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CMIO/CHIO Summit: Managing Clinical Decision Support and Improving Workflow

December 27, 2016
by Trudy Millard Krause, UTHealth School of Public Health
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The Scottsdale Institute CMIO/CHIO Summit set out to foster collaboration among chief medical information officers and chief health information officers from prominent healthcare systems across the country

Executive Summary: Twenty chief medical information officers (CMIOs) and chief health information officers (CHIOs) of leading health systems gathered in Chicago this past fall to share best practices and lessons learned regarding clinical decision support (CDS) and improving clinical work flow. This report captures their discussion and shared insights.

Summit participants: David Classen, M.D., Pascal Metrics and University of Utah; Greg Forzley, M.D.,  Trinity Health, Anupam Goel, M.D., Advocate Health Care, Greg Hindahl, M.D., BayCare Health System; Kim Jundt, M.D., Avera Health; Michael Kramer, M.D., Spectrum Health; Michele Lauria, M.D., EasternMaine Healthcare Systems; Thomas Moran, M.D.; Northwestern Medicine; Nnaemeka Okafor, M.D., Memorial Hermann Health System; Theresa Osborne, M.D., Spectrum Health; Jerry Osheroff, M.D., TMIT Consulting, LLC, Luis Saldana, M.D., Texas Health Resources; Anwar Sirajuddin, Memorial Hermann Health System; Andy Spooner, M.D., Cincinnati Children’s Hospital Medical Center; Peter Springsteen, M.D., Munson Healthcare; Pete Stetson, M.D., Memorial Sloan Kettering Cancer Cente; Jeffrey Sunshine, M.D., University Hospitals; Randy Thompson, M.D., Billings Clinic; Paul Veregge, M.D., Catholic Health Initiatives; Alan Weiss, M.D., Memorial Hermann Health System

Organizer: Scottsdale Institute; Sponsor: Deloitte; Moderator: Deloitte (Ken Abrams, M.D.)

Introduction: The Scottsdale Institute CMIO/CHIO Summit was held in Chicago on September 30, 2016. The objective of the Summit was to foster collaboration among chief medical information officers (CMIOs) and chief health information officers (CHIOs) from prominent healthcare systems across the country, with the intention of learning from shared experiences, best practices and proven approaches.

The group was tasked with reviewing the maturity of the clinical decision support (CDS) processes within organizations that responded to a pre-summit survey. Based on those findings a productive discussion evolved regarding CDS and lessons learned. Future visions and emerging trends and technologies were explored, along with the impact to CDS and the CMIO/CHIO role. The impact of future payment policies such as MACRA and bundled payments on information systems was also explored.

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Throughout the Summit, underlying themes stressed the importance of CDS in patient outcomes, physician performance, organizational quality metrics and, ultimately, reimbursement strategies. This critical component thereby requires organizational commitment and support along with evolving strategies for system improvement and sustainability to meet future demands and opportunities.

Pre-Summit Survey Results

In advance of the summit, the Scottsdale Institute circulated a survey among CMIOs and CHIOs regarding CDS with the intention of collecting information to initiate fact-based discussion during the summit. The survey was written by Dr. Michael Kramer, Dr. Nnaemeka Okafor, Dr. Luis Saldana, Dr. Anwar Sirajuddin and Dr. Alan Weiss. Twenty-two responses were returned. The responses indicated there were varied levels of maturity in CDS implementation and design. A summary of responses follows:

> The most frequently identified knowledge-management system used for CDS was an EHR tool such as Epic or Cerner, but other responses reported using tools such as Word, Excel, Tableau or others.

> CDS project-management initiatives were most frequently organized by steering committees or councils, but the majority of responses varied greatly.

> 59% of respondents reported that the CDS elements were not reviewed on a regular basis.

> 65% reported that very minimal customization of the CDS tool was allowed across hospitals or practices.

> 68% stated that the organizational approach to alerts and CDS was a combination of “buy” and “build.”

> Among the value-added decision support initiatives that showed a return on investment (ROI), Sepsis and VTE ranked as the top two.

> Analytics for Radiology was the top area of CDS that was being considered by the respondents.

> 73% felt that ACR Appropriate Use Criteria were the most appropriate for radiology.

> 89% were not incorporating cognitive computing or artificial intelligence.

> 50% reported limited activity around consumer related data integration such as patient monitoring.

