InformationWeek Stories by Ken Terry

InformationWeek Stories by Ken Terryhttp://www.informationweek.comInformationWeeken-usCopyright 2012, UBM LLC.2013-06-19T09:06:00ZHealthcare Collaborative, IBM Partner On Big Data PlatformNew collaborative of healthcare organizations to develop tools to manage population health, using version of IBM's Netezza warehousing appliance.http://www.informationweek.com/healthcare/clinical-systems/healthcare-collaborative-ibm-partner-on/240156886?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> (click image for larger view and for slideshow)</div> Big data analytics is set to make another big mark on healthcare. IBM, one of the leaders in the space, <a href="http://www.businesswire.com/news/home/20130613005721/en/Provider-Led-Data-Alliance-Launched-Develop-Share-Pioneering">has partnered with</a> the Premier Healthcare Alliance and four healthcare systems to develop the kinds of analytic tools that will be required for population health management. Dubbing itself the Data Alliance Collaborative (DAC), the group in addition to IBM includes Carolinas Healthcare System of Charlotte, N.C.; Catholic Health Partners of Cincinnati; Fairview Health Services of Minneapolis; and Texas Health Resources of Arlington, Texas. All four of the systems are members of Premier's ACO Collaborative, which includes 79 healthcare organizations in 40 states. DAC is a subset of the ACO group. Premier chose IBM as its partner in the venture partly because it already uses a lot of IBM hardware and software in aggregating member data for benchmarking and other purposes, said Keith J. Figlioli, senior VP of healthcare informatics for Premier, in an interview with InformationWeek Healthcare. In addition, he noted, IBM and Premier codeveloped "an integrated payer and provider data model that can become extensible." [ Effective use of big data in healthcare starts with teaching it in medical school. Read <a href="http://www.informationweek.com/healthcare/clinical-systems/big-data-use-in-healthcare-needs-governa/240151395?itc=edit_in_body_cross">Big Data Use In Healthcare Needs Governance, Education</a>. ] The IBM data model, or data infrastructure, is the platform that DAC members are using to develop their analytic applications, said Figlioli. The platform is capable of integrating clinical, financial and claims data across care settings, regardless of what kind of system generated the information, he said. This infrastructure is a kind of advanced data warehouse, based on the <a href="http://www-01.ibm.com/software/data/netezza/">IBM Netezza</a> data warehousing appliance. Some DAC members have either never had a data warehouse before or have repositories that are narrowly focused on particular kinds of information, Figlioli said. Carolinas Healthcare System has a legacy data warehouse that cannot be used to run reports expeditiously, Allen Naidoo, the organization's VP for advanced analytics, told InformationWeek Healthcare. In contrast, he said, the IBM data model is very flexible, allowing him to "get near real time data" and to run reports "on the fly" with Netezza, "which makes processing go at lightning speed." This sounds like real competition for <a href="http://www.informationweek.com/healthcare/clinical-systems/new-healthcare-data-warehousing-model-ga/240151160">Health Catalyst</a>, a data warehousing company that recently has gained a number of adherents and investors among large healthcare organizations. Carolinas Healthcare System, which has formed an accountable care organization, recently began receiving claims data from health plans and employers. With the help of Netezza, Naidoo said, this will provide the system with a "360-degree view of the patient. For example, I can tell from EHR data whether the physician has written a script. From the claims data, I can tell you whether the patient has filled that script. So, if the patient is not compliant with a medication, we'll know that from the value brought by these two data sets." DAC's members hope to use a similar approach to improve transitions of care. For example, one of the first co-development projects is a tool designed to quickly notify providers about groups of patients who have not filled prescriptions within 24 hours of discharge. This tool might take advantage of Surescripts' community medication histories or other data sources, Figlioli said. DAC members also are co-developing an "all-cause predictive readmissions model" that analyzes both EHR and administrative data to identify the patients who are most likely to be readmitted before they're discharged. The DAC model will identify risk factors leading to readmissions, tying patients to appropriate evidence-based checklists based on their condition. IBM cannot commercialize anything developed by the collaborative, said Figlioli. However, he noted, a vendor might sell applications that it develops for the platform itself. For example, he noted, "One leading system integrator is creating assets for this group that will later be commercialized if somebody consumes them." That integrator is Perficient, a St. Louis-based firm that has built a <a href="http://www.perficient.com/About/News-Releases/2013/Perficient-Premier-Development">benchmarking application</a> for PremierConnect, a "business intelligence, data warehousing and social networking solution" unrelated to DAC. What DAC members come up with won't be proprietary, Figlioli said. "They'll be completely transferable assets. The idea is that there's a co-development agreement with all the data alliance members, and the data alliance will get bigger over time, and the intent is to include all of the trading partners." Within six months, he added, he expects at least four more organizations to join DAC. From the perspective of Carolinas Healthcare System, Naidoo said, the most important advantage of the collaborative is that it enables the partners to learn from one another as they develop the population health management tools they need. Moreover, he added, IBM has begun to provide DAC members with insights on how companies in other industries, such as banking and financial services, use analytics.2013-06-17T09:06:00ZTool Forecasts Remote Patient Monitoring ROIWeb-based program forecasted a positive return on investment in remote monitoring for all five California healthcare groups who tested it.http://www.informationweek.com/healthcare/mobile-wireless/tool-forecasts-remote-patient-monitoring/240156745?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div>(click image for larger view and for slideshow)</div>The <a href="http://www.connected-health.org">Center for Connected Health</a> (CCH) and the <a href="http://www.techandaging.org">Center for Technology and Aging</a> (CTA) have collaborated on the development of a <a href="http://connected-health.org/media/5389632/roi%20tool%20release%20final_7.10.13.pdf">Web-based tool</a> for analyzing the return on investment (ROI) in remote patient monitoring (RPM) technologies. With funding from the California Healthcare Foundation, five California medical groups recruited by CTA tested and validated the tool. Up to now, few payers have covered remote monitoring of patients with serious illnesses because there was no evidence of ROI. With the advent of payment reform and the Medicare and Medicaid penalties for excess re-admissions, healthcare organizations are growing interested in RPM, and some have initiated pilots to test the technology. But it's still difficult for them to evaluate whether RPM will save more than it costs when they roll it out to their organizations. That's where the ROI tool comes in. "This new tool not only assists program managers to evaluate financial ROI, but it also identifies potential program efficiencies, making the ROI tool effective for both evaluation and decision making," said Kamal Jethwani, MD, corporate manager of research and innovation for CCH, in a news release. [ Should some mobile health apps be regulated as medical devices? Read <a href="http://www.informationweek.com/healthcare/policy/fda-warns-mobile-health-apps-makers/240155716?itc=edit_in_body_cross">FDA Warns Mobile Health Apps Makers</a>. ] In an interview with InformationWeek Healthcare, Jethwani called the Turbotax-like program a "planning and modeling tool." Organizations can insert their pilot data into it, he said, or they can use benchmark data suggested by CCH if they are only in the planning stages of an RPM effort. If the group or hospital system has pilot data, it can project the results of scaling the program up. The tool asks questions that many healthcare executives and doctors would not consider asking, said Jethwani. For example, how many doctor hours does a particular RPM program require? How much of a burden is it on nurses and other staffers? The tool then has users add those costs to other known expenses such as the average cost per patient per month of a particular vendor's RPM program. The ROI tool uses electronic health record (EHR) or claims data to calculate the financial benefit of an RPM program and to whom it would accrue. If the program helps a hospital prevent excess Medicare re-admissions in the first 30 days after discharge, for instance, the hospital would reap financial rewards by avoiding penalties. Re-admissions averted after 30 days, on the other hand, would benefit only the payer, unless the healthcare system were taking financial risk for care delivery. The five groups that helped CCH and CTA <a href="http://www.techandaging.org/CTA%20RPM%20ROI%20AgeTech%20Presentation.pdf">test the tool</a> were Centura Health at Home, a home health agency; Dignity Health, a large healthcare system based in San Francisco; Healthcare Partners, a Los Angeles-based medical group and independent practice association; Sharp Healthcare, a San Diego-based healthcare system; and the Central California VA system. All of them calculated positive ROI over a five-year-period, using the ROI tool with pilot data. Centura's pilot involved patients with chronic diseases, and nearly half of its estimated financial return was due to a reduction in nurse visits. The RPM tests of Dignity, Sharp, and the VA all involved patients with congestive heart failure, who are responsible for a large share of re-admissions. Healthcare Partners, which had the largest projected ROI over five years, was using RPM with patients who had chronic obstructive pulmonary disease (COPD). In its trial, Healthcare Partners used a simple interactive-voice-response (IVR) system to send automated phone messages to patients asking about their health status. The patients responded on the keypad of their phone, and nurses monitored the data at the group's offices. If a patient showed certain symptoms, a nurse called him and, if necessary, had him hospitalized. Based on a sample size of 70 patients, the ROI tool projected what would happen if the Healthcare Partners program were gradually scaled up over five years. It calculated that the ROI would be 1.3 in the first year, soaring to 18.9 in the fifth year. The returns came mainly from reduction in hospital re-admission rates. Besides the decreased costs of providing care -- a boon to Healthcare Partners, which takes financial risk -- the rapid rise in ROI was due to the low cost of the interactive-voice-response system, Jethwani said. Scaling the IVR program to the whole population of discharged patients with congestive heart failure would be relatively inexpensive, he said. The next step for the researchers is to persuade other provider organizations to try using the tool in their RPM pilots. "We hope to do a systematic data analysis of about 30 sites and then do a peer-reviewed publication on the ROI of RPM in general," said Jethwani. "We also want to take that user feedback and put it into product development for the next phase, and maybe do a second release of the tool a year from now."2013-06-13T09:06:00ZGE Healthcare To Plow $2B Into Software DevelopmentCompany sees waste and low productivity in healthcare as opportunity for technology solutions.http://www.informationweek.com/healthcare/admin-systems/ge-healthcare-to-plow-2b-into-software-d/240156601?