up with for now, she said.2013-05-17T08:46:00ZAmerican Medical Association report finds that doctors who use EHRs during exams can maintain a good relationship with patients.http://www.informationweek.com/healthcare/electronic-medical-records/ehrs-communication-can-co-exist-for-doct/240155065?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href=" http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137"><img src="http://twimgs.com/informationweek/galleries/automated/943/Cerner-patient-portal_tn.png" alt=" 7 Portals Powering Patient Engagement" title="1 7 Portals Powering Patient Engagement" class="img175" /></a><br /><div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->Computers need not come between patients and physicians in the exam room if doctors think carefully about how they're using electronic health records and interacting with patients, according to a <a href="http://www.ama-assn.org/assets/meeting/2013a/a13-bot-21.pdf">new report</a> from the American Medical Association (AMA) board of trustees. <P> Doctors who communicate well with patients when they use paper records also tend to have fewer problems talking to patients than other doctors do when they use EHRs in the exam room, the report said. <P> The board of trustees presented the report in response to a resolution by the AMA's medical student section at the association's annual meeting last year. According to the resolution, the medical student section was concerned about <a href="http://www.hschange.org/CONTENT/1125/?words=issue%20brief%20131%20are%20we%20talking%20less?">a 2010 study</a> that "found that patients of many clinicians using EHRs believe the presence of a computer in the exam room to have a negative effect on their interpersonal communication with their physician." <P> Consequently, the resolution asked the AMA to "study the effect of electronic devices, including but not limited to computers and tablets, in the exam room on doctor-patient communication" and "recommend alternatives and modifications." <P> <strong>[ Computers do annoy patients, according to another report. Read <a href="http://www.informationweek.com/healthcare/clinical-systems/clinical-decision-support-a-turnoff-for/240147681?itc=edit_in_body_cross">Clinical Decision Support A Turnoff For Patients, Says Study</a>. ]</strong> <P> The AMA searched the literature and found that "research has consistently indicated that patient satisfaction does not appear to be adversely affected by the introduction of computers into the examination room," the board of trustees report said. However, patients do pick up on their doctors' attitudes toward computers. The more positive the physician is, the reported noted, the more likely patients are to prefer computer use in their exams. <P> Several other factors influence patient-physician interactions when doctors use EHRs in the exam room: These include the positioning of the computer monitor or device in relation to doctor and patient; physicians' proficiency in using computers; and features of the technology, such as the processes required to input data and the nature and frequency of clinical reminders and pop-ups. <P> Doctors who are better at interacting with patients in general fare better at integrating their interviewing of patients with their EHR tasks, the report noted. Technical improvements in EHRs, such as streamlining data input and focusing computer tasks "on activities that meaningfully influence patient outcomes," could improve the physician-patient interaction. But so could the removal of "spatial barriers," such as using mobile monitors or configuring exam rooms to enable physicians to maintain eye contact while using computers. <P> There's also good evidence, the report noted, that inviting patients to look at the computer screen and share information with the doctor improves the quality of the interaction and fosters shared decision-making. <P> The report cited behaviors Kaiser Permanente has recommended to help doctors integrate computers into their meetings with patients, including explaining what they're doing as they move through the EHR and pointing to the screen. It also mentioned a <a href="http://www.aafp.org/fpm/2006/0300/p45.html">Family Practice Management (FPM) article</a> that listed several tips to improve doctor-patient communications when a computer is being used. <P> William Ventres, an Oregon family physician who was the lead author on the <em>FPM</em> piece, told <em>InformationWeek Healthcare</em> that the biggest challenge in this area is the lack of physician education on how to use EHRs during an exam. <P> "Most people starting out with EHRs get very little training on how to use them in terms of the doctor-patient relationship," he said. "The computer is put down in front of them and they're told to use it. And there are many different ways of using it, but people don't get that education." This is not only a problem for older physicians who are accustomed to paper charts, he noted. Younger physicians might be more tech savvy, but they're still learning how to interact with patients. "It's hard to learn that relational part at the same time you're tending to the computer." <P> Mobile devices such as laptops and tablets can help doctors perform these tasks simultaneously, but they don't overcome the inherent limitations of the point-and-click templates in EHRs, he pointed out. Those templates are designed to document physical findings and the answers to yes/no questions, not to record the nuances of a patient's story. "Patients don't talk point and click," he said. "Patients talk story."2013-05-14T12:27:00ZAs value-based payments take hold, insurers aim to access EHR clinical data and move to automated, real-time information exchange.http://www.informationweek.com/healthcare/admin-systems/health-plans-seek-ehr-data-for-new-payme/240154846?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/7-big-data-engines-look-to-reinvent-medi/240144641"><img src="http://twimgs.com/informationweek/galleries/automated/930/Opener_image_tn.jpg" alt=" 7 Big Data Solutions Try To Reshape Healthcare" title=" 7 Big Data Solutions Try To Reshape Healthcare" class="img175" /></a><br /> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Health plans are rapidly migrating to value-based payments models, according to a new report from Availity, which provides Web-based connectivity between providers and payers. As a result of this market shift, plans are seeking new types of information from providers and want to automate the exchange of data to facilitate the new payment models. <P> The <a href="http://www.availity.com/documents/Availity_Study_on_Plan_Readiness_to_Operationalize_New_Payt_Models.pdf">Availity report</a> is based on interviews that Porter Research recently conducted with 39 health insurers. These plans, which include payers of different sizes and types -- including not-for-profit, for-profit, commercial, Blue Cross Blue Shield and Medicare Advantage plans -- are representative of the marketplace, said Brian Kagel, director of business intelligence for Availity, in an interview with <em>InformationWeek Healthcare</em>. <P> <a href="http://en.wikipedia.org/wiki/Pay_for_performance_%28healthcare%29">Value-based payment models</a> reward healthcare providers for meeting quality and efficiency goals, rather than for simply delivering a service, as in fee-for-service models. Among the value-based payment models referenced in the report are accountable care organizations, patient-centered medical homes, payment for coordination, pay for performance and bundled payments. <P> <strong>[ Are delays inevitable in healthcare reform? See <a href="http://www.informationweek.com/healthcare/policy/meaningful-use-stage-2-needs-more-time-c/240154262?itc=edit_in_body_cross">Meaningful Use Stage 2 Needs More Time, CHIME Says</a>. ]</strong> <P> Eighty-two percent of the respondents said that development of new payment models was a "major priority" for their organizations. Twenty percent said that these models support more than half of their business today; 40% predicted that that will be the case in three years; and 60% said that it will happen in five years. <P> Currently, 75% of the respondents are focusing their value-based payment initiatives on employer group plans, and 54% on Medicare Advantage plans. <P> Ninety percent of respondents agreed they need new kinds of data from providers and must automate the exchange of that information. Nearly three-quarters of the insurance executives said their companies planned to implement this automation within the next 12 to 18 months. Right now, however, 90% of the plans use a hybrid automated/manual process, and fewer than 50% have real-time automation capabilities, the report said. <P> The new kinds of data that the health plans seek include information in electronic health records (EHRs), lab systems and hospital admission-discharge-transfer (ADT) systems, said Kagel. Payers want this data, which isn't included in claims, "to give them a broader perspective of the patients, to understand the patient's history and where there might be [cost] risks," he said. They can also apply analytics to the data for care-management purposes, he added. <P> In addition, he noted, the plans want to use the same data to measure the performance of individual providers and groups. "They want to know what care was delivered and what were the outcomes of care -- whether prospectively, making sure they're focusing on the right patients and delivering preventive care more holistically, or retrospectively, looking at the quality measures and quality reporting within those value-based models." <P> From a plan perspective, it's important to automate the exchange of this information so that fewer people are needed to collect it and so that it can be gathered on entire populations. And it needs to be collected in near real time, Kagel said, so that the plans can be apprised of what's happening with members in the healthcare system. <P> "Take census reports in a hospital. In many cases, those are phoned or faxed in once a day or periodically from a hospital to a payer. Through a real-time connection to a hospital system, we can do it patient-by-patient, as it occurs, with richer information." <P> However, it will be some time before most plans have this capability, Availity CEO Russ Thomas told <em>InformationWeek Healthcare</em>. "We see a transitional process for the health plans. For example, we're implementing portal capabilities within the plan's care management system to allow real-time viewing of information. Where we think that will ultimately go is integrating that same information into their backend system for adjudication [of payments] and authorization [of tests and procedures]. Right now, we're seeing interim steps as plans upgrade their technological capabilities." <P> In the long run, he said, plans should be able to use the clinical data they pull from EHRs and other sources to help calculate value-based payments. "It's not going to happen overnight, and it might not happen in the next year or two. But as plans enter risk-based relationships with their provider groups, they have to find ways to automate the assessment and calculation of those risk payments so providers can get paid as quickly as possible." <P> Availity recently <a href="http://www.informationweek.com/healthcare/interoperability/ehr-vendor-insurer-agree-on-two-way-data/240153322">announced a three-way deal</a> with Florida Blue and EHR vendor Greenway that will enable Greenway users to receive claims-based patient summaries from Florida Blue and send clinical data back to the plan. According to Availity, this is the first bidirectional exchange of clinical information between a health plan and its providers.2013-05-13T14:53:00ZFramework aims to simplify writing interfaces between healthcare information systems, help researchers gather clinical data from EHRs.http://www.informationweek.com/healthcare/interoperability/hl7-preps-healthcare-clinical-messaging/240154770?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/7-big-data-engines-look-to-reinvent-medi/240144641"><img src="http://twimgs.com/informationweek/galleries/automated/930/Opener_image_tn.jpg" alt=" 7 Big Data Solutions Try To Reshape Healthcare" title=" 7 Big Data Solutions Try To Reshape Healthcare" class="img175" /></a><br /> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Health IT standards-development organization HL7 has developed a new standards framework for clinical messaging. Known as Fast Health Interoperable Resources (FHIR), the new architecture could simplify the writing of interfaces between healthcare information systems. It could also provide a much-sought method for clinical research organizations to pull data out of electronic health records (EHRs). <P> The HL7 membership will vote in September on whether to accept FHIR as a draft standard for trial use. If enough organizations test it and find it feasible, HL7 could adopt FHIR as a "normative" standard by the end of 2014. <P> According to <a href="http://www.hl7.org/implement/standards/fhir/fhir-summary.pdf">an HL7 document</a>, "FHIR solutions are built from a set of modular components called 'resources.' These resources can easily be assembled into working systems that solve real world clinical and administrative problems at a fraction of the price of existing alternatives... FHIR has resources for administrative concepts such as patient, provider, organization and device as well as a wide variety of clinical concepts covering problems, medications, care plans, financial concerns and more." <P> In an interview with <em>InformationWeek Healthcare</em>, Charles Jaffe, MD, CEO, of HL7, explained that these "resources" take the place of the traditional elements in HL7 messages. If new elements are desired, they can be created in an hour or two, he said, and can be quickly validated for interoperability. In contrast, he noted, the process for adding new components to HL7 messages currently can take weeks or longer, "because the [HL7] balloting process needs to establish that the specification you've developed is reliable and achieves the end result you want." <P> <strong>[ Learn more about why interoperability is gaining supporters. Read <a href="http://www.informationweek.com/healthcare/interoperability/why-telemedicine-should-be-integrated-wi/240154542?itc=edit_in_body_cross">Why Telemedicine Should Be Integrated With EHRs, ACOs</a>. ]</strong> <P> FHIR also addresses two other problems that healthcare organizations have had in using HL7's current