Tag Archives: Healthcare

Pilots underscore Amazon healthcare strategy

Amazon’s initial moves into healthcare have analysts like Forrester’s Jeff Becker wondering what its larger game might be.

In the last two years, Amazon has increasingly set its sights on the healthcare industry as it makes acquisitions and tests healthcare products internally that could be pushed out to customers in an effort to solve larger issues, such as the lack of prescription price transparency and the high cost of healthcare.

The Amazon healthcare strategy includes acquiring online pharmacy PillPack and digital health technology startup Health Navigator. It also includes co-founding Haven. The initiative aims to use their combined resources and test new ways of lowering healthcare costs for their employees and is in partnership with Berkshire Hathaway and JPMorganChase.

“I think the most interesting thing they’re doing is following along the storyline of bringing down their own employee medical cost,” Becker said.

Jeff BeckerJeff Becker

Becker believes the company’s strategy is currently focused on cultivating the use of voice technology in healthcare and creating a “more shoppable healthcare experience” for patients and employers.

Some efforts are already proving fruitful. Others are more of a question mark. Becker pointed to Haven as one place that may not be making the kind of progress it set out to make.

The big picture

The Haven initiative is combining data, technology and resources from Amazon, Berkshire Hathaway and JPMorganChase to lower prescription drug costs and medical treatment for patients, according to the company’s vision statement.

Amazon announced the Boston-based joint venture in January 2018, but it didn’t get the name Haven until earlier this year. According to Haven’s vision statement, it’s not looking to make a profit as it seeks to find ways to lower healthcare costs. Haven plans to “reinvest any surplus” back into the initiative’s work to improve health outcomes and lower costs. While its current focus centers on employees of all three companies, the vision is to eventually share its innovations with others.

One of the first pilot healthcare services to grow out of the Haven initiative is Amazon Care, for Amazon employees in the Seattle area. The pilot service offers virtual and in-person care from Oasis Medical through a mobile app.

Becker called Amazon Care a “digital front door” for lowering employee healthcare costs by addressing an employee’s minor healthcare needs and potentially sidestepping costly urgent care visits.

“If they can reduce the overuse of the ER, the digital front door strategy will pay for itself,” he said.

Amazon Care also offers same-day prescription deliveries. The service utilizes Amazon’s $753 million acquisition of PillPack, a digital pharmacy that sorts medication by dose and delivers to a patient’s door. The PillPack acquisition has since been rebranded as PillPack by Amazon Pharmacy. This month, it started working with Blue Cross Blue Shield of Massachusetts by integrating pharmacy services into the health insurer’s “MyBlue” app.

Amazon also acquired a start-up called Health Navigator earlier this year, its first healthcare-related acquisition since PillPack. Health Navigator provides services such as online symptom checking and triage tools for digital health companies seeking to steer patients to the right location to seek care. The acquisition plays a role in the overall Amazon healthcare strategy as it will become part of the Amazon Care health service.

Kamaljit BeheraKamaljit Behera

“If you go by what Amazon’s spokesperson revealed, they want to eliminate costs associated with travel, as well as the inconvenience associated with waiting times for patients,” Kamaljit Behera, an analyst at Frost & Sullivan, said. “This is where we see Amazon coming strong into the telehealth space.”

The work Amazon is doing through the Haven initiative and pilots like Amazon Care points to what Becker thinks will be the wider Amazon healthcare strategy: a one-stop-shop for patients seeking healthcare options.

What if there was a marketplace for shoppable healthcare experiences?
Jeff BeckerAnalyst, Forrester

“What if there was a marketplace for shoppable healthcare experiences?” Becker said.

That idea is a long way off, but Becker believes Amazon is testing the idea now, starting with its Amazon Care pilot, to find ways to introduce technology and cut down on costs. Yet beyond Amazon Care, the Haven name hasn’t been associated with many projects, and Becker said there hasn’t been much in the way of updates about Haven and the work Haven CEO Atul Gawande, M.D., has been doing — something he will be looking for in 2020.

Behera echoed Becker, saying he believes the Amazon healthcare strategy going forward will be to extend health services with a more consumer-centric offering.

“Amazon will be looking to create a much more curated, personalized space,” Behera said.

Amazon will continue focus on voice

Amazon’s main goal appears to be lowering healthcare costs through its efforts with the Haven initiative, but one area Amazon will continue to develop is voice technology in healthcare, Becker said.

Early partnerships with health systems like Boston Children’s Hospital to build Alexa skills, or voice capabilities, served as indicators of the company’s interest in healthcare. In 2016, AWS partnered with Boston Children’s to start building Alexa skills for parents, Becker said. Recently, Amazon announced the creation of a skill that enables Alexa to refill prescriptions by voice, as well as remind patients to take their medication.

Amazon has continued to build out Alexa skills for the healthcare industry, and Becker speculates that Alexa will be the first virtual assistant to be HIPAA-compliant. Indeed, Amazon is creating healthcare skills that are etching closer to being HIPAA-compliant, such as Express Scripts and Cigna Health Today, which give eligible customers the ability to use voice to manage prescriptions and engage in health improvement programs.

Becker said Amazon has six ongoing protected health information-processing pilot programs. He described the company as the first to “cross the finish line” for voice-only two-factor authentication, which first authenticates a voice profile and then asks for a unique verbal pin to access protected health information (PHI).

“We’ve been waiting for some kind of way they are going to overcome the authentication requirements for starting to process PHI,” he said.

As Amazon builds healthcare skills for Alexa, Becker said AWS will eventually play a major role as a data processing platform for the Alexa voice skills. At the recent AWS re:Invent 2019 conference, Amazon introduced Transcribe Medical, which records patient-doctor interactions and turns voice into text. The service is helping clinicians with medical notes, but Becker believes it points to a longer-term use case as a data processing tool.

Transcribe Medical can be made more robust by combining it with services like Amazon Comprehend Medical, which uses natural language processing and machine learning to extract pertinent pieces of medical information from unstructured text, according to Becker.  

“If you have a HIPAA-compliant Alexa service, Transcribe Medical will convert those conversations to text, and then Comprehend Medical will identify clinical facts within that text,” Becker said. “You’re starting to see a more compelling set of capabilities for having medical conversations with consumers over a voice channel. I think that’s part of what they’re building.”

