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Innovator Awards Program 2018: Semifinalists

February 19, 2018
by the Editors of Healthcare Informatics
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Editor’s Note: We at Healthcare Informatics were once again ecstatic with the exceptional quality of the submissions we received from innovating patient care organizations across the U.S. In addition to the four winning teams this year (whose stories will be posted throughout this week), our editorial team also selected several runners-up. Below, please find descriptions of the initiatives of the 14 teams whom we have awarded semifinalist status in this year’s program.

Centre for Addiction and Mental Health (Ontario, Canada)

Improving patient care through achievement of HIMSS EMRAM Stage 7

In May 2014, CAMH implemented a clinical information system using a big-bang approach with an integrated team of clinicians, information technology, and other staff. But after implementation, CAMH noted a lack of clinical practice standardization. A new initiative emerged that included work to refine the inputting of clinical documentation to the EHR, the development of electronic whiteboards to display and manage assessment and risk factors, leveraging data to inform improvement initiatives, and many other requirements as defined by the HIMSS EMRAM (EMR Adoption Model) Stage 7 criteria.

CAMH is the first academic teaching hospital to achieve HIMSS Stage 7 in Canada; this achievement is a milestone in both the Canadian and international health landscape. Now, more than 99 percent of CAMH clinically-relevant documentation is completed directly within the EHR and CPOE (computerized provider order entry) rates have been over 90 percent since December 2016. What’s more, the creation of a suicide risk dashboard has led to 90 percent of patients having a suicide risk assessment completed within 24 hours of admission.

Cleveland Clinic (Cleveland, Ohio)

An enterprise imaging service

The goal of the enterprise imaging service is to provide a comprehensive longitudinal medical record through incorporation of all medical images into a single archive. Through a universal viewer, the archive is integrated with the EHR and provides a foundation for image distribution to all caregivers throughout the enterprise. The archive also serves as a foundation for image sharing. Implementation required a comprehensive assessment of all image generating equipment throughout all hospitals and outpatient centers.

The Clinic’s officials say that the establishment of an enterprise imaging program has led to the consolidation of imaging archives throughout the health system. Images which were not previously easily accessible are now readily viewable through the EHR (electronic health record) with access points both within the firewall and from home. To date, 11 different service lines and more than 440 pieces of image generating equipment outside of radiology have been integrated.

Compass Medical (Massachusetts)

Annual wellness, chronic care management and quality outcomes

By leveraging new information technology, Compass Medical has been able to follow proven population health management and care management principles, allowing patient care leaders to identify and target specific population groups, stratify and prioritize care gaps and engage and individualize care plan activities. In 2016, for example, Compass Medical was able to identify and target more than 14,000 Medicare patients that were struggling to manage their chronic health conditions and needed a more personalized and comprehensive care plan. One year later, Compass Medical developed and launched a new Chronic Care Management Program to help engage with and closely manage Medicare patients that suffer from two or more chronic health conditions. With the help of its EHR and big data platform, Compass Medical positioned itself to automate many of the workflows for care management nurses.

The Annual Wellness Visit (AWV) is another example of a preventive care service that has been positively affected by leveraging IT. In 2017, national trends suggested utilization of AWV were still hovering around the low 20-percent range with the highest performing state reaching 35 percent. Utilizing EHR-based patient engagement campaigns for increasing focused outreach, incorporating a team based care model with scribes, and creating standard work processes for reducing provider burden have helped Compass Medical reach 57 percent AWV utilization for its Medicare eligible population by the end of year 2017.

Duke University School of Medicine (Durham, N.C.)

A NICU discrete event simulation model

Duke’s neonatal clinicians care for more than 800 babies each year in the Duke Neonatal Intensive Care Unit (NICU). Although the majority do well, about 40 babies do not survive. How could they improve outcomes and save lives? Duke’s neonatal research team partnered with analytics company SAS to create an analytics-based model of Duke Children’s Hospital’s Level IV neonatal intensive care unit. The result was the creation of a discrete event simulation model that closely resembled the clinical outcomes of Duke’s training unit, which was validated using data held back from the original model, which also closely tracked actual unit outcomes.

The model uses a vast resource of clinical data to simulate the experience of patients, their conditions and staff responses in a computerized environment. It creates virtual babies experiencing care within a simulated NICU environment, including virtual beds staffed by virtual nurses. The research team attests that they cannot find any evidence of discrete event simulation modeling being used in a NICU setting, making this a first in neonatal care.