messaging standard. First, hospitals often customize the messages by adding "extensions" to messages to accommodate their own needs. When they send these messages from one information system to another, they're human readable, but the receiving system may not be able to understand the messages. FHIR solves that problem by "defining a simple framework for extending and adapting the existing resources," the HL7 document says. <P> "In FHIR, the resources approach development in a way that the ambiguity doesn't interfere with the interpretation by another recipient," Jaffe explained. "You can message back and forth and not have the ambiguity." The messages also remain human readable, he added. <P> Second, every time a healthcare organization changes one system, it must rewrite HL7 interfaces to all of its other systems. This can cost a large, multi-hospital organization millions of dollars a year, Jaffe noted. "FHIR will change that paradigm of interface development. It will be easier and far less expensive," he said. <P> According to Jaffe, FHIR is compatible with all of the document templates in HL7's <a href="http://www.hl7.org/implement/standards/product_brief.cfm?product_id=7">Clinical Data Architecture</a> (CDA). That includes the Continuity of Care Document (CCD) that's built into some EHRs and the <a href="http://www.hl7standards.com/blog/2012/03/22/consolidated-cda/">Consolidated CDA</a> that must be used for the care summaries that have to be exchanged during transitions of care in Meaningful Use stage 2. Because both FHIR and CDA are based on HL7's Reference Information Model, Jaffe views the two architectures as complementary. Users should be able to move seamlessly back and forth between FHIR and CDA templates, he said. <P> "They not only can live together, but they'll enhance one another because of the ability to choose what's best for the circumstances," he said. <P> FHIR is also compatible with a wide variety of data transport mechanisms, including SOAP and RESTful. The latter is a Web API that allows looser coupling of Web services than SOAP does. <P> In addition, Jaffe noted, FHIR can be used to create other kinds of communication protocols. For example, he said, "You can put some of the HL7 specs in the read-only memory of a cellphone, so you don't have to transmit all of a message -- which might demand a lot of bandwidth -- each time you send the message from one device to another." <P> FHIR also provides a major opportunity to connect clinical care and medical research, he said. "Right now, the clinical research industry has a very hard time getting data out of EHRs. That will become orders of magnitude easier in this environment." <P> Conversely, if FHIR were applied to a "learning health system," he added, that might lead to faster transfer of new discoveries to patient care. <P>2013-05-13T11:53:00ZAgency seeks feedback on interoperability efforts in the field while continuing to guide private sector's efforts.http://www.informationweek.com/healthcare/interoperability/onc-webinar-reveals-details-of-data-exch/240154746?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/admin-systems/6-revenue-cycle-management-systems-tackl/240062614"><img src="http://twimgs.com/informationweek/galleries/automated/899/RCM_01_dreamstime_tn.jpg" alt="6 Healthcare Revenue Cycle Management Systems To Watch" title="6 Healthcare Revenue Cycle Management Systems To Watch" class="img175" /></a><br /> <div class="storyImageTitle"> 6 Healthcare Revenue Cycle Management Systems To Watch</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->In a webinar hosted by the National eHealth Collaborative (NeHC) last week, the Office of the National Coordinator of Health IT (ONC) <a href="http://www.nationalehealth.org/ckfinder/userfiles/files/Governance%20Update%20Slide%20Deck(1).pdf">revealed some details</a> about the interoperability work it <a href="http://www.informationweek.com/healthcare/interoperability/onc-awards-hie-interoperability-work/240152326">recently delegated</a> to two outside entities, the New York eHealth Collaborative (NYeC) and DirectTrust, the first two recipients of grants under ONC's Exemplar HIE Governance Program. <P> In collaboration with the <a href="http://www.nationalehealth.org">NeHC</a>, a nonprofit entity that educates the industry about the agency's activities, ONC also has established a health information exchange (HIE) forum for HIE governing entities. This forum, which will hold its next meeting May 29, is designed to help HIEs share best practices, discuss common challenges, and address them together, while identifying areas where new solutions are needed. <P> NYeC is the <a href="http://www.informationweek.com/healthcare/interoperability/interoperability-initiative-poised-to-tr/240009172">driving force</a> behind the EHR/HIE Interoperability Work Group (IWG), a consortium of 19 states, 20 EHR vendors and 22 HIE vendors that are collaborating on practical solutions to advance interoperability. Together with Healtheway, the nonprofit entity that operates the eHealth Exchange (successor to the Nationwide Health Information Network Exchange), IWG has contracted with the Certification Commission for Health IT (CCHIT) to test and certify EHRs and HIEs for interoperability. <P> <strong>[ Fed up with compliance roadblocks? Read <a href="http://www.informationweek.com/healthcare/interoperability/interoperability-depends-on-ehr-vendors/240153698?itc=edit_in_body_cross">Interoperability Depends On EHR Vendors: AHA</a>. ]</strong> <P> Under terms of its ONC grant, NYeC agreed to perform certain tasks related to provider directories, an essential component of secure clinical messaging, and patient matching, which is needed for query-based information exchange. <P> Specifically, NYeC will conduct pilot projects showing methods to optimize use of a provider directory during exchanges of messages that use the Direct Project secure messaging protocol. And it will conduct a learning forum to identify and improve patient-matching practices when sharing clinical information within and across communities. Both of these activities will take place from July to December 2013. <P> John Donnelly, president of InterPro Solutions, is leading NYeC's initiative. In the webinar, he explained that his task force is recruiting five to seven participants for the provider directory pilots. These participants will be states and vendors that may or may not be IWG members, he said. They will test various models for querying provider directories to support exchange of Direct messages both between EHRs and health information service providers (HISPs) and between HISPs. HISPs are the entities that convey Direct messages between trusted healthcare parties. <P> The results of these pilots, Donnelly noted, will be fed back to ONC and incorporated into IWG's Direct Specifications Implementation Guide by February 2014. <P> Seven to 12 participants, including states, regional HIEs and vendors, will be recruited for a learning forum that will develop a best practices guide on patient-matching practices for electronic record query and retrieval. The forum's goals are to improve matching algorithms, set and measure matching thresholds, and improve data quality for matching fields. <P> DirectTrust is accrediting HISPs and registration and certification authorities in conjunction with the Electronic Healthcare Network Accreditation Commission (EHNAC). Its ultimate goal is to enable HISPs to exchange information freely without having to create costly, time-consuming trust agreements with one another. <P> ONC gave DirectTrust a grant to support that work. So far, DirectTrust, which includes about 40 HISPs, HIEs and other entities, has accredited one HISP, and has accepted seven other HISPs and registration authorities as candidates for accreditation, according to DirectTrust president and CEO David Kibbe. <P> Farzad Mostashari, the national coordinator of health IT, emphasized the high priority that his office places on accelerating the expansion of interoperability among health IT systems across the nation. Noting that software vendors are working hard to build data exchange capabilities into their EHRs for Meaningful Use stage 2, he said that healthcare reform might also improve the business case for health information exchanges (HIEs) by making it "more profitable to share information than not to share information." <P> Meanwhile, ONC continues to guide the private sector's efforts to increase interoperability. The agency recently released a "<a href="http://www.healthit.gov/sites/default/files/GovernanceFrameworkTrustedEHIE_Final.pdf">framework for trusted health information exchange</a>" that conveys what it regards as model "rules of the road." <P> Alluding to ONC's effort last year -- later retracted -- to start a rulemaking process for national HIE governance, Mostashari recalled that he was persuaded by commenters who said, "'don't do rulemaking until you know what the problems are that you're trying to solve and don't freeze the market just as we're trying to get some interoperability going here.'" Consequently, ONC is trying to find out what's going on in the market and what works and doesn't work in interoperability. <P> However, he added, ONC will revisit the regulatory approach to HIE governance if necessary. "If the evidence shows that we need rulemaking to do that, we're not going to be averse to doing that, if that's what it takes," he stated.2013-05-10T14:36:00ZSurescripts annual report shows 38% growth in electronic prescribing in 2012, plus growing use of online medication histories and benefit data.http://www.informationweek.com/healthcare/cpoe/medicare-incentives-spur-jump-in-e-presc/240154676?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ 9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_i mage_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div> <!-- /KINDLE EXCLUDE --> The number of prescriptions sent electronically in 2012 soared 38% to 788 million from 570 million in 2011, according to the <a href="http://www.surescripts.com/downloads/npr/National%20Progress%20Report%20on%20E%20Prescribing%20Year%202012.pdf">latest annual report</a> from Surescripts, a company that electronically connects physician offices with pharmacies. <P> The big increase appears to be related to two factors: First, the government's Meaningful Use incentive program has spurred massive growth in the adoption of electronic health record (EHR) systems, most of which include e-prescribing modules. Surescripts data shows that in 2012, 87% of e-prescribers used an EHR, rather than a standalone e-prescribing application, to write prescriptions. <P> Second, the Centers for Medicare and Medicaid Services (CMS) has had a separate e-prescribing incentive/penalty program since 2009. Now in the penalty phase, the program will <a href="http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ERxIncentive/Downloads/2013SE13__eRx2014PaymentAdjustment_032613.pdf">reduce 2014 Medicare payments</a> by 2% for physicians who do not meet requirements for being a successful e-prescriber by June 30 of this year. <P> David Yakimischak, executive VP and general manager, e-prescribing, for Surescripts agrees that these factors have promoted adoption of e-prescribing. But he told <em>InformationWeek Healthcare</em> that physicians are continuing to use the technology in ever-greater numbers because it provides real value to them. <P> "E-prescribing is adding value and helping them practice medicine better," he said. "That's what's necessary for them to continue to use it." <P> <strong>[ Prescription drug abuse is a big problem; learn how some are trying technology to fight it. <a href="http://www.informationweek.com/healthcare/interoperability/rx-abuse-data-tools-sought-by-healthcare/240154001?itc=edit_in_body_cross">Rx Abuse Data Tools Sought By Healthcare</a>. ]</strong> <P> Despite this rapid growth, Surescripts' report also showed that the number of prescription renewals routed electronically dropped 15% to 82 million in 2012 from 96 million in the previous year. Up to that point, the number of electronic refills had increased every year since 2008. <P> The reason for this anomaly, Yakimischak said, is that Surescripts changed how it measured renewals. Before this year, the company counted any request for a renewal, whether it was approved or denied; but in 2012, it included only approved requests in its refill figure. Under the old methodology, he said, the number of renewals would have exceeded 100 million last year. <P> Another major report finding is that 47% of patient visits generated an electronically delivered medication history. That represented a growth rate of 48% in this component of e-prescribing over the previous year. <P> Community medication histories show what other providers prescribed for patients. They come from available prescribing data, which in past years had some fairly big holes in it, making some doctors reluctant to bother with these histories. According to a <a href="http://www.hschange.org/CONTENT/1202/1202.pdf">2011 research brief</a> by the Center for Studying Health System Change (HSC), medication histories were available from Surescripts for about 50% of patients, although the percentage varied from region to region. <P> The use of electronic eligibility and benefit information also jumped by a third in 2012, according to Surescripts. The HSC survey showed that this kind of information was available for 50%-80% of patients, but was often out of date or had other limitations. <P> Yakimischak believes that other factors besides the overall growth in e-prescribing account for the rise in the use of medication histories and benefit information. Health plans and pharmacy benefit managers (PBMs) have raised the percentage of patients for whom this data is available, he said, and have greatly reduced the time it takes to deliver the information to the point of care. Also, he noted, software vendors have started to integrate data from medication histories in decision support tools such as drug interaction checkers. These and other advances have encouraged more providers to use these added-value features of e-prescribing, he said. <P> The number of prescribers (not all of them doctors) who sent prescriptions electronically jumped 25% to 489,000 in 2012 from 390,000 a year earlier. This included 69% of office-based physicians, according to Surescripts. <P> The biggest growth in this category occurred among solo practitioners. Fifty-eight percent of these doctors prescribed electronically in 2012, vs. 46% in 2011. The second largest increase was in practices of two to five doctors, 64% of which included e-prescribers, compared to 53% a year earlier. And the highest percentage of e-prescribers (65%) was found in practices of six to 10 doctors, up 18% from 2011. <P> Strangely enough, the Surescripts report shows a higher percentage of doctors in groups of 10 or fewer practitioners were e-prescribing than in larger groups. Yakimischak admits that this seems counterintuitive, since other studies show that more large practices have adopted e-prescribing. However, he said, big groups and hospital systems tend to have fewer individual physicians who write prescriptions than small practices do. So the individual adoption is higher in the small groups. <P> The top 10 states in 2012 for utilization of electronic prescription routing, prescription benefit and medication history services were: Delaware, Minnesota, Ohio, New Hampshire, Massachusetts, North Carolina, Vermont, Missouri, Maine and South Dakota. Overall, physician adoption of e-prescribing was greater than 70% in 24 states, and no state had a rate below 40% in 2012. <P> <i>Innovation is tough amid today's regulatory checklists. The leaders on our Healthcare 20 list are getting it done. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/051313hc/?k=axxe&cid=article_axxt_os">Healthcare CIO 20</a> issue of InformationWeek Healthcare: Boston area CIO John Halamka reflects on the marathon bombing. (Free registration required.)</i>2013-05-09T12:00:00ZTelemedicine expert Rashid Bashshur says mobile health technologies must integrate with EHRs to make accountable care organizations work.http://www.informationweek.com/healthcare/interoperability/why-telemedicine-should-be-integrated-wi/240154542?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/policy/240005118"><img src="http://twimgs.com/informationweek/galleries/automated/848/SS_ACO_dreamstime_01_tn.jpg" alt="8 Accountable Care Organizations Worth Closer Examination" title="8 Accountable Care Organizations Worth Closer Examination" class="img175" /></a><br /> <div class="storyImageTitle">8 Accountable Care Organizations Worth Closer Examination</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> A veteran observer of telemedicine says that it's time for the various technologies grouped under that rubric to be integrated with mainstream medicine so that patients can receive the appropriate care from the right provider at the right site of care, while reducing waste and duplication of effort. <P> In a <a href="http://online.liebertpub.com/doi/pdfplus/10.1089/tmj.2013.9998">lengthy editorial</a> in the publication <em>Telemedicine and eHealth</em>, Rashid Bashshur, director of telemedicine at the <a href="http://www.med.umich.edu">University of Michigan Health System</a>, also argued that this form of care delivery is essential to accountable care organizations (ACOs). <P> "If properly constructed, a full-service telemedicine network would provide the foundation for a successful ACO," he wrote. "It would introduce the necessary organizational change in the delivery process rather than simply making the old system operate electronically." <P> In an interview with <em>InformationWeek Healthcare</em>, Bashshur defined telemedicine as "as a system of care where the providers and the recipients of care are not in the same place at the same time," but use IT to communicate with each other. However, he added, certain aspects of mobile health technology, such as fitness and wellness apps that patients use on their smartphones without interacting with providers, would also fit into the same category. <P> <strong>[ Want more on mobile health IT? See <a href="http://www.informationweek.com/healthcare/mobile-wireless/10-mobile-health-apps-from-uncle-sam/240145790?itc=edit_in_body_cross">10 Mobile Health Apps From Uncle Sam</a>. ]</strong> <P> In his commentary, Bashshur said there is a need to develop "telemedicine systems that incorporate and integrate the core elements of healthcare reform, namely, EHR [electronic health record], MU [meaningful use], HIE [health information exchange] and ACO." <P> How would he integrate telemedicine with EHRs? To start with, he noted in the interview, a healthcare provider who has a virtual encounter with a patient via telehealth should create an EHR for that patient. Then the information can be ported over to a personal health record (PHR) that the patient can view on a portal that also allows communication with the provider. The physician can use an HIE to share that information with other providers caring for the same patient. <P> When mobile and home monitoring comes into play, the situation becomes more complex, he said, because the sheer volume of data can easily overwhelm providers. Part of the solution, he stated, lies in "how well the electronic record is organized. There are some systems that allow you to go to the key points you're after, and others require you to read through a lot of other stuff. There are ways the EHR can be organized to simplify the search process." <P> But it's still difficult to separate the relevant from the irrelevant information in a huge data stream. Today's EHRs are incapable of doing that (although EHR vendor eClinicalWorks <a href="http://www.informationweek.com/healthcare/mobile-wireless/ehr-vendors-tap-software-developers-to-e/240152693">promises a new feature</a> to address that challenge in the near future). So some providers -- the University of Michigan Health System included -- have nurse care managers sift through the incoming monitoring data to detect changes in patients' conditions. At UMHS, for example, the nurses are supposed to call patients with congestive heart failure if they gain more than three pounds in a day. <P> But it's not clear whether nurses are always watching the data or interpreting it correctly, Bashshur pointed out. Automation, he said, could improve the process "by reducing individual variations in judgment. It shouldn't be what this nurse or that nurse thought at that particular time. It should be a standard protocol that is applied uniformly. And second, when there's a red signal, it should provoke an action. Something should be done." <P> In the bigger picture, he said, ACOs and other organizations that do population health management need full-service telemedicine networks to engage patients in managing their health and improving their health behavior. That's critical, he said, if you want to keep people healthy and spend less on healthcare. <P> Telemedicine networks, he said, could be used to provide preventive care and patient education, as well as for diagnosing and treating non-serious conditions in telehealth consults. With telemedicine, "you don't have to bring everybody in for small problems. You can sort them out before they come in." If patients need to be seen, a specialist at an academic medical center like UMHS can bring them in, he added. Otherwise, he or she can handle the problem remotely and refer them back to the primary care physician in their community. <P> <i>Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/040113hc/?k=axxe&cid=article_axxt_os">The Right Health IT Priorities?</a> issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)</i>2013-05-09T11:52:00ZPersonal mobile devices still present huge security challenge, say HIMSS Analytics focus group participants.http://www.informationweek.com/healthcare/security-privacy/health-it-execs-top-worries-security-byo/240154568?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/security-privacy/232500404"><img src="http://twimgs.com/informationweek/galleries/automated 724/07_Goods_App_Device_600x600_shadow_tn.jpg" alt="Health Data Security: Tips And Tools" title="Health Data Security: Tips And Tools" class="img175" /></a><br /> <div class="storyImageTitle">Health Data Security: Tips And Tools</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->Seven senior IT executives who participated in a focus group conducted by analyst group HIMSS Analytics cited data security concerns -- especially those related to the growing use of personal mobile devices -- as among their top challenges. Other pressing issues included the growth in data storage needs and health information exchange. <P> Although the focus group was small, what the participants said reflected <a href="http://apps.himss.org/content/files/comcastfinal042313.pdf">the IT infrastructure priorities of the industry</a>, as represented in a recent survey by the Health Information Management and Systems Society (HIMSS), according to a report on the focus group. <P> The IT executives lamented their loss of control over device management in a "bring your own device" (BYOD) environment. As one participant noted, "you can't lock down [providers'] personal e-mail." <P> <strong>[ Want more on BYOD in healthcare? Read <a href="http://www.informationweek.com/healthcare/mobile-wireless/halamka-knows-perils-and-promise-of-heal/240144414?itc=edit_in_body_cross">Halamka Knows Perils And Promise Of Healthcare BYOD</a>. ]</strong> <P> Another participant pointed out that with the proliferation of personal smartphones and iPads in hospitals, "data is exchanged insecurely whether you like it or not," regardless of how many security controls are put in place. Providers tend to find workarounds that can jeopardize data security, several people said. <P> According to a <a href="http://www.himssanalytics.org/research/AssetDetail.aspx?pubid=81559&tid=131">December 2012 HIMSS survey</a> on mobile devices, 75% of hospitals are using "remote wipe" capabilities to eliminate data on lost or stolen devices. Also, many facilities are using mobile devices to access data but not to store it, noted Jennifer Horowitz, senior research director of HIMSS Analytics, in an interview. <P> "For the most part, organizations are viewing these devices as access tools and not necessarily as storage tools. They don't want the data [to reside] on the device," she said. <P> The focus group participants pointed out that the use of wireless networks makes it difficult, if not impossible, to prevent employee use of the Internet for personal reasons. Although some hospitals tried to restrict access to websites such as Amazon, Facebook and Twitter, they found that employees figured out how to reach those sites by using their institution's guest network. <P> When clinicians are working, rather than playing, they might encounter "drop zones" in their wireless networks where the signals to mobile devices fade out. Participants reported using a variety of solutions to address this problem, including "virtual desktops" that let users who experience a dropped signal pick up where they left off when wireless access is restored. One participant said his institution used a microwave network to transmit and receive data in places where cellular signals are blocked. <P> Data storage was cited as another problem, mainly because of the spread of data-hungry picture archiving and communications systems (PACS). Among the issues were "the ability to store an ever-increasing number of data-intensive images, challenges in exchanging images created by remote clinicians, and securing images taken with a mobile imaging machine," according to the report. <P> One participant said his organization had trouble linking to remote sites because the only solution available was "painfully slow." Yet he did not mention the possibility of using a cloud service to store data and applications. <P> In general, the participants "were approaching the use of cloud computing with caution," the report said. Some executives said they were comfortable with the use of a private cloud hosted by their primary health IT vendor. But they were still more likely to store administrative data in the cloud than clinical data containing personal health information. <P> One major obstacle to using the cloud, Horowitz pointed out, is the difficulty that providers have had in obtaining business associate agreements (BAAs) from cloud vendors. Under the latest HIPAA rules, providers are required to have BAAs with cloud computing firms. If they don't, they could get in trouble with the government, and they also run the risk of being sued if there is a security breach involving personal health information. <P> "If hospitals put their information out there in the cloud, and anybody else has access to or control over it, hospitals need to feel secure that the appropriate security mechanisms are put into place," Horowitz said. <P> Although <a href=" http://www.informationweek.com/healthcare/policy/microsoft-updates-cloud-agreement-for-hi/240153864">Microsoft and Box</a> recently announced that they have HIPAA-compliant BAAs, some other public cloud vendors apparently don't. It is unclear, however, why any technology vendor that hosts a private cloud service designed primarily for hospitals or physician practices would not sign a BAA. <P> Lisa Gallagher, VP of technology solutions for HIMSS, told <em>InformationWeek</em> that in the recent past, "some cloud vendors were reluctant to sign BAAs." But the new HIPAA Omnibus Rule makes it clear that all providers must have such agreements in place with cloud providers. "So, now cloud providers must sign BAAs when their services include receiving and storing PHI [personal health information]."2013-05-07T09:06:00ZAnalytics company teams with DHHS and the Centers for Medicare and Medicaid Services to give developers data that could help them create better healthcare apps.http://www.informationweek.com/healthcare/clinical-systems/archimedes-analyzes-medicare-claims-for/240154272?