Below is the fourth in a series of guest posts from Nirav R. Shah, MD, MPH, the commissioner of health for the state of New York. Look for more of his blogs in the Intel Healthcare Community in the coming months.


Mr. Jones shows up in the emergency room, complaining of severe insomnia. The problem list on his electronic health record highlights his ailments -- diabetes, asthma, anxiety, depression and migraines. A doctor prescribes a stronger anti-anxiety medication, but his insomnia does not subside.


Now imagine if that problem list also reveals that Mr. Jones is homeless, struggles with a substance abuse problem, and has a son who is in and out of prison – a surefire recipe for insomnia, if ever there was one.  Instead of giving him a pill, the staff uses that information to reach out to existing community agencies that help Mr. Jones find stable housing, a new drug counselor and support for his son -- for less than the cost of an emergency room visit.


That’s what happens when you have a health home, a health care model that delivers coordinated care to the state’s neediest patients, those who have complex behavioral, medical and long-term health needs and two or more chronic conditions.


A health home is not a physical place, but rather a model of health care in the Affordable Care Act geared for the 5 percent of the population that accounts for 50 percent of our total health care costs. Maimonides Medical Center has created the Brooklyn Health Home, which targets adults with complex health issues, serious mental illness, HIV and substance abuse issues, and is funded by the New York State Medicaid program.


Each patient in the Brooklyn Health Home has a care team comprised of a care manager, care navigator, and primary care doctor, and if needed, a psychiatrist and/or therapist. Other potential team members include specialty physicians, home care nurses, social workers, residence managers, substance abuse providers and caregivers in the home.


The team members are linked through the Statewide Health Information Network for New York, or SHINY-NY. If a patient sees a specialist or gets a new medication, everyone on his team knows about it.


Medical problems are only part of the equation. Problem lists in the Brooklyn Health Home also include social challenges and together with medical issues, get prioritized from the patient’s perspective. Everyone on the team knows if a patient gets evicted, experiences domestic violence or loses his home health aide. That’s what makes the model unique – an entire team is looking out for patients who not only have multiple medical needs but are vulnerable to social factors that sabotage good health.  After all, the social determinants of our lives – income, education, housing -- have as much of an impact on our health as medical ones, if not more.


With Mr. Jones, we know that connecting him to a new substance abuse counselor is likely to go farther than simply handing him a new medication. By creating a patient-centered problem list, we can lower the use of hospital emergency departments, reduce hospital inpatient admissions and cut back on 30-day readmissions. We can also improve patient care.


When we know the social context of a patient’s life, we get a bigger picture of his health needs. Health data lets us do that and makes it possible for us to address the social hindrances to good health as well as the medical ones.


What questions do you have?

Genome resequencing allows us to understand how genetic differences affect health and cause diseases. This is an important step in detecting anomalies associated with many genetically inherited diseases like Heart Disorders, Down Syndrome, Cystic Fibrosis and Chromosomal Abnormalities.


Next Generation Sequencing (NGS) technologies running on High Performance Computing (HPC) architectures have enabled the sequencing on DNA at groundbreaking speeds. However the storage, analysis and management of the massive DNA sequence datasets produced as a result of NGS research, is a new challenge. Hadoop and Mapreduce technologies come into play here by allowing parallel read-mapping algorithms to scale effectively and resulting in shorter execution times and lower costs (from software execution and hardware).


Among other areas Hadoop technologies may be useful are data storage, data management, statistical analysis and statistical association between various data sources. Organizations are now able to store large datasets in Hadoop Distributed File Systems (HDFS) and are able to use real-time analytics software to access data directly from HDFS bypassing any data migration headaches. Software packages like Myrna, developed by Ben Langmead, Kasper Hansen and Jeff Leek (John Hopkins University) is one such tool that allows the calculation of differential gene expressions in RNA-seq datasets on cloud (Amazon Elastic Map Reduce) or Hadoop clusters .


