Covid restrictions motivates Cerner to Completes First Remote, Virtual EHR Implementation in T

The staff at Macon Community Hospital and Cerner decided to implement the EHR system on a remote level, which is the first of its kind for the vendor.

Rural hospitals have always had a disadvantage when it comes to interoperability and EHR implementation, primarily due to a lack of funds compared to larger hospitals.

According to the most recent ONC data brief in late 2018, small and rural hospitals were about half as likely to share records compared to their larger counterparts. In total, only 62 percent of small hospitals shared this information.

Dig Deeper

How Cerner is Using EHR Optimization to Combat COVID-19

How HIEs Are Promoting Interoperability for Rural Providers

Cerner EHR Implementation Will Go Live at Rural MO Health System

Once the COVID-19 pandemic began, the staff at Macon Community Hospital wanted to transition to the Cerner EHR platform due to its added COVID-19 benefits and experience with smaller health facilities.

While the vendor has always implemented its EHR at the provider site, the hospital staff and Cerner decided to use this unique opportunity to implement the software remotely. Prior to the start of the implementation, the hospital had already been working with Cerner on testing and training for the system. 

The implementation process began at the beginning of the coronavirus and rather than postponing the go-live due to the pandemic, it officially launched on March 30.

According to the vendor, despite the lack of in-person support staff at the hospital, the implementation went live without an issue. Due to reduced patient intake in anticipation of the COVID-19 surge, clinicians at the hospital were able to train and get acclimated to the new EHR system.  The hospital implemented Cerner’s cloud-based CommunityWorks system, which allows for rural hospitals to share information with similar health organizations and even those that have experienced an influx of patients due to COVID-19.
Despite the human tragedy of Covid deaths, there is a glimmer of hope around the sides of the cloud.  In many instances, the pandemic has stimulated telehealth, remote monitoring, innovative ways of work remotely, including installing new hardware/software electronic health records.  The combination of decreased normal patient loads other than coronavirus patients has lightened clinical loads to reevaluate hospital processes, continuing medical education, and maintenance.  The spread of the COVID-19 pandemic has forced providers, stakeholders, and government agencies to develop strategies to prepare for the surge of testing and treatment demands.

The coronavirus presents the ultimate test for health systems and a number of adjustments will be made to acclimate to the spread of the virus.








Cerner Completes First Remote, Virtual EHR Implementation in TN:

What ONC's Cures Act Final Rule Means for Clinicians and Hospitals

It has been over ten years since GeorgeW. Bush established the Office of The National Coordinator for  Health Information. The technology was established by  He and his advisors were prescient about what was to come.  It has been a long and stumbling road, but their action created movement and competition for the best solutions. As a founder of an "RHIO" (now an obsolete acronym), it transitioned into today's acronym, HIE, or Health Information Exchange.  In the beginning, the movement was led by volunteers, unpaid visionaries who worked in the health system, and knew what was missing.  Most of them worked, unrecognized with no financial reward. Its organizational structure was developed over a period of several years. 

Early proponents developed a set of acronyms and tested several business models, most of which failed.  The capital investment was and still is considerable.  Federal and State grants were a temporary startup incentive.  Most funding sources lasted for a finite time hoping other sources would materialize but  HIE would fail financially. At the time the nation's largest HIE was the Indiana HIE which ran on a foundation of organizations and federal fundings.  The Riverside Health Information Organization followed its own plan. The Riverside County Medical Association and San Bernadino County Medical Society joined forces and assisted area hospitals and providers to gain ownership of the project.  In 2004 few providers or hospitals had electronic medical records. EMR was embryonic.  There were few if any electronic health records to connect together. ONCHIT functioned to establish interoperability standards. This required another organization to certify the standard (CCHIT)

Medicare (CMS) realized this was their opportunity to derive clinical information from a wide variety of sources.  At the same time, most clinicians wanted to have nothing to do with EHR for reasons now that are quite apparent.  CMS quickly established a leadership role, and it played well to interoperability. CMS provided considerable financial incentives and/or penalties in order for hospitals and providers to purchase EHRs. Unfortunately, the systems were immature and user-unfriendly.  Despite the severe limitations, the use of EHR increased until it reached a tipping point. Several large software vendors developed a large market share (Epic, Cerner, and others). The major market segments were divided into small to medium size provider groups and large enterprise systems such as Universities and large medical clinics.

As ONHIT was formulating a National Health Information Exchange, individual software vendors struggled to become certified, however, ONCHIT and Medicare continued to change the standard and developed a meaningful use standard that required certain data sets and reporting requirements to qualify for full Medicare reimbursements. The standard had nothing to do with hospital usage or provider usage. 

The EHR systems remain poorly designed dysfunctional, inefficient, and have led to physician frustration reduced efficiency and early retirement for many physicians.

The latest update for Health Information Exchanges can be found at ONC's Cures Act Final Rule

What the Final Rule Means

What ONC's Cures Act Final Rule Means for Patients

What ONC's Cures Act Final Rule Means for Doctors and Hospitals

What ONC's Cures Act Final Rule Means for Developers

Final Rules Dates

What ONC's Cures Act Final Rule Means for Clinicians and Hospitals

Coronavirus in the Emergency Department

The Covid19 pandemic patient in an emergency department necessitates a complete alteration of patient flow and sanitization methods in a mix of 'normal" emergency patients.  Emergency patients present with a wide variety of non-urgent and urgent cases including trauma, life-threatening cardiac events, and surgical emergencies.

