Cloud Computing

The idea is to create a connected ecosystem of care, given that "no single device, app, or piece of data in isolation that will deliver benefits to patients."

A researcher discovered the North Carolina-based tech vendor is leaking protected patient data through its Amazon S3 bucket twice in a month.

For National Health IT Week 2018, HIMSS Analytics delivered new research exploring some key trends, looking closely at established software infrastructure and emerging technologies alike. "What we're seeing as far as a state of the market is acceleration beyond the EMR," said Blain Newton, executive vice president of HIMSS Analytics. "We're seeing it manifest in a few different ways." Those post-EHR technologies and trends include blockchain, cloud computing, security, precision medicine, supply chain, telehealth and, of course, network infrastructure. Electronic health records. EHRs are a key piece of the health IT infrastructure and the market segment is very mature with near universal adoption, according to HIMSS Analytics data – but only 2 percent of hospitals have a single vendor enterprise EHR. Instead, the average system has 15 vendors across its affiliates — making the next issue a complex mess. "We're seeing migration past the EMR as a foundation as well as retrofitting how we create scale and secure infrastructure," Newton said. Interoperability. With mega-mergers such as Dignity and CHI and CVS Health and Aetna – as well as Amazon's partnership with JPMorgan Chase and Berkshire Hathaway – significant challenges are arising amid the hodgepodge of EHR vendors. "Creating a secure environment where interoperability can happen is not a challenge of desire," said Newton. "It's very technical." Telehealth. Whereas the U.S. has surpassed a 50 percent adoption rate for telehealth capabilities, the average hospital has upwards of five different products installed, meaning it has yet to widely reach enterprise-level deployments. The surprise HIMSS Analytics found in its data is that the highest adoption levels for telemedicine tools are among non-profit hospitals with 100 beds or fewer. "For a technology that the ROI is not yet entirely clear, you're seeing nonprofits with a very significant lead in adoption, presumably to reach out to rural populations," said Newton. "Either way, it's an unexpected view, we thought it would be large hospitals." When asked whether they plan to invest in telehealth in the next two years, 27 percent said yes, 18 percent said no and 55 percent said they weren't sure. Precision medicine. In contrast to EHRs' near-ubiquity and telehealth on the rise, precision medicine adoption today is limited. The top three reasons are a lack of funds, technologies, and the clinical expertise necessary to undertake such programs. That said, 45 percent of respondents to HIMSS Analytics research said they plan to expand precision medicine work, while 23 percent do not and 32 percent are unsure. Security. This should come as no surprise, but Newton said that "healthcare is absolutely a target," for nefarious attacks as 29 percent of breaches last year hit healthcare, a higher rate than any other industry. "Twelve percent of hospitals do not have basic IT security systems," Newton said. "That's a bit frightening because whether you're the Mayo Clinic or a rural provider in South Dakota, you're a target." Protecting health data is one of the reasons more hospitals are looking to the cloud. But it's not the only one. Cloud computing. Sixty-five percent of hospitals currently use cloud services in some capacity, and Newton said that it's expected the majority of EMRs will be cloud-based by 2020. Among the reasons healthcare organizations move to the cloud: 37 percent said it's for disaster recovery, while 25 percent said the cloud lowers current IT maintenance costs, another 25 percent answered that it'd sue to a lack of on-site IT staff or expertise and 13 percent do so to meet the need for a scalable always-on app or service. "There's a significant component just looking at baseline IT costs, regardless of the motivator, the cloud is coming, on-premise is a thing of the past," he said. "It has really shifted wholesale here because of efficiencies and levels of service. I would expect this to continue increasing."  Blockchain. Blockchain is still in the hype stage, to be certain, though it also appears that some early days type of activities are happening with 50 percent of health org's either investigating or building a business case around Blockchain, and doing so with plans to run a proof of concept in the next 24 months. But payers, pharma and tech vendors are moving more quickly than healthcare providers, which may be hanging back to let the others figure it out first. Non-providers, in fact, are twice as likely as providers to conduct a proof of concept or pilot in the next two years. Patient-generated health data. This was another surprising finding. "Organization said they are at least moderately prepared for consumer-generated data," said Newton. While more than 80 percent of patients are already expecting to see data in their record, in fact, 67 percent of hospitals are looking to invest. Just don't expect it to happen quickly. "When we talk to CIOs, they flat out said this is an issue of data governance," he explained. "We don't believe we have adequate governance in place to manage consumer generated data." Supply chain. Acknowledging that a better name for supply chain in this context might be utilization management and resource stewardship, Newton described it as "one of the biggest things we see happening." Four of the top 10 predictive technologies are supply chain management related and hospitals should proactively invest in clinical infrastructure for tools that alert clinicians to risk or enable traceability that helps determine which products or people are safest and most cost-effective, as well as technology to enable learning systems. "I see this as becoming something significant over the next 18 months or so and becoming much more enterprise focused as folks look to drive down costs and improve care," he added. "We see this as a powerful new capability that organizations are looking to go after." What it all means Broadly speaking, the state of HIT today is a digitized system now in place and a renewed investment in infrastructure to harness that and drive emerging trends such as predictive analytics, patient engagement and population health on the road to value-based care.   Some of it is being done on the EHR foundation while other work is more about retrofitting older technologies to create secure infrastructure scale that accordingly.   "People are looking up and saying the infrastructure we put in place 10 years ago isn't robust enough today," Newton said. "It's a mix of true innovation and securing things built to support a tech stack from a few years ago." Twitter: @SullyHIT Email the writer: tom.sullivan@himssmedia.com

