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Market Profile: Health IT Leaders, and Silicon Valley, Have Their Eyes on Cleveland

February 14, 2018
by Heather Landi
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Cleveland, Ohio has long been recognized for its leading medical centers, as it has more than 60 medical centers, including three major health systems—Cleveland Clinic, University Hospitals and MetroHealth System—and hospitals such as the Louis Stokes VA Medical Center and St. Vincent Charity Medical Center. Within the broader Northeast Ohio region, there also are Western Reserve Hospital and Health System, based in Cuyahoga Falls, Ohio, Akron-based Summa Health System, and several hospitals within the Cincinnati-based Mercy Health system, as well as a number of educational institutions involved in cutting edge medical research, namely Case Western Reserve and Cleveland State University.

Northeast Ohio also is home to a number of very successful health IT startups—Explorys, originally spun off from the Cleveland Clinic, was acquired by IBM Watson in 2015, and Cleveland-based CoverMyMeds, which started in 2008, was acquired by McKesson last January. That all adds up to a tremendous amount of healthcare and health IT-related innovation and advancement in one region of the country, and in a city that’s not even the largest city in Ohio (Columbus has that ranking).

And while the three biggest health systems in Cleveland have long been focused on medical innovation—the Cleveland Clinic launched its commercialization arm, Cleveland Clinic Innovations back in 2000—there are many indications that Cleveland is fast becoming a hotbed of healthcare innovation, and a city to watch in the health IT space.

Speaking of the Cleveland health IT market, local health IT consultant Frank Myeroff says, “I think we’re bleeding edge.” Myeroff, who is president and co-founder of Solon, Ohio-based Direct Consulting Associates, an IT consulting and staffing firm, cites growing focus and investment in the development of new healthcare technologies from both within local health systems as well as from the Cleveland business community, such as the opening of the Global Center for Health Innovation in 2014.

With the Cleveland Clinic and large health systems like UH, the market naturally attracts health technology startups and entrepreneurs, Myeroff says. “If I’m a new tech startup, I want the Cleveland Clinic to be my beta site because of the name recognition. For the health systems, they test new technology systems, and some succeed and some don’t, but it’s a competitive advantage, because if you win, you’re the first one to have that technology.”

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An Increasingly Consolidated, Advanced Market

It’s no surprise that cutting-edge research and innovation within Cleveland are receiving an exceptional level of support at the Cleveland Clinic, the 10-hospital integrated health system on the leading edge in terms of clinical quality improvement, clinical integration, and IT innovation.

Cleveland also is a very consolidated healthcare market, notes Deanna Moore, vice president, corporate communications at The Center for Health Affairs, a hospital association for Northeast Ohio hospitals. “We’re a marketplace that has 46 community hospitals, across a nine-county region, and over the course of the last couple of decades, most have affiliated with UH or Cleveland Clinic,” she says.

According to many Cleveland healthcare executive leaders, in many ways consolidation has actually helped to advance the forward evolution of health IT in the region. “There has been a lot of market consolidation in this area; between Cleveland Clinic, MetroHealth and University Hospitals, and if draw a little bit broader and get down to Akron, there are only a small handful of integrated healthcare delivery networks. And why I think that’s important, when you think about health IT, is that when you have large integrated delivery networks the natural thing for them is to buy large EHRs (electronic health record systems) and there’s a lot in IT to make that process work well. Because it’s a mature market, the implementation, adoption and use of EHRs, and health IT more generally, is probably a little bit further along than in markets that are more fragmented, from a healthcare standpoint,” says David Kaelber, M.D., Ph.D., the chief medical informatics officer (CMIO) at MetroHealth System.

Myeroff notes that the ongoing trend of business affiliations between patient care organizations in the area results in the larger, more advanced health systems sharing technology solutions with smaller and medium-sized hospitals. “That technology is being pushed down, and many of the larger health systems also provide EHR implementations and hosting services to the organizations they have business affiliations with,” he says.