Accommodating this mix of patients requires registration outside in a 'safe' zone where others will not be contaminated by Coronavirus. An outside Kiosk can be utilized for ambulatory patients. Patients can then be given instructions and/or a text message when to come in.

Emergency department staff will need to use PPE when dealing with suspected coronavirus patients.

Cardiopulmonary Examination places the examiner in close proximity to a patient. Fortunately today a system exists EKO which affords a safe examination distance using an amplified stethoscope head and blue tooth connections to a smartphone. This combination also allows for real-time recording. In addition to these capabilities, EKO provides an algorithm for analysis and diagnosis of heart sounds.

A Stethoscope is a universal tool that enables clinicians to quickly assess the patient's heart and lung sounds during triage. The COVID-19 workflow uses lung sounds to identify wheezes for escalation to proper treatment protocols.

Healthcare workers need a stethoscope that protects them from infection so that they can focus on caring for their patients. Frontline providers wearing stethoscopes can be exposed to viruses.

Frontline providers use auscultation to make critical triage and management decisions. This places them in direct contact with their patients and makes them highly vulnerable to infection during outbreaks. Eko stethoscopes give providers options for reducing disease exposure by removing bodily contact. Sounds can be transmitted wirelessly by local Bluetooth and remote WiFi, delivering best-in-class heart sounds, lung sounds, and ECG data.

The Emergency Room at SUNY Downstate, NY

Blockchain for Health Care and Biomedical Science

JMIR - View Announcement: Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

The Journal of Medical Internet Research (JMIR) is inviting submissions for a special issue of the journal that will be dedicated to blockchain for health care and biomedical science.

Health care today is known to suffer from siloed and fragmented data delayed clinical communications and disparate workflow tools due to the lack of interoperability caused by vendor-locked health care systems, lack of trust relationships among data holders, and security/privacy concerns regarding data sharing.

Blockchain technology and decentralized applications (DApps) have the potential to alleviate the traditionally high dependency on centralized, trusted parties for certification of information integrity and data ownership. These distributed ledger technologies (DLTs) mediate transactions and exchanges of digital assets in a decentralized and consensus-driven nature, which allows agreements (ie, smart contracts) to be directly made between interacting parties while guaranteeing their execution. Key properties of blockchain technology, including immutability, decentralization, distribution, replicated storage, and transparency, provide a unique position for this technology to serve as a potential infrastructure to address pressing issues in health care, such as incomplete records at the point of care and difficult access to patients’ own health information.  

Aside from health care data sharing that is of paramount importance for improving care quality, there is also a wide range of opportunities for health care to leverage a decentralized technology, such as tracking the provenance of medical devices, expediting the process of medical billing and medical claims adjudication, connecting alike patient populations to clinical trials, and creating more patient-centered services. Besides the identifications of various opportunities in the use of blockchain technology in health care, research efforts on rigorously analyzing the performance of blockchain-based health care systems, proposed or existing, that focuses on security, privacy, scalability, availability, and robustness are highly demanded.

In addition, blockchain technology also opens up new opportunities for biomedical science and to disrupt the current publishing and peer-review system. 

Following the examples of previously published papers on blockchain in health care in JMIR journals, authors are invited to submit papers describing original, unpublished research results, position papers, proposals, tutorials (“How-to…”, “What is…?”), case studies and tools. Papers are solicited that deal with health care or biomedical research topics related to DLT like blockchain.

Topic areas include, but are not limited to:

• Provenance and trust management of medical devices or medications

• Medical workflow enhancements with decentralized approaches

• Security analysis of blockchain-based solutions

• Decentralized management and monitoring of healthcare IoT/Edge devices

• Anonymity and privacy in blockchain-based healthcare systems

• Innovative architectures & platforms for driving health care interoperability

• Scalability, security, privacy, and system robustness

• Large datasets (eg, medical image data), AI, and Blockchain technology

• Fraud detection and avoidance in medical billing

• Biomedical Science DApps

• Digital tokens, incentives, economic ecosystems

• Medical or patient identity provision and maintenance

Blockchain proposals (such as http://www.researchprotocols.org/2018/9/e10163/) are welcome as long as they contain sufficient details of the current status (early-stage proposals may be transferred to JMIR Res Protoc but will still show up in the e-collection).

Submission of Papers

THE DEADLINE HAS BEEN EXTENDED DUE TO THE COVID19 SHELTER IN PLACE

Extended submission deadline: March 31st, 2020 (earlier submissions may be published faster and receive priority, so please submit your manuscript as soon as it is ready).

To submit, please go to http://www.jmir.org/author and in step 1 of submission, select “Theme Issue 2019: Blockchain” section from the section drop-down list. See also How do I submit to a theme issue?

For this special issue, the regular Article Processing Fees are discounted by 20%.

Timeline

Submission of Full Paper Due: March 31st, 2020

Editors

JMIR Editor-in-chief

Gunther Eysenbach MD MPH FACMI