Athenahealth has received multiple bids, according to CNBC. The prices, reportedly at $131 per share are below a previous cash bid for the healthcare software firm in an unsolicited move by Paul Singer’s Elliott Management. WHY IT MATTERS Hospital CIOs and CFOs that are either already subscribing to athenahealth’s cloud-based EHR or practice management services or considering switching to a new cloud vendor need to know where the company stands. Will it be bought by another EHR maker or taken over by activist investors looking to break it up to make a profit? Or another fate altogether? Those questions will remain unanswered until athenahealth is either acquired or the board makes up its mind to remain independent. THE TREND CNBC’s report was based on anonymous sources and did not name which companies might be among the multiple bidders. Earlier this month, however, Healthcare IT News reported that activist investor Elliott Management was putting the brakes on its takeover bid, just two weeks after speculation arose that Elliott might be athenahealth’s best suitor with potential acquirer’s Cerner and UnitedHealth not interested. Elliott Management already owns 9 percent of athenahealth’s stock and offered as much as $7 billion in a buyout offer earlier this year. In June, CEO Jonathan Bush stepped down following reports of sexual misconduct and domestic abuse. Twitter: @SusanJMorse Email the writer: susan.morse@himssmedia.com

The software giant will enable caregivers to communicate and integrate with EHR systems.

Cincinnati-based Mercy Health announced this week that it is investing in San Diego-based NucleusHealth, developer of cloud-hosted picture archiving communications systems and teleradiology services. Terms of the investment were not disclosed. Mercy Health implemented the technology this past year, and apparently liked it so much that it's decided to become a minority investor in the company. It's the most recent instance of a health system embracing that strategy for innovation – partnering with a third-party vendor to help spread technology it believes can help drive improvements for other hospitals. In 2016, NewYork-Presbyterian purchased a stake in telehealth company Avizia, for instance, and UPMC invested in predictive analytics and pop health startup RxAnte. NucleusHealth's Nucleus.io platform leverages secure Microsoft Azure cloud for better scalability and cost efficiency for PACS. The health system implemented the technology in less than three months – and managed to extend out a sharing network of 300 different locations over the next six, said Mike Hibbard, Mercy Health's vice president of IT, applications and service delivery. Mercy Health's IT team now taps Nucleus.io as a backup PACS when the main enterprise system is undergoing updates or maintenance, but may expand its use for other applications, he noted. NucleusHealth will still operate as an independent company, but will work in tandem with Mercy Health to create new features and workflows for system-wide deployment of its browser radiology workstation, Azure-based cloud storage and other image management tools, officials said. "We are very pleased to have this unique opportunity to partner with Microsoft and one of the nation’s best health systems,” said Vishal Verma, MD, NucleusHealth CEO. “This combined team has the unique ability to optimize our platform to create a true transformation of the medical imaging market." Mercy Health, which operates hospitals across Ohio and into Kentucky, is not to be confused with Mercy, the large St. Louis-based health system that spans Missouri, Kansas, Arkansas and Oklahoma. But both have made big cloud-hosted PACS news in the past two weeks. Earlier this month, Mercy Technology Services, the IT division of St. Louis-based Mercy, announced it would commercialize its own cloud-based PACS system for other hospitals to deploy. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