Discussion on the survey results pointed out the great variation in maturity in CDS system integration. Dr. Jerry Osheroff noted the CMS-recommended “CDS 5 Rights Framework” is a very helpful guide to shape CDS to drive performance and quality. The spectrum of maturity levels can be seen in each of the 5 CDS Rights dimensions. The challenge: “Make the RIGHT thing to do the easy thing to do!”

Dr. Michael Kramer noted that very few organizations assess all the 5 Rights during the development. Even less common is some form of evaluation to see if the rule continues to fire. In one example, a health system’s lab-test names changed but the rule was not updated. Important safety and quality outcomes can become unreliable without anyone knowing the system configuration has changed.

There was common support for a goal of finding non-interruptive methods in CDS. Alerts are a feature in the immature stage, whereas non-interruptive functionality would reflect the mature stage. Alerts can be seen as “guard rails,” designed to keep the user on track. However, they can eventually turn into “stop signs” that become interruptive and lead to “alert fatigue.” Dr. Pete Stetson of Memorial Sloan Kettering Cancer Center noted that alerts are a form of data displays, but the real need is cognitive support through visualization and summarization—“finding what you need when you need it.” Dr. Michael Kramer said, “Good design means that best practice is hardwired into the workflow and the alert only fires when someone deviates from that standard. Good alerts are designed in the context of streamlined workflow and rarely trigger.” Dr. David Classen added that CDS alerts should be viewed along a continuum—they initially educate on evidence-based medicine guidelines and over time they become guardrails as clinical knowledge becomes learned behavior.

The discussion evolved into identifying a “mature” model of CDS, and agreed that a standardized maturity model does not yet exist. Key elements in the maturity of CDS were listed as follows:

> Definitions

> Goals

> Internal Alignment/Buy-In

> Control/Management

> Alerts/Order Sets

> Process/Workflow—Future Vision

> Tools

> Accountability

> Performance Management

Dr. Osheroff offered an example of the mature CDS approach that makes the right thing easy as the Society of Hospital Medicine’s recommended/proven approach to improving VTE prophylaxis (a top priority target of SI organizations, per the Pre-Summit Survey). They recommend powerful order sets that incorporate simple VTE risk stratification (directly linked to corresponding risk-appropriate orders), as well as an easy mechanism to document contraindications to chemoprophylaxis via check box within the order set. This makes risk assessment and risk-appropriate ordering, as well as signaling exclusion from quality measures in appropriate circumstances, all a seamless part of the ordering workflow.

Dr. Michael Kramer noted that organizations may have hundreds of rules. Many of these rules predate any informatics standards and what are now recognized as best practices. It is common to have rules become ineffective or incorrect as codes change or processes change. Ownership through event analysis and decision-logic tracking and documentation are critical to keep the CDS timely, accurate and useful. In order to avoid an “interruptive” CDS, the process should be amended to evolve from alerts and redundancies to a system that delivers analytics and improves workflows. Yet, it was agreed, most systems are still in the interruptive phase of CDS. To advance to workflow applications the organization must embrace data as part of the clinical mindset rather than alert response. To do this, the organization requires layered teams of academics, clinicians and practical users creating decision strategies as a group. At Texas Health Resources, Dr. Luis Saldana formed the CDS Team to manage the lifecycle of CDS knowledge, e.g., order sets and alerts, and to measure the resulting demonstrable impact.

Drs. Alan Weiss, Nnaemeka Okafor and Anwar Sirajuddin summarized their learnings at Memorial Hermann by noting the following key points:

> Maturation of CDS requires support from the CEO, making it an organizational priority.

> To advance the application, you must recognize the problems through smart data analytics, identifying trends, spotlighting causes and explanations, finding options for solutions and using reports to change behavior.

> Strong analytics are needed to support improvements in both physician and patient outcomes.

Dr. Michelle Lauria from Eastern Maine concurred, noting that CDS supports consensus-building and alignment across clinical units, connecting specialties together, although establishing care guidelines across the full continuum is still in an early stage of development.

Additional supporting comments centered around the challenges in leading diverse groups to a CDS consensus, especially if alignment across the organization is lacking. Additionally, maturity levels may vary across clinical teams: some systems simply providing documentation templates (immature) to alerts (moderate maturity) and to efficient decision-support messaging systems (mature). An efficient decision-support messaging system should recognize that some care protocols require absolutes and some allow variations.