Frost & Sullivan’s Behera said Alexa and voice technology is an integral part of the Amazon healthcare strategy. It’s looking to address a known healthcare pain point — physician burnout — with emerging tech.

Based on industry estimates, 40% of physician burnout is related to the EHR, Behera said. While interacting with a patient, physicians enter information into a patient’s electronic health record, a process that can be burdensome and negatively impact the patient-physician relationship. Transcribe Medical, which is HIPAA eligible, could reduce the data entry burden. EHR vendor Cerner is partnering with Amazon to introduce the service as a digital assistant for providers.

“AI-driven interactive, virtual assistants are becoming a common background technology for medical transcription, documentation … and even customer relationship management,” Behera said.

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Connected medical devices experts highlight IoT remote monitoring

BOSTON — Healthcare facilities can advance their patient care with IoT remote monitoring if manufacturers understand how to develop and use connected medical devices.

Medical IoT remote monitoring “will change the way you do service, the way your customers perceive you, not just you, but your products. They become reliant on the network of things that you provide them, not just the transaction,” said Anthony Moffa, senior director of ThingWorx IIoT Platform at PTC.

IoT remote monitoring gives manufacturers access to real-time information from the field that is unfiltered and unbiased, which they can use to secure and maintain connected medical devices. Devices can transmit data back to manufacturers on key performance indicators — such as power settings or the number of times a device was turned on and off — that they can use to improve connected medical devices. Engineers don’t have an easy time observing their devices in the field consistently, but anyone can sit in front of their laptop and see how devices perform, said Paul O’Connor, director of medical development at Boston Engineering.

Moffa and O’Connor were among the experts discussing considerations for connected medical device manufacturers during the panel “How to leverage IIoT to improve medical device innovation and user insights,” which was held on Dec. 10. It was hosted by Boston Engineering, the Massachusetts Medical Device Industry Council and PTC.

[Medical IoT remote monitoring] will change the way you do service, the way your customers perceive you, not just you, but your products.
Anthony Moffaenior director, ThingWorx IIoT Platform at PTC

Here is a rundown of the event’s expert advice on how to address problems before IoT development begins, how to secure medical devices and the importance of identifying the needs that remote monitoring connected medical devices can address.

How to get started with remote monitoring for medical IIoT devices

Organizations often introduce IoT remote monitoring for connected medical devices with the intent to improve their products and differentiate themselves from the competition. Remote monitoring with IoT might have to overcome resistance.

“Somebody has to own [the project] and you have to have coordination between all your team members, so service, marketing operations, the R&D side; they all have to work together. If they don’t, it’s going to be an uphill battle,” Moffa said.

During IoT remote monitoring, developers should try to answer several questions:

  • Do you really know how your customers are using the product?
  • What settings do they actually use?
  • What is the optimal proactive maintenance schedule?
  • Do the components perform in a way that meets their needs?
  • How has device use changed since introduction?
  • Is the product over-engineered?

Developers can now track the data to answer these questions from around the world and apply the real-time insights and feedback to the next generation of the product.

“Think of your own product line and what you want to know about how your products are being used. Think about what you need first versus how [IoT remote monitoring technology] can help me,” O’Connor said. “You can test for years and not actually get real-time data on a global basis.”

Organizations might also see resistance from their customers. IT pros could see connected medical devices and remote monitoring as a threat to network security. The manufacturers must show how the device will bring value to the hospital, show how it’s secure and why it won’t put the network at risk, Moffa said.

Connected products typically have some built-in security processes. For example, all IT pros must make sure to encrypt communications and safely pair devices. When devices have basic security measures, adding remote monitoring security for post-market surveillance is a low security risk, said Elizabeth Couture, security software engineer at Geisel Software. Hackers won’t be particularly interested in data about what the current pressure on a sensor is or what firmware the device is running, which is the data that a device manufacturer would want from IoT remote monitoring. When manufacturers have continued access to deployed devices, they can increase the security of the product through processing device data with behavioral analytics to pick out deviations from the normal device use.

Create a culture of security

For something to be secure, the whole team must secure the product, including different engineering and support groups when it’s developed, designed and implemented outside of the facility.

“[Medical IIoT device manufacturers] need to have a culture of security. Security is not a thing you do once and then you are done with it. And it’s not a thing that you can slap on the end of the finished product,” said Elizabeth Couture.

Most hacks today are caused when attackers find bugs in widely used software from trusted organizations that are implemented on devices, said Couture. The organization that made the software announces that they have a fix for the bug, which makes applying updates critical. Organizations must plan how to update devices in the field, otherwise they will have a security hole that the entire internet knows about.

Steps to tackle security challenges
Follow these steps to prepare for security challenges.

Organizations must apply layered security and not treat medical devices as if they exist in a lockbox that no hacker will ever break into. A malicious actor should not be able to command the medical IIoT device to do dangerous things or access any patient data. By the time a medical device passes all Food and Drug Administration procedures, it’s usually 15 years old, Couture said.

“I wouldn’t trust a 15-year-old computer to buy it off the shelf. You have to be so sure that everything is safe, and that means that we need to assume that something will go wrong in the future,” she said.

When dealing with a larger number of connected medical devices, it’s important to make sure that devices have an incredibly narrow application to secure the multitude of endpoints that consumable items represent, Couture said. IT pros might be tempted to be lax on security for consumer devices, but they must tighten restrictions to prevent malicious actors from accessing the whole network through a device.

The best way to restrict application use on a medical device is to have very strict controls on the API, Moffa said. Limit the ability to use the device connection to go onto other networks, because as soon as a device connects to multiple different networks, malicious actors have a larger surface area to initiate a potential attack, he said.

Another way that organizations can improve their device security is to have other IT pros attempt to hack it. Smaller organizations might have to hire an outside expert if they don’t have people internally who focus on cybersecurity. Even having someone from a different group in an internal team attempt to hack a device will uncover security holes, Couture said.

“People used to approach cybersecurity as if ‘I am the best at building walls. I will build this wall around the product and everything is safe because I’m really good at that.’ But nowadays it’s not just about building good walls, it’s about learning the skills that a hacker would actually use to attack a product and attacking your product,” she said.

Keep the customer in mind, no matter the use of remote monitoring

Remote monitoring with IoT starts with user needs and adds value for them, said Raj Sivakumar, global product director at Hologic. Remote monitoring can improve the reliability of technology. When organizations use IoT remote monitoring for predictive maintenance, field engineers can identify when a component is going to fail and replace it without any downtime. With analytical tools, medical device users can take advantage of the device utilization rates to understand if their team uses the devices optimally or if they need more training.

