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Top Ten Tech Trends 2017: Clinical Transformation: The Time Is Absolutely Now

March 20, 2017
by Mark Hagland
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After decades of being predicted, clinical transformation is happening—but are there enough signposts along the pathway?
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With hospitals, physicians, and all providers being told consistently now by the purchasers and payers of U.S. healthcare that they need to move systemically to improve patient outcomes, cut or curb costs, maximize efficiency, and enhance the patient/consumer/community experience, there’s simply no way around an intensive drive into clinical transformation. But how quickly are providers moving to do the core work involved in clinical transformation—to rework care delivery, optimize clinician workflow, provide robust clinical decision support, and leverage data and analytics to engage in the constant “blessed cycle” or “virtuous cycle” of data gathering, analysis, and sharing, clinical performance improvement and care process reform, and more data gathering, analysis and sharing?

Though just a few years ago, the executives and managers of most U.S. patient care organizations were still somewhat fumbling around in the dark for magic bullets and other clues, the good news is this: the leaders of pioneering patient care organizations are beginning to create templates that their peers can follow, in the journey that lies ahead. Take for example the folks at Allina Health in Minneapolis. Craig Strauss, M.D. and his fellow leaders at Allina have been leveraging data and analytics to transform cardiology care delivery processes, including completely reworking how they manage percutaneous coronary intervention, or PCI, also commonly known as coronary angioplasty. For their innovative work, they were named the number-one winning team in this year’s Healthcare Informatics Innovator Awards Program.

They key to the Allina breakthrough? A savvy combination of leadership, collaboration, mission- and vision-driven effort, and the strategic leveraging of data through analytics, tied closely to virtuous cycles of continuous performance improvement. It’s a combination that the leaders of more and more patient care organizations are clicking into all around the country.

Mark Werner, M.D.


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Says Strauss, a practicing cardiologist and the medical director of Allina Health’s Minneapolis Heart Institute Center for Healthcare Delivery Innovation (MHI-HDI), “I think that clinical transformation is the identification of opportunities to improve quality and outcomes and reduce costs, and implement effective strategies from a process improvement standpoint, to effectively achieve those outcomes, with a strong foundation of data, including a retrospective outlook that informs efforts.” And, on the proverbial journey of 1,000 miles? “I think we’re at the beginning,” Strauss says. “We’ve begun to identify a potential shift from volume to value, and healthcare systems are working to develop systems of care that provide value over volume, but that’s a process that takes time and requires payer and provider transformation; but as much as we’ve talked about shifting from volume to value, we’re still in a very early phase of beginning to do it.”

On the plus side, Strauss says, “There’s no shortage of data available in healthcare. The challenge is identifying the subset of data that can drive change. To do that, we need to be able to look retrospectively at what has happened to populations we care for, and then develop the ability in a prospective manner to improve patient outcomes. So I think there will be a growing need for clinical analytics, a growing dependence on analytics, and a growing need for physicians and other clinician leaders to carry this out.”

“I do think that the pace of change in clinical care is faster than it has ever been, certainly during our respective careers,” says Mark Werner, M.D., national director of clinical consulting at The Chartis Group, a Minneapolis-based consulting firm. Werner, who has helped lead health systems and a health plan as a physician executive, says, “I think the pace is trying to accelerate, and is probably being driven by a few things, including technological advances that are changing how care is provided, as well as the growing ability to share information. In that sense, healthcare is becoming equally about information management as it is in the direct provision of services”—and that in itself is pushing clinical transformation forward.

Brian Patty, M.D.

Not surprisingly, some clinician and clinical informatics leaders working in the trenches right now see a strong link between the leveraging of core performance improvement methodologies like Lean management in patient care organizations, and clinical transformation specifically. Brian Patty, M.D., CMIO at Rush University Medical Center in Chicago emphasizes that “The organizations where I’ve seen clinical transformation efforts work well are using Lean methodologies,” he says. And, referring to his organization’s team of clinical informaticists, Patty says that “Where we come in, it has to work in and through the EHR [electronic health record]. And if we can make a care delivery process work through the EHR, we can hardwire it. And whether you’re using care pathways or workflow navigators, or all the tools in your EHR, you have to understand those tools.” CMIOs and others who are going to be working to execute on clinical transformation, he says, will necessarily have to do so using organized tools and methodologies—as many already are.

Dave Levin, M.D.

