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The I.T. and Data Analytics Drive

June 1, 2018
by Mark Hagland
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As providers plunge further into risk-based contracting, data analytics and strong IT foundations are seen as critical success factors

As challenging as it is for the leaders of hospitals, medical groups and health systems to strategize broadly around the plunge into risk-based contracting, strategizing around the information technology foundations and data analytics to support that journey is turning out to be equally challenging. That is the verdict of leaders from across the spectrum of U.S. healthcare, and from the hospital, physician group, integrated health system, and health plan sides of the table.

Fundamentally, says Shawn Griffin, M.D., vice president, clinical performance improvement and applied analytics, at the Charlotte-based Premier Inc., “The response to risk is trying to increase control, and our data systems have not been organized to give us total control over processes. The challenge,” Griffin says, “is that your insurance company you’re contracting with controls and owns the data; data ownership is an important concept. And even doctors aren’t all on the same EHR [electronic health record], who are in the same network. And now that the system of care isn’t just hospitals, but outpatient and post-acute as well, you have to build data and IT governance” around participation in value-based healthcare contracting. “You have different metrics for different claims and clinical data types; and the fact that we’re trying to bring in different types of data and tell the same story with them, is difficult. And the lack of interoperability is a huge challenge," he says.

“I feel like we’re making progress on the claims data, because organizations are getting better at doing claims analytics; we’re now beginning to be able to use claims data to identify, for example, who the high-risk and high-cost patients are,” says Joe Damore, Griffin’s colleague and a vice president at Premier Inc. “But I still see a huge challenge in the lack of interoperability among EHRs. I don’t see anyone who’s mastered the situation yet of networks that are using multiple EHRs.”

“We have a sketch of interoperability that often involves dumbing down the information you share among EHRs. Almost nobody talks about claims interoperability,” Griffin adds. “Medicare Advantage versus commercial plans, multiple Medicare Advantage plans, all are different versions of claims data. We all have a phrasebook for a foreign language,” he adds.

Health plan leaders agree that there are some very fundamental challenges involved, including on the payer side. Speaking of the challenges for providers partnering with health plans, in marrying clinical and claims data, as well as simply in getting data to providers in a timely way, Chris Jaeger, M.D., vice president of accountable care innovation and clinical transformation at the San Francisco-based Blue Shield of California, says, “Having been on both the provider and plan sides, those are definitely real hurdles. It speaks to immaturity in master data management. And even when there’s more mature enterprise master data management, it will vary across organizations, so that’s a huge problem. And with respect to data timeliness, one challenge relates to plans sharing adjudicated claims data, where inevitably there’s a lag. On the provider side,” he adds, “my last experience was with PPO shared-savings contracts, and we had problems with timeliness and accuracy of data from plans, and sometimes just in terms of the master data management.”

Chris Jaeger, M.D.

What’s more, Jaeger says, data integrity remains a core challenge, in all situations involving health plans sharing data with provider organizations. “We were seeing data integrity issues that we needed to fix, before we could marry the plan data with our clinical data. And a lot of vendors will say they have the capability to deal with that, but the devil is in the details. So, we’ve been partnering with some of our provider partners, sitting down with them, with their resources, as well as with the partnering population health vendors, to improve how the data is moved and used, so they can do a better job.” What’s more, he says, “Data management doesn’t sound like a sexy value proposition, but it ends up being of incredible value. So really, if an organization is able to cleanse and aggregate data from multiple sources and bring the data into its analytics, you get better results.”

Getting Physicians Engaged in the Broader Effort

When it comes to getting physicians in practice engaged and motivated to support ACO (accountable care organization) and other value-based healthcare initiatives, the challenges are manifold, says R. Todd Richwine, D.O., chief medical informatics officer at the Texas Health Physicians Group, the 757-physician umbrella physician group attached to the Texas Health Resources integrated health system, which is based in the Dallas suburb of Arlington. Asked what he’s learned in the past few years around this, Richwine says, “Overall, that this is all too complicated. And that’s a big part of why I got into this role. When I came into our EHR from an older one that frankly was simpler and easier to use, I was astounded by the complexity, as an end-user. I went to a one-day conference, and our chief system clinical information officer said that we need to make the right thing, the easy thing to do. Doctors want to do the right thing, but if it’s too complicated, they’ll not do that. So, my guiding principle as CMIO has been to make the right thing the easy thing to do. We don’t want to add to the confusion or workload of physicians.”

