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A Leading CHIO Discusses the VA’s Progress on Health IT Innovation

July 23, 2018
by Heather Landi
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The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., providing care at 1,240 health care facilities, including 170 medical centers and 1,061 outpatient sites of care, serving 9 million enrolled veterans every year.

The VHA is advancing forward in a number of areas to leverage health IT to change the way patients experience medical care and to improve health outcomes. The VA was one of the earliest pioneers of electronic health records (EHRs), as the agency began its shift from a paper-based to a computer-based records system in the 1980s, although research into an electronic system began a decade earlier. Also in the early 1980s, the VA made its software available without restriction in the public domain to other government and private sector organizations, which offers the use of VistA as the standard-bearer for EHR implementation around the world.

Francine Sandrow, M.D., chief health information officer (CHIO) at the Corporal Michael J. Crescenz Veteran's Affairs Medical Center in Philadelphia, is involved in a number of VHA clinical informatics initiatives. Sandrow is a board-certified emergency medicine physician, and she also is boarded in clinical informatics. In her CHIO role, she works to help facilities realize their potential to help patient populations through the application of technology. Sandrow will be speaking on a panel about digitizing patient engagement at the upcoming Florida Health IT Summit, being held at the Hilton St. Petersburg Bayfront July 24-25.

Currently, Sandrow is involved with the VA’s work to standardize instances of the VA’s EHR, known as VistA, in preparation for the roll out of a new Cerner EHR platform, scheduled to be deployed at three sites in Washington state by 2020. The VA signed a contract with Cerner in May, and the entire deployment could take 10 years to complete. “We are working to standardize our tools and our workflows. When they deploy the Cerner EHR, if the workflows are similar across the VA, it will take less work for the deployment at each facility,” she says.

While the Cerner EHR deployment grabs the headlines, the VA healthcare system is moving forward with many innovative IT initiatives, both at the national and local level. Just this past June, President Donald Trump signed the Veterans Affairs’ Mission Act into law, which will provide more than $50 billion in federal investments to the VA’s healthcare system. Major provisions of that law included an expansion of telehealth services to veterans (passed by Congress as the Veterans in E-Health and Telemedicine Support Act of 2017, or VETS Act). These provisions allow a licensed healthcare professional of the VA to practice his or her profession using telemedicine at any location in any state.

“This gives the VA an incredible opportunity, as it’s allowing a veteran to have telehealth visits with any VA provider, regardless of where the patient is or where the provider is,” Sandrow says, noting that state licensing laws and policies have been a major barrier to the practice of telehealth. “Congress basically obliterated that barrier for the VA and our Office of Connected Care has developed applications to allow telehealth to be provided pretty seamlessly. I think that the VA model is actually going to be one that’s going to be looked at by community providers. It’s amazing that we now we have a network throughout the country of all these providers who can see patients anywhere.”

Sandrow notes that there are significant advantages to working in the VA healthcare system to advance health IT initiatives.

“I think I’ve had opportunities here because of the size of the organization, opportunities that you just don’t get in your typical community hospital or even academic institution,” she says. “One of the things that I think people don’t realize is that the VA is the single-largest graduate medical education provider in the country. Most of our major VA centers have academic affiliates and we have agreements where research is done across the two institutions. In Philadelphia, our academic affiliate is the University of Pennsylvania. Our research department is fairly large, and we have a lot of grants that are coming in, and that leads to unique opportunities for us.”

Sandrow points to a project she was involved in that was a collaboration between the VA and IBM Watson Health. “For that project, I was able to work with our human factors engineering team, and that project focused on identifying patients who were at-risk for post-traumatic stress disorder, but who had not actually been diagnosed with it. Through this project, they were identifying patients at-risk by simply feeding their charts into the engine of Watson. I think working within the VA, whatever your interest is in, as long as its improving veteran care, you have opportunities to grow. It’s exciting.”

In a separate collaboration, this week, the VA announced it was extending its partnership with IBM Watson Health to apply artificial intelligence to help interpret cancer data in the treatment of veteran patients. First announced two years ago as part of the National Cancer Moonshot initiative, VA oncologists have now used IBM Watson for Genomics technology to support precision oncology care for more than 2,700 veterans with cancer, according to a press release.

VA treats 3.5 percent of the nation's cancer patients—the largest group of cancer patients within any one healthcare group. VA established a central “hub” in Durham, North Carolina where a group of oncologists and pathologists receive tumor samples from patients nationwide and sequence the tumor DNA. They then use AI to help interpret the genomic data, identifying relevant mutations and potential therapeutic options that target those mutations. More than one-third of the patients who have benefited from VA's precision oncology program are veterans from rural areas where it has traditionally been difficult to deliver cutting-edge medical breakthroughs, according to the VA.

Driving Innovation on Many Fronts

Sandrow also notes that the sheer size of the VHA can be a barrier to clinicians and IT leaders sharing best practices. To address this issue, the VHA initiated a Shark Tank-style competition to identify best practices to improve veterans’ health care. According to the VHA website, this past January, 10 winning ideas were selected from among 19 finalists for the first Shark Tank competition. Champions for each of the 10 practices completed a six-month facilitated replication at one or more VA facilities, adapting and implementing their programs, leading to gold status practices being replicated at over 40 sites.

