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NorthShore Partners with Genetics Testing Lab to Fast-Track Personalized Medicine

September 12, 2017
by Rajiv Leventhal
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NorthShore University HealthSystem’s Center for Personalized Medicine and Ambry Genetics, a clinical genetics-testing lab, are partnering up to offer genetic testing and research in a step towards advancing precision medicine in preventive care.

Specifically, Aliso Viejo, Calif.-based Ambry is collaborating with NorthShore’s Genomic Health Initiative (GHI) by performing whole exome sequencing (WES) on 10,000 enrolled patients and compiling their sequencing data and electronic medical record (EMR) data in an IRB-approved (internal review board) study. According to officials of the organizations involved, GHI is a comprehensive genomic research program designed to investigate genetic variations (DNA mutations) that may contribute to certain conditions affecting NorthShore (Evanston, Ill.) patients. The results of these analyses may lead to new insights into the relationship between genetic variation and disease.

This partnership looks to bring a paradigm shift regarding the role hospitals play in the future of genomic medicine. The collaboration’s aim is to empower clinicians with innovative diagnostic tools and data interpretation to galvanize a new era of precision medicine that can be a blueprint for hospitals broadly. The collaboration centers on NorthShore’s advanced EMR system integration and the dissemination and coordination of genetic testing to healthcare providers, from primary care to obstetrician gynecologists to cardiologists. When appropriate, cases will be referred to NorthShore’s network of sub-specialized genetic counseling clinics, according to officials.

With a prevention-minded approach, another initiative of the partnership is to implement and utilize a genetic risk score (GRS), which summarizes a person’s genetic predisposition to disease using aggregated data from multiple risk variants. The GRS test was developed by NorthShore researcher Jianfeng Xu, in order to provide primary care physicians with a quantitative tool to better understand and stratify risk of disease.  The initial focus is to offer the GRS test for prostate cancer and then expand to other conditions.

“Preventing and managing disease through scientific excellence and high-quality care is the cornerstone of this partnership,” said Aaron Elliott, Ph.D., CEO, Ambry Genetics, said in a statement. “NorthShore and Ambry share the same patient-first philosophy and focus on scientific innovation to improve the future of healthcare.”

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Study: Clinical Decision Support EHR Alerts Can Lower Health Costs, Complications

August 20, 2018
by Rajiv Leventhal
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When physicians follow the recommendations of context-specific clinical decision support at the point of care, clinical and financial outcomes should improve, according to new research.

Researchers, in the recent study, published in the American Journal of Managed Care, examined more than 26,000 patient encounters to determine whether utilization of clinical decision support (CDS) is correlated with improved patient clinical and financial outcomes. In the treatment group, the provider adhered to all CDS recommendations, while in the control group, the provider did not adhere to CDS recommendations.

The analysis examined the associations between adherence to recommendations from Choosing Wisely—a clinical decision support platform from Stanson Health—embedded into clinical decision support alerts, and four measures of resource use and quality.  They found and concluded:

  • Encounters in which providers adhered to all alerts had significantly lower total costs, shorter lengths of stay, a lower probability of 30-day readmissions, and a lower probability of complications compared with nonadherent encounters.
  • Full adherence to Choosing Wisely alerts was associated with savings of $944 from a median encounter cost of $12,940.
  • Health systems should consider real-time CDS interventions as a method to encourage improved adoption of evidence-based guidelines.

In 2012, the ABIM Foundation—a healthcare quality organization devoted to advancing medical professionalism—introduced the Choosing Wisely (CW) initiative, a voluntary effort by more than 70 physician subspecialty societies to identify commonly used low-value services, with the intent to stimulate provider–patient discussions about appropriate care and thereby reduce low-value tests and treatments. But initial research of the CW recommendations found that providers had difficulty interpreting guidelines and evaluating patient risk.

To this end, the researchers attested that an EHR (electronic health record) infrastructure could provide real-time computerized clinical decision support to inform healthcare providers when their care deviates from evidence-based guidelines. CDS comprises a variety of tools, including computerized alerts and reminders with information such as diagnostic support, clinical guidelines, relevant patient information, diagnosis-specific order sets, documentation templates, and drug–drug interactions.

For this study, CW recommendations were implemented in the EHR at a large academic health system in the form of 92 alert-based CDS interventions, both inpatient and ambulatory. When initiating a potentially inappropriate order, a provider received real-time notification of deviation from a CW recommendation. That provider then had the option to cancel, change, or justify the order, if he or she agreed with the alert’s recommendation in the context of the individual patient.

It should be noted that two of the study’s authors are employed by Optum, which is a licensed reseller of Stanson Health, including its Choosing Wisely alert content evaluated in this study. What’s more, another of the authors is employed by Cedars-Sinai, which is the major shareholder of Stanson Health.

In the end, the researchers recommended that health systems consider real-time CDS interventions as a method to encourage improved adoption of CW and other evidence-based guidelines. A meta-analysis of CDS systems concluded that by providing context-specific information at the point of care, the odds of providers adopting guideline recommendations are 112 times higher.