And, more specifically, says Dave Levin, M.D., the former CMIO of Cleveland Clinic and a partner in the Suffolk, Va.-based Amati Health consulting firm, using data specifically to change care processes “has always been about actionable knowledge: you’ve got to deliver it to the right place at the right time in a way that I can make it actionable as a patient or caregiver.”

It’s exactly that kind of thinking that has helped to propel clinical transformation action forward at UT-Southwestern Healthcare in Dallas, where leaders there have been propelling forward their Ambulatory Quality Outcomes (AQO) Project, an initiative that is improving processes and outcomes across 40 medical specialties, through the use of data-driven rapid-cycle improvement processes to improve care delivery and care management. It’s for that initiative that UT-Southwestern’s team was named the first-place winning team in 2016 in Healthcare Informatics’ Innovator Awards Program. With regard to their awareness of the need to move quickly and also systemically across their organization with their clinical transformation work, Jason Fish, M.D., assistant vice president for ambulatory quality, and associate CMIO, for the organization, told Healthcare Informatics last year at this time, “From an analytics and IT standpoint, our culture had been one where we were struggling along, giving people some really cool one-off projects, but we shifted towards broad building of quality,” Fish says. “So we had a lot of learning around that, to build things in a way that fit within this framework.”

Physicians in Practice: Becoming Overwhelmed by Mandates?

Given recent, rapid policy and regulatory changes at the federal level, some industry leaders believe that physicians in practice, in particular, may be finding the current moment overwhelming in terms of mandates for change. “We are starting to see the needle move” on clinical transformation, “and instead of talking about implementing and adopting EHRs, we’re talking about how we leverage these tools to impact patient care delivery and provider behavior, and so on,” says George Reynolds, M.D., the former CIO and CMIO of Children’s Hospital Medical Center in Omaha, and an independent consultant. “And yet the pace of regulatory and other change,” he cautions, “which already was challenging under meaningful use, is becoming even harder under MACRA”—the Medicare Access and CHIP Reauthorization Act of 2015—he cautions. “We keep using the word ‘overwhelming,’” he says, “and I keep thinking of the guy in ‘Princess Bride’ who uses the word ‘inconceivable’ over and over. I think it’s hard for doctors to understand the context and meaning of what they’re doing,” he says. “We’ve managed to disconnect our profession, the practice of medicine, from meaningful connection with our patients, as these regulations and these tools have served to separate them. And there are ways this could be reversed. So part of clinical transformation has to start with that physician-patient interaction. Think about Facebook, and how Facebook allows you meaningful connection with people with whom you might just have exchanged Christmas cards with. So what the EHR needs to become is a shared platform for communication between patients and providers.”

Reynolds cautions about physicians becoming overwhelmed speak to some of the core challenges in the path forward around clinical transformation. In this, CIOs and especially CMIOs, along with CMOs, CNOs, and other leaders of patient care organizations, will surely be the collective glue that will hold this industry-wide venture together, as providers move forward to rework patient care itself. Only time will tell as to how rapidly success can be achieved in an enterprise that simply cannot afford to fail. 


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AMIA Charts Course to Learning Health System

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Initiative seeks to create virtuous cycle where clinical practice is not distinct from research

In September 2015, at AcademyHealth’s Concordium 2015 meeting in Washington, D.C., I saw a great presentation by Peter Embi, M.D., who was then an associate professor and vice chair of biomedical informatics as well as associate dean for research informatics and the chief research information officer at the Wexner Medical Center at Ohio State University. 

That day Dr. Embi outlined some of the limitations of the traditional approach to evidence-based medicine —  that it is a research/practice paradigm where the information flow is unidirectional, and clinical practice and research are distinct activities, with the research design as an afterthought. “We want to leverage information at the point of care and in engagements with patients so we can systematically learn. That is what the learning health system is all about,” Embi said.

But in the current model, he noted, there is little consideration of research during planning of health systems. That limits the ability to invest in and leverage clinical resources to advance research. Also, there are no financial incentives for non-researchers to engage in research. Research as an afterthought also leads to regulatory problems and wasted investments.

Embi argued for moving from “evidence-based medicine” to an “evidence-generating medicine” approach, which he defined as the systematic incorporation of research and quality improvement into the organization. Rather than findings flowing only from research done looking back at historical data, this approach creates a virtuous cycle where clinical practice is not distinct from research.

