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Cerner, Children's National to Help UAE Pediatric Center with Health IT

February 15, 2018
by Rajiv Leventhal
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Al Jalila Children's Specialty Hospital, the only pediatric hospital in the United Arab Emirates, has entered into an agreement with Washington, D.C.-based Children's National Health System to form a health IT strategic partnership.

The partnership is an extension of The Bear Institute for Health Innovation, a Children's National collaboration with Cerner Corporation, according to officials. Per the terms of the deal, Cerner, the electronic health record (EHR) company based in Kansas City, Mo., will serve in a strategic advisory role to guide Al Jalila Children's in effectively using health IT to deliver high-quality care for children across the Gulf Cooperation Council and the region.

Formed in 2013, The Bear Institute is a partnership created between Children's National Health System and Cerner to advance evidence-based pediatric medicine through technological innovation. The Bear Institute has rolled out dozens of solutions to some 3,000 caregivers across the Children's National health system. 

"We're excited to enter into this new collaboration with Al Jalila Children's and, with the support of Cerner, plan to bring our best practices in patient-centered health IT to children in the UAE," said Kurt Newman, M.D., president and CEO of Children's National.

Added Mohamed Alawadhi, M.D., chief operating officer of Al Jalila Children's, “As the only children's hospital in the UAE and one among the few in the Middle East, we are constantly striving to provide the best possible care for patients, and this includes excellence in service delivery and subsequent patient satisfaction. At Al Jalila Children's, we have adopted global industry practices for IT, and with the signing of this agreement with Children's National, we aim to achieve a robust system with advanced and evidence-based pediatric care clinical pathways that will assist in providing high-level medical care to children in the UAE and the region."

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At the Beverly Hills HIT Summit, CIO Tracy Donegan Shares the Story of Her Los Angeles Hospital’s Up-From-the-Ground IT Development

November 13, 2018
by Mark Hagland, Editor-in-Chief
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Martin Luther King, Jr. Community Hospital CIO Tracy Donegan shared insights from her team’s experiences laying the hospital’s IT foundation

What is it like to start from scratch with a new hospital design expressly for a high-need community, and to create the entire IT and physical infrastructure for that facility? That’s exactly the proposition that was facing Tracy Donegan and a team of IT and other professionals, prior to the July 2015 opening of the 131-bed Martin Luther King, Jr. Community Hospital (MLKCH) in south central Los Angeles in July 2015.

Offering an insider’s view of all the preparations leading to that opening, Tracy Donegan, MLKCH’s chief information and innovation officer, shared her perspectives on the lessons learned in that process, with attendees, on November 8, at the Sofitel Hotel Los Angeles at Beverly Hills, during the Beverly Hills Health IT Summit, sponsored by Healthcare Informatics. Donegan offered those perspectives in the opening keynote address at the Summit on Thursday morning, under the title, “Developing a World Class IT Infrastructure for a World Class Hospital.”

That 2015 hospital opening represented a ground-up effort that incorporated the latest technology into its design. It also marked the closing of a one chapter of South Los Angeles’ health history and the beginning of a new one, as MLKCH shares the same site in the Willowbrook neighborhood as the area’s previous hospital, Martin Luther King Jr./Drew Medical Center, which had closed in 2007.

“The original King-Drew Health Center was borne out of the 1968 riots,” Donegan told her Summit audience. “The governor did a study and found that a lack of healthcare was a major cause of unrest. But it became known as ‘Killer King’” because of its problems. “There was a famous incident involving a patient who was lying on the floor in the ED, and her husband called 911 because no one would help her.” Fortunately, she noted, a strong public-private partnership emerged between Los Angeles County and the University of California systems, which in 2011 formed a 501c3 organization, which engaged Elaine Batchlor, M.D., as CEO.

“In the beginning,” Donegan told her audience, “there was absolutely nothing there, there were no employees, there was no technology, no building, it was definitely a  blank slate. We wanted to be bold and take a risk, and Dr. Batchlor, when she was forming the team—made sure to start with a mission and a vision for the organization; she wanted to bring something to the community that they could be proud of and call their own, not just replace the old hospital.”


Tracy Donegan

As Healthcare Informatics Associate Editor Heather Landi noted in a Sep. 11 article on the MLKCH opening,  Donegan told her that “We were fully unencumbered by technology and the systems that you would have in a hospital that had been opened for many years. We were able to implement a fully integrated electronic health record (EHR) from the get-go.”