Houston Methodist (Houston, Texas)

A coordinated care/Medicare Shared Savings Program (MSSP) initiative

Houston Methodist's MSSP program, Houston Methodist Coordinated Care (HMCC), can track and report Medicare patients’ healthcare visits and medical details. The successful execution of the program is a layering of technologies with the foundation being the organization’s integrated EHR platform and a separate population management tool.

The project was centered around six core elements: 1) becoming the first ACO (accountable care organization) in Texas to acquire real-time admission, discharge and transfer (ADT) notification capability that links all health providers; 2) chronic heart failure home monitoring; 3) real-time notification when HMCC patients came into the ED; 4) risk assessments for emergency room visits, hospital readmissions and the need for complex care; 5) same-day appointment facilitation; and 6) care team alerts. In sum, there were 17,000 Houston Methodist patients in HMCC in 2017, year-to-date, with 105 participating physicians. Total healthcare cost savings year-to-date are more than $1.3 million, according to officials.

Indiana University Health (Indianapolis, Ind.)

FHIR HIEdrant: making big data actionable at the point of care

One of the difficult challenges for many HIEs (health information exchanges) is the time and effort that it takes to reach out to a second system to search for needed data at the point of care. As such, the goal at IU Health was to develop an application within the clinical workflow that will, at the click of a single button, bring back data to that workflow relating to the patient’s chief complaint from the HIE.

The first phase of this project was building the framework and the mechanisms to make this a possibility and apply it to a single context: an emergency department patient with chest pain. Leaders at IU Health are utilizing the Fast Healthcare Interoperability Resources (FHIR) standard to communicate out from the IU Health Cerner EHR to the HIE to retrieve five specific data elements that are germane to caring for a chest pain patient in the emergency department and understanding their risk. Within the workflow, the clinician is being presented the most recent: ECG, cardiology note, discharge summary, catheterization report, and more. According to IU Health officials, this is the first FHIR-based application that directly accesses an HIE and delivers context-specific data about a patient directly to the clinical workflow.

Johns Hopkins Health System (Baltimore, Md.)

inHealth precision medicine initiative

The precision medicine initiative at Johns Hopkins Medicine and University–inHealth–seeks to improve individual and population health outcomes through scientific advances at the intersection of biomedical research and data science. Through a collaboration of The Johns Hopkins Applied Physics Laboratory (APL), and Johns Hopkins Medicine (JHM), inHealth is building a big-data precision medicine platform with the goal of accelerating the translation of insight into care delivery.

The first result of this broad, multidisciplinary effort was the successful creation of two Precision Medicine Centers of Excellence (PMCoE) focused on multiple sclerosis and prostate active surveillance. The organization’s Technology Innovation Center has developed applications to garner new data and learnings from clinical practice and feedback into discovery. Physicians have begun using the discovery platform to facilitate conversations with their patients about their treatment options and risks. The experiences of these centers will lead the next wave of PMCoEs, expanding the utility of the platform.

Lakeland Health (St. Joseph, Mich.)

Something wicked this way comes

Leaders at Lakeland Health set three core cybersecurity goals: (a) put risk management and cybersecurity near the top of health system leadership agenda; (b) use innovative strategies and tools to execute the cybersecurity program; and (c) shift focus from fear to clinical integrity. The cybersecurity program covered the hospitals, clinics, home care, hospice and all the different legal entities which comprised the health system. In order to ensure strategic direction and alignment, a steering committee was set up which met every two weeks.

The cybersecurity program execution was focused on three work-streams—process, technology and team members. In the process work stream, execution covered implementation and audit of policies and procedures, risk assessment and HIPAA (Health Insurance Portability and Accountability Act) compliance, and a monthly information security executive dashboard which was reviewed by the steering committee. Despite this continuing threat, the cybersecurity program delivered strong results in different areas, including: more than 100 business associate agreements (BAA) were signed; annual HIPAA risk assessment and remediation plans were put in place; the initial internal phishing campaign eventually lowered the click rate to 10 percent; there was a five-fold increase in the suspicious emails forwarded to the security team; and more than 1,000 laptops were encrypted.

Lexington Clinic (Lexington, Ky.)

