More big hospitals are looking to integrate into a single EHR and EPIC seems to be the preferred option to do that. The uncertainty from Oracle, a traditional SQL database company, migrating its backend to Cerner might be one factor. A benevolent dictatorship is better than a dictatorship was one quote. Allscripts has suffered. Worth noting Cerner still is the leader internationally. From Becker October 2022 Contact [email protected] for more info.
Excerpt
Two large health systems — Atlanta-based Emory Healthcare and Houston-based Memorial Hermann — recently switched their EHRs from Oracle Cerner to Epic, continuing a trend of bigger hospital groups moving to the Verona, Wis.-based software giant.
Several health system CIOs and other IT leaders told Becker’s the reasons for this include the desire to consolidate to one EHR from multiple vendors, with Epic being the most dominant player, while others said not to put too much stock in the name of the companies as the EHRs are fairly similar and depend on what your patients and clinicians are looking for.
“When you’ve seen one health system, you’ve seen one health system,” said Aaron Miri, senior vice president and chief digital and information officer of Jacksonville, Fla.-based Baptist Health.
But he said Baptist Health went to Epic, a transition completed July 30, to integrate into a single EHR.
Review finds more problems and thus they have decided to delay until they are fixed. Related news is Oracle, Cerner and VA under fire for accessibility issues. From the Federal News Network – October 2022
The Department of Veterans Affairs is further delaying the rollout of its new Electronic Health Record to additional sites, as it troubleshoots problems that have led to patient harm and frustrated its health care workforce.
The VA is also sending letters to every veteran who may have been impacted by problems with the EHR currently running at five VA locations across the U.S.
Next week is the Epic UGM in Wisconsin at the Epic campus. Midnight Museum is the theme for 2022. The cool stuff ahead looks interesting to us.
UGM is in-person at Epic’s campus in Verona, Wisconsin. For those who cannot attend in-person, the General Session: Executive Address & Cool Stuff Ahead will be livestreamed on Tuesday, August 23 from 8:45-noon central. Sign up here to register for the live stream. Additionally, session materials and recordings for most sessions will be available on the Session Archive site post-UGM.
In additional news related to Epic KeyCare Expands Nation’s Only Virtual-First Care Platform Built with Epic via $24M Series A Investment [press release].
Excerpt:
CHICAGO, Aug. 17, 2022 /PRNewswire/ — KeyCare, Inc., the nation’s only virtual-first care platform built with Epic, today announced the closing of $24 million in series A funding backed by 8VC, LRVHealth, Bold Capital, and Spectrum Health Ventures.
KeyCare offers health systems the ability to easily augment their care teams, optimize capacity, and widen their digital front doors by partnering with a nationwide network of virtual care groups. Patients can schedule appointments with a variety of Virtualists via their own health system’s MyChart portal or call center. Virtualists then complete the encounter on KeyCare’s Epic platform, thus ensuring a seamless experience and interoperable records.
Gather for a grand exhibition of the year’s achievements and new initiatives in the Epic community. R&D leaders present a gallery of new and future innovations, sharing their vision for the history-making breakthroughs beyond the horizon.
Kiosks are a highly effective way to interact with customers, but in healthcare settings, they must be handled carefully to avoid compliance, privacy and cybersecurity problems.
Evan Schuman
Sometimes, the mere existence of a kiosk at a certain location can itself reveal potentially protected and sensitive information. Consider a kiosk that allows patient check-in, but one that happens to be located near the entrance of an office that handles abortion procedures. Could someone merely using the kiosk at that location appear on a prosecutor’s list in some states? And if that patient actually was going in for an abortion procedure, would that patient then have a cause of action against the kiosk owner? The provider using the kiosk?
A variety of entities are exploring various updates to HIPAA. Some of those proposed changes are looking to prohibit seeking information that may imply/suggest sensitive information. Consider this story from TechCrunch: “The relevant bit of the case referral to the CJEU related to whether the publication of the name of a spouse or partner amounted to the processing of sensitive data because it could reveal sexual orientation.
The court decided that it does. And, by implication, that the same rule applies to inferences connected to other types of special category data” the story said, adding “this might have broad implications moving forward, in all contexts where Article 9 is applicable, including online advertising, dating apps, location data indicating places of worship or clinics visited, food choices for airplane rides and others.”
The life partner reference could be sought innocuously, such as when asking for the name of someone to be contacted, either in case a procedure has a problem or even someone to contact to pick up the patient after a procedure.
