http://www.informationweek.comInformationWeeken-usCopyright 2012, UBM LLC.2013-01-03T09:08:00ZBig data medicine is still largely unproven, but that's not stopping several medical centers and analytics vendors from jumping in with both feet.http://www.informationweek.com/healthcare/electronic-medical-records/7-big-data-solutions-try-to-reshape-heal/240144641?cid=RSSfeed_IWK_authorsSkepticism is a two-edged sword. Not enough of it, and an IT manager might find himself duped into investing in software "solutions" that go nowhere. Too much of it, and skepticism can leave an IT department behind as it waits for enough proof to show a particular platform will improve outcomes beyond a reasonable doubt. <P> Big data analytics is at that tipping point right now in the healthcare industry. Several vendors promise better quality of care and reduced expenditures, but evidence to support those claims is somewhat tentative. Similarly, some critics of the big data movement say healthcare providers need to squeeze all the intelligence they can from small data sets before moving on to larger projects. <P> In a recent post in <a href="http://thehealthcareblog.com/blog/2012/08/29/small-data/">The Health Care Blog</a>, for instance, consultants David C. Kibbe, M.D., and Vince Kuraitis argue that instead of succumbing to the allure of big data analytics, providers should focus on using small data better. In other words, concentrate on the clinical data already available in digitized form and use only those health IT tools that are <em>directly</em> applicable to care management. <P> Big data analytics, on the other hand, attempts to parse mounds of data from many disparate sources to discover patterns that could be useful in problem solving. For example, researchers are employing the big data approach <a href="http://www.informationweek.com/healthcare/clinical-systems/how-big-data-is-fighting-multiple-sclero/232901236">to study genetic and environmental factors</a> in multiple sclerosis to search for personalized treatments. <P> Some of this research might lead to exciting payoffs down the road, but IT companies are not waiting. As Kibbe and Kuraitis point out, technology firms are touting big data analytics as a must-have for healthcare systems and physician groups that aim to become accountable care organizations or make ACO-like arrangements with payers. As these ACOs and healthcare organizations try to profit under shared-savings or financial risk contracts, these proponents claim, big data can help them crunch the data for quality improvement and cost reductions. <P> Some providers are already using big data in patient care. <a href="http://www.businessweek.com/articles/2012-05-17/the-health-care-industry-turns-to-big-data">According to <em>BusinessWeek</em></a>, "many [providers] are turning to companies such as Microsoft, SAS, Dell, IBM, and Oracle for their data-mining expertise." And healthcare analytics is a growth business. Frost & Sullivan projects that <a href="http://www.frost.com/c/10046/sublib/display-report.do?id=NA03-01-00-00-00">half of hospitals will be using advanced analytics</a> software by 2016, compared to 10% today. <P> Are healthcare providers ready for big data analytics, or should they be content with the more limited data analytics capabilities built into their EHR systems and relational databases to point the way to new policies and procedures? <P> When asked to weigh in on the big data/small data debate during a recent interview with <em>InformationWeek Healthcare</em>, David Blumenthal, former head of the Office of the National Coordinate of health IT, said, "It's not an either/or choice. Big data starts with small data. As we have more information on health and disease and the patterns of care ... that information will provide useful insights into what works, what doesn't. What the natural history of disease is. It will enable us to do studies faster and more efficiently ... But it's going to take a while to figure out how to use the data." <P> As for the skepticism heard from many big data critics, Blumethal said, "[We] take on faith that science offers opportunities. And most of the time, our faith is vindicated." <P> With that perspective in mind, <em>InformationWeek Healthcare</em> looked at seven companies and large medical centers that have already jumped into the water.<a href="https://www.explorys.com/">Explorys</a>, a Cleveland Clinic spinoff, offers a cloud-based performance management platform that taps into a healthcare provider's clinical, financial and operational data to look for previously undiscovered patterns. Among its clients are St. Joseph Health System, MedStar and Catholic Health Partners. <P> Unlike old-school analytics, which relies on relational databases, the company has enlisted the services of Cloudera, a Hadoop-based software and services firm, to help its engineers and informaticians do the heavy lifting. <P> The Explorys platform allows providers to do three things: Do searches across patient populations and care venues to help identify disease trends; coordinate rules-driven patient registries; and view performance metrics -- a key ingredient if an organization plans to meet ACO requirements. <P> Of course, all this firepower is meaningless if it doesn't generate the hard data to demonstrate better quality of care and lower costs. <P> Anil Jain, M.D., chief medical information officer at Explorys, explained that because the company is relatively young, it has yet to generate those kinds of results. Put another way, there's no proof that it can reduce the number of foot amputations in diabetics or reduce the number of myocardial infarctions in patients with pre-existing heart disease. <P> But some of the data generated by Explorys suggests it is approaching that target. Working with Catholic Health Partners in Cincinnati, for instance, the analytics platform helped increase pneumonia vaccination rates by 14%, breast cancer screenings by 13% and increased HbA1c testing of diabetics -- a measure of long-term blood glucose control -- by 3%. <P> A recent report in <a href="http://www.ncbi.nlm.nih.gov/pubmed/22759621">the Journal of the American Medical Informatics Association (JAMIA)</a> outlined an Explorys project that looked at EHR-generated patient data from nearly 1 million patients from several different healthcare systems. The analysis helped clinicians pinpoint those most at risk for blood clots in the extremities and lungs. The analysis took only 125 hours and required minimal manpower for a project that would typically take years to perform using traditional research methods. <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a> <P><a href= " http://www.humedica.com/">Humedica</a> offers a cloud-based population-wide analytics system. It connects patient information across varied medical settings -- ambulatory and inpatient -- and time periods to generate a longitudinal view of patient care. The company has data on close to 25 million patients in more than 30 states, which allows individual clients to compare their performance against a very large population. <P> The company's service integrates, normalizes and validates clinical data from across the continuum of care to include not only medications, lab results, vital signs, demographics, hospitalizations and outpatient visits, but also physician notes and lab results, taking advantage of both structured and unstructured data. Its client base draws from four categories: integrated delivery networks (IDN), large academic medical centers, multi-hospital health systems and large multi-practice medical groups. <P> A case in point: Mid Hudson Medical Group's patient-centered medical home has been using Humedica's MinedShare analytics service to measure its patient population and compare its services against industry best practices. <P> For instance, the 125-physician practice was able to extract data on its diabetic patients to determine which patients had a HgA1c reading above 7% on their last visit -- an indication of less-than-optimal blood glucose control -- and who had not been seen by a physician in 12 months. With that ammunition in hand, the medical home reached out to these at-risk patients and were able to see about one-third of them at least once within the first eight months of the program. In this group, one-third achieved an HgA1c under 8% and 60% of those with an HgA1c over 9% are being intensively managed through frequent visits with their primary care physician. <P> As further evidence that Mid Hudson is seeing a return on its investment in the clinical metrics provided by Humedica MinedShare, the provider has now achieved level 3 recognition by the National Committee on Quality (NCQA). <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a> <P> <P><a href="http://www.intersystems.com/">InterSystems</a> likes to remind healthcare providers that even a large enterprise warehouse might not be enough to provide all the intelligence needed to improve quality care and generate significant savings. And the emergence of accountable care organizations and similar pay-for-performance models are making the need for such intelligence all the more urgent. <P> InterSystems offers its HealthShare healthcare informatics platform, with its embedded Active Analytics component, to address the issue. Like many other big data vendors, it collects, aggregates, normalizes and presents patient data from a variety of silos to help decision makers improve their clinical and financial outcomes. <P> Rhode Island is using HealthShare statewide to facilitate health information exchange, as well as aggregate and analyze patient data. This enables the state's medical practices to exchange clinical summaries to improve coordination of care, a major component of ACOs. <P> Gary Christensen, CIO of the Rhode Island Quality Institute, praised HealthShare in a testimonial on the InterSystems website, saying "... HealthShare gives RIQI the analytics needed to target cost savings and provide a level of quality of care that physicians can't get by looking at their own records." During a recent interview with <em>InformationWeek Healthcare</em>, Christensen said his team used InterSystems' analytics tools to determine that 8% to 12% of major lab tests done in more than a quarter of the population of Rhode Island were duplicative and medically unnecessary. <P> The nation of Sweden also has tapped into InterSystems' firepower, using HealthShare to create a <a href="http://www.intersystems.com/casestudies/healthshare/sweden.html">national EHR system</a> for 9 million people. The system is a browser-base display of patient demographics, medication lists, lab data, allergies and related information. <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a> <P>Insurance fraud, one of the healthcare industry's most vexing problems, takes up a lot of <a href="http://www.pervasive.com/">Pervasive's</a> time and attention. Pervasive's DataRush, an application framework and analytics engine for high-speed parallel data processing on multi-core computers and multiple computer clusters, helps service providers with contracts with state agencies detect Medicaid fraud. In one case study highlighted on its website, Pervasive boasts about helping to recover reimbursement for Medicaid claims that should have been collected from private insurers. <P> In order to detect fraud, some service providers match insurance files using SQL Server, a long tedious process. DataRush's fast-paced fuzzy matching system searches two databases -- one containing Medicaid claims from the state and the other the names of patients enrolled in private plans -- to find overlap. The end result has been lower operational costs and quicker ROI, according to a <a href="http://bigdata.pervasive.com/Solutions/Healthcare-Fraud-And-Abuse.aspx">Pervasive case report.</a> <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a>Clinical Query might not have the same profit motive as commercially available big data companies, but it can certainly hold its own in the race to squeeze intelligence from mountains of untapped medical data. <P> <a href="http://www.informationweek.com/global-cio/interviews/beth-israel-deaconess-medical-center-emb/240006766">Clinical Query</a>, a medical informatics platform in use at Beth Israel Deaconess Medical Center, was designed to improve quality while reducing costs. To accomplish these twin goals, clinicians need to focus not only on the care of the patients sitting in front of them, but also the larger population with the same disease or condition -- so-called population health management. That mandate requires data analytics tools that are much more sophisticated than most. <P> Enter Clinical Query. John Halamka, <a href= "http://www.bidmc.org/">BIDMC's</a> CIO, refers to it as a clinical trials/clinical research business intelligence system. It's a search engine married to a huge database of patient records that lets hospital employees test hypotheses about what causes a disease, for instance, or test which drug, diet or lifestyle variables might reduce the risk of developing one. <P> The repository contains 200 million data points on 2.2 million patients, including medications taken, diagnoses and lab values. The query tool is capable of navigating 20,000 medical concepts through the use of Boolean expressions. All the data has been mapped to standard medical language codes. Diagnoses, for instance, have been mapped to ICD-9; medications to RxNorm codes; and lab data to Logical Observation Identifiers Names and Codes (LOINC). <P> With the help of Clinical Query, a clinician or researcher might, for instance, search the records to find out how many patients with breast cancer also take ACE inhibitors, a class of drugs used to treat high blood pressure. If the results reveal a strong correlation between the drug and the malignancy, the hospital could do a deeper analysis and set up a formal research project to investigate the link. <P> The ultimate goal would be to discover a new medical intervention that would improve the survival of the entire population of breast cancer patients. <P> "What's unique about Clinical Query is that it's completely self-service," Halamka said. "I didn't have to go out and hire an analyst. I didn't have to get special permission to get access or approval from our [institutional review board] to use it." <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a> <P>During a recent <a href="http://digitalhealthconference.com/">Digital Health Conference</a> sponsored by the New York eHealth Collaborative, Martin Kohn, M.D., chief medical scientist at IBM, and Pat Skarulis, CIO at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York, outlined a joint venture to use the Watson supercomputer's big data capabilities to help oncologists provide better care for MSKCC patients. <P> Kohn pointed out that Watson isn't just a "search engine on steroids," or even a massive database. It relies on parallel probabilistic algorithms to analyze millions of pages of unstructured text in patient records and the medical literature to locate the most relevant answers to diagnostic and treatment-related questions. <P> Ninety percent of the world's data has been created in the last two years, and 80% of that data is unstructured. As any clinician with a pile of unread medical journals knows, that massive collection of information includes far too many papers for any one human to read. <P> Watson reads it for them at lightening fast speed. <P> With the help of <a href="http://www.informationweek.com/healthcare/electronic-medical-records/natural-language-processing-takes-center/232601951">natural language processing</a> (NLP), the computer not only pulls out relevant terms to match the search terms in a clinician's query, but it also understands the idioms and other idiosyncratic expressions in the English language. And with the help of temporal, statistical paraphrasing and geospatial algorithms, it finds meaningful relationships between the clinician's question and its massive collection of medical facts and theories. <P> MSKCC decided to collaborate with IBM to "build an intelligence engine to provide specific diagnostic test and treatment recommendations," Skarulis said. The two organizations now are combining data from MSKCC's massive database, called Darwin, with all of Watson's NLP capabilities. IBM is using all of the medical center's structured patient data and its NLP tools to convert the medical center's free text consultation notes into usable data. Skarulis hopes to launch a pilot shortly that will allow the supercomputer to work on real medical cases. <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a> <P>The University of Pittsburgh Medical Center (UPMC) is taking its big data initiative a step further, investing $100 million to create a comprehensive data warehouse that brings together data from more than 200 sources across UPMC, UPMC Health Plan and other affiliated entities. <P> To collect, store, manage and analyze the information maintained in the data warehouse, UPMC will use the Oracle Exadata Database Machine, a high-performance database platform; IBM's Cognos software for business intelligence and financial management; Informatica's data integration platform; and dbMotion's SOA-based interoperability platform, which integrates patient records from healthcare organizations and health information exchanges. These tools will manage the 3.2 petabytes of data that flows across UPMC's business divisions. <P> The goal is to help physicians tap into a more intelligent EHR; flag patients at risk for kidney failure based on subtle changes in lab results; or predict the most effective, least toxic treatment plan for an individual breast cancer patient based on her genetic and clinical information. In the case of breast cancer, much of this work will be done through analyzing groups of patients so that researchers and physicians can follow their reaction to treatments and their health status over time. <P> Officials at UPMC explained that they will begin using their new analytical tools on data gathered from a group of 140 breast cancer patients that were previously studied. Researchers already have both genomic and EHR data for these patients, which will give researchers a head start in their quest to understand the nuances of individuals and their response to medical treatment. <P> Neil de Crescenzo, senior VP and general manager of Oracle Health Sciences, said the initiative is important both for <a href="http://www.informationweek.com/big-data/news/healthcare/clinical-systems/poor-data-management-costs-healthcare-providers/240004286">Oracle</a> and UPMC because the enterprise healthcare analytics platform they're developing integrates data from clinical, genomics, financial, administrative and operations across the organization. These all are areas that need to drive greater efficiency into their workflows as UPMC tackles the challenges of coping with the exponential growth in data. <P> To sort through its data challenges, UPMC will use a wide range of Oracle tools, including Oracle Enterprise Healthcare Analytics and Oracle Health Sciences Network. UPMC also will implement Oracle Fusion Analytics, as well as multiple components of Oracle Fusion Middleware such as Oracle Hyperion Profitability and Cost Management to support cost-based accounting and Oracle Identity and Access Management Suite Plus for regulatory compliance and data protection. <P> <strong>RECOMMENDED READING</strong> <P> <A href="http://www.informationweek.com/healthcare/clinical-systems/big-data-analytics-wheres-the-roi/240012701">Big Data Analytics: Where's The ROI?</a> <P> <a href=" http://www.informationweek.com/healthcare/clinical-systems/pediatric-cardiologists-turn-to-clinical/240144141">Pediatric Cardiologists Turn to Clinical Analytics</a> <P> <a href="http://www.informationweek.com/software/information-management/13-big-data-vendors-to-watch-in-2013/240144124">13 Big Data Vendors To Watch In 2013</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/ibm-watson-finally-graduates-medical-sch/240009562">IBM Watson Finally Graduates Medical School</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-big-da/240008670">Healthcare Execs Must Prepare For Big Data</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569">Think Small Data Before Big Data, Healthcare Gurus Argue</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/pittsburgh-healthcare-system-invests-100/240008989">Pittsburgh Healthcare System Invests $100M In Big Data</a>2012-12-14T09:06:00ZOne of the nation's top healthcare CIOs discusses Beth Israel Deaconess Medical Center's $200K project to secure personal devices used for work.http://www.informationweek.com/healthcare/mobile-wireless/halamka-knows-perils-and-promise-of-heal/240144414?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/electronic-medical-records/ 9-mobile-ehrs-compete-for-doctors-attent/240144143"><img src="http://twimgs.com/informationweek/galleries/automated/923/mobile_doc_i mage_175.jpg" alt="9 Mobile EHRs Compete For Doctors' Attention" title="9 Mobile EHRs Compete For Doctors' Attention" class="img175" /></a><br /><div class="storyImageTitle">9 Mobile EHRs Compete For Doctors' Attention</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div> <!