They concluded, “Our findings contribute to the evidence base surrounding the use of CDS and improvements in patient clinical and financial outcomes. Formal prospective cohort studies and randomized CDS intervention trials, perhaps randomizing providers assigned to receive CDS interventions, should be prioritized to help guide future provider strategies in regard to reducing low-value care.”

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Study: Many U.S. Hospitals won’t Reach HIMSS Stage 7 Until 2035

August 14, 2018
by Rajiv Leventhal
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Unless the healthcare IT ecosystem experiences major policy changes or leaps in technological capabilities, many hospitals will not reach Stage 7 of HIMSS Analytics’ Electronic Medical Record Adoption Model (EMRAM) until 2035, according to new research.

The study, published in the August edition of the Journal of Medical Internet Research, analyzed Healthcare Information and Management Systems Society (HIMSS) Analytics’ EMRAM data from 2006 to 2014.

HIMSS Analytics is the research arm of the Healthcare Information and Management Systems Society (HIMSS). HIMSS Analytics developed the EMRAM in 2005 as a methodology for evaluating the progress and impact of electronic medical records on health systems around the world. Tracking their progress in completing eight stages (0-7), hospitals can review the implementation and utilization of information and technology applications culminating with Stage 7, which represents an advanced electronic patient record environment. Other Stage 7 requirements include: leveraging an external HIE (health information exchange); use of a data warehouse; and having robust data analytics functions.

The researchers of this study noted that the meaningful use (MU) program has promoted electronic health record (EHR) adoption among U.S. hospitals. And while studies have shown that EHR adoption has been slower than desired in certain types of hospitals; generally, the overall adoption rate has increased among hospitals.

However, the researchers continued, these studies have neither evaluated the adoption of advanced functionalities of electronic health records (beyond meaningful use,) nor forecasted EHR maturation over an extended period in a holistic fashion. “Additional research is needed to prospectively assess U.S. hospitals’ electronic health record technology adoption and advancement patterns,” the researchers stated.

The HIMSS EMRAM data set was used to track historic uptakes of various EHR functionalities considered critical to improving healthcare quality and efficiency in hospitals. A technology diffusion model was then used to predict the technological diffusion rates for repeated EHR adoptions where upgrades undergo rapid technological improvements. The forecast used EMRAM data from 2006 to 2014 to estimate adoption levels to the year 2035.

In 2014, more than 5,400 hospitals completed HIMSS’ annual EMRAM survey (86 percent of total U.S. hospitals). Back in 2006, the majority of the U.S. hospitals were in EMRAM Stages 0, 1, and 2. But by 2014, most hospitals had achieved Stages 3, 4, and 5, the study noted.

The researchers found that in 2006, the first year of observation, peaks of Stages 0 and 1 were shown as EHR adoption precedes HIMSS’ EMRAM. By 2007, Stage 2 reached its peak. Stage 3 reached its full height by 2011, while Stage 4 peaked by 2014. This forecast indicates that Stage 5 should peak by 2019 and Stage 6 by 2026, according to the data revealed in the study.

The researchers noted, “Although this forecast extends to the year 2035, no peak was readily observed for Stage 7. Overall, most hospitals will achieve Stages 5, 6, or 7 of EMRAM by 2020; however, a considerable number of hospitals will not achieve Stage 7 by 2035.” They concluded, “These results indicate that U.S. hospitals are decades away from fully implementing sophisticated decision support applications and interoperability functionalities in electronic health records as defined by EMRAM’s Stage 7.”

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HHS OIG Fines eClinicalWorks $132,500 For Violating Corporate Integrity Agreement

August 1, 2018
by Heather Landi
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The Health and Human Services (HHS) Office of Inspector General (OIG) fined electronic health record (EHR) vendor eClinicalWorks $132,500 for failing to report patient safety issues to the regulatory body as reportable events in a timely manner.

According to the OIG website, eClinicalWorks paid the fine July 18. The EHR vendor is required to report these patient safety issues to OIG as part of its corporate integrity agreement (CIA) with the agency.

eClinicalWorks entered into a CIA back in May 2017 as part of a settlement with the U.S. Department of Justice to resolve a False Claims lawsuit. According to the DOJ’s case, the company allegedly violated federal law by misrepresenting the capabilities of its software and for allegedly paying kickbacks to certain customers in exchange for promoting its product, according to the U.S. Department of Justice. As part of that settlement, eClinicalWorks also paid a $155 million settlement over the allegations.

The five-year CIA requires, among other things, that the company retain an Independent Software Quality Oversight Organization to assess eClinicalWorks’ software quality control systems and provide written semi-annual reports to OIG documenting its reviews and recommendations. The company must provide prompt notice to its customers of any safety related issues and maintain on its customer portal a comprehensive list of such issues and any steps users should take to mitigate potential patient safety risks.

Further, the agreement also requires eClinicalWorks to allow customers to obtain updated versions of their software free of charge and to give customers the option to transfer their data to another EHR software provider, without penalties or service charges. The vendor must also retain an Independent Review Organization to review its arrangements with healthcare providers to ensure compliance with the Anti-Kickback Statute.

 

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