Innovative companies like Intel Corporation are interested in collaborating with various key partners in the Life Sciences area in an effort to accelerate such work. Intel wants to provide businesses with an open enterprise Hadoop platform alternative for next generation analytics and life sciences, called the Intel® Distribution for Apache Hadoop Software, which provides better manageability and performance – optimized for Intel Xeon processors.


In this paper, we demonstrate how to install and configure Myrna and its required components – Bowtie, R/Bioconductor and SRA toolkit within the Intel® Hadoop Distribution. Read the paper.


What is your experience with big data and Hadoop in life sciences? Do you think Hadoop is ready to become the life sciences research and analytics platform of the future?

Recent privacy storms around government surveillance, big data / analytics, social media and so forth have led many media publications to proclaim “privacy is dead.” To cope with these trends, as well as wearables, drones, Internet of Things (IoT) and other technologies just around the corner we need to move beyond a view of privacy in absolutes. If we truly had no privacy, and all of our personal information was available to anyone that wanted it then we would be in much worse shape from a privacy standpoint than we currently are.


Research studies have shown that users are increasingly empowered with mobile devices, apps, social media, and new trends around wearables and IoT are sure to compound this. This empowerment has enabled users to be productive in ways we couldn’t imagine a decade ago. However, this has also provided a lot of rope with which users can, mostly inadvertently, hurt themselves and others from a privacy standpoint. This is evident in studies such as Workarounds in Healthcare, a Risky Trend that shows that when usability is lacking in solutions or security, or IT departments get in the way of healthcare workers they find alternative workarounds that get the job done, unfortunately also adding non-compliance issues and additional privacy and security risk. This trend is particularly acute in healthcare where personal information can be very sensitive and is heavily regulated, for example by HIPAA, and healthcare and wellness apps working with such information are proliferating at an amazing pace.


To cope with this increasing empowerment of users, and the fact that user behavior is a major and growing source of privacy risk, users need to make better decisions regarding how to engage in technologies. Consumers make purchasing decisions every day, where they evaluate the value of the purchase against the cost and make a decision whether to buy or not. Viewing decisions whether to engage in technologies through this metaphor we can think of the purchase as the potential engagement in technology, the value as the benefit of the engagement, and the cost as what privacy we are giving up by engaging which depends on the personal information that will be shared as part of the engagement.


In many technology engagements today users pay little to no attention to the “privacy cost” as evidenced by studies that show little attention to permissions granted to apps being installed on mobile devices. To address this we need to improve technologies that show end users the “privacy cost” of their decisions. Further, effective privacy and security awareness training for users is much needed. We can learn from the gaming industry where gamers, including young children, learn highly complex games “on the go” without ever reading a manual.


Technologies such as app permission watchers, ad network detectors, site advisors, endpoint DLP have started to shine a light on “privacy cost” and risks and thereby influence users to make better decisions regarding where and how they engage including what apps they use, what websites they visit, and what actions they perform on their devices.


Much work remains to be done here to help users make better decisions about what technologies they want to engage with, and how they want to engage including how they will configure and use the technologies to both achieve their goals, while minimizing the privacy cost and risk.


What questions do you have?

The third annual Intel Health & Life Sciences Innovation Summit webcast series is coming Oct. 23. These online sessions will feature panel discussions with experts on the next wave of healthcare technology and personalized medicine, plus live Q&A so you can ask questions to those who are on the forefront of healthcare transformation. Register for the webcast series here and reserve your spot for these hour long broadcasts.


Leading up to the online webcasts, we have asked industry leaders to share some of their thoughts on the future of healthcare technology. Below is a guest blog from Cliff Bleustein, MD, MBA, Managing Director & Global Head of Healthcare Consulting Dell Services - Healthcare & Life Sciences, on the widespread adoption of clinical data warehouses and how analytic tools holds the promise of better health, not just better healthcare. Let us know what you think and remember to sign up for the webcasts.



