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At World of Health IT-Barcelona, HIMSS’ Lieber Sees Forward Progress—on a Global Scale

November 26, 2016
by Mark Hagland
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HIMSS’s Steve Lieber shares his perspective on (varying rates of) HIT change taking place across Europe—and beyond

In the midst of a buzz of activity at the World of Health IT (WoHIT) conference, being held last week in Barcelona, Spain, H. Stephen (Steve) Lieber, president and CEO of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), sat down to speak with Healthcare Informatics Editor-in-Chief Mark Hagland about the World of Health IT conference, commonalities in terms of challenges and opportunities among healthcare IT leaders worldwide, and what the future holds. He also spoke with Hagland about the new partnership announced during WoHIT, between HIMSS and the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), in which CHIME will be a partner with HIMSS on international conferences such as the World of Health IT conference. Below are excerpts from that interview.

I’ve been told that there are about 1,000 attendees here at the conference? And how many vendor participants are there here?

Yes, that’s right, at the moment, we’re counting about 1,000 attendees—and about 45 vendor companies participating.

This conference has taken on different forms, correct?

Yes, essentially two different forms. There have been years where we’ve had a combined eHealthWeek and World of Health IT. We were in Riga, Latvia—a combined ministerial eHealthWeek and World of Health IT, last year. About the past five or six years, we’ve done a combined ministerial event and World of Health IT. So in June, we had eHealthWeek, that was the ministerial event; this is designed to be less focused on policy, and more on practice. The ministerial event rotates with the presidency of the European Union. Sometimes that works well, sometimes, it’s a smaller country, so we’ve separated them. But we’ve held an intermittent World of Health IT conference since 2006.

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Steve Lieber

Tell me a bit more about your new partnership with CHIME?

We announced at the opening session today that HIMSS and CHIME have entered into an agreement, in which we will operate outside the United States as a single entity. So it’s the HIMSS staff that’s here—we have offices in the U.K., Germany, and Singapore. And we will present many things under a co-branding agreement. Of course, some things will remain particular to each organization. The EMRAM [the HIMSS Analytics schematic that describes and documents the evolution and advancement of clinical information systems in patient care organizations, both in the United States and worldwide] is HIMSS; EMR certification is CHIME [a CHIME process]. So we’ll present this as an event that is HIMSS-CHIME International.

HIMSS has really become totally international at this point, correct?

Yes, that’s correct; we’re operating actively in about 35 countries in the world now. We have things going on in probably 15 more, but those more one-off things. But yes, we have sustained activity now in about 35 countries.

On a personal level, you must be constantly traveling, Steve?

Yes, though I’m only the third-most traveled staff member! We actually have two staff members who travel more than I do!

When you look at information systems development and at the evolution of the roles of healthcare IT leaders, on an international level what are you and your colleagues at HIMSS trying to accomplish these days? Where are the opportunities for the association as an international organization?

The mission of HIMSS for a long time—that is, transforming healthcare through better patient outcomes, higher quality, fewer medical errors, and higher patient and clinician satisfaction—all of those are possible through the adoption of technology, and we’re just trying to extend that concept. And we’re not trying to proselytize from the U.S. to the rest of the world; we’re just trying to engage people all over the world, and are creating and developing events that allow people to share insights with one another and learn from one another.

It’s astonishing how similar the concepts are internationally, such as security; in the panel that I moderated on security issues around medical devices, the issues that were brought up really were fundamentally similar internationally, even as the policy landscapes differ by country. And the population health issues are fundamentally similar as well.

That’s right, exactly. And I’ve found that I can do virtually the same presentations anywhere in the world. And we don’t do much around payment per se, and that’s one area with differences. But when it comes to healthcare and what technology can do, it’s cost, quality, and access. Everybody thinks healthcare costs too much, and recognizes that the quality isn’t what it should be, and everybody has challenges getting the care that’s needed. In the U.S., that translates into insurance access. But even in other countries, there are access issues that are common across the world. People go to doctors, they get sick, they need care. And leaders in all the world’s health systems are struggling with fundamentally similar problems.

And the explosion in chronic illness is becoming truly global; I heard a presentation recently by an American consultant who is working in a major Middle Eastern country that has a surreal level of type-2 diabetes—over 60 percent of the population of one country!

That’s right, and you add to that the aging of the population, which is also global, and is even worse right now in Europe—yes, these issues are universal.

In a session earlier today, CIOs from hospitals and health systems in France, Belgium, and Italy expressed a level of consensus around a rather amazing set of similarities in terms of the issues that CIOs are facing across western Europe, issues that are similar to those being faced by hospital and health system CIOs in the United States.

