A digital front door that no one’s walking through

The Weekly Gist: The Winter is Coming Edition

Image result for patient portal

Here’s this week’s good news in health IT: over 90 percent of hospitals now provide portals or similar platforms allowing patients to electronically access their medical records, according to a new report from the Office of the National Coordinator for Health IT (ONC).

The bad news, however, is that few patients actually use them. Fewer than eight percent of hospitals report that half or more of their patients have activated their patient portal, and nearly 40 percent reported that less than ten percent of patients have logged on. This is in spite of data in the report showing that two-thirds of hospitals offer services like secure messaging, electronic bill pay, and online scheduling that are highly valued by consumers.

The root cause lies in simplicity and connectivity. Each hospital or independent physician practice has its own portal, forcing the patient to manage multiple logins and navigate myriad systems, each of which only displays a slice of their medical records. Rarely can the systems communicate with each other to allow providers access to the patient’s complete record.

Asking patients to navigate multiple portals from different healthcare providers is like asking them to use different web browsers for each site they visit—it’s cumbersome and nonsensical, the hallmark of a design driven by regulatory requirement rather than consumer value.

What’s needed is one, unified consumer portal for healthcare, which integrates all the different providers’ information feeds. For that, we’d need a truly consumer-centric healthcare system, built around and controlled by the individual. Maybe one day.


Aetna, Anthem, Health Care Service Corporation, PNC Bank and IBM announce blockchain network


Network will eventually be open to new members for secure digital sharing of healthcare information.

Aetna, Anthem, IBM, Health Care Service Corporation and PNC Bank have partnered to create a blockchain technology network aimed at improving transparency and interoperability in the healthcare industry. 

The groups intend to use blockchain for more efficient claims and payment processing. Blockchain enables the secure exchange of information. It will also benefit more accurate provider directories.


Collaboration is key in the industry as a more cost-effective alternative to merging to create more competitive and efficient systems.

The current network is expected to add additional health organizations in the coming months, including providers, startups, and technology companies.

Initial members include three of the nation’s largest insurers, Anthem; HCSC,a customer-owned health insurer that includes Blue Cross and Blue Shield plans; Aetna, which is now part of the CVS Health business; IBM, which is a leading blockchain provider; and PNC Bank, which is a member of The PNC Financial Services Group.

Blockchain technology gives health systems an edge because it ideally creates faster, more efficient and secure claims and payment processing.

Insurers are mandated to maintain accurate provider directories, a time consuming and often manual practice involving numerous emails, phone calls and even fax exchanges.

For providers, a new technology that can actually reduce time spent in administrative clicks on a computer is a boon.


Despite major initiatives to digitize healthcare information, improvements in transparency and interoperability are still needed for that data to be shared.

Blockchain is designed to fill that role, reducing administrative errors and costs and ultimately enhancing patient care. The network also enables the companies to build and deploy new solutions.

Walmart last year filed a patent to use blockchain for medical records. A pharmaceutical industry consortium called the MediLedger Project, launched in 2017, is using blockchain to track pills across the supply chain, according to Fortune.


“Through the application of blockchain technology, we’ll work to improve data accuracy for providers, regulators, and other stakeholders, and give our members more control over their own data,” said Claus Jensen, chief technology officer at Aetna

Rajeev Ronanki, Anthem chief digital officer Rajeev Ronanki: “Timely access to medical information has been a stumbling block for creating a seamless consumer experience. With a trusted foundation based on transparency and cryptography, we will provide a faster, safer and more secure way to exchange medical information to transform the  consumer healthcare experience.”

What’s more, blockchain will enable large networks to exchange health data in a transparent and controlled way, according to Lori Steele, general manager for Healthcare and Life Sciences for IBM.

“Using this technology, we can remove friction, duplication, and administrative costs that continue to plague the industry,” added Chris Ward, head of product, PNC Treasury Management.


Softer bookings dampen Cerner’s Q3 growth


Dive Brief:

  • Cerner’s new bookings fell short of expectations in the third quarter of 2018, leading to lower than expected revenue for the period. While sales of licensed software grew 43% from a year ago to $1.59 billion, the EHR vendor didn’t match the second quarter’s $1.78 billion.  
  • Third quarter revenue totaled $1.34 billion, up 5% from the same period the prior year.
  • The earnings report comes as Cerner is under fire again for its performance on a Department of Defense contract. According to Politico, independent investigators for the Pentagon gave the company poor marks on its MHS Genesis EHR implementation, calling the system “not effective and not suitable” and “not interoperable.” The low assessment echoes an April DOD report.