Now that the nation has invested billions of dollars in electronic medical records, it’s time to start looking for ways to make a better return on that investment. To date, we’ve seen some gains in quality of care as a result of EMR use, but not much in the way of cost savings or improvements in the health of the U.S. population. But realists in the industry never expected EMRs alone to rescue a health system in which poorly managed chronic conditions and health costs are constantly increasing.


EMRs are, by and large, a tool for creating a new system, not a new system in and of themselves. And you have to go way beyond basic EMR adoption to make that tool really productive. Given that the vast majority of hospitals and physician practices are a long way from Stage 7 of the HIMSS Analytics model of EMR adoption, it’s not surprising that we are not seeing the kind of changes that we all want.


There is good news on the horizon, however. Industry-wide, healthcare IT companies are focusing a lot of attention on developing new analytic tools to help us find the cost-savings and health improvements of which we dream. The most sophisticated new tools are designed to marry the clinical data gathered by EMRs with financial and population data available from other sources to provide deeper understanding of the interaction between disease, individual patient characteristics and the health system.


These new analytic tools will depend on the creation of data integration and management systems that can pull data from clinical applications, EMRs, patient-reported data, healthcare financial systems and demographic and population data sources. The baseline for using these tools is a clinical data warehouse, or CDW, that can extract and house data from the clinical silos that are everywhere in healthcare.


The idea of the CDW is taking hold even as hospitals struggle to fully adopt electronic systems. In some ways, those hospitals that are laggards in the EMR adoption process may benefit from their procrastination by creating a CDW concurrently with an EMR system. They’ll be ready to quickly move from EMR adoption to analytics adoption if they build in a data integration function as they build their electronic systems.


With wide spread adoption of clinical data warehouses, enormous amounts of patient data can be de-identified and made available for researchers to study and analyze. When you add the promise of genomic data to the clinical data, and add in demographic, sociologic and financial data, the vehicle for creating new understanding becomes even more powerful.


So how do we find that intersection of population health and individual well-being that will help save our struggling health system? Analytics. Knowledge is the engine that will power our vehicle, driving us to that intersection where we can see all the forces that act on health. Analytic tools can refine crude data to a form that can fuel the knowledge of how people get sick and what processes we need to change to improve health.


Want an example of how population health studies have the power to give life and health to individuals? Think of the revolutionary finding that a lack of folic acid during the first weeks of pregnancy was the cause of many neural tube defects, like spina bifida. Food manufacturers started adding folic acid to a wide variety of common foods, and the rate of neural tube birth defects declined precipitously.


That understanding took years of hard work. With more data and sophisticated analytic tools, insights like this can come much faster and with less effort. The result will be an explosion of knowledge and the ability to reform our lives from conception to be healthier and less prone to the illnesses that plague our lives and cost us billions to treat.


What questions do you have?

The third annual Intel Health & Life Sciences Innovation Summit webcast series is coming up next week on Oct. 23-24. These online sessions will feature panel discussions with experts on the next wave of healthcare technology and personalized medicine, plus live Q&A so you can ask questions to those who are on the forefront of healthcare transformation. Register for the webcast series here and reserve your spot for these hour long broadcasts.


Leading up to the online webcasts, we have asked industry leaders to share some of their thoughts on the future of healthcare technology. Below is a guest blog from Stanley Crane, chief innovation officer at Allscripts, on accessing healthcare data. Let us know what you think and remember to sign up for the webcasts.


There’s a different aspect of Allscripts Open initiative that occurred to me while I was watching a TED talk by Intel’s Eric Dishman.


That idea is Care Anywhere. Previously, I had limited my thinking about Open as being a data-sharing, innovation, collaboration initiative.


But Open is about more than breaking down the silos around information. It’s about helping to transform care by making it easier for patients and providers to escape physical limitations around care delivery.


Overcoming physical barriers to detect heart trouble


Spaulding International has an electrocardiogram (ECG) device that patients can use anywhere, with the result saved in the patient’s electronic health record (EHR). The patient no longer has to go to the physical hospital for an ECG.