-- /KINDLE EXCLUDE -->"BYOD is an unstoppable force." That's the unequivocal view of <a href= " http://www.informationweek.com/global-cio/interviews/beth-israel-deaconess-medical-center-emb/240006766 ">Dr. John Halamka</a>, CIO of Beth Israel Deaconess Medical Center. Halamka, speaking on Tuesday's <a href= " http://tech.ubm.com/iwkhc ">InformationWeek Healthcare Virtual Event</a>, discussed the opportunities the bring-your-own-device movement affords IT managers and clinicians alike, as well as the risks and responsibilities now placed on CIOs' shoulders. <P> "Although CIOs would much rather focus on the cool apps of the future or that 3D holographic iPad, compliance and regulatory imperatives are a must do," Halamka said. Much of his presentation dealt with those imperatives and the accountability associated with them. <P> His take-home message on how to keep patient data safe was straightforward: "Policy is no longer enough." <P> Until recently, <a href="http://www.bidmc.org/">BIDMC</a> clinicians had to follow a detailed policy that outlined procedures for password protection, encryption, device firewalls, time out periods, automatic wipes and the like if they were going to use their personal mobile device to access patient data. <P> <strong>[ Most of the largest healthcare data security and privacy breaches have involved lost or stolen mobile computing devices. For possible solutions, see <a href=" http://www.informationweek.com/news/galleries/healthcare/security-privacy/232500404?itc=edit_in_body_cross"> 7 Tools To Tighten Healthcare Data Security</a>]</strong> <P> Unfortunately, about a year ago an unsecured personal laptop containing sensitive data was stolen from one of BIDMC's doctors, costing the medical center hundreds of thousands of dollars in legal fees and forensic analysis. At that point, the institution decided that it had to go beyond policy and put specific technologies in place to secure all devices, Halamka said. <P> BIDMC's IT department initially shut down all smartphone email protocols, with the exception of <a href="http://en.wikipedia.org/wiki/Exchange_ActiveSync ">Exchange Activesync</a>, which lets IT managers enforce certain settings on a mobile device. Then, the team audited all BIDMC-purchased devices, tagging each of them and ensuring that their data was <a href="http://www.informationweek.com/healthcare/security-privacy/2-healthcare-data-breaches-show-importan/232800389">properly encrypted</a>. Next, they turned to the personally owned devices being used to access the BIDMC network and encrypted the data on those devices, scanned for malware, and installed antivirus updates and patches as needed. Equally important, they required employees to attest to all the devices they use in the workplace, and to the fact that the sensitive data on them had been encrypted. <P> It was a big project given the age of some of the hardware and software. In addition to using Bitlocker and FileVault2, the BIDMC IT department had to install self-encrypting drives to secure some devices. <P> In total. BIMDC spent about $200,000 on the project, but as Halamka pointed out, it can cost an institution that much if it loses a single unsecured laptop. <P> Again, the lesson is clear: Don't wait until federal regulators come knocking at your door asking why you didn't secure a stolen iPad that contained HIPAA-related patient data. They don't want to hear that you had a policy in place and that you <em>warned</em> the doc to encrypt the device. Like it or not, accountability rests on your shoulders. <P> <em>Join two prominent IBM healthcare executives, along with Dr. Carolyn McGregor, associate professor at the University of Ontario Institute of Technology, and Annamarie Saarinen, founder of the Newborn Foundation, to discuss how big data analytics is helping to improve outcomes and reduce morbidity and mortality among critically ill infants and ICU patients. This IBM-sponsored Webcast will take place on Dec. 17 at 1:00 p.m. EST. Register <a href="https://www.techwebonlineevents.com/ars/eventregistration.do?mode=eventreg&F=1005300&K=HCEA">here</a>. </em>2012-12-10T08:00:00ZCPOE and clinical decision support won't help you get in shape or spend more time with the family, but they should be among your New Year's priorities.http://www.informationweek.com/healthcare/cpoe/5-healthcare-it-resolutions-for-2013/240144068?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/healthcare/mobile-wireless/10-medical-robots-that-could-change-heal/240143983"><img src="http://twimgs.com/informationweek/galleries/automated/920/RP-VITA_tn.jpg" alt="10 Medical Robots That Could Change Healthcare" title="10 Medical Robots That Could Change Healthcare" class="img175" /></a><br /><div class="storyImageTitle">10 Medical Robots That Could Change Healthcare</div><span class="inlinelargerView">(click image for larger view and for slideshow)</span> </div><!-- /KINDLE EXCLUDE -->It's time to start thinking realistically about what you'd like to accomplish in 2013. Consider making these five resolutions. <P> <strong>Get on board with CPOE.</strong> Almost two-thirds of U.S. hospitals have yet to install a computerized physician order entry system, according to <a href="http://www.himssanalytics.org/home/index.aspx">HIMSS Analytics,</a> even though studies strongly suggest they reduce the cost of care and improve its quality. <P> But the problem with much of this research is that it's been done in large academic centers. Most patient care in the U.S. is delivered in community hospitals and group medical practices, so it's only natural for IT executives in those settings to think twice about the huge capital investment CPOE entails. <P> The <a href="http://www.nehi.net/publications/8/saving_lives_saving_money_the_imperative_for_computerized_physician_order_entry_in_massachusetts_hospitals">Massachusetts Hospital CPOE Initiative (MHCI)</a> has addressed the cost issue as it applies to community hospitals. That initiative, which generated the Clinical Baseline and Financial Impact Study, did an in-depth analysis of six Massachusetts community hospitals, looking at 4,200 charts to see if a CPOE system could prevent adverse drug reactions and reduce the use of unnecessary medications and lab tests. The latest MHCI stats, from 2008, found that a CPOE program would pay for itself for the average community hospital in about 26 months. <P> <strong>[ Is it time to re-engineer your clinical decision support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross">10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> <strong>Step it up on security.</strong> Security experts say it's not a question of if your organization's patient data will get breached, but when. If that's the case, your goal for 2013 must include a program to minimize the danger, including regular risk analyses. <P> A <a href = "http://www.informationweek.com/healthcare/security-privacy/2-healthcare-data-breaches-show-importan/232800389 ">recent data breach</a> at Massachusetts Eye and Ear Infirmary (MEEI) and Massachusetts Eye and Ear Associates drives this point home. The provider agreed to pay a $1.5 million fine to the Department of Health and Human Services, after allegations were made that it failed to comply with certain HIPAA rules that govern the security of individually identifiable health information. <P> The provider's failure to conduct a risk analysis was "the big thing" highlighted by the feds, notes Chad Boeckmann, president of Secure Digital Solutions. "For quite some time, they weren't maintaining these requirements or being proactive. It's about maintaining due diligence." <P> According to the latest <a href="http://www2.idexpertscorp.com/ponemon2012/">privacy and security study</a> by Ponemon/ID Experts, 81% of organizations let employees use their own mobile devices to access patient information, but 46% admit to "doing nothing at all to ensure BYOD is secure." <P> That's mind boggling. It's hard to exaggerate the danger of such lax security policies. If your IT staff isn't up to the task, find the money to hire an outside firm. It will cost you a lot more to manage the fallout from a data breach than it will to prevent one. <P> <strong>Update your EHR.</strong> If you were one of the early adopters, chances are your EHR system is showing its age, unless you've contracted with a vendor for state-of-the art upgrades. So it may be time to consider switching or upgrading. <P> More than 600 EHRs are certified as meeting the criteria needed to qualify for Meaningful Use financial incentives. Finding the right vendor in this maze isn't easy. One thing to keep in mind: Be realistic about how much technical support you will need after the system is installed and how much support you will actually <em>get</em> from overcommitted vendors. <P> Most successful medical practices don't rely solely on their EHR vendors, says <a href="http://www.informationweek.com/healthcare/electronic-medical-records/overworked-ehr-vendors-not-big-on-tech-s/240005036">Mark Wagner,</a> senior research director for health IT advisory firm KLAS. They supplement the vendor's resources with competent staff of their own, and sometimes with third parties to fill the gaps. <P> <strong>Dig into clinical decision support.</strong>. <a href="http://www.nytimes.com/2012/12/04/health/quest-to-eliminate-diagnostic-lapses.html?_r=0">Diagnostic mistakes</a> are responsible for about 15% of errors that harm patients, according to The Institute of Medicine. Similarly, almost one of three cancer patients in the U.S. gets the <a href="http://www.healthmgttech.com/articles/201211/supercomputers-reduce-cancer-treatment-analysis-to-seconds.php">wrong diagnosis, and the wrong treatment.</a> <P> If your IT team isn't digging into statistics such as these, 2013 is the right time to look at a CDS system. Among the tools to consider: Isabel, put out by Isabel Healthcare, <a href="http://dxplain.org/dxp/dxp.pl">Dxplain,</a> UptoDate, and <a href="http://www.informationweek.com/healthcare/clinical-systems/medical-search-engine-shootout-clinicalk/232600864">Elsevier's ClinicalKey</a>. <P> <strong>Hire more data analysts.</strong> Almost every CIO I speak with laments the talent shortage in healthcare IT. And with the push to do more big data analytics and get started in population health management, top-flight analysts are no longer a "nice-to-have" but a must-have. <P> Some of the best advice I've seen on keeping this resolution comes from two members of <em>InformationWeek Healthcare</em>'s advisory board: <P> Stephanie Reel, CIO at Johns Hopkins University, says that in order to attract and retain talented IT managers "... it's important to pay attention to your employees and ensure them some rational quality of life if you can." Similarly, Dan Drawbaugh, CIO at University of Pittsburgh Medical Center, recently outlined UPMC's retention effort, which includes special technology training programs, off-site work arrangements, flexible workweeks, employment contracts and redesigned working environments. <P> <i> Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/111212hc/?k=axxe&cid=article_axxt_os">Mobile Power</a> issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)</i>2012-11-30T13:42:00ZAmerica's patient safety record is a source of embarrassment that angers both clinicians and patients. The right IT tools can help mitigate the danger to life and limb.http://www.informationweek.com/healthcare/patient/safety-technology-anger-and-hope/240142964?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/patient/showArticle.jhtml?articleID=227700175"><img src="http://twimgs.com/informationweek/galleries/automated/527/surescripts-pad-in-hand_tn.jpg" alt="Health IT Boosts Patient Care, Safety" title="Health IT Boosts Patient Care, Safety" height="175" class="img175" /></a><br /><span class="inlinelargerView">(click image for larger view)</span><br/><div class="storyImageTitle">Slideshow: Health IT Boosts Patient Care, Safety</div></div><!-- /KINDLE EXCLUDE -->America doesn't have a very impressive patient safety record. <P> Consider these statistics: <P> --U.S. healthcare providers make about 1 million <a href= "http://sts-healthcare.com/automated-testing-healthcare-software-blog-0/bid/84926/Preventable-Medical-Errors-5-Patient-Safety-Statistics">medication errors</a> each year. <P> --Roughly 50,000 to 100,000 deaths occur annually in the U.S. from adverse drug reactions. <P> --Up to one in four patients in the U.S. are harmed at some point in their lifetimes <a href="http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html">by a variety of medical mistakes.</a> <P> --Doctors perform operations on the wrong body part as often as 40 times a week. <P> Several medical thought leaders are working on ways to improve these stats with various new operational and cultural approaches, but let's not ignore what technology can accomplish. <P> The Office of the National Coordinator for Health Information Technology must have had some of these abysmal figures in mind when it launched the <a href="http://www.healthit.gov/buzz-blog/health-innovation/patient-safety-developer-contest-to-help-reduce-medical-errors/">Reporting Patient Safety Events Challenge.</a> The intent of the challenge was to help encourage reporting of adverse reactions and to modernize the paper-based system for reporting these events, ONC's Adam Wong told <em>InformationWeek Healthcare</em>. That paper approach is responsible for too few reports being submitted, Wong says, but also "inaccurate reports due to errors in transcription. It's also less secure, since reports are transmitted by fax rather than a secure communication system." <P> <a href= "http://www.informationweek.com/healthcare/interoperability/award-winning-it-vendor-simplifies-adver/240142518">KBCoreSM, a software platform that collects clinical data and analyzes safety reports,</a> won the competition -- held in April through August of 2012, with winners announced November 14 -- making it easier for stakeholders to submit reports and for patient safety organizations to obtain meaningful insights from the reports themselves. <P> <strong>[ Is it time to re-engineer your clinical decision support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross"> 10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> The software integrates with an electronic health record -- and other device and medication databases, such as scanned barcodes worn on patient wristbands -- to extract data. KBCoreSM uses an HL7 interface to gather relevant information, and users can submit either a fully identified or anonymous report while knowing the platform provides secure communications between professionals and organizations. <P> Hopefully, software like this will let providers get a better handle on medication errors. But even before KBCoreSM came along, there were useful tools available to address the nation's patient safety shortcomings. <P> The New England Healthcare Institute, a nonprofit health policy institute, has been doing its part. A NEHI report emphasizes the value of currently available but underutilized IT tools such as <a href="http://www.nehi.net/uploads/one_pager/9_cpoe_one_pager.pdf">computerized physician order entry.</a> It rightly refers to CPOE as "a revolutionary computer application designed to intercept errors where they usually occur -- at the time medications and diagnostic tests are ordered. Not only does CPOE automate the order-writing function, it also incorporates clinical decision support during the order-entry process." <P> Despite CPOE's potential to improve patient safety, U.S. hospitals have been dragging their feet on implementation. As of the third quarter of this year, 35% of U.S. hospitals had a CPOE system, according to HIMSS Analytics -- in other words, almost two-thirds of our hospitals have yet to take advantage of the technology. <P> Of course, price is a barrier for many hospitals. The most recent cost analysis from <a href="http://www.nehi.net/publications/8/saving_lives_saving_money_the_imperative_for_computerized_physician_order_entry_in_massachusetts_hospitals">NEHI and the Massachusetts Technology Collaborative</a>, performed in 2008, found that the onetime average total cost of a CPOE system is $2.1 million, with an annual increment in operating costs of $435,000. However, the report estimated that a CPOE that includes robust clinical decision support could reduce adverse drug reactions and unnecessary drug and laboratory test use, generating an annual savings to each hospital of $2.7 million. Drug and lab test costs drop when physicians have easy access to cost-effective prescribing guidelines and alerts available in a well-planned CPOE/clinical decision support system. <P> Of course, like all other technologic advances, CPOE systems -- and the EHRs they inhabit -- have their downside. Data transmission errors do occur in these systems. <a href="http://www.nejm.org/doi/full/10.1056/NEJMsb1205420">Dean Sitting and Hardeep Singh</a> from the University of Texas and Baylor College of Medicine, respectively, point out that it's not uncommon for data transmission tables to have mismatched data fields. Such errors, for example, could cause an order for 30 mg of oxycodone, sustained release, to be mapped to 30 mg, immediate release, resulting in a patient receiving the wrong formulation. <P> Most healthcare stakeholders would agree, however, that the benefits of information technology outweigh the risks. There's certainly reason to be hopeful. <P> <i> Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/111212hc/?k=axxe&cid=article_axxt_os">Mobile Power</a> issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)</i>2012-11-19T11:58:00ZWith so many doctors bringing their smartphones and tablets to work and patient data breaches reported all the time, IT managers need to make the right choices. http://www.informationweek.com/healthcare/mobile-wireless/byod-is-mobile-device-management-the-ans/240142303?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/leadership/iw-500-10-healthcare-it-innovators/240006527"><img src="http://twimgs.com/informationweek/galleries/automated/859/01_dreamstime_tn.jpg" alt="IW 500: 10 Healthcare IT Innovators" title="IW 500: 10 Healthcare IT Innovators" class="img175" /></a><br /> <div class="storyImageTitle">IW 500: 10 Healthcare IT Innovators</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->Of all the issues that keep health IT managers awake at night, it's hard to find one more vexing than mobile device management. A recent survey of healthcare providers makes that painfully obvious. <P> Security and management concerns are top of mind for many these organizations, according to <a href= "http://www.informationweek.com/tech-center/mobile-security/byod-security-tops-doctors-mobile-device/240012626">a KLAS report.</a> The study, <a href="https://www.klasresearch.com/Store/ReportDetail.aspx?ProductID=747"> "Mobile Healthcare Applications: Can Enterprise Vendors Keep Up?"</a>, asked 105 respondents, most of whom were C-level managers, about their use of mobile technology in hospitals and found that securing personal devices via MDM software is one of their top concerns. <P> When the execs were asked what their organizations are looking to do to secure personal devices used at work, data encryption was the number 1 response. MDM was number 2, which, according to Eric Westerlind, the report's author, is telling. Since the use of encryption is already widespread, the high interest in MDM is promising, Westerlind says. <P> "[Providers] are concerned with making sure tablets are secure, and it's difficult because it's a personal device," he says. "Whatever they install can't be too intrusive, and sometimes that can be an issue with MDM. But when you're dealing with patient information, anything that contains data covered by HIPAA needs to be secured, and those devices need to be able to be wiped clean." <P> <strong>[ How can patient engagement help transform medical care? Check out <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>. ] </strong> <P> <a href="http://www.informationweek.com/healthcare/security-privacy/malware-threatens-medical-device-securit/240009311">Ken Kleinberg, a health IT consultant with the Advisory Board,</a> told <i>InformationWeek Healthcare</i> that the operating systems of mobile devices have more robust security features than the legacy Windows systems found in hospitals. But he emphasizes that hospitals need strong BYOD security policies, including mobile application management tools. "It's not just that you're going to control the configuration on the device; you're also going to control what application can be loaded on that device," he says. <P> A hospital's IT organization can give doctors a list of the applications it has vetted, Kleinberg notes. If a doctor wants to use a document reader, for instance, the hospital might suggest one. If he wants to use a dosing calculator, it might suggest three apps and make them available on its application server. <P> During interviews with several IT pros, it became obvious that when the conversation turns to MDM, one size doesn't fit all. Rather than choose an MDM product, <a href="http://www.informationweek.com/global-cio/interviews/beth-israel-deaconess-medical-center-emb/240006766">Beth Israel Deaconess Medical Center</a> has for now "settled on enforcing tight security policies through Exchange ActiveSync," says BIDMC CIO John Halamka. "It is highly likely we are capturing most, if not all, BYODs that access BIDMC resources, as email is by far the most frequently used application," Halamka says. "We really do not have other applications that have been customized to run on smartphones and tablets. Our applications are native to the Web, so the ability to install and manage mobile applications is not something we've encountered as a problem yet."For those healthcare providers that do require native mobile apps for their physicians, several vendors offer MDM platforms to address security threats. <P> Bob DeLisa, president of <a href="http://www.coopsys.com">Cooperative Systems</a>, a Connecticut-based IT support and consulting firm, offers some advice on choosing a system. He tells clients choosing an MDM tool to base their decision "on the age and scalability of your current infrastructure." DeLisa says to take a look at Meraki, for instance, when doing an infrastructure upgrade and server-based solutions like Good, MobileIron, or BoxTone if they've recently upgraded. <P> Many hospitals and practices prefer to install a custom-built BYOD solution, but those that want to go with an MDM vendor must weigh a long list of issues. Among the technical issues: <P> -- Which mobile operating systems do you need to support? <P> -- Do you plan to host the MDM system on your network? <P> -- What email system do your clinicians use, and will it be compatible with the MDM tool? <P> -- Will the MDM software enable you to remain HIPAA-compliant? <P> -- What are the software's lock and wipe capabilities? <P> -- Will you use the MDM tool to push out other apps that clinicians insist on using to manage patients? <P> Most of these questions are outlined in an Avema Critical Wireless <a href="http://www.avema.com/mobile_device_management.html">Buyer's Guide</a>, which Halamka mentioned in a recent email exchange. <P> George Brenckle, CIO at UMass Memorial Healthcare in Worchester, Mass., takes a different approach to BYOD. He prefers to focus on managing data rather than managing devices, which is one reason UMass has switched to a virtual desktop approach. With all of its sensitive patient data on hospital servers, there's no risk of breaches from stolen or lost iPads and laptops. <P> What about commercial MDM products? Brenckle says the challenge is trying to keep one step ahead of the rapidly changing mobile device ecosystem. "So you invest in one of these MDM tools and it's working well, and suddenly a new tablet or smartphone comes on the market that the tool isn't equipped to manage," he says. <P> BOYD isn't going away -- and why would we want it to? It helps clinicians provide better, speedier patient care and has no doubt saved lives on occasion. Once you find the right IT solution, it will certainly save you some sleepless nights as well. <P> <i> Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/111212hc/?k=axxe&cid=article_axxt_os">Mobile Power</a> issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)</i>2012-11-09T08:05:00ZBrains aren't enough to land that dream job. Humility and a willingness to learn are just as crucial.http://www.informationweek.com/news/240062662?