Yes, it’s amazing what the commonalities are nowadays. And of course, we have representation at this conference not only from healthcare IT leaders from across Europe, but also from the Middle East, Asia, Latin America, and the United States, of course.

Yes, one of the panelists this morning, a CIO from Peru, expressed similar sentiments as well. Meanwhile, what do you see happening in the next few years at these HIMSS-sponsored conferences, both the WoHIT conferences, and the eHealthWeek events?

The reality is that we’ve created something of an artificial marketplace here at our conferences; there isn’t yet a true pan-European market; all the countries are moving at different paces. And we certainly can measure the European market by the level of sophistication of different health systems here. Spain, for example, has one of the higher levels of IT adoption, of all the European countries. Germany, on the other hand, has a relatively low level of IT adoption; they really have not yet bought into the enterprise-wide EMRs that capture data from all sources. They’re still mostly in silos. There’s still an approach to healthcare that I’m going to equate to the United States ten years ago—in terms of IT. Another country that’s going to be a big surprise is Turkey—there’s a huge government effort in investing in EHRs there. We recognized a Stage 7 hospital this morning from each of the following countries: Turkey. Korea, Germany, Singapore, Spain--each now have one Stage 7 hospital. And so you’ve got different things going on. The UK market seems to be actually start to move, with the NHS recognizing that to solve their issues, they’re going to have to get smarter about the use of technology; meanwhile, the Nordics have a long history of adoption of technology.

Are you optimistic overall about the pace of change and forward evolution in healthcare IT, internationally?

Yes, I am. It’s interesting that when I started at HIMSS in 2000, the discussion back then, granted, this was in the United States, was, ‘Is IT worth it?’ But really, nowhere in the world is that a question any longer; it’s how to allocate the resources s and what to do first. So yes, I am optimistic about all of this. What’s more, HIMSS has contributed to this, and I’m proud of our contribution. And this is why I work for a not-for-profit. I’m motivated by trying to do good. So yes, I’m very optimistic about the direction, because there’s universal recognition of the value of IT. Now it’s a matter of how to do it, how to do it smartly, within the resources available. And it really is a journey.

 


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Allscripts Sells its Netsmart Stake to GI Partners, TA Associates

December 10, 2018
by Rajiv Leventhal, Managing Editor
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Just a few months after Allscripts said it would be selling its majority stake in Netsmart, the health IT company announced today that private equity firm GI Partners, along with TA Associates, will be acquiring the stake held in Netsmart.

In 2016 Allscripts acquired Kansas City-based Netsmart for $950 million in a joint venture with middle-market private equity firm GI Partners, with Allscripts controlling 51 percent of the company. With that deal, Allscripts contributed its homecare business to Netsmart, in exchange for the largest ownership stake in the company which has now become the largest technology company exclusively dedicated to behavioral health, human services and post-acute care, officials have noted.

Now, this transaction represents an additional investment for GI Partners over its initial stake acquired in April 2016, and results in majority ownership of Netsmart by GI Partners.

According to reports, it is expected that this sale transaction will yield Allscripts net after-tax proceeds of approximately $525 million or approximately $3 per fully diluted share.

Founded 50 years ago, Netsmart is a provider of software and technology solutions designed especially for the health and human services and post-acute sectors, enabling mission-critical clinical and business processes including electronic health records (EHRs), population health, billing, analytics and health information exchange, its officials say.

According to the company’s executives, “Since GI Partners' investment in 2016, Netsmart has experienced considerable growth through product innovation and multiple strategic acquisitions. During this time, Netsmart launched myUnity, [a] multi-tenant SaaS platform serving the entire post-acute care continuum, and successfully completed strategic acquisitions in human services and post-acute care technology. Over the same period, Netsmart has added 150,000 users and over 5,000 organizations to its platform.”

On the 2018 Healthcare Informatics 100, a list of the top 100 health IT vendors in the U.S. by revenue, Allscripts ranked 10th with a self-reported health IT revenue of $1.8 billion. Netsmart, meanwhile, ranked 44th with a self-reported revenue of $319 million.

According to reports, Allscripts plans to use the net after-tax proceeds to repay long-term debt, invest in other growing areas of its business, and to opportunistically repurchase its outstanding common stock.

The transaction is expected to be completed this month.

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Study Links Stress from Using EHRs to Physician Burnout

December 7, 2018
by Heather Landi, Associate Editor
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More than a third of primary care physicians reported all three measures of EHR-related stress
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Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.