Compare that with wearing a Holter monitor, a technology that has been in clinical use since the 1960s. You go to the doctor’s office, and they attach leads. You walk around with it for 24 hours. Then you bring it back. A few days later, you get a report.


When do the doctor and patient make a decision based on that report? A week after the fact? It’s inefficient because the doctor and patient have to be in the same place at the same time – a doctor’s office or hospital. And what if the results warranted a quick response?


We can use Open to help overcome that physical limitation, as we did for ECGs with Spaulding. And there are other technologies, too – a continuous glucose monitor, scales, various pedometers – with lots more coming from our diverse developer base.


Care Anywhere means that no matter where the patient is, he or she can contribute to the corpus of knowledge that may help the physician make a better, faster decision. Open technology, and our partnership with Intel, will help get the information to the right place at the right time.


Mobile devices usher in a new era in healthcare


In my career, I’ve seen three major transitions. From 80 column cards to terminals (yes, I started that long ago), from terminals to PC’s, and from character-based to a graphical user interface.


Today, we’re in the midst of another, maybe the largest transformation of them all – from primarily a keyboard and mouse interaction model, to a touch and gesture method of navigating through systems.


And at the same time, we’re moving away from being tied to a physical location for information. (As a 3-year-old recently asked his mom, “Does your phone know everything?”). Windows 8 devices (and others) enable change in how we practice healthcare today.


These new interfaces challenge healthcare IT organizations to build new ways – both provider and patient-centric ways – of navigating the growing data we have available about the patient. Previously we’d build a system by saying, “Here are the fields in the database; make a form to help us fill them out.” Those days are long gone.


Today, we try to anticipate what the doctor wants to see, and bubble those things to the top. We want them to have exactly the information they need so they can plan the best care for the patient.


Our Windows 8-based mobile EHR will automatically make charts and graphs to help the doctor educate the patient and show the effect of their medications. We’re optimizing screens and touches to “make things easy” not just “make all things possible.”


We live in revolutionary times. With the confluence of the pervasive Internet, the next generation of devices, new operating systems, wearable devices, and Open toolkits – we’re on the verge of realizing this idea of Care Anywhere and making healthcare into a team sport.


Isn’t that what you want for your family?

The four finalists for the 2013 Intel Innovation Award have been announced and they represent a wide range of innovation that is occurring in healthcare technology.


Congratulations to Bioscape Digital, Greenway Medical Technologies, IPG, and Velocity Medical Solutions for advancing to the finals. Read more about each company and their submissions for the award.


From here, each company will present at the 2013 Health IT Leadership Summit on Nov. 12 at the Fox Theater in Atlanta. One will be named as the top innovator.


You can see the past winners and finalist here and see some of their innovative products and services


The daylong The Health IT Leadership Summit features panels and presentations on the issues most affecting industry growth, including the Affordable Care Act, health information exchanges, payer programs and disruptive technologies. The Summit was founded by three organizations:  Georgia Department of Economic Development, Metro Atlanta Chamber and Technology Association of Georgia (TAG) Health. Additional information and registration:


What type of innovation are you seeing in healthcare? Let me know, and be sure to stay tuned as the winner of the Intel Innovation Award is announced next month.

The third annual Intel Health & Life Sciences Innovation Summit webcast series is coming Oct. 23. These online sessions will feature panel discussions with experts on the next wave of healthcare technology and personalized medicine, plus live Q&A so you can ask questions to those who are on the forefront of healthcare transformation. Register for the webcast series here and reserve your spot for these hour long broadcasts.


Leading up to the online webcasts, we have asked industry leaders to share some of their thoughts on the future of healthcare technology. Below is a guest blog from Christa Schauermann, Healthcare Solutions Advisor at Insight, on mHealth and data security. Let us know what you think and remember to sign up for the webcasts.