Dr. Kramer asserted that the CMIO/CHIO’s role should be to create visibility to such chaos and assign accountability to move forward to an improved quality focus both to legacy and new rules. CDS teams ensure there is a rigorous process to evaluate existing rules before adding more alerts to a system. The team should include subject-matter experts from the clinical side and the informatics side for coordination and elimination of chaos. Dr. Kramer offered questions to consider (see p. 5), stating that the safety and reliability of care processes are at-risk if the answer is no to any of the questions. Informatics teams should lead rigorous knowledge management and regular evaluation of clinical decision support and partner with clinical-evidence-based experts and process owners. “Expensive? Perhaps. Such expertise and rigor are the table stakes of managing our new models of hardwired and reliable systems of care,” he said.

The best strategy for an effective CDS system is Informatics + Analytics + Quality. Deployment for this strategic framework includes interdisciplinary management of the infrastructure, reduction of redundancies and alert fatigue and streamlining workflows through visualization to ensure predictive analytics that support clinical decision making.

The group acknowledged shared experiences and lessons learned from CDS implementation and management. Key concepts included issues related to the level of data required, the usability of the system, the need for monitoring, acknowledgement of organizational needs and acceptance of change. Fostering an environment where change is accepted and collaboration across organizations to create best practices are two key areas the group identified.

Future Visions

CDS is an IT-enabled tool that has changed the way care is delivered. Effective mature CDS contributes to improved clinical outcomes for the patient as well as improved performance measures for the physician and the healthcare organization. A mature CDS incorporates elements of actual clinical practice and the human equation. According to Dr. Nnaemeka Okafor, CDS evolution requires process engineering and accountability. Process engineering studies the workflow and collects and analyzes data, then relates the findings to the CDS toolbox. Accountability applies the appropriate resources, assigns training and monitors utilization and practice.

Dr. Jeff Sunshine said we should engage CDS to provide feedback on clinical choices that inform the physician, for example, of the percentage of clinicians who had previously selected each option or to offer predictive outcomes of the choices for that patient. Dr. Andy Spooner added, “Ideally you want the relevant knowledge presented at exactly the point a decision is about to be made—but how do you accurately predict that?”

An ideal future development would be the cross-system application of CDS so that one vendor system could “talk” to another vendor system across platforms. The reality is that patients cross systems and collaboration across platforms would contribute greatly to coordinated patient management. As Dr. Alan Weiss noted, “Cross-platform data integration does facilitate knowledge sharing, but the real challenge is leadership—holding people accountable for behavior change is key—how do we make that easy?”

Emergent Technologies

It was generally agreed that technological advances are only useful if they contribute to the organizational objective by providing valuable new options for getting the CDS 5 Rights correct through enhanced information, channels and formats. The current reliance on reports can lead to data overload without actionable strategies. If the purpose of reports is to change behavior then they need an appropriate display to create a culture of change. Retrospective reporting needs to change to real-time prospective predicting.

Some helpful technological advances could focus on the following:

> Natural language processing (NLP) and voice recognition to convert speech to text and trigger real-time relevant alerts, recognizing that speech creates a better patient story;

> Data mining to continually identify the most commonly used notes to simplify and standardize documentation;

> The Internet of Things, which represents an opportunity for real-time alerts based on data streaming;

> Patient, or consumer-generated data, inclusive of patent-reported outcomes, biometrics and notifications, allows patients to become part of the care team, which could be transformative, with tools such as Open Notes and Patient Portals that garner greater patient satisfaction;

> Patient-aggregated information, which can challenge privacy issues and result in external data in the record that is not vetted or validated, leading to new risks;

> Patient engagement outside of the encounter is a top priority for the organization, yet a real challenge to the provider, who must avoid the potential data tsunami of too much information.

Data overload was recognized as a real risk, with the related new technologies potentially becoming distractions from the real goal of improvements in clinical decision making. Dr. Thomas Moran said, “Technology is not the disrupter, we, the physicians need to be the disrupters!” The CMIO and CHIO must activate the catalyst for change. To do so, the CMIO and CHIO must have credibility, must have a seat at the C-Suite table and must relate actions to ROI.