Development of a direct-to-employer network

Costs of certain services often vary dramatically between providers, so by selectively designing benefits to increase cost-sharing at providers who provide more expensive care, enrollees are incentivized to see the more efficient providers who provide care at a lower cost, reducing average overall expenditure. Savings can then be passed on to the employer. In this project, implementation was examined with an organization with a self-funded insurance model. Steering beneficiaries toward a tighter network of providers resulted in significant overall reductions in expenditure while improving the health of the overall employee population. Rather than limiting their employee health plan to a lower percentage of area providers like most similar plan designs, the employer entered into a direct-to-employer program with a local, multispecialty physician group: Lexington Clinic.

A key component of a direct-to-employer plan is population health. Lexington Clinic was able to utilize analytics software to deliver value to the employer by implementing high cost/high utilization analysis, undetected chronic disease engagement, and ancillary modality management. Lexington Clinic also determined that there were specific interventions that could be made at critical junctures in the care continuum of the employee population. These interventions would be designed to prevent health issues before they arise, reducing future expenditures and worsened health outcomes. Via the Lexington Clinic premier network, the employer demonstrated a clear reduction in aggregate expenditure from the 2015 to 2016 time period of more than 4 percent.

Lutheran Medical Center (Wheat Ridge, Colo.)

An app for staff engagement

At Lutheran Medical Center, it became a priority to redesign the way in which the staff was engaged. The organization started to use an anonymous crowdsourcing platform in 2016 with the goal to create recipes for success that would help leaders in the organization ask the right questions through an anonymous tool to enhance engagement. Using the tool has established a venue for staff to engage in problem solving and design ideas on their own terms in an anonymous way where all can follow along in the conversation in real time. The application/website started its use in the pharmacy department as a means to understand low engagement scores. This tool allowed for all staff to be involved while not taking them away from their daily duties.

Lutheran Medical Center was in the 11th percentile when it came to staff satisfaction only two years ago, but now ranks in the 43rd percentile compared to the national average. Having the ability to get staff buy-in before a change happens has been critical in impacting staff satisfaction. Before, only those invited to certain meetings had the opportunity to voice their opinions; now everyone can be reached with a single email or app use. It has been used for solving several clinical problems as well, such as how to design a “cord-free” patient room, and how to transport oxygen tanks around the hospital.

Mercy (St. Louis, Mo.)

Using NLP for heart failure EHR documentation

The goal of this project was to use NLP to extract key cardiology measures from physician and other clinical notes and incorporate the results into a dataset with discrete data fields. This dataset would then be used to obtain actionable information and contribute to the evaluation of outcomes of medical devices in heart failure patients.

Three key measures that are commonly stored in clinical notes and not available in discrete fields include ejection fraction measurement; patient symptoms including dyspnea, fatigue, dizziness, palpitations, edema and pulmonary congestion; and the New York Heart Association (NYHA) heart failure classification. Mercy patients had 35.5 million clinical notes from both inpatient and outpatient encounters that were extracted, processed and then loaded onto an NLP server. NLP queries were developed by a team of Mercy data scientists to search for relevant linguistic patterns and then evaluated for both precision and recall. The use of NLP in this project facilitated the extraction of vital patient information that is not available in any discrete field in the EHR. Without the ability to track the changes in these three essential measures, it becomes much harder to identify the point of disease progression which is a crucial factor for the evaluation of current treatments and could inform future interventions, according to Mercy officials.

Mosaic Life Care (St. Joseph, Mo.)

Revenue management analytics dashboard

Mosaic Life Care provides healthcare and life care services in and around St. Joseph, Missouri and the Kansas City Northland area. The organization’s finance and revenue cycle teams faced challenges with data silos that required caregivers to manually obtain information from disparate systems and manually collate information, subjecting the process to human error, inconsistent processes and concerns about data accuracy.

With the goal of developing a flexible “source of truth” dashboard, the enterprise data warehouse team developed an integrated revenue management analytics solution with a front-end dashboard by leveraging the core EDW solution and architecture platform to extract data from the best of breed systems. Through the new dashboard, financial analysts and management teams can perform analysis and predict future trends. As a result, the dashboard enables real-time, data-driven business decisions inclusive of multi-disparate systems within a single unified platform.

NYU Langone Health (New York City, N.Y.)