Dive Insight:

Cerner attributed the lower-than-expected software bookings to timing and pointed to a strong pipeline of potential business hookups. Technology resales were also somewhat off in the third quarter.

“There isn’t anything that’s forcing clients to go get deals done,” Cerner CFO Marc Naughton said during a Thursday earnings call. “The market is still active. We just didn’t get much of it in Q3.”

Cerner also said it is not yet seeing the full impact of government contracts. Nonetheless, officials called it a strong quarter with solid results.

“We continue to have good contributions from our key growth areas” of population health, revenue cycle management and health IT outsourcing, said Chief Client Officer John Peterzalek, who replaces departing President Zane Burke starting next week.

“As we look at our portfolio and our investment plans, there’s some transformation of our own that we need to do to make sure we’re positioned well for the opportunities in front of us,” said Cerner Chairman and CEO Brent Shafer. “Part of that work is creating an operating model that is really designed to support innovation at scale. We are at scale now and want to continue to scale.”

Meanwhile, Cerner faces fresh competition from commercial health giant UnitedHealth, which is expanding into EHRs with a fully integrated system in 2019. During a recent earnings call, UnitedHealth CEO David Wichmann said the company will launch a “fully individualized, fully portable” EHR early next year leveraged off its Rally mobile wellness platform.



ONC Pushes Public Health Agencies to Improve HIE Integration


HIE Integration

The few public health agencies with HIE integration have reported more complete, higher quality data than those without a connection.

An ONC resource on how public health agencies utilize health information exchange (HIE) integration contains best practices and insights using interviews from public health agencies in 16 jurisdictions.

The findings detailed in the report focus on strategies for public health and HIE integration across six categories: leadership, technical, financial, privacy and security, policy, and health IT developers.

ONC partnered with Clinovations Government + Health (CGH) to examine HIE use among public health agencies. These state and community agencies can assist in improving the health of populations through disease prevention activities using data from public health screening and treatment services, laboratories, pharmacies, environmental health monitors, emergency medical services, local public health agencies, and clinical care providers.

Public health agencies function within states and communities and collect data from providers to use for data registries and disease surveillance systems. With an HIE connection, public health agencies can benefit from improved interoperability and reduce redundant connections.

While public health information systems with HIE integration have increased in recent years according to ONC, the practice is not yet widespread. In 2012, a survey from the Association of State and Territorial Health Officials (ASTHO) found 13 state public health agencies received lab results and nine received reportable diseases through HIE organizations.

“This trend occurs as researchers discover instances of higher quality in public health data transmitted from HIE organizations, as compared to clinical information systems,” stated the report. “For example, a 2013 investigation of electronic lab report messages finds data enriched by an HIE organization is more complete, compared to data from clinical systems.”

Public health systems with integrated HIE organizations have also been shown to yield improvements in care coordination and clinical efficiency, according to qualitative research in upstate New York, central Texas, Indiana, and New Mexico.

Still, HIE integration within public health systems is a relatively recent undertaking.

ONC highlighted three factors as contributing to this lack of integration:

  • An existing reporting infrastructure already facilitates public health reporting for health care providers.
  • The HIE organization’s technical solution does not often supply public health agencies with the level of data required for public health functions
  • Limited resources are available to dedicate to HIE infrastructure.

In its report, ONC determined that a combination of flexible, standardized technical solutions, policy enabling standardized public health reporting through HIE organizations and secondary data use, and affordable connectivity solutions offered by health IT developers could address these issues.

Interviewees highlighted a number of objectives driving the need to encourage more HIE integration in this care setting.

Most stated HIE integration could streamline the number of connections and thereby reduce costs for healthcare providers, HIE organizations, and public health agencies sharing information. Additionally, integration could support providers in achieving public health requirements for the EHR incentive programs.

Other interviewees expressed interest in developing a sustainable platform for clinical and public health data exchange for improved analytics and quality measurement.

To achieve these aims, ONC outlined ways public health agencies can overcome barriers to HIE integration — specifically, lack of standardization, gaps in standard use and adoption, lack of aligned messaging standards, and inconsistent data quality pose issues in integration.

Improving standards for public health data exchange is especially necessary.