What CMIOs/CHIOs Can Do to Prepare for MACRA and New Payment Models

MACRA will revise payment models by combining meaningful use and quality for the MIPS scale. The goal of CMS is a drop in resource utilization. In order to be prepared for MACRA the group agreed that certain strategies can be implemented in advance:

> Build MACRA provider planning and tracking capabilities to ensure a clear understanding of the annual MIPS or APM path that each provider will follow.

> Identify quality measures and build displays for those measures at the provider level even if using group reporting.

> Base performance assessment on Hierarchical Condition Coding (HCC) levels with Alternative Payment Model (APM) and Quality and Resource Use Report (QRUR) adjustments.

> Work toward a methodology to identify a true cost of care for specific services that will be bundled, such as total hips and knees for 2018.

> Identify clearly in advance decisions on shared payments per episode and reach those decisions via collaboration.

> Understand that risk adjustment, quality measures and payment may be dependent on documentation quality and accuracy, including the use of HCC codes and comprehensive problem lists. The care-planning process must include both medical and social problems to have the greatest impact. Risk-based APM’s may depend on managing non-medical problems.

Data Quality and Documentation Quality

Data quality and documentation quality are related but present different challenges. When performance measures drive compensation, the baseline data is critical and must be accurate. The care team relies on both clinical documentation and quality assessors in the EHR. Yet everyone agreed clinical documentation often is of poor quality, generally from cut-and-paste behaviors and redundancy. Dr. Stetson suggested the use of the Physician Documentation Quality Instrument (PDQI) as a simple means of assessing quality and providing feedback for improvement. Dr. Michelle Lauria suggested that physicians be required to do note-review on peers to identify issues and foster improvement. Dr. Jerry Osheroff described a new checklist tool to ensure that quality-measure data are accurate and trustworthy (recently published within a guide to improving care processes and outcomes). Dr. Alan Weiss said that part of the problem is the physician hasn’t defined data quality based on purpose—purpose related to influencing medical decision-making and clinical value.

Lessons Learned: How CMIOs/CHIOs can Advance CDS

1. Stress documentation reform to make records medically meaningful for the patient benefit. Change data documentation and collection from a reimbursement focus to a patient outcome focus.

2. Synthesize the experiences and strengths from the organizations within the Scottsdale Institute to identify what the future of CDS could look like.

3. Articulate the value proposition of the CDS Informatics Team to lead to role clarity and improved collaboration.

4.  Develop a maturity model for CDS levels, along with a recommended staging process and a corresponding benchmarking process facilitated by the Scottsdale Institute.

5. CMIO/CHIOs should take a critical role in translating health reform such as MACRA and other value-based contracting efforts into a value platform that leverages people/process/technology best practices.

6. Teach responsible clinical documentation skills and etiquette in medical schools as a requirement for delivering quality care.

7.  Apply pressure to vendors to standardize CDS tools and maintain CDS as a core function of the EHR. Knowledge management and analytics to ensure CDS reliability should be part of the standard EHR CDS package from vendors. Informatics teams should be able to easily report on alert fatigue and gaps in the annual review process with subject-matter experts.

8. Continue to expand CMIO/CHIO and Informatics resources and personnel in health systems, with senior-level decision-making, to realize the ROI on CDS.

9. Build a culture of innovation throughout the health system.

10. Build informatics capability that includes ongoing review and prudent development of CDS alerts. This process should include assessment and monitoring of CDS effectiveness against negative factors like alert fatigue.

 


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UC Davis Health’s Physician-Specific Approach to Addressing Burnout

October 16, 2018
by Rajiv Leventhal, Managing Editor
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To combat the physician burnout epidemic, one health system is taking matters into its own hands

Physician burnout has long been a significant healthcare challenge, but in recent years with the advent of various technologies into clinical workflows, along with an array of regulatory requirements, the problem seems to be getting worse.

Indeed, there is no shortage of research that backs up the notion that physicians are overburdened, with some surveys having found that 30 to 60 percent of clinicians report symptoms of burnout, which can threaten patient safety and physician health. What’s more, EHRs (electronic health records) are consistently cited as the top burnout factor, largely due to the time one must spend in them documenting and performing other administrative tasks. To this point, a commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Although federal health officials have been outspoken about the need to combat these issues while improving physician satisfaction, some hospitals and have health systems have been taking matters into their own hands. In Sacramento, not long ago, clinical and IT leaders at the University of California, Davis (UC Davis) Health were eager to get funding to develop and roll-out a program to improve physician efficiency levels within the EHR.

