Consortium News

  • 13 Oct 2015 9:53 AM | Denny Brennan (Administrator)
    By Sabriya Rice  | Modern Healthcare | October 10, 2015

    In 2012, a preteen entered the emergency department at Children's National Medical Center in Washington, D.C., with a high fever, weight loss and diarrhea. The attending pediatrician suspected a rare, travel-related infectious disease, as the child had just been in Southeast Asia.

    Specialists combed through the Centers for Disease Control and Prevention website for health alerts from the region. They ran tests. All came back negative.

    Only after two days did the hospital turn to a diagnostic decision-support software program called Isabel. Once a clinician typed in the child's symptoms, a list of potential conditions popped up within seconds.
    The specialists quickly realized their initial mistake. “Biased by the patient's travel history, we didn't consider a pretty straightforward diagnosis,” recalled Dr. Paul Manicone, associate chief of the hospitalists division for Children's National Health System. Isabel directed the team's attention to hypothyroidism, a condition they had overlooked.


  • 07 Oct 2015 1:24 PM | Deleted user

    By Joseph Conn  | March 20, 2015

    Electronic health-record interoperability is at the heart of the Office of the National Coordinator for Health Information Technology's half of a two-pronged federal rule-making effort announced Friday. 

    The new rule covers the next phase of the government's $28 billion EHR incentive payment program. The ONC portion deals with the technical aspects that EHR developers must meet for their systems to quality for use in the program. A tandem rule for Stage 3 meaningful use also was released Friday by the CMS covering providers' use of the technology.

    The ONC portion takes dead aim on achieving interoperability, a goal set by Congress in 2009 that has been on the back burner as regulators initially focused on promoting EHR adoption. 

    The proposed new rule “identifies how health IT certification can support the establishment of an interoperable nationwide health information infrastructure” and also lists nine priorities. 

    Topping the list is a proposal to adopt “new and updated vocabulary and content standards for the structured recording and exchange of health information, including a Common Clinical Data Set composed primarily of data expressed using adopted standards.” 

    It also specifies use of the Consolidated Clinical Document Architecture, or C-CDA, an exchange standard developed by Health Level 7, a not-for-profit healthcare standards development organization.

    The rule also listed as a top priority facilitating the exchange of healthcare data through “application programming interface capabilities,” which would make the use of APIs a testing and certification requirement. APIs are essentially software intermediaries that allow different devices and systems to understand each other and to share data.

    The shift in emphasis to interoperability was foreshadowed in January when the ONC issued a 10-year “Interoperability Roadmap” that, among other things, set as a target the selection, adoption and widespread use and exchange of a common set of electronic clinical information at the nationwide level by the end of 2017. 

    Using federal persuasion to move the healthcare industry toward the widespread use of APIs was a key recommendation in a 2014 report by a panel of scientist/advisors known as the JASON, which looked at interoperability problems confronting the healthcare industry under contract with the Agency for Healthcare Research and Quality. 

    A modified version of the JASON recommendations are being explored by a consortium of several large healthcare providers and major health IT developers known as the Argonaut initiative. 

    Another priority in the new rule is the required adoption of technology known as data segment for privacy, or DS4P, which uses so-called metadata tagging to earmark certain data for special handling in compliance with federal and state privacy laws. 

    One particularly stringent healthcare privacy law, known as 42 CFR Part 2, requires that providers obtain the consent of patients in federally funded drug and alcohol treatment programs each time their medical records are disclosed to another healthcare organization, even for treatment, payment or other healthcare operations. DS4P technology enables the attachment of those consents—or constraints—to patient's electronic records. 

    The ONC noted DS4P technology has moved from the drawing board into use by providers, pointing out that a Florida organization with DS4P technology “has saved some hospitals millions of dollars associated with the cost of care.” That's because “the patients they treat with substance abuse or behavioral health issues were able to send an electronic referral and get a discharge performed earlier in the process,” the rule makers wrote. 

    Last year, a federal advisory panel recommended taking only “baby steps” toward requiring the use of DS4P technology in the EHR incentive payment program. 

    ONC rule makers said they are proposing only an “initial step.” They're requiring qualifying developers to create EHRs that can apply privacy tags only to entire documents containing sensitive information, and that these documents can be sent and received with the tags. 