“Smart mobile devices and applications, working in concert with cloud computing, social networking and big data analytics, will be at the core of global health care transformation.” Pat Hyek, Ernst & Young


mHealth, also known as mobile health, is the ugly duckling turned adorable sibling of electronic health, or eHealth. By embracing information and communication technology (ICT) for clinician device sharing, mHealth is growing up into the hospital hall mainstream. Beyond the mega trending phase, mHealth is maturing into an adult, with strong ideals, supported by a proven path and community cause.  Four out of five practicing physicians use smartphones, computer tablets, various mobile devices, and/or numerous apps in their customary medical practices, according to a Jackson & Coker report. This growth is enabling mHealth to give healthcare professionals advances in providing care faster and with historical productivity. Even with this incredible growth of mobile device communication and adaptation, many believe our world culture is barely scratching the surface of advances in cures and answers to our most formidable ailments.


As mobility devices begin to provide care givers with opportunities to retrieve large data repository research and reach the most rural of patients, while providing lower costs, improved outcomes and quicker care access, there is a kink in mHealth’s armor. Unfortunately, within our use of device driven data knowledge and positive patient outcome, there is a concern. Data breaches linking facility reputations to HIPAA fines and major privacy concerns push security issues to the forefront of infrastructure needs. There is no denying the amazing impact of patient care utilizing combined mHealth access. But, what does a facility do to support protected health information (PHI)?  Here are a couple tips to begin the approach to safer data environments:    


1. Create mobile device procedures around Choose Your Own Device (CYOD), the managed alternative to Bring Your Own Device (BYOD) procedures including technical controls and management procedures around your employees - Care takers want access to their EHR’s from their mobile device. Using HIPAA compliant cloud based applications; this can be doable with slim infrastructure upgrades.


2. Cloud controls for your facility - Threats to your IT environment are changing constantly. Web hosting cloud security solutions provide iron-clad, reliable ways to maintain up-to-the-minute protection with low per-seat costs and minimal maintenance provided your service agreement addresses data breaches and patient data loss.


mHealth will continue to find ways to grow up in each medical facility, through hospital halls and within the reaches of the most rural locations. How both IT and healthcare embrace mHealth’s expansion, through excellent security options, will give those who are passionate, about the whole patient, the industry leading edge in mHealth security support. 


What questions do you have?

The third annual Intel Health & Life Sciences Innovation Summit webcast series is coming Oct. 23. These online sessions will feature panel discussions with experts on the next wave of healthcare technology and personalized medicine, plus live Q&A so you can ask questions to those who are on the forefront of healthcare transformation. Register for the webcast series here and reserve your spot for these broadcasts.


Leading up to the online webcasts, we have asked industry leaders to share some of their thoughts on the future of healthcare technology. Below is a guest blog from Cristine Kao, Global Marketing Director, Healthcare Information Solutions, Carestream Health, Inc., on patients going mobile. Let us know what you think and remember to sign up for the webcasts.


A patient using a mobile device for healthcare-related purposes is no longer a surprise. There is a plethora of applications available for people to track health trends, set reminders to take medications, and provide tips related to exercise and diet. One area of medicine that is absent from the mobile patient revolution is radiology/medical imaging, but we at Carestream see that this is going to change soon.


We commissioned a study by IDR Medical earlier in 2013 that looked into whether patients would be interested in gaining access to their medical images. The results overwhelmingly showed that patients do want access to these images, and not only do they want access, but they want the ability to share these images too—be it with family members or with other physicians. Out of 1,000 survey participants, only 83 percent said they would be interested in using a patient portal for their medical images. Additionally, parents indicated that a patient portal would be helpful in storing, sharing and accessing their children’s images.


Eighty percent of respondents said that they would use an imaging portal in such a way. As an added bonus among our findings, patient portals were found to be desirable among all age groups, from the 18-24 year olds, all the way up to those 71 and older. In fact, 59 percent of those 71 and older considered themselves “very likely” to use a patient portal if provided the opportunity. From these findings, we have found that not only are patient portals important to providing patients with valuable health information, but that medical imaging is a component that should be a part of these technologies.


