Collaborating to solve for clinician challengesDr. Walter Kerschl, senior director and chief medical officer for Cerner East Region, discussed the myriad of themes facing the clinician community. He focused on the chronic care crisis, the opioid crisis, medical error (the third leading cause of death in the United States), changing payment models (where health systems are challenged to meet the needs of the poorest and most vulnerable patients), the need to adapt quickly to regulatory change, clinician burnout and improved interoperability.
“I would like to challenge each of you throughout the next few days to find solutions to meet these challenges,” Kerschl said. “Let's find the value in all that is offered. Don't just keep up with change. Let's drive change.”
“We always say that health care moves slowly, but it actually moves more quickly than we realize,” said Cerner’s Chief Client Officer John Peterzalek in a Q&A with Kerschl. “Health care information technology has been somewhat slower than the other industries out there, but the American Recovery and Reinvestment Act of 2009 and the HITECH Act that followed put the wind in the sails to get the industry wired.”
Peterzalek discussed the idea of continuous advancement: a combination of engineering, architecture and process designed to help health care providers get out of the world of the packaged software. “Providers have to do an upgrade of some components to take advantage of the technology they have,” he said, “so it’s on us to make that a seamless, less disruptive process for them.”
Peterzalek talked about the tenants of continuous advancement that Cerner is committed to:
- Higher quality – More frequent and automated quality checks will yield higher quality solutions with fewer defects.
- Faster access with less effort – Faster access to new capabilities empowers clients to spend more time on strategic initiatives rather than code maintenance.
- Available and secure – Improve availability by leveraging geographically diverse infrastructure services will resolve and deploy fixes to security concerns across the client base.
- Always current – Being “always current” is always the standard.
The complexity of AI in health care
Despite its “buzzword” status, artificial intelligence (AI) holds incredible promise for the health care industry. “Everyone hears ‘AI’ and tends to think of Alexa, but using AI for health care is more complicated than using it to order groceries,” Peterzalek said. “We’ve spent the better part of the last 20 years aggregating all this data, and sometimes it can feel like we have everything coming in and nothing coming out, but this information is incredibly valuable. The challenge now is: How do we take this mass store of data and use it for analytics in terms of how we interact with patient and the electronic health record (EHR)?”
One exciting area where AI could help, Peterzalek said, is with clinician burnout. AI transformations pave the way for Cerner applications – like our voice-enabled EHR – to relieve some of the cumbersome elements of a clinician’s job.
“I think that's the next generation of what we do,” Peterzalek said. “It's unlikely that we're going to do this all by ourselves. There are some incredibly talented AI companies out there that we'll partner with at some point as we work through open architecture. Our ability to implement things that have not been developed in-house here in Kansas City will be great, and we can take advantage of that.”
In the near term, we can expect to see AI being leveraged for analytics purposes and translated into information that clinicians can use. Virtual interaction with a health care system is “no longer a Star Trek concept,” Peterzalek added, “it's a real thing that can be very close.”
Industrywide focus on security
One of the biggest deterrents of AI – and a chief concern for every health care system today – is privacy and security concerns, Peterzalek said. “Security is on the agenda of every organization out there,” he said. “The trick to security is to make it as non-disruptive as it can be. We need it to be as much in the background as it possibly can be, but also something we will not compromise on.”
Smarter care means better care
This year’s CHC theme is “smarter care,” and Peterzalek put that into context for the CPC audience. “When I hear ‘smarter care,’ my mind immediately goes to the cool stuff that's out there – wearables and the Internet of Things,” he said, “But at its core, smarter care should be more efficient care. From an industry perspective, we know that what we do can be inefficient. With the pressures that everyone in here faces – declining reimbursement and value-based care – smarter care will make us much more efficient.”
Finally, Peterzalek concluded, smarter care is better for people. “It's not just patients,” he said. “Smarter care also happens when we're not patients. I want the ability to interact with my health when I feel fine, and use that information when I don't feel well. Smarter care for the person results in a better health experience and outcomes. Simply put: Smarter care is better care.”
“It’s about making sure our clients are front and center in everything we do.”— Cerner (@Cerner) October 7, 2018
Cerner Chief Client Officer John Peterzalek discusses how Cerner’s vision starts with physicians from the #CPC18 #CHC18 stage. pic.twitter.com/DBlOA4lpDz
The rise of pharmacogenomics and integrated precision medicine
In an afternoon session on precision medicine, speakers from MedStar Health and St. Jude Children's Research Hospital discussed the current state of pharmacogenomics (the study of how genes affect a person's response to drugs) and their organizations' experiences.
"We need to pivot to gene-guided care in America to get ahead of things," said Pete Celano, MedStar’s director of consumer health, who posited that gene-guided care can help deliver personalized treatment for individuals based on their unique genetic makeup.