Built from the ground up, MLKCH incorporates technology into every aspect of its design—from the facility itself to service delivery to post-discharge care, according to Batchlor. “We deliberately sought the technology and used the technology as we designed our policies, procedures and approaches to care delivery from the beginning,” she told Landi.

Further, “The hospital was recognized by HIMSS Analytics, the analytics arm of the Healthcare Information and Management Systems Society (HIMSS), as Stage 6 on the EMR (electronic medical record) Adoption Model in its first year of operation. This year, the hospital was recognized as HIMSS Stage 7 for EHR best practices—a status achieved by only 6.4 percent of hospitals nationwide by the end of 2017.”

What’s more, as Landi reported, “The inpatient facility was constructed to integrate technology into care delivery. All inpatient beds are ‘smart beds’ that weigh each patient automatically each day and record the findings in the patient's EHR. The “smart beds” also detect when a patient is getting out of bed and can alert the attending nurse if the patient is deemed a fall risk,” Donegan told Landi. Inpatient rooms also are wired with MyStation technology for patient interaction. “By using the TV in the patient’s room, we can engage the patient in health education when he or she first arrives at the hospital. They take a fall risk assessment on their TVs, and that’s integrated with the EHR so that clinicians are notified of patients with a fall risk,” she said.

Meanwhile, “The hospital’s clinical staff carry secure smartphones that interface with the EHR system and inpatient biomedical devices. Donegan also noted that “We also have over three dozen unique medical devices integrated with the EHR, and that was unique and progressive at the time we opened the hospital.” The hospital opened with clinical protocols programmed into the EHR system, she says. “That helps clinicians practice in a manner that’s consistent with best practices and evidence.”

“Technology is really about supporting high-quality patient care and patient safety,” Donegan said. “One area that we are really proud of is our ability to leverage technology to support medication safety. We use smart bar coding and scanning for dispensing medications in the hospital and for use of blood products. That is a huge patient safety boost.”

Later in the day on Nov. 8, Donegan sat down with Healthcare Informatics Editor-in-Chief Mark Hagland, to converse about her experience. Below are excerpts from that interview.

Can you speak to the advantages versus disadvantages of building a hospital’s IT infrastructure from the ground up?

Well, the huge advantage was that we could do anything. The sky was the limit, and really, we did anything we wanted.

Did you face significant budget limitations?

We really weren’t too limited. The IT budget was $16 million, which was good for a pretty small hospital. Where we held back was what we knew we couldn’t implement—for example, RFID, and patient information systems. There was so much going on. And it was easy in the sense that we didn’t have to rip and replace. And the vendors really had a hard time understanding that we didn’t need everything—we didn’t need data migration capabilities. Yet that also hurt us because we couldn’t hire everyone at once, we were all strangers working on this. So we had to do a lot of optimization. And when the new people came on board, there was some redesign they were asking us to do. And we still want to adhere to our guiding principles. We tried to focus as much on single-source vendor offerings, pre-built content, and implementing broadly usable solutions.

Would you say that you made any big mistakes along the way?

We made some funny minor mistakes, such as wasting a bit of money on a soft go-live prior to the full go-live. And we did things like buying the wrong supply cabinets that didn’t fit the spaces, for example. It was just silly things. For example, we couldn’t finish our server room because the cell phones didn’t work in the basement.

It’s a bit like building a house, then?

Yes, it really is.

What do you think you did really well?

I think the teaming aspect was really smart. But again, we can’t take credit for that, because that was built into the story of the hospital. But in 2012 when I came in, there were only five of us. And I wrote the requirements for HR, and I didn’t know a thing about it. And sometimes, not knowing is a blessing, because you’re fresh. So I remember building out that whole application portfolio and all the interfaces. We had our interface design schematic filled out before we even started the Cerner implementation.

What would you say to fellow CIOs and to CMIOs, about the cultural issues involved?

I had prepared a slide for the presentation that I didn’t end up including, which focused on the consultant mentality—in a very good sense. It’s about the fact that everyone in the organization are my clients. Here’s an example of what I mean: after I had left the organization after working on contract, and had then come back into it, I had a series of meetings with end-users and leaders in the hospital organization. And my assistant was arranging to have people come to my office to meet with me, and I remember thinking, I should have them coming to me as though I were summoning them. I wanted to look at them as clients.