“Many of these projects are going on to be funded, developed and deployed throughout the country. I think we have a lot of ground-breaking processes that we’re working on and that you’re seeing being reflected in the community hospitals,” Sandrow says.

Sandrow also points to the VHA’s Life-Sustaining Treatment Decisions Initiative (LSTDI) as another industry-leading effort. LSTDI is a national VHA quality improvement project led by the National Center for Ethics in Health Care (NCEHC) with the aim of promoting personalized, patient-driven care for veterans with serious illness by eliciting, documenting, and honoring their values, goals, and preferences. The initiative involves a new national policy to standardize practices related to discussing and documenting goals of care and life-sustaining treatment decisions, and the tools, resources, education, and monitoring to support clinicians and facilities in making practice changes.

VA is the first health care system in the world to develop and implement practices and related tools across the health care system, setting a new standard for discussing and documenting treatment decisions with high-risk patients, according to the VA.

“When people reach the end of life, whether it’s a natural end of life or they have developed a terminal condition, there are decisions that have to be made, and medicine, as a whole, does a very poor job of handling those discussions,” Sandrow says. “The VHA has developed an entire program to not only document patients’ preferences, but to provide patients, through our palliative care providers, support and assistance at that difficult time in the patient’s life. When you are treating a patient, you’re also treating their family, and the end of life is one of hardest times for the family as well.”

VA healthcare leaders are also focused on advancing population health management efforts, particularly to improve preventive care measures. Through a partnership with Walgreens, veterans can receive immunizations, such as flu vaccines, at any Walgreens location and the immunization records are electronically shared with the VA and then connected to the patient’s VA medical record. Both Walgreens and VA are participants in the Sequoia Project’s eHealth Exchange, a health data sharing network, which enables veterans’ medical records to be integrated. According to Sandrow, this data sharing effort enables the immunization records from Walgreens to be reconciled with VA providers’ clinical reminders, enabling them to more effectively provide patient-centered care.

“Another area that we’re working on right now is that we are working to identify high-risk populations,” Sandrow says. “We have a tool that identifies, via a CAN (care assessment need) score, that estimates the probability that a patient is going to have a significant hospitalization or death within the next 365 days. We can use that score to find people who are being underserved. If you have someone who has a really high CAN score, but has a low cost to the VA, then we may be missing opportunities.”

She continues, “Because our EHR addresses all aspects of that patient’s care—primary care, inpatient, mental health—we have an advantage, I think, over many of the community organizations. What we’re trying to do now is to bring together the data that we have and the risk factors that we can identify to improve care, across the board, to our patients.”




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Survey: Healthcare Orgs Ramping up Investment in AI, Confident about ROI

November 16, 2018
by Heather Landi, Associate Editor
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The majority of health care executives (91 percent) are confident they will see a return on investment (ROI) on artificial intelligence investments, although not immediately, and foresee the greatest impact of AI will be on improving health care, according to an OptumIQ survey.

Most (94 percent) health care leaders responded that their organizations continue to invest in and make progress in implementing AI, with 75 percent of healthcare organizations say they are implementing AI or have plans to execute an AI strategy, based on OptumIQ’s survey of 500 senior U.S. healthcare industry executives, primarily from hospitals clinics and health systems, life sciences organizations, health plans and employers. OptumIQ is the intelligence arm of data and analytics of Optum, an information and technology-enabled health services business that is part of UnitedHealth Group.

While many healthcare organizations have plans, progress is mixed across sectors. Of the 75 percent who are implementing AI or have plans to execute an AI strategy, 42 percent of those organizations have a strategy but have not yet implemented it. Employers are furthest along, with 22 percent reporting their AI implementations are at a late stage, with nearly full deployment.

The average AI implementation is estimated to cost $32.4 million over five years. The majority of respondents (65 percent) do not expect to see a ROI before four years with the average expected period being five years. However, employers (38 percent) and health plans (20 percent) expect ROI sooner, in three years or less, according to the survey.

The survey found that health care leaders universally agree the greatest impact of AI investment will be on improving health care. Thirty-six percent expect AI will improve the patient experience; 33 percent anticipate AI will decrease per-capita cost of care; and 31 percent believe AI will improve health outcomes.

Most health care leaders believe AI can make care more affordable and accessible. Ninety-four percent of respondents agree that AI technology is the most reliable path toward equitable, accessible and affordable health care.

AI will make care more precise and faster, according to respondents. The top two benefits respondents expect to see from incorporating AI into their organizations are more accurate diagnosis and increased efficiency.