    The ONC will not require vendors to develop systems that can tag discreet data elements within a record, such as a specific, sensitive prescription or lab test result, even though that's technically possible to do.

    The 431-page ONC rule is slated for official publication in the Federal Register March 30, which will trigger a 60-day public comment period. A final rule is expected to be issued this year. 

    Software in compliance with provisions of the 2015 Edition criteria won't be required for use by providers in the EHR incentive payment program until 2018, but, theoretically, the systems could be adopted as early as next year if vendors perform the upgrades and have their systems tested and certified to the new standards before then.

  • 07 Oct 2015 12:52 PM | Deleted user  |  By Michael Sandler  | October 5, 2015
    (This story was updated at 1:30 p.m. ET.)

    Dartmouth-Hitchcock, Elliot Health System and Frisbie Memorial Hospital will jointly own a new company with Harvard Pilgrim Health Care that will share clinical information and financial risk for 80,000 New Hampshire residents.

    The joint venture, called Benevera Health, will bring together financial and clinical data to give the partner providers access to analytics that can help them manage care for all of the New Hampshire members in Harvard Pilgrim's fully insured plans.

    The organizations' executives said Monday that they would make significant investments in technology to support the effort. Premiums for Harvard Pilgrim members will be 4% lower than they would have been without the venture, they said.

    “Our new company is a game changer,” Harvard Pilgrim CEO Eric Schultz said in a news release. “The goal is to vastly improve patient care in New Hampshire by injecting personnel and new technology that will provide doctors and other clinicians with the information they need to help their patients make the best choices about their healthcare. "

    More providers could be joining the venture, officials said.

    Harvard Pilgrim is in talks with seven other hospitals about being included in the venture, said Rick Weisblatt, chief of innovation and strategy at Harvard Pilgrim.

    The ongoing discussions revolve around what the providers' capital contribution would be, what the budget would be and how governance would work. Harvard is seeking more hospitals through this calendar year, and he expects providers to decide by mid-November.

    The joint venture is aiming to involve a broad coalition of hospitals for the company, Weisblatt said.

  • 29 Sep 2015 3:44 PM | Deleted user

    Helps alleviate the age-old question: How much is my co-pay?

    September 28, 2015 10:35 AM Eastern Daylight Time
    WATERTOWN, Mass.--(BUSINESS WIRE)--A visit to the doctor’s office often includes the moment when the patient is asked if they have a co-pay and the amount. With numerous health plan options available to consumers and the growing popularity of tiered network plans, this question is no longer as straightforward as it once was. Sometimes neither the patient nor the health care provider knows the answer. Co-pays now vary widely based on a combination of factors that can lead to confusion. To help remedy this, Tufts Health Plan created a new tool for providers that accurately determines a patient’s co-pay in real time and based on their specific plan information.

    “With our new tool, the guesswork is eliminated. Providers have the confidence of knowing the correct co-pay amount to collect from their patients and our members. As a result, the overall experience is improved for the physician, their office staff and the patient.”

    “This tool has been extremely helpful in helping us manage patients as they enter the door,” said Sabrina Latimore from Mount Auburn Hospital. Latimore manages the Pre-Admission Review Department. “It can be confusing trying to determine what the patient’s cost-share is, this tool provides clear and concise information and lets us focus on what matters most: the patient’s health. Tufts Health Plan has been a great partner by listening to our needs and proactively providing us with a tool that allows us to be more efficient and to better serve our patients.”

    Tufts Health Plan currently offers a variety of tiered plans on the market. In tiered plans, hospitals and physicians are grouped into different levels or ‘tiers’ and members pay different amounts for co-pays, coinsurance and deductibles based on the tier designation of their health care provider. If a provider cannot determine accurately what tier they are in relative to their patient’s health plan, they may charge the wrong co-pay amount, leading to the patient overpaying or the provider being underpaid – resulting in frustration for both parties involved.

    “Tiered network plans were created to reward quality and help decrease health care costs – ensuring value for members and employers. However, these types of plans are still new to market,” said Marc Spooner, Tufts Health Plan’s president of commercial products. “We began hearing from providers that a major pain point was determining the correct co-pay amount for their patients – and we decided to take action.”