And in that regard, we were having some dissatisfaction with certain end-user aspects of the clinical information systems, on the part of some specialists. One issue came up around the needs of radiologists. As it turns out, the source of the problem was with UCLA IT; but the radiologists don’t care whose fault a particular problem is; they just wanted that problem fixed. No one wants to hear someone blaming something on someone else. So what I did was that I went out and showed radiologists during their workdays, to find out what was going on for them, and to solve their problems.

And what did you learn?

I learned a lot of different things, and even discovered problems that they didn’t know about that I saw. Meanwhile, solving problems quickly for end-users is important, even if it’s not an IT problem. For example, we’re building a new reading room for the radiologists, and some of them were sending emails, copying everyone in the new organization, complaining that they didn’t have rugs in the reading room. So the vice president of facilities went out and bought rugs for the reading room the very night that the problem was brought to his attention. And I emailed back to chair of radiology to let him know that the complaint had been addressed. Sometimes, people need to forget about formal titles and roles, and just get things done.

One of the transformations taking place is around the role of the CIO and other senior healthcare IT leaders—the idea that they need to be real strategic and organizational leaders in their patient care organizations, not just, as in the past, order-takers for technology. What are your thoughts on that.

It really is an advisor role. As I said in my presentation, I almost changed my title when I first got the job, in order to take out the “innovation” piece, because really, innovation is part of everyone’s jobs, it’s theirs to own. I think being an advisor and encouraging fellow colleagues to explore new applications and ways of doing things—just being behind them and supporting them and letting them do their job and take their organization to the next level—all that is important. I’m a facilitator. Again, this goes back to the consultant role—especially because I was a consultant for so long. So in terms of leadership, encouraging them to do their thing. When I first got there, that whole consultant-type role—informaticists acting as consultants, I asked them how they wanted to be organized, and that’s how they wanted to be organized—as consultants.

 

 


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In Texas, Healthcare Leaders Take a Tech-Enabled Approach to Combat the Opioid Crisis

September 28, 2018
by Heather Landi, Associate Editor
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In many ways, emergency physicians across the country are at the front lines of the battle against opioid abuse and addiction, as patients who are abusing or addicted to opioids are frequent users of emergency care.

The ED is often a hospital “entry point” for addicted patients, who present in the ED asking for prescription opioids to manage pain, or patients who are overdosing may arrive for treatment or are experiencing related crises. A significant challenge facing the healthcare industry in trying to combat opioid addiction is the lack of real-time information available at the point of care to alert emergency physicians about a patient’s medication use and history of ED visits.

Armed with real-time information about patients’ and their opioid use, physicians can provide referrals for substance abuse treatment or case management, rather than duplicating medical tests performed at another hospital. Tied in with the issue of opioid addiction, but also separate from it, excessive use of ED care is an ongoing problem facing hospitals and health systems as high users of ED care often have underlying social, mental or substance abuse problems that require care coordination and healthcare services provided outside of a hospital.

Healthcare leaders in Texas recently took steps to address many of these challenges facing hospital ED care teams by working with Salt Lake City-based company Collective Medical to give care teams throughout the state access to the Collective network and care coordination platform. The Texas Hospital Association (THA), which represents more than 85 percent of the state’s acute care hospitals and healthcare systems, or about 486 organizations, announced a partnership with Collective Medical back in May that will enable ED care teams in member hospitals to have access to an information exchange for more actionable information at the point of care.

While Texas is not the hardest-hit state in the opioid epidemic, the number of people in Texas dying from an overdose of opioids continues to grow. In 2016, there were 1,375 opioid-related overdose deaths­­­ in Texas, a rate of 4.9 deaths per 100,000 persons compared to the national rate of 13.3 deaths per 100,000 persons, according to the National Institute on Drug Abuse.

According to Collective Medical, the Emergency Department Information Exchange (EDie) platform will enable care teams in Texas hospitals to more rapidly identify complex patients in real-time with notifications and actionable care plan information. Through the platform, which integrates with electronic health record (EHR) systems, providers also gain insights into their patients, such as prior ED utilization, social determinants, prescription histories and advanced directives, which enables provide to make informed decisions regarding medically unnecessary admissions and readmissions.  

“Collective is proven to improve patient outcomes in states across the country, and it is an invaluable tool for hospitals combating the opioid epidemic,” Ted Shaw, THA president and CEO, says. Shaw adds that deploying the Collective platform is just the first step to connecting all the caregivers at various point in the continuum of care. “We want to make sure that whether it be in the ER, or in the outpatient setting, within the hospital or between two hospitals, that there is a connectivity that results in actionable information, that sends alerts, and puts information in front of caregivers that allows them to make informed decisions.”