Dr. Kaelber also notes that the majority of the health systems in the Cleveland and Akron area, are “Epic shops,” meaning they partner with Verona, Wis.-based Epic for their EHR systems. “I think because there is such a large Epic EHR presence here, it really allows us to leverage the technology and also sort of the collective experience a lot of us have with the EHR, specifically the Epic EHR, to do more things,” he says.

And while the health systems and hospitals in the Cleveland area are highly competitive from a business standpoint, there is collaboration around technology initiatives, many local healthcare leaders say. “At a health IT and informatics level, we do collaborate,” Kaelber says.

“We’re fortunate that there are good healthcare IT leadership in the region, and that has helped to keep us at the forefront,” Ed Marx, Cleveland Clinic CIO, says. In fact, many seasoned health IT leaders have returned to Cleveland—Marx had served as CIO at University Hospitals earlier in his career and Robert Eardley was recently named CIO at University Hospitals, where he had previously served as associate CIO seven years ago.

“There are some good, strong healthcare IT leaders in the region, and there have been for many years. We’ve all worked together for a number of years, have learned together and have gone off to different areas, now three or four of us are coming back and bringing back some things that we’ve learned in other markets. It’s been very collegial,” Marx says.

Under senior executive leadership, a number of local hospitals and health systems also have banded together to tackle serious community health issues, particularly the opioid epidemic. Ohio has been one of the states hit hardest by the opioid crisis, with 86 percent of overdose deaths in 2016 involving an opioid. According to the Centers for Disease Control and Prevention (CDC), Ohio’s drug overdose deaths rose 39 percent between mid-2016 and mid-2017, triple the U.S. average, and the third-largest increase in the country.

Last year, local hospitals and health systems, including MetroHealth, UH and Cleveland Clinic, and in coordination with The Center for Health Affairs, formed the Northeast Ohio Hospital Opioid Consortium to formally address the issue. Among the initiatives the Consortium will pursue are sharing data and best practices, finding new and better ways to manage pain without using the prescription painkillers that lead to addiction in the first place, and applying for grants together as one entity.

Ohio leaders are also trying to lead the way in the nation’s fight to address the growing opioid problem by leveraging technology. In December, Ohio Third Frontier, a technology-based economic development initiative, awarded a handful of grants, totaling $8 million, to entrepreneurs who proposed creative ideas for tech solutions in the battle against drug abuse and addiction. One concept that was awarded a grant proposed an opioid risk assessment screening app to help medical professionals identify patients with risk factors for opioid abuse. In the final phase of the Ohio Opioid Technology Challenge, winning solutions will receive funding to cultivate the solution into a product.

Nurturing Health IT Innovation and Startups

The major health systems in the Cleveland area all individually focus on developing healthcare technology innovation—University Hospitals last year launched UH Ventures, for example, to support innovation and commercialization of discoveries. However, the health systems also work with community partners. All three major health systems are tenant partners of the Global Center for Health Innovation, located in downtown Cleveland. The Center is an event space and showroom for the latest in medical product development, education and technology and partners with 45 healthcare, health IT and medical innovation brands. The space also houses the HIMSS Innovation Center and the HIMSS Cybersecurity Hub, initiatives of the Chicago-based Healthcare Information and Management Systems Society.

John Paganini, president and owner of Cleveland-based health IT consulting firm Paguar Informatics, previously managed the operations and logistics of the HIMSS Innovation Center in his prior position as senior manager of interoperability initiatives at HIMSS North America. Beyond hosting events and meetings, the Global Center for Health Innovation supports ongoing vendor collaboration on health IT issues such as cybersecurity and interoperability.

MetroHealth’s Dr. Kaelber says the Innovation Center has proven to be a catalyst for innovation. “We were already being entrepreneurial and trying to push the ball forward with health IT, and I think having that as an additional catalyst here has helped us to do more things, both collectively and individually,” he says.

It was recently announced that BioEnterprise, a company that promotes and nurtures healthcare companies and bioscience technologies, will now oversee marketing, promotion and tenants at the Center with the aim of growing the area’s biomedical sector. In addition, back in October, Silicon Valley innovation company Plug and Play announced a three-year partnership with Cleveland Clinic and JumpStart Inc. to bring a new biotech and digital health innovation accelerator to downtown Cleveland.