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div>(click image for larger view and for slideshow)</div>GE Healthcare plans to invest $2 billion over the next five years to accelerate its software development. The company said it would work closely with the <a href="http://www.informationweek.com/global-cio/interviews/ges-huge-software-ambition-3-key-takeawa/232400188">GE Software Center of Excellence</a> in San Ramon, Calif. -- itself the product of a $1 billion investment --as well as other research and development hubs around the world. In its <a href="http://www.genewscenter.com/Press-Releases/GE-Healthcare-to-invest-2-billion-in-software-development-over-next-five-years-4044.aspx">announcement,</a> GE Healthcare said it would focus its new development strategy on "maximizing asset performance; improving hospital operations management; improving clinical effectiveness; and optimizing care across entire populations." The company plans to: -- Increase productivity through scheduling efficiencies, faster data entry, clinical decision support, and "financial gains that allow for expansion." -- Reduce costs by optimizing workflow and eliminating waste. -- Minimize rework and redundancies by enhancing collaboration and improving access to information. GE Healthcare already is the largest software developer in the GE corporation. Why invest so much money in health IT now? [ What challenges do states face in modernizing health technologies? Read <a href="http://www.informationweek.com/government/state-local/state-cios-make-progress-on-health-it/240156464?itc=edit_in_body_cross">State CIOs Make Progress On Health IT</a>. ] In an interview with InformationWeek Healthcare, Jan De Witte, president and CEO of healthcare IT and performance solutions for GE Healthcare, said the decision was motivated by the amount of waste and the low productivity in healthcare, which GE views as a big opportunity. Just on the operations side, he said, "a 10-20% improvement is feasible." And overall, in an industry that is estimated to waste about 25% of its resources, there's a tremendous opportunity to profit from improvement, he said. "Software is going to be a tremendous lever to build a more productive workflow and more powerful analytics to drive productivity and eliminate some of that waste," he said. Although the industry has already invested a lot in digitization, he added, much more needs to be done to "turn that data into insights and more productive processes." To reach its ambitious goals, GE is counting on a big data approach that many in the industry view as critical to the next phase of healthcare. "With today's capabilities, we can accelerate change by bringing data out of different silos together to draw conclusions," he said. One example is sepsis control. "You can bring together data from different patients in different populations to identify the risk for sepsis early," said De Witte. "This is a simple yet powerful example of leveraging data from different places over time and drawing conclusions from that." De Witte acknowledges that workflow and culture change will be required to harness technology in such efforts. GE Healthcare's performance solutions unit, he noted, includes consultants who work with clinicians on change management and teach them Lean and Six Sigma skills "to change processes and help them adapt." Similarly, he pointed out, the <a href="http://www.informationweek.com/healthcare/electronic-medical-records/caradigm-expands-health-information-exch/240149713">Caradigm joint venture</a>, owned by GE and Microsoft, has an application that assigns a risk factor to each patient at discharge. That's used to help nurses and discharge planners decide how the patient should be cared for during the two months after discharge so that hospitals can avoid readmissions. The key to success, he said, is using the software to help the staff reengineer their processes. Overall, he stated, "It's not just software that's going to do it. It's software plus process reengineering that will drive significant change." GE's new software development program will draw heavily on the expertise of the parent company's San Ramon facility. That R&D center, De Witte said, "has a lot of deep expertise and platform capabilities and reusable components, including analytics, workflow management and data security. So for the core platform elements, we're going to leverage the San Ramon facility, which creates these elements, not just for GE Healthcare, but for other businesses in GE." GE Healthcare will be able to apply much of the new resources it is developing in its businesses around the world, he said. "The economics of healthcare are very aligned across the globe, so the opportunities for improvement are the same." The company will also export some of its new applications to Caradigm, he added. GE also will improve the user interfaces for GE's electronic health records and other healthcare products. It is already stepping up its investment in this area, he noted. Last year, for instance, GE introduced a "universal viewer" for radiology images that reduced the number of clicks required to "read" images by 70%. GE is also expanding its EHRs to meet the needs of accountable care organizations. Among the areas of focus are financial risk management, operations management, care management and patient engagement, he said.2013-06-11T15:10:00ZCCHIT Releases Framework for ACO Health ITIT roadmap from certification group, most detailed yet, describes what will be needed for population health management.http://www.informationweek.com/healthcare/policy/cchit-releases-framework-for-aco-health/240156440?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">8 Accountable Care Organizations Worth Closer Examination</div> (click image for larger view and for slideshow)</div>The Certification Commission for Health IT (CCHIT) has <a href="https://www.cchit.org/hitframework">issued a framework</a> for accountable care organizations (ACOs) to use as they assemble the components of the health IT infrastructure they will need to do population health management. Created by commission members and a blue ribbon advisory panel, the technology roadmap is designed to help ACOs "mitigate some of the risks associated with taking on accountability for costs, quality of care and patient loyalty," says the <a href="http://www.cchit.org/c/document_library/get_file?uuid=47dd2a86-2872-41c7-8fbd-dbc260eddf5d&groupId=18">CCHIT ACO HIT Framework</a> document. According to its authors, the framework is the first "consensus-developed, publicly available" document to address these issues. The National Committee on Quality Assurance (NCQA) <a href="http://www.ncqa.org/Portals/0/Programs/Accreditation/Accred08/ACO/ACO-web%20FINAL.pdf">accredits ACOs</a>, but it doesn't explain the requisite IT infrastructure in the detail that CCHIT's framework does. [ Health IT vendor Lumeris has issued its own ACO guidelines. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/will-doctors-c-the-way-to-accountable-ca/240153330?itc=edit_in_body_cross">Will Doctors 'C' The Way To Accountable Care?</a>. ] The framework is described as a guide for planning, purchasing and building a health IT infrastructure capable of meeting an ACO's goals of providing "high-quality, efficient care while developing patient and clinician loyalty under different types of financial arrangements." These arrangements include fee-for-service with upside-only risk sharing, up- and down-side risk sharing for a substantial portion of a patient population, and global-risk contracts covering most patients. The framework is not only intended for provider organizations. Payers partnering with provider groups in ACOs might also be interested, the document says. Another potential audience, it notes, are health IT developers who plan to create the technology that providers will need in the future. The framework, which includes all of the government's Meaningful Use criteria, focuses on four primary areas: -- Information sharing between and among clinicians, patients and other authorized entities. -- Data collection and integration from multiple clinical, financial, operational and patient-derived sources. -- Health IT functions that support patient safety. -- Privacy and security protections. The framework document strongly urges organizations forming ACOs to establish "a data warehouse that can accept, store, normalize and integrate data from multiple clinical, operational, financial and patient derived systems." As of 2011, only about 30% of U.S. hospitals <a href=" http://www.himss.org/files/himssorg/content/files/20110221_Anvita.pdf">had such data warehouses</a>, according to HIMSS Analytics. Some of the specific use cases in the framework required very complex connections among various data sources. For example, to "identify best setting for care," CCHIT suggests the use of "technologies that can assess acuity of care, record and display patient and family needs and circumstances, present benefit and health plan provider network information, and access real-time information on available beds and personnel, for appropriate setting of care." No healthcare organization has these kinds of capabilities today, acknowledged Grace Terrell, MD, CEO of <a href="http://www.cornerstonehealth.com">Cornerstone Health Care,</a> a 360-provider multispecialty group in High Point, N.C., and one of the framework's coauthors, in an interview with InformationWeek Healthcare. "The framework as it's constructed is about where we need to go, not where we are now," she said. "It's not doable for anybody right now with the current technology and infrastructure we have today." Current EHRs, she pointed out, were designed for episodic care, not population health management. Some vendors are "trying to superimpose early versions of some of what we need for population health on top of that," she added, but Cornerstone had to use third-party applications as well in its own ACO efforts. The framework doesn't assume that the infrastructure of the future will be built around EHRs, she added. Drawing an analogy to the proliferation of apps for mobile devices, she said, "We don't worry about the underlying platform, we pull apps in to help us with various functions. It would seem to me that as EHRs become commodities, the next wave of functionality will be applications." When Cornerstone -- which has had an EHR since 2005 -- set off down the ACO path a couple of years ago, Terrell said, the CCHIT framework would have come in handy for guidance on where to prioritize their investment and how to evaluate vendors. Many physician groups and smaller hospitals, she noted, are calling themselves ACOs without any idea of the IT infrastructure they'll need. CCHIT, a nonprofit organization, is known primarily for its certification of EHRs. Asked whether it plans to certify ACO health IT at some point, CCHIT spokeswoman Sue Reber replied, "We're in early days, and there's so much here that some of these organizations haven't contemplated before. The intent of this framework is to educate and inform, drawing on the expertise we have on the commission and the advisory panel. Time will tell whether the market is looking for something more concrete from us, perhaps in the form of a certification program."2013-06-11T15:00:00ZEHR Association Launches Developer Code Of ConductIndustry leaders praise voluntary code as move in the right direction. However, some of the code's fine print is not so inspiring.http://www.informationweek.com/healthcare/electronic-medical-records/ehr-association-launches-developer-code/240156456?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div>(click image for larger view and for slideshow) </div>The HIMSS Electronic Health Records Association (EHRA) has unveiled a developer "code of conduct". According to a press release, the association created the guidelines "as a reflection of its members' commitment to supporting safe healthcare delivery, fostering continued innovation, and operating with high integrity in the market for EHR users and their patients and families." No companies are required to abide by the code, but those that do will be able to feature it in their marketing materials, along with an EHRA-designed logo. The EHR developer <a href="http://www.himssehra.org/docs/EHR%20Developer%20Code%20of%20Conduct%20Final.pdf">code of conduct</a> focuses on general business practices, patient safety, interoperability and data portability, clinical and billing documentation, privacy and security, and patient engagement. The area of the code that received the most attention from attendees at an EHRA press conference was the requirement that adopting companies participate in patient safety organizations (PSOs) and report health IT-related patient safety incidents. In addition, participating vendors cannot contractually prohibit customers from discussing patient safety issues associated with their products. [ What's behind some doctors' avoidance of EHRs? Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/why-some-doctors-dont-lean-on-ehr/240155618?itc=edit_in_body_cross">Why Some Doctors Don't Lean On EHR</a>. ] An EHRA spokesperson told InformationWeek Healthcare that some of EHRA's 40 members -- which include all of the leading vendors -- belong to PSOs today. But she couldn't say how many did or name any of them. Another code provision that stands out is one requiring vendors to help customers transfer their patient data when they switch from one EHR to another. Some vendors have made that <a href="http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/practice-management/ehrs-way-around-start-costs">very difficult in the past.</a> Industry leaders present at the conference were effusive in their praise of the EHRA's code of conduct. Farzad Mostashari, national coordinator of health IT, singled out the data portability, patient safety, and interoperability provisions. Michael Barr, senior VP of the American College of Physicians, also lauded the patient safety provision and said that there should be no contractual limits on discussions of safety issues. However, some of the code's fine print was less inspiring. For example, although adoptees promise to participate in one or more PSOs, the code contains a long list of caveats about the timing of such participation, such as waiting for "the outcome of current industry and policy discussions." The first statement in the code commits vendors to "emphasize accurate communication about the functionality and benefits of our products and services." Every vendor purports that its marketing claims are accurate; but if customers find that that's not true, they have no one to complain to but the vendor. Similarly, all participating vendors must promise to enable their customers "to exchange clinical information with other parties, including those using other EHR systems … to the greatest extent possible." But Mostashari told <a href=" http://www.healthcareitnews.com/news/mostashari-3-interoperability-questions">Healthcare IT News</a> only a few months ago that his office was still getting complaints from providers who said their vendors were making it difficult to exchange information. The EHR Association does not intend to check on whether EHR vendors that claim to adhere to the code actually do so. Instead, it states, adopting firms will be responsible for deciding how to apply the code. Nevertheless, a company's commitment to following the code can be incorporated into its marketing materials, which can also sport an EHRA logo. Asked at the press conference whether there's a system for ensuring that adopting vendors actually adhere to the code, EHRA chair Michele ("Mickey") McGlynn, senior director for strategy and operations at Siemens, replied that vendors need to have documentation showing that they've adopted the code and make that available to customers upon request. "We believe that it will become transparent as to who adopts [the code] because people will ask whether or not a company follows the code," she said. The association encourages any EHR vendor, regardless of whether it belongs to the EHRA, to subscribe to the code of conduct. Although the focus is on vendors of complete systems, association officials said that modular EHR vendors can sign on, too. The EHR Association's members approved the code of conduct, which was developed over several months with input from medical societies and other stakeholders. But until the code was officially released, no vendors could actually pledge to follow the code. So nobody had signed on the dotted line at press time, although many companies are expected to in the near future. 2013-06-10T14:56:00ZMore Mobile EHRs Add Speech RecognitionThird-party interfaces to iPad native applications allow more EHR vendors to voice-enable their products.http://www.informationweek.com/healthcare/mobile-wireless/more-mobile-ehrs-add-speech-recognition/240156350?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> (click image for larger view and for slideshow) </div> While some companies <a href="http://www.informationweek.com/healthcare/mobile-wireless/ehr-makers-answer-doctors-calls-for-mobi/240156084">still lag behind</a>, EHR vendors are moving rapidly to enable their mobile products with speech recognition, either directly or through third-party interface vendors. In the first category is Cerner, which just last month integrated Nuance Communications' speech recognition product with its ambulatory mobile EHR for iPads, according to Jon Dreyer, director of mobile solutions marketing for Nuance. In an interview with InformationWeek Healthcare, Dreyer added that in January, <a href="http://www.informationweek.com/healthcare/electronic-medical-records/nuance-adds-voice-recognition-to-mobile/240009721?">Epic embedded Nuance in its latest mobile EHRs for the iPhone and iPad. Allscripts, which voice-enabled its Sunrise inpatient mobile EHR some time ago, doesn't yet have speech in its Wand ambulatory EHR. But an Allscripts spokesperson told InformationWeek Healthcare that Wand will be integrated with the <a href="http://mmodal.com">MModal</a> and <a href="http://www.apple.com/ios/siri/">Apple Siri</a> voice recognition applications later this summer. [ A recent usability survey puts Athenahealth on top. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/athenahealth-ehr-wins-usability-poll/240156204?itc=edit_in_body_cross">Athenahealth EHR Wins Usability Poll</a>. ] Other major companies are also using third-party vendors to provide an iPad-native front end that includes speech recognition to their EHRs. For example, Dreyer said, Nuance is integrated with Iconx, which makes a <a href="https://store.nextgen.com/Content/PDF/0000354.jpg">mobile interface for NextGen,</a> and with MedMaster Mobility, which <a href="http://marketplace.greenwaymedical.com/inex_solutiondetail?solutionId=a2C600000001tnpEAA">does the same for Greenway.</a> Small independent vendors have also built speech-enabled mobile EHRs for certain specialty areas, such as emergency departments, urgent care centers, and dermatology. For example, Nuance is embedded in <a href="http://nuancehealthcareblog.com/2012/03/26/app-of-the-month-march-2012-montrue-technologies-inc-sparrow-edis/">Sparrow EDIS,</a> Montrue Technologies' ED-specific iPad application, and <a href="http://nuancehealthcareblog.com/2012/05/31/app-of-the-month-may-2012-lightning-charts/">Touch Medix's Lightning Charts</a>, also designed for the ED. <a href="http://nuancehealthcareblog.com/2013/02/07/mhealth-app-of-the-month-february-2013-electronic-medical-assistant/">Modernizing Medicine</a> and <a href="http://nuancehealthcareblog.com/2012/04/24/app-of-the-month-april-2012-ez-derm/">EZDerm</a> have devised mobile EHRs specifically for dermatologists. "The reality is that it's impractical to do any kind of documentation on mobile devices if you don't have speech," Dreyer stated. "Nobody's going to type into this thing or peck away at the onscreen keyboard. So the feedback from customers in the market today that are leveraging this has been very positive." This is especially true in very busy environments such as the ED and in specialties where physicians must give their full attention to physical exams, Dreyer said. "It's either where the users themselves are mobile and jumping from one patient to the next, or where the physician is more hands on and having a computer between physician and patient gets in the way." The ability to use speech for ordering simple meds is already available on some speech-enabled mobile products. But much more is coming down the line. To begin with, Dreyer noted, Nuance wanted to make sure that its cloud-based speech recognition product for mobile EHRs was very fast and accurate. "That's the number one thing that the user needs and wants," he said. But now some of Nuance's developer partners are beginning to add "command and control" features for information retrieval. Introduced by Nuance less than year ago, these features allow users to ask the application to show them things like their patient lists, a particular patient's lab results, or when the patient's next appointment is. By the end of the year, Dreyer said, Nuance will introduce the next generation of command and control, which uses interactive features that depend on its "clinical language understanding" (CLU), a form of natural language processing. This "virtual assistant," Dreyer explained, will manage dialog between the user and the application. "For example, if a doctor wants to start a patient on a medication," he said, "the system can ask for clarifying information based on the information it needs. It knows it needs medication, dosage, frequency, dispensed amount, and refills in order to place a med order. So it'll continue to ask that, and CLU is parsing out the information you're telling it so you can get a string of information, and if you miss anything, it will let you know. It will also look into the drug interaction tables in the EMR and leverage that content and present it to the user in a very natural flow." How does the speech recognition application access the EHR database to get the drug interaction rules? All mobile EHRs are thin clients interacting with a server that stores the EHR application and the data. So Nuance's cloud-based application can communicate with the server that stores the EHR to get the necessary information. One thing that's still unclear, however, is how much clinicians want to trust a speech recognition system that could potentially misinterpret what they say when they're ordering a medication or a lab test. This has been a challenge for <a href="http://www.informationweek.com/healthcare/cpoe/first-speech-enabled-mobile-cpoe-lacks-d/240150952">Intermountain Healthcare and MModal,</a> which are jointly developing a speech recognition system that can be used in computerized physician order entry (CPOE). To date, their beta version has been used only for prescribing common, frequently prescribed meds. Lab and imaging orders and nursing orders are next on the roadmap.2013-06-07T12:25:00ZAthenahealth EHR Wins Usability PollFocus on helping doctors use its ambulatory electronic health record software pays off for EHR upstart Athenahealth in KLAS Research survey.http://www.informationweek.com/healthcare/electronic-medical-records/athenahealth-ehr-wins-usability-poll/240156204?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div>(click image for larger view and for slideshow) </div><a href="http://www.athenahealth.com">Athenahealth</a>, a Watertown, Mass.-based vendor that is better known for its revenue cycle management software than electronic health record products, beat eight bigger vendors for ambulatory EHR usability in a <a href="http://www.klasresearch.com/News/PressRoom/2013/AmbulatoryEMR2013">survey performed by KLAS Research.