“By adding IoT to this environment you’re able to increase the throughput of your technicians, because you can do some things remotely. You might walk a customer through a workflow on a screen, rather than physically,” Moffa said.

The data provided through remote monitoring gives engineers information for maintaining devices. IoT sensors can record the temperature and other variables that would inhibit or show the decline of medical devices. For example, without remote monitoring, an anesthesia machine in an operating room could fail when a patient is under. The patient must be moved to another room and hooked up to another machine. The time under anesthesia is increased, which means there is more risk for the patient. IoT predictive maintenance is critical from a risk management perspective in healthcare, Sivakumar said. If technicians know a machine will fail well ahead of time, they can apply this change. Eliminating downtime means patients spend less time in the hospital, which decreases their chances of getting sick from something they didn’t come in with.

“You could talk to people about the issues they have [with your device]. There’s no aversion to doing that; Everyone thinks it’s a good idea,” O’Connor said. “But it’s being able to define a starting point. Start small with something that you can control and have access to.”

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3 healthcare CIOs on what they think 2020 will bring

Three healthcare CIOs believe 2020 will come with exciting opportunities as well as challenges — not unlike 2019.

They are heading into the new year with the goal of building a more digitally-focused healthcare system. They’re also focused on improving the patient experience through continuous patient monitoring and predictive analytics backed by artificial intelligence and machine learning programs, telehealth services and greater access to data.

That won’t be easy. Arthur Harvey, Boston Medical Center CIO, said one challenge he foresees is integrating data across the continuum of care.

Here are their biggest takeaways from 2019 and what’s on their agendas for the new year.

What is your biggest takeaway from 2019?

Craig RichardvilleCraig Richardville

Craig Richardville, CIO at SCL Health in Broomfield, Colo.: The biggest takeaway from 2019 is that the future of healthcare delivery and financing is as unknown as it’s ever been. What that means is that we have an opportunity to participate in its new definition and to start painting the vision of the future. 

Arthur Harvey, CIO at Boston Medical Center: To me, as a CIO, I’ve got to be focused on the business rather than just technologies and looking for technologies that solve my business problems. I think one of the biggest challenges we’re having is the acceleration of the need to share data across the continuum of care with people who are… my partners, but I don’t control them. We’ve got to come up with techniques and technologies to share data across the continuum of care that are doable by organizations of different sizes. I can’t expect a little community health center to do what I can do. If I look at what we spent a lot of time on this year, it’s that.

John Bosco, CIO at Northwell Health in Manhattan, N.Y.: In general, I would say things are changing rapidly in healthcare. We’ve got care model reform. For us it’s a lot of growth and expansion… it feels like controlled chaos.

What new trend or technology came onto the scene in 2019 that you’ll be paying attention to in 2020?

Richardville: There was not a new technology, from my perspective, that took us by storm, but rather a heightened interest and advancement in business use cases in several areas. First, digital transformation and assets. Secondly, voice services as both an input mechanism and natural language processing. Thirdly, artificial intelligence with providing self-service, assistance and the building of a digital workforce. All of these will be accelerated in 2020 with improved adoption and acceptance.

Arthur HarveyArthur Harvey

Harvey: Data democratization, or self-service. The idea of providing data and providing tools that could be used by people outside of IT to come to some business conclusions. This isn’t revolutionary, but I think we’re at a point right now where most places have something like Tableau… and I think extending that down to the provider level, I think we’re going to see that in 2020. That’s a good thing so people can use data to inform their decisions on how they provide care or manage their practice.

Bosco: We’re only at the very beginning of transformation when it comes to continuous patient monitoring. Being able to put sensors on patients when they come in the door is really huge. I think we’re all at the very beginning of that. We’ve got about four, five or six pilots going on of different sensors for different purposes in our hospitals. Sensors backed up by AI and machine learning programs, we think, are going to have an incredible impact on healthcare and we’re only at the very beginning of that.

What challenge presented itself in 2019 that you will be dealing with in 2020?

Richardville: The continued challenge with each and all of our progressions will be the culture and its ability to transform through change management and change realization. We need to create a culture of continuous change, improvement, and the courage to transform and advance ourselves and our industry.

Harvey: Data integration across different organizations. It was hard enough to do data integration inside of an organization for years, that’s why HL7 was invented. But now, when we’re trying to do it across organizations it gets hard. Part of it is we need standards. I would describe current standards for a lot of this data as evolving.

John BoscoJohn Bosco

Bosco: Patient experience is No. 1 — it tends to be No. 1 in a lot of places. That’s been a big challenge and will continue to be. From the IT side, patient experience is broad. It’s thinking about access to finding care, scheduling care and the administrative aspect of coming here. How easy do we make all of that? We’re also doing a lot with trying to stay in contact with patients after they leave and help them get well and stay well.

What are you most excited for in 2020?

Richardville: I think you need to keep your head on a swivel and your eyes completely open. The speed in which solutions will be available both inside and outside of the industry will grow exponentially. So your ability to take advantage of the current, be prepared for the future and be flexible for the unknown will be characteristics of success.

Harvey: Most of the things that have me jazzed are things that have been around a while but now are getting to the point where adoption actually improves healthcare. As an example, I’m very excited about telehealth. I think it’s now become much more mainstream, and that’s a good thing. That’s a good thing for patients for providers, for everybody … being able to extend [healthcare] services for convenience purposes to get patients where they need to be seen for minor stuff. I think we’re going to see some real advantages there.

Bosco: The cutting-edge stuff is always the most fun, so I’m very excited to continue testing and piloting innovations. I think AI is going to rule the world in healthcare and in our personal lives, so I would have to label that as most exciting. I think it’s going to get to the point where everything is so much smarter, so much more sophisticated because it’s being driven by AI behind the scenes. Every part of our lives is going to become more sophisticated because of this and this is going to have a profound impact on everyone.

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Healthcare 2020 trends emphasize virtual, holistic patient care

Lowering the price of healthcare will be top of mind in 2020. For healthcare CIOs, that could mean investing in telehealth tools and analytics platforms that are geared toward making healthcare more accessible, less expensive and more personal.