Starting this spring, the "Plug and Play Cleveland HealthTech Accelerator," which will be located in about 10,000 square feet of space in the Global Center for Health Innovation, will operate two cohort programs annually, inviting a group of at least 10 companies every six months. The Clinic will collaborate with up to six of the companies every year to pilot their health care innovations.

“It’s going to be a new generation of the global center, and that’s all going to be happening this year,” Paganini says. “This HealthTech Accelerator is really going to move forward the healthcare innovation in this region.”

And, out of the Global Center, several initiatives have evolved with the intent of driving medical technology development, including the Cleveland Medical Hackathon, which encourages doctors, nurses, IT professionals and public health workers to propose technology solutions to a number of healthcare challenges. In April, the Global Center will host the second annual Medical Capital Innovation Competition, in which teams representing new medical device and technology products pitch their inventions, says Paganini.

The Global Center for Health Innovation, which is publicly financed, is one example of how city and county government leaders are supporting the growth of healthcare technology and biomedical sectors to boost the area's economic development.

The greater Cleveland area has a booming biotechnology and biomedical industry that now includes more than 700 companies. Business and public leaders now have their eyes set on building up a health-tech and high-tech business corridor on the east side of Cleveland. The Health-Tech Corridor (HTC), founded in 2010, is a public-nonprofit collaboration between BioEnterprise, The Cleveland Foundation, the City of Cleveland and MidTown Cleveland that has worked to rebrand the 3-mile stretch between downtown and University Circle.

According to the website, HTC leaders recognized that the 3-mile area offers companies “close proximity to four world-class healthcare institutions including the Cleveland Clinic and University Hospitals, six business incubators, four academic centers, and more than 170 high-tech and health-tech companies engaged in the business of innovation.”

Paganini says of the Northeast Ohio market, “To me, that is the power of this region, in that there are organizations that might typically compete with each other, yet are all working together to move the industry forward, to move the region forward, and move healthcare forward, and ultimately, the patient benefits.”


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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 ewesterlind@reactiondata.com.

 

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Drexel University Moves Forward on Leveraging NLP to Improve Clinical and Research Processes

January 8, 2019
by Mark Hagland, Editor-in-Chief
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At Drexel University, Walter Niemczura is helping to lead an ongoing initiative to improve research processes and clinical outcomes through the leveraging of NLP technology

Increasingly, the leaders of patient care organizations are using natural language processing (NLP) technologies to leverage unstructured data, in order to improve patient outcomes and reduce costs. Healthcare IT and clinician leaders are still relatively early in the long journey towards full and robust success in this area; but they are moving forward in healthcare organizations nationwide.

One area in which learnings are accelerating is in medical research—both basic and applied. Numerous medical colleges are moving forward in this area, with strong results. Drexel University in Philadelphia is among that group. There, Walter Niemczura, director of application development, has been helping to lead an initiative that is supporting research and patient care efforts, at the Drexel University College of Medicine, one of the nation’s oldest medical colleges (it was founded in 1848), and across the university. Niemczura and his colleagues have been partnering with the Cambridge, England-based Linguamatics, in order to engage in text mining that can support improved research and patient care delivery.

Recently, Niemczura spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding his team’s current efforts and activities in that area. Below are excerpts from that interview.

Is your initiative moving forward primarily on the clinical side or the research side, at your organization?

We’re making advances that are being utilized across the organization. The College of Medicine used to be a wholly owned subsidiary of Drexel University. About four years ago, we merged with the university, and two years ago we lost our CIO to the College of Medicine. And now the IT group reports to the CIO of the whole university. I had started here 12 years ago, in the College of Medicine.

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And some of the applications of this technology are clinical and some are non-clinical, correct?

Yes, that’s correct. Our data repository is used for clinical and non-clinical research. Clinical: College of Medicine, College of Nursing, School of Public Health. And we’re working with the School of Biomedical Engineering. And college of Arts and Sciences, mostly with the Psychology Department. But we’re using Linguamatics only on the clinical side, with our ambulatory care practices.