“EHRs that meet ONC’s Health IT Certification Program requirements support transport protocols such as Direct for transport of Continuity of Care Documents (CCDs),” wrote ONC. “Public health content is standardized at the provider (EHR) and public health level, but the method of transport is not. The HL7 implementation guides and certification standards for public health information exchange do not require any specific transport mechanism, which can vary by state or region.”

Using transport methods such as the Direct standard could assist in improving standardization in public health data exchange.

To help public health agencies more efficiently exchange health data, ONC provided a summary of best practices for HIE use.

“One jurisdiction’s HIE organization respondents describe an increasingly electronic environment as being overall good for the community with the ability to share information across trading partners,” stated ONC.

“However, public health agency respondents caution against the growing electronic gap between public health and health care providers, where health care providers increasingly use health IT with exchange capabilities, but public health agencies do not have comparable technology to participate in exchanges,” the agency advised.

Finally, ONC emphasized the need for collaboration between public health agencies, HIEs, healthcare providers, and health IT developers to work toward bidirectional, standards-based health data exchange.

“Standards alignment must integrate public health information systems and HIE organizations, with transport mechanisms and terminologies meeting all of the public health data requirements,” maintained ONC.

Editor’s Corner—Why the Biden-Faulkner exchange over EHR access touched a nerve


Joe Biden

It’s hard to say exactly what transpired at that January meeting between then-Vice President Joe Biden and Epic CEO Judy Faulkner.

What we do know is that it triggered a visceral online reaction over the importance of interoperability and access to health data—and even some Twitter threads on the nuances of HIPAA. But that might be more telling about where the industry currently stands and the direction it’s quickly heading.

It began last week when Politico recounted the exchange between Biden and Faulkner as told by the vice president’s aide Greg Simon, who now serves as president of the Biden Cancer Initiative. The short version: Faulkner reportedly asked Biden why he wanted 1,000 pages of medical records to which Biden retorted, “None of your business.”

“It went downhill from there,” Simon said.

The story developed more on Monday, when former White House Chief Technology Officer Aneesh Chopra told CNBC the meeting was cordial and there “was a motivation and desire to work together to improve data access.” An Epic spokesperson told Health IT News that the company “supports patients’ rights to access their entire record,” adding that Biden was “consistently polite and positive” during the meeting.

By then, Twitter had worked itself into a full lather. Many were particularly incensed at Faulkner’s insinuation that that length and complexity of a medical record somehow rendered it useless to patients.

The reactions to Biden’s exchange with Faulkner may say more about the state of health IT than the interaction itself that was either contentious or cordial, depending on who you ask. There’s still a lot of frustration over the amount of money invested in EHR adoption and the fact that interoperability is still a challenging task.

At the same time, the vast majority of the industry is embracing the concept of replacing medical paternalism with patient-centered care, and more healthcare consumers are recognizing the benefits of having all of your health information at your fingertips.

In other words, demand is growing, but healthcare is still short on supply. That might explain the visceral reactions.

This week, Chilmark Research analyst Brian Eastwood argued that the debate over patient access to data revolves more around culture than software, and that’s probably true. Embracing the idea that patients should be able to access their medical record is a basic hurdle before anyone can tackle the technology that can make that happen.

But the heated debate that followed shows how much people across the healthcare industry see this as a core priority. It may not have infiltrated every corner of the ecosystem, but it touched a nerve that was far more basic than the technical minutia of interoperability or data standardization. It’s clear that the broader notion that patient records aren’t just the property of the health system—or even the software vendor—is carving out a substantial role in healthcare’s ongoing transformation. Any insinuation to the contrary is seen as shortsighted.

Clearly, it’s not ubiquitous yet, but there’s a strong undercurrent pushing the industry beyond the question of why patients might want their data and into the how. Perhaps that’s a small measure of progress. – Evan | @DB_Sweeney@FierceHealthIT

CMS Finalizes 2018 Meaningful Use Requirement Flexibilities


CMS revises 2018 meaningful use requirements

Revisions include a 90-day reporting period, exceptions for decertified EHR technology, and acceptable versions of certified EHR technology.

As part of a final rule for hospital inpatient reimbursement for 2018, CMS has also finalized a host of revision to the meaningful use requirements for eligible providers participating in the EHR Incentive Programs next year.

Chief among the revisions is the reduction of the EHR reporting period next year to 90 days for “new and returning participants attesting to CMS or their Stage Medicaid agency,” states the final rule to be published on August 14. The revised reporting period must comprise a continuous 90 days between Jan. 1, 2018 and Dec. 31, 2018.