    Tufts Health Plan proactively created this new provider co-pay tool to meet the needs of providers and their patients. The Plan held focus groups and surveys of providers to hear their feedback on the program and continue to make modifications and improvements based on ongoing feedback from providers. Some of the positive feedback included providers saying:

    • “We trust the information that we receive from the website. We have never had an issue with incorrect co-payment information that we have given to a patient.”
    • “Great information to be able to help member with questions they may have.”
    • “Tufts Health Plan provider portal is an easy system to use, takes a couple of clicks to locate information. Good two way system of locating a patient.”
    • “Incorporating the actual costs of things like cardiac rehab, pain management and sleep studies has helped us better serve our patients.”
    Continued Spooner: "With our new tool, the guesswork is eliminated. Providers have the confidence of knowing the correct co-pay amount to collect from their patients and our members. As a result, the overall experience is improved for the physician, their office staff and the patient.”

    The new Provider Co-pay Tool, available for providers through the Tufts Health Plan Provider Portal and through a standard eligibility and benefits EDI transaction, supports providers in Tufts Health Plan’s commercial products network and is in line with its overall goal of providing more cost and quality transparency for members, employers and providers. The plan is achieving this through the creation of innovative Cost & Quality tools including the introduction of EmpowerMe, an online cost estimator that allows members to more effectively manage their health care costs by providing highly personalized cost information on their medical treatments and out-of-pocket expenses. Additionally, Tufts Health Plan recently enhanced its existing ‘Find a Doctor’ search tool to include quality and cost information that can be accessed by members.

  • 25 Sep 2015 2:45 PM | Denny Brennan (Administrator)

    Sep 25, 2015 |Jessica Bartlett Reporter Boston Business Journal 

    Blue Cross Blue Shield of Massachusetts is backing a medical imaging company, with the insurer announcing a $5 million investment in LifeImage.

    The six-year-old Newton company specializes in sharing medical images with multiple providers, with the goal of reducing duplicative procedures, reducing radiation exposure, and improving care coordination within a health system.

    Zaffre Investments, which is the investment arm of Blue Cross Blue Shield of Massachusetts and spearheaded the investment, said the LifeImage technology had the potential to improve care delivery and patient outcomes in Massachusetts and beyond.

    “LifeImage represents technology that we believe enables these goals and makes it easier for patients to navigate the health system,” said Tuoyo Louis, managing director of Zaffre Investments, in a release.

    In addition to the funding, Zaffre Vice President Steven Fox will serve as board observer at LifeImage to make connections between the technology and providers in the Blue Cross network.

    Already, LifeImage is being used by more than 120 multi-site health systems in the country, including in Massachusetts.

    “We continue to build out and enhance this intelligent, interoperable health data network and are excited to expand our strategic partnerships with industry leaders who share in our vision,” said Hamid Tabatabaie, LifeImage CEO and co-founder, in a release.

    The investment follows a $17.5 million financing round the Newton company received in May. That funding was led by Cambia Health Solutions, with participation from existing investors Cardinal Partners, Galen Partners and Long River Ventures.

    To date, the company has raised $62.3 million.

  • 25 Sep 2015 2:38 PM | Denny Brennan (Administrator)

    CHICAGO, Sept. 24, 2015 /PRNewswire-USNewswire/ -- The Blue Cross Blue Shield Association (BCBSA) announced today the collective commitment of all 36 independent Blue Cross and Blue Shield (BCBS) companies to contribute comprehensive data on healthcare quality and costs to Blue Cross Blue Shield Axis SM (BCBS Axis SM), an industry-leading data capability that is unprecedented in scope and scale. BCBS Axis powers the transformation of healthcare by providing insights and solutions for employers, consumers and physicians to improve the quality and affordability of care. 

    This commitment vastly expands the volume of data included in BCBS Axis, which reflects more than $350 billion in annual claims along with 36 million provider records and more than 700,000 BCBS patient reviews. The breadth of the data makes BCBS Axis the healthcare industry's largest aggregated data resource and the only one that includes information from every ZIP code in the United States.