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/7-big-data-engines-look-to-reinvent-medi/240144641"><img src="http://twimgs.com/informationweek/galleries/automated/930/Opener_image_tn.jpg" alt=" 7 Big Data Solutions Try To Reshape Healthcare" title=" 7 Big Data Solutions Try To Reshape Healthcare" class="img175" /></a><br /> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->Archimedes, a San Francisco-based healthcare modeling and analytics company, <a href="https://stagecms.archimedesmodel.com/PR-1-May-2013"> has joined forces</a> with the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to make CMS claims data more accessible to and usable by software developers and researchers who are seeking solutions to improve healthcare and lower its costs. <P> The collaborative effort will use Archimedes' ARCHeS Simulation and Analytics software to analyze the recently published Medicare Data Entrepreneurs Public Use File (DE-SynPUF). This is a set of free downloadable files containing a subset of claims data representing a "synthetic" 5% sample of Medicare claims from 2008 to 2010. <P> CMS calls the data synthetic because it has not only been de-identified, but it has also been altered to safeguard the privacy of the patients involved, said Mika Newton, VP, ARCHeS and consulting business leader for Archimedes. For example, it does not contain information about geographical location, and it mixes certain kinds of clinical data, such as blood pressure and cholesterol level, among different patients. In the aggregate, however, it represents what the patient population looks like and retains the data structure of the original claims information, he said. <P> <strong>[ Electronic health record (EHR) companies are beginning to partner with outside software developers. Read <a href="http://www.informationweek.com/healthcare/mobile-wireless/ehr-vendors-tap-software-developers-to-e/240152693?itc=edit_in_body_cross">EHR Vendors Tap Software Developers To Expand Reach</a>. ]</strong> <P> Software developers and researchers can use ARCHeS to query and analyze the rates of various outcomes for specific Medicare populations, such as those with a particular health condition, age criterion, medication use, or a combination of these factors. This can be very powerful, because the dataset represents millions of patients, Newton pointed out. <P> Health IT firms and researchers can run ARCHeS Population Explorer against the DE-SynPUF, which is freely available on the CMS website, to determine the viability of particular solutions or research projects under development, he said. This can be useful in applying for a grant or deciding whether an idea is worth pursuing before a lot of time and money is spent on a pilot. <P> For example, he said, the average inpatient cost for patients with diabetes exceeds that for patients without the disease or with a less severe form of it by a certain amount. If a solution is designed to make it easier to control diabetes, one can infer from the difference between these cohorts how much that application might save. <P> Archimedes built the ARCHeS software with funding from the Robert Wood Johnson Foundation. Its original goal was to help the government or guideline makers decide whether to pursue certain healthcare policies. For example, Newton noted, if policy makers are considering whether to reduce the amount of calories in restaurant food to reduce obesity, they could use ARCHeS to model how much money or resources that would save. If the Joint National Committee that sets guidelines for treating hypertension decides to change its recommendations, it can use ARCHeS to see how much that would cost and how it might affect outcomes. <P> Software developers that want to use ARCHeS Population Explorer can download the basic version for free to view the synthetic Medicare claims data. If they want to use the analytics within their own application or build a solution around it, they must pay a license fee, Newton said. Archimedes charges government agencies only a fraction of what the ARCHeS license costs commercial firms, he added. <P> Another Archimedes application, indiGO, <a href=" http://www.informationweek.com/healthcare/clinical-systems/futuristic-clinical-decision-support-too/232500603">is being used by a number</a> of healthcare organizations to predict the chances of patients developing a serious chronic condition. It also suggests to patients and clinicians the best interventions for warding off heart attacks, strokes, or other serious adverse events. Among the organizations that have adopted indiGO are Kaiser Permanente, <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Intermountain</a>, the Marshfield Clinic, Fairview Health Services, and the Colorado Beacon Consortium. <P> Archimedes will demonstrate ARCHeS Population Explorer immediately preceding the fourth annual Health Datapalooza, scheduled for June 3-4 at the Omni Shoreham Hotel in Washington, D.C.2013-05-06T14:41:00ZHealthcare CIO group tells U.S. senators that providers need extension on current timeframe for EHR, interoperability work.http://www.informationweek.com/healthcare/policy/meaningful-use-stage-2-needs-more-time-c/240154262?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/ 9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_i mage_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div><!-- /KINDLE EXCLUDE -->The College of Health Information Management Executives (CHIME) has proposed a <a href="http://www.cio-chime.org/chime/PressReleases/pr5_6_2013_9_12_38.asp">one-year extension of Meaningful Use stage 2</a> to "maximize the opportunity of program success." The recommendation was part of a letter that CHIME sent to six U.S. senators who asked for feedback on their <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ehr-incentive-program-is-off-track-senat/240153117">recent report</a> that criticized the direction of the Meaningful Use program. <P> According to the organization of healthcare CIOs, an additional 12 months to meet the stage 2 requirements "will give providers the opportunity to optimize their EHR technology and achieve the benefits of stage 1 and stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policy makers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules." <P> At present, stage 2, which was postponed by a year from the initial time frame, <a href="http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives">encompasses 2014 and 2015</a>. CHIME's proposal would probably result in stage 3 being pushed back from 2016 to 2017, said George Hickman, the board chair of CHIME, in an interview with <em>InformationWeek Healthcare</em>. Adding a year to stage 2, he said, "implies more working time for building a good stage 3." <P> <strong>[ Doubt about regulations' timeline has been brewing for a while. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/docs-hospitals-say-delay-meaningful-use/240146442?itc=edit_in_body_cross">Docs, Hospitals Say Delay Meaningful Use Stage 3</a>. ]</strong> <P> Right now, he noted, "stage 3 is not well defined." Extending stage 2 will enable policy makers to measure the experience of healthcare providers in stage 2 and incorporate that into stage 3. In addition, he said, it will provide more time to improve the interoperability of systems and devise a reliable national solution for matching patients with their data. <P> On the interoperability front, Hickman, who is executive VP of Albany Medical Center in Albany, N.Y., noted that only four EHRs have been certified so far to send and receive messages using the Direct secure messaging protocol. Pointing out that "Direct is one way to meet [stage 2] data exchange requirements around transitions of care," he asks, "How many vendors are ready to get their products certified in that area? And do providers have time to adopt and implement that and exchange data with other providers?" <P> Albany Medical Center is the first healthcare organization in the state of New York to use Direct "in a production environment for both its hospital and its ambulatory clinics," he said, and so far no other providers in the area have developed a similar capability. <P> "It feels like we're the first to invent the fax machine," said Hickman. "Nobody else has a fax machine yet, and we're waiting for others to catch up so we can have some data exchange. And here we are, almost halfway through 2013 and nearly a year away from when we'd attest to stage 2." <P> This is one example of the nationwide problem with the stage 2 timetable that CHIME is trying to address, he said. "If we're there and others aren't there yet, and that's the lion's share of providers, we need to slow things down a bit so we can get everybody caught up." <P> CHIME's letter also calls for Congress to encourage the Office of the National Coordinator of Health IT (ONC) to develop a nationwide patient matching system to replace the piecemeal solutions that provider organizations and health information exchanges across the country have devised. Noting that this is a patient safety issue, Hickman said that a national patient identifier -- opposed by privacy advocates -- is one way to approach this. Alternatively, a standardized matching algorithm could be developed to identify patients uniquely, he said. <P> The Health Information Management and Systems Society (HIMSS) <a href="http://www.informationweek.com/healthcare/patient/himss-asks-congress-for-patient-identity/240007949">espoused the same idea</a> last fall, and a prominent health IT advocate and consultant <a href=" http://www.informationweek.com/healthcare/admin-systems/national-patient-id-system-debate-stoked/240151956">recently started a petition</a> at whitehouse.gov to lift the Congressional ban on a national patient identifier. <P> CHIME also raised the issue of excessive auditing of providers in the Meaningful Use program, which can lead to auditors looking beyond attestation to Meaningful Use. Hickman cited auditors who, according to other CIOs, have pried into whether the use of certified EHRs to protect security complies with the latest HIPAA regulations. <P> Overall, Hickman said, the senators' white paper raised "some issues that were worth looking at." CHIME agrees that the Meaningful Use program, like any other taxpayer-funded program, should be scrutinized and held accountable, he said. <P> "On the other hand," he added, "we believe that it would be a mistake to 'throw the baby out with the bathwater.' To believe that some things should be scrutinized doesn't mean that the program as a whole should be called into question. We think it's a great program, and we want it to continue." <P> Many CIOs, he pointed out, "built incentive money into the business cases that they took to their boards to get the funding to go down the path and implement EHRs and interoperability. To pull that money off the table would not be prudent or helpful to what we're trying to do as a nation to create a health information network."2013-05-03T12:02:00ZMyfamily app presents content from Healthfinder.gov site to help consumers take charge of their healthcare.http://www.informationweek.com/healthcare/mobile-wireless/lyfechannel-wins-hhs-mobile-app-challeng/240154146?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/mobile-wireless/ss01081310mobilehealthappsunclesam/240145790"><img src="http://twimgs.com/informationweek/galleries/automated/937/01_Opening_Image_tn.jpg" alt="10 Mobile Health Apps From Uncle Sam" title="10 Mobile Health Apps From Uncle Sam" class="img175" /></a><br /><div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> The Department of Health and Human Services (HHS) has chosen a mobile health application from San Francisco-based Lyfechannel as the winner of its healthfinder.gov Mobile App Challenge. The winning app, which received a $50,000 cash prize, uses content on preventive care and health promotion from the <a href="http://healthfinder.gov/Default.aspx">healthfinder.gov</a> website to help consumers design family health plans. <P> The purpose of the contest was to get consumers more involved in their own healthcare by using a medium that has captured their attention, said Don Wright, MD, deputy assistant secretary for health and director of the Office of Disease Prevention and Health Promotion, in an interview with <em>InformationWeek Healthcare</em>. <P> "In light of the fact that mobile technology and the mobile environment are exploding, we thought that we should exploit this technology in our efforts to promote disease prevention and health promotion activities, especially as it's related to clinical preventive services," he said. <P> The app includes information about the preventive services that, under the Affordable Care Act (ACA), <a href="http://kaiserfamilyfoundation.files.wordpress.com/2011/04/8061-021.pdf">health plans must cover</a> if they intend to participate in the state health insurance exchanges. Wright noted that the ACA aims to address shortfalls in the utilization of preventive services, "and we wanted to create a tool that would increase use of those services." <P> <strong>[ Want new ways to take charge of your health? Read <a href="http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137?itc=edit_in_body_cross">7 Portals Powering Patient Engagement</a>. ]</strong> <P> According to an <a href="http://www.hhs.gov/news/press/2013pres/04/20130430a.html">HHS news release</a>, "Submissions were reviewed based on weighted criteria, including usability and design, evidence of co-design, innovation in design, functionality and accuracy, and healthfinder.gov branding. Particular emphasis was placed on the use of plain language and health literacy principles, as well as connecting users to healthfinder.gov information about clinical preventive services." <P> Lyfechannel's <a href=" http://lyfechannel.com/?page_id=13">Myfamily app</a> enables consumers to use their mobile phones to enter their age, gender and pregnancy status on behalf of themselves and their family members. Based on that information, the app provides each individual with tailored content from healthfinder.gov on appropriate preventive services. In addition, it sends them monthly alerts about the preventive care they need, helps them track medical appointments and immunizations, and lists preventive services that their plans must cover under the ACA. <P> The next version of the app, LyfeChannel CEO Dave Vockell told <em>InformationWeek Healthcare</em>, will include health risk assessments related to conditions such as cardiovascular disease and cancer screenings. "It will augment the healthfinder.gov recommendations and be more tailored to engaging conditions you might already have or helping to surface them," he said. <P> Lyfechannel's app is available for iPhones and iPads and the firm will soon add an Android version. Its content can be read in English or Spanish. <P> There are also plans to connect the app with electronic health records (EHRs), Vockell said, adding that Lyfechannel's other apps are integrated with Allscripts. Wright commented, "It's our hope that eventually this app will be incorporated into the EHR. That's the direction the entire country is moving in." <P> In the first phase of the HHS contest, the 26 participating app developers "worked with end users, via a crowdsourcing platform called Health Tech Hatch (HTH), to build a working prototype," the press release said. "More than 160 individuals registered as testers and provided more than 260 comments." <P> The value of this crowdsourcing approach, Vockell said, was somewhat limited by the fact that many of the testers were healthcare providers and "technology early-adopter participants." So Lyfechannel's developers augmented this approach by conducting an impromptu focus group in the parking lot of a dollar store in El Cerrito, about an hour's drive from San Francisco, he said. <P> Presenting the healthfinder.gov content in a user-friendly manner was a paramount goal of the contest, and Wright said that Myfamily does so in a way that can be understand by almost any American. But Vockell added that health literacy is not just a matter of reading level. While the content from healthfinder.gov is at a 6th or 7th grade reading level, he noted, "Myfamily tries to translate the information from the consumer into a clear action plan, which is a core component of the literacy principles."2013-05-02T11:31:00ZNaviHealth uses algorithms, outcomes database to create protocols for therapy, reduce variations in care.http://www.informationweek.com/healthcare/clinical-systems/post-acute-care-manager-promises-lower-c/240154053?