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/leadership/8-health-it-certification-programs-offer/240007993"><img src="http://twimgs.com/informationweek/galleries/automated/875/01_HIT_PRO_FINAL_tn.jpg" alt="8 Health IT Certification Programs Offer Career Boost" title="8 Health IT Certification Programs Offer Career Boost" class="img175" /></a><br /> <div class="storyImageTitle">8 Health IT Certification Programs Offer Career Boost</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->During <em>InformationWeek Healthcare</em>'s recent <a href= "http://www.informationweek.com/healthcare/leadership/cio-roundtable-how-to-navigate-the-healt/240004426 ">CIO Roundtable</a> discussion, several of our advisory board members brought up the "talent war" in health IT. <P> Stephanie Reel, CIO at Johns Hopkins University, said that in order to attract and retain talented IT managers "... it's important to pay attention to your employees and ensure them some rational quality of life if you can." Similarly, Dan Drawbaugh, CIO at University of Pittsburgh Medical Center, discussed UPMC's retention effort whereby special technology training programs, off-site work arrangements, flexible workweeks, employment contracts, and redesigned working environments "are all being aggressively pursued and implemented." <P> So why do so many healthcare IT job candidates say it's hard to break into the specialty? One obstacle is the insistence of many hiring managers on limiting their searches to technologists who already have a background in health science. <P> The debate revolves around one issue: Is it easier to teach an IT generalist the clinical principles needed to work in a hospital or practice, or teach a clinical specialist the general IT principles? Although there are legitimate arguments on both sides of this debate, in my mind if an IT pro has drive, a high IQ -- and an affinity for healthcare -- there are almost no limits on what he or she can accomplish. <P> <strong>[ The debate on which qualifications an IT job candidate needs to work in a hospital or medical practice rages. Read <a href="http://www.informationweek.com/healthcare/leadership/do-health-it-hires-need-a-clinical-backg/232601029?itc=edit_in_body_cross">Do Health IT Hires Need A Clinical Background?</a> ]</strong> <P> But let's assume for the moment that a job candidate either has lots of experience in health IT or can convince a potential employer that his or her experience in another industry is enough to quality for the position. Is that enough to land a coveted position? <P> Not really. There's still the issue of personality fit. And that's where some IT brainiacs fall short. There seems to be an inverse relationship between deep analytical skills and social adeptness -- or what psychologists now refer to as <a href="http://en.wikipedia.org/wiki/Emotional_intelligence">emotional intelligence.</a> Granted, I'm over-generalizing, but some technologists pride themselves on being mavericks and trail blasters. Unfortunately, hiring managers might interpret that independence of spirit as arrogance and an inability to play well with others. <P> That perceived arrogance can begin with the cover letter and resume. Take, for example, a cover letter mentioned in <a href="http://www.resumania.com/ ">Resumania</a>, a syndicated column by Max Messmer. One job candidate boasts: "Mark is the absolute best at what he does. Mark is an entrepreneur. Mark is a scholar ... Mark is a big picture thinker." As Messmer points out, "Mark is off the mark with this cover letter." <P> Here's another socially clueless cover letter: "I have guts, drive, ambition, and heart, which is probably more than a lot of the drones that you have working for you." And how about this one: "I'm not a people person. I'll take dealing with a computer over a person any day of the week." <P> Somewhere along the line, those job applicants got the impression that presenting themselves as self-confident and driven is enough to win the day. It's not. <P> Self-assuredness needs to be balanced with a measure of humility and a willingness to learn. Without those traits, even the brightest IT specialist just isn't going to fit in. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i>2012-11-05T12:06:00ZHurricane Sandy took many lives and caused billions of dollars in damage. But so does a healthcare system that still refuses to embrace interoperability.http://www.informationweek.com/news/240044378?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/news/galleries/healthcare/interoperabil ity/240001675"><img src="http://twimgs.com/informationweek/galleries/automated/805/Maine_Healath _infonet_tn.jpg" alt="8 Health Information Exchanges Lead The Way" title="8 Health Information Exchanges Lead The Way" class="img175" /></a><br /> <div class="storyImageTitle">8 Health Information Exchanges Lead The Way</div> <span class="inlinelargerView">(click image for larger for slideshow)</span> </div><!-- /KINDLE EXCLUDE --> There's nothing like a common enemy or problem to bring people together. In the days since Hurricane Sandy, we've witnessed countless acts of heroism and generosity in the face of destruction and despair. It's a pity Americans can't bring that same sense of common purpose to health information exchanges. <P> Many would argue that the immediate threat and aftermath of a storm far outweigh the negative consequences of a poor system for sharing patient data. But that's an illusion. Some 50 people died in Hurricane Sandy, but more patients die each day as a result of poor communication among clinicians and inadequate exchange of data during transitions from hospitals to nursing homes and rehab facilities. <P> When Mr. Suarez, suffering from congestive heart failure, is discharged from a hospital to a nursing home, the nursing home staff can make any number of life-threatening mistakes if they don't have the necessary details on his medications, allergies, diet restrictions, and cognitive abilities. Multiply that potentially lethal situation by all of the hospital discharges nationwide each year, and you have the makings of a perfect storm. <P> <strong>[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see <a href="http://www.informationweek.com/news/galleries/healthcare/admin-systems/232602435?itc=edit_in_body_cross"> 10 Top Medical Practice Management Software Systems </a>. ]</strong> <P> So given the urgency, what are we waiting for? At last week's <a href= " http://symposium.connected-health.org/ ">Connected Health symposium</a> in Boston, <a href= " http://www.boston.com/whitecoatnotes/2012/07/26/david-blumenthal-leave-partners-healthcare-head-commonwealth-fund/mmPwMlMiOPoro2u0Q6lekN/story.html ">Dr. David Blumenthal,</a> the CIO at Partners Healthcare and former head of the Office of the National Coordinator (ONC) for Health IT, addressed some of the issues. During a presentation on how to create an effective national HIE, he described it as a "sociotechnical project that has technical aspects as well as enormous political, economic and social aspects." <P> Among the political issues to contend with is a contingent of Congressional naysayers who would like to dismantle Meaningful Use, one of the most important measures to promote widespread EHR adoption. Obviously, we can't exchange healthcare data nationwide if providers don't have that data in an electronic system. <P> MU Stage 2 is slowly moving providers further down the path toward interoperability. It's being accomplished by insisting that at least 10% of patient data be transmitted "down the line" during any kind of transition from one care setting to another. It's a small step, but nevertheless a place to start. <P> Blumenthal also placed a great deal of emphasis on putting technical standards in place so that providers can share information more easily. ONC has made major strides in this arena, and more is to come. <P> A <a href= "http://www.informationweek.com/healthcare/interoperability/interoperability-initiative-poised-to-tr/240009172 ">public-private consortium</a> is putting in place a system that should provide interoperability among disparate EHR systems and HIEs. If it's successful, it will provide plug-and-play connectivity between EHRs and HIEs and between HIEs. This initiative would drastically cut the expense of interfaces and would let more than half of the U.S population and their healthcare providers access health data shared among multiple states and systems. <P> Healtheway, the new private-sector entity that operates the <a href= " http://www.ehealthinitiative.org/ ">eHealth Exchange</a> (successor to the Nationwide Health Information Network), has partnered with a consortium of states, EHR vendors, and HIE vendors to implement standards that will make it easier to exchange health information. <P> Despite this progress, there's at least one issue no one wants to touch: the individual patient identifier code. <P> I've spoken to several CIOs at large healthcare systems who have spent serious money creating <a href= " http://www.informationweek.com/healthcare/leadership/25-cios-transforming-healthcare/240002426 ">master patient indexes</a> that try to figure out if, for example, John Miller and John J. Miller are the same patient. All that work could be eliminated if each patient entering the U.S. healthcare system had the equivalent of a social security number. But whenever that proposal comes up on the national scene, we hear critics shout socialism for fear that such a numbering system brings us one step closer to a government-run healthcare system. <P> The sad truth about Hurricane Sandy is that the heroism seen during and after the storm in some cases quickly devolved into self-absorption as commuters fought over scarce gasoline and other essentials. Let's hope the nation's healthcare policy-makers and IT stakeholders don't succumb to the same kind of small-minded bickering. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i> <P> <P>2012-11-01T12:23:00ZNot everyone is impressed with the latest health IT megatrend. At least one prominent critic says payment reform should take precedence. http://www.informationweek.com/news/240012701?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/admin-systems/240001004"><img src="http://twimgs.com/informationweek/galleries/automated/798/01_Intro_tn.jpg" alt="11 Healthcare-Focused Business Intelligence Tools" title="11 Healthcare-Focused Business Intelligence Tools" class="img175" /></a><br /> <div class="storyImageTitle">11 Healthcare-Focused Business Intelligence Tools</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> If you're old enough to remember the Reagan administration, you remember the politically charged expression "trickle-down economics," which referred to the theory that if you provide benefits and incentives to businesses and the wealthy, those benefits would trickle down to wage earners at lower socioeconomic levels. <P> In some ways, big data analytics is like trickle-down economics. Only the biggest healthcare providers with the deepest pockets can afford the kind of analytics platforms required to get useful intelligence from tens of thousands of patient records. But in theory, those benefits will trickle down to smaller providers that either don't have the financial support or the large patient populations to do this type of data crunching on their own. <P> How exactly is this supposed to work? Consider this example: A<a href="http://www.ncbi.nlm.nih.gov/pubmed/23083525"> recent study conducted by Kaiser Permanente</a> looked at the incidence of blood clots among women from two integrated health care programs and two state Medicaid programs, who were taking various oral contraceptive (OC) formulas. Their analysis revealed that one formula in particular, containing drospirenone, increased the threat of blood clots by 77% when compared to the risk in women taking several other OC formulas. <P> How might such <a href= "http://www.informationweek.com/healthcare/clinical-systems/think-small-data-before-big-data-healthc/240006569 ">big data analytics</a> benefit the checkout girl at my local supermarket, or my car mechanic and his wife, who live in a small town and may be part of a group practice that can't do this kind of research? <P> Proponents of big data would say that's what peer-reviewed journals are for. The big guys publish the work in a creditable venue and clinicians in smaller community practices learn from their findings. <P> <strong>[ Is it time to re-engineer your clinical decision support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross"> 10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> The only flaw in that reasoning is the huge lag time between published research and widespread adoption of that research in the trenches -- 5 to 10 years, by some estimates. In some cases, the research never gets put into practice. <P> And that disconnect between <a href= "http://www.informationweek.com/healthcare/clinical-systems/health-it-execs-urged-to-promote-big-dat/240009034 ">big data analysis</a> and the rest of the healthcare system is only one of many. A panel discussion at last week's <a href="http://symposium.connected-health.org/ ">Connected Health Symposium in Boston</a> raised several others. Even the session's title suggested controversy: "Big Data Healthcare Analytics: Frontier or Fiction?" <P> Charlie Baker, president of <a href="http://www.generalcatalyst.com/about">General Catalyst Partners,</a> a venture capital firm, and former Secretary of Health and Human Services for the Commonwealth of Massachusetts, suggested that the industry put less emphasis on big data and more on fundamental payment reform. To fix what's broken in the healthcare system, Baker says, "I'd start with a reimbursement system that awards technology, procedures, fragmentation... and punishes primary care... There's nothing about big data in the short term that's going to solve that problem." <P> Baker went on to emphasize what many other stakeholders are shouting about: Finding a way to move from a pay-for-services system to a pay-for-value system has to be our top priority, not big data analysis. <P> That's not to suggest that such analysis shouldn't play a role in healthcare reform. But all the big data in the world isn't going to give us a substantial ROI if hospitals and individual practitioners continue to be rewarded for the quantity rather than quality of care they provide. <P> <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i>2012-10-23T09:07:00ZPartnership with Memorial Sloan-Kettering Cancer Center suggests IBM's supercomputer is ready to help oncologists manage their most challenging cases.http://www.informationweek.com/news/240009562?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/leadership/iw-500-10-healthcare-it-innovators/240006527"><img src="http://twimgs.com/informationweek/galleries/automated/859/01_dreamstime_tn.jpg" alt="IW 500: 10 Healthcare IT Innovators" title="IW 500: 10 Healthcare IT Innovators" class="img175" /></a><br /> <div class="storyImageTitle">IW 500: 10 Healthcare IT Innovators</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> It's been more than a year since IBM's Watson computer appeared on <em>Jeopardy</em> and defeated several of the game show's top champions. Since then the supercomputer has been furiously "studying" the healthcare literature in the hope that it can beat a far more hideous enemy: the 400-plus biomolecular puzzles we collectively refer to as cancer. <P> A recent presentation by Martin Kohn, IBM's chief medical scientist, and <a href="http://www.informationweek.com/healthcare/leadership/the-informationweek-healthcare-cio-25/229301286 ">Pat Skarulis</a>, CIO at New York's Memorial Sloan-Kettering Cancer Center, suggests Watson's up to the challenge. <P> During last week's <a href= "http://digitalhealthconference.com/ ">Digital Health Conference</a>, sponsored by the New York eHealth Collaborative, Kohn and Skarulis outlined an impressive initiative their two organizations have embarked upon to use Watson "in the trenches" to treat oncology patients at Sloan-Kettering. Kohn outlined some of the basics of the project. <P> He was quick to point out that the supercomputer isn't just a "search engine on steroids," or even a massive database. It relies on parallel probabilistic algorithms to analyze millions of pages of unstructured text in patient records and the medical literature to locate the most relevant answers to diagnostic and treatment-related questions. <P> <strong>[ Is it time to re-engineer your Clinical Decision Support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross"> 10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> Kohn explained that 90% of the world's data has been created in the last two years, and 80% of that data is unstructured. As any clinician with a pile of unread medical journals knows, that massive collection of information includes far too many papers for any one human to read. Watson reads it for them. At the time of the <em>Jeopardy</em> competition, for instance, it was capable of reading 65 million pages of text per second. <P> With the help of <a href="http://www.informationweek.com/healthcare/electronic-medical-records/natural-language-processing-takes-center/232601951 ">natural language processing</a> (NLP), the computer not only pulls out relevant terms to match the search terms in a clinician's query, but it also actually understands the idioms and other idiosyncratic gibberish we call English. Which means Watson can make sense of the fact that Americans park in driveways and drive on parkways, or the fact that noses run and feet smell. <P> Put another way, Watson does much more than just locate relevant keywords in its database. With the help of temporal, statistical paraphrasing and geospatial algorithms, it finds meaningful relationships between the clinician's question and its massive collection of medical facts and theories. <P> Armed with this skill, the supercomputer works through several logical steps to help physicians through their decision-making process. Once it understands the nature of the request, Watson generates a long list of hypotheses in response to the clinician's question. Then it assigns priority ratings to those hypothetical answers based on its analysis of millions of pages of stored data. Next, it generates a confidence level for each of the likely answers so that it can help physicians make an evidence-based decision. <P> In the final analysis, however, it's the clinician who must review the best solution and choose a course of action. He or she also has the option to ask Watson to supply all of the supporting literature upon which the computer based its answers. Similarly, Watson may ask for additional data, suggesting specific lab tests be done to improve the probability of arriving at a correct diagnosis or treatment regimen. <P> Of course all this impressive technology would only be an exercise in IBM bravado if there were no real patients and doctors to put Watson to the test. Enter Sloan-Kettering. <P> As Skarulis pointed out during her presentation, the medical center has about 2,000 order sets it can pull from when choosing a cancer treatment. Finding the best fit for each patient is no easy task. To help, Sloan-Kettering can tap its own massive database, called Darwin, which includes everything that has happened to all of its 1.2 million inpatients and outpatients over 20-plus years. In essence, that database embodies "the thinking patterns of all our experts," she explained. <P> The medical center decided to collaborate with IBM to "build an intelligence engine to provide specific diagnostic test and treatment recommendations," Skarulis says. The two organizations are now combining all of Darwin's intelligence with all of Watson's NLP capabilities. IBM is using all of the medical center's structured patient data and its NLP tools to convert the medical center's free text consult notes into usable data. <P> The team will first use this approach to tackle non-small-cell lung cancer. It has brought in <a href="http://www.mskcc.org/cancer-care/doctor/mark-kris ">Mark Kris, MD</a>, one of MSKCC's top lung cancer experts, to help develop training cases for Watson to work on, focusing on 14 to 20 data elements, including the size and location of a patient's tumor, the presence of any genetic mutations (Sloan-Kettering does a full genomic analysis on all of its lung and colon cancer patients), and whether the tumor has spread to other tissues. <P> Watson's task is to follow the protocol that Kohn outlined above and come back with a list of diagnostic and treatment options for physicians to choose from, with confidence ratings for each option. Ideally, a treatment regimen that Watson concludes has a 95% confidence rating, for example, would help oncologists choose from the 28 different chemotherapy cocktails they have at their disposal. <P> <a href="http://www-03.ibm.com/press/us/en/pressrelease/36989.wss ">Watson's training</a> has prepared it for its role as a clinical decision support system. But now that it has graduated medical school, it's time for a real world residency. Skarulis hopes to launch a pilot program by the end of this year that will allow the supercomputer to work on real cases. It's hard to imagine an attending oncologist who would <em>not</em> want such a resident assisting him at the bedside.2012-10-17T08:44:00ZGenuine healthcare reform can't happen until facilities and doctors get patients more involved in their own care. To do that, patients need fast access to more data.http://www.informationweek.com/news/240009146?