Value-based medicine to improve clinical care

The goal of the project was to leverage health IT tools and related workflows to improve the value of inpatient care. Finance collaborated with the project’s physician champions to identify variations in care both internally and compared to benchmarked external institutions. The project’s physician champions collaborated with IT physician informaticists and IT project teams to design interventions to both reduce cost and improve clinical care.

The suite of interventions included: electronic clinical pathways; blood protocols; intravenous (IV) to oral (PO) medication changes; and lab ordering enhancements. Electronic pathways were created for heart failure, colon surgery, and pneumonia, and blood ordering clinical decision support and analytics were built. These projects realized significant two-year savings, including: electronic clinical pathways: $12.9 million; lab modifications: $3 million; blood utilization: $2.9 million; and IV to PO: $2.2 million.

Penn Medicine (Philadelphia, Pa.)

Standard clinical iPhone effectively enhances patient care

In January 2016, Penn Medicine met with Apple engineers to develop an economic and efficient full configuration Standard Clinical iPhone (SCiP) to work with Penn’s mobile device management tool while leveraging Apple’s Device Enrollment Program (DEP) and Volume Purchasing Program (VPP). Using this method saved the organization 975 man hours in its initial deployment using DEP streamlined setup (15 minutes versus one hour for each iPhone). Pushing additional apps to devices without needing an Apple ID and password for download or manual touch also made the implementation efficient. By implementing this project, it placed a vital tool into caregivers’ hands, officials say.

Just by using the secure texting, clinicians were able to coordinate patient flow across care settings with multiple providers and mended gaps in communication. One example had the cardiac surgery team on a thread with the patient’s current caregivers. The nurse took a picture of the surgical site and sent it securely with a description, concerned about swelling around the surgical site. The surgical team was able to provide immediate feedback and resolve the issue remotely.


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At Partners HealthCare, Bringing Digital Transformation to Clinical Care

September 18, 2018
by Rajiv Leventhal, Managing Editor
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Last spring, Partners HealthCare, founded by Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital, and California-based software company Persistent Systems, announced a strategic collaboration to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Indeed, with the digital platform, Partners’ leaders hope to enable greater exchange of information across healthcare providers everywhere, and make available open source applications to any health system. At the time of the 2017 announcement, officials said that the co-developed digital platform will be based on Substitutable Medical Applications & Reusable Technologies (SMART), an open, standards-based technology platform along with Fast Healthcare Interoperability Resources (FHIR). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” according to the announcement.

Healthcare Informatics Managing Editor Rajiv Leventhal recently spoke with Sandy Aronson, executive director of information technology at Partners Healthcare, about this collaboration, its specific goals and outlook, and how things have come along so far. Below are excerpts of that discussion.

What would you say is the greatest significance behind this collaboration?

I have been at Partners for about 15 years, and the first 13 of those years were primarily focused on the clinical use of genetics and genomics. In that space, we created a suite of applications that was architected differently than health IT applications are typically architected. These were applications that helped with the generation of interpreted reports for genetics and genomics sequencing test results. So, where normally in health IT applications you create a transaction system and then try to bolt a knowledge base on top of it to the extent you can, we decided to architect this in the opposite way.

We built a knowledge base that deeply modeled the tests that a laboratory offers, the genes that are covered by that test, variants known to exist in these genes, variants that are learned over time, and the state of knowledge linking those variances to clinically relevant facts—so disease states, drug response, drug efficacy, etc. So we built this deep knowledge base and built a transaction system on top of it, and made a rule that you can’t report out test results unless you keep the knowledge base up-to-date and consistent with your test results. And that enables you to automate the generation of reports.

But as a result, we wound up with this continually-updated knowledge base, so based on that we created what would now be a SMART on FHIR app that plugs into the EHR [electronic health record] and provides clinicians with alerts if something new and potentially clinically relevant is learned about a variant previously identified in one of their patients. So it created this notion of a knowledge base alert being interjected into clinical care.

We studied this and found that clinicians liked it, but the rate at which this learned was dependent on the number of transactions that flow through the system, because that’s how geneticists would gather the data that would enable them to improve their assessment of variants. So we registered this as a medical device, distributed it outside of Partners, and networked the different instances together, so it could learn not just based on our volume, but other folks’ volume as well. Ultimately, we sold that to Sunquest [Information Systems]. The thing we feel was most important was creating this infrastructure that facilitated new clinical processes and captured, shared, and federated data in a way that enabled learning to care.