Overall, what are you doing?

If you look at our EHR [electronic health record], there are discrete fields that might have diagnosis codes, procedure codes and the like. Let’s break apart from of that. Let’s say our HIV Clinic—they might put down HIV as a diagnosis, but in the notes, might mention hepatitis B, but they’re not putting that down as a co-diagnosis; it’s up to the provider how they document. So here’s a good example: HIV and hepatitis C have frequent comorbidity. So our organization asked a group of residents to go in and look at 5,700 patient charts, with patients with HIV and hepatitis C. Anybody in IT could say, we have 677 patients with both. But doctors know there’s more to the story. So it turns out another 443 had HIV in the code and hep C mentioned in the notes. Another 14 had hep C in the code, and HIV in the notes.

So using Linguamatics, it’s not 5,700 charts that you need to look at, but 1,150. By using Linguamatics, we narrowed it down to 1,150 patients—those who had both codes. But then we found roughly 460 who had the comorbidity mentioned partly in the notes. Before Linguamatics, all residents had to look at all 5,700 charts, in cases like this one.

So this was a huge time-saver?

Yes, it absolutely was a huge time-saver. When you’re looking at hundreds of thousands or millions of patient records, the value might be not the ones you have to look at, but the ones you don’t have to look at. And we’re looking at operationalizing this into day-to-day operations. While we’re billing, we can pull files from that day and say, here’s a common co-morbidity—HIV and hep C, with hep C mentioned in those notes—and is there a missed opportunity to get the discrete fields correct?

Essentially, then, you’re making things far more accurate in a far more efficient way?

Yes, this involves looking at patient trials on the research side, while on the clinical side, we can have better quality of care, and more updated billing, based on more accurate data management.

When did this initiative begin?

Well, we’ve been working with Linguamatics for six or seven years. Initially, our work was around discrete fields. The other type of note we look at has to do with text. We had our rheumatology department, and they wanted to find out which patients had had particular tests done—they’re looking for terms in notes… When a radiologist does a report on your x-ray, it’s not like a test for diabetes, where a blood sugar number comes out; x-rays are read and interpreted. The radiologists gave us key words to search for, sclerosis, erosions, bone edema. There are about 30 words. They’re looking for patients who have particular x-rays or MRIs done, so that instead of looking for everyone who had these x-rays done, roughly 400 had these terms. We reduced the number who were undergoing particular tests. The rheumatology department was looking for patients for patient recruitment who had x-rays done, and had these kinds of findings.

So the rheumatology people needed to identify certain types of patients, and you needed to help them do that?

Yes, that’s correct. Now, you might say, we could do word search in Microsoft Word; but the word “erosion” by itself might not help. You have to structure your query to be more accurate, and exclude certain appearances of words. And Linguamatics is very good at that. I use their ontology, and it helps us understand the appearance of words within structure. I used to be in telecommunications. When all the voice-over IP came along, there was confusion. You hear “buy this stock,” when the message was, “don’t buy this stock.”

So this makes identifying certain elements in text far more efficient, then, correct?

Yes—the big buzzword is unstructured data.

Have there been any particular challenges in doing this work?

One is that this involves an iterative process. For someone in IT, we’re used to writing queries and getting them right the first time. This is a different mindset. You start out with one query and want to get results back. You find ways to mature your query; at each pass, you get better and better at it; it’s an iterative process.

What have your biggest learnings been in all this, so far?

There’s so much promise—there’s a lot of data in the notes. And I use it now for all my preparatory research. And Drexel is part of a consortium here called Partnership In Educational Research—PIER.

What would you say to CIOs, CMIOs, CTOs, and other healthcare IT leaders, about this work?

My recommendation would be to dedicate resources to this effort. We use this not only for queries, but to interface with other systems. And we’re writing applications around this. You can get a data set out and start putting it into your work process. It shouldn’t be considered an ad hoc effort by some of your current people.

 

 


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