R. Todd Richwine, D.O.

Still, Richwine says, “I’ve really enjoyed” working with fellow physicians on clinical IT development around clinical performance improvement efforts. “As I’ve been able to go out to physician clinics and talk about improving quality measures, with rare exceptions, our physicians are interested and motivated to improve their outcomes, especially around chronic conditions like diabetes and hypertension; they very actively look for those patients who aren’t following up or who are falling outside the parameters on a regular basis. Once I show them the tools and techniques, they get very interested and get their teams involved in improving outcomes for those patients.”

“The success of value-based care can only come if your physicians are truly involved,” says Sohail, the CIO at the Dallas-based Premier Management Company, a firm that organizes and manages ACOs (and is unrelated to the Charlotte-based Premier Inc.). “And unless and until you are able to provide them no more than three actions they’re supposed to take, around a particular patient, in order to be successful clinically or financially, they’ll never be able to execute,” says Sohail (who uses one name only). “So keeping value-based care as simple as possible, and as smart as possible, is key, knowing that physicians have very limited time and are running on a treadmill, and building systems around them that can optimize their work, and show them that if they adopt the system, they’ll be successful, and if not, they won’t,” he says.

Meanwhile, fundamental IT foundational issues remain, says Premier Inc.’s Griffin. “You need interoperability to make this work, and interoperability requires connectivity, so you need to be fleshing out your connections with all your providers, and you need to get the wiring down. And you’ve got to be working with your physicians, and make sure your clinicians are at your table as your building out your plan, and solving problems, not just increasing responsibilities. There’s no magic bullet, but there are islands of competency, where leaders of patient care organizations are doing this well, and sharing information with others.”

What’s more, says Premier Inc.’s Damore, “I also think you need to take an interdisciplinary approach to governance of IT. The CMIO and CIO can lead that effort, but shouldn’t be doing it in isolation. You need clinicians, your quality leader, your financial leader, and your clinical integration leader. So you need multiple people at the table. And you need to develop a roadmap that’s logical.”

“I think the biggest piece that I’d point to is that, through all of the iterations around value-based healthcare, and various programs, etc., there really is a handful of core building blocks and common set of needs around familiarizing themselves with data aggregation, predictive analytics, and performance measurement,” says Laurie Sprung, Ph.D., vice president, consulting, at The Advisory Board Company, the consultative firm based in Washington, D.C. Given that, Sprung says, “Healthcare IT leaders need to familiarize themselves with those elements. And many technology people have a philosophy of how they want their technology infrastructure to look and how the pieces relate to each other. I get that, they want to rationalize all the elements. But if you start out focusing on where your organization needs to go with this, you’ll be better off, because the technology is not in its final form yet, so it’s not just what the technology does, but how it aligns with the building blocks of creating a value-based care delivery system,” she emphasizes.

Laurie Sprung, Ph.D.

And the IT leaders of organizations that are early on the journey into value-based healthcare are already learning important things, says Michael Restuccia, vice president and CIO at Penn Medicine, the multi-hospital system based in Philadelphia. “First and foremost,” he says, “we learned what the definition of a readmission was. And I think the institutional knowledge and agreement of what a readmission is and is not, was a big learning for us. And we learned that, at times, different parts of our organization had different definitions of it.” In other words, he says, “We’ve learned that we needed to standardize our definitions, in order to modify our behaviors. And the IT system is the glue that holds that together.”

“Organizations need to focus on enterprise data governance and data management, as a key capability that can be built up; and they need to take a leap of faith and begin trusting the health plans more, with respect to data sharing,” says Blue Shield of California’s Jaeger. “When I was on the provider side as a CMIO, and we started talking about sharing clinical data with plans, there was a lot of fear that the data would be used against us, in terms of competitive advantage we had in relation to competing provider organizations. So the key is to take that leap of faith and share data with health plans, understanding that the health plans have legal constraints with what they can do, too, with respect to HIPAA (Health Insurance Portability and Accountability Act of 1996). So focusing on value-based incentives and quality improvements, will help the people we’re both trying to help—the patients.”

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ASCO Picks IBM Watson Exec to Lead CancerLinQ

August 10, 2018
by David Raths
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Big data platform collects and analyzes data from cancer patients at practices nationwide

The American Society of Clinical Oncology (ASCO) has named a former IBM Watson executive as the new CEO of its CancerLinQ big data platform.

Cory Wiegert was most recently vice president of product management for IBM Watson Health. Prior to joining IBM, Wiegert held positions with Sterling Commerce, Siebel Systems Inc., Centura Software and Safety-Kleen.