Two reports on healthcare 2020 predictions lay out potential trends facing healthcare organizations in the new year. Forrester Research’s report focuses on healthcare reform efforts as well as the rise in telehealth. Frost & Sullivan’s report highlights the role social determinants of health data analytics platforms will play in 2020 and predicts a backlash against AI in healthcare.

The detailed healthcare 2020 reports have been pared down here for healthcare CIOs, highlighting tech trends like telehealth and data analytics platforms.

Telehealth visits will increase

Forrester believes virtual care will grow substantially, predicting that providers will conduct millions of new virtual visits in 2020.

Jeff Becker, an analyst at Forrester and one of the authors of the “Predictions 2020: Healthcare” report, called telehealth “the fastest growing place of service across all care delivery touchpoints” where “everybody is rushing in to claim a stake.”

Jeff BeckerJeff Becker

One of the drivers behind the growth in virtual visits is the desire to control patient inflow to brick-and-mortar care delivery systems, Becker said.

Engaging patients in the home, workplace or other convenient locations first and helping them make a decision on the right place to seek medical care can reduce what Becker called the “drastic overuse of an emergency room.”

Historical outpatient claims data suggests that about 43% of outpatient visits could be addressed through a virtual care visit, according to Forrester, pointing to telehealth as one option healthcare CIOs should look at to reduce costs associated with care delivery.

Social determinants of health in 2020

Another healthcare 2020 prediction is that social determinants of health data will play a big role in how payers and health systems improve patient outcomes, and healthcare CIOs will need to key in on tools like analytics platforms to make use of that data, according to Frost & Sullivan.

Frost & Sullivan analysts predict that by the end of 2020, 40% of U.S. health systems and insurance companies will use social determinants of health data, such as income and housing status, to make risk assessments or business decisions, as well as conduct patient outreach.

Kamaljit BeheraKamaljit Behera

Factors driving its growth include an understanding that most of a patient’s health outcomes are attributable to factors beyond direct medical care, according to Kamaljit Behera, an analyst at Frost & Sullivan.

We believe proactively engaging the right patients based on their social determinant of health can improve health outcomes.
Kamaljit BeheraAnalyst, Frost & Sullivan

“57% [of patients] have a moderate to high risk for financial insecurity, isolation, housing insecurity, transportation and food insecurity, among others,” Behera said during a webinar on healthcare 2020 predictions. “We believe proactively engaging the right patients based on their social determinant of health can improve health outcomes and help healthcare organizations meet quality standards.”

Frost & Sullivan believes that within the next five years, social determinants of health data will become critical for improving patients’ quality of care, as well as optimizing the cost of care. In lockstep, health IT products such as population health management platforms that track and analyze patient outcomes will also gain prominence.

AI growth, challenges

The AI in medical imaging market will cross the $400 million mark in 2020, but Behera said that AI companies have a tough road ahead. He believes they will need to rethink how they use data, train algorithms and implement AI to convince the healthcare community of no-harm use.

Medical imaging, or radiology, is one of the most mature areas for AI and clinical use cases, Behera said. Yet even in radiology, the use of AI will be checked in 2020.

“AI in the recent past has advanced tremendously. Its ability for diagnosing and detecting disease is climbing higher and higher, but the very important question still remains, what happens if something goes wrong,” Behera said.

The safest way for physicians to use AI is to confirm a diagnosis rather than improve care with new insights, Behera said. Due to this caution, health IT vendors will continue to make non-clinical applications of AI such as workflow automation the priority. Additionally, Behera said roughly 75% of AI companies in medical imaging will continue to focus on image analysis as the main AI use case.

“Things look promising in AI more from an operational and workstream optimization [standpoint], but we still have quite a way to go before getting into real support in the clinical decision-making process leveraged by AI solutions,” Behera said.

On healthcare reform

Healthcare’s big price tag will take center stage next year as voters hear from presidential candidates and prepare to cast their votes.

U.S. Democratic presidential candidates Elizabeth Warren and Bernie Sanders have championed a “Medicare for All” plan or option, which would expand a federal health insurance program historically geared at those 65 and older or managing certain disabilities to everyone.

The full Medicare for All plan would introduce a federally funded public insurance plan to U.S. citizens and eliminate private health insurance, eliminating 900 health insurers and 507,000 employees, according to the Forrester healthcare 2020 report.

“When I dug into the numbers, it didn’t surprise me that I came to the conclusion that Medicare for All in its current definition would fail,” Forrester’s Becker said. “What did surprise me is how much uptick there is in support of a public option and how much legislative movement there is for, not a single payer system, but a secondary public option.”

According to the Forrester healthcare 2020 report, voter support in the U.S. is low for a Medicare for All plan, but 70% of voters would support a public plan option that preserves the option of private insurance. 

The report noted that providers have mixed feelings about a public insurance option. While more coverage means less uncompensated care, Medicare patients generate lower reimbursement rates than patients covered under private insurance contracts.

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Data silos hinder IoT in healthcare; tech giants could help

The Internet of Things in healthcare may not be a new idea, but it’s the key to creating a more connected world within healthcare, according to one analyst.

The Internet of Things, or IoT, is the connection of a group of digitized objects that can collect, send and receive data. Digital medical device use was born out of clinical need, often circumventing IT for approval or advice, said Gartner analyst Gregg Pessin. Now healthcare organizations are dealing with silos of IoT devices and data.

Gregg PessinGregg Pessin

“In the past, the CIO or the IT department has had little input into what happens in that acquisition process, so you end up with IoT solutions, many of them from many different companies, that all work in their own little world inside that clinical environment,” Pessin said.

That is changing. Healthcare organizations are beginning to see value in breaking down silos and bringing IoT data together to create a single view of a patient. Tech giants like AWS are pushing into the healthcare market providing platforms to gather and analyze IoT data while making it more accessible.

CIO’s perspective on IoT in healthcare

IoT data silos and the lack of interoperability in healthcare are major challenges, according to Craig Richardville, CIO of SCL Health, based in Broomfield, Colo. They must be overcome for a healthcare organization to make better use of the IoT data it’s collecting.

Craig RichardvilleCraig Richardville

In healthcare, integrating vast amounts of IoT data into provider workflows is a complex, uphill battle, Richardville said. But as the healthcare industry matures, he said, there is growing opportunity to standardize and integrate IoT data back into provider workflows to create a more complete view of a patient.