Scott MacDonald, M.D., the health system’s EHR medical director, says that in order to get that funding, his team needed to show the organization’s leadership, via a pilot project, that a program designed around improving physician efficiency in the EHR was worthwhile and valuable. They ended up getting a small team together, mostly volunteers from various UC Davis Health locations, and piloted two high performing clinics and two low performing ones, based on efficiency data from Epic, MacDonald recalls.

In order to determine which clinics were doing well with their EHRs, and which ones were not, the UC Davis Health team looked at a number of factors. For one, they would examine a given individual physician to see if he or she was spending more than the average amount of time on certain EHR “in-basket” tasks, explains MacDonald. “We would then look and compare that data to others in that physician’s department and specialty to see if there were outliers. So that’s a useful tool for us to recognize that this person is efficient with chart reviews but inefficient with writing notes, [for example].”

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MacDonald says that they would also survey the physicians to see what they personally feel they are most inefficient with in the EHR. “We wanted to make sure that we address their biggest areas of frustration,” he says, noting that the organization is also looking to add a chief wellness officer to help accomplish this.

Problems in the Trenches

MacDonald says that his team, based on anecdotal conversations with physicians, believes that it’s “patently obvious that doctors are frustrated by EHRs and IT, as well as the other factors from the changes in the healthcare system over the last few years, as well as the regulatory environment.”

That said, MacDonald doesn’t believe that EHRs are hurting the physician-patient relationship; more so that they are “blamed” for hurting it. “Because of what’s happened over the course of the last decade, with lots of regulatory requirements, even going back to the 1990s with CMS [the Centers for Medicare & Medicaid Services] billing regulations, all those things have been addressed in a lot of organizations through the EHR. So people tend to shoot the messenger and blame the EHR for these ills. But the EHR is really just a tool, and if that tool is built and trained well, it’s certainly a real boon to the quality of care we deliver,” he says. “If people know how to use the tool effectively when they are seeing a patient, [it will] become a partner in the care with the patient, rather than a mediator of the care,” he emphasizes.

Providing some more context, MacDonald believes that if doctors have the computer screen up between them and the patient, and all the patient sees are the wires coming out of the back of the monitor, that doesn’t make for a good experience for the patient. “But if you are in a triangle with the patient and the monitor, and you are engaging the patient in the data you are looking at, then it could be a real positive. Across the U.S., we have not trained our physicians in that aspect of modern medicine. How we use the tool is part of the relationship with the patient,” he says.

A Program Designed for the Physician

UC Davis Health’s Physician Efficiency Program (PEP), modeled after the pilot project in the four clinics last year, tapped program manager Melissa Jost, who oversees six analysts. Teams of three are deployed to clinics to train and build features within the Epic EHR platform. What’s more, Jost supervises two builders and four trainers, an approach that MacDonald believes makes this program particularly unique. “We integrate the building and training in one team. So when we go out to the clinics and work with [physicians], we can not only show them how to use the tools that exist, but also build the tools if one doesn’t exist and there is something that is workflow-specific that’s needed.”

Each team spends up to six weeks in a clinic monitoring workflows, reviewing EHR-use metrics and working one-on-one with each physician to personalize and optimize their use of EHR tools. Clinics also reduce each physician’s patient schedule by 50 percent to allow time for the training sessions right in the clinic during normal clinic hours, with team members also available for follow-up questions or sessions on site, according to officials, who also note that the goal is to engage all primary and specialty care ambulatory physicians by 2020.

MacDonald admits that to date, the data isn’t perfect, but it gives his team broad strokes about how effective individuals, clinics and groups are using the EHR system. Nonetheless, officials point to some encouraging results from the program—namely a 12-percent increase in physician satisfaction, 24-percent increase in physician efficiency, and an average reduction of 25 hours less per month in time spent working after hours per physician trained.

And in terms of anecdotal physician feedback, MacDonald says that they love the program so far. “We have been getting rave reviews,” he notes, noting that he recently asked physicians at one clinic their feelings about the program and how it can improve, to which the near universal response was, “When are you coming back?”

When asked if physicians feel that the core problem with EHRs is the documentation requirements, or technical flaws in the systems themselves, MacDonald chalks it up to a “mix of everything.” He says that this type of tension is common in informatics, and people ask, “Why can’t Epic just do [X]?” But MacDonald notes that oftentimes the system actually can do that thing and the physician might not know how to do it. “Often, people’s frustrations can be easily met with simple training because the tools are already there from the vendor. But that’s not always the case, and that’s why we do additional build work to customize it,” he says.