The partnership also supports THA’s recent voluntary guidelines for hospital ED prescribers of opioids, Shaw says. “One challenge with the opioid crisis in Texas is the need to capture information and look at the prescribing patterns out there, and then share that information appropriately in a HIPAA compliant fashion. This system is one that would do that,” he says.

Heather Marshall, M.D., a Texas-based ED physician and president of the Southwest Region for Alteon Health, a physician-led company that provides management and ED staffing services for hospitals, says the technology platform has been a “gamechanger” for ED clinicians in organizations where it’s been deployed.

When ER clinicians have access to real-time information about their patients, including medical histories, ER visits and prescriptions, it enables clinicians to provide better patient care and creates more operational efficiency, Marshall notes. “Instead of taking me two hours to figure out what’s going on with the patient, I have the information in 15 minutes. We can then provide the appropriate care to the patients, and by turning patients more quickly, we create operational efficiency as we can care for more patients.”

She continues, “We have people who have opioid problems and are simply accessing ER departments in good faith because they are not feeling well, but the solution to their problems isn’t necessarily that they need another CT scan, the solution to their problem is that they need treatment and they need to deal with the underlying disorder,” she says, noting that the ED network is a “win for everybody.” We get better operational efficiency when we’re not having to repeat workups and we’re able to get patients follow-up care.”

Marshall recently moved to Houston, but also currently continues to practice emergency medicine in New Mexico, where she previously lived. Marshall is familiar with Collective Medical’s ED network and care coordination platform as a result of her previous emergency medicine work both in New Mexico and in Washington State, where the technology has been deployed. The benefits of the Collective network also havespread by word-of-mouth among ED physicians.

About 10 years ago, many practicing clinicians in Seattle hospitals were recognizing the growing problem of opioid abuse and overdoses, according to Marshall. “Many of the practicing clinicians had identified issues with care coordination and lack of interoperability between EHRs. We felt it day-to-day, but we didn’t have data to move things. In 2007, the levers shifted, and we were able to identify that we had a health emergency on our hands and we needed a different set of tools,” Marshall says.

Several hospital ER departments in Seattle initially piloted Collective Medical’s EDie platform, and the platform was then rolled out across most of the state as part of a statewide collaborative effort to address overutilization of ED services. That effort was spearheaded by the Washington State American College of Emergency Physicians, the Washington State Medical Association and the Washington State Hospital Association. The initiative, called “ER is for Emergencies,” deployed seven best practices, one of which centered on interoperable health information exchange. As part of that effort, the collaboration engaged with Collective Medical to deploy its EDie technology. Other best practices focused on development of patient care plans, participating in prescription monitoring programs and patient education on appropriate ED use, Marshall notes.

According to a Brookings Institute study of the Washington State “ER is for Emergencies” program, the state saved $34 million in emergency department costs and Medicaid ED visits declined 10 percent in its first year of use in 2013. Likewise, care teams across the state have reduced opioid prescriptions coming out of the ED by 24 percent since the program’s inception.

A similar effort was rolled out in in the state of New Mexico in 2016 through a collaboration between the New Mexico Hospital Association, UnitedHealth Group, Molina Healthcare, Blue Cross Blue Shield and Presbyterian Healthcare Services. Collective Medical is currently partnered with more than a dozen state hospital associations and more than 550 hospitals in 13 states, from Alaska to Massachusetts, have deployed the company’s software and have joined the ED network. The technology platform is endorsed as a best practice for emergency medicine by the American College of Emergency Physicians.

According to Collective Medical, use of the network has improved care collaboration in healthcare organizations across the country. CHI St. Anthony’s Hospital, a critical access hospital located in Pendleton, Oregon, was able to reduce unnecessary ED visits from identified frequent ED users from 17 percent of overall visits to nine percent within six months of implementing the Collective platform. Within one year, the hospital reduced narcotic prepack prescriptions coming out of the ED by 60 percent and realized hospital cost savings of $200,000, the company says.