“That’s really the ecosystem we all want to create,” he said. “The end game is [a system] that is fully connected all the way through, safely and securely, that allows us to consume or digest that information and get that back into someone’s professional workflow so they can take advantage of the information. The outcome of that is we make better decisions.” 

Richardville believes IoT is the future of healthcare, further enabling a healthcare organization’s connection to patients in their homes. IoT in healthcare can grow an organization’s capabilities when it comes to remote patient monitoring, social determinants of health and other areas of healthcare. IoT data can help providers and healthcare leaders “make more precise and intelligent decisions,” he said. 

Richardville said IoT could provide greater connection to patients but that privacy and security should remain top of mind for healthcare CIOs as that connection to patients and data collection grows. It’s also important that a healthcare system has the capability to analyze the data coming from connected devices — an area where tech giants could play a significant role.

Companies like Amazon, Apple, Google and Microsoft, all of which continue to push into healthcare, could provide healthcare organizations with IoT data gathering and analytics capabilities, Richardville said. SCL Health has a “strong relationship” with Google, which he sees as an “accelerator” to the digital healthcare work the organization is doing.  

“When you look at the companies, whether it’s Amazon or Google or Microsoft, all getting into this space … it actually allows us to be able to lift our game,” Richardville said. 

When it comes to IoT, Gartner’s Pessin said there is strong motivation in healthcare to move toward platform products, which offer tools to gather and analyze IoT data.  

Tech giants further enable IoT in healthcare

Healthcare organizations are buying more patient data-collecting and IoT-enabled devices, which is creating a “tidal wave of data” healthcare CIOs have to deal with, Pessin said.

The amount of computing and storage power required to process that much data is likely more than an on-premises data center can handle. That’s where external, third-party players like tech giants come in, according to Pessin.

“What are they great at? They’re great at scaling resources and they’re adding all of these great, specific kinds of platform solutions like IoT services that they can sell on the platform,” Pessin said.

AWS, for example, has AWS IoT services that health IT and medical device manufacturer Philips Healthcare is using. Philips created a customer-facing HealthSuite digital platform to provide customers with the capability to “connect devices, collect electronic health data, aggregate and store data securely, analyze data and create solutions on the cloud,” according to the Philips HealthSuite digital platform website.

Dale Wiggins, general manager of the HealthSuite digital platform, said Philips chose AWS to be its cloud provider to store large amounts of data and large X-ray and MRI image files from Philips medical devices. The next step for the Philips HealthSuite platform is to use AWS IoT services for remote support management of Philips devices, Wiggins said.

AWS IoT provides Philips with a more cost-effective way to offer remote support capabilities on Philips devices to healthcare customers, he said.

“We’re looking at using IoT to solve a lot of legacy issues with our existing remote support capabilities with new, cutting-edge, always on, always available services that AWS really supports through what they provide with IoT,” he said.

AWS IoT offers device software, control services and data services, depending on customer needs, according to Dirk Didascalou, vice president of AWS IoT. AWS provides the infrastructure for IoT services and is HIPAA-compliant, but it does not have access to customer data through AWS IoT, Didascalou said.

Partnerships with tech giants and healthcare organizations, medical device manufacturers and even EHRs are becoming the norm, according to Pessin. Healthcare organizations create the data and tech giants can provide tools to collect, analyze and store that data. Pessin said healthcare CIOs have to be ready to develop partnerships between the two.

“The advances in digital care delivery that are coming are going to require massive resources, and it’s those large digital giants that have that available,” Pessin said. 

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Zerto plays big role in McKesson’s disaster recovery plan

For McKesson Corporation, downtime may literally be a matter of life or death.

Hospitals and other healthcare facilities can’t reasonably keep every type of drug in stock in their own dispensaries. McKesson distributes drugs and medical supplies to hospitals, both during routine resupplies and emergencies. A strong and properly tested disaster recovery plan ensures nothing stops those important deliveries.

“We’re delivering pharmaceuticals. If we can’t ship product, somebody could die,” said Jeffrey Frankel, senior disaster recovery engineer at McKesson Corporation.

McKesson Corporation is a Fortune 7 pharmaceutical giant with about 70,000 employees and business units spread across the world. From an IT perspective, each of those units run autonomously — there is no single IT infrastructure that connects all of them. Each location has its own IT staff without standardized technology stacks.

Still, all disaster recovery (DR) inside McKesson is handled by a central DR group, which Frankel is a part of. He said the biggest reason for this was to standardize DR practices across the business units and make it easier to establish and follow protocol.

“Individual units might be using VMware or Hyper-V or anything at all. But security standards and DR standards need to meet ours,” Frankel said.

A centralized DR group also made it easier to test and prove recoverability. Frankel said this was especially important for keeping insurance and auditors satisfied.

McKesson began using Zerto six years ago, and it was the first time the organization used a third-party vendor for DR. Frankel and his DR group were only responsible for the pharmaceutical side of the business at the time, and they were previously using VMware Site Recovery Manager (SRM). However, Frankel said Zerto proved to be so much more efficient than SRM that the DR group’s responsibility expanded to the entire organization.

Headshot of Jeffrey FrankelJeffrey Frankel

One key feature that led Frankel to a Zerto purchase was journaling that allows for point-in-time recovery. He said this is a key difference between high availability (HA) and DR that many in his organization didn’t initially understand. McKesson was already replicating to a second site, which solved the HA use case, but DR needs the additional functionality of restoring to an earlier version if files are corrupted or compromised.

Frankel evaluated Actifio, Veeam and SRM, and said Zerto had them beat on functionality, ease of use and flexibility. McKesson’s business units have a wide array of failover setups, including on premises to Microsoft Azure, on premises to another on-premises data center, Microsoft Hyper-V to Azure cloud, VMware to Azure and VMware to IBM data availability as a service. Zerto worked with all of these setups, in addition to lowering McKesson’s RTOs and RPOs.

“We have a wide variety of implementations, but none of our RPOs are ever above 15 minutes,” Frankel said.

DR isn’t just the technology behind it. McKesson’s group is broken down into three teams, each handling a different aspect of DR.

The first team handles business continuity from the facility standpoint. They focus on the portion of the disaster recovery plan that deals with what to do if the facility is compromised and where workers go in order to continue working.