MacDonald adds that in healthcare, there is always this “undercurrent of external requirements that don’t appear to people to have much clinical value,” such as reporting on quality measures, data collection, and regulatory requirements, but most physicians do reluctantly accept the necessity of these things by working in the modern healthcare system. “But if we can mitigate [the burden] by giving them a faster way of doing it, they will appreciate it,” he says.

 


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Report: athenahealth Has Multiple Bidders for Sale of the Company

October 15, 2018
by Heather Landi, Associate Editor
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Watertown, Mass.-based health IT company athenahealth has attracted interest from at least five potential bidders for a possible sale of the company, people familiar with the matter told Bloomberg.

In an article posted Friday, Bloomberg reports that private equity players including Bain Capital, Hellman & Friedman, Clayton, Dubiliar & Rice and TPG are considering bids for athenahealth, the people said, asking not to be identified because the matter is private. Elliott Management Corp., the sometimes-activist fund run by billionaire Paul Singer, is also weighing a bid, people familiar with the matter told Bloomberg.

Elliott, which owns 9 percent of athenahealth, may keep that stake if it is unsuccessful in acquiring the company, the people said.

“athenahealth has received indications of interest above $135 a share, the people said, with final bids due by the end of the month,” Bloomberg reported.

As previously reported by Healthcare Informatics, in May, Elliott Management made an all-cash takeover offer to buy athenahealth, at a valuation of $6.9 billion. The investors sent a letter to athenahealth’s board proposing to acquire the company for $160 per share. In the letter, the investors criticized leadership at the electronic health record (EHR) vendor for failing to make the changes necessary “to enable it to grow as it should and to create the kind of value its shareholders deserve.”

The story continued to take turns throughout the summer, particularly following the resignation of CEO and President Jonathan Bush in June. Bush’s resignation came just a few weeks after Elliott Management’s takeover bid, and just a few days after reports surfaced that the athenahealth chief had allegedly assaulted his ex-wife more than a decade ago, and also created a “sexually hostile environment” at the company.   

Following the news, various companies, both inside and outside of healthcare, were brought up as possibilities to buy athenahealth, including the Kansas City-based EHR giant Cerner Corp.

According to a report in the New York Post published in early September, Elliott Management was cited as the favorite to win the athenahealth takeover bid, reporting that Cerner and UnitedHealth declined an opportunity to acquire the health IT company.

The Sept. 6 report noted that “The healthcare companies that would most logically be interested in athenahealth, including Cerner Corp. and UnitedHealthcare, have taken a pass…” As such, Elliott has now teamed up with investment firm Bain Capital on its bid, the New York Post noted at the time.

Bain Capital owns Waystar, a healthcare technology company that was recently formed by combining Navicure and ZirMed, two revenue cycle management vendors. Waystar may benefit if Bain buys athenahealth, an industry banker told the New York Post.

However, almost two weeks later, another report in the New York Post indicated that Elliott Management had backed away from its $160-a-share bid for athenahealth. “As a result of Singer’s retreat and the lack of robust interest from others, athena has extended a final bid deadline by 10 days — to Sept. 27, sources said. Singer backing off the promised bid is a stark turnaround in the battle for the health care tech company,” the New York Post article stated.

According to an October 11 article in the New York Post, suitors whose offers were deemed too low months ago are being invited to take a second look, according to sources. Bids are now believed to value the company at no greater than $135 a share.

“athena first sought final bids by a Sept. 17 deadline. Then, it extended that deadline by 10 days. Now, the company will likely not make a decision until next week at the earliest on how to proceed, two sources said,” according to the article.

“The seller is deciding between a full sale, a merger with Pamplona Capital’s NThrive or to continue as a listed company,” the New York Post article reported.

The New York Post article also reports that if the company decides not to sell or merge, it will have to find a new CEO to replace Bush, sources said. Former GE chief Jeff Immelt has been running Athena as its executive chairman since the summer.

“They definitely need a CEO that is not Jeff Immelt,” the analyst said in the article. “If I’m the candidate, I would want to know what Elliott’s perspective is going forward.”