According to the final rule, the motivation for finalizing revisions to meaningful use requirements in 2018 is “to continue advanced of certified EHR technology utilization, focusing on interoperability and data sharing.”

Many of the other finalized changes owe much to mandates included in the 21st Century Cures Act, such as an exception for Medicare payments adjustments for eligible professionals and hospitals affected by EHR decertification. For those providers unable to satisfy meaningful use requirements because their certified EHR technology is now or becomes decertify, they will be able to avoid meaningful use penalties (but also miss out on EHR incentives). EPs will have until Oct. 1, 2017 to submit their applications; hospitals, July 1, 2017 — barring further changes made by CMS.

Additionally, EPs who provide “substantially all” of their services in ambulatory surgical centers (ASC) will avoid Medicare payment adjustments in 2017 and 2018:

We proposed to define an ASC-based EP under § 495.4 as an EP who furnishes 75 percent or more (or alternatively, 90 percent or more) of his or her covered professional services in sites of service identified by the codes used in the HIPAA standard transaction as an ASC setting in the calendar year that is two years before the payment adjustment year. In addition, we proposed to use Place of Service (POS) Code 24 to identify services furnished in an ASC and requested public comment on whether other POS codes or mechanisms should be used to identify sites of service in addition to or in lieu of POS code 24. For the reasons discussed in section IX.G.4. of the preamble of this final rule, we are finalizing the definition of an ASC-based EP as an EP who furnishes 75 percent or more of his or her covered professional services in sites of service identified by POS 24.

As for the type of CEHRT required for meaningful use attestation, CMS has finalized a policy that allows eligible professionals to use 2014 Edition, 2015 Edition, of a combination of the two for the purposes of EHR reporting in 2018.

That being said, the federal agency determined that calls to revise meaningful use objectives and measures, meaningful use audits, the Merit-Based Incentive Payment System (MIPS), and CEHRT grant funding were beyond the scope of the final rule and therefore not met.

The federal agency faced considerable pushback from industry groups advocating for significant change to the EHR Incentive Programs. Last month, the American Hospital Association (AHA) called for the cancellation of Stage 3 Meaningful Use, which is set to begin in 2018. The association claimed that the phase’s meaningful use requirements were overly burdensome.

“These excessive requirements are set to become even more onerous when Stage 3 begins in 2018,” AHA stated in a letter to CMS. “They also will raise costs by forcing hospitals to spend large sums upgrading their EHRs solely for the purpose of meeting regulatory requirements.

Based on this final rule, the EHR Incentive Programs will carry on as planned.

Can Patrick Soon-Shiong silence his many critics?


LOS ANGELES, CA - MARCH 22: CEO of Abraxis Health Institute Patrick Soon-Shiong during a Urban Economic Forum co-hosted by White House Business Council and U.S. Small Business Administration at Loyola Marymount University on March 22, 2012 in Los Angeles, California. Topics discussed at the forum included the Obama administration's support for policies that create private sector-jobs and future entrepreneurs. (Photo by Kevork Djansezian/Getty Images)

On the phone, Patrick Soon-Shiong speaks slowly and deliberately. He clearly trusts himself, but he doesn’t trust journalists anymore.

A series of scathing articles by STAT News and Politico sent stocks in his publicly-traded companies tumbling earlier this year. On Monday, he has an opportunity to change that narrative somewhat, with the unveiling of data from human trials of his cancer vaccine at a major oncology conference.

The stories allege that despite his bold claims, Soon-Shiong’s NantWorks subsidiaries are underperforming and reliant on contracts from other companies in the group. Reporters have also claimed that one of his companies, NantHealth, has received contracts from institutions that had received donations from his nonprofit foundation — a major conflict of interest. This was not adequately disclosed prior to the massive initial public offering of NantHealth, they argue, which may violate SEC laws.

For his part, Soon-Shiong, dismisses the allegations noting that part of the motivation behind those stories was political: “They had never written about me until they saw this picture of me with Trump.”

Speaking to MedCity on Wednesday after his recent appointment to a national health IT advisory committee, Soon-Shiong detailed how the various threads of his career are converging toward a pivotal moment. A solution for healthcare is almost within reach and he’s poised to unveil what he believes is a disruptive cancer therapy – the Nant vaccine – at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago on Monday.

This story clearly clashes with many other viewpoints in the industry.