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href=" http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137"><img src="http://twimgs.com/informationweek/galleries/automated/943/Cerner-patient-portal_tn.png" alt=" 7 Portals Powering Patient Engagement" title="1 7 Portals Powering Patient Engagement" class="img175" /></a><br /><div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->NaviHealth, a company that uses health IT and case managers to manage post-acute care for health plans and healthcare systems, is working with healthcare systems on Medicare bundled payment pilots that involve hospital care and post-acute-care for up 90 days after discharge. <P> Signaling the new importance of post-acute-care in the industry, the company <a href="http://www.businesswire.com/news/home/20130425005867/en/naviHealth-Receives-Strategic-Investments-BlueCross-BlueShield-Venture">recently received investments</a> from Blue Cross Blue Venture Partners, an offshoot of the Blue Cross Blue Shield Association, and Ascension Health Ventures, a fund controlled by Ascension Health and several other healthcare organizations. <P> NaviHealth uses a proprietary, evidence-based analytics technology to identify the best treatment regimens for patients and to help reduce variations in care. The technology relies on algorithms and a database of 750,000 patient outcomes that have been tracked over 10 years, said Carter Paine, senior VP of business development for NaviHealth, in an interview with <em>InformationWeek Healthcare</em>. <P> This database was created by SeniorMetrix, a firm that NaviHealth acquired shortly after its formation. SeniorMetrix has been selling its technology to Medicare Advantage plans for 14 years, and has worked with Kaiser Permanente for a decade. <P> <strong>[ Want more on the state of post-acute care? Read <a href="http://www.informationweek.com/healthcare/interoperability/health-it-progress-in-post-acute-care-re/240151316?itc=edit_in_body_cross">Health IT Progress In Post-Acute Care Remains Slow</a>. ]</strong> <P> NaviHealth uses this technology to do functional assessments of patients while they're still in the hospital, focusing on three areas: lower body, upper body, and cognitive ability. <P> "Those are the primary drivers of what kind of post-acute therapy someone should be receiving," Paine said. "It's not diagnosis alone. Function is the core driver of how post-acute therapy regimens should be structured. Function is the key variable we use in our database to do a patient assessment and predict what that post-acute protocol should look like." <P> Applying its algorithm to the functional findings and the outcomes of similar patients drawn from its database, NaviHealth creates a protocol that determines both the recommended treatment regimen and the right type of care setting for that patient. It provides this information to patients and caregivers to help them make good decisions, and also gives it to post-acute-care facilities. <P> In addition, Paine said, NaviHealth measures the performance of post-acute providers in each market it enters. Within three to six months, he noted, the firm knows which providers are the most efficient and deliver the highest quality care. <P> "There's a lot of variation, and the tool allows us to educate patients on who the quality providers are, not just the ones who will pick them up the fastest or who are closest to home," he said. <P> After discharge, NaviHealth nurse case managers "round" in post-acute-care facilities once a week to reassess patients and adjust their therapy protocols, he added. They also guide transitions of care to ensure that patients get their discharge medications and see their primary care doctor if they're discharged to home. Regardless of whether patients have a doctor, the nurses perform most of the care management, including teaching patients how to manage their own care. <P> Although it's too early to say NaviHealth reduces readmissions, the company has been able to reduce customers' spending on post-acute care by 15% to 30% without having an adverse effect on outcomes, Paine said. <P> Because the information systems in post-acute-care facilities are generally limited, NaviHealth collects its own data without connecting to those providers' systems. However, it does integrate with hospital EHRs to download key clinical data about its patients, Paine said. <P> Post-acute care has always been important to health plans, because it accounts for 20% to 25% of their total medical spending, he said. With the advent of healthcare reform, it has also become a matter of concern to hospitals, which are being <a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html">penalized by Medicare for excessive readmissions</a> and which are also starting to take bundled payments for acute and post-acute care. <P> Post-acute-care providers have been receptive to NaviHealth's approach, Paine said. This is partly because they want to remain in health plans' networks, and also because hospitals are their biggest source of referrals.2013-05-02T08:51:00ZInvestors eye the growing wearable health device market as sensors become more sophisticated and deliver more health information to consumers.http://www.informationweek.com/healthcare/mobile-wireless/jawbones-bodymedia-buy-wearable-monitors/240153991?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-gadgets/240012613"><img src="http://twimgs.com/informationweek/galleries/automated/894/01_IMEC_tn.jpg" alt="10 Wearable Health Gadgets" title="10 Wearable Health Gadgets" class="img175" /></a><br /> <div class="storyImageTitle">10 Wearable Health Gadgets</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->Jawbone's <a href="http://www.prnewswire.com/news-releases-test/jawbone-to-acquire-bodymedia-inc-furthering-its-leadership-in-wearable-technology-205375161.html">acquisition of BodyMedia</a>, a leading vendor of wearable health monitors, has drawn renewed attention to the potential of the mobile health market. Although it's not clear whether a wave of consolidation lies ahead, the purchase of BodyMedia underlines the rapid growth of the "quantified self" consumer market. <P> Long known for its Bluetooth audio speakers, Jawbone burst into the mobile health products space in 2011 with its Up bracelet, which tracks a user's movement and sleep patterns and displays the results on a smartphone. Jawbone just announced an iOS app platform on which <a href="http://content.jawbone.com/static/www/pdf/press-releases/UP-Platform-pr-043013.pdf">10 outside partners are integrating their apps with its device</a>. <P> BodyMedia, one of the oldest firms in the wearable sensor field, was founded in 1998. Its Fit armband, which has been approved by the Food and Drug Administration (FDA) for weight loss, helps users track weight and calorie intake, as well as activity and sleep. Its Core 2 armband, set to launch later this year, can track a user's heart rate, temperature, heat flux, sweat and motion, according to <a href="http://medcitynews.com/2013/04/jawbone-acquires-bodymedia-launches-up-app-platform/">MedCity News.</a> <P> <strong>[ Check out these mobile health apps from the government. Read <a href="http://www.informationweek.com/healthcare/mobile-wireless/ss01081310mobilehealthappsunclesam/240145790?itc=edit_in_body_cross">10 Mobile Health Apps From Uncle Sam</a>. ]</strong> <P> BodyMedia has been featured on the NBC-TV show "The Biggest Loser" and also has partnerships with Jenny Craig and Apex Gyms, <a href="http://mobihealthnews.com/21990/breaking-jawbone-acquires-bodymedia/">MobiHealth News</a> reports. In January, the company launched a pilot with Cigna, which wants to use its devices in diabetes prevention and management. BodyMedia holds 87 patents, along with a <a href="http://www.prnewswire.com/news-releases-test/jawbone-to-acquire-bodymedia-inc-furthering-its-leadership-in-wearable-technology-205375161.html">staggering amount of data generated by its devices</a>, according to a news release. <P> All of this made BodyMedia an attractive target for acquisition. But the real opportunity for Jawbone lies in BodyMedia's depth of experience in wearable monitors and its understanding of analytics, said Mohit Kaushal, MD, a partner in San Francisco-based venture capital firm Aberdare Ventures, in an interview with <em>InformationWeek Healthcare</em>. <P> With multiple sensors, advanced analytics, the right interface, and the right behavioral science for presenting this information to consumers, Jawbone and BodyMedia could help improve wearers' health, said Kaushal, who is the former chief strategy officer of West Health Institute. <P> The de-identified data in BodyMedia's database also could be valuable, he said. Although there's no way to connect this information with clinical data, he noted, the sensor data could provide value on its own. For example, he said, "if you can capture a person's weight, how much exercise they get, and their hydration and diet information, that can create a very rich data source. You can use that data to create not only the analytics, but also the platform to message the results back to me and improve my lifestyle." <P> Venture capitalists have been showing an appetite for health IT, particularly in the consumer mobile health product market. Their nearly <a href="http://www.informationweek.com/healthcare/mobile-wireless/health-it-investments-approach-500-milli/240153263">half-a-billion-dollar investment</a> in the sector during the first quarter set a record. <P> "Our healthcare system is going through transformational change. So it's not surprising that the technologies and tools that enable that transformation are getting a lot more interest and traction in the investment community," said Kaushal. <P> Will BodyMedia's acquisition boost the value of similar companies? Absolutely, said Kaushal. "Acquisitions are a good thing, because it shows there's a market need and a wish to value those types of products," he said. "The space has been growing for the past couple of years and waiting for acquisitions. Aetna's purchase of iTriage shows how the space is evolving and maturing." <P> Nevertheless, Kaushal would not predict whether the wearable monitor field or any other consumer play will be a big beneficiary of investor interest in the next year. What he does forecast is that there will be big growth in "information-based companies in healthcare," whether they target consumers, providers or payers. <P> In Kaushal's view, this is all about healthcare transformation. "Services and technologies that enable that transformation, in our opinion, will be held in really high value by the marketplace."2013-04-30T11:22:00ZMicrosoft responds to new HIPAA regulations that make cloud service providers "business associates" of healthcare providers and health plans.http://www.informationweek.com/healthcare/policy/microsoft-updates-cloud-agreement-for-hi/240153864?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/mobile-wireless/ss01081310mobilehealthappsunclesam/240145790"><img src="http://twimgs.com/informationweek/galleries/automated/937/01_Opening_Image_tn.jpg" alt="10 Mobile Health Apps From Uncle Sam" title="10 Mobile Health Apps From Uncle Sam" class="img175" /></a><br /><div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->Cloud service providers are starting to take notice of the new HIPAA security regulations that define them as "business associates" of HIPAA-covered entities such as healthcare providers and health plans. Microsoft has just announced</a> a revised <a href="http://www.prnewswire.com/news-releases-test/microsoft-updates-business-associate-agreement-to-address-new-hipaa-requirements-and-help-enable-healthcare-organizations-to-maintain-compliance-in-the-cloud-204691141.html">business associate agreement (BAA) for its cloud services</a> that reflects the new HIPAA Omnibus Rule governing data security. Last week, Box, which offers another cloud storage and information sharing platform, made a similar announcement, claiming that its <a href="http://www.informationweek.com/healthcare/electronic-medical-records/box-expands-healthcare-offerings/240153650">compliance with the latest HIPAA regs</a> distinguishes it from most of its competitors. <P> Among other things, the <a href="http://www.hhs.gov/news/press/2013pres/01/20130117b.html">HIPAA Omnibus Rule</a>, which went into effect March 26, requires covered entities to sign BAAs with business associates that commit the latter to protect personal health information (PHI) when it's under their control. The business associates must also sign BAAs with subcontractors that have access to PHI. And business associates are directly accountable to the Office of Civil Rights in the Department of Health and Human Services for security breaches. <P> The definition of "business associate" has also changed, noted Hemant Pathak, assistant general counsel of Microsoft, in an interview with <em>InformationWeek Healthcare</em>. Now it includes firms that maintain and store PHI, such as cloud storage providers, as well as those that create, receive or transmit PHI. <P> <strong>[ Are your patients involved enough in their own care? Read <a href="http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137?itc=edit_in_body_cross">7 Portals Powering Patient Engagement</a>. ]</strong> <P> Microsoft's new BAA applies to Office 365, Microsoft Dynamics CRM Online and Windows Azure Core Services. Microsoft HealthVault, the company's personal health record platform for consumers, has had its