    The data include more than 2.3 billion procedures conducted annually from more than 20,000 healthcare facilities and 540,000 physicians. It allows Blue Cross and Blue Shield companies to equip employers, consumers and physicians with accurate and actionable information based on their vast data resources. Covering 1 in 3 Americans, the Blue Cross and Blue Shield System is uniquely positioned to provide insights and intelligence on healthcare quality and cost at the local, regional and national levels by drawing on data from a network that includes more than 92 percent of physicians and 96 percent of hospitals nationwide.

    "The depth, breadth and scope of the data in BCBS Axis are unprecedented," said Scott Serota, president and CEO of BCBSA. "Through our actionable data, and the speed at which it is available, we are leading a transformation of the healthcare system to improve the quality and affordability of care."

    BCBS Axis gives employers a deeper understanding of their workers' care needs and utilization. Employers can quickly and accurately benchmark their organization's performance to deliver better outcomes for patients and more affordable pricing. By leveraging the data, BCBS companies also help consumers gain access to reliable and accurate information on more doctors, hospitals and procedures. This enables them to locate the right doctor at the best value and make better informed, personalized healthcare decisions. The unmatched breadth of data in BCBS Axis also powers solutions for healthcare professionals by benchmarking care delivery patterns and driving more coordinated, patient-focused care that improves health outcomes for patients.

    To learn more about BCBS Axis, visit

    About the Blue Cross Blue Shield Association

    Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 105 million members – one in three Americans. For more information on the Blue Cross Blue Shield Association and its member companies, please visit
    SOURCE Blue Cross Blue Shield Association

  • 24 Sep 2015 10:45 AM | Denny Brennan (Administrator)

    Healthcare Informatics | September 23, 2015 | By Mark Hagland

    Accountable care organization (ACO) work continues to move forward at the Springfield, Massachusetts-based Baystate Health, a six-hospital health system serving large swaths of western Massachusetts. Anchored by flagship facility Baystate Medical Center in Springfield, the health system encompasses six hospitals, 80 medical groups, and its own health plan, Health New England, which has 200,000 members. Baystate Health serves 900,000 patients across four counties.


  • 23 Sep 2015 10:31 AM | Denny Brennan (Administrator)

    Life as a Healthcare CIO | John Halamka, MD | September 22, 2015

    The September 2015 HIT Standards Committee was notable for the naming of new members and for the incorporation of the NwHIN Power Team (Dixie Baker) Standards Maturity model in all of ONC’s planning.

  • 23 Sep 2015 10:24 AM | Denny Brennan (Administrator)

    MobiHealthNews | Aditi Pai | Sep 23, 2015 

    Pharma company AstraZeneca has publicly released preclinical data from more than 50 of its medicines in order to find new drug combinations for cancer treatments. The data AstraZeneca released will be used in a competition it created in partnership with the DREAM Challenge, a non-profit, collaborative community that runs crowdsourcing efforts for biology.

    People who participate in the challenge will develop computer models that identify the properties of drugs that make them powerful when combined. Anyone who has the training or expertise to work with these models is invited to participate. The winners of AstraZeneca’s challenge will be able to submit their prediction for publication in the journal Nature Biotechnology.

    Other organizations that partnered with AstraZeneca for the challenge, which is called AstraZeneca-Sanger Drug Combination Prediction DREAM Challenge, include the Wellcome Trust Sanger Institute, the European Bioinformatic Institute, and Sage Bionetworks.

    “AstraZeneca has a deep and broad oncology development program assessing combinations of immunotherapies and small molecules to address the significant unmet need across a wide range of cancers,” Susan Galbraith, head of the Oncology Innovative Medicines Unit at AstraZeneca, said in a statement. “This open innovation research initiative complements our own efforts brilliantly and we are delighted that the findings could be published for the benefit of the global scientific community.”

    Combining cancer therapies can often be more effective than monotherapy, AstraZeneca explained, and this increases the possibility that a patient will overcome drug resistance.

    AstraZeneca has released approximately 10,000 tested combinations that measure whether a drug can destroy cancer cell lines from different tumors, like colon, lung, and breast cancer tumors. The Wellcome Trust Sanger Institute is making genomic data available to DREAM Challenge participants for all of these cell lines as well.