After having done that, we took a step back and said OK, what should we do next? The infrastructure we built was very specific to issues where genetics and genomics are the major components to deciding what to do for a patient. So we wanted to look at all of the things that made that infrastructure hard to do, and build a platform to make it easier to build things like GeneInsight [an IT platform company owned and developed by Partners], and then distribute that platform, so that in addition to building examples of a similar infrastructure, others can build those examples, too. We wanted that platform to make it easier to distribute apps that are created by different folks in different organizations, ultimately with the goal of networking those apps together.

We are at a unique point in time where you have these new data types coming online that can be helpful to the care delivery process, you have algorithmic-based medicine starting to come into use, both machine learning-based and not, and you have people looking at transformative ideas on how to alter clinical processes where in order to incorporate these new data types and incorporate algorithmic-based approaches to care, you need new kinds of IT support in order to enable these transitions to occur. And that creates an opportunity, not only related to the specific transitions, but also to start collecting data for specific clinical problems in a much finer-grained way that lays the groundwork for these networks that can build the data that’s required to underlie continuous learning processes.

All of this is happening in a time with incredible cost pressure in healthcare, which does constrain internal investment but also makes organizations far less resistant to change. The goal here is to fundamentally enable clinicals to evolve their practices, their care, new data, ideas, and techniques in ways they haven’t done in the past.

Sandy Aronson

And how are you working with Persistent Systems on this, specifically?

We are building this platform together. The platform is called HIP, or health innovation platform, and the platform itself will be open-source, and it sits on top of the current clinical IT ecosystem. You interface it to underlying systems, and then it handles things like some aspects of security, authentication, and HIPAA, but also access to data as well as incorporating shared algorithms.

The goal is having different places hook up the platform, and once it is hooked up, it should create a uniform surface on top of the platform so that apps built on top of the platform become more shareable and distributable. We are now focused on both building the platform and building certain apps. And the apps get interjected to the EHR as SMART on FHIR apps.

Can you give some examples and details of the apps that are being built?

One example is that we have been working with BWH’s cardiology [department] on this program that they have, where if you look at heart failure, which affects about 2 percent of the population and has a very high mortality rate with a great deal of costs associated with it, there are guidelines that have been shown to really be helpful, yet very few people are treated in a way that actually adheres to guidelines. And that’s because the process of getting them to guideline-based care involves this drug selection and titration process that requires a lot of interaction, some of which can make patients unconformable.

But as it turns out, you can instantiate a process where you use patient navigators to take patients through this drug selection and titration process, interacting with them far more frequently than a cardiologist would ever be able to, to get them to guidelines. It’s a data-intensive process. So we are providing support for that program through the HIP platform today and we are really focused on deepening that support.

What are your goals in the next 12 to 24 months regarding this partnership? What would you like to see happen?

The ideal world is that our group and Persistent Systems will continue to add more capabilities to the platform, and that the platform is reducing costs. So many clinicians have ideas on how to fundamentally improve care but they can’t put those ideas into use without these kinds of IT interventions.

One thing I hope is that this will continuously reduce the cost of building those interventions and as a result, our team, and others, too, will develop more of these apps. We hope to see some cross-institutional adoption of apps built here and elsewhere, that the sharing will begin at the app level and ideally, in two years or so, we will be having real conversations about how we can get the networking between apps really going.


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Cigna to Invest $250M in Venture Fund with Eyes on Healthcare Startups

September 17, 2018
by Rajiv Leventhal, Managing Editor
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Cigna, the Connecticut-based health services company, has announced the launch of Cigna Ventures, a corporate venture fund focused on investing in promising healthcare startups and growth-stage companies.

Cigna has specially committed $250 million of capital to Cigna Ventures to invest in transformative and innovative healthcare companies “that are unlocking new growth possibilities in healthcare and will bring improved care quality, affordability, choice, and greater simplicity to customers and clients,” officials said in a press release.

Cigna Ventures is particularly focused on companies across three strategic areas: insights and analytics; digital health and retail; and care delivery/management. Officials say the venture fund was created to help Cigna identify, assess and sponsor early-stage innovation ideas that warrant deeper exploration through focused pilot and test-and-learn activities with the goal of realizing meaningful business value.