Even with widespread use of EHRs and health information exchanges (HIEs), Marshall says there are often gaps in real-time information about a patient’s medical history and a technology solution, such as the Collective Medical platform, can help to fill those gaps

“It’s a difference between push and pull,” she says, noting that an ER physician typically needs to have a concern about a patient or a suspicion that a patient has recently been to another ER in order to query the EHR or HIE. “You’re really dependent on making a judgment about a patient or them disclosing information. That’s a pull; I have to go and ask for information,” she says. “What Collective Medical Technologies is doing is their system is a push system. Every state or organization sets the trigger threshold for what they are looking for. The ER doctors can set the trigger threshold so that if a patient has been to a local ER, let’s say five or six times in the last 12 months, the system pushes that notification to the physician.”

A Collective Effort to Combat the Opioid Crisis

There are efforts at the hospital, community, state and federal level to address the growing problem of opioid misuse, abuse and addiction. Last week, the U.S. Senate passed The Opioid Crisis Response Act of 2018, which includes numerous important health IT provisions. The House passed its version of the legislation in June, and a committee to reconcile the differences between the two is nearing a resolution.

While the opioid crisis has gained attention in the past few years, Marshall says the problem of opioid abuse and addiction has been building for two decades. “When I was in medical school from 1996 to 2000, all the teaching to nurses and physicians was that we don’t treat pain enough. The entirety of the subject matter on this was more pain treatment, and for some reason, we locked ourselves into thinking that only meant opioids,” she says. “It’s become pretty clear to me that what I was taught in medical school has created a new set of problems, and we didn’t have a good handle on how to treat that problem.”

She continued, “We’ve learned that even giving three or four days of scheduled narcotics can change the patient’s body chemistry such that they develop some tolerance. If I’m a treating clinician, and I suddenly have information that tells me that the injury that this patient has is an old injury, not a new injury, that might change the medicine that I prescribe that day.”

Marshall also notes that there is growing support in the medical community for the application of universal precautions to patients being considered for or treated with opioid therapy for chronic pain. The concept of universal precautions has its origins in infectious diseases, such as wearing gloves when handling blood products. “The idea is that we should be using universal precautions every time we prescribe opioids. Every person that I prescribe an opioid to has a risk for addiction. As an ER physician, I don’t have time to do the level of analysis to determine that person’s risk. So, you can give a patient two pills, and then have them follow up with a primary care doctor a pain management specialist who can determine the co-morbidities for addiction dependence or medication misuse,” she says.

And, Marshall notes that the work to address today’s opioid epidemic will be a long-term effort. “It’s going to takes us 15 to 20 years to catch up to the addiction that has developed over the last 20 years. But, if we start doing the right things now, we’re going to see the benefit in 10 to 15 years,” she says.

 

 


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A New Development Throws a Wrench into the Athenahealth Saga

September 18, 2018
by Mark Hagland
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The ongoing drama over the future of EHR vendor athenahealth seems to have entered a new phase, with a development that potentially throws a monkey wrench into its business process

The ongoing drama over the future of the Watertown, Massachusetts-based athenahealth appears to be continuing. Healthcare Informatics Managing Editor Rajiv Leventhal reported on Sep. 7 that “Elliott Management, a New York hedge fund led by billionaire Paul Singer, is the favorite to win the athenahealth takeover bid now that Cerner and UnitedHealth have declined an opportunity to acquire the health IT company, according to a report in the New York Post.”

Now, however, the situation seems abruptly to have changed. The New York Post reported on Monday that “Paul Singer’s Elliott Management has backed away from its $160-a-share bid for Athenahealth, The Post has learned. Singer, while getting cold feet at $160 per share, could be mulling a bid at a lower price, sources said. At the same time, other suitors — including some strategic companies that had made initial inquiries — have also gone quiet, sources close to the situation said.”

The Post’s Josh Kosman and Carleton English, who had also authored the newspaper’s Sep. 6 report, stated in yesterday’s article that, “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,” they added.

What’s more, they wrote, “Elliott succeeded in a tough activist fight to get Athena to oust founder and chief executive Jonathan Bush, a cousin of former President George W. Bush, and to put the company up for sale.  Singer’s firm in May said it was prepared to pay $6.9 billion for Athena — contingent on due diligence.” And they quoted an unnamed source who told them, “There has been a lot of speculation on Elliott’s motives” for saying in May it was prepared to pay $160 a share. “It feels now like they never really wanted to own it” and were just setting a floor for the auction, the source told the reporters. athenahealth is a leading vendor of electronic health record and physician practice management solutions.

Healthcare Informatics will update readers on this story as new developments occur.

 

 

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