    This isn’t the first time AstraZeneca has invested in crowdsourcing for its medicines. In April, Boston-based patient network PatientsLikeMe announced a five-year research collaboration deal with AstraZeneca. As part of the deal, AstraZeneca will have full access to PatientsLikeMe’s global network, and the company will use the data to shape future medicine development and work to improve outcomes in different therapeutic areas, with an initial focus on respiratory disease, lupus, diabetes and oncology.

  • 21 Sep 2015 1:14 PM | Denny Brennan (Administrator)

    Health IT Security |Elizabeth Snell on September 21, 2015

    Strong health IT security measures are essential for healthcare organizations of all sizes, especially with cybersecurity threats on the rise. Covered entities need to ensure that their systems are current with the latest security options, and also conform with federal, state, and local standards.

    The International Organization for Standardization (ISO) has a set of standards for handling IT security, and Tufts Health Plan recently conformed to the ISO 27001:2013 Standard Security Program. Everything from physical and electronic security must be considered before the health IT security audit is performed, as well as access control to human resources security and regulatory compliance.

    Tufts CISO Deb Stevens discussed the recent health IT security certification

    Tufts Chief Information Security Officer Deb Stevens discussed the preparation process with, and said that working toward complete health IT security is critical for all healthcare organizations.

    HEALTHITSECURITY.COM: Tell me about what the ISO certification means to Tufts Health Plan.

    DEB STEVENS: To Tufts Health Plan, the ISO 27001:2013 certification allows us to convey to all of our constituents, and therefore our competitors, that we pay a great deal of attention to security, that we have an ongoing cyber security program, and that we care about security: we invest in it. The cyber security program is recertified every year to ensure we continuously meet the requirements. What went into the preparation process to get ready for that?

    DS: The preparation process for us started years ago when we built our cyber security program off the ISO 27001: 2005 standard, as well as NIST’s standards. At that time, all of the industry and all of the security regulations for privacy and security were coming out, both at federal and state levels. All of those states have unique notification and privacy laws as well. Rather than waiting for new laws and regulations to come out and then reacting, we chose to be proactive and map out our program based on the ISO 27001: 2013, or the earlier standards, and conduct a quick map and gap as new regulations came out.

    This process took a number of years to build out the program, and then four years ago, we started mapping out the framework and preparing to get certified. What advice would you give to other healthcare organizations that are maybe working toward their own certification?

    DS: Start by mapping their current practices against ISO 27001:2013 to get a baseline of where your cyber security program is and start the process based on risk. This way, you have a better understanding of the data, programs, processes, and documents that are already in place and can then make thoughtful investments based on risk, budgets, etc. to become certified. What was the greatest challenge for Tufts Health Plan in working toward the ISO certification?

    DS: ISO 27001:2013 certification requires that you have an internal audit performed by a third party and while we were successful in identifying the best partner for Tufts Health Plan, we also had to work internally to identify the right team members to assist and respond during the internal audit phase. Finding that appropriate third party partner could be a challenge for other organizations. What do you think are top issues right now for healthcare organizations in terms of their data security?

    DS: Advanced persistent threats, or APTs, on end points, such as your desktop is a top issue. So often today, people – end users or anyone who has access to a computer – become an unwitting part of an attack. You get an email that looks like it’s from your friend, your bank, or a company you’re buying something from, and when you open it, your machine is being infected by malware that intends to steal data. This is similar to many of the attacks that have been in the news as of late, which is really part of a daily news cycle: who got hacked today?

    So, advanced persistent threats and end users not knowing the role they play are both key issues. What are key takeaways for healthcare organizations following large-scale data breaches, such as Anthem?

    DS: It depends on the breach itself. If it’s a breach where something has gone wrong, for example, that could be a result of not investing in security. If someone has a laptop or other mobile device that is not encrypted and they lose it, then there’s a breach, and that’s a poor demonstration of due diligence, which could have been avoided by simply spending $50 to encrypt it. That’s one end.

    On the larger end, and I think it’s highlighted every time a major breach occurs, there are entire groups of “soldiers” who do nothing but try and hack into companies, like with Sony, and the same can happen to healthcare organizations. When those types of people want to invest in the resources needed to access your data, that’s difficult to combat and plan against. Managing risk while enabling business and proactively monitoring, is key to any cyber security program. 

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