A second team focuses on consulting and logistics. This team works with executives to outline the scope of what’s needed for DR, including what’s considered mission-critical and the order in which business applications need to be brought back. This team also schedules tests and handles logistics and coordination when disaster strikes.

Finally, the engineering team, which Frankel is a part of, is responsible for all the technical aspects of the disaster recovery plan. They piece together the IT tools that make the previous team’s plan work.

One new feature Zerto introduced that Frankel wants to expand is its analytics capabilities. Before this was implemented, he would have to give direct access to the Zerto console to consultants, auditors and other non-IT personnel in order to look at the data. This meant untrained staff could accidentally start a failover process. The analytics and reporting functions have removed that risk.

“We didn’t want to give nontechnical people admin rights. Now, they can’t break anything,” Frankel said.

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Digital transformation projects are an opportunity for healthcare CIOs

IT departments are central to digital transformation projects in healthcare. But for those projects to be successful, healthcare CIOs will need to ensure they’re ticking off the basic IT checklist while pushing their departments into new territory.

John Kravitz, CIO at Geisinger Health System in Danville, Penn., said digital transformation, or the use of digital technology to change how healthcare operates and delivers care, requires healthcare CIOs to think outside the box and consider new, digital ways to make IT and the overall health system operate more efficiently.

“Looking at transformation and how we’re about to approach that in IT, it’s extremely important that we take off the blinders and we look at things in a different way,” Kravitz said.

Before pursuing a digital transformation project, healthcare CIOs should start with the fundamentals such as making sure the healthcare organization has a solid IT infrastructure in place, according to Kravitz. At the 2019 CHIME Fall CIO Forum, Kravitz and Judy Kirby, CEO of executive search firm Kirby Partners in Heathrow, Fla., talked about why that strong IT foundation is so important and how healthcare CIOs can successfully lead digital transformation projects.

Building a strong foundation

Today’s healthcare CIOs are expected to be experts on emerging technology, yet they’re also tasked with IT basics like keeping the lights on.

Kirby Partners CEO Judy KirbyJudy Kirby

“Organizations are saying, ‘We’ve got to be digital; we’ve got to be transformational,'” Kirby said. “Yet they’re really confused on what that means and how to get there.”

For healthcare CIOs to lead digital transformation projects, Kirby said it’s necessary to get four things right first:

  1. Focus on the fundamentals

To get started, Kirby said it’s vital healthcare CIOs take stock of how the IT infrastructure is performing. Having an IT system that functions “exceptionally” can provide a strong foundation for digital transformation projects, she said.

“If you don’t have the IT train on the track, you can’t transform,” Kirby said. “So, you’ve got to do that first, you’ve got to do it well, you’ve got to do it exceptionally.”

She recommended CIOs use key performance indicators to set expectations for IT employees and to provide transparent metrics on what they need to deliver on, she said.

  1. Build up health IT leaders

Building a successful IT team means identifying weak links and finding ways to make the entire team stronger, Kirby said. Healthcare CIOs will need strong leaders to be digital transformation ambassadors, and their success will hinge on relationships within the healthcare organization. CIOs can lead by example to demonstrate how to build those relationships and provide good service, she said.

Kirby gave the example of a successful CIO who “insists on rounding,” or going out into the healthcare organization to assess employee needs and to foster relationships between IT and the clinical staff.

“When he sends his CTO out there to round, they don’t go by themselves,” she said “They go with one of their technicians who has a cartful of goodies — monitors, cables — so that when [they encounter] an issue, they try to fix it right there.”

  1. Keep the IT team engaged

Healthcare CIOs should engage their teams not just by setting expectations but by helping them meet realistic goals and celebrating the victories along the way. Celebrating success can go a long way in keeping the team engaged, she said.

“Don’t just make it when something large is going on, celebrate a lot,” Kirby said. “It keeps them happy, it keeps them successful, it keeps them wanting to do better and wanting to do more. I know you’re busy, but take the time.”

For Kirby, engagement also means taking the time to help the IT team grow and develop, she said.

  1. Communicate

Lastly, healthcare CIOs need to communicate frequently, in detail and in a way that is easy to understand, Kirby said.

“If there’s one thing we hear when we’re out there doing site visits, it’s, ‘We want a great communicator,'” Kirby said.

Leading digital transformation

Geisinger’s Kravitz comes at digital transformation from firsthand experience.

Looking at transformation and how we’re about to approach that in IT, it’s extremely important that we take off the blinders and we look at things in a different way.
John KravitzCIO, Geisinger Health System

While Kirby talked about the importance of building a strong foundation to support digital transformation projects, Kravitz spoke about how healthcare CIOs can then drive that transformation within their healthcare organizations.

He said successful digital transformation projects need executive leadership support. CIOs charged with leading the effort not just across IT but across the whole organization should make sure the IT and executive leadership teams are in sync on goals. Doing so presents a vision to employees and sets clear priorities.

Geisinger Health System CIO John KravitzJohn Kravitz

Kravitz said a good place to start is to identify three to five processes critical to the organization and then find ways to change and enhance those processes through digitization, such as making it easier for low-acuity patients in emergency rooms to receive care via telemedicine visits instead of waiting hours for an in-person visit.

“Look at those types of things where you make it a lot simpler, a lot cleaner,” Kravitz said. “Look at all the opportunities within your health system for faster service.”

Digital transformation isn’t just a top-down project, according to Kravitz. He said healthcare CIOs need to also start at the bottom by establishing performance targets for employees. Here, it’s important to assess and measure productivity, set clear goals and benchmark those goals, Kravitz said.

Kravitz said healthcare CIOs should also help to create a governance committee of executive and IT leaders from across the organization. The committee is charged with keeping the healthcare organization on the same page during the digital transformation effort. It is also responsible for establishing a communication program that provides regular progress updates and includes meetings for the project. Finally, it should work to develop what Kravitz called a “digital narrative” that will be used to explain the project and get buy-in from employees.

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Value-based care models hung up on lack of resources

A survey of more than 1,000 healthcare providers finds a lack of resources to be the biggest hurdle when shifting to a value-based care reimbursement model.

A value-based care model pays providers based on patient outcomes rather than the amount of services provided. The Centers for Medicare & Medicaid Services began promoting value-based care in 2008. Support for the initiative quickly followed with legislation, including the Affordable Care Act, which passed in 2010.