own BAA since 2009. That pact has also been upgraded in accordance with the Omnibus Rule, Pathak said. <P> Microsoft put a BAA in place for Office 365 in 2010 and subsequently offered it for its other cloud services. It developed the agreement in conjunction with a consortium of covered entities, including health insurer WellPoint and the academic medical centers of Duke University, the University of Iowa and Thomas Jefferson University, Pathak said. That initial BAA complied with the proposed HIPAA requirements embodied in the HITECH Act of 2009. <P> "All those customers told us, with HITECH coming online, that a BAA was a threshold minimum requirement to consider a subscription to a cloud service such as Office 365," Pathak said. <P> The first customer to sign the revised BAA was Johns Hopkins University, he noted. In addition, the Texas Department of Health and Human Services and the city of Chicago have already signed the agreement, he said. <P> Microsoft's strategy in offering a single BAA that covers all of its cloud services (HealthVault excepted) is to make life easier for its customers, said Dennis Schmuland, Microsoft' chief health strategy officer, U.S. health & life sciences, in an interview. "We're trying to simplify things for the customers and enable them to consolidate their cloud strategy under a single governance, risk and compliance framework," he said. "That allows them to have a BAA for multiple cloud offerings, whether they're for productivity, communications, collaboration, data hosting, application hosting or CRM. One business associate agreement serves all of those." <P> The new BAA has been designed to fit entities of every size, from a five-physician practice to a 50,000-user organization such as Advocate Healthcare in Chicago, Pathak said. While some customers have asked Microsoft to enter their own agreements, he said, the company insists that everyone sign its BAA. <P> "It's not really feasible and not scalable for us to manage that subscription service out of our data centers to each individual customer's requirements," he explained. "It has to be managed and delivered in a uniform process to all our subscribers." <P> Some healthcare providers have not asked cloud service providers to sign BAAs in the past, but any covered entities that fail to enter these agreements run a serious compliance risk, Pathak noted. Schmuland agreed. "We'll provide the protections, regardless, and we'll help them comply. But if they choose not to sign a BAA, they're at risk," he said. <P> Beyond the HIPAA security requirements, he added, Microsoft is also committed to protecting the privacy of PHI, both for covered entities and consumers. The company promises not to mine the data or use it for any secondary purposes, and it guarantees that it will not commingle data from one covered entity with that of any other entity that uses its cloud services. <P> <i>Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/040113hc/?k=axxe&cid=article_axxt_os">The Right Health IT Priorities?</a> issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)</i>2013-04-29T12:30:00ZMedical practices and the Canadian government save millions per year after transitioning to electronic health records, study says.http://www.informationweek.com/healthcare/electronic-medical-records/canada-doctors-reap-roi-from-ehrs/240153789?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ 9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_i mage_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div> <!-- /KINDLE EXCLUDE --> Canada, which began subsidizing electronic health records (EHRs) systems for its physicians a few years before the U.S. did, is starting to see financial benefits from the use of EHRs, according to a new report. Canada Health Infoway, the nonprofit firm that administers the government subsidy program, commissioned the EHR <a href="http://s3.documentcloud.org/documents/690256/final-infoway-emr-benefits-english-summary.pdf">benefits evaluation study</a> from PWC. <P> Based on a survey of Canadian and international literature and unpublished studies, the report said community-based practices saved an estimated $84 million Canadian ($82.9 million U.S.) in 2012 from the reduction in paper record handling. In addition, EHR use has decreased the numbers of duplicate tests and adverse drug events, saving $93 million ($91.8 million U.S.) last year for the government-financed healthcare system. <P> However, the "maturity of use" among the 56% of Canadian physicians who have EHRs is still limited, the study found. For example, only a small fraction of them are expected to benefit from using their EHRs to improve chronic disease management and preventive care. <P> A recent <a href="http://content.healthaffairs.org/content/32/1/63.abstract">RAND study</a> of U.S. healthcare showed that, despite the increased use of EHRs, "the quality and efficiency of patient care are only marginally better" than they were before the government launched its EHR incentive program. <a href="http://www.americanehr.com/blog/2013/03/himss13-ehr-satisfaction-diminishing/">Another recent study</a> found that a third of U.S. physicians were dissatisfied with the ability of EHRs to decrease their workload, and about the same percentage had not recovered their productivity since they adopted EHRs. <P> The Infoway report, in contrast, suggested that Canadian physicians are weathering the transition to EHRs fairly well. <P> <strong>[ Venture capitalists see healthcare as a lucrative business. Read <a href="http://www.informationweek.com/healthcare/mobile-wireless/health-it-investments-approach-500-milli/240153263?itc=edit_in_body_cross">Health IT Investments Approach $500 Million In Q1</a>. ]</strong> <P> Since implementing EHRs, for example, 67% of family physicians, office managers and specialists in Canadian province Saskatchewan report that their practices are more productive than they were earlier. And according to a pan-Canadian study cited by Infoway, physician office billings remained stable from the date of EHR implementation through an 18-month follow-up period. <P> That study did not measure the numbers of patients seen, noted Jennifer Zelmer, senior VP of clinical adoption and innovation at Canada Health Infoway, in an interview with <em>InformationWeek Healthcare</em>. But, like their U.S. counterparts, Canadian physicians receive most of their revenue from fee-for-service billing. So the data suggests that most doctors continued to see as many patients as they did before adopting EHRs, she said. <P> The report cited another Canadian study showing that primary care physicians recouped their investment in electronic medical records (EMRs) within 10 months. "Fourteen of 17 primary care clinics had a positive return on their investments in EMRs and for those, time to break-even ranged from 1-37 months." <P> Of course, ROI depends partly on how much a practice has invested in its EHR. Operating through the provincial governments, Infoway has so far given $340 million to nearly 20,000 physicians for EHR implementation, Zelmer said. The organization is continuing to pay more to doctors who achieve "clinical value milestones" (similar to Meaningful Use) in their use of EHRs, she added. <P> Some practices adopted EHRs before the subsidy programs began in different provinces, she said. So some doctors invested more in their systems than others did. The same is true in the U.S., where many physicians already had EHRs before the Meaningful Use program began. <P> Canadian physicians, however, may have a leg up on U.S doctors in achieving ROI. That's because Infoway has created "peer to peer clinical support networks" in which experienced EHR users help new adopters figure out how to integrate EHRs into their workflow. "That kind of approach has been really effective in helping physicians who are newer users to use some more of those advanced functions," Zelmer pointed out. <P> The report indicated that Canadian physicians are beginning to see the quality and safety benefits of EHRs. Most Alberta, Canada, physicians, for example, said their patients were receiving test results faster and were ordering fewer redundant tests since they got EHRs. They also stated that their ability to manage patients' chronic diseases has been improved by the use of EHR alerts and reminders. <P> But the report noted that only three percent to 18% of primary care physicians in Canada were estimated to be using their EHRs to improve chronic and preventive care. <P> "The experience has been that when physicians first adopt EHRs, there are some functions they use right away and others that they start to pick up over time," Zelmer observed. "And some physicians are still early in their EMR journey. They're still in that first sense of getting the initial use and the initial benefits." <P>2013-04-26T08:56:00ZProviders don't need more regulation -- they need fewer obstacles to complying, says hospital association. http://www.informationweek.com/healthcare/interoperability/interoperability-depends-on-ehr-vendors/240153698?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/interoperability/5-tools-connect-patients-to-their-health/240062597"><img src="http://twimgs.com/informationweek/galleries/automated/898/01_sidewalk_rgb_tn.jpg" alt="5 Tools Connect Patients To Their Healthcare" title="5 Tools Connect Patients To Their Healthcare" class="img175" /></a><br /> <div class="storyImageTitle">5 Tools Connect Patients To Their Healthcare</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->The American Hospital Association (AHA) does not want the federal government to impose more regulations on healthcare providers to encourage health information exchange. <P> It would, however, like the government to demand more from electronic health record (EHR) vendors to advance interoperability at several different levels, according to an <a href="http://www.aha.org/advocacy-issues/letter/2013/130419-cl-cms-0038-nc.pdf">AHA letter</a> to the Office of the National Coordinator of Health IT (ONC). The AHA sent the letter in response to the ONC's request for information (RFI) on how to increase interoperability. <P> From the AHA's viewpoint, healthcare payment and delivery reforms, coupled with the government's Meaningful Use requirements, are all that's required to propel providers along the path to more effective health information exchange. What stands in the way of that, however, are external barriers. Hence the AHA would like ONC "to remove barriers for interoperability and support development of a robust infrastructure for health information exchange." <P> <strong>[ Are poorly designed electronic healthcare record systems driving medical personnel back to paper? Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/healthcare-workarounds-expose-ehr-flaws/240151710?itc=edit_in_body_cross">Healthcare Workarounds Expose EHR Flaws</a>. ]</strong> <P> "The federal government already has a remarkable number of requirements to share information," said Chantal Worzala, director of policy for the AHA, in an interview with <em>InformationWeek Healthcare</em>. "If you look at the Meaningful Use stage 2 requirements, whether you're reporting to public health or sending transition-of-care documents to the next provider when a patient leaves the hospital or is referred to another physician, those requirements already exist. Also, the rules require providers to give patients access to their information via a portal." <P> The challenge is that providers don't have the infrastructure in place to meet existing requirements, said Worzala. "So we'd prefer that the government focus on removing the barriers to the exchange that [is] required under Meaningful Use or [is] incentivized via programs like the Accountable Care Act," she said. <P> Among other things, the AHA letter said that EHR vendors should be required to use the same medical terminology for 2014 certification. However, the most important such requirement in the ONC's current certification criteria -- that all EHRs use the SNOMED-CT vocabulary for problem lists -- is an issue for AHA partly because it duplicates the ICD-10 coding system that the industry must move to next year. AHA said the ONC should require the ability to "cross-walk" from SNOMED to ICD-10 in certified EHRs. <P> Worzala noted that SNOMED is not widely used in the U.S., even though it was developed here. AHA is concerned that providers lack the technical and educational resources and the strategic plans to implement problem lists based on SNOMED by Oct. 1, 2013, when Meaningful Use Stage 2 goes into effect for hospitals. The key challenge seems to be that doctors aren't sure how well their diagnoses will be translated into a uniform terminology like SNOMED. So healthcare organizations would like to see the mapping to SNOMED better vetted and tested.Another major conundrum for AHA is the requirement that EHRs be able to send and receive secure messages using the Direct Project email protocol. Although this is fundamental to being able to exchange clinical summaries at transitions of care in Meaningful Use stage 2, AHA is unclear on whether providers will actually be able to access these documents through Direct and incorporate them into EHRs. It would like the government to publish results of its Direct pilots with statewide HIEs. <P> In addition, the association wants the ONC to require vendors to incorporate the SOAP transport standard "for more robust exchange of computable data." Under the current regs, <a href=" http://www.informationweek.com/healthcare/electronic-medical-records/ehra-guides-vendors-on-data-transport-me/240149830">Direct capability is required</a> but SOAP and another transport standard are optional. <P> Another big AHA concern is that state health departments and immunization registries might not gear up to accept electronic data from providers in time to meet the MU stage 2 criteria. The AHA urges the Centers for Medicare and Medicaid Services (CMS) to redouble its efforts in this area, while expressing appreciation for the work that's been done so far to enable nearly 1,000 hospitals to send lab data conforming to the LOINC standard to public health agencies. The association also calls on CMS to develop a website showing the ability of these agencies to receive the data that providers must send them under the MU stage 2 rules. <P> In addition, AHA wants the government to explore the possibility of using national provider identifiers (NPIs) to create comprehensive directories of providers for use in secure messaging. And to address the patient matching problem, which now requires provider organizations to create expensive and separate master patient indexes, the AHA suggests that HHS look into re-using the consumer ID system being developed for state health insurance exchanges. Finally, it wants the government to deal with variations in state privacy laws and strictures in the HIPAA regulations that inhibit health information exchange. <P> An <a href=" http://www.cio-chime.org/chime/PressReleases/pr4_18_2013_2_34_35.asp">earlier response</a> to the ONC RFI from the College of Healthcare Information Management Executives (CHIME) requested the government to certify HIEs "via standard interfaces, standard methods for isolating sensitive information, standard means to securely transport patient care information (i.e., Direct), standard ways to accurately identify patients and standard protocols for tracking consent." <P> Worzala said the AHA had not spoken to CHIME about this proposal, but added, "There's a lot of agreement between AHA and CHIME on the need for technology to support interoperability." <P> Neither the AHA nor the CHIME letter referenced the work that is being done by the <a href="http://www.informationweek.com/healthcare/interoperability/interoperability-initiative-poised-to-tr/240009172">Interoperability Work Group</a> and Healtheway to certify HIEs with the help of the nonprofit Certification Commission for Health Information Technology (CCHIT).2013-04-25T14:05:00ZCloud storage service announces new healthcare partner applications, customers and security compliance.http://www.informationweek.com/healthcare/electronic-medical-records/box-expands-healthcare-offerings/240153650?