Flash forward to 2019 and Dr. Embi is now president & CEO of Regenstrief Institute Inc., vice president for learning health systems at IU Health, and chairman of the Board of Directors of the American Medical Informatics Association (AMIA). And he is still advocating for a shift to evidence-generating medicine. He and AMIA colleagues recently published a paper in JAMIA offering more than a dozen recommendations for public policy to facilitate the generation of evidence across physician offices and hospitals now that the adoption of EHRs is widespread.

The paper cites several examples of current high-visibility research initiatives that depend on the EGM approach: the All of Us Research Program and Cancer Moonshot initiative, the Health Care Systems Research Collaboratory, and the development of a national system of real-world evidence generation system as pursued by such groups as the US Food & Drug Administration (FDA), Patient-Centered Outcomes Research Institute (PCORI), National Institutes of Health (NIH), and other federal agencies.

The paper makes several recommendations for policy changes, including that the Trump administration should faithfully implement 2018 Revisions to the Common Rule as well as establish the 21st Century Cures-mandated Research Policy Board. The administration must implement this provision to better calibrate and harmonize our sprawling and incoherent federal research regulations.

Another recommendation is that the HHS Office of Civil Rights (OCR) should refine the definition of a HIPAA Designated Record Set (DRS) and ONC should explore ways to allow patients to have a full digital export of their structured and unstructured data within a Covered Entity’s DRS in order to share their data for research. In addtion, regulators should work with stakeholders to develop granular data specifications, including metadata, and standards to support research for use in the federal health IT certification program.

The AMIA authors also suggest that CMS leverage its Quality Payment Program to reward clinical practice Improvement Activities that involve research components. This would encourage office-based physicians to invest time and resources needed to realize EGM, they say.

Based on the paper’s findings, AMIA is launching a new initiative focused on advancing informatics-enabled improvements for the U.S. healthcare system. The organization says that a multidisciplinary group of AMIA members will develop a national informatics strategy, policy recommendations, and research agenda to improve:

• how evidence is generated through clinical practice;

• how that evidence is delivered back into the care continuum; and

• how our national workforce and organizational structures are best positioned to facilitate informatics-driven transformation in care delivery, clinical research, and population health.

A report detailing this strategy will be unveiled at a December 2019 conference in Washington, D.C.



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Definitive Healthcare Acquires HIMSS Analytics’ Data Services

January 16, 2019
by Rajiv Leventhal, Managing Editor
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Definitive Healthcare, a data analytics and business intelligence company, has acquired the data services business and assets of HIMSS Analytics, the organizations announced today.

The purchase includes the Logic, Predict, Analyze and custom research products from HIMSS Analytics, which is commonly known as the data and research arm of the Healthcare Information and Management Systems Society.

According to Definitive officials, the acquisition builds on the company’s “articulated growth strategy to deliver the most reliable and consistent view of healthcare data and analytics available in the market.”

Definitive Healthcare will immediately begin integrating the datasets and platform functionality into a single source of truth, their executives attest. The new offering will aim to include improved coverage of IT purchasing intelligence with access to years of proposals and executed contracts, enabling transparency and efficiency in the development of commercial strategies.

Broadly, Definitive Healthcare is a provider of data and intelligence on hospitals, physicians, and other healthcare providers. Its product suite its product suite provides comprehensive data on 8,800 hospitals, 150,000 physician groups, 1 million physicians, 10,000 ambulatory surgery centers, 14,000 imaging centers, 86,000 long-term care facilities, and 1,400 ACOs and HIEs, according to officials.

Together, Definitive Healthcare and HIMSS Analytics have more than 20 years of experience in data collection through exclusive methodologies.

“HIMSS Analytics has developed an extraordinarily powerful dataset including technology install data and purchasing contracts among other leading intelligence that, when combined with Definitive Healthcare’s proprietary healthcare provider data, will create a truly best-in-class solution for our client base,” Jason Krantz, founder and CEO of Definitive Healthcare, said in a statement.

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Machine Learning Survey: Many Organizations Several Years Away from Adoption, Citing Cost

January 10, 2019
by Heather Landi, Associate Editor
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Radiologists and imaging leaders see an important role for machine learning in radiology going forward, however, most organizations are still two to three years away from adopting the technology, and a sizeable minority have no plans to adopt machine learning, according to a recent survey.

A recent study* by Reaction Data sought to examine the hype around artificial intelligence and machine learning, specifically in the area of radiology and imaging, to uncover where AI might be more useful and applicable and in what areas medical imaging professionals are looking to utilize machine learning.