Despite the push, the shift to a value-based care rather than fee-for-service model has been slow — but steady. Indeed, data analytics company Definitive Healthcare LLC found that the number of U.S. states and territories with value-based care programs has risen from three in 2011 to 48 in 2018.

This year, the company surveyed more than 1,000 healthcare leaders to determine the state of value-based care, as well as what implementation will look like in 2020.

Value-based care: Barriers and accelerators

Kate Shamsuddin, senior vice president of strategy at Definitive Healthcare, said she was surprised that 25.3% of respondents pointed to lack of resources as the biggest barrier to implementing a value-based care model, given the initiative dates back to 2008.

Definitive Healthcare senior vice president of strategy Kate ShamsuddinKate Shamsuddin

“We would’ve anticipated that the number of resources required to support value-based care would’ve been increasing over time to support the success of these programs and initiatives,” she said. “So that was pretty surprising to see that at the top of the list as a barrier.”

Survey takers also pointed to “gaps in interoperability” and the “unpredictability of revenue stream” as barriers to implementing value-based care programs. “Changing regulations and policies” was another barrier identified by 16.2% of respondents.

Shamsuddin was struck by the “changing regulations and policies” barrier because of the amount of visibility the federal government has provided into policy implementation. Additionally, Shamsuddin said that while changing policies is listed as a barrier, 16.1% of respondents also selected it as a factor that is accelerating the adoption of value-based care.

Almost half, 44.8%, of survey respondents cited “appropriate provider compensation and incentives” as the biggest reason why adoption of a value-based care model moved forward within their organization. In a value-based care model, providers can receive bonuses for performing above-quality care standards. Yet they can also be penalized if their performance falls below those standards.

Shamsuddin said being able to adjust provider compensation and incentives is one way to ensure all stakeholders are “growing in the same direction” when implementing a value-based care program.

“That is one I think we’ll continue to see as an accelerator, especially with healthcare systems being a little bit more, let’s call it experimental, in how they’re willing to move away from the fee-for-service model,” she said.

What CIOs should pay attention to in 2020

As value-based care model implementation evolves in 2020, Shamsuddin said it will be important for healthcare CIOs to keep an eye on federal regulation and policy, which survey takers said was both a barrier and an accelerator.  

Additionally, one of the main areas that will cause change in value-based care program implementation is a growing understanding among providers of how accountable care organizations (ACOs) and bundled payment models such as the Medicare Shared Savings Program work, according to 31.1% of survey respondents.

ACOs and bundled payment models, or alternative payment models that require providers to take on risk and share in the losses and benefits of patient care, will “evolve and become easier to understand,” making it more likely for providers to transition to a value-based care model, according to the survey.

ACOs are associations of hospitals, providers and insurers that assume medical and financial responsibility for their patients; the Medicare Shared Savings Program is a voluntary program that encourages healthcare providers to come together as an ACO. The program provides different participation options to ACOs and allows them to take on varying levels of risk and responsibility for patients.

Consolidation within healthcare will also create what Shamsuddin called a “wild card” in how effective value-based programs will be. When two health systems are thinking about combining, Shamsuddin said it will require healthcare providers to be “open and strategic” around how they’re going to bring in value-based care initiatives during a merger.

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ONC urged to slow down for the sake of patient data security

Seven healthcare leadership organizations have called for federal agencies to slow down their work on proposed interoperability and information blocking rules, which are expected to be finalized by the end of 2019. Their major concern is patient data security.

In a letter to the House Committee on Energy and Commerce, healthcare organizations including the American Medical Association (AMA), the College of Healthcare Information Management Executives (CHIME) and the American Health Information Management Association (AHIMA) outlined their concerns with security of healthcare data apps and a lack of security guidelines enabling third-party access to patient data.

They also worry there will be confusion about exceptions to information blocking and are concerned about implementation timelines for regulation requirements.

In February, the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS) proposed rules that would require healthcare organizations to use FHIR-enabled APIs to share data with healthcare apps. They also seek to define exceptions to information blocking, or unreasonably preventing patient data from being shared. The goal of the proposed rules is to foster greater data sharing and easier patient access to healthcare data.

“The use of APIs and third-party applications has the potential to improve patient and provider access to needed health information,” the letter said. “It also brings us into uncharted territory as patients leave the protections of HIPAA behind.”

The organizations stated that they support the work to improve information sharing through the use of APIs, but they noted it is “imperative that policies be put in place to prevent inappropriate disclosures to third-parties and resultant harm to patients.”

Letter underscores patient data security concern

It’s not the first time ONC has heard concerns about patient data security.

During a U.S. Senate Committee on Health, Education, Labor and Pensions meeting in May, committee chairman Sen. Lamar Alexander cautioned ONC to take interoperability slow and address issues such as privacy concerns when downloading patient data to healthcare apps.

The letter echoes that caution, suggesting that certified APIs should be required to have more security features and provide patients with privacy notices and transparency statements about whether data will be disclosed or sold.  Additionally, the letter notes a lack of security guidelines for providers as they bring third-party apps into their systems, and urges ONC to require API vendors to mitigate threats and security issues that could impact the provider connected to the API.

While healthcare apps and patient data security is the biggest sticking point, healthcare leaders also outlined other areas of concern such as “reasonable timelines” for implementing the final rules, and making exceptions to information blocking clearer. The healthcare leaders asked that ONC provide more examples of actions that would satisfy the exception requirements before the final rules are implemented.

‘Getting it right’

Healthcare leaders then requested ONC continue with the rulemaking process instead of finalizing the rules as they are now, and take more time to work through the issues outlined in the letter.

Lauren Riplinger, vice president of policy and government affairs at AHIMA, said the letter is a formal message to Congress to stress the importance of slowing down and “getting it right.”

She wants the community to “make sure we’re defining things properly, that the implementation periods make sense, and that it’s reflective of the environment and landscape in which we’re currently at as we work toward implementation of these final rules — whenever it gets finalized.”

They say Mars, and this letter says Hawaii. Eventually, everyone will say the moon. That’s where we’re headed.
John HalamkaExecutive director of the health technology exploration center, Beth Israel Lahey Health

In response to the letter, ONC prepared a statement that said the organization is “mindful of the need to balance concerns of incumbent stakeholders with the rights of patients to have transparency and actionable choice in their healthcare.”

John Halamka, executive director of the health technology exploration center at Beth Israel Lahey Health in Boston, said when it comes to rulemaking, it’s better for ONC to ask for Mars and settle for the moon, which he said was the intended goal to begin with.