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ 9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_i mage_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div> <!-- /KINDLE EXCLUDE --> Box, a cloud storage and information sharing platform used in many different industries, has announced a major <a href="http://finance.yahoo.com/news/box-powers-healthcare-information-revolution-140000829.html">expansion of its healthcare focus</a>. Among other things, Box has revealed 10 new partner applications, an investment in iPad-native electronic health record (EHR) vendor <a href="http://www.informationweek.com/healthcare/electronic-medical-records/9-mobile-ehrs-fight-for-doctors-attentio/240144143?pgno=6">Drchrono</a>, its compliance with the latest HIPAA security rules, and a list of some healthcare organizations that are using its services. <P> Among the latter, the company said in a news release, are Henry Ford Health System, Beaumont Health System, HealthTrust Europe, Johns Hopkins HealthCare Solutions, Wake Forest Baptist Health, San Juan Regional Medical Center and Garden City Hospital. "Hundreds more healthcare customers" use Box "to share, manage and collaborate on content in the cloud," according to the release. <P> Most of this activity, so far, has been confined to non-clinical functions, although Garden City Hospital, Beaumont Health System and Wake Forest School of Medicine are all using Box to store clinical data as well, said Whitney Bouck, enterprise general manager of Box, in an interview with <em>InformationWeek Healthcare</em>. <P> Box expects many more healthcare systems will use its service to store and share personal health information (PHI) now that the firm has become fully compliant with the <a href="http://www.informationweek.com/healthcare/policy/hipaa-changes-could-create-new-bureaucra/240146842">latest HIPAA security rules</a>, which were published in January. Among other things, these rules make healthcare providers responsible for ensuring that their business associates protect PHI and that they have agreements to that effect with those business associates. According to the press release, Box is one of the few cloud providers that have been willing to sign these business associate agreements. <P> <strong>[ Trying to decide where to store your stuff? Read <a href="http://www.informationweek.com/cloud-computing/software/8-great-cloud-storage-services/240151180?itc=edit_in_body_cross">8 Great Cloud Storage Services</a>. ]</strong> <P> Unsurprisingly, several of Box's initial partnerships in the healthcare space involve secure messaging services. TigerText offers secure text messaging in hospitals and other clinical settings, helping doctors and nurses communicate with each other about patient care. Medigram, a startup firm, does the same. Both companies will use Box to archive text message attachments such as images, files and notes. <P> Doximity, which includes a social network and a secure messaging and collaboration service for doctors, will offer Box accounts with 50 GB of free storage to the 150,000 users it says are in its network. <P> Other Box partners include Umbie Dental Care, a Web-based practice management system for dentists; MedViewer, which allows users to view, communicate and share medical images on iPhones and iPads using a DICOM viewer; MediCopy, which provides release-of-information and document scanning services to hospitals; HealthTap, which offers consumers the ability to get answers to health questions from a network that includes 35,000 physicians, according to the firm; and PaxeraUltima, a PACS viewing application designed for iPads. In addition, Drchrono will store EHR content such as lab reports, videos and images in Box. <P> Box's ultimate goal "is to be the collaboration and communication layers between a variety of different tools and applications and EHR systems," Bouck said. By doing so, she noted, Box could help providers exchange data with each other and with patients. It would also give them new cloud-based workflow tools that enable them to better coordinate care and fully integrate their mobile devices into that workflow. <P> Box has hired Missy Krasner, formerly a Google Health executive and an assistant to David Brailer, the first national coordinator of health IT, to lead its healthcare expansion. Asked how Box would integrate with disparate EHRs, Krasner replied that "EHRs are not good workflow management tools, they're recording tools," and that's why so many external applications have been built around them. Much of the mobile communications between different clinicians, she said, would never be included in the EHR but can be efficiently stored and shared in the cloud. <P> "Box can archive a lot of the messages, including those with attachments such as X-rays or pictures that you're sending to another doctor," she said. "Box can take that material and archive it, and make it totally searchable." <P> Another major use for Box is to help consumers collect records from multiple providers and store it in a single place, she said. This is difficult now because patients have to log onto separate portals attached to different EHRs, she noted. <P> Krasner noted that Google Health tried to provide a "very cool looking personal health record" (PHR) that would aggregate these multiple records. The idea was for consumers to import their data from multiple sources and direct it to whomever they wanted. But this "untethered PHR" failed, she said, because it proved to be too difficult to integrate all of the clinical data from different EHRs with Google Health. Many other reasons have also been advanced for <a href="http://mobihealthnews.com/11480/10-reasons-why-google-health-failed/">the initiative's demise</a>. <P> Box has a different take on the Google Health idea that it would like to develop. Krasner compared it to what some EHR vendors are doing with the VA-created <a href="http://www.va.gov/bluebutton/">Blue Button</a> that enables patients to download their electronic records. "Box could be an embedded button on an EHR. So when you're doing that download, it could go directly into a Box account. It could be another doctor's Box account, it could be a shared account, it could be enterprise account, or could be doctor to patient."2013-04-25T11:30:00ZPuberty typically wreaks havoc with diabetes control, but a Yale study that combines adolescence and diabetes coping programs reverses that trend.http://www.informationweek.com/healthcare/patient/web-programs-help-adolescents-control-di/240153591?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href=" http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137"><img src="http://twimgs.com/informationweek/galleries/automated/943/Cerner-patient-portal_tn.png" alt=" 7 Portals Powering Patient Engagement" title="1 7 Portals Powering Patient Engagement" class="img175" /></a><br /><div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> When children with type 1 diabetes enter puberty, the double stress of coping with their condition and the transition to adolescence often leads to reduced control of their diabetes. In a <a href="http://care.diabetesjournals.org/content/early/2013/04/05/dc12-2199.abstract">Yale University study,</a> children in this age group (11-14 years old) who used Web-based interactive programs that taught them how to deal with these factors showed improvement in their HbA1c results and quality of life (QOL) scores. <P> The study in <em>Diabetes Care</em>, "Internet Psycho-Education Programs Improve Outcomes for Youth With Type 1 Diabetes," included 320 children who were randomized to one of two Internet-based interventions, both developed at Yale. TeenCope was designed to help young people with diabetes cope with adolescence, and Managing Diabetes showed them how to better manage the condition, partly through lifestyle modification. <P> At 12 months, the subjects in both groups had stable quality of life scores and "minimal" increases in HbA1c levels, and there were not significant differences between the two groups in those primary outcomes. After 18 months, however, the young people who had completed both programs had lower HbA1c levels and higher QOL ratings. They also scored higher in social acceptance and self-efficacy, and had lower perceived stress and diabetes-related family conflict, compared with those who had completed just one course. <P> Margaret Grey, lead author of the study and dean of the Yale School of Nursing, told <em>InformationWeek Healthcare</em> that even though HbA1c results were slightly worse for the children who had taken only one of these programs, those levels were actually better than would have normally been expected in this age group. <P> <strong>[ Is greater patient autonomy needed to boost provider-patient partnerships? <a href="http://www.informationweek.com/healthcare/patient/healthcare-patient-engagement-remains-el/240153526?itc=edit_in_body_cross">Healthcare Patient Engagement Remains Elusive</a>. ]</strong> <P> "<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1399-5448.2007.00266.x/abstract">Some studies</a> show that HbA1c goes up two points, on average, over a year or two [around puberty] and tends to stay up until they're 15 or 16," said Grey, who is also a professor of nursing at Yale. "So being able to maintain control [of their diabetes] over that period is very important." <P> Why did the kids who took both programs do better than those who did only one? Grey believes that it's because they need both training in coping with adolescence and a "booster" course in how to manage their diabetes. "So the two programs complement each other, and it appears you get better outcomes by doing both." <P> The study "oversampled" minority kids to present a balanced appraisal of children from different segments of society, Grey noted. "But the Latino and black kids who stayed in the study were more likely to come from a middle-class background vs. a lower-class background," she said. So the results didn't fully account for the many low-income children who <a href="http://pewinternet.org/Reports/2013/Teachers-and-technology">don't have high-speed Internet</a> access at home. <P> The programs used in the study were designed for desktop and laptop computers. The researchers plan to develop versions of these applications that are optimized for mobile devices so they can study the impact on young people. A quarter of U.S. teenagers <a href="http://www.pewinternet.org/Media-Mentions/2013/Teenagers-Smartphones-How-Theyre-Already-Changing-The-World.aspx">now access the Web</a> primarily on smartphones or cellphones, according to the Pew Internet Research Center. <P> Quality of life scores were a primary endpoint of the study, she noted, because she takes a holistic view of health that includes the difficulty of complying with the requirements of diabetes self-management. "If we have treatments that are so burdensome for kids that they commit suicide, they're just as dead as the kids who ultimately end up with serious complications [from diabetes]. So in all of our studies, we've used quality of life as well as HbA1c."2013-04-24T08:50:00ZCigna will offer MDLive service, which lets members request online video, telephone or e-mail consultations with doctors for non-urgent care needs.http://www.informationweek.com/healthcare/mobile-wireless/cigna-to-offer-telehealth-coverage-to-se/240153477?