</a> Eighty-five percent of Athenahealth's clients said they had achieved usability, compared to only 55% of the customers of its most distant competitor. KLAS polled physician leaders of 163 practices with more than 25 doctors. Athenahealth received the highest ratings in usability at launch, current usability, and overall functionality. The runners-up in out-of-the-box usability were eClinicalWorks, GE Healthcare CPS, Greenway and Epic, with Cerner, NextGen, Allscripts Enterprise and McKesson Practice Partner bringing up the rear. In current usability, Athenahealth was followed by eClinicalWorks; GE; Epic and Cerner in a tie; NextGen; and Allscripts and McKesson in a tie. In functionality, Athenahealth received an overall score of 4.2 on a scale of five, doing especially well in physician documentation and support for a mobile device. The other vendors, in descending order of their ratings, were Epic, GE, Greenway, NextGen, Allscripts, Cerner, eClinicalWorks and McKesson. [ Mobile EHR apps are more popular than ever, according to the companies that sell them. Read <a href="http://www.informationweek.com/healthcare/mobile-wireless/ehr-makers-answer-doctors-calls-for-mobi/240156084?itc=edit_in_body_cross">EHR Makers Answer Doctors' Calls For Mobile Apps</a>. ] Vendors who helped their customers use the software they bought scored higher. Both Athenahealth and Epic excelled in this area. "The best screen layouts and workflows cannot compensate for poor code quality," the report also noted. Those kinds of issues were "usability show-stoppers" for some EHRs because they required extensive customer efforts to make systems usable, the report said. Jasmine Gee, a spokesman for Athenahealth, said the vendor had achieved its results partly through its emphasis on tracking physician performance. Because the EHR is a "software as a service" product hosted by the company, Athenahealth's staff can see the data that's being entered in the EHR. In addition, a feature of the system tells them how long it takes physicians and their staff to perform specific functions in the EHR. Athenahealth uses that data and doctor interviews to improve its system and help users who are having problems. "If a physician spends a lot of time on the exam portion, we ask what's going on -- is it a software or a training issue -- and use the data to intervene," said Gee. This is similar to what the company does with office managers who use its revenue cycle management software. "We use best practices to figure out whether you're doing well, and if you're doing poorly, you'll get a phone call," she said. Michelle Holmes, a senior manager at <a href="http://www.ecgmc.com">ECG Management Consultants</a> in Seattle, said Athenahealth's victory was surprising, given its short time selling an EHR. But she gave credit to the company for its ability to respond quickly to the market.As for why all of the hospital information system vendors except for Epic did poorly in the survey, she noted that they'd started out behind on the ambulatory side and are still trying to catch up. That's actually not quite true of Allscripts, which began as an ambulatory vendor and later bought in-patient EHR vendor Eclypsis. Recently, she noted, Cerner and Meditech decided to ditch their old ambulatory-care EHRs, which weren't working well for most customers, and build entirely new systems. Cerner's new model is pretty good, she said, but isn't well known yet in the industry. Meditech's new entry won't be on the market for another year, she added. Overall, she said, the usability of EHRs has been slow to improve. "One of the downsides of Meaningful Use has been the lack of progress across the board on usability. There's hasn't been progress anywhere, unless somebody is doing a new rebuild [of their EHR]," she noted. EHRs from the major vendors tend to be poorly suited for specialists, she said, a point also made in the KLAS survey, which showed significant percentages of specialists were unhappy with the usability of their systems. The vendors need to overhaul their software entirely to fit the workflow of those specialties, she said, but they're not likely to do that soon. The "easy fix" is to integrate voice recognition with the EHRs and let specialists dictate into boxes for the subjective, objective, assessment and plan parts of the patient exam, she said. Evan Steele, president of <a href="http://srssoft.com">SRS Software,</a> an EHR vendor that was not rated in the KLAS survey, agreed that specialists have received short shrift. As a result, primary care doctors are generally happier with their EHRs than specialists, and some specialists such as ob/gyns are happier than others, such as orthopods and ophthalmologists. Asked whether the KLAS survey was representative, as it focused on large practices, Steele said that a recent SRS survey about physician satisfaction with EHRs found that practice size was not correlated with whether doctors would recommend their system to a friend. So he doesn't think it makes any difference. However, he said, the small sample size of the KLAS survey might have led to some skewing of the results. "With 163 groups and nine vendors, there are 17 to 18 data points per vendor, so you can get a lot of variability. You might get three doctors that love the Athena interface, and that drives their score. With 150 to 200 practices [per vendor], you're not going to get that variability and volatility."2013-06-06T15:13:00ZDoctors Slowly Accept Health Information ExchangesAlmost half of practices plan to join HIEs, but rise is slow, and far more hospital-owned than private practices are interested, says study.http://www.informationweek.com/healthcare/interoperability/doctors-slowly-accept-health-information/240156199?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/clinical-systems/ss1120126hievendors/240142427"><img src="http://twimgs.com/informationweek/galleries/automated/910/01_Medicity2_tn.jpg" alt="6 HIE Vendors: How They Measure Up" title="6 HIE Vendors: How They Measure Up" class="img175" /></a> <div class="storyImageTitle">6 HIE Vendors: How They Measure Up</div>(click image for larger view and for slideshow)</div>Nearly half of physician practices plan to join some kind of health information exchange (HIE), according to <a href="http://capsite.com/assets/Uploads/2013-Ambulatory-EHR-Study-FINAL.pdf">the fifth annual survey</a> of ambulatory practice management systems and EHRs by <a href="http://www.himssanalytics.org">HIMSS Analytics</a>, the research arm of the Health Information Management and Systems Society (HIMSS). But far fewer practices actually participate in an HIE today, the findings show. Among the 846 practices that responded to the survey were hospital owned and freestanding practices of all sizes, ranging from one-doctor offices to groups of 100 or more physicians. Forty-six percent of the respondents planned to join a HIE, with 19% preferring a state health information exchange, 16% wanting an HIE that was part of a hospital or healthcare system, and 11% endorsing a regional HIE. Thirty-seven percent said they had no such plans. In the "other" category (17%) were practices that already belonged to exchanges and respondents who were unsure, HIMSS Analytics executives told InformationWeek Healthcare. Of the privately owned practices, just 39% said they planned to join an HIE; 46% had no such plans. In contrast, 62% of hospital-owned groups said their organization planned to participate in an exchange, and just 14% did not. Notably, 25% of the hospital-owned practices expected to be part of a hospital system HIE, vs. just 13% of the freestanding practices. [ HIEs don't necessarily save money across the board. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/hie-participation-doesnt-create-test-sav/240155853?itc=edit_in_body_cross">HIE Participation Doesn't Create Test Savings, Study Says</a>. ] Brendan Fitzgerald, research director of HIMSS Analytics, said that this was part of the reason for the disparity between the two types of practices. In addition, he noted, "Much of the decision making in that area is out of the hands of the individual hospital-owned practice. The hospital would make that decision. On the freestanding side, they're deciding whether they want to engage in an HIE." Overall, the percentage of practices that had HIE plans was only slightly higher this year than in 2012, when it totaled 43%. Some other key findings of the HIMSS Analytics report: -Private practices are using a great variety of EHRs, and they consider more EHRs when looking to purchase one than hospital-owned groups do. -The EHR vendor with the highest market share among hospital-owned practices is Epic, with 33%. In the freestanding sector, Epic has only a 4% market share, and eClinicalWorks is the leader with 11%. Fitzgerald noted that hospital-owned practices have different priorities than private groups do, including the ability to communicate across care settings. So they require more "bells and whistles" in their EHRs. And in the ambulatory EHR market overall, he added, "there is still a high level of fragmentation." The survey showed that a third of practices planned to purchase a new EHR, upgrade their system, or replace it. But despite evidence that <a href="http://www.americanehr.com/about/News/13-03-05/Survey-of-Clinicians-User-satisfaction-with-electronic-health-records-has-decreased-since-2010.aspx">many physicians are unhappy with their EHRs</a>, only 6% are looking to replace them, according to the report. Whether practices are hospital owned or freestanding, Fitzgerald said, "they've committed a lot of time and effort to making these EHR purchases, and they want to make it work. Given the effort, I don't think many people are jumping at the chance to 'rip and replace' and purchase a new system." Within size categories, there were notable differences in what was driving EHR purchases. For example, 35% of practices with more than 100 doctors saw the ability to exchange patient data among facilities as the biggest driver, whereas that was the top goal in only 17% of all practices. Making their practice more efficient was more important to practices of three to 10 physicians than to respondents as a whole. "Smaller practices want to be more efficient, but larger practices that serve larger communities have different parameters," Fitzgerald noted. "They want to be able to integrate seamlessly with larger organizations. It has to do with day-to-day workflow and how they want to utilize their EHR solution." There was a more diverse set of vendors in the area of practice management (PM) systems than in the EHR arena. Fitzgerald said that was related to the fact that most practices have had PM systems longer than they've had EHRs. So when they bought EHRs, many of them kept their current PM systems and interfaced the two systems rather than buying an integrated solution. Blaine Newton, senior VP of HIMSS Analytics, added that many practices held off on upgrading their PM systems when they were busy implementing EHRs. Now they're catching up, "and we're seeing pickup in practice management tools," he said. Neither executive believed that the impending transition to ICD-10 was the main motivating force in these investments.2013-06-06T13:56:00ZHealthTap Expands Into Mobile Health App ReviewsDoctors rate and recommend mobile apps for consumers, but none of the reviews are negative.http://www.informationweek.com/healthcare/mobile-wireless/healthtap-expands-into-mobile-health-app/240156176?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div>(click image for larger view and for slideshow)</div>  HealthTap, an online service that enables patients to ask doctors health-related questions for free, has launched AppRx, a new mobile health app review service. Its 40,000-plus physicians can review or rate any of the roughly 40,000 mobile health apps available in the iTunes and Google online stores. <a href="http://www.informationweek.com/healthcare/patient/ask-a-doctor-healthtap-gives-free-advice/231900839">HealthTap</a> CEO Ron Gutman told InformationWeek Healthcare that thousands of physicians are already participating. To make it easier for doctors to find apps that might interest them, the company has written brief descriptions of the consumer programs and has slotted them into <a href="http://digests.healthtap.com/?email_link=1#apps/directory/32">30 categories</a> on its website. These include both "health" apps, such as fitness, wellness and sleep apps, and "medical" apps, such as programs that help people manage asthma or pregnancy. In addition, the company uses its knowledge of the physicians' specialties and areas of expertise to suggest apps that they might want to try, Gutman said. [ Will some apps be regulated as medical devices? Read <a href="http://www.informationweek.com/healthcare/policy/fda-warns-mobile-health-apps-makers/240155716?itc=edit_in_body_cross">FDA Warns Mobile Health Apps Makers</a>. ] To ensure quality control, a medical review board evaluates a doctor's first 30 app reviews before they are posted. Afterward, doctors are free to post reviews on their own. The mobile health app categorization is similar to the structure that HealthTap uses to help consumers ask questions. However, Gutman said, physicians cannot use HealthTap to "prescribe" apps to patients, just as they can't prescribe medications or give specific medical advice to consumers. "We are recommending apps, not prescribing them to a specific person," he said. "This is just education at large." The majority of apps reviewed on the HealthTap site are free. Gutman