Kevin Fitzpatrick stepped down as the nonprofit CancerLinQ’s CEO in April 2018. Richard Schilsky, M.D., who was serving as interim CEO of CancerLinQ, will continue his role as ASCO's chief medical officer.

CancerLinQ collects and analyzes data from cancer patients at practices nationwide, drawing from electronic health records, to inform and improve the quality of cancer care. Its database contains more than a million cancer patient records. The effort has two major components:

• The CancerLinQ quality improvement and data-sharing platform for oncology practices,

• CancerLinQ Discovery, which provides access to high-quality, de-identified datasets derived from the patient data to academic researchers, non-profit organizations, government agencies, industry, and others in the oncology community.

CancerLinQ LLC also has established a number of collaborations with government and nonprofit entities -- including American Society of Radiation Oncology, Food and Drug Administration, and the National Cancer Institute -- as well as industry through its collaborators AstraZeneca, Tempus, and Concerto HealthAI.

In a statement, ASCO CEO and CancerLinQ LLC Board of Governors Chair Clifford A. Hudis, M.D., said Wiegert’s arrival “comes at a pivotal time, as we are quickly building on and improving CancerLinQ's core quality improvement platform for oncologists and data analytics services for the broader cancer community."

As CEO, Wiegert will be tasked with developing new solutions to help oncology practices improve the day-to-day care they provide their patients and continuing to serve CancerLinQ collaborators.




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A ‘Google’ for Clinical Notes Draws Interest

August 8, 2018
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Developed at the University of Michigan, EMERSE allows users to search the EHR’s unstructured clinical notes
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Those of us who cover healthcare informatics often hear clinicians and researchers talk about the problems involved in doing analytics or research on unstructured data in clinical notes. That was why I was intrigued when I saw that informatics teams at the University of North Carolina School of Medicine are implementing a tool called EMERSE (Electronic Medical Record Search Engine), which allows users to search free-text clinical notes from the electronic health record (EHR). They describe it as being like "Google" for clinical notes. 

But then I noticed that the tool was actually created quite a while ago, in 2005, at the University of Michigan, and has been in use there ever since. So I reached out to its developer, David Hanauer, M.D., a clinical associate professor of pediatrics and communicable diseases at the University of Michigan Medical School. He also serves as assistant director for clinical informatics in UM’s Comprehensive Cancer Center’s Informatics Core as well as associate chief medical information officer at the UM Medical Center.

Hanauer told me that the developers of EMERSE at Michigan have a grant from the National Cancer Institute to further develop the tool and help disseminate it, with a focus on cancer centers around the country. “We are about one year into the grant,” he said. “We have spent the last year cleaning up the infrastructure to make it even easier for people to adopt. We have been working hard on technical documentation. When we started it, we had almost no documentation; now we have substantial and detailed documentation about how to implement and run it.”  

The five sites implementing EMERSE as part of the grant are the University of North Carolina, University of Kentucky, University of Cincinnati, Case Western Reserve University and Columbia University.

I asked Hanauer if health systems continue to struggle with unstructured data in clinical notes. “They all absolutely struggle with it,” he said. “They have mostly been ignoring it, to tell you the truth. That is why we believe and hope EMERSE will fit well into this environment of people needing different tools.”

I also asked him to describe some of the use cases. Most generically, anybody who needs to look through the chart and doesn’t know exactly where to look can get benefit from it, he said. He described three categories of users: research, clinical care and operations. “For example, in research you could use it for cohort identification. You want to find patients who meet your needs when it comes to a research study. This is important in part because ICD codes, the go-to way people often try to identify a cohort, are often inaccurate and non-specific.”

According to the EMERSE web site, for studies in which eligibility determination is complex and may rely on data only captured within the free text portion of documents, EMERSE can be a rapid way to check for mentions of inclusion/exclusion criteria.

In another example, EMERSE also can be used to help find details about a patient rapidly, even during a clinical visit. “For example, if a patient mentions that a certain medication helped their migraine three years ago but can’t remember the name, just search the chart for 'migraine' and find that note within seconds,” the web site notes. Cancer registrars can use EMERSE for data abstraction tasks, including difficult-to-find information such as genetic and biomarker testing.

Hanauer said at Michigan, clinicians have a way to access EMERSE from their Epic EHR. “If you have a patient’s record open, you can click a button, it will log you into EMERSE and bring that patient’s context over, and you can start searching in just of a few seconds.”