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/leadership/iw-500-10-healthcare-it-innovators/240006527"><img src="http://twimgs.com/informationweek/galleries/automated/859/01_dreamstime_tn.jpg" alt="IW 500: 10 Healthcare IT Innovators" title="IW 500: 10 Healthcare IT Innovators" class="img175" /></a><br /> <div class="storyImageTitle">IW 500: 10 Healthcare IT Innovators</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> All one has to do is listen to the Democratic and Republican rhetoric about the role of government in healthcare to get a sense of how contentious this issue has become. And anyone who has ever spent time dealing with his local DMV or Social Security office can certainly understand why critics question the wisdom of further involving government bureaucracy in healthcare. <P> But there's at least one area in which government bureaucrats have gotten it right: Stage 2 Meaningful Use. The Centers for Medicare and Medicaid Services requires providers to meet several patient engagement benchmarks that will have a positive impact of the quality of care the public receives. <P> Specifically, MU Stage 2 requires that more than 50% of all patients seen by clinicians get timely online access to their health information, including diagnostic test results and medication lists. It also requires that more than half of a provider's patients must receive a clinical summary of their office visit within one business day. These and similar CMS rules are a step forward in getting patients more engaged and enthusiastic about participating in their own care, rather than just passively accepting whatever their provider deems necessary. <P> But such mandates only scratch the surface. In fact, in many respects, Meaningful Use is almost meaningless to many patients. What the public really needs is a full- throttled campaign to get them on the road to self-care, and full transparency from hospitals and medical practices. Health IT can play a role in both endeavors. <P> Patient portals are probably the best vehicle to provide patients with the data that CMS requires, but smart clinicians will offer much more than these basics, including a well-stocked patient education library; an "internal Facebook" that gives patients the opportunity to share coping skills with others suffering from the same disorder; help with health insurance procedures; telemed capabilities; recommendations for health-related smartphone apps; and secure email access to clinicians. <P> Similarly patients want to know that if they travel far from home, data that's stored in their primary care physician's records are available elsewhere. All the more reason for providers to sign onto a health information exchange. <P> There's certainly no lack of creative e-tools on the market to help providers meet this patient engagement challenge. <em>InformationWeek Healthcare</em> recently posted a <a href="http://www.informationweek.com/healthcare/patient/7-e-health-tools-to-get-patients-engaged/240008652">slide show featuring a handful of promising tools</a>. To widen physicians' choices, Allscripts just announced <a href="http://www.mhimss.org/news/allscripts-launches-app-challenge-ehr-access">its Open App Challenge</a> at Health 2.0 in San Francisco. It's a competition that should bring even more innovation into this market niche. The contest, which offers substantial cash awards, is looking for developers in several categories, including what it describes as "enhanced patient engagement (i.e. remote monitoring, self-management, healthy lifestyles.)" <P> Obviously, patient engagement tools can get expensive and each practice and hospital has to find the right mix. But offering patient the bare minimum required to meet MU rules and grab that coveted financial incentive check is short-sighted. <P> What's also short-sighted is the less than transparent relationship that so many healthcare organizations have with their patients. I've spoken with countless friends and acquaintances who are deeply skeptical about the quality of care they receive from their physician. Frankly some of this skepticism borders on paranoia and the unfounded belief that organized medicine is only interested in its bottom line. <P> But some of the concern is based on well-documented medical mismanagement, misdiagnosis, and sloppiness on the part of the healthcare industry. <a href="http://online.wsj.com/article/SB10000872396390444620104578008263334441352.html">A disturbing analysis in the <em>Wall Street Journal</em></a>, penned by Marty Makary, MD, a Johns Hopkins Hospital surgeon, points out that: "Medical mistakes kill enough people each week to fill four jumbo jets." <P> Given this very real threat, patients have the right to see a hospital's statistics on infections, readmissions, and surgical complications. If your facility hopes to gain full patient engagement--which depends in part on patients' <em>trust</em>--it needs to offer an online dashboard to list this kind of data, along with the annual volume of each type of procedure it does, mortality rates for various surgeries, patient satisfaction scores, nurse-to-patient ratio, and much more. <P> The <a href="http://businessoverbroadway.com/big-data-provides-big-insights-for-u-s-hospitals">federal government</a> and independent analysts have already done some of the leg work on these issues. You can, for example, view a <a href="http://businessoverbroadway.com/us-hospitals-and-health-outcome-metrics ">US map that rates hospitals on readmissions and mortality rates</a>. <P> This kind of transparency is long overdue. And it will foster the kind of <a href="http://www.informationweek.com/healthcare/patient/patient-engagement-tools-reduce-hospital/240008088">patient engagement</a> that can truly transform healthcare.2012-10-09T08:28:00ZMobile technology could play a huge role in meeting the federal MU regulations, but the Stage 2 rulebook virtually ignores this potential.http://www.informationweek.com/news/240008671?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/mobile-wireless/240003081"><img src="http://twimgs.com/informationweek/galleries/automated/828/01_Doctor_Ipad3_tn.jpg" alt="11 Super Mobile Medical Apps " title="11 Super Mobile Medical Apps " class="img175" /></a><br /> <div class="storyImageTitle">11 Super Mobile Medical Apps </div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Mobile apps and devices have taken the healthcare industry by storm. So why is the word "mobile" mentioned only once in the 672 pages of Meaningful Use Stage 2 regulations? One can only guess the rationale behind that decision, but several experts see the need for more emphasis in this arena. <P> Pam Matthews, senior director of regional affairs at HIMSS, for instance, was recently quoted in a <a href="http://www.mhimss.org/news/stage-2-analysis-mhealth-will-play-role-meaningful-use">mHIMSS post</a> as saying how mobile technology could help meet MU requirements for more patient engagement and data exchange: "[Y]et in the final rule they remained silent on mobile. HIMSS supports the development of guidelines to achieve transitions of care through patient-centered mobile interfaces. We encourage consideration of including mobile health technology in future stages of meaningful use." <P> Robert Jarrin, senior director of government affairs at Qualcomm, made a similar point in the same article, written by Eric Wicklund, editor of mHIMSS. Again emphasizing the fact that the Stage 2 regs put a premium on patient engagement, giving the public the ability to view and download health data, Jarrin says, "access to health information can be provided by any means of electronic transmission according to any transport standard. ... This is an enormous opportunity for certified EHRs and EHR systems to harness the power and ubiquity of mobile broadband connectivity to make health information available via smartphones, laptops, tablet PCs, pads and mobile medical devices." <P> It's a shame the Centers for Medicare and Medicaid Services didn't spend more time encouraging the use of mobile technology in the MU regs. A recent phone interview with Matthew Holt, co-chairman of the popular Health 2.0 Conference, made it clear that there's a <em>lot</em> going on in this arena worth paying attention to. And while Holt and I didn't talk specifically about Meaningful Use, his comments are nonetheless relevant. <P> <strong>[ Why is mobile so important? Read <a href="http://www.informationweek.com/healthcare/patient/more-consumers-get-health-info-on-mobile/240008624?itc=edit_in_body_cross">More Consumers Get Health Info On Mobile Devices</a>. ]</strong> <P> Before we dived into specific mobile medical apps, Holt made a point of saying that mobile tools shouldn't be artificially separated from all the other health IT applications and platforms now in use. <P> "I'm not a fan of calling something mHealth. People tend to think of mobile as this weird separate thing," he said. His point being that mobile technology is just one component of an overall IT strategy. The vast majority of successful applications in healthcare technology will eventually "include the same data and a similar experience whether you're on a cell phone, a 7-inch tablet, an iPad, a computer, or a TV," says Holt. In that context, "calling something mobile or not mobile won't really make sense." Perhaps that's why CMS didn't see the need to devote much discussion to mobile technology in the Stage 2 regulations, assuming that providers would simply use the technology to extend their overall game plan. <P> So what exactly is out there in the mobile world to help hospitals and practices achieve their overall IT strategy? <P> Holt mentioned mobile EHRs during our discussion, including <a href="http://www.allscripts.com/en/solutions/ambulatory-add-ons/wand.html">Allscripts Wand</a>. It's a native iPad app that gives clinicians access to the company's EHR system. It was designed from the ground up to work on the tablet, offering many of the features of the server-based EHR and allowing patient data to move back and forth from the device to the server. <P> Similarly there's the <a href="https://drchrono.com/ipad_ehr/">Dr Chrono EHR,</a> which started out as an iPad application and remains so. Holt also mentioned Practice Fusion, which originally had a Web-based EHR that's accessed on a desktop computer, and now has an iPad version. <P> There are also several tools built for smartphones or other small devices that can help providers meet Meaningful Use regs. In the hospital setting, there's an app called Patient Touch from <a href="http://www.patientsafesolutions.com/">PatientSafe Solutions</a>, which works on an iPod Touch using a hospital's Wi-Fi system, explained Holt. The app is designed primarily for nurses to help them do documentation. For instance, the app lets clinicians view patient information, schedule medication, assign care team members, and keep track of important messages and interventions. <P> So regardless of how much ink the federal government gives to mobile technology in its rulebook, there's little doubt that finding the right apps and devices will help providers achieve MU milestones faster and easier.2012-10-01T09:06:00ZCredible sources are raising serious concerns about the value of health IT. Some, but not all, of their criticism is warranted.http://www.informationweek.com/news/240008133?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/news/galleries/healthcare/EMR/232300279"><img src="http://twimgs.com/informationweek/galleries/automated/700/01_Allscripts_RemoteforHDM_175.jpg" alt="12 EHR Vendors That Stand Out" title="12 EHR Vendors That Stand Out" class="img175" /></a><br /> <div class="storyImageTitle">12 EHR Vendors That Stand Out</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> The last two weeks haven't been kind to the vendors and users of electronic health records. <P> A <a href="http://online.wsj.com/article/SB10000872396390443847404577627041964831020.html">recent column in <i>The Wall Street Journal</i></a> challenged the notion that EHRs are reducing healthcare costs, citing data from an exhaustive scientific review of 36,000 studies on the subject. <P> Similarly, the <a href= "http://www.informationweek.com/healthcare/electronic-medical-records/ehrs-under-fire-for-inflating-medicare-b/240007902">Center for Public Integrity,</a> an investigative news organization, last week posted an article saying that healthcare providers may be inappropriately using EHRs to justify higher evaluation and management (E&M) coding levels, a practice it maintains is <a href= "http://www.publicintegrity.org/2012/09/19/10812/growth-electronic-medical-records-eases-path-inflated-bills">costing Medicare billions of dollars a year.</a> The article, by Fred Schulte, charges that federal officials, because they were intent on increasing adoption of EHRs, ignored warnings that the systems could help physicians raise coding levels. <P> The core of the allegations is that EHRs let doctors copy and paste findings from previous notes into current notes, providing documentation that can be used to justify higher coding levels. In a <a href="http://www.nytimes.com/interactive/2012/09/25/business/25medicare-doc.html">letter sent last week to major national medical organizations,</a> U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder stated: "There are troubling indications that some providers are using [EHR] technology to game the system, possibly to obtain payments to which they are not entitled." <P> <strong>[ For more on the role of EHRs in clinical research, see <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790?itc=edit_in_body_cross">Health IT's next challenge: Comparative Effectiveness Research</a>. ]</strong> <P> These accusations echo concerns I've had over the last year or so. When I first signed on as editor of <i>InformationWeek Healthcare</i> in 2011, I expressed <a href="http://www.informationweek.com/healthcare/leadership/guarded-optimism-for-healthcare-it/229401323">guarded optimism about EHRs,</a> guarded in part because "with so much money in play, I'm sure some hospitals and group practices will try to game the system--with taxpayers and patients picking up the bill." <P> Just last week I posted a column about accountable care organizations, in which I wrote again about the risk of upcoding and gaming the system. <a href="http://www.informationweek.com/healthcare/clinical-systems/accountable-care-it-gets-us-only-halfway/240007867">In that column</a> I discussed the shaky research foundation on which ACOs are based: pilot projects that likewise used "creative medical coding" to justify their cost savings. <P> That said, not all of the recent criticism heaped upon EHR vendors and buyers is justified. The <i>Wall Street Journal</i> critique, by Stephen Soumerai, a professor at Harvard Medical School, and Ross Koppel, from the University of Pennsylvania, doesn't tell the whole story. <P> Based on their reading of what they refer to as an "extensive new study," their column concludes that "the most rigorous studies to date contradict the widely broadcast claims that the national investment in health IT--some $1 trillion will be spent, by our estimate--will pay off in reducing medical costs." <P> There are several problems with their analysis. <P> The original research paper they refer to was published online October 7, 2011, not exactly what I'd call new. More important, after the investigators sifted through the 36,000 reports, they were left with 31 that were considered worth analyzing, and of that small group, all were performed no later than 2009. In fact, 12 of the 31 economic analyses were at least ten years old. <P> It's unfair to conclude that currently available EHR systems are a bad investment by looking at implementations and cost analyses that are relatively old. In this fast-evolving EHR market, 2009 is practically ancient. Likewise, a deeper dive into the research paper, published in the <a href="http://jamia.bmj.com/content/19/3/423.abstract"><i>Journal of the American Medical Informatics Association (JAMIA)</i></a>, raised other doubts about whether the economic analyses are grounds for questioning the value of EHRs in the current U.S. healthcare system. <P> For instance, several of the studies looked at health IT projects in other countries. And the single 2009 cost analysis, which looked at the benefits of a medication safety alert system, concluded that the system would likely result in a cost <em>savings</em> of about $450,000. <P> To be fair, while the <i>JAMIA</i> study doesn't convincingly prove that EHRs are a waste of money, neither does it lend strong support to the extravagant claims made by advocates who sold the federal government on the health IT incentive plan. As Soumerai and Koppel point out in the <i>Wall Street Journal</i> column, "Lobbyists promised that these technologies would make medical administration more efficient and lower medical costs by up to $100 billion annually." <P> We're not there yet--by any stretch of the imagination. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i>2012-09-24T14:35:00ZAccountable care organizations rely on software tools to deliver cost-effective care. But ACOs may be built on a shaky foundation.http://www.informationweek.com/news/240007867?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/policy/240005118"><img src="http://twimgs.com/informationweek/galleries/automated/848/SS_ACO_dreamstime_01_tn.jpg" alt="8 Accountable Care Organizations Worth Closer Examination" title="8 Accountable Care Organizations Worth Closer Examination" class="img175" /></a><br /> <div class="storyImageTitle">8 Accountable Care Organizations Worth Closer Examination</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> It's hard to imagine a successful accountable care organization (ACO) that doesn't rely heavily on IT. ACOs require that clinicians meet a long list of quality measures to prove that they're acting in an accountable way to reduce costs without reducing the quality of medical services. And most of those metrics are best tracked with software. <P> But the very foundation upon which ACOs are built could be shaky, making software tools only so effective. Let me explain. <P> Consider the Medicare-based Shared Savings Program ACO. It's a group of doctors, hospitals, and other healthcare providers that has agreed to work together to deliver high-quality care to at least 5,000 Medicare beneficiaries for at least three years. To obtain government financial rewards, the ACO has to report on 33 quality standards and show improvement in 32 of them within those three years. In a nutshell, if the ACO can prove that the cost of caring for these ACO patients is less than what the Centers for Medicare & Medicaid Services (CMS) would anticipate under the standard fee-for-services model, the ACO providers get to share in some of the savings. <P> CMS breaks the quality measures into four categories: patient and caregiver experience; care coordination and patient safety; preventive health; and caring for at-risk populations. <P> <strong>[ Looking for a PACS platform to replace an outdated system? See <a href="http://www.informationweek.com/healthcare/clinical-systems/9-must-see-picture-archivingcommunicatio/240006960?itc=edit_in_body_cross">9 Must-See Picture Archiving/Communication Systems</a>. ]</strong> <P> In the care coordination and patient safety category, <a href="http://www.informationweek.com/healthcare/clinical-systems/banner-health-aetna-reach-for-aco-gold/240000516 ">ACOs</a> must report readmission rates for all conditions during the first and second years of the program, and in year three they must show evidence that they've lowered that rate. In the preventive health category, in year one of the program they must report the number of flu and pneumonia vaccinations they've administered; the number of depression, colorectal cancer, and mammography screenings they've done; and the number of patients who use tobacco--and then show that they've improved those numbers in years two and three. <P> Some ACO quality data is easy to collect. Consider the performance standard for measuring tobacco use. Most EHRs already track that, and the data can be easily gathered using tools such as Microsoft Excel and SAP Crystal Reports. <P> The standards on hospital readmissions, on the other hand, pose a bigger challenge. In addition to the overall hospital readmission rates, ACOs face specific requirements for ambulatory-sensitive conditions such as congestive heart failure. They must report the admission rate in the first year for those conditions, and in years two and three meet a specific benchmark. <P> Some healthcare providers have turned to vendors such as Curaspan Health Group to track admission and readmission stats. Curaspan uses what it refers to as a "patient transition network" that monitors exchanges between hospitals and post-acute-care providers using its proprietary DischargeCentral software. The software generates reports that tell hospitals which post-acute-care facilities and clinicians aren't responding to requests for them to see referred patients or are responding too slowly. Once a hospital knows which clinicians or facilities are dragging their feet, it can take action to correct the problem, reducing the risk of their patients needlessly being readmitted. <P> These are just two example of IT's ability to meet ACO standards. But if <em>genuine</em> accountability is your goal, technology gets you only halfway there. Providers need a proven structural model to make an ACO cost effective, and at least one prominent thought leader questions whether the current approach will do the trick. <P> In a recent <em>Journal of the American Medical Association</em> editorial, <a href="http://en.wikipedia.org/wiki/Donald_Berwick ">Donald M. Berwick, MD</a>, the former administrator of CMS and one of its ACO architects, says: <a href="http://jama.jamanetwork.com/article.aspx?articleid=1357248 ">"The accountable care organization is a guess."</a> Put another way, the government is guessing that this model will in fact lower costs while improving patient care. <P> Part of the problem is the shaky research foundation upon which the model was based. It's based in part on the Physician Group Practice Demonstration (PGPD), a series of experiments spearheaded by CMS. During that five-year project, CMS rewarded medical groups for improving clinical outcomes by concentrating on better care coordination and transitioning of care from facility to facility for patients with chronic diseases. <P> <a href= "http://jama.jamanetwork.com/article.aspx?articleid=1357260 ">Recent analyses of PGPD have been disappointing.</a> Berwick points out in the JAMA editorial that the medical practices were able to demonstrate "widespread gains in healthcare quality ... but only inconsistent and generally small effects on cost." <P> Equally disturbing: A more recent analysis suggests that PGPD practices may have been gaming the system by "overcoding." When compared to a control group of practices, the PGPD docs were more likely to submit codes that indicated their patients' illnesses were more serious, which in turn would make it easier to claim clinical improvements and savings when they were treated. <P> Berwick offers a stinging reaction to this finding: "Neither patients nor the nation are well served when administrative manipulations masquerade as changes in care. What is needed is better care, not better coding." Amen to that!2012-09-18T09:06:00ZIf the industry remains resistant to change, it will eventually render itself obsolete.http://www.informationweek.com/news/240007428?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/healthcare/leadership/iw-500-10-healthcare-it-innovators/240006527"><img src="http://twimgs.com/informationweek/galleries/automated/859/01_dreamstime_tn.jpg" alt="IW 500: 10 Healthcare IT Innovators" title="IW 500: 10 Healthcare IT Innovators" class="img175" /></a><br /> <div class="storyImageTitle">IW 500: 10 Healthcare IT Innovators</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Perhaps you've seen the TV commercial for a popular arthritis drug that says, "A body at rest tends to stay at rest, while a body in motion tends to stay in motion." The ad refers, of course, to a law of physics called inertia--which brings to mind the U.S. healthcare system. <P> Our arthritic system certainly suffers from an unwillingness to move forward. It stubbornly clings to a fee-for-service model, focuses most of its energy on treatment rather than prevention, and resists IT innovations that can transform it into a nimble, cost-effective business. <P> And speaking of business models, the U.S. medical system has fallen victim to the same kind of myopia that recently bankrupted Kodak and seriously weakened the railroad industry over the years. <P> In January 2012, Kodak filed for Chapter 11, and as David Asch and colleagues from the Philadelphia VA Medical Center point out, the company's demise was largely the result of not understanding what kind of business it was in--at least from its customers' point of view. <P> In last week's <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1206862"><i>New England Journal of Medicine,</i></a> Asch and associates point out that "Kodak was late to recognize that it was not in the film and camera business: it was in the imaging business." And when the public found a better way to get their images, namely through digital services, it was too late for Kodak to catch up. <P> <strong>[ Looking for a PACS platform to replace an outdated system? See <a href= "http://www.informationweek.com/healthcare/clinical-systems/9-must-see-picture-archivingcommunicatio/240006960?itc=edit_in_body_cross">9 Must-See Picture Archiving/Communication Systems</a>. ]</strong> <P> The railroad industry has suffered from the same shortsightedness, imagining that it's in the train business when in fact it's in the transport business. And that mistake has cost it dearly, allowing competitors with cars, trucks, and planes to make major inroads into its business (no pun intended). <P> Healthcare could be driving down this same dead-end street, imagining it's in the healthcare industry while what customers really want isn't healthcare but <em>health.