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KLAS Report: Behavioral Health EHR Vendors Demonstrate Poor Performance

October 10, 2018
by Heather Landi, Associate Editor
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The behavioral health electronic health record (EHR) vendor market has shown poor performance, to date, according to customers, who cite slow development, implementation challenges and lackluster customer support, according to a KLAS Research report.

A recent KLAS report examines behavioral health EHR performance, based on interviews with 149 unique organizations to get their perspective on the performance of these solutions. According to the organizations interviewed, the settings in which behavioral health EHRs are used are primarily outpatient/private practice (78 percent); intensive outpatient/residential day program (64 percent); inpatient residential treatment center (42 percent) and acute psychiatric services (22 percent).

The report, KLAS’ first on behavioral health EHRs, is intended to give executives at behavioral health organizations a high-level overview of the market and to shine a spotlight on where vendors can improve. Specifically, the report dives into the behavioral health vendors used most frequently (in both inpatient and outpatient settings) and their performance in product quality, development, and service and support. 

Organizations who offer behavioral health services need robust IT solutions that can support their efforts, however, on average, the overall performance of behavioral health vendors is very low. According to KLAS, the average overall score for behavioral health vendors is 70.8 (out of 100), putting behavior al health in the second percentile of all software market segments that KLAS measures (about 100 total).

Several factors contribute to this low performance, KLAS researchers note in the report. Organizations’ needs vary greatly based on the types of services they offer and the states they operate in, and this latter factor specifically impacts reporting. What’s more, a one-size-fits-all solution isn’t adequate for most organizations. Also, behavioral health vendors often overcommit on what they can deliver and are slow to develop the functionality organizations need and request.

According to KLAS “While vendor performance is low across the board, most frustrated customers plan to stay with their behavioral health vendor due to limited resources and a lack of compelling alternatives,” the researchers wrote.

Among the vendor solutions covered in the report are Cerner’s Community Behavioral Health solution, Cerner’s Millennium Behavioral Health, Core Solutions, Credible, Harris Healthcare, Netsmart, Qualifacts, Valant and Welligent.

Credible, a Rockville, Md.-based vendor that provides web-based EHR software for behavioral health providers, is leading what, so far, is an underperforming segment with wide variation, according to the report. KLAS researchers also note that Valant, a Seattle-based company that behavioral health HER software, is strong among private practices.

“Credible and Valant manage to give their customers a more consistent experience,” the report authors wrote. “Of the vendors used broadly in both outpatient and inpatient settings, Credible is most consistent thanks to their stronger implementation and training process, which has helped most customers find success with the easy-to-use, cloud-based system. Valant, whose customers are mostly private practices, also has an easy-to-use product, which was designed by a licensed psychiatrist. Valant’s multi-pronged approach to training (which includes a train-the-trainer program as well as online tools, such as webinars and blogs) helps private practices feel they get good value for their money.”

Despite the challenges, few are planning to replace, KLAS notes. One CIO interviewed for the report said, “Our CEO was considering other options a while ago. That person spends every spare minute trying to figure out what is best for us, and the CEO's research suggested that there really isn't anything better than [our current EHR] on the market.”

KLAS researchers also found that most behavioral health vendors have been slower to develop than customers would like or have failed to keep development promises. “Missed development timelines are referenced by almost all customers who say their vendor hasn’t kept promises,” the report authors wrote. “Even Credible, the overall top-performing behavioral health vendor, has overcommitted on timelines, specifically for new treatment-planning and state-reporting functionality.”

Cerner is the most mature of the enterprise health system EHR vendors when it comes to behavioral health, according to the report. Cerner has been developing their go-forward Millennium platform and incorporating learnings and content from their acquired Anasazi product (renamed Community Behavioral Health).

KLAS researchers found that overall customer satisfaction with the two products is comparable. In regard to Millennium, health system clients report higher satisfaction; relatively strong support and previously unattainable benefits, like integration across service lines, make up for product inadequacies mentioned by some behavioral health–specific Millennium customers.

Looking at other health system EHR vendors, Meditech has customers live with their integrated behavioral health solution, though adoption is light to date. Epic recently released a behavioral health–specific module, but no customers were yet live at the time of this research. Several of Epic’s inpatient EHR customers say they would have to pay an additional fee for the behavioral health module, according to the report.

Allscripts has no specific platform for behavioral health and recently sold their stake in Netsmart, making them the only EHR vendor—among those in use at large health systems—with no behavioral health–specific solution, the report authors state.

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