In 2005, the platform was written to work with a homegrown EHR. When UM transitioned to Epic in 2012, Hanauer and team used that as an opportunity to make it more powerful. “When we went live with Epic, it became clear there were some architectural limitations that were probably going to limit the future power of the software,” he recalled. “We leveraged the design and concepts and rewrote it from scratch. But even though we were going to work with Epic, we designed it specifically so it would not be tied to any particular EHR.”

Because it deals with patient records, security and audit logs have to be taken very seriously. Every time you log into EMERSE, you come to an attestation page. “You have to declare why you are using it for this session,” Hanauer explained. “We have tried to make it as simple as possible. Almost every institution that does research now has an electronic IRB system, so we have a way you can pull a user’s IRB-approved study into the EMERSE database, and a list appears of that user’s studies only. The user can click on it, record that use, and move forward.” There also are quick buttons for common administrative use cases.

I asked Hanauer if other academic medical centers had developed similar search tools. He said some have created local tools. “The main difference with EMERSE is that it is proven it can work elsewhere. (It was used at the VA in Ann Arbor, Mich., on the VistA system.) “We have a long track record of use and have been working on the infrastructure to disseminate it,” he said. “We are giving it away at no cost, but it is almost like running a software company, where you have to have a web site, user documentation, and system administrator documentation. To me, it doesn’t make a lot of sense for others to reinvent the wheel when this is something we have invested millions of dollars in at this point.”

He stressed that although the grant project is focused on five cancer centers, they are giving the software away at no cost, and are glad to help anybody interested in getting it up and running. “One of the key challenges is that the users can’t control whether it gets deployed or not,” he said. “Our biggest challenges is not the users, who are contacting us and asking us for it, but getting this through local IT leadership, and that is a big hurdle.”

Why would CIOs be opposed to deploying this tool? “I think their plates are full and a lot of times people are looking for vendor solutions,” he surmised.  “I also think that often people don’t understand what the issues are. Some people think they will just get some off-the-shelf NLP software. But I can assure you that that software will not be able to do the kinds of things that EMERSE can do. That is partly because a lot of medical documents are not in natural language. Medical documents are anything but. They are a mess.”



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Anthem Expands $500M Deal with IBM with Focus on IT Automation, AI

July 26, 2018
by Heather Landi
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Health insurer Anthem has expanded its services agreement with technology leader IBM with a focus on using artificial intelligence (AI) and automation to improve operational efficiency and modernize technology platforms.

With this collaboration, Armonk, New York-based IBM and Indianapolis-based Anthem, one of the largest U.S. health insurance coampnies, will work together to help drive Anthem’s digital transformation and deliver an enhanced digital experience for its nearly 40 million consumers, Anthem said in a press release.

In 2015, Anthem entered into a five-year, $500-million-dollar strategic technology services partnership with IBM in which the technology giant provided operational services for Anthem’s mainframe and data center server and storage infrastructure. As part of that agreement, Anthem has been able to leverage IBM Cloud solutions to increase the ease, availability and speed of adding infrastructure to support new business requirements, the company said.

Under the expanded agreement, IBM will provide Anthem with enterprise services for its mainframe and data center server and storage infrastructure management. In addition, IBM will work with Anthem towards creating an AI environment which will allow for an automated infrastructure providing 24/7 digital capabilities. This will bring greater value and access to Anthem's consumers, care providers, and employees, Anthem said.

IBM and Anthem will also continue to work together on IT automation. Since 2015, the two companies’ have implemented over 130 bots, automating over 70 percent of the monthly high volume repetitive tasks. This includes bots that can identify when a server is reaching capacity to shift workloads to other less utilized servers ensuring that work is not impacted. This capability has improved systems availability as well as freed up resources to work on higher-value projects, Anthem said in a press release.
“We are seeing a dynamic change in the healthcare industry, requiring us to be more agile and responsive, utilizing advanced technology like AI to drive better quality and outcomes for consumers,” Tim Skeen, senior vice president and chief information officer, Anthem, Inc., said in a statement. “Our continued strategic partnership with IBM will help establish a stronger foundation for Anthem to respond to the changing demands in the market, deliver greater quality of services for consumers and help accelerate Anthem’s focus on leading the transformation of healthcare to create a more accessible, more affordable, more accountable healthcare system for all Americans.”

“The collaboration between IBM Services and Anthem has already laid the groundwork to improve healthcare processes and quality,” said Martin Jetter, senior vice president, IBM Global Technology Services. “Our latest agreement will accelerate Anthem’s growth strategy and continued leadership as one of the largest healthcare insurance companies and provide a solid path to bringing new efficiencies in driving digital transformation.”


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