</em> "Healthcare is just a means to an end--and an increasingly expensive one. If we could get better health some other way ... then maybe we wouldn't have to rely so much on healthcare," Asch said. <P> There are alternative ways to better health, and many of these options make use of information technology. Patients' alternative path typically starts off by doing an Internet search to understand their symptoms and the standard treatments for a specific disorder. They then shop online for the best approach to their condition, which sometimes takes advantage of the orthodox healthcare system and sometimes takes them to chiropractors, nutritionists, massage therapists, acupuncturists, hypnotists, and other less conventional practitioners. <P> Other patients are turning to their smartphones to see what their options are within the traditional healthcare system. <a href="http://www.castlighthealth.com/company/">Castlight Health,</a> for instance, provides an online shopping platform for <a href="http://www.informationweek.com/healthcare/patient/mobile-app-helps-consumers-shop-for-heal/232800146">healthcare.</a> Castlight says it lets consumers "see their options for selecting a doctor or choosing a lab or clinic, complete with cost and quality of care information, before they make an appointment." The company recently introduced a mobile app that lets consumers use their phones to access pricing and quality data. <P> We're always going to need hospitals, surgeons, and prescription medication to manage life-threatening illness, but patients increasingly are turning away from the mainstream healthcare system to manage chronic disorders. To remain relevant, clinicians need to get deeply involved in the patient engagement business, and use all the relevant IT tools now available. <P> Patient portals, secure email systems, and online patient education libraries are a significant part of this effort. Some hospitals are even setting up what's best described as "internal Facebook" systems that let patients share experiences and support one another. <P> <a href="http://www.informationweek.com/global-cio/interviews/childrens-medical-center-dallas-gets-soc/240006804">Children's Medical Center Dallas,</a> for instance, has set up a <a href="http://www.childrens.com/new-and-current-patients/current-patients/childrens-social-network/">Patient and Family Social Network,</a> which lets past and present patients and their families share stories. The network is divided into communities of patients coping with disorders in various specialties: gastroenterology, neurology, cardiology, and so on. <P> Patients and their parents at Children's also have access to a patient portal, called MyChart, where they can see test results, a list of medications, and alerts for appointments. They can request prescription refills, make appointments, interact with clinical staff through a HIPAA-compliant email system, and get information about insurance coverage. <P> To stay relevant in any industry, managers have to think the way their customers do, whether they process photos, move freight across the country, or remove gallbladders. Inertia simply isn't an option. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i>2012-09-12T00:01:00ZAmong 10 IT teams transforming parts of the U.S. healthcare system, you'll find important lessons in innovation and persistence.http://www.informationweek.com/news/240006527?cid=RSSfeed_IWK_authorsThe 2012 <em>InformationWeek 500</em> healthcare IT award winners include several forward-thinking organizations whose primary goal is to improve the quality of the care they provide while lowering its cost. Anyone who reads the daily newspapers knows what a gargantuan task that will be. <P> Medical thought leaders estimate that as many as 50% of treatments currently in use are not supported by clinical research. It's difficult to provide quality patient care if there's no solid evidence upon which to base treatment protocols. <P> Likewise, the evidence shows that healthcare spending is out of control. A recent <a href="http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml">PwC report</a>, for instance, found that wasteful spending in the health system may be as high as $1.2 trillion. Much of that waste results from overtreatment. That can take the form of duplicative tests or treatments based on diagnostic procedures that have not been shown to actually pinpoint the existence of the disease they're designed to detect. The Institute of Medicine estimates overtreatment is costing the nation at least <a href="http://well.blogs.nytimes.com/2012/08/27/overtreatment-is-taking-a-harmful-toll/">$210 billion a year</a>. <P> Each of the <em>IW 500</em> honorees profiled in this slideshow is tackling these thorny issues with the help of innovative technology. Beth Israel Deaconess Medical Center in Boston, for instance, recently launched Clinical Query, a clinical trials/clinical research system that combines a search engine and a database of 200 million data points on 2.2 million patient records. The tool lets hospital employees test hypotheses about what causes a disease, for example. <P> Sparrow, a large healthcare system in central Michigan, recently launched a massive Care Transformation Initiative to convert physician practice locations to its electronic health record (EHR) system and implement electronic charting in more than 600 departments. When all was said and done, 5,000 users had mobile access and patient data was being shared among several hospitals participating in the Great Lakes Health Information Exchange (HIE). <P> Such HIEs are one key to cost-effective medical care. Among their benefits: HIEs allow clinicians in diverse settings to share test results from the same patient, eliminating the temptation to perform the same test over and over. Similarly, doctors in different locations can share the record of a patient's allergies, reducing the risk of life-threatening complications when prescribing new medication. <P> Premier, an alliance of healthcare providers, certainly had healthcare waste in mind when it created its Efficiency Dashboard. The dashboard contains hospital-specific data on waste in each of 16 measures, including staffing inefficiency, pharmacy overutilization, suboptimal staffing skill mix, excessive length of stay, excessive readmissions, and inappropriate level of care. Using its database, Banner Health in Phoenix saved $850,000 a year through more appropriate use of CT scans on community-acquired pneumonia patients and $800,000 to $1 million annually by reducing clinical practice variations in bowel surgery. <P> These are just a few of the thinkers and doers featured in the profiles that follow. Their creative approaches to patient care make one thing abundantly clear: Innovation comes in all shapes and sizes. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center><a href="http://www.bidmc.org/">Beth Israel Deaconess Medical Center</a> (BIDMC), one of Harvard Medical School's teaching hospitals, has a long history of IT innovation. The latest addition to the family is a medical informatics platform called Clinical Query. John Halamka, BIDMC's CIO, refers to it as a clinical trials/clinical research business intelligence system. It's a search engine married to a huge database of patient records that lets hospital employees test hypotheses about what causes a disease, or test which drug, diet, or lifestyle variables may reduce the risk of developing one. <P> The repository contains 200 million data points on 2.2 million patients, including medications taken, diagnoses, and lab values. The query tool is capable of navigating 20,000 medical concepts through the use of Boolean expressions. All the data has been mapped to standard medical language codes. <P> With the help of Clinical Query, a clinician or researcher might search the records to find out how many patients with breast cancer also take ACE inhibitors, a class of drug used to treat high blood pressure. If the results reveal a strong correlation between the drug and the malignancy, the hospital could do a deeper analysis and set up a formal research project to investigate the link. The ultimate goal is to discover a new medical intervention that would improve the survival of the entire population of breast cancer patients. <P> Access to Clinical Query, as well as to the other clinical apps in the BIDMC system, is simplicity itself. A single sign-on protocol gives physicians access to 146 clinical apps--including an order entry app, a performance manager governing safety and quality, an emergency department dashboard, PeopleSoft ERP, and thousands of professional journals--as well as the 2 million-plus patient records. Other employees, and students, get a set of sign-on rights depending on their role in the organization. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a>In the last two years, <a href="http://www.sparrow.org/">Sparrow's</a> Care Transformation Initiative has converted 23 physician practice locations to its EHR system, implemented electronic charting in more than 600 departments, overhauled the healthcare system's Web presence, introduced internal and external cloud technology, and put in place a mature data analytics system. <P> This massive project consisted of 293 sub-projects, but at the center of the initiative were four core components. <P> -- iSparrow is a single EHR system used to schedule patients and handle billing, documenting, and coordinating care. It also includes a 'one-stop shop' where patients can get access to their medical record and their entire care team. <P> -- Sparrow's internal cloud houses the most commonly used clinical apps and collaboration tools. Clinicians gain secure access from any device and at any location. <P> -- iSparrow Charts is a full charting and workflow system that gives employees access to patient information and speeds physician case review. <P> -- An enterprise analytics engine pulls data from disparate clinical and financial systems to deliver up-to-the-hour information to administrative and patient care teams. <P> In practical terms, Sparrow Health System, located in the mid-Michigan region, has seen several tangible benefits from its Care Transformation Initiative: 5,000 users now have mobile access. Patient data extends beyond the walls of Sparrow and is shared among several hospitals participating in the Great Lakes Health Information Exchange. Within a few months, more than 11,000 patients were using the redesigned Web service to manage their care and communicate with clinicians. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a><a href="http://www.premierinc.com/">Premier</a> is a collaborative healthcare alliance of more than 2,600 member hospitals and health systems. In the simplest terms, the purpose of its analytic tool, called Efficiency Dashboard, is to take the waste out of the healthcare system. The dashboard pre-populates hospital-specific data on waste in each of 16 measures, pulled automatically from Premier's clinical, financial, and operational database, which according to Premier, is the nation's largest comparative database, with comprehensive data from one in four hospital admissions. Among the measures: staffing inefficiency, pharmacy overutilization, suboptimal staffing skill mix, excessive length of stay, excessive readmissions, and inappropriate level of care. <P> Banner Health, a Phoenix-based system with 23 acute care hospitals, uses Premier's database to determine how well it delivers care when compared to top performers. The goal is to develop clinical practice guidelines that can then be adopted across the health system. Premier says that by using its system, Banner is saving: <P> -- $1.6 million per year through more appropriate use of an abdominal adhesion barrier used in Caesarian sections. <P> -- $850,000 a year through more appropriate use of CT scans on community-acquired pneumonia patients. <P> -- $800,000 to $1 million annually by reducing clinical practice variations in bowel surgery. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a><a href="http://www.mch.com/">Miami Children's Hospital</a> (MCH) recently implemented a Pediatric Electronic Data System (PEDS). After two years of in-house development, MCH launched its customized electronic medical record (EMR) system in April 2012 following the successful deployment of a virtual desktop infrastructure. <P> The PEDS system captures virtually all patient data, including care records (radiology, pharmacy, rehabilitation, outpatient, and inpatient) and registration and billing information, in a comprehensive system. To improve coordination of care, MCH also implemented several PEDS-related initiatives, such as electronic consent forms for patients and families, and information kiosks in key locations to improve workflow. <P> With PEDS, patients need only register once at the MCH main campus or any of the hospital's outpatient centers, a time- and cost-saving benefit to the hospital and a convenience for families, particularly when young patients must see multiple specialists and access varied MCH services. <P> Recognizing the rapid growth of mobile devices, smartphones, tablets, and laptops, MCH designed its EMR system to move data faster than the patient, so that pediatric patients, family members, and physicians can have real-time access to data from virtually any location, building a supportive and efficient healthcare ecosystem centered on the patient. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a><a href="http://www.radnet.com/">RadNet</a>, which operates more than 230 outpatient imaging centers in eight states and performs over 5 million imaging exams each year, needed to improve medical results turnaround time and radiologists' work environment, while at the same time reducing costs. <P> Normally, when an x-ray, ultrasound, CT scan, MRI, PET/CT scan, or mammogram is completed, a radiologist interprets the image and dictates his or her findings into a digital recording system. Transcriptionists then transcribe these recordings, and the radiologist who dictated the original report electronically approves the report. Once the radiologist approves the original report, it is then sent (via fax, electronic messaging protocols, or snail mail) to the physician who requested the diagnostic imaging exam in the first place. <P> This protocol posed two problems. RadNet was spending over $10 million each year on transcription costs, and there was a typical lapse of 24 to 72 hours from when the radiologist dictated the report to when he or she signed the report. <P> To address these issues, the company decided to develop its own system using a small vendor's speech-to-text recognition engine. That enabled RadNet to provide a highly customizable workflow for each of its 500+ radiologists, who could customize the workflow and workspace to their liking. <P> RadNet anticipates potential annual savings of $7 million to $8 million. And because the company controls the software, it can respond to radiologists' suggestions in mere weeks, rather than having to depend on a ponderous software-enhancement process from a commercial vendor. Equally important, because the radiologist generates the report and signs off on it right away, RadNet can eliminate the typical long delays. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a><a href="http://intermountainhealthcare.org/pages/home.aspx">Intermountain Life Flight</a> provides air transport services to hospitals and emergency departments in the Intermountain West. Their helicopters and airplanes are mobile intensive care units, utilizing specialized emergency equipment and systems. <P> Because Life Flight medical crews have had to write patient data on paper, introducing the possibility of human error and inefficient workflow, Intermountain's Technology Innovation Lab developed an iPad application that allows crews to enter critical patient data into the patient's medical form before arriving at the hospital, ensuring a seamless transfer of care between Life Flight crews and hospital providers. <P> The iPad doesn't take a lot of space on a helicopter--which is critical in confined areas--and flight crews can easily share data captured on the iPad with other clinicians. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a>In June 2011, <a href="http://www.kindredhealthcare.com/">Kindred Healthcare</a> CIO Rick Chapman was asked to lead the Integration Project Management Office for a large acquisition. He also was asked: "Can your IT department absorb three outsourced data centers and transition 400 servers, convert 22,000 users in more than 1,600 locations to Kindred's IT services, transition more than 75 websites to a central support center, replicate 75 terabytes of data, and realize annual IT operational expense savings of $1,000,000+ per year as a result?" <P> The team accomplished the IT goals in only three months. <P> Kindred Healthcare, located in Louisville, Ky., recently acquired RehabCare Group--a provider of rehabilitation program management services. Part of the IT team's goal was to transition the new users to Kindred's standard systems running in Kindred's data centers using Kindred's cost-efficient IT operating model. <P> The IT management team used Cisco UCS hardware and network services, EMC storage products, VMware hypervisor software, Microsoft operating systems, and Citrix application delivery tools to successfully complete the following steps. <P> First, they leveraged the existing Citrix technology stack to extend SAP general financial, HR, and payroll standardized Kindred application services to unmodified RehabCare workstations for "day one" use and for continued use during the transition. <P> Second, virtualization was used to transform physical servers into virtual servers within the existing RehabCare data centers. The virtual servers were replicated over the network while still "live" and then consolidated onto standardized platforms in the Louisville data center. <P> Network connections were established between Louisville and the RehabCare data centers, allowing RehabCare users to have access to Kindred systems. The team left the existing network addresses in place to change as little as possible and reduce the risk of service disruption. They systematically shut down portions of the original network at the RehabCare locations as workloads were transitioned to the Louisville data center. <P> They also collaborated with EMC to provide storage and data replication infrastructure. Matched sets of hardware were shipped to the RehabCare data centers. The equipment was integrated into the temporary Cisco UCS virtualization infrastructure, and high-speed network connections were established between each RehabCare data center and the Louisville data center to support data replication. The virtual storage was aligned with the virtualized workloads being moved and coordinated with the requisite network changes. <P> Quite a feat to accomplish in three months. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a>In 2011, <a href="http://www.sharp.com/index.cfm">Sharp Healthcare</a> partnered with aLabs to compete in the laboratory market. The IT department played a pivotal role in this new partnership. <P> The IT project kicked off October 4, 2011, and the existing vendor had to be transitioned out by November 1, which left the IT team 20 working days to complete the project. The scope of the work effort and the breadth of the information to be provided to the new aLabs applications required activity from almost every area of the IT department. <P> Staff from the interface team, the Cerner teams, network, desktop, site support, Lawson, Hospital Business Systems, customer support, technical assistance center, accounts, information security, patient care, telecom, and document imaging teams all had a role in this transition. During the four-week timeline, the IT and aLabs teams worked to establish connections between the Sharp and aLabs systems, swapping out devices from the previous vendor, adding new locations for draw stations, and facilitating new phone and data cabling and AT&T lines. New lab clinical data interfaces to the aLabs systems were developed and tested. New patient types were created and new billing interfaces implemented. <P> The IT team conducted security evaluations on protected health information sharing, business associate agreements were created and signed, and College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA) certification reviews were coordinated. The team established new accounts, created new physician profiles in the faxing system, created new reports, and changed existing ones. <P> The new setup allows lab data to be sent outbound to aLabs for two purposes, going to two different systems. The first is a repository for operational data and is used to provide dashboards to lab management for efficiency monitoring and improvement. The second is used by the healthcare system for clinical reporting. <P> The data also populates a third-party portal. The healthcare system can use the portal as either a front-end or an interface source for physician office EMRs. Since finalization of this contract on November 1, some 455 new users have been added, 301 of whom have been using the portal. Further enhancements will provide electronic data entry of orders, from physician EMR systems, into the Sharp Lab system. <P> While the focus of this initiative was certainly increased productivity and revenue generation, quality and patient care were also important considerations. In the past, much of the lab data sent outside from physician offices didn't become a part of the patient record. Patients now benefit from having all data in their EMRs. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a>As is the case for most healthcare systems, security at <a href="http://www.chop.edu/">Children's Hospital of Philadelphia</a> (CHOP) is a top priority. With that in mind, the hospital recently established an IT and business team to develop a new role-based security system as part of a larger Epic EHR implementation project. <P> Role-based security is based on the scope of practice (i.e., role) of each clinician working at the hospital. So clinicians would gain access to various components of the EHR system based on their scope of practice, which varies among MDs, RNs, LPNs, and so on. Each role required that the hospital create templates within Epic. In total, the system had to accommodate 9,000+ users and nearly 500 roles. <P> To reach its goal, the project team developed a custom table within the hospital's HR database and mapped a user's job title and department to his or her Epic role template. Given the large number of users and various roles involved, CHOP incorporated Epic templates that supported multiple departments and clinical units so a user can be anywhere in CHOP's Care Network and still have the same level of access to support patient care. <P> The project has borne fruit: It has significantly reduced user-specific access to key clinical systems by linking 89% of active users to role templates. Epic also reported that the overall Epic Acute implementation was the most successful in its history. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a><a href="http://www.centene.com/">Centene</a>, a managed healthcare business that provides insurance to state-funded programs such as Medicaid and foster care, aims to differentiate and grade its physicians, hospitals, pharmacies, and other clinicians to ensure the best health outcomes at a reasonable operational and medical cost. <P> During the last several years, Centene has invested in a portfolio of technologies that includes a core enterprise data warehouse based on Teradata technology called Centelligence; a statistical predictive modeling system based on a portfolio of Microstrategy, Microsoft, IBM, and Optum technologies; and Web portals. The Web portals have become an important vehicle through which the company provides training webinars, multimedia content, and secure messaging. <P> Among the recent tools offered through the provider portal: <P> -- Administrative indexes and information products, which include an online member panel roster; claims history; authorization history and status; and the provider administrative efficiency index, which measures--compared to peers--the relative cost to do business with a given provider (based on electronic vs. telephone vs. paper transactions). <P> -- A clinical portal, which includes clinical practice guidelines; clinical quality reporting; an electronic summary member health record; online care gap notification; and health risk identification support, targeted at conditions and diseases addressed by the primary care provider and "health-home" designated providers. (A health home provider offers integrated care, which can range from a primary care doctor to dentist to behavioral health professional who all share the same information and coordinate treatment based on that information.) <P> -- Clinical applications available to network primary care providers and health-home designated providers. These apps deliver regular risk-adjusted, practice-level clinical quality, utilization, and administrative cost reporting information. <P> The Centelligence reporting system that produces the information for these systems is powered by proprietary statistical software, fully integrated using clinical and operations data, and housed in the Teradata data warehouse. <P> Operationally, the company has found that this comprehensive communication strategy is effective for both small and large providers. Those who perform well, from an administrative, clinical, and utilization perspective, are often interested in risk-based incentive programs that can make doing business with Centene very attractive. Providers who are not performing as well as their community peers are given assistance to boost their overall outcomes. <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center> <P> <strong>RECOMMENDED READING</strong> <P> <a href="http://www.informationweek.com/1343">Complete <em>IW 500</em> coverage and resources</a> <P> <a href="http://www.informationweek.com/500/12/results"><em>IW 500</em>: Innovators and Rulebreakers</a> <P> <a href="http://www.informationweek.com/500/12/government">Top 15 Government IT Innovators For 2012</a> <P> <a href="http://www.informationweek.com/global-cio/interviews/20-great-ideas-to-steal/240006553"><em>IW 500</em>: 20 Innovative IT Ideas To Steal (2012)</a> <P> <a href="http://www.informationweek.com/news/galleries/global-cio/interviews/231600980">20 Innovative IT Ideas To Steal (2011)</a> <P> <a href="http://www.informationweek.com/infrastructure/reviews/informationweek-500-20-great-ideas-to-st/227400099">20 Great Ideas To Steal (2010)</a> <P> <a href="http://www.informationweek.com/healthcare/leadership/10-healthcare-it-innovators-informationw/231600867">10 Healthcare IT Innovators: <em>InformationWeek 500</em> (2011)<a/> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790">Health IT's Next Big Challenge: Comparative Effectiveness Research</a> <P> <a href="http://www.informationweek.com/hc/video">Fireside Chat with Bill Spooner, CIO of Sharp Healthcare</a> <P> <a href="http://www.informationweek.com/healthcare/clinical-systems/mathematical-modeling-meets-disease-prev/240002926">Mathematical Modeling Meets Disease Prevention</a>2012-09-12T00:01:00ZSocial network lets patients and their families share stories and support one another.http://www.informationweek.com/news/240006804?cid=RSSfeed_IWK_authorsHanging out on a social network isn't what you'd expect seriously ill children to be doing as part of their treatment, but they are at Children's Medical Center Dallas. The private, not-for-profit facility launched a social network a year ago as part of its Children's Online Experience initiative. </P> <P> With 559 beds in facilities on two campuses, Children's Medical Center Dallas is the fifth largest pediatric health provider in the nation. It's a Stage 7 facility, a distinction awarded by the Healthcare Information and Management Systems Society to recognize healthcare providers that have fully integrated IT into patient care and gone paperless.</P> <P> The medical center's Patient and Family Social Network lets past and present patients, 13 years of age and older, and their families share stories and support one another. The network is divided into communities of patients coping with disorders in various specialties: gastroenterology, neurology, cardiology, and so on.</P> <P> Carisa Weaver, a 13-year-old patient, uses the social network and other components of the Children's Online Experience to manage her insulin-dependent Type 1 diabetes. "It's kind of cool that I'm not alone doing this," she says. "There are other people out there that can help me." Carisa's mother, Alice, describes the hospital's social network as "a little like an internal Facebook where we can organize our profiles the way we want to be seen."</P> <P> <strong>Beyond Social</strong></P> <P> Patients and their parents also have access to a patient portal, called MyChart, where they can see test results, a list of medications, and alerts for appointments. They can request prescription refills, make appointments, interact with clinical staff through a HIPAA-compliant email system, and get information about insurance coverage.</P> <P> Patients can also use the portal to tap into an extensive library of hospital-recommended educational material. They can message the hospital's clinic through the portal, and physicians can start one-on-one email dialogues as needed.</P> <P> <!-- Image Aligning Right --> <div class="inlineStoryImage inlineStoryImageRight"> <img src="http://twimgs.com/informationweek/1343/343IW500_BI_CMCexterior_175.jpg" alt="The 559-bed medical center has gone paperless" title="The 559-bed medical center has gone paperless" class="img175"> <div class="storyImageCaption">The 559-bed medical center has gone paperless</div> </div> <!-- / Image Aligning Right --> <P> The portal provides access to remote care logs, in which diabetic children, for instance, can input blood glucose readings into the hospital's database. They can also input when they've eaten, as well as their dose of short-acting and long-acting insulin. That data can be accessed through the medical center's electronic health record system.</P> <P> Children's Medical doesn't do a lot of custom work on its IT infrastructure. "We tend to not build systems from scratch but buy off-the-shelf, packaged solutions," says CIO Pamela Arora. That said, a good bit of customization went into development of the Children's Online Experience. The goal was to create a seamless user experience, including single sign-on. Arora's team used IBM's Collaborative tool suite, marrying it to the Epic EMR and Tridion's content management system.</P> <P> The number of portal users is growing. In June, 268 new users registered and 3,800 unique users signed in. The vast majority of them were over the age of 18, indicating that the portal is attracting parents and older patients.</P> <P> Children's Medical Center's social network, patient portal, and other IT initiatives are engaging patients in the process of getting and staying healthy. That's no accident. Using IT to deliver better pediatric care is part of the center's core tech mission, says Arora.</p> <P> <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center></p>2012-09-12T00:01:00ZBIDMC, the No. 1 company in the <i>InformationWeek 500</i>, gives more clinicians access to faster queries.http://www.informationweek.com/news/240006766?cid=RSSfeed_IWK_authorsLike all the hospitals affiliated with Harvard Medical School, Beth Israel Deaconess Medical Center aims to be the best of the best. A closer look suggests the hospital is achieving that lofty goal partly by taking shrewdly calculated technology risks. </p> <P> A centerpiece of BIDMC's IT-based innovation is a new medical informatics platform called Clinical Query. To appreciate its value, you need to understand the current healthcare environment.</p> <P> With the push to reform medical care in the U.S., providers are expected to improve quality while reducing costs. And clinicians are under pressure to focus not only on the care of the individual patients sitting in front of them, but also the larger population with the same disease or condition--so-called population health management. That mandate will require much more sophisticated data analytics tools.</p> <P> Enter Clinical Query. John Halamka, BIDMC's ball-of-fire CIO, refers to it as a clinical trials/clinical research business intelligence system. It's a search engine married to a huge database of patient records that lets hospital employees test hypotheses about what causes a disease, for instance, or test which drug, diet, or lifestyle variables may reduce the risk of developing one.</p> <P> The repository contains 200 million data points on 2.2 million patients, including medications taken, diagnoses, and lab values. The query tool is capable of navigating 20,000 medical concepts through the use of Boolean expressions. All the data has been mapped to standard medical language codes. Diagnoses, for instance, have been mapped to ICD-9; medications to RxNorm codes; lab data to Logical Observation Identifiers Names and Codes (LOINC). </p> <P> So with the help of Clinical Query, a clinician or researcher might search the records to find out how many patients with breast cancer also take ACE inhibitors, a class of drug used to treat high blood pressure. If the results reveal a strong correlation between the drug and the malignancy, the hospital could do a deeper analysis and set up a formal research project to investigate the link. The ultimate goal is to discover a new medical intervention that would improve the survival of the entire population of breast cancer patients. </p> <P> Not only would Clinical Query do the legwork to detect a link between breast cancer and ACE inhibitors, but it would also take a research hypothesis to the next stage, what Halamka calls the "drink" stage after the initial "sip" of data. </p> <P> "Suppose I actually want to take the data on the 66,000 patients I just identified in my search and enroll them in a clinical trial," Halamka explains. "Once the institutional review board gives approval for that, we can take this query and automatically write letters to the primary care physicians to enroll these patients in the trial." It's a huge time saver.</p> <P> Access to Clinical Query, as well as to the other clinical apps in the BIDMC system, is simplicity itself. A single sign-on protocol gives physicians access to 146 clinical apps--including an order entry app, a performance manager governing safety and quality, an emergency department dashboard, PeopleSoft ERP, and thousands of professional journals--as well as the 2 million-plus patient records. Other employees and students get a set of sign-on rights depending on their role in the organization. </p> <P> The internally developed software under the Clinical Query hood is based on an open source system known as Informatics for Integrating Biology &amp; the Bedside. And because the platform pulls data from multiple clinical and administrative applications, the hospital's IT team had to normalize the data with the use of the aforementioned vocabularies, LOINC, ICD-9, and RxNorm.</p> <P> <!-- Image Aligning Right --> <div class="inlineStoryImage inlineStoryImageRight"> <img src="http://twimgs.com/informationweek/1343/343IW500_Halamka_01_175.jpg" width="175" height="175" alt="InformationWeek 500 Top 5: BIDMC - Self-service makes BIDMC's medical platform a standout, says Halamka" title="InformationWeek 500 Top 5: BIDMC - Self-service makes BIDMC's medical platform a standout, says Halamka" class="img175" /> <div class="storyImageCaption">Self-service makes BIDMC's medical platform a standout, says Halamka</div> </div> <!-- / Image Aligning Right --> <P> "What's unique about Clinical Query is that it's completely self-service," Halamka says. "I didn't have to go out and hire an analyst. I didn't have to get special permission to get access or approval from our [institutional review board] to use it."</p> <P> Clinical Query is only one part of BIDMC's BI anatomy. Expert analysts at the hospital also do more sophisticated mining, looking at raw patient data and, in some cases, evaluating the quality of data that feeds Clinical Query and other apps. The hospital's IT team has reached out beyond its 2 million patients to look at community-wide data sources to find ways to manage the health of larger patient populations.</p> <P> BIDMC runs one of 32 Pioneer Accountable Care Organizations recently started nationwide, taking commercial electronic health records software in doctors' offices, such as eClinicalWorks, GE Centricity, and more specialized programs, and writing specifications "to download data elements to a common community repository to do population analytics," Halamka says. Once again, the goal is better, cheaper patient care--what policymakers now call accountable care.</p> <P> Halamka is also a driving force behind creating a state-funded, privately managed, cloud-based health information exchange in Massachusetts. The HIE is contracting with 16 EHR vendors to service doctors across the state via a massive interconnected network, due to go live in October.</p><strong>Early Adopter</strong></p> <P> Other academic medical centers have endeavored to use patient records to feed their clinical research machine, but the information feeding Clinical Query is more comprehensive. The data on patients' medication use, for example, is more complete than found elsewhere because of the way clinicians at BIDMC are required to track patients' drug intake. Similarly, because BIDMC has been using an EHR system since 1985--long before the industry got hip to EHRs--it has an impressive amount of longitudinal data per patient.</p> <P> Clearly, the culture at BIDMC is to be a first IT mover. Halamka is proud of the fact that it was the first hospital "to go live with iPads in clinical care. We did it one hour after they were invented." BIDMC staffers went down to the Apple store, bought the tablets, and put them to use in the hospital's emergency department. That may not sound especially bold in today's healthcare environment, but in early 2010 it was fearless. </p> <P> More cutting edge was the hospital's custom EHR system, called Online Medical Record. Halamka is quick to point out: "We built it ourselves. I wrote part of it. It's Web-based, cloud-hosted, runs on tablets. How many EHRs in the world have those characteristics?" </p> <P> In practical terms, that means physicians can easily access a patient's text records and images from anywhere in the world. And all of the hospital's patients can likewise get access to all of their data. They can also have secure email conversations with their doctors and renew prescriptions online, even see their doctors' calendars to book appointments most convenient for them (rather than their clinicians).</p> <P> Getting Clinical Query up and running did pose some challenges, but the stumbling blocks were more policy-related than technological. The Health Insurance Portability and Accountability Act requires that providers keep patients' medical data private or risk large fines. Letting employees access 2 million patients' confidential records therefore required that BIDMC put in place some serious safeguards to remain compliant. </p> <P> De-identifying the records was the most obvious precaution, but the nature of the Clinical Query search engine required more. </p> <P> <!-- Image Aligning Right --> <div class="inlineStoryImage inlineStoryImageRight"> <img src="http://twimgs.com/informationweek/1343/343IW500_Halamka2_175.jpg" width="175" height="175" alt="InformationWeek 500 Top 5: BIDMC - BIDMC was the first hospital to use iPads in clinical care, says Halamka (left, with Dr. Henry Feldman)" title="InformationWeek 500 Top 5: BIDMC - BIDMC was the first hospital to use iPads in clinical care, says Halamka (left, with Dr. Henry Feldman)" class="img175" /> <div class="storyImageCaption">BIDMC was the first hospital to use iPads in clinical care, says Halamka (left, with Dr. Henry Feldman)</div> </div> <!-- / Image Aligning Right --> <P> Suppose for argument's sake that a BIDMC employee wants to snoop on his neighbor. The neighbor happens to have one blue eye and one green eye (a unique identifier), and the employee wants to know if he's on anti-psychotic meds. The employee could create a query that lists all blue-eyed, green-eyed people taking mental health medication, in which case there's a good chance the neighbor's confidential data would show up. To prevent such unlawful snooping, Clinical Query always throws in a few additional arbitrary patients to the search results, creating just enough ambiguity to keep patients' secrets secret. Normally, a database search is supposed to give precise results, but in this scenario, the researcher's initial goal isn't supposed to be to identify individual patients, but to find correlations between diseases and risk factors.</p> <P> Still, the hospital's institutional review board initially was concerned that giving all hospital employees--rather than just physicians--access to Clinical Query was unwise. The IRB feared that "people will share data of a competitive or embarrassing nature," Halamka says. BIDMC jumped that hurdle by requiring all employees to take a HIPAA training course so they understand their obligation under federal law to protect patient privacy and understand what information they could legally reveal. </p> <P> <strong>An Old Data Problem</strong></p> <P> A major technological obstacle to making Clinical Query fully functional centered on the variable nature of medical terminology. As a matter of contrast, there are only six data elements in the average ATM transaction, but the average patient record contains about 65,000 data elements. Complicating matters further is the fact that different clinicians may define each element differently.</p> <P> "There's huge uncertainty about what each data element means," Halamka says. A simple term such as "fever" may mean different things to different docs. Likewise, some clinicians may define hypertension as a blood pressure above 120/80, while others use different numbers. To get meaningful search results to track disease trends or correlations between risk factors and disease, researchers need consistent terminology.</p> <P> With that challenge in mind, BIDMC created a hierarchical ontology of language, in effect a tiered list of precise definitions of medical words. And then every patient record had to be mapped to this ontology. </p> <P> A simple example illustrates the tangible benefits of putting such an ontology in place. In 2004, Merck announced the voluntary worldwide withdrawal of Vioxx (rofecoxib), an arthritis and acute pain medication, because a clinical study that took more than a year to perform revealed patients on the pain killer were at increased risk for heart attack and stroke. Had investigators input the terms "rofecoxib" and "cardiovascular disease" into Clinical Query, it would have taken about a second to find that connection.</p> <P> It's hard to match the innovations that have come out of BIDMC and the rest of the Harvard healthcare family. "We were the first Web-based health record, the first computerized provider order entry system, the first to use iPads," Halamka says. Asked why the Boston hospital chooses to be on the cutting edge of information technology, he jokes: "It's so cold and miserable here six months of the year, there's nothing else to do but work." That work benefits not just the patients BIDMC serves, but the entire U.S. healthcare system. </p> <P> <!-- KINDLE EXCLUDE -->&#9; <center><a href="http://www.informationweek.com/1343"><img src="http://twimgs.com/infoweek/1343/1343_500_return_to_homepage.gif" width="299" height="45" hspace="0" vspace="0" alt="Go to the 2012 InformationWeek 500 homepage" title="Go to the 2012 InformationWeek 500 homepage" border="0"/></a></center></p> <!-- /KINDLE EXCLUDE --> <P>2012-09-10T08:00:00ZThis large Massachusetts group practice has made medical data exchange a top priority by establishing a centralized Web portal with area hospitals.http://www.informationweek.com/news/240006965?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/news/galleries/healthcare/interoperability/240001675"><img src="http://twimgs.com/informationweek/galleries/automated/805/Maine_Healath_infonet_tn.jpg" alt="8 Health Information Exchanges Lead The Way" title="8 Health Information Exchanges Lead The Way" class="img175" /></a><br /> <div class="storyImageTitle">8 Health Information Exchanges Lead The Way</div> <span class="inlinelargerView">(click image for larger for slideshow)</span> </div><!