As more people turn to genomic testing to learn about themselves and their health, pharmacogenomics will continue to rise in importance.
Advancing interoperability through CommonWell and Carequality
In today's evolving health care landscape, it's important providers have immediate access to a patient's record. Through the collaboration between CommonWell and Carequality, both Lafayette General Hospital and Winona Health System have great benefitted from a connected patient record.
Panelists from Lafayette General Hospital and Winona Health System shared their organizations’ experiences moving to CommonWell and Carequality to better connect their patients' records to health care providers on different EHR systems.
"Since going live, we have decreased duplicate diagnostic testing because records are there for the provider to review," said Nikki Manuel, informatics nurse specialist at Lafayette General Health.
EHR efficiency and physician burnout
Banner Health presented on how they had improved EHR efficiency among physicians. They began by asking their clinicians how they are using data within their own clinics; the hospital system discovered that about half of the physicians were reporting burnout. After-hours EHR use was common, but use of the EHR during "pajama time" was also being associated with lack of physician wellbeing.
Banner Health looked for ways to improve EHR usage with their physicians and developed and implemented a monthly comprehensive physician scorecard as a tool for clinician performance in a residency setting. The scorecard tracked after-hours time spent in the EHR. In early assessments, it was determined that some physicians are more efficient in the EHR than others.
Metrics were tracked over a three-month period and provided several focus group recommendations for clinicians:
- Increase pre-charting
- Focus on agenda-setting
- Complete more EHR tasks in the exam room
- Pre-clinic huddling
- Write less - while still including what matters
- Finish notes same day
- Increase use of pre-completed templates and autotexts
- Use dictation technology
Although the initial goal was simply to expose physicians to the data and their time spend in the EHR at Banner Health, the physicians and residents found the scorecard introduced beneficial, accurate and valuable information for them to increase their efficiency and effectiveness.
Implementing a clinically driven revenue cycle
Leaders representing Centra Health, Kern Medical and Olathe Health led a panel discussion on Cerner’s Clinically Driven Revenue Cycle™ (CRDC) implementation and practice within their health systems. Each panelist's employer is either preparing for or is live with new CRDC solutions. Attendees discussed their experience in making the switch to Cerner's CRDC, as well as emphasized the importance of uniting clinical and financial teams to achieve a CDRC transformation.
For those organizations preparing to switch to CDRC, panelists gave candid and practical advice. The transition likely would not be easy or seamless. The key to successful implementation is communication between departments.
"We know that reaching the top of the summit is worth the energy that we're going to put into it," said Toni Smith, chief nursing officer at Kern Medical Center.
Physician problem solving with SMART on FHIR
In a panel discussion, health care IT leadership from the University of Texas Health Science Center, CoxHealth and American Society of Anesthesiologists discussed how open innovation in an academic setting can pave the way for opportunities to improve experiences at the point of care.
"How do you get your clinicians to use these apps?” asked CoxHealth’s CMIO Dr. Louis Krenn when talking about using SMART on FHIR to develop apps. “If you choose the right applications, it isn't hard.”
Not only can open development provide enhanced data reporting and innovative patient safety analytics, it can also help identify the different ways smaller health systems can leverage the open ecosystem to meet business needs. SMART on FHIR has the power to drive real change in the industry, and developing apps with physician input and buy-in helps solve business challenges.
Using clinical decision support to fight the opioid crisis
Dr. Matthew Sullivan, associate CMIO at Atrium Health, led a session about Atrium Health's use of clinical decision support (CDS) alerts within Cerner Millennium™ to provide its physicians with the right information, at the right time, to help make the right decision when prescribing opioid prescriptions. Through the adoption of CDS, Atrium has seen a reduction in the number of prescriptions written.
"In tackling the opioid use disorder problem," said Sullivan, "we can elevate the hope for a lot of people and advance care."
Recognizing Cerner Physician All-Stars
The following individuals were recognized as CPC Physician All-Stars:
- Dr. Joel McAlduff, Vice President and Chief Medical Information Officer, Medstar Health
- Dr. Marcus Scarbrough, Chief Medical Officer at Lawrence Memorial Hospital
- Dr. Emily Webber, Associate Chief Medical Officer at IU Health
- Dr. David Cammita, Director of Health Care Informatics at Dignity Health
- Dr. William Feaster, Chief Health Information Officer, CHOC Children's Hospital
Cerner Health Conference (CHC) is Cerner’s annual, industry-leading health care event, taking place this year from Oct. 7-11 at the Kansas City Convention Center. To learn more or to register for the conference and sign up for education sessions, visit the CHC website.
Make sure to check out our #CHC18 Twitter Moment:2018 Cerner Health Conference (#CHC18)