“Cigna’s commitment to improving the health, well-being and sense of security of the people we serve is at the front and center of everything we do,” Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said in a statement. “The venture fund will enable us to drive innovation beyond our existing core business operations, and incubate new ideas, opportunities and relationships that have the potential for long-term business growth and to help our customers.”

As an article in Bloomberg noted, “Health insurers have been starting venture-capital arms to find new ideas to improve their businesses and generate financial returns. UnitedHealth Group Inc., the biggest health insurer, said in November that its Optum unit was creating a venture arm with $250 million in funds. Humana Inc., Kaiser Permanente, and a group of Blue Cross and Blue Shield insurers all have venture units.”

According to officials, the venture fund builds on Cigna's existing venture activity, including collaboration with five venture capital partners and an equal number of existing direct investments. These include leading the C1 round of financing with Omada Health, investments in Prognos, Contessa Health, MDLIVE and Cricket Health.

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The Shock of the New: The Paris Art World of 1916—and the U.S. Healthcare Landscape of 2018

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This year’s “Top Ten Tech Trends” cover story package looks at the emergence of new disruptors to the industry

I’m currently absorbed in a very compelling book, Picasso and the Painting That Shocked the World, by Miles J. Unger, and published this year by Simon & Schuster. This book traces the trajectory of one of the greatest artists of the 20th century, Pablo Picasso, as he moved towards creating a painting that shattered all the artistic conventions of the time: “Les Demoiselles d’Avignon,” a cubist rendering of several women in erotic poses, but with a jagged, savage, pseudo-primitivist artistic treatment that sent shockwaves through the European art world. In choosing an implicitly controversial subject, and moving towards a revolutionary treatment, influenced very strongly by exhibits of indigenous African art that he had recently seen, Picasso relished the opportunity to shock the middle classes—as they say in France, épater les bourgeois. But he also faced a complex set of artistic challenges and dilemmas.

As Unger notes, “By taking up [poet Charles] Baudelaire’s challenge, he was setting up a deliberate contrast, proposing an alternate version of modernism that would not simply substitute a cramped naturalism for the tired formulas of the Academy.” This revolutionary painting, Unger writes, “would have all the metaphysical ambition of a Salon set piece while delivering its message in a language that was completely new: iconoclastic rather than conventional; radical rather than conservative; subversive rather than reassuring.”

Working on and off from late 1906 through late summer 1907, the Spanish artist endured self-doubt, recrimination, and stumbles; work on the painting “consumed him for more than eight months, months of unremitting labor, personal hardship, and spiritual anguish,” Unger reports. And then, when it was finally publicly exhibited in Paris in 1916, “Les Demoiselles” caused shock and furor, before it ultimately became one of the touchstone works of the 20th century. As art critic Hilton Kramer wrote in 1992, “Whereas [Pierre] Matisse had drawn upon a long tradition of European painting—from Giorgione, Poussin, and Watteau to Ingres, Cézanne, and Gauguin—to create a modern version of a pastoral paradise… Picasso had turned to an alien tradition of primitive art to create in Les Demoiselles a netherworld of strange gods and violent emotions.”

And while healthcare industry innovations emerge out of a completely different context from modernist paintings, there is something of the “shock of the new” (to reference art critic Robert Hughes) about some of the new partnerships and delivery and payment innovations taking place these days in U.S. healthcare. Even as the leaders of hospitals, medical groups, and health systems evolve forward into newfangled accountable care organizations and other value-based contracts, unprecedented new business combinations like the planned CVS-Aetna merger and the Amazon/Berkshire Hathaway/JP Morgan Chase initiative, as well as forays by technology giants like Google (Alphabet), Apple, and Microsoft, threaten to shatter l ong-held assumptions about how the healthcare industry will be organized and operated.

This year’s “Top Ten Tech Trends” cover story package looks at the emergence of new disruptors to the industry, as well as a host of other issues facing the industry right now, from the sprint forward towards true interoperability, to the need for patient-generated data to support value-based care delivery, to the question of how industry consolidation will impact physicians in practice. As we’ve done for years now, we editors at Healthcare Informatics bring you the bold, the innovative, the shocking, and the speculative, in a stimulating package of articles that will help you consider some of the top trends impacting the entire industry right now.

No cubist paintings here; but, like the art galleries of Paris in the first decade of the 20th century, a chance to peer into the future of our world.

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