Change Healthcare on Tuesday said that its blockchain-enabled Intelligent Healthcare Network will be available on Amazon Web Services. Change’s network enables blockchain technologies for more secure and efficient financial transactions throughout the claims process. Hospitals and health insurance companies can use the cloud service to track the status of claims submissions and remittances. They will benefit from having an immutable, auditable and accessible record, as well as reduced administrative costs and near real-time claim adjudication, Change said. This takes to the next level January’s s announcement that Change’s  intelligent healthcare network is now blockchain enabled. The intelligent healthcare network is now being paired with a cloud-based network built on Amazon Web Services. "AWS's flexibility, scalability, and reliability makes them an ideal partner to extend our connectivity to the cloud and offer next-generation technologies, such as blockchain, to facilitate and speed payer-provider information exchange,” said Kris Joshi, EVP and president of Network Solutions for Change Healthcare. “Moving forward, we will enlist the expertise and technologies of other players in the healthcare space to extend the availability, functionality, and value of this network." Through its blockchain, the intelligent healthcare network can generate nearly 50 million milestone blockchain transactions per day at an average rate of 550 transactions per second, Change said. The network reaches nearly all government and commercial payers, more than 5,500 hospitals, 800,000 physicians, and 60,000 pharmacies. It handles approximately one of every five patient records in the U.S., and processes 12 billion healthcare transactions and $2 trillion in claims annually. AWS is a subsidiary of Amazon that provides on-demand cloud computing platforms to individuals, companies and governments, on a paid subscription basis. Twitter: @SusanJMorse Email the writer: susan.morse@himssmedia.com

CareCloud and Google on Tuesday announced that CareCloud is joining the Google Cloud Technology Partner Program. CareCloud said it will use Google’s Healthcare API to extend its interoperability, patient experience, and practice management services to ambulatory customers. In a steady stream of developments, Google and rivals Amazon Web Services, IBM and Microsoft are gearing up next-generation cloud offerings and research firm Black Book predicted recently that 30 percent of practices will replace their electronic health record within three years and the majority of those are investigating cloud options. CareCloud Chief Technology Officer Josh Siegel explained that aligning with Google enables the company to bring economies of scale to providers for addressing problems unique to ambulatory medicine, even those physician groups aligned with an ACO of clinically integrated network, in a way it otherwise could not. "We are both focused on interoperability and machine learning to improve clinical quality and practice efficiency," Siegel said. "We at CareCloud believe this will add unique perspective that can be combined with the work Google is doing with research hospitals and health systems to bring these new capabilities to the hands of providers." Google Cloud, for instance, joined the National Institutes of Health Science and Technology Research Infrastructure for Discovery, or STRIDES Initiative, in July to help NIH unlock large biomedical datasets for researchers. That announcement came during the same week that former Cleveland Clinic CEO Toby Cosgrove, MD, joined Google Cloud as an advisor to the health and life sciences team. Twitter: SullyHIT Email the writer: tom.sullivan@himssmedia.com

The ongoing saga of athenahealth and Elliott Management continues. Shares of the cloud-based health IT company fell sharply Tuesday morning on news that the hedge fund – which has recently been seen as the most likely candidate to acquire the company after a long and contentious courtship – has reportedly recoiled from the $160 share price. While activist investor Paul Singer may finally be throwing in the towel after many months of pressure on the Watertown, Massachusetts company, he may also simply be angling for a lower price. Reports earlier this month, in fact, indicated that EHR rival Cerner and insurer UnitedHealthcare are not interested in athenahealth. Now, athenahealth seems willing to be patient and weigh its options, having extended the due date for a final bid by 10 days, according to the New York Post. Elliott Management had indicated its willingness to pay the $160 share price, a total of some $6.9 billion, for the company in May. But by June – when athenahealth founder and CEO Jonathan Bush was forced to step down after allegations of past domestic violence – at least one Wall Street observer wondered whether the sale process might eventually drag on so long that Elliott would rescind its offer, likely knocking the share price back down to the $135-$140 range. Twitter: @MikeMiliardHITN Email the writer: mike.miliard@himssmedia.com

The analytics platform, built using open APIs, aims to enable a collaborative environment to speed development of targeted treatments for patients.