-- /KINDLE EXCLUDE -->If I had to choose just one piece of technological magic to transform healthcare, it would be interoperability. <P> Suppose by some stretch of the imagination that every single U.S. hospital, medical practice, clinical lab, nursing home, and home health agency were interconnected and sharing patient data in real time. <P> No need to redo the ultrasound on Mrs. Smith because you can't locate the original one performed just last week at the hospital across town. No reason to worry whether she's allergic to the antibiotic she's about to receive because the medication history and allergy list from her last physician are now available via an EHR-to-EHR link. The list of advantages goes on and on. <P> Although the U.S. healthcare system is a <em>long</em> way from this kind of <a href= " http://www.informationweek.com/healthcare/interoperability/interoperability-initiative-adds-structu/232601875 ">interoperability</a>, several healthcare systems are moving in the right direction. <P> A case in point: <a href= "http://www.atriushealth.org/ ">Atrius Health,</a> the largest multi-specialty medical practice in New England, has implemented an interoperability strategy that has generated a lot of positive feedback and participation from its physicians. <P> The group practice includes 1,075 physicians, 50 practice locations, and nearly 1 million patients, and it has strategic relationships with several area hospitals, including Beth Israel Deaconess Medical Center (BIDMC), Beverly Hospital, New England Baptist Hospital, Brigham and Women's Hospital, Newton-Wellesley Hospital, Faulkner Hospital, and Boston Children's Hospital. <P> <strong>[ To find out which medical apps doctors and patients are turning to, see <a href="http://www.informationweek.com/news/galleries/healthcare/mobile-wireless/232200263?itc=edit_in_body_cross">9 Mobile Health Apps Worth A Closer Look</a>. ]</strong> <P> Atrius, which uses Epic for practice management and clinical record keeping, faced the challenge of sharing patient data with all of those independent hospitals. So it started what <a href= " http://www.atriushealth.org/aboutUs/leadershipTeam.asp ">CIO Dan Moriarty</a> refers to as a Web-portal-based interoperability project. The Atrius/BIDMC link was the first to go live, in January 2010. <P> In practical terms, what this means is that when an Atrius physician admits a patient for gallbladder surgery at BIDMC, for instance, he can open his Epic system and click a single button to take him directly into BIDMC's e-records on this patient--despite the fact that BIDMC doesn't use Epic's EHR. <P> As Moriarty explains: "Doctors don't have to open a Web browser. They don't have to log onto a VPN. There's no need to log on to each hospital's clinician portal." It's all automated and takes about two seconds to gain access to records that in the past would have taken much longer and required many more clicks. <P> What made this interoperability initiative workable was an integration utility--an API of sorts--that let Atrius link with each of its hospital partners. The underlying technology is SOAP-based Web services. <P> Moriarty is quick to point out that technology is only part of the success story. The fact that Atrius already established strategic relationships with these hospitals laid the groundwork for the kind of cooperation needed to implement each hospital/Atrius setup. <P> And of course, the Atrius "easy portal" isn't the only means by which the practice's physicians can gain access to patient data from other hospitals and practices. Massachusetts recently established a <ahref= "http://www.maehi.org/health-it/health-information-exchange ">statewide health information exchange</a> to share such data. In Moriarty's view, Atrius's interoperability initiative complements that larger system, it doesn't replace it. <P> But by any yardstick you care to use, the Atrius <a href= " http://www.informationweek.com/healthcare/interoperability/ehr-interoperability-key-for-meaningful/240006244 ">interoperability</a> "magic" is still quite an achievement, one from which group practices nationwide can learn. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i> <P>2012-09-06T10:14:00ZMedication alerts are supposed to ensure patient safety, but clinicians ignore them when bombarded with too many. This dilemma needs to be solved.http://www.informationweek.com/news/240006861?cid=RSSfeed_IWK_authorsMedication alerts within EHRs can save lives, but as many clinicians are quick to point out, these alerts can also prove to be a major headache. The alerts sometimes note potential adverse effects that even first year medical students would know. While there's no perfect system, we can do better. <P> Given that between 33% and 96% of medical alerts are ignored, there's little doubt that providers need help in this regard. A good place to start is with a core set of critically important drug/drug interactions (DDIs) that everyone in your healthcare system needs to watch. <P> With that in mind, researcher Shobba Phansalkar, from Brigham and Women's Hospital in Boston, along with colleagues from Harvard, Rand Corp., and UCLA, did an exhaustive review of medication databases to compile a must-have list of severe DDIs. They came up with 15 essential interactions that all your clinicians should probably have access to in a clinical decision support system (CDSS). The list, published in the latest issue of <em><a href= " http://jamia.bmj.com/content/19/5/735.abstract ">Journal of Medical Informatics Association</a></em>, was derived from Partners Healthcare System Medication database; commercial databases, including Micromedex, First Data Bank, and Drugs.com; and from academic research papers written by experts in the field. <P> Once you have a core list in place, the next logical step is to expand it with less critical but useful alerts, and then decide how to alert physicians to the entire data set. Typically a CDSS prioritizes medical alerts into three tiers. The most serious, life threatening DDIs, are set up as a hard stops in the system. As Phansalkar explains in the JAMIA paper, that requires the med order be cancelled or that one of the two interacting drugs be discontinued. In tier two, clinicians would have to give a reason for overriding an alert for a moderately serious DDI. Tier 3 is reserved for non-interruptive yet useful alerts. <P> Deciding where to place a medical alert in a three-tier system is only one of the related issues. IT managers and clinical leaders have to join forces to decide which type of clinician needs to see which alerts. It doesn't make sense for a physician to see an alert that's only relevant for a pharmacist, for instance. In other words, we need role-specific drug alerts. <P> That point was driven home in a study published in April issue of <em><a href= " http://www.ijmijournal.com/article/S1386-5056%2812%2900013-5/abstract ">International Journal of Medical Informatics</a></em>. V.A. and Regenstrief healthcare researchers observed 30 physicians, nurse practitioners, and pharmacists entering and processing a total of 320 outpatient prescription orders. They found that <a href= " http://www.informationweek.com/healthcare/cpoe/alert-fatigue-searching-for-a-cure/232800101 ">prescribing clinicians often were confused about why the EHR delivered alerts</a> and determined that the electronic warnings tended to be oriented more toward pharmacists than those who write prescriptions. <P> The researchers also found that prescribers spent too much time retrieving data in response to an alert, suggesting that EHR systems should automatically deliver relevant information from patient records, such as test results and documentation about adverse reactions to certain medications. "Prescribers wanted more patient-specific alerts, and were particularly appreciative of alerts triggered by a patient's laboratory values," said the article. <P> Because the medication alert system at Regenstrief is home grown and more readily customizable, it allows alerts to be tweaked based on lab data from individual patients. In a recent interview published in <em><a href= "http://www.ama-assn.org/amednews/2012/04/16/bil10416.htm ">American Medical News,</a></em> Jon D. Duke, MD, assistant professor at the Indiana University School of Medicine, talks about Regenstrief's Context-Aware Drug-to-Drug Interaction (CADDI) alert system, which is capable of such specificity. "... if there&#8217;s an interaction between a medication like an ACE inhibitor and a potassium supplement, which is a common interaction associated with hyperkalemia, the system goes and checks the [patient&#8217;s] last potassium level and is able to then increase or decrease the intensity of the alert based on whether there was any abnormal baseline levels." <P> It's likely clinicians will keep complaining about alert fatigue for some time to come. But as medical informatics specialists get better at designing medication databases, we'll eventually find the right balance between patient safety and clinician convenience. <P> <i>See the future of business technology at <a href="http://www.interop.com/newyork/?_mc=WEYLBQNY07">Interop New York</a> Oct. 1-5. It's the best place to learn about next-generation technologies including cloud computing, BYOD, big data, and virtualization. End of Summer Discounts end Sept. 5. Save up to $800 on Interop New York Conference Passes with code WEYLBQNY07. </i>2012-08-27T10:39:00ZLook for growth in mobile health, telemedicine, clinical analytics, and personal health records&#8212;and an EHR vendor shakeout.http://www.informationweek.com/news/240006254?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/mobile-wireless/240003081"><img src="http://twimgs.com/informationweek/galleries/automated/828/01_Doctor_Ipad3_tn.jpg" alt="11 Super Mobile Medical Apps " title="11 Super Mobile Medical Apps " class="img175" /></a><br /> <div class="storyImageTitle">11 Super Mobile Medical Apps </div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Ultimately the goal of all healthcare--IT included--is to put itself out of business. That may sound a bit strange but medicine's primary objective is to cure disease, or prevent it from occurring in the first place. And as the profession gets better at these two tasks, the public should become increasingly self-sufficient and have less and less need for its services. <P> How far down this path will we be in 12 months? Probably not too far. But we are making progress on five fronts: <P> <strong>Mobile Health.</strong> This segment of the industry offers the most promise. It's no exaggeration to describe consumers' and physicians' embrace of mobile health apps, smartphones, and tablets as transformational. <P> Docs are in love with their iPads, and for good reason. When IT teams were asked "Which mobile computing devices are doctors in your organization using for medical purposes" in <a href="http://reports.informationweek.com/abstract/105/8692/Healthcare/research-healthcare-it-2012-priorities-survey.html"><em>InformationWeek Healthcare</em>'s 2012 Priorities Survey,</a> 66% cited iPads or other tablets, up from 45% just a year earlier. This love affair continues to develop because tablets give them access to EHR data, drug reference materials, and a host of valuable data that in the past was only available in the office or hospital. That kind of access should improve patient outcomes. <P> Similarly, consumers are loading all sorts of fitness apps on their phones, while patients with chronic diseases are taking advantage of apps and iPhone attachments that let them measure blood pressure, blood glucose, and much more. <P> <strong>[ Are you ready to take on another tough job? Read <a href="http://www.informationweek.com/healthcare/clinical-systems/health-its-next-big-challenge-comparativ/240005790?itc=edit_in_body_cross">Health IT's Next Big Challenge: Comparative Effectiveness Research</a>. ]</strong> <P> Roughly half of consumers predict that within the next three years mobile health will improve the convenience (46%), cost (52%), and quality (48%) of their healthcare, according to a <a href="http://www.informationweek.com/big-data/news/healthcare/mobile-wireless/240001979/doctors-concerned-about-consumers-mobile-health-use?cid=SBX_bigdata_related_news_Mobile_&_Wireless_big_data=&itc=SBX_bigdata_related_news_Mobile_ ">PricewaterhouseCoopers (PwC) survey</a> of consumers, payers, and physicians in both developed and emerging markets around the world. <P> Whether or not this enthusiasm translates into better health and less need for medical services will depend in part on the "stickiness" of these apps. Unfortunately many consumers fall out of love with their mobile health apps after only a few uses. <P> <strong>Personal health records.</strong> Speaking of stickiness, PHRs seem to have none. Until recently <a href="http://www.informationweek.com/news/healthcare/patient/232400272">few consumers have signed on for standalone PHRs,</a> and I've devoted a fair amount of digital ink to reasons why that's the case. But that will likely change in the next year or so--at least for those consumers who have the most skin in the game, namely patients with chronic, life-threatening disorders. <P> I suspect so-called <a href="http://www.informationweek.com/healthcare/patient/interactive-phrs-make-patients-more-proa/240003784">"interactive PHRs"</a> will catch on in 2013. These digital tools link personal health records to electronic health records. <P> It seems <a href="http://www.informationweek.com/healthcare/patient/microsoft-integrates-healthvault-with-gr/240002703">Microsoft is placing its bets on this PHR/EHR marriage as well.</a> The company has <a href="http://www.greenwaymedical.com/news/article/?id=427">launched a pilot program</a> with Greenway Medical Technologies that will add clinical data from PrimeSuite, Greenway's electronic health record, to Microsoft's HealthVault platform. The joint effort will let patients create a HealthVault account and access their clinical information from PrimeSuite's PrimePatient online portal, including demographics, allergies, medications, vital signs, social and family history, procedures, labs tests, and patient care plans.<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/admin-systems/240001004"><img src="http://twimgs.com/informationweek/galleries/automated/798/01_Intro_tn.jpg" alt="11 Healthcare-Focused Business Intelligence Tools" title="11 Healthcare-Focused Business Intelligence Tools" class="img175" /></a><br /> <div class="storyImageTitle">11 Healthcare-Focused Business Intelligence Tools</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> <strong>Telemedicine</strong>. Several large healthcare systems have established relationships with telemed companies. <a href="http://www.americanwell.com/PressRelease_The_University_of_%20South_Florida_and_American_Well_to_Bring_Telehealth_to_Seniors_Living_at_The_Villages_Retirement_Community.htm">American Well</a>, for instance, recently teamed up with Tampa-based University of Southern Florida Health to provide telehealth services to residents of The Villages, a large retirement community northwest of Orlando. The company has also partnered with Allscripts to integrate telehealth functionality into patients' EHRs. The system is being piloted at USF Health, and the EHR vendor plans to expand it to selected customers nationwide in January, 2013. <P> Finally <a href="http://www.informationweek.com/healthcare/mobile-wireless/sentaramdlive-deal-points-to-telehealth/240005928">Sentara Healthcare,</a> a large healthcare system with locations across Virginia, has struck a <a href="http://www.mdlivecare.com/pages/press_08202012.html">deal with MDLIVE</a>, a Sunrise, Fla.-based firm, to provide physicians with telephone and online video consults with patients in Virginia and to serve as a referral network for patients who need to be seen in person. <P> <strong>EHR vendor shakeout.</strong> Healthcare providers have more than 600 certified EHR systems to choose from if they want to qualify for Meaningful Use financial incentives. It's likely many of these vendors won't survive 2013 for several reasons. Some smaller companies have jumped into the market too quickly, hoping to get a quick return on their investment without making much of an investment to begin with. <P> At a recent <em>InformationWeek Healthcare</em> Virtual Event, Mark Wagner, senior research director at KLAS, explained that EHR vendors are so busy selling systems that they barely have time to support the ones they've installed, much less create a platform that meets all of a provider's needs. That kind of over commitment is sure to build resentment and a bad reputation among hospitals and practices with little or no internal IT support staff. The resulting winnowing process may put some EHR vendors out of business, but the surviving companies will likely offer services that ultimately improve patient care. <P> <strong>[ Technology can't solve all problems. Read <a href="http://www.informationweek.com/healthcare/electronic-medical-records/when-medical-informatics-clashes-with-me/240003990?itc=edit_in_body_cross">When Medical Informatics Clashes With Medical Culture</a>. ]</strong> <P> <strong>Clinical Analytics</strong> Most EHR systems fall short when it comes to heavy duty analytics. Many can generate simple reports but that's just not enough to meet the demands placed upon providers to meet various government mandates on interoperability and clinical performance. And providers are starting to see that EHRs by themselves have limited potential. <P> "In the clinical space, there was a belief that if you put in an EHR, all your problems of interoperability would go away," according to <a href="http://www.informationweek.com/healthcare/clinical-systems/clinical-analytics-boosts-ehr-effectiven/232602439">John Edwards, a director at PwC, commenting on one of their recent surveys.</a> "There is evidence in the survey that providers were realizing that the 'silver bullet' of EHRs needed to be enhanced with clinical informatics people." <P> Close to half of providers expect to add technical analysts in the next two years, while 35% will hire additional clinical informaticists, according to the survey. Some 70% of insurance companies will boost staffing on the technical side of clinical analytics and 30% will add informaticists. <P> Similarly a <a href="http://www.informationweek.com/healthcare/clinical-systems/hospitals-seek-analytics-tools-in-rush-t/240005948?cid=nl_IW_healthcare_2012-08-23_html&elq=4c296cd302494f929be5318a2a14b02a">recent report from Frost and Sullivan</a> says hospitals will soon see a significant increase in the use of analytics tools. Their latest figures show that while only 10% of U.S. hospitals implemented health data analytics tools in 2011, that number will grow to approximately 50% adoption in 2016. <P> It's unlikely the healthcare industry is going out of business any time soon, no matter how effective it becomes at delivering patient care. But by the same token, developments in all five IT hot spots suggest we're moving in the right direction. <P> <em>This article will also appear on the <a href="http://www.himss.org/ASP/index.asp">HIMSS website</a> on September 10 as part of their celebration of National Health IT Week. More details are available <a href="http://press.himss.org/press-release/media-alert/media-alert-calling-all-bloggers-join-1st-national-health-it-week-blog-car">here.</em></a>2012-08-21T13:35:00ZInnovative approach to medical data analysis can yield new treatment options at a lower cost.http://www.informationweek.com/news/240005790?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --> <div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511"><img src="http://twimgs.com/informationweek/galleries/automated/707/01_autonomyscreenshot_tn.jpg" alt="5 Key Elements For Clinical Decision Support Systems" title="5 Key Elements For Clinical Decision Support Systems" class="img175" /></a><br /> <div class="storyImageTitle">5 Key Elements For Clinical Decision Support Systems</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE --> Healthcare providers are being pushed to deliver more cost effective medical care and to improve the health of not just individual patients but large populations. One key to carrying out both mandates is finding more clinically effective treatment options. <P> Many academic medical thought leaders insist that the best way to find those treatment protocols is to test them in randomized controlled trials. Such RCTs require a large group of control subjects to receive either a placebo or conventional therapy and a large group to receive the experimental treatment in question. The problem is RCTs are outrageously expensive. In today's cost conscious healthcare system, that's a problem. <P> Enter comparative effectiveness research. CER compares two or more accepted treatments to determine which are most effective. Medical informatics comes into the picture because it's now possible to get these projects off the ground by analyzing huge patient databases. And much of that patient data can now be gleaned from electronic health record systems. <P> The American Recovery and Reinvestment Act of 2009 has earmarked $1.1 billion for CER. The <a href="http://www.ahrq.gov/Fund/recoveryawards/osawinfra.htm">Agency for Healthcare Research and Quality</a> (AHRQ), the federal agency tasked with improving the quality, safety, efficiency, and effectiveness of health care, has been using part of that money to fund research on data infrastructure so that clinicians can figure how to take advantage of all the patient data in the Medicare system to compare treatment options. Other AHRQ-sponsored research has been looking at how to create an all-payer, all-claims database that clinicians can tap into for the same purpose. <P> <strong>[ Most of the largest healthcare data security and privacy breaches have involved lost or stolen mobile computing devices. For possible solutions, see <a href="http://www.informationweek.com/news/galleries/healthcare/security-privacy/232500404?itc=edit_in_body_cross">7 Tools To Tighten Healthcare Data Security</a>. ]</strong> <P> Other CER-related projects include one led by <a href="http://www.cvrn.org/who/bios/magid.html">David J. Magid, MD,</a> director of research at the Colorado Permanente Group. His team searched through thousands of the group's EHRs to figure out which anti-hypertensive drugs are most effective when patients don't respond to first-line treatment with diuretics. The team managed to keep its research costs down to $200,000, a small fraction of what a randomized controlled trial would cost, and still came up with useful results, namely that beta blockers and ACE inhibitors work well. <P> Similarly a <a href="http://xnet.kp.org/newscenter/pressreleases/nat/2011/040611interoperability.html">consortium of large healthcare systems</a>, including Kaiser Permanente and Mayo Clinic, is capitalizing on the power of tens of millions of e-records to generate research. For example, they recently launched <a href="http://www.dor.kaiser.org/external/Joe_Selby/">programs to mine their EHRs</a> to compare treatment protocols for diabetes. <P> "With these large databases and detailed clinical information, we can conduct comparative, effective research in real world settings, with a full range of patients, not just those selected for clinical trials," Joe V. Selby, director of Kaiser's research division, states in a recent issue of <a href="http://www.scientificamerican.com/article.cfm?id=the-best-medicine-july-11">Scientific American.