In a more traditional privacy issue, the positioning and exact location of a kiosk can be critical. Whether or not a privacy screen is used–it should be–is one issue. Are other patients permitted to line up behind someone entering data into a kiosk? Can the person right behind that person see the screen directly? Can someone seated in a certain chair in the waiting room see data being entered on the screen?
James Walker, the director of healthcare at OLEA Kiosks, argued that the kiosk positioning is a tricky balancing act. For privacy purposes, it should be isolated and away from others, but for usage purposes, it needs to be close and convenient.
“If you don’t change the physical path of the patients between the door and the traditional front desk, it’s far less likely they will use them. I think it’s critical that you group them together,” Walker said. “It’s about where the queue is, where the seating is and setting things up so you are giving the patient using the kiosk the best possible privacy while making sure people know they are there and what they are for. Ideally you would have a registrar out there facilitating the process, inviting folks to use them, answering questions, but also keeping people from positioning themselves where they can see content.”
Still, with the hiring limits in healthcare settings today, it is often difficult to free up staff to assist with kiosks.
Walker said that some privacy efforts go too far and morph into the ludicrous.
“I had a client getting upset with me because the client put the kiosks in a spot where, if a person was on the second floor balcony, they could use their phone to zoom in on kiosk screens on the first floor. There’s only so much you can do with the kiosk hardware itself,” Walker said. “Even in brand new spaces, the people doing the design often don’t understand the technology and the privacy implications. Or, worse yet, nobody told them they intended to use kiosks. It’s also interesting that a person can stand at the registration desk answering personal questions that people can readily overhear, but health systems and patients are paranoid about a patient standing in front of a screen typing information.”
Another consideration is the tablet–a close cousin to the kiosk–and its own set of privacy and compliance risks. The tablet was supposed to slowly replace the clipboard, but the added convenience of the tablet means that it can hold–and access–far more data. That is a privacy issue.
The idea of switching to the tablet was to make it easier for the patient. It is easier and faster to type than to hand write. The tablet can also offer easy choices via a menu pulldown. Again, the advantage of convenience brings with it privacy problems.
The kiosk has information stored on it and, typically, it has network access to servers with far more data. This is made worse by the fact that tablets are relatively easy to steal–especially given how busy staffs are and how little anyone is watching people in a waiting room.
A thief might steal the tablet just for the hardware (see theft of iPad at Kaiser), with the intent to wipe it clean once off the property of the medical facility. But just like a stolen laptop, such a theft requires reporting the theft of all data that the tablet either had or had access to. That is likely going to be a huge disclosure.
Some tablet thieves are explicitly interested in stealing sensitive data, but it likely doesn’t matter. Legally, facilities must assume that the bad guy is an identity thief,regardless of actual intent.
Therefore, the better way to replace the clipboard is a very-difficult-to-steal kiosk.
There is yet another worry: How manufacturers and other businesses that own the kiosks behave, far removed from the medical facility that either leases it or buys it. Among the biggest and most aggressive data companies are Google and Amazon. And Amazon is getting deeper and deeper into this space, with kiosks likely impacted.
As PBS is reporting, “In a nearly $4 billion deal, Amazon plans to buy One Medical, a primary care group with nearly 200 locations across the country. Privacy advocates are voicing concerns about Amazon controlling people's online purchase data as well as their health care records.”
“A person who is blind or has limited vision may find that the web-based platform their doctor uses for telehealth appointments does not support screen reader software. A person who is deaf and communicates with a sign language interpreter may find that the video conferencing program their provider uses does not allow an interpreter to join the appointment from a separate location,” the Justice statement said. “A limited English proficient person may need instructions in a language other than English about how to set up a telehealth appointment.”
All of these matters are important, but most regulators will be lenient as long as they see reasonable best-efforts deployed. For example, no healthcare kiosk needs to support 50 or more global languages. But it would be compliance pragmatic to support the ten languages most often spoken in the area where the kiosk is to be deployed.
Noted on Becker’s today. Valley Health looks like it runs Epic currently, just not it’s own managed system. There has been a lot of uncertainty surrounding Oracle purchase of Cerner. On LinkedIn there are reports of layoffs at Oracle (not formally acknowledged) and the VA morass is just an albatross hanging around Oracles neck. For more information email [email protected]
MarinHealth Medical Center (Greenbrae, Calif.) received $20 million from the state to help install its Epic EHR system. MarinHealth is replacing its current EHR system with Epic EHR in collaboration with the University of California San Francisco Medical Center and aims to have the EHR fully installed and in service by August.