Because it’s part of the rulemaking process, federal agencies no doubt anticipated pushback from the healthcare community, Halamka said. Ultimately, he believes ONC is headed in the right direction, and the letter asking for the time necessary to work through the details is understandable. Fine tuning of the proposed rules, or sub-regulatory guidance, is crucial, he said. “They say Mars, and this letter says Hawaii,” Halamka said. “Eventually, everyone will say the moon. That’s where we’re headed.”

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CIO talks lessons learned from Meditech Expanse upgrade

Healthcare organizations may no longer be shopping for EHRs the way they once were, but that doesn’t make implementation any easier.

It took three years of planning and budgeting before Beth Israel Deaconess Medical Center went live with electronic health record vendor Meditech’s latest product at three community hospitals.

Jeannette Currie, CIO of community hospitals at Beth Israel Deaconess Medical Center in Boston, led the initiative to upgrade to the latest version: Meditech Expanse, a web-based EHR designed for mobility. The effort took a year longer than expected.

At the recent Meditech Physician and CIO Forum in Boston, Currie detailed challenges she faced before and during the implementation at the Beth Israel Deaconess Medical Center (BIDMC) community hospitals — and some of the lessons she learned along the way. Her biggest goal was to create a unified IT culture across the three community hospitals which had, up until this point, operated independent IT shops.

For Maurice Abney, CIO at LifePoint Health in Brentwood, Tenn., who attended the forum, his biggest takeaway was how Currie’s budget changed significantly when planning for an EHR implementation, and how it’s better to plan for spending more rather than less.

This was a confirmation that you need to budget it now so you won’t have to ask for it later.
Maurice AbneyCIO, LifePoint Health

“This was a confirmation that you need to budget it now so you won’t have to ask for it later,” Abney said.

Challenges with EHR implementation

In 2015, BIDMC decided to upgrade the Meditech EHR at three community hospitals and had an estimated go-live date of Oct. 1, 2017. BIDMC’s goal was to reduce the number of outpatient EHRs from multiple vendors used in its community hospitals by migrating the sites to a single EHR from a single vendor. The community hospitals also all used different versions of the Meditech EHR.

BIDMC, now part of Beth Israel Lahey Health following a merger earlier this year, is a healthcare system composed of academic medical centers, teaching hospitals, community hospitals and specialty hospitals that employs more than 4,000 physicians and 35,000 employees. It is now one of the largest health systems in Boston.

As she planned the EHR implementation project, Currie said delays occurred due to added project scope and additional software requirements that were missing from the original plans. Plus, while BIDMC initially planned to upgrade the community hospitals to the Meditech 6.1 platform, an earlier version of the Meditech EHR, the health system changed its mind and decided on Meditech Expanse, the latest EHR version.

Even with budgeting and planning, the go-live date was pushed back a year, and the project’s estimated budget nearly doubled from an estimated $14.7 million to an actual budget of $27.3 million.

Strategies for addressing challenges

As Currie prepared to unify the three hospitals onto one EHR, she encountered four major challenges: resistance to change and getting the hospitals past the idea that the new EHR implementation was a simple update to their existing Meditech EHRs, breaking down the hospitals’ history of separateness, consolidating IT staff and creating a clear pathway for decision-making involving all three entities.

Jeannette Currie, CIO of Community Hospitals at Beth Israel Deaconess Medical Center, speaks at the recent MEDITECHPhysician and CIO Forum.
Jeannette Currie, CIO of Community Hospitals at Beth Israel Deaconess Medical Center, speaks at the MEDITECHPhysician and CIO Forum about leading a MEDITECHExpanse implementation at three community hospitals.

This wasn’t the community hospitals’ first Meditech EHR implementation, but upgrading to Meditech Expanse was complicated by the EHR’s added features and functions, according to Currie. The product introduced new workflows and an entirely new platform. Currie said getting the hospitals past that “upgrade mentality” was challenging.

To address the problem, Currie decided to brand the implementation CommunityONE. Her hope in using the word “community” was to steer the upgrade away from EHR tweaks toward a push to unify the IT culture between the three hospitals, something she said was crucial to the project’s success.

She set a mission statement for the project, which outlined what she was aiming to do and why. The mission statement, “to develop, implement and manage a single patient-focused BIDMC Community Hospital EHR using principles of best practice to support clinical excellence, fiscal accountability and a productive experience,” was repeated and promoted throughout the project.

Identifying the benefits of the Meditech Expanse product was also important, Currie said. The gains included a single patient clinical record accessible across the three hospitals, operational efficiency by having the same EHR available for clinicians working at all three hospitals, working with Meditech to house the hospitals’ data, and the creation of a single IT department for the three hospitals.

Consolidating IT staff was a major hurdle because of varying staffing levels, experience and pay scales, Currie said. She worked to fix pay discrepancies and to clearly define IT responsibilities, something the organization is still challenged with. Currie said employees were chosen from across the three sites to form the community hospitals IT department.  

Currie established guiding principles to lead the major organizational change. They included clear project governance structured to promote the project mission. She wanted to make sure to give an equal voice to each hospital, outline participation expectations and be transparent about decisions.

“We needed all the hospitals to participate in the process to create that future. That adds to the cultural aspect because then people feel ownership about what they’re creating and what their end product will be,” she said.

Decision making was the project’s biggest challenge and one of the biggest drivers behind the extended go-live date, Currie said. Each organization came to the table with “passion” for the way their hospital had operated, and they had to work through how they were going to make decisions as a unified IT culture. 

“We had to learn how to reach consensus,” she said.

Currie said she outlined a clear method for decision making, and built the culture through continuous face time and getting to know each other.

“It was a pain in the butt to drive from Plymouth or some of these other areas in Boston traffic to get together,” she said. “But we really found that that in-person time was what promoted respect … people on these teams became friends and that allowed them to work together and become willing to share this system and respect each other’s perspectives.” 

Lessons learned

On Oct. 1, 2018, Meditech Expanse went live at all three hospitals.

Currie said the launch’s success was due to a strong command structure including local command centers set up at each of the sites that were linked to help identify common issues. The IT team also had frequent huddles, identified emerging issues and had boots on the ground to provide support.

At the center of the success was communication, and keeping a consistent message between the three hospitals, she said.

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