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.

Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.

Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.

“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology, as part of a legislative mandate to publicly report health care quality data. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

Measures included agreeing that EHRs add to the frustration of their day, spending moderate to excessive amounts of time on EHRs while they were at home and reporting insufficient time for documentation while at work.

Many prior studies have looked into the factors that contribute to burnout in health care, Gardner said. Besides health information technology, these factors include chaotic work environments, productivity pressures, lack of autonomy and a misalignment between the doctors' values and the values they perceive the leaders of their organizations hold.

Prior research has shown that patients of burned-out physicians experience more errors and unnecessary tests, said Gardner, who also is a senior medical scientist at Healthcentric Advisors.

In this latest study, researchers found that doctors with insufficient time for documentation while at work had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

The researchers also found that EHR-related stress is dependent on the physician's specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress -- including general internists (39.5 percent), family medicine physicians (37 percent) and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists and hospital medicine specialists reported all three measures of EHR-related stress.

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Gardner suspects that other factors, such as a chaotic work environment, contribute to their rates of burnout.

"To me, it's a signal to health care organizations that if they're going to 'fix' burnout, one solution is not going to work for all physicians in their organization," Gardner said. "They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that's really the problem in their group."

However, for those doctors who do have a lot of EHR-related stress, health care administrators could work to streamline the documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner said.

Making the user interface for EHRs more intuitive could address some stress, Gardner noted; however, when the research team analyzed the results by the three most common EHR systems in the state, none of them were associated with increased burnout.

Earlier research found that using medical scribes was associated with lower rates of burnout, but this study did not confirm that association. In the paper, the study authors suggest that perhaps medical scribes address the burden of documentation, but not other time-consuming EHR tasks such as inbox management.

 

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HHS Studying Modernization of Indian Health Services’ IT Platform

November 29, 2018
by David Raths, Contributing Editor
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Options include updating the Resource and Patient Management System technology stack or acquiring commercial solutions

With so much focus on the modernization of health IT systems at the Veteran’s Administration and Department of Defense, there has been less attention paid to decisions that have to be made about IT systems in the Indian Health Service. But now the HHS Office of the Chief Technology Officer has funded a one-year project to study IHS’ options.

The study will explore options for modernizing IHS’ solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination of the two. One of the people involved in the analysis is Theresa Cullen, M.D., M.S., associate director of global health informatics at the Regenstrief Institute. Perhaps no one has more experience or a better perspective on RPMS than Dr. Cullen, who served as the CIO for Indian Health Service and as the Chief Medical Information Officer for the Veterans Health Administration

During a webinar put on by the Open Source Electronic Health Record Alliance (OSEHERA), Dr. Cullen described the scope of the project. “The goal is to look at the current state of RPMS EHR and other components with an eye to modernization. Can it be modernized to meet the near term and future needs of communities served by IHS? We are engaged with tribally operated and urban sites. Whatever decisions or recommendations are made will include their voice.”

The size and complexity of the IHS highlights the importance of the technology decision. It provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 federally recognized tribes in 37 states. Its budget was $5.5 billion for fiscal 2018 appropriations, plus third-party collections of $1.02 billion at IHS sites in fiscal 2017. The IHS also faces considerable cost constraints, Dr. Cullen noted, adding that by comparison that the VA’s population is four times greater but its budget is 15 times greater.

RPMS, created in 1984, is in use at all of IHS’ federally operated facilities, as well as most tribally operated and urban Indian health programs. It has more than 100 components, including clinical, practice management and administrative applications.

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About 20 to 30 percent of RPMS code originates in the VA’s VistA. Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements. But Dr. Cullen mentioned that IHS has developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle).

Because the VA announced in 2017 it would sundown VistA and transition to Cerner, the assessment team is working under the assumption that the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA. And RPMS, like VistA, resides in an architecture that is growing outdated.

The committee is setting up a community of practice to allow stakeholders to share technology needs, best practices and ways forward. One question is how to define modernization and how IHS can get there. The idea is to assess the potential for the existing capabilities developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture. The technology assessment limited to RPMS, Dr. Cullen noted. “We are not looking at COTS [commercial off the shelf] products or open source. We are assessing the potential for existing capabilities to be brought into “a modern technology architecture.”

Part of the webinar involved asking attendees for their ideas for what a modernized technology stack for RPMS would look like, what development and transitional challenges could be expected, and any comparable efforts that could inform the work of the technical assessment team.

 

 

 


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