doesn't deny that the doctor reviewers are biased toward free apps, but he views that as a strength of the service. "We want to keep it as close as possible to the consumer experience. If a developer decides to charge for a certain app, it creates a barrier. If it's worth it, the consumer will buy the app, and so will the doctor." There are no negative reviews of apps on the HealthTap site. "We decided we'd take a positive approach and let the community as a whole decide what they don't like," rather than allowing individual doctors to criticize particular apps, Gutman said. What this means is that physicians can either recommend or skip an app. If consumers don't see a particular app reviewed on the site, that probably means that no physicians liked it, he added. While it's possible that some meritorious apps could get passed over as a result, he noted, their developers are free to bring them to the HealthTap physicians' attention. The entire physician directory is publicly available, he said, and all of the reviewers are identified by name. For the past year or so, it was not HealthTap, but another company named Happtique that gained attention for its plan to review mobile health apps for consumers. In February, Happtique, a subsidiary of the Greater New York Hospital Association's for-profit division, published the final standards in its ambitious certification program, and it is <a href="http://www.happtique.com/app-certification/">now accepting medical education and nursing apps</a> for certification. After a recent shakeup at the company, questions were raised about Happtique's commitment to this program, but the company <a href="http://mobihealthnews.com/22415/exclusive-happtique-refocuses-on-hospitals-ceo-ben-chodor-resigns/">told MobiHealth News</a> that it was still on track. Gutman said he was unfamiliar with Happtique's plans and that they had nothing to do with HealthTap's decision to branch into mobile app reviews. "This takes a long time to put together from a technical perspective and a community building perspective. We waited for the right timing to come out with this." HealthTap <a href="http://mobihealthnews.com/22707/healthtap-takes-on-app-curation-prescribing/">recently received $24 million</a> in its second round of venture capital funding. Among the investors: Khosla Ventures, Mayfield Fund, Mohr Davidow Ventures, former Google CEO Eric Schmidt, Mohr Davidow and Esther Dyson.2013-06-06T09:39:00ZHHS Looks To Close Healthcare Data Infrastructure GapsFederal health agency studies the data standards, security, methods and other factors needed to support patient-centered outcomes research.http://www.informationweek.com/healthcare/policy/hhs-looks-to-close-healthcare-data-infra/240156126?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div>(click image for larger view and for slideshow)</div>Two units of the Department of Health and Human Services (HHS) have embarked on an effort to identify how the government can help fill gaps in the data infrastructure required to do patient-centered outcomes research (PCOR). The Office of the National Coordinator of Health IT (ONC) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) are collaborating in the initiative, which they expect will take 10 months. The ONC has awarded a contract to the National Opinion Research Center (NORC) at the University of Chicago to assist with the effort. NORC, which has had extensive experience in working with government agencies, will assemble "multiple advisory groups to explore different standards, policies and services required to establish this infrastructure," the listserv announcement said. "In addition, ONC will be posting documents from this effort for public input," it said. The Affordable Care Act directs HHS to build data capacity for patient-centered outcomes research -- also known as comparative effectiveness research (CER) -- which evaluates which tests and treatments are most effective. The law also establishes the <a href="http://www.pcori.org">Patient-Centered Outcomes Research Institute</a> (PCORI), a nonprofit entity that is managing the national CER program. [ Who's making a difference in healthcare? Read <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>. ] Of the funds allocated for this purpose, 80% are going to PCORI and 20% to the HHS PCOR Trust Fund, according to an ONC official who asked not to be identified. Four percent of the total funding, or nearly $200 million, will be available through ASPE to assist in the development of the PCOR data infrastructure through FY 2019. In essence, the ONC official told InformationWeek Healthcare, ONC is going to look at the long-term strategic direction of the CER effort, what will be required to create the necessary infrastructure, where the gaps are, and which areas should receive priority for government funding. Among the areas currently under consideration are: -- data standards, -- data aggregation and access, -- data sources and content that need to be captured, -- data security policies, -- governance policies and structures, -- analytical methods, and -- how to translate research results into improvements in patient care. In its planning, ONC will consider all of the current activities that could help support CER, including the activities of PCORI and those of ONC and the Centers for Medicare and Medicaid Services (CMS) in encouraging health information exchange and interoperability. "We want to leverage everything we have in place now and a lot of the activities that are going on already, and how can we make complementary strategic investments that will move that ball forward quickly," said ONC's spokesperson. The CMS recently <a href="http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/PQRS-Call-for-Measures-Announcement.pdf">solicited suggestions</a> about new patient outcomes measures that could be added to the metrics in the Physicians Quality Reporting System (PQRS), widely regarded as the forerunner of the agency's pay-for-performance program for physicians. Although that program focuses on provider evaluation, and the CER program is about assessing the effectiveness of treatments, the ONC official noted that there could be synergies among government programs that depend on reporting of data from electronic health records. "Our focus will be on comparative effectiveness research," she said. "But the last thing we want to do is create silos in this infrastructure." PCORI, meanwhile, has not waited for the data infrastructure to be perfected to start its work. The institute recently announced it would <a href="http://www.pcori.org/2013/national-patient-centered-research-network/">spend up to $68 million</a> to support development of a National Patient-Centered Clinical Research Network. PCORI has allocated $56 million to support up to eight new or existing clinical data research networks that will conduct randomized CER studies using data from clinical practices. In addition, it will provide $12 million to support up to 18 new or existing "patient-powered research networks." Over time, PCORI expects all of these networks to become integrated with each other, the announcement said. In May, PCORI approved <a href="http://www.pcori.org/2013/pfa-cycle-ii/">51 research awards totaling $88.6 million</a> over five years. That brought the total of PCORI's grants for specific studies to $129.3 million. A third round of grants is expected later this year.2013-06-05T10:36:00ZEHR Makers Answer Doctors' Calls For Mobile AppsMore than 100 EHRs will offer mobile access, native iPad versions or both by 2014, but voice recognition is still missing.http://www.informationweek.com/healthcare/mobile-wireless/ehr-makers-answer-doctors-calls-for-mobi/240156084?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div>(click image for larger view and for slideshow) </div>Electronic health record vendors are responding to pent-up demand among doctors for EHRs they can access on mobile devices, including smartphones and computer tablets. According to a <a href="http://www.prweb.com/releases/2013/5/prweb10553455.htm">new national survey</a> by Washington, D.C.-based Black Book Rankings, 122 companies said they would introduce fully functional mobile access to their EHR products, native iPad versions, or both by the end of this year. Another 135 EHR vendors said that mobile apps were in their strategic plans. Among the leading vendors that already offer mobile versions of their EHRs are Greenway, NextGen, Cerner, GE, Allscripts and eClinicalWorks. Interestingly, however, <a href="https://www.drchrono.com/products/ehr/">drchrono,</a> one of the first iPad-native EHRs, garnered the highest customer satisfaction scores in a follow-up poll of more than 1,400 practices. Although the Black Book survey results clearly show a shift toward mobility in the EHR market, the details are somewhat murky. First, it's unclear how many current or future applications are or will be iPad-native. That's important, because most doctors don't want an EHR system on their mobile device that replicates all of the features in the desktop version -- they want a simplified version, according to Black Book. So "virtual desktops" for mobile devices are out. [ If your state is leaning hard on doctors to adopt EHR guidelines, you need to read this: <a href="http://www.informationweek.com/healthcare/policy/ehr-mandate-riles-massachusetts-doctors/240155859?itc=edit_in_body_cross">EHR Mandate Riles Massachusetts Doctors</a>. ] Second, although vendors have designed some mobile EHRs for iPhones and other smartphones, their functionality is limited because of device size. In fact, 95% of doctors surveyed by Black Book said their biggest problem with mobile EHRs is the smartphone's small screen. The survey found that 89% of primary care doctors and internal medicine subspecialists use smartphones to communicate with staff, and 51% of all clinicians use them to perform medical research on the Internet. Eight percent use a mobile device for electronic prescribing, accessing records, ordering tests or viewing results. But 83% of the respondents said they'd use mobile EHRs to update patient charts, check labs and order medications if those features were available to them on their mobile devices. A quick check of some of the top mobile EHRs in Black Book's poll indicates that they're designed mainly for doctors' use when they're rounding or out of the office. Despite Black Book's assertion that doctors would buy such EHRs as replacements for traditional EHRs that they dislike, the major vendors are not creating standalone products that would cannibalize their own sales of desktop/laptop EHRs. They're leaving that to smaller companies like drchrono. Another thing they're leaving to this upstart firm, for the most part, is speech recognition, although one might expect that to be part of any iPad-based EHR. Even <a href="http://www.greenwaymedical.com/solutions/primemobile/">Greenway</a>, which has put a lot of emphasis on its PrimeSpeech natural language processing application, does not advertise it in conjunction with its mobile EHR. A year ago, eClinicalWorks said it would <a href="http://www.informationweek.com/healthcare/electronic-medical-records/natural-language-processing-takes-center/232601951">release a voice recognition app</a> called Scribe at the same time as its mobile EHR, but eCW Mobile does not include Scribe. And, although Allscripts bundles speech recognition with its Sunrise Mobile app for inpatient use, its <a href="http://www.allscripts.com/en/solutions/ambulatory-add-ons/wand.html">iPad-native Wand EHR</a> for ambulatory care apparently lacks voice enablement. Wand, however, is more complete than most mobile EHRs, allowing clinicians to complete a variety of tasks: add or update clinical information for a patient, view patient summary information, obtain a longitudinal view of patient data, capture the history of the present illness, e-prescribe and communicate online. The version for Allscripts Professional EHR even lets users complete a review of systems and document a physical exam, enter orders, and submit charges for an encounter. Other mobile EHRs from leading vendors provide the ability to view key parts of the EHR including lab results, e-prescribe, pull up appointment lists, search for patients, e-mail or fax messages, and capture charges. But documentation in most of these products is limited to editing clinical summaries and charges. Black Book's survey, like others before it, found that doctors prefer iPads and iPhones to other types of mobile devices. Nevertheless, some mobile EHRs such as Greenway's also can be used with Android phones and tablets. Finally, the survey found that most hospitalists, primary care doctors, office-based physicians, rheumatologists and nephrologists looked forward to the availability of mobile EHRs. But only 14% of surgeons, including orthopods, ophthalmologists and ENT specialists, had any interest in these applications.2013-06-03T09:06:00ZHIE Participation Doesn't Create Test Savings, Study SaysPhysicians in Colorado HIE ordered fewer lab tests and the same number of imaging tests, but costs remained constant.http://www.informationweek.com/healthcare/electronic-medical-records/hie-participation-doesnt-create-test-sav/240155853?