Valley Health (Winchester, Va.) is spending $50 million to install their own Epic EHR system after using the EHR through a partnership with Falls Church, Va.-based Inova Health System since 2014.
We noticed an industry first the other day as Certify is moving forward with installation of patient check-in units which utilize facial recognition. We think this the first such patient check-in for Epic EHR and a kiosk to be installed. There have been patient check-in via palm for example. Fujitsu did those at one time. They worked but the palmreader units naturally cost quite a bit more than a camera. Facial recognition and payment by facial have emerged in 2022 as the leading biometric by far. Also noted on HealthcareDive for reference.
The units are designed and manufactured by Olea Kiosks of Cerritos, CA. For more information you email [email protected]
PRESS RELEASE
Olea certify click for full size
Arlington, VA: May 12th, 2022 – VHC Health (VHC), a community-based health system providing medical services to the Washington, DC metropolitan area, is excited to announce that it will be implementing positive patient identification (PPID) using facial biometrics at all VHC locations, making VHC the first healthcare system in the region to implement this innovative patient experience. CERTIFY’s PPID capabilities will be integrated into VHC’s existing electronic health record and administrative systems to create a seamless experience for both patients and administrative staff .
“VHC is proud to be the first health care system in the DMV area to partner with CERTIFY Health to enhance the patient experience,” said Michael Mistretta, Senior Vice President and Chief Information Officer at VHC Health. “This is one of several recent investments that VHC has made in innovative technologies as we strive to provide the safest, most secure options for our patients and community.”
The purpose of biometric PPID is to verify identity throughout the patient journey, starting with check-in. Patient mis-identification and fraud have become increasingly rampant issues, leading to liabilities for healthcare providers. One of the most secure mechanisms to prevent this is incorporating biometric authentication into healthcare registration and procedures.
VHC will launch the biometric PPID check in experience with a pilot in the Hospital’s radiology and cardiology departments in early June with plans to fully implement the platform by the end of 2022.
“It’s an amazing opportunity for us to have a strategic partner who is committed to innovation around the patient experience the way VHC is and so willing to adopt some of the most cutting-edge technology in healthcare right now” said Marc Potash, CEO of CERTIFY Health. “Our innovative PPID technology will safeguard VHC patient information and increase speed and efficiency during the check-in process.” CERTIFY Health’s platform integrates with leading biometric modalities to verify patient identities which is directly integrated into the EHR.
About VHC Health:
olea certify – click for full size
VHC Health provides exceptional medical services as the region’s community health system. Virginia Hospital Center was recently designated a 2021 Top Teaching Hospital by The Leapfrog Group, selected for the Healthgrades 2021 Outstanding Patient Experience AwardTM and has received 19 consecutive ‘A’ grades from The Leapfrog Group. Virginia Hospital Center is a 453-bed not-for-profi t teaching facility and designated as a Magnet® hospital by the American Nurses Credentialing Center. VHC Health is a proud member of the Mayo Clinic Care Network – a national network of independent healthcare organizations.
About CERTIFY Health:
About CERTIFY Health: CERTIFY Health provides a seamless patient experience via biometric authentication and digital intake solutions. Our platform encapsulates the end-to-end patient experience from intake to check-in kiosks and even payments. Together, they form CERTIFY Care – an omni-channel digital platform that streamlines and improves patient workflows. CERTIFY Health envisions a world where healthcare organizations leverage patient engagement and authentication technology to their full potential to reduce fraud, medical errors and so much more. For more information you can visit us at www.certifyhealth.com.
Winchester, Va.-based healthcare system Valley Health is spending $50 million to install their own Epic EHR system, the Northern Virginia Daily reported August 1.
Valley Health has used Epic EHR through a partnership with Falls Church, Va.-based Inova Health System since 2014. Valley Health is installing its own upgraded version of the Epic EHR system with the goal of improving flexibility and maintaining independence.
The project is slated for completion in November 2023.
“This is a pretty major endeavor for us,” said Valley Health President and CEO Mark Nantz. “It’s a big lift. Most of you who were here back in 2012 and 2014, it was a lot of work then and it will be a lot of work now. But it will be our own.”
Valley Health will maintain its partnership with Inova during the transition.