The survey found that respondents are looking to AI to solve immediate data challenges – from routine tasks to truly understanding consumers’ health needs. Of those health organizations that are already investing in and implementing AI: 

  • 43 percent are automating business processes, such as administrative operations or customer service;
  • 36 percent are using AI to detect patterns in health care fraud, waste and abuse; and
  • 31 percent are using AI to monitor users with Internet of Things (IoT) devices, such as a wearable technology

With more organizations seeing the benefit of adopting an AI strategy, 92 percent agree that hiring candidates who have experience working with AI technology is a priority for their organization. To meet this need, nearly half (45 percent) of health care leaders estimate that more than 30 percent of new hires will be in positions requiring engagement with or implementation of AI in the next 12 months. However, health organizations seeking to hire experienced staff will likely face talent shortages.

“Artificial intelligence has the potential to transform health care by helping predict disease and putting the right insights into the hands of clinicians as they treat patients, which can reduce the total cost of care,” Eric Murphy, CEO of OptumInsight, said.

“Analytics isn't the end, it's the beginning – it's what you do with the insights to drive care improvement and reduce administrative waste,” Steve Griffiths, senior vice president and chief operating officer of Optum Enterprise Analytics, said. “For AI to successfully solve health care’s biggest challenges, organizations need to employ a unique combination of curated data, analytics and health care expertise... We are already seeing a race for AI talent in the industry that will grow as adoption continues to increase.”






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Breaking: The 2019 Healthcare Informatics Innovator Awards Program is Open

November 15, 2018
by the Editors of Healthcare Informatics
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Providers and vendors can now submit their entries to the Healthcare Informatics Innovator Awards Program

The 2019 Healthcare Informatics Innovator Awards Program is now open for submissions. As always, it’s a great privilege and pleasure for us to sponsor this program.

And as many readers know, the concept of team-base recognition, which began with the 2009 edition of the program, has encompassed numerous sets of multiple winning teams that our publication has recognized for their achievements across a very broad range of areas.

As it always does, the Healthcare Informatics Innovator Awards Program recognizes leadership teams from patient care organizations—hospitals, physician groups, clinics, integrated health systems, payers, HIEs, ACOs, and other healthcare organizations—that have effectively deployed information technology in order to improve clinical, administrative, financial, or organizational performance.

The Innovators Program, as it has in the last few years, also recognizes vendor solution providers who are asked to describe their core products or services in five categories. We are asking vendors to submit their innovation in one of five critical health IT areas: Data Security; Value-Based Care; Revenue Cycle Management; Data Analytics; and Patient Engagement.

Indeed, again this year, the Innovator Awards program will again include two tracks for innovation recognition—one for healthcare provider organizations and one for technology solution providers.

The submission form link for both tracks is right here. The deadline for submissions is January 4, 2019.

What’s more, the winning teams will be featured in an upcoming issue of Healthcare Informatics, and winning vendor teams will be awarded free digital distribution of whitepapers to all HIT Summit Series attendees.

At Healthcare Informatics, we are honored to be able to showcase these kinds of case studies from both providers and vendors, which we believe embodies the spirit of innovation around adaptive change that will light the way for their colleagues from across the industry.

At a time of extraordinary change in healthcare, now is as great a time as ever to showcase your innovations. Please consider submitting an entry to our program, and good luck in your entry!

--The Editors of Healthcare Informatics


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New Blockchain Project Sets to Tackle Provider Credentialing

November 12, 2018
by Rajiv Leventhal, Managing Editor
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A group of five healthcare enterprises—National Government Services, Spectrum Health, WellCare Health Plans, Inc., Accenture, and The Hardenbergh Group—are linking up to participate in a distributed ledger program aimed at resolving administrative inefficiencies related to professional credentialing.

The project, Professional Credentials Exchange, is being developed by ProCredEx and Hashed Health, a blockchain innovation consortium. The exchange leverages “advanced data science, artificial intelligence, and blockchain technologies to greatly simplify the acquisition and verification of information related to professional credentialing and identity,” according to officials.

In an announcement, officials noted that credentialing healthcare professionals “is a universally problematic process for any industry member that delivers or pays for patient care.  The process often requires four to six months to complete and directly impedes the ability for a healthcare professional to deliver care and be reimbursed for their work.”

They added, “Hospitals alone forfeit an average of $7,500 in daily net revenues waiting for credentialing and payer enrollment processes to complete.  Further, nearly every organization required to perform this work does so independently—creating a significant administrative burden for practitioners.”

As such, the groups, via the exchange, will aim to address the time, cost, and complexity associated with these processes by facilitating the secure, trusted exchange of verified credentials information between exchange members.

Included in the collaboration are WellCare Health Plans, which serves about 5.5 million members, and Spectrum Health, a 12-hospital health system in western Michigan. National Government Services is a Medicare contractor for the Centers for Medicare & Medicaid Services (CMS), and processes more than 230 million Medicare claims annually.

"A fundamental component of developing the exchange lays in building a network of members that bring significant verified credential datasets to the marketplace," Anthony Begando, ProCredEx's co-founder and CEO, said in a statement.  "These are the leading participants in a growing group of collaborators who bring data and implementation capabilities to accelerate the deployment and scaling of the exchange."

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