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/clinical-systems/ss1120126hievendors/240142427"><img src="http://twimgs.com/informationweek/galleries/automated/910/01_Medicity2_tn.jpg" alt="6 HIE Vendors: How They Measure Up" title="6 HIE Vendors: How They Measure Up" class="img175" /></a> <div class="storyImageTitle">6 HIE Vendors: How They Measure Up</div>(click image for larger view and for slideshow)</div> The use of health information exchanges (HIEs) in ambulatory care is unlikely to produce significant cost savings through reductions in rates of testing, <a href="http://jamia.bmj.com/content/early/2013/05/21/amiajnl-2012-001608.short?g=w_jamia_ahead_tab">a new study</a> in the Journal of the American Medical Informatics Association (JAMIA) concludes. But the researchers emphasized that there may be other economic benefits of HIE from "downstream outcomes of better informed, higher quality care." The hypothesis of the study -- based on earlier predictions by health policy experts -- was that if physicians had online access to results of tests recently ordered by other doctors, they wouldn't order those tests again for the same patients. If that proved to be true, according to the hypothesis, there should be some cost savings. The researchers measured the test ordering rates and the associated costs in Mesa County, Colo. from 2005, when Quality Health Network (QHN) launched an HIE in the area, to 2010. In the latter year, 85% of local practices were participating in the HIE, the paper said. Using claims data from Rocky Mountain Health Plans, the dominant health plan in the market, the researchers compared the test ordering rates of 306 providers in 69 practices before and after they joined the HIE. For both primary care providers and specialists, the rate of lab testing increased over the five-year period but dropped significantly after their practices joined the HIE. The rates of imaging test orders remained more or less constant over the time period and were not affected by HIE. [ ONC has released resources to help providers prepare for information exchange. Read more at <a href="http://www.informationweek.com/healthcare/leadership/onc-steps-up-mu-stage-2-preparation/240155724?itc=edit_in_body_cross">ONC Steps Up MU Stage 2 Preparation</a>. ] The total costs of the lab tests did not drop significantly after the practices joined QHN. The average cost per test did not change much, either, which raises the question of why overall costs did not drop with ordering rates. The researchers explained that they used different methods to analyze costs and testing rates to reduce the skewing effect of a few very expensive imaging tests. But in any case, it doesn't appear that the availability of the test results through the HIE had much effect on costs. In an interview with InformationWeek Healthcare, lead author Steve Ross, MD, associate clinical professor at the University of Colorado School of Medicine, said that the percentage of practices that were involved in QHN didn't reach critical mass until around 2008. He pointed out that there's a network effect in the use of HIE data that is related to the adoption of the exchange. "The more people are on it, the more value it's going to have," he said, and the more likely providers are to use it. However, Ross noted, HIE participants had access to test results from some physicians who did not belong to QHN. That is because the bulk of the tests were done at one of the two area hospitals, which used QHN to deliver lab results electronically to staff physicians. All of their results went to the HIE, although only those who were online with the exchange could receive them in their EHR. Physicians who used the HIE to look up results on tests ordered by other physicians could therefore find any that were performed by the hospitals, even if the doctors who ordered the tests did not participate in QHN. A more important caveat to the study results is that physicians are generally reluctant to leave their workflow to look up clinical data from other practitioners on a website. According to Ross, if the providers in the JAMIA study had been able to look up community test results on their patients without leaving their EHR, it's very possible that the HIE would have proved its effectiveness further. The study's data was insufficient to distinguish the extent to which physicians were using the HIE merely to receive test results or were going on the QHN site to look up outside information, Ross said. But, he pointed out, "[The latter] is where you're really going to see the benefit -- where you have access to something you wouldn't have had access to otherwise." Another <a href="http://content.healthaffairs.org/content/31/3/488.abstract?sid=283686cc-97b7-4573-8c09-aea8be2aede6">recent study</a> found that physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40%-70% greater likelihood of an imaging test being ordered. The study's authors speculated that electronic access does not decrease test ordering in the office setting may even increase it, possibly because of system features that are enticements to ordering. 2013-05-31T09:40:00ZEHR Mandate Riles Massachusetts DoctorsDoctor's angry blog post calls attention to year-old law that would punish those who don't meet Meaningful Use EHR criteria with loss of their medical licenses.http://www.informationweek.com/healthcare/policy/ehr-mandate-riles-massachusetts-doctors/240155859?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div>(click image for larger view and for slideshow) </div>Massachusetts physicians are concerned about an amendment to a state law that would require them to show proficiency in the use of electronic health records (EHRs) sufficient to meet the federal Meaningful Use criteria -- or risk losing their medical licenses in 2015. Howard Zwerling, MD, a practicing doctor in Massachusetts and president of EHR vendor ComChart, took these concerns nationwide with a <a href="http://thehealthcareblog.com/blog/2013/05/27/an-open-letter-to-massachusetts-physicians/">widely noticed post</a> on The Health Care Blog earlier this week. In his "open letter to Massachusetts physicians," he said that the practice of medicine had already become more difficult because of external mandates. "And now, the politicians intend to tell physicians which software they must use in their office and which [EHR] options must be utilized during the office visit," he wrote. Ronald W. Dunlap, MD, president of the Massachusetts Medical Society, told InformationWeek Healthcare that the society is hopeful that it can get the state Board of Registration in Medicine to adopt a more flexible interpretation of this provision so that physicians don't have to meet the government's MU standards on certified EHRs to keep their licenses. [ Are government health regulation deadlines unrealistic? Read <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>. ] "If the rigid interpretation of this law is upheld, it's going to be a problem in 2015," he said. "If we were to implement that, half to two-thirds of the state's physicians would not be able to be licensed." This high estimate is not based on any technological backwardness in Massachusetts. EHR adoption in the state is widespread compared to the rest of the country. But a large percentage of Massachusetts physicians are not even eligible to register for the Meaningful Use program, Dunlap noted. Either they are surgeons or other hospital-based specialists such as radiologists or pathologists, <a href=" http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html">who are excluded</a> from the program, or they're pediatricians who don't have enough Medicaid patients in their practices to qualify for government incentives. Dunlap estimated that of the 28,000 licensed physicians in Massachusetts, just 4,500 are primary care physicians. Those doctors and up to 2,500 medical subspecialists are eligible professionals (EPs) as defined by the Centers for Medicare and Medicaid Services (CMS). Most of the other doctors are not, he said. As a result, although many of the non-EPs are skilled at using EHRs, they would not pass the proficiency test that would allow them to keep their licenses if it required them to show Meaningful Use. A small percentage of physicians continue to resist acquiring EHRs, Dunlap said. These are mostly solo practitioners who don't want to spend the money and older doctors who are close to retirement. But as hospitals and other large organizations employ more doctors, "the numbers of those people are decreasing daily," he said. The original state law mandating that physicians use EHRs by 2015 <a href="http://www.physicianspractice.com/staff/state-ehr-mandates">was passed in 2008.</a> Last summer, the amendment was added at the instigation of state Sen. Richard T. Moore, according to Dunlap. The medical society, which had been discussing with the board ways for doctors to show they were using EHRs "meaningfully," was caught off guard. Now the society is trying to drum up support from hospitals and other stakeholders to put pressure on regulators so they will interpret the law favorably for physicians. "We're hoping that we can get this interpreted so it's not a rigid, government-defined standard of Meaningful Use," Dunlap said. "Using computers meaningfully is different from that rigid standard. That's the position we're taking: we're hoping it's a broader demonstration of competence that applies to a lot of different specialties." Zwerling, though, is taking a more defiant stand. His blog post called on all of his colleagues to write letters calling for the repeal of the law to Gov. Deval Patrick, the state secretary of health and human services, and their local representatives. 2013-05-29T13:20:00ZONC Steps Up MU Stage 2 PreparationAgency releases interoperability guidelines, launches training modules to help providers meet criteria for information exchange.http://www.informationweek.com/healthcare/leadership/onc-steps-up-mu-stage-2-preparation/240155724?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> (click image for larger view and for slideshow)</div>With seven months to go before Meaningful Use Stage 2 kicks in, the Office of the National Coordinator of Health IT (ONC) has taken several steps to ensure that providers understand the MU interoperability criteria and that they have the ability to meet those requirements. Among other things, ONC has <a href="http://www.healthit.gov/sites/default/files/direct_implementation_guidelines_to_assure_security_and_interoperability.pdf">released new guidelines</a> for implementing Direct secure messaging; it has begun urging health information service providers (HISPs), which convey Direct messages between clinicians, to get accredited through DirectTrust, a nonprofit trade organization; and it has released a suite of <a href="http://www.healthit.gov/providers-professionals/interoperability-training-courses">electronic training tools</a> to help providers prepare for interoperability. The five Web-based training modules are designed for use by regional extension centers (RECs), Beacon Communities, state health information exchanges, and other EHR implementers assisting hospitals and providers in achieving Meaningful Use Stage 2, according to an ONC fact sheet. The first module presents an overview of interoperability basics. The other four courses address interoperability in transitions of care, lab exchange with EHRs, patient and family engagement and public health. Trainers and providers can access the modules on an <a href="http://www.healthit.gov/providers-professionals/interoperability-training-courses">ONC website</a> or through the national health IT REC site if they have user accounts. The courses are available to mobile users on computer tablets, including the Galaxy and iPad 2 and 3. [ Do EHRs impede doctor-patient communications? They don't have to. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/ehrs-communication-can-co-exist-for-doct/240155065?itc=edit_in_body_cross">EHRs, Communication Can Co-Exist For Doctors, AMA Says</a>. ] The interoperability basics module uses a storytelling approach to explain the fundamentals of health information exchange. The top level of this course seems to be oriented to providers and the general public. Trainers can drill down to documents that provide more in-depth information. The new guidelines for Direct messaging, which update protocols released last year, "provide recommended policies and practices for health information service providers (HISPs), trust communities and accrediting bodies, such as DirectTrust," ONC states in its guideline document. ONC strongly urges HISPs providing services to eligible professionals and hospitals in Meaningful Use Stage 2 to adopt these protocols and participate in accreditation programs such as that of DirectTrust, which recently received a grant from ONC. The guidelines cover Security and Trust Agents (STAs) that may be operated by a healthcare entity, or more commonly, by a HISP. They also cover Registration Authorities, which establish the identities of certificate subjects, and Certificate Authorities, which issue certificates to HISPs and other organizations that convey Direct messages. The functions of an RA and a CA may be performed by a single entity or by multiple entities. The document notes that many HISPs "are employing Direct in a way that proactively enables exchange with a given HISP's boundaries while not offering mechanisms or supporting policies that enable exchange with other HISPs. Such limitations effectively block providers using different HISPs from exchanging patient information" and could hamper care coordination and the ability to meet the MU Stage 2 requirements. "[The new guidelines are designed] to ensure Direct is being implemented in a way that will support vendor-to-vendor exchange and interoperability across geographic, organizational and vendor-related boundaries," said Claudia Williams, director of ONC's state health information exchange program, in a <a href="http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/direct-implementation-guide-support-interoperability/">blog post.</a> Williams noted that DirectTrust will incorporate the new implementation guidelines into its accreditation process. In <a href="http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/directtrust-builds-transparency-confidence-direct-exchange/">another blog post,</a> Kory Mertz, ONC's challenge grant director, went even further in endorsing DirectTrust as ONC's unofficial accreditation body for HISPs: "We encourage HISPs to get accredited by DirectTrust and add their anchor certificates to its trust bundle to ensure the providers using their services are able to change information across vendor and organizational boundaries." While Direct is not the only permissible method of exchanging information in MU Stage 2, ONC requires EHRs to include Direct messaging capability as part of its 2014 certification requirements. Providers must use certified EHRs to show Meaningful Use in the federal EHR incentive program.2013-05-29T11:35:00ZFDA Warns Mobile Health Apps MakersAgency says some apps may be regulated as medical devices, but expert predicts final FDA guidance won't resolve critical issues.http://www.informationweek.com/healthcare/policy/fda-warns-mobile-health-apps-makers/240155716?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div>(click image for larger view and for slideshow)</div>  The Food and Drug Administration (FDA)'s letter admonishing an Indian software developer that it needs FDA clearance for its urinalysis app is a warning to other mobile health firms marketing apps that could be construed as medical devices. But the FDA's action alone does not establish which kinds of apps could be regulated, noted Bradley Thompson, an attorney with the Washington-based law firm Becker, Epstein and Green who is an expert on mobile health regulations. In fact, even the FDA's final guidance on mobile health apps, which is due this fall, will not settle some of the most important issues in this area, Thompson told InformationWeek Healthcare. The <a href="http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/ucm353513.htm">FDA's letter</a> was sent to Biosense Technologies Private Ltd., an Indian firm with a U.S. address in Mountain View, Calif. Biosense (which is not related to a U.S. company with the same name) makes <a href="http://www.uchek.in">an app called uChek</a>, which is designed for use with commercially available urinalysis test pads, also known as dipsticks. When soaked in urine, these dipsticks turn different colors. A uCheck user takes photos of the test strips with an iPhone camera, and the app identifies the concentrations of certain substances in those strips. The developer claims that uChek produces test results equivalent to those of "semi-automated urine analyzer machines." The FDA letter said that uChek appears to meet the definition of a medical device that requires FDA approval. Although the commercial dipsticks are cleared, the agency noted, any automated strip reader must receive separate clearance as a medical device. But it left the door open for the company to argue that uChek did not have to be regulated. Thompson said this kind of letter is rare and is generally reserved for neophytes who don't understand FDA rules. [ Mobile health apps are one way to get patients better involved in their own care. See <a href="http://www.informationweek.com/healthcare/interoperability/5-healthcare-tools-to-boost-patient-invo/240062597?itc=edit_in_body_cross">5 Healthcare Tools To Boost Patient Involvement</a>. ] On the other hand, he noted, one of the FAQs on Biosense's website indicates that the company is very aware of FDA regulations. Using the exact language specified by FDA, that section states that uChek is a class I medical device, which doesn't require FDA clearance. Curiously, he added, the company had earlier stated that its app was not a medical device; but after Thompson testified about this issue and named uChek in front of a Congressional committee, it added this FAQ to its site. Is there evidence that uChek doesn't do what it claims to do and therefore might be a threat to patient safety? Thompson responded that Gray Sheet, a medical device trade publication, had interviewed experts who said that Biosense had not done sufficient research to show that the app was reliable under FDA standards. Thompson's firm recently did a survey of 100 randomly chosen mobile health apps on iTunes, reading the descriptions of each one. What the researchers discovered, he said, is that eight of the apps "clearly required FDA clearance or approval, and to our knowledge didn't have it," he said. "Another 30% could have gone either way. There wasn't enough information on iTunes to make a judgment about it." The FDA's final guidance on mobile health, when it comes, is unlikely to resolve all of the regulatory issues, because two of the biggest ones will not even be part of that rule, Thompson said. They won't be in the final guidance because they weren't included in the <a href=" http://www.informationweek.com/healthcare/policy/mobile-apps-proposed-fda-rule-will-disru/231002336">draft rules</a> that were released in 2011, he noted. One of the areas that FDA failed to address is the difference between disease-related and wellness-related apps. A diet app that includes a calorie tracker and a pedometer, for example, doesn't need to be regulated if it's promoted for general wellness and fitness. "But if you take that same app and market it to people who have diabetes as a way to manage their diabetes, it's a medical device," Thompson said. While uChek clearly has features of a mechanical device, in that it uses test strips and a camera, he said, other mobile health apps can be regarded as a device even if they only involve software. "Standalone software that does no more than use the computing power of a cellphone can be a medical device, if it's basically for managing a disease," he said, citing dosage calculators and imaging apps. The other issue that FDA has not addressed -- but has said that it will deal with in a separate guidance -- is the definition of accessories, Thompson observed. Currently, anything used with a medical device to help it operate is defined as an accessory to that device and must be regulated. For example, he noted, software that connects a glucose meter to a cellphone could be defined as an accessory. Getting that definition updated to fit modern reality is a big priority for the industry, he said. 2013-05-28T11:18:00ZWhy Some Doctors Don't Lean On EHREHR use has less to do with doctors' tech savvy than how they deal with clinical uncertainty, suggests research.http://www.informationweek.com/healthcare/electronic-medical-records/why-some-doctors-dont-lean-on-ehr/240155618?cid=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> (click image for larger view and for slideshow) </div>  A new study argues that some doctors make only minimal use of electronic health records (EHRs) not because they're Luddites, but because their style of practice "absorbs" clinical uncertainty rather than trying to minimize it through the use of IT. If this is true, the widespread adoption of EHRs may not change how some doctors diagnose and treat patients. <a href="http://jamia.bmj.com/content/early/2013/05/21/amiajnl-2012-001377.full.pdf+html">The study</a>, which was published in the Journal of the American Medical Informatics Association (JAMIA), used interviews and direct observations of 28 physicians in a Texas multispecialty group to explore the reasons why some doctors used the practice's EHR more than others did. The researchers showed that the physicians' perceptions of uncertainty in caring for their patients were correlated with how they used the EHR. For the uninitiated, uncertainty is a universal attribute of medical practice, not a sign of an incompetent clinician. Good evidence <a href="http://content.healthaffairs.org/content/24/1/80.abstract?sid=971dca42-4997-4ea7-ab98-3c50b734e559">supports less than half </a>of what doctors do, and there are many clinical situations in which they don't know what they're confronting or, even if they do, what they should do about it. Based on their observations and interviews, the researchers divided the Texas doctors into three categories: reductionists, who believed that the more structured data they recorded in the EHR, the less uncertainty they had and the better the care they were providing; absorbers of uncertainty, who spent more time conversing with patients and less time documenting information; and hybrids, who exhibited characteristics of both reductionists and absorbers. [ Learn more about reluctant EHR users. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/15-of-physicians-declining-ehrs-deloitte/240155154?itc=edit_in_body_cross">15% Of Physicians Declining EHRs: Deloitte Survey</a>. ] "The distinguishing factor in categorizing physicians as uncertainty reducers was their overarching focus on information as the key driver of uncertainty management," the study said. Lead author <a href="http://hollylanham.com/">Holly J. Lanham</a>, assistant professor of medicine/hospital medicine at the <a href="http://www.uthscsa.edu">University of Texas Health Science Center San Antonio</a>, told InformationWeek Healthcare that this was partly because these doctors thought that their documentation would help other providers caring for the same patient. In contrast, the study noted, the physicians with an uncertainty absorption perspective believed that their interaction with patients during a visit was the key to successful diagnosis and treatment. "Information contained in the medical record was important to these physicians, but much less so than information that was created, uncovered and emphasized during patient encounters." Unsurprisingly, the physicians who believed that the kind of information they documented in the EHR could reduce uncertainty were much higher users of the system than the absorbers were, with the hybrids falling in between. However, Lanham emphasized, that didn't necessarily mean that the reductionists were more tech savvy. Some absorbers were highly technological, but they didn't believe that the answers to their diagnostic and treatment questions necessarily lay in the EHR. Of the 28 physicians included in the study, 13 were classified as reductionists, five were absorbers, and 10 were hybrids. The latter believed that the information contained both in the EHR and their patient interactions were crucial to their work. Lanham could not explain the prevalence of reductionists in the study sample. EHR adoption was voluntary in the group, she said, although there was peer pressure to use the system so that everyone could see the data and so that the practice could do quality reporting. There were no financial incentives to enter structured data in the EHR, she added. However, physicians who did more than the average amount of dictation were charged for transcription. One physician who was still dictating many of his notes, rather than entering the data in templates, told her he was paying $800-$1,000 a month for the privilege. However, he said, he wouldn't change because that's how he practiced medicine. The study suggested that perhaps "standardized clinical documentation could be inadvertently driving physicians toward an uncertainty reduction mindset, and thus unwittingly orchestrating the loss of alternative clinical mindsets." Lanham said that this would concern her if it resulted in "less context and less inclusion of a physician's assessment" in the medical reasoning process. "Uncertainty reduction is helpful, and IT is already designed to help us with that," she said. "What I'm hoping is that the finding of this paper will encourage EHR developers and policy makers to recognize that uncertainty is inevitable and figure out how to help doctors and nurses cope with that uncertainty."2013-05-23T12:18:00ZDOD Seeks Commercial EHRHagel 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div>(click image for larger view and for slideshow) </div>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. 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. 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. [ 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>. ] 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. 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. 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." 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> 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. 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. "Hagel's problem is going to be with Congress," commented Mike Corrigan, VP of consulting firm Warren Suss Associates, in an interview with InformationWeek Healthcare. "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." 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. 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. 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."2013-05-22T09:06:00ZDoximity Branches Into CME With Cleveland ClinicProfessional 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div>(click image for larger view and for slideshow) </div>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. 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. Doximity tracks users' CME credits, both from its own program and from other programs if physicians forward their CME certificates to the network. [ 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>. ] "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." In an interview with InformationWeek Healthcare, 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. "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. 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." 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. 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. 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." 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. "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.2013-05-21T12:34:00ZPatientsLikeMe Launches Open Research ExchangeSocial 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div>(click image for larger view and for slideshow)</div>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. 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’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 InformationWeek Healthcare. 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. [ 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>. ] "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." 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. "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." 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. 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. 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. "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." 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.2013-05-20T09:06:00Z15% Of Physicians Declining EHRs: Deloitte SurveyDeloitte 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div> (click image for larger view and for slideshow) </div>  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. 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. 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. 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. [ 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>. ] 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. 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.'" 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." <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. 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. The Deloitte survey also had these notable findings: -- 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. -- 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. -- A third of doctors communicate with consumers using e-mail or texts. -- 15% of physicians use telemedicine for follow-up or diagnostic visits with patients. -- 14% of respondents allow consumers to schedule visits and access test results and medical records via mobile devices. -- Nearly six in 10 physicians don't employ mobile health technologies -- tablets or smartphones -- for clinical purposes. 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 Tackles Teen Records PrivacyBoston 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle">10 Mobile Health Apps From Uncle Sam</div>(click image for larger view and for slideshow)</div> 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. 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. "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. [ 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>. ] 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. … 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)." 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 InformationWeek Healthcare. 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. 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. "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." 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. 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. 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. 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." 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." 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.2013-05-17T08:46:00ZEHRs, Communication Can Co-Exist For Doctors, AMA SaysAmerican 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle"> 7 Portals Powering Patient Engagement</div>(click image for larger view and for slideshow)</div>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. 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. 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." 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." [ 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>. ] 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. 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. 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. 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. 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. William Ventres, an Oregon family physician who was the lead author on the FPM piece, told InformationWeek Healthcare that the biggest challenge in this area is the lack of physician education on how to use EHRs during an exam. "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." 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."2013-05-14T12:27:00ZHealth Plans Seek EHR Data For New Payment ModelsAs 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> (click image for larger view and for slideshow)</div>  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. 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 InformationWeek Healthcare. <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. [ 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>. ] 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. Currently, 75% of the respondents are focusing their value-based payment initiatives on employer group plans, and 54% on Medicare Advantage plans. 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. 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. 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." 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. "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." However, it will be some time before most plans have this capability, Availity CEO Russ Thomas told InformationWeek Healthcare. "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." 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." 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.2013-05-13T14:53:00ZHL7 Preps Healthcare Clinical Messaging StandardFramework 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware <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> <div class="storyImageTitle"> 7 Big Data Solutions Try To Reshape Healthcare</div> (click image for larger view and for slideshow)</div>  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). 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. 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." In an interview with InformationWeek Healthcare, 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." [ 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>. ] 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. "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. 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. 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. "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. 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. 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." 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." Conversely, if FHIR were applied to a "learning health system," he added, that might lead to faster transfer of new discoveries to patient care. 2013-05-13T11:53:00ZONC Webinar Reveals Details of Data Exchange ProjectsAgency 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=SBX_iwk_related_commentary_Handhelds/PDAs_hardware<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> <div class="storyImageTitle"> 6 Healthcare Revenue Cycle Management Systems To Watch</div> (click image for larger view and for slideshow)</div>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. 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. 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. [ 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>. ] 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. 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. 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. 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. 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. 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. 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. 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." 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." 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. 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.