As we commemorate the 32nd anniversary of the Americans with Disabilities Act (ADA), the Justice Department and the Department of Health and Human Services (HHS) are partnering to publish guidance on the protections in federal nondiscrimination laws, including the ADA, Section 504 of the Rehabilitation Act of 1973, Title VI of the Civil Rights Act of 1964 and Section 1557 of the Patient Protection and Affordable Care Act, requiring that telehealth be accessible to people with disabilities and limited English proficient persons. These laws work in tandem to prohibit discrimination and protect access to health care. The guidance is available here on the Justice Department website. The guidance is also available here on the HHS website.
“Telehealth has become an evolving and common pathway for accessing healthcare, particularly as our society becomes increasingly digitized,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “It is critical to ensure that telehealth care is accessible to all, including patients with disabilities, those with limited English proficiency and people of all races and national origins. Federal civil rights laws protect patients from discrimination regardless of whether they are receiving health care online or at the doctor’s office. The Department of Justice will vigorously enforce the ADA and other civil rights laws to ensure that health care providers offering telehealth services are doing so free from discrimination.”
“We have seen important expansions in health care technologies, such as telehealth, that provide great convenience and help for people seeking care,” said Acting Director Melanie Fontes Rainer of HHS’s Office for Civil Rights. “This guidance makes clear that there is a legal obligation to ensure that all people receive full access to needed health care and can connect to telehealth services, free of discriminatory barriers. While we celebrate the progress of the ADA, we know how important it remains to uphold the rights of people with disabilities and other protected individuals to make our country accessible and inclusive for all. That work has been a priority of this Administration from day one, and President Biden’s Executive Order on advancing equity explicitly includes people with disabilities in its call for comprehensive action.”
Technological developments and the COVID-19 public health emergency have increased the importance of providing telehealth and greatly expanded its use. Telehealth can take many forms, including communication between a patient and a health care provider via video, phone or other electronic means. While telehealth has many benefits, including making health care more available and convenient, certain populations may face discrimination or other barriers in accessing care provided via telehealth. For example:
A person who is blind or has limited vision may find that the web-based platform their doctor uses for telehealth appointments does not support screen reader software.
A person who is deaf and communicates with a sign language interpreter may find that the video conferencing program their provider uses does not allow an interpreter to join the appointment from a separate location.
A limited English proficient person may need instructions in a language other than English about how to set up a telehealth appointment.
The HHS Office for Civil Rights and Justice Department’s Civil Rights Division have collaborated to provide this new guidance to help health care providers better understand their nondiscrimination obligations and patients better understand their rights under federal law in this area. The guidance provides examples of actions that may be discriminatory and describes steps that providers may need to take to ensure that health care offered via telehealth is accessible. The guidance also provides a list of resources that providers and patients may wish to consult for additional information about telehealth and civil rights protections.
If you believe that you or someone else has been discriminated against because of your race, color, national origin, disability, age, sex or religion in programs or activities that HHS directly operates or to which HHS provides federal financial assistance, you may file a complaint with the HHS Office for Civil Rights at: https://www.hhs.gov/civil-rights/filing-a-complaint/index.html.
If you believe that a telehealth provider has violated your or another person’s civil rights, you may file a complaint with the Department of Justice Civil Rights Division at: https://civilrights.justice.gov/#report-a-violation.
Oracle in June purchased Cerner, a medical-records giant, for about $28 billion.
The US Department of Veterans Affairs tapped Cerner in 2018 to overhaul its information systems.
Long-standing issues with the technology and the cost of the project just became Oracle’s problem.
Excerpt
Before 2018, the VA was identifying some of the same problems Ellison said he wanted to fix. The Department of Defense provides medical care to troops until they become veterans, at which point the VA takes over. One goal of the VA’s upgrade was to give providers at both organizations a way to see those patients’ records digitally.
But VA officials have said this goal, among others, has suffered as the Cerner rollout has dragged on. The Office of Inspector General overseeing the VA has issued more than 10 reports about several issues and more than 60 recommended fixes, a handful of which are two years old and still haven’t been implemented, frustrating lawmakers.
Crashes and slowdowns of Cerner’s technology have caused VA staffers to switch to pen and paper. Providers have struggled to learn the new system, leading the VA to implement more training. And a quirk of the Cerner record has sent physicians’ medical orders in Spokane, Washington, to an unmanned inbox, leading to delays in care.
One of the reports described a case in which a psychiatrist’s order to schedule a follow-up appointment for a patient without a home was lost in the queue. The report said the patient, who was at risk of suicide, called a crisis line four weeks later about a plan to self-harm, then was hospitalized.