Reaction Data, a market research firm, got feedback from imaging professionals, including directors of radiology, radiologists, chiefs of radiology, imaging techs, PACS administrators and managers of radiology, from 152 healthcare organizations to gauge the industry on machine learning. About 60 percent of respondents were from academic medical centers or community hospitals, while 15 percent were from integrated delivery networks and 12 percent were from imaging centers. The remaining respondents worked at critical access hospitals, specialty clinics, cancer hospitals or children’s hospitals.

Among the survey respondents, there was significant variation in the number of annual radiology studies performed—17 percent performed 100-250 thousand studies each year; 16 percent performed 1 to 2 million studies; 15 percent performed 5 to 25 thousand studies; 13 percent performed 250 to 500 thousand; 10 percent performed more than 2 million studies a year.

More than three quarters of imaging and radiology leaders (77 percent) view machine learning as being important in medical imaging, up from 65 percent in a 2017 survey. Only 11 percent view the technology as not important. However, only 59 percent say they understand machine learning, although that percentage is up from 52 percent in 2017. Twenty percent say they don’t understand the technology, and 20 percent have a partial understanding.

Looking at adoption, only 22 percent of respondents say they are currently using machine learning—either just adopted it or have been using it for some time. Eleven percent say they plan to adopt the technology in the next year.

Half of respondents (51 percent) say their organizations are one to two years away (28 percent) or even more than three years away (23 percent) from adoption. Sixteen percent say their organizations will most likely never utilize machine learning.

Reaction Data collected commentary from survey respondents as part of the survey and some respondents indicated that funding was an issue with regard to the lack of plans to adopt the technology. When asked why they don’t ever plan to utilize machine learning, one respondent, a chief of cardiology, said, “Our institution is a late adopter.” Another respondent, an imaging tech, responded: “No talk of machine learning in my facility. To be honest, I had to Google the definition a moment ago.”

Survey responses also indicated that imaging leaders want machine learning tools to be integrated into PACS (picture archiving and communication systems) software, and that cost is an issue.

“We'd like it to be integrated into PACS software so it's free, but we understand there is a cost for everything. We wouldn't want to pay more than $1 per study,” one PACS Administrator responded, according to the survey.

A radiologist who responded to the survey said, “The market has not matured yet since we are in the research phase of development and cost is unknown. I expect the initial cost to be on the high side.”

According to the survey, when asked how much they would be willing to pay for machine learning, one imaging director responded: “As little as possible...but I'm on the hospital administration side. Most radiologists are contracted and want us to buy all the toys. They take about 60 percent of the patient revenue and invest nothing into the hospital/ambulatory systems side.”

And, one director of radiology responded: “Included in PACS contract would be best... very hard to get money for this.”

The survey also indicates that, among organizations that are using machine learning in imaging, there is a shift in how organizations are applying machine learning in imaging. In the 2017 survey, the most common application for machine learning was breast imaging, cited by 36 percent of respondents, and only 12 percent cited lung imaging.

In the 2018 survey, only 22 percent of respondents said they were using machine learning for breast imaging, while there was an increase in other applications. The next most-used application cited by respondents who have adopted and use machine learning was lung imaging (22 percent), cardiovascular imaging (13 percent), chest X-rays (11 percent), bone imaging (7 percent), liver imaging (7 percent), neural imaging (5 percent) and pulmonary imaging (4 percent).

When asked what kind of scans they plan to apply machine learning to once the technology is adopted, one radiologist cited quality control for radiography, CT (computed tomography) and MR (magnetic resonance) imaging.

The survey also examines the vendors being used, among respondents who have adopted machine learning, and the survey findings indicate some differences compared to the 2017 survey results. No one vendor dominates this space, as 19 percent use GE Healthcare and about 16 percent use Hologic, which is down compared to 25 percent of respondents who cited Hologic as their vendor in last year’s survey.

Looking at other vendors being used, 14 percent use Philips, 7 percent use Arterys, 3 percent use Nvidia and Zebra Medical Vision and iCAD were both cited by 5 percent of medical imaging professionals. The percentage of imaging leaders citing Google as their machine learning vendor dropped from 13 percent in 2017 to 3 percent in this latest survey. Interestingly, the number of respondents reporting the use of homegrown machine learning solutions increased to 14 percent from 9 percent in 2017.


*Findings were compiled from Reaction Data’s Research Cloud. For additional information, please contact Erik Westerlind at


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