</a> <P> Boston's Beth Israel Deaconess Medical Center, one of the teaching hospitals affiliated with Harvard Medical School, recently entered the CER arena in a big way. Starting this month, the medical center launched <a href="http://geekdoctor.blogspot.com/2012/04/clinical-query-i2b2-and-queryhealth.html">Clinical Query,</a> a searchable patient data repository that lets researchers and clinicians look for potential connections between diseases, treatment options, and risk factors, which in turn can become the jumping off point for a research project. <P> So if a Harvard researcher wants to compare the benefits of diuretics to ACE inhibitors among patients with hypertension, he can use Clinical Query to look at the records of more than 2 million patients and 200 million data points, including diagnoses, medications taken, lab values, and radiology images. <P> A comparison of data on the two classes of high blood pressure meds might reveal that one is more effective than the other. And while the results of that CER analysis may not carry the same weight as a randomized clinical trial in which groups of patients were actually given the drugs in real time to see which were more effective, the CER results can still guide clinicians on treatment options for their patients. <P> Given the fact that comparative effectiveness research will likely cost far less than a randomized clinical trial, it's time healthcare stakeholders take a closer look at this approach. The challenge for IT departments is going to be getting searchable patient data repositories up and running. Few hospitals have the resources to create their own version of Clinical Query. But at the very least, they need to start ramping up their data warehousing and data mining initiatives. <P> EHR systems are now collecting invaluable information that physicians can use to detect disease patterns, clusters of patients exposed to specific toxins, and groups of patients who respond well to various drug regimens. We can't waste this gold mine. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i>2012-08-06T14:00:00ZDon't expect much help after signing on the dotted line for a new electronic help record system. EHR vendors' resources are stretched thin as they struggle to meet demand, and you'll have to find ways to fill the inevitable gaps in support and employee training.http://www.informationweek.com/news/240005036?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"> <a href="http://www.informationweek.com/news/galleries/healthcare/EMR/232300279"><img src="http://twimgs.com/informationweek/galleries/automated/700/01_Allscripts_RemoteforHDM_175.jpg" alt="12 EHR Vendors That Stand Out" title="12 EHR Vendors That Stand Out" class="img175" /></a><br /> <div class="storyImageTitle">12 EHR Vendors That Stand Out</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE --> At <em>InformationWeek Healthcare</em>'s recent virtual event, <a href="https://www.techwebonlineevents.com/ars/eventregistration.do?mode=eventreg&F=1004529&K=MAA1&tab=agenda">Electronic Health Records: Moving Beyond The Basics</a>, Mark Wagner, senior research director for <a href="http://www.klasresearch.com/">KLAS</a>, a health IT advisory firm, shared the expectations of many healthcare providers looking to purchase an electronic health record system. One clinician's demands summed up the thoughts of many: <P> "I want a system that can be customized but that doesn't take an IT expert to do it. I want a system that meets meaningful use and has a PM [practice management] system to accompany it. I would love a system that meshes with our specialty without having to modify it too much. Lastly, I want an affordable system that keeps up with all the mandates pushed on our specialty and yet does not slow down our productivity." <P> In an ideal world, that system would exist, but there's the dream and then there's reality, Wagner says. And the reality is that compromises have to be made, especially in today's market where EHR vendors are so busy selling systems that they barely have time to support the ones they've installed, much less create a platform that meets all your needs. <P> <strong>[ For more background on e-prescribing tools, see <a href="http://www.informationweek.com/news/galleries/healthcare/CPOE/231901601?itc=edit_in_body_cross">6 E-Prescribing Vendors To Watch</a>. ]</strong> <P> There are more than 600 EHRs that are certified to meet the Centers for Medicare and Medicaid Services' Meaningful Use financial incentives. Finding the right vendor in this maze of confusing options requires an appreciation for these market conditions. <P> To begin with, there's a good chance the vendor you choose is going to say: We'll put you on our list and get back to you in eight months. Some vendors might be able to install the system immediately but then will move onto their 100 other customers, leaving you to fend for yourself with staff training and tech support. In this environment, expecting a vendor to provide the ideal system--that's fully customizable, effortlessly meets all the MU requirements, meshes with all your specialists' needs, is affordable, and doesn't affect staff productivity--isn't in the cards. <P> Vendor resources are stretched too thin to make that happen. And with <a href= "http://www.informationweek.com/news/healthcare/policy/240003586 ">accountable care</a> and <a href="http://www.informationweek.com/news/healthcare/policy/232800525">ICD 10</a> on the horizon, the need for sophisticated EHR systems will only escalate. How does a healthcare provider cope? <P> The most successful medical practices don't rely solely on their EHR vendors. They supplement the EHR vendor's resources with competent staff of their own, sometimes with the help of a third party, to fill the gaps, Wagner said. <P> And the most successful providers accept the fact that EHR implementation will inevitably affect <a href= "http://www.informationweek.com/news/healthcare/EMR/232901480 ">physician productivity</a>, at least at the onset. Be prepared for the hurricane. <P> <i>InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital <a href="http://www.informationweek.com/gogreen/073012hc?k=axxe&cid=article_axxt_os">CIO Roundtable</a> issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.) </i>2012-07-31T08:40:00ZSeveral thought leaders are pushing the PHM approach to healthcare, but we need more sophisticated EHRs and clinical analytics systems to make it a reality.http://www.informationweek.com/news/240004578?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/admin-systems/240001004"><img src="http://twimgs.com/informationweek/galleries/automated/798/01_Intro_tn.jpg" alt="11 Healthcare-Focused Business Intelligence Tools" title="11 Healthcare-Focused Business Intelligence Tools" class="img175" /></a><br /> <div class="storyImageTitle">11 Healthcare-Focused Business Intelligence Tools</div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div> <!-- /KINDLE EXCLUDE -->In my 30 years as a journalist and science writer, I've seen countless "healthcare revolutions" come and go. So I can't help but wonder if the new push to reform patient care using population health management (PHM) is another of those "revolutions." <P> In a recent interview, <a href= " http://www.healthcareitnews.com/news/qa-mostashari-it-and-delivery-system-reform ">Farzad Mostashari, director of the Office of the National Coordinator of Health Information Technology</a>, emphasized the need for new healthcare delivery models, which in his estimation should include PHM. <P> So exactly what is PHM? Experts define it in various ways. According to <a href= "http://www.mathematica-mpr.com/publications/pdfs/health/PHM_brief.pdf ">Mathematica, a policy research group</a>, PHM aims to ''improve population health by attacking 'the upstream causes of so much of our ill health,' including poor nutrition, physical inactivity, and substance abuse. One <a href= " http://medical-dictionary.thefreedictionary.com/population+health+management ">medical dictionary</a> defines it as, "The coordination of care delivery across a population to improve clinical and financial outcomes, through disease, case, and demand management." <P> Those are noble aims but identifying the upstream causes of poor health and improving care coordination are tall orders for our fragmented healthcare system. What's needed are sophisticated IT tools and a willingness on the part of clinicians to embrace them to turn patient population management into a long-term tactic. <P> <strong>[ Is it time to re-engineer your clinical decision support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross"> 10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> On the IT front, a recent report from <a href= " http://www.informationweek.com/news/healthcare/clinical-systems/232901120">the Institute for Health Technology Transformation</a> sees several roadblocks to fully realized PHM. The report cites a variety of technology tools needed to keep populations healthy and minimize the need for expensive interventions such as emergency department visits and hospitalizations. <P> Those tools include electronic health records, telehealth platforms, electronic registries, data management software, and analytics systems. Providers can use EHRs and automation tools in particular to identify and stratify patients who need special attention or care; identify care gaps; measure outcomes; and encourage patients to assume more responsibility for their health, the report says. <P> However the tools healthcare providers currently use don't have the ability to store, manage, and distribute comprehensive, timely, and relevant information to the degree needed for PHM, the report concludes. <P> EHRs, for example, often don't contain the data about the care that patients have received outside an organization, and they aren't designed for interoperability. Likewise, many EHRs don't generate the real-time alerts for preventive and chronic care, and don't generate quality and population reporting. <P> Similarly, many clinical analytics tools currently in use are quite primitive, reporting a few basic facts and figures about a patient panel. The next generation of BI tools will have to be predictive and prescriptive to make PHM a reality. <P> On the clinician side, there are other thorny issues to contend with. Physicians have been trained to provide individual care, not population care, and while PHM proponents might counter that population care is simply individual care multiplied by X, it's more complicated than that. <P> Many of the interventions needed to improve the health of a large population fall more into the realm of education and public safety than they do into medical practice. Getting diabetics to exercise more or eat a heart-healthy diet, for instance, isn't what doctors do best. That's traditionally been handled by nurse educators and public health agencies, often with the help of public service campaigns or classroom instruction. <P> Similarly, many doctors object to having clinical practice guidelines imposed upon them, even when those guidelines have been proven to improve the health of large patient populations. Physicians argue that what works on a population as a whole doesn't always work on individual patients. And from a statistical point of view, that makes sense. <P> A clinical trial that shows a drug lowers serum cholesterol in 1,000 patients doesn't prove that it will be effective--or safe--when administered to an individual patient who didn't share the lifestyle, gender, eating habits, and genetic predisposition of the 1,000 patients in the clinical trial. <P> The bottom line: Unless our IT systems get a major upgrade and clinician concerns are addressed, patient health management may become another one of those fanciful "solutions" that fade into the sunset. <P> <i>In this InformationWeek Healthcare virtual event, <a href="https://www.techwebonlineevents.com/ars/eventregistration.do?mode=eventreg&F=1004529&K=xxxxx&tab=register&K=7IK">EHRs: Beyond The Basics</a>, experts will discuss how to improve electronic health record systems. It happens July 31.</i>2012-07-19T11:30:00ZWhat's the sense of having IT systems in place that can help cut medical costs if physicians ignore the price tag of the care they provide? http://www.informationweek.com/news/240003990?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/mobile-wireless/240003081"><img src="http://twimgs.com/informationweek/galleries/automated/828/01_Doctor_Ipad3_tn.jpg" alt="11 Super Mobile Medical Apps " title="11 Super Mobile Medical Apps " class="img175" /></a><br /> <div class="storyImageTitle">11 Super Mobile Medical Apps </div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE -->Ever ask your family doctor how much the test she just ordered will cost? Chances are she doesn't know. Physicians have been trained to provide the best possible care and to order whatever procedures they deem necessary to diagnose and treatment disease, regardless of the cost. <P> That philosophy is consistent with the Hippocratic oath, but as the nation tries to cope with its runaway medical tab, that philosophy requires close scrutiny. And it's especially important given all the IT systems in place that can help contain medical costs. <P> Tools are available that can help reduce the number of duplicative or otherwise unnecessary diagnostic tests doctors order. And although their main function is not cost containment, these systems can have a profound effect on the bottom line. EHRs, for example, when properly implemented, can keep clinicians informed of recent lab tests and imaging studies--through the magic of HL7. <P> HL7, which stands for <a href= " http://www.informationweek.com/news/healthcare/interoperability/232700314 ">Health Level Seven</a>, is the set of standards that lets a healthcare provider format electronic information so that it can be exchanged between two or more databases that speak different languages. Data in a hospital's radiology information system, for instance, can be shared with the laboratory information system. And both systems can share test results with a hospital's EHR, keeping clinicians informed of tests that others have ordered. <P> <strong>[ Is it time to re-engineer your clinical decision support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross"> 10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> Health information exchanges, both private and public, take this sharing capability even further by making caregivers aware of procedures performed at other hospitals and medical practices. Even the <a href= " http://www.informationweek.com/news/healthcare/interoperability/231500596 ">Direct Project</a>, the national protocol for secure clinical messaging, can help physicians stay current about test results and treatment regimens from other caregivers. Direct Project is push technology that lets physicians, hospitals, labs, pharmacies, and other entities exchange results, reports, and other clinical data over a secure network. Providers can view Direct Project messages on a website or use their EHRs to send and receive messages if those EHRs have Direct capability. <P> These tools are valuable, but they run up against a deeply rooted medical culture that doesn't pay all that much attention to costs. This culture begins to take hold during medical school. As soon as medical students begin their clinical training, they're encouraged to consider all the diagnostic possibilities when caring for patients, say Lisa Rosenbaum, MD, and Daniela Lamas, MD, editorial fellows at the <em>New England Journal of Medicine</em>. <P> So what is most likely a case of community-acquired pneumonia, during medical rounds soon morphs into a possible pulmonary blood clot or heart failure, "necessitating" a chest CT, ultrasound, and sophisticated cardiac procedures that push the patient's bill into the stratosphere. <P> Many physicians would argue that ignoring these more remote diagnoses means putting costs ahead of patients' welfare, and that's simply unethical. But Rosenbaum and Lamas point out in their recent NEJM editorial, <a href= " http://www.nejm.org/doi/full/10.1056/NEJMp1205634 ">Cents and Sensitivity--Teaching Physicians to Think about Costs</a>, "Considering cost serves not only the equitable distribution of finite services but also the real interests of individual patients. Medical bills, after all, are among the leading causes of personal bankruptcy." <P> Those bills would be significantly lower if physicians stopped ordering unnecessary procedures. And there's now solid evidence to show that <a href= " http://www.nejm.org/doi/full/10.1056/NEJMp0911423 ">some routine diagnostic and screening tests really are a waste of money.</a> <P> Among the worst offenders: <a href= " http://annals.org/article.aspx?volume=155&issue=6&page=375 ">screening EKGs,</a> chest X-rays before outpatient surgery, and CT scans or MRIs after a patient faints. Unnecessary tests have become so prevalent that nine major medical organizations have launched <a href= " http://choosingwisely.org/ ">"Choosing Wisely" campaigns</a> to educate clinicians and the public about wasteful testing. <P> Of course, there is another side to this story: Many malpractice lawsuits have been filed against physicians for failing to diagnose life-threatening diseases, and one way docs cope with the lawsuit threat is to over-order diagnostic procedures to catch even the most unlikely disorders. <P> Still, the mandate to "do no harm" requires clinicians to not just worry about their patients' physical well-being but their financial limitations. And that means taking full advantage of EHRs, HIEs, direct messaging, and related IT tools. As Rosenbaum and Lamas put it, "Helping a patient become well enough to climb the stairs to his apartment is meaningless if our care leaves him unable to afford that apartment." <P> <i>Get the new, all-digital <a href="http://www.informationweek.com/gogreen/052112hc/?k=axxe&cid=article_axxt_os">Healthcare CIO 25</a> issue of InformationWeek Healthcare. It's our second annual honor roll of the health IT leaders driving healthcare's transformation. (Free registration required.)</i>2012-07-17T11:30:00ZAs healthcare providers incorporate deep analytics and advanced clinical decision support into everyday practice, they'll turn standardized medicine into personalized medicine.http://www.informationweek.com/news/240003806?cid=RSSfeed_IWK_authors<!-- KINDLE EXCLUDE --><div class="inlineStoryImage inlineStoryImageRight"><a href="http://www.informationweek.com/news/galleries/healthcare/mobile-wireless/240003081"><img src="http://twimgs.com/informationweek/galleries/automated/828/01_Doctor_Ipad3_tn.jpg" alt="11 Super Mobile Medical Apps " title="11 Super Mobile Medical Apps " class="img175" /></a><br /> <div class="storyImageTitle">11 Super Mobile Medical Apps </div> <span class="inlinelargerView">(click image for larger view and for slideshow)</span></div><!-- /KINDLE EXCLUDE --> Thought leaders in academic medicine have been pushing hospitals and medical practices to adhere more closely to evidence-based clinical guidelines, which some call standardized medicine. But many docs in the trenches complain that when it comes to patient care, the one-size-fits-all rule just doesn't work. <P> And for good reason. When you work day after day with patients, you quickly realize that while the results of large-scale, randomized clinical trials may apply to the population as a whole, they don't apply to every individual member. That's what makes personalized medicine is so exciting. <P> Personalized medicine's goal is to use a patient's genetic makeup, lifestyle, age, gender, and environment to provide a tailored treatment regimen. And information technology is playing a pivotal role in making that goal a reality. <P> <strong>[ Is it time to re-engineer your clinical decision support system? See <a href="http://www.informationweek.com/news/galleries/healthcare/clinical-systems/232300511?itc=edit_in_body_cross"> 10 Innovative Clinical Decision Support Programs</a>. ]</strong> <P> A recent account in the <a href="http://www.nytimes.com/2012/07/08/health/in-gene-sequencing-treatment-for-leukemia-glimpses-of-the-future.html?partner=rss&emc=rss"><em>New York Times</em></a> drives that point home. It tells the story of Dr. Lukas Wartman, a Washington University cancer researcher who developed the very disease he was studying, adult acute lymphoblastic leukemia. After eventually running out of treatment options, he and his colleagues decided to sequence his entire genome to see if they could pinpoint a mutation that was causing his disease. <P> With the help of 26 sequencing machines and the university's supercomputer, they did in fact locate a mutation that was contributing to his disease by causing the overproduction of a specific protein. Once they pinpointed that defect, they were able to administer a drug that targeted the problem. The drug, which isn't normally given to patients with adult acute lymphoblastic leukemia, put Wartman into remission. <P> That account highlights the promise of IT-enhanced genetic analysis. It has the ability to find the unexpected, and to point clinicians in directions that officially sanctioned treatments and evidenced-based research have yet to go. Its ultimate goal is to design preventative and therapeutic regimens as unique as your fingerprints. <P> While success stories like Dr. Wartman's are rare, they won't be for long. A few months ago, IBM announced that a cancer research and treatment center in Italy, the Fondazione IRCCS Istituto Nazionale dei Tumori, is testing <a href="http://www.informationweek.com/news/healthcare/patient/232602907">Clinical Genomics,</a> IBM's new decision-support tools. These tools are designed to help physicians personalize treatments based on automated interpretation of pathology guidelines and intelligence from past clinical cases documented by the hospital. <P> These tools are also helping AIDS researchers in Europe analyze genomic and clinical data to make better decisions about the drug cocktails used to treat HIV patients, said Chalapathy Neti, director of global healthcare transformation at IBM Research in an interview with <em>InformationWeek Healthcare.</em> <P> Similarly, Dell is so convinced that health IT will play a major role in medicine's future that it's putting the infrastructure in place to support the use of <a href="http://www.informationweek.com/news/healthcare/clinical-systems/232400034">electronic health records in genomics research.</a> Dell recently donated $4 million in server capacity and services to support a project aimed at applying personalized medicine to pediatric cancer care. The clinical trial project initially focuses on <a href= "http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002381/">neuroblastoma,</a> a rare, deadly cancer that strikes one in 100,000 children annually before the age of 5 and is responsible for one in seven pediatric cancer deaths. <P> When will we see the fruits of such futuristic technology? For patients like Lukas Wartman, the answer is now. But he works in a top-flight research facility with easy access to gene sequencers, supercomputers, and statistics software. I suspect the rest of us won't see this kind of <a href="http://www.informationweek.com/news/healthcare/clinical-systems/232500152">personalized medicine</a> for several years--but it's worth the wait. <P> <i>Get the new, all-digital <a href="http://www.informationweek.com/gogreen/052112hc/?k=axxe&cid=article_axxt_os">Healthcare CIO 25</a> issue of InformationWeek Healthcare. It's our second annual honor roll of the health IT leaders driving healthcare's transformation. (Free registration required.)</i>