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/news/galleries/healthcare/mobile-wireless/232602982"><img src="http://twimgs.com/informationweek/galleries/automated/763/01_philips_eICU_tn.jpg" alt="Telemedicine Tools That Are Transforming Healthcare" title="Telemedicine Tools That Are Transforming Healthcare" class="img175" /></a><br /> <div class="storyImageTitle">Telemedicine Tools That Are Transforming Healthcare</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->Cigna has become the latest national insurer to pitch telehealth to employers. Cigna, which has been using RelayHealth for "Web visits" since 2007, will start offering <a href="http://www.mdlive.com">MDLive's telehealth service</a> to its self-insured customers nationwide, starting July 1, for plans that become effective Jan. 1, 2014. <P> Cigna members in these self-insured plans will be able to request online video, telephone or e-mail consultations with primary care physicians for non-urgent care needs such as cold and flu, rashes, and headaches. MDLive doctors are available 24/7 and respond to requests within an average of 11 minutes, according to a news release. <P> Over the past few years, United Healthcare, WellPoint and Aetna have also embraced telehealth as a way to lower health costs and increase convenience for members. United's <a href=" http://www.uhc.com/innovation/2010_first_quarter/doctor_will_see_you.htm">NowClinic</a> offers telehealth consultations in 22 states. WellPoint recently began <a href="http://www.informationweek.com/healthcare/mobile-wireless/wellpoint-to-launch-national-telehealth/240145551">covering telehealth</a> in California and Ohio, using the service of American Well, and Aetna is <a href=" http://www.theinsuranceexchange.com/Carrier_Forms/Teladoc_Flyer.pdf"> running a pilot</a> with Teladoc in Texas and Florida. <P> <strong>[ More doctors are monitoring patients remotely. Read <a href="http://www.informationweek.com/healthcare/mobile-wireless/telehealth-to-grow-six-fold-by-2017/240146847?itc=edit_in_body_cross">Telehealth To Grow Six-Fold By 2017</a>. ]</strong> <P> Commenting on Cigna's deal with MDLive, Jackie Aube, the insurer's product development director, said in the press release, "MDLive's telehealth services enable our increasingly mobile and time-constrained customers to schedule a virtual consult with a board-certified physician and resolve a non-emergency medical issue in less than one hour. It's a cost-effective and convenient alternative to an office visit with your primary care physician." <P> The agreement with MDLive is similar to Cigna's coverage of its members' visits to retail clinics such as those of Walgreens and CVS, Cigna spokesman Joe Mondy told <em>InformationWeek Healthcare</em>. Cigna will continue offering the services of McKesson's RelayHealth, which enables patients to do online consultations with their own physicians, he added. <P> MDLive will be integrated directly into the insurer's consumer platform, MyCigna.com, and will also be featured in Cigna's new mobile app, which helps members locate and select physicians and urgent care centers, Mondy said. <P> MDLive has always offered its customers -- mainly self-insured employers -- the ability to send summaries of telehealth encounters to their employees' primary care doctors, said Randy Parker, CEO of MDLive, in an interview. As part of the integration with Cigna, MDLive will now be able to transmit these documents to the patients' personal physicians via Cigna. This is similar to what Cigna does with some convenient care clinics, Mondy noted, adding that the clinical summary can go right into the doctor's electronic health record system. <P> If a patient doesn't have a primary care physician and needs a follow-up visit, MDLive will recommend one from Cigna's directory. Cigna itself does the same for patients who visit retail clinics and don't have their own doctor. <P> With its other customers, MDLive functions as a standalone service that the employers require their insurance company administrators to cover, Parker said. Cigna is the first plan that is providing MDLive to its eligible self-insured members. He sees this large-scale application of telehealth as a validation that "telehealth is now accepted for population health management." <P> Overall, he said, the announcement shows that "telehealth is no longer something that's just being piloted, it's something that's accepted as part of the way the healthcare of the future will have to work."2013-04-22T09:06:00ZGreenway and Florida Blue strike deal to use Availity as conduit for care summaries that providers need and EHR data that insurers want. http://www.informationweek.com/healthcare/interoperability/ehr-vendor-insurer-agree-on-two-way-data/240153322?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href=" http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137"><img src="http://twimgs.com/informationweek/galleries/automated/943/Cerner-patient-portal_tn.png" alt=" 7 Portals Powering Patient Engagement" title="1 7 Portals Powering Patient Engagement" class="img175" /></a><br /><div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->Ambulatory EHR vendor Greenway, insurer Florida Blue, and Availity, a national health information network, have begun <a href="http://www.businesswire.com/news/home/20130418005102/en/Availity-Greenway-Apply-Interoperability-Improve-Health-Care">enabling providers</a> to receive health plan care summaries in Greenway's EHR and to send clinical data back to the insurer. <P> This bidirectional exchange of clinical information between a health plan and its providers is a first, according to Availity. But it won't be the last. EHR vendors Athenahealth, Allscripts, eClinicalWorks, and GE Centricity are all integrated with Availity, and Greenway says it intends to make similar arrangements with other health plans this year. Among the plans that own Availity besides Florida Blue, and that could potentially participate with Greenway or other vendors, are Humana, Minnesota Blue Cross and Blue Shield, WellPoint, and Health Care Services Corp. (HCSC), which includes Blues plans in Illinois, New Mexico, Oklahoma and Texas. <P> <a href="http://www.availity.com">Availity</a>, which enables Web-based administrative transactions between providers and insurers, has long offered health plan care summaries, based on claims and other data, to physician practices on its Web portal. But until a year or two ago, relatively few providers were accessing those care profiles, which include alerts about patients' care gaps. Not only did providers have to go to a portal to obtain the information, but they also had no financial incentive to look at this data, noted Availity CEO Russ Thomas in an interview with <em>InformationWeek Healthcare</em>. <P> <strong>[ Multiple efforts are afoot to enable electronic health record systems to work together. Read <a href="http://www.informationweek.com/healthcare/interoperability/ehr-interoperability-a-hot-topic-at-hims/240150443?itc=edit_in_body_cross">EHR Interoperability A Hot Topic At HIMSS</a>. ]</strong> <P> But, with the advent of healthcare reform, financial incentives have started to change, making health plan data more valuable to providers. "As payment reform models evolve, whether they're accountable care organizations or other risk-based models, there's a demand for new information types," Thomas pointed out. <P> The workflow barrier must still be overcome, however, and that's where the Greenway arrangement comes in. <P> Under the arrangement with Florida Blue, Greenway customers will be able to see care summaries containing up to two years of patient care history within their EHR. According to Justin Barnes, VP of marketing and government affairs for Greenway, these summaries will be in the form of continuity of care documents (CCDs), which many providers use to exchange clinical summaries. When these CCDs arrive, they will flow into the patient history area of the EHR for easy viewing by clinicians, he said. <P> Integrating this information, along with care alerts, into the clinical workflow is crucial to Florida Blue and other plans, Thomas said. "This is increasingly important to plans as they work to more effectively manage the cost of care." <P> Florida Blue will also be able to obtain from Greenway EHRs the data it needs to improve care management, Thomas said. Although this information will be packaged in the CCD format, it will serve a variety of purposes, including quality data collection for pay-for-performance programs and for Healthcare Effectiveness Data and Information Set (HEDIS) reporting to the National Committee on Quality Assurance (NCQA). Among the types of data that can be pulled from the EHR, he added, are demographic information, health problems, medications, allergies and progress notes. <P> As Greenway strikes deals with other plans, Barnes said, it will customize these functions to each insurer's needs. "We do that proactively today," he said. "We enable our customers to submit data to all of these pay-for-performance programs that are available to them. Every plan has a different kind of program." <P> In addition, practices will be able to attach documents, such as surgical notes, to claims and send them to Florida Blue through Availity. But as the integration between Greenway and Florida Blue's system deepens, Barnes added, that will become unnecessary, as payers will be able to simply request certain information and have it immediately transmitted to them from the EHR. The same system can be used for prior authorizations and notifications of hospital discharges and transfers. <P> Availity announced last June that it was <a href="http://www.availity.com/documents/News_Release_Availity_Announces_Clinical_Capabilities.pdf">expanding its clinical documentation abilities</a>, including real-time exchange of in-patient information between hospitals and health plan case managers, medical attachments to claims, automated extracts from physician EHRs for HEDIS reporting, and EMR integration with health plan care summaries. The deal with Greenway and Florida Blue is an outgrowth of that initiative.2013-04-19T13:13:00ZVenture capitalists plug a record $493 million into healthcare technology, with consumer-focused companies receiving the lion's share.http://www.informationweek.com/healthcare/mobile-wireless/health-it-investments-approach-500-milli/240153263?cid=RSSfeed_IWK_ALL<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href=" http://www.informationweek.com/healthcare/clinical-systems/7-portals-powering-patient-engagement/240147137"><img src="http://twimgs.com/informationweek/galleries/automated/943/Cerner-patient-portal_tn.png" alt=" 7 Portals Powering Patient Engagement" title="1 7 Portals Powering Patient Engagement" class="img175" /></a><br /><div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Venture capital investments in the health IT sector continue to accelerate, according to the <a href="http://mercomcapital.com/vc-funding-in-healthcare-it-sector-continues-torrid-pace-in-q1-2013-with-$493-million-reports-mercom-capital-group">latest report</a> from the Mercom Capital Group, a global communications and consulting firm. In the first quarter, health IT firms raised a record $493 million, compared with <a href="http://www.informationweek.com/healthcare/leadership/health-it-startups-make-vcs-swoon/240147655">$1.2 billion for all of last year</a>. The number of VC deals jumped to 104 from 51 in the previous quarter and 30 in the prior-year period. <P> "The trend we began to see last year of VCs investing in consumer-focused companies like mobile health, telehealth, personal health, social health, and scheduling, rating & shopping has become much more pronounced," commented Raj Prabhu, CEO of Mercom Capital Group, in a news release. "The enormous market opportunity in consumer-focused health has appeared to pique the interest of investors and is likely to continue to grow as witnessed by the surge in VC activity." <P> Of the five companies that received the largest infusions of VC funds in the first quarter, only one -- Fitbit, a vendor of mobile wellness apps that received $30 million -- was a pure consumer play. Health Catalyst, which got $41 million, offers a data warehousing solution; xG Health Solutions, the recipient of $40 million, offers population health data analytics and patient and population-focused care management tools. NantHealth, which raised $31 million, aims to deliver next-generation care through the use of advanced secure fiber networks, cloud computing and wireless mobile technology. One Medical Group, which took in $30 million, is a national concierge practice with an advanced health IT infrastructure. <P> <strong>[ Today's investments are tomorrow's realities. See what's ahead; read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/health-it-in-2018-crystal-ball-predictio/240152349?itc=edit_in_body_cross">Health IT In 2018: Crystal Ball Predictions</a>. ]</strong> <P> It's not surprising that the deals involving the biggest dollar amounts would involve health IT infrastructure, Prabhu told <em>InformationWeek Healthcare</em>, because those companies need more capital than a startup that is developing a mobile health app. However, he emphasized, the vast majority of firms that received VC funds were consumer-related health IT companies in areas like personal health, social networking and telehealth. <P> The impact of the industry's transition to value-based care and population health management is not attracting VCs to health IT as much as the consumer market potential is, Prabhu added. Partly because of the new availability of healthcare data to consumers on mobile devices, he said, "The market potential on the consumer side of health is huge." <P> The growing trend of healthcare companies investing in or forming health IT companies is also visible in Mercom's data. <a href="http://www.informationweek.com/healthcare/clinical-systems/new-healthcare-data-warehousing-model-ga/240151160">Health Catalyst,</a> for example, raised $8 million of its $41 million in VC funds from Kaiser Permanente Ventures and CHV Capital, which is affiliated with Indiana University Health. And xG Health Solutions is a spinoff of the Geisinger Health System. <P> "VC firms like to go into a deal with these corporate VCs or big healthcare organizations, because the risk is a little spread out," Prabhu said. "Also, with these big guys coming in with a lot of money and expertise, the outlook is better." <P> The number and combined value of disclosed merger and acquisition (M&A) deals did not change much from the fourth quarter, noted Prabhu. In the first quarter of 2013, there were 46 M&A transactions. Twenty-two health information management companies were acquired, followed by 11 health IT "service providers." The biggest M&A deal, valued at $293 million, was Athenahealth's acquisition of Epocrates, a leading provider of mobile educational content to physicians. Just behind that was Allscripts' purchase of dbMotion, a vendor of interoperability products, for $235 million. <P> Over the period from 2010 to 2012, the Mercom report noted, the biggest acquirers of health IT firms have been other companies in the field, including McKesson (six deals), Quality Systems (6) and CompuGroup Medical (5). Among these and other health IT firms on the acquirer list, Prabhu said, some make synergistic purchases that help them accelerate their capabilities. Others are buying market share. <P> Prahbu doesn't know whether the second quarter will be as big as the first. But he said he was confident that VC funding for 2013 would exceed that of 2012. <P> "Everybody's excited about this sector," he said. "It's one of the few areas that's hot, and everyone understands it has great potential. Considering what happened in the first quarter, we're on pace for this to be a great year." <P> <i>Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/040113hc/?k=axxe&cid=article_axxt_os">The Right Health IT Priorities?</a> issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)</i>