Our solution to including radiology in the patient engagement trend is the patient portal, MyVue, which allows patients to access and share their medical images. Among trials conducted, we’ve seen positive results from patients—both on how much they enjoy the technology, but also about how easy it is to navigate the portal. When working with Houston Medical Imaging, less than 2 percent of users needed to make support calls regarding the technology, and most of the calls made were to reset passwords.


Another trial we conducted with Ferrara Hospital in Italy saw that 98 percent of patients were satisfied with the ability to view their diagnostic images through the web on a personal computer or tablet. The key point being that, like with Houston Medical Imaging, the patients found the technology to be intuitive. With a platform that is easy to learn and use, we predict that future users will have a similar easy experience when first accessing MyVue. If the technology were difficult to understand or took a great deal of training, then we would not be seeing the successful adoption rates that we have been seeing so far.


As expected, the rise mobile in healthcare applications has resulted in increased involvement from the FDA. Current FDA guidelines state that "if a mobile app is intended for use in performing a medical device function (i.e. for diagnosis of disease or other condition, or the cure, mitigation, treatment, or prevention of disease), it is a medical device." Because of this rule, Carestream is predicting that all image viewers being developed and going to market—whether they are meant for patients, physicians, or clinicians—will need to have FDA clearance for diagnostic use as a medical device.


It is clear that we have entered an age where patients want to be more involved in their own healthcare—be it in tracking information, using that information to make healthy choices, or being able to share the information with different healthcare providers. As vendors, it is our responsibility to build and provide the technologies that address these needs. If we fail to accomplish this, then we are hurting ourselves, healthcare providers, and the patients, and we do not want a lose-lose-lose situation.


What questions to you have?

Below is the third in a series of guest posts from Nirav R. Shah, MD, MPH, the commissioner of health for the state of New York. Look for more of his blogs in the Intel Healthcare Community in the coming months.


When we think about the benefits of health data, we typically consider the impact on patients. No more duplicate tests. Smarter prescriptions. Better care at a lower cost.


But patients aren’t the only ones to benefit from the release of health data. Here in New York, the data is spurring high tech ingenuity and creating new business opportunities.


New York now has the largest health care IT accelerator program in the country, the New York Digital Health Accelerator. It’s a public-private partnership between the New York eHealth Collaborative, the Partnership Fund for New York City and the New York State Department of Health


The accelerator paired up tech gurus with decision makers in health care, two groups who rarely rub elbows but who now need to come together for health IT innovation. And for nine months, the accelerator acted as an incubator for eight companies. These companies were chosen from a pool of 250 applicants, who were hand-picked to design cutting edge health care technology to serve patients and providers.


To do that, the accelerator secured $4.2 million in funding from eight strategic investors and mentorship from 23 provider organizations in New York. These organizations represent stakeholders from across the continuum of care, including hospitals, nursing homes, federally qualified health centers and private practices.


Last May, we got a glimpse of what the accelerator has done, and the results have been nothing short of astounding. Among the 23 provider organizations that have provided mentorship, 17 pilot projects have been launched. And among the eight companies chosen to be in the accelerator, new technology has already emerged. Among them: 


• Software that supports team-based medication management and reconciliation for high risk patients.

• A referral platform for hospitals discharging patients to help them select the best doctors for their post-acute care. 

• An app that enables physicians to improve care coordination with the use of text messaging.


As you might imagine, the accelerator has been quite an economic boon for New York. At its current pace, the program over the next five years is projected to create 1,500 jobs and generate $150 million to $200 million in additional venture capital investment, which will spur further innovation in health IT.


For their efforts, the accelerator has gotten national recognition from some pretty important people:


Todd Park, our nation’s chief technology officer, has said that this program is one that other states should seek to emulate.

• The California Healthcare Foundation has called the New York Digital Health Accelerator one of the most successful accelerator models in the country. In particular, the report noted the financial and strategic ties that have already been forged in the market. These strong market ties are critical because they will determine which accelerators survive and thrive in the long term.

• The Rotman School of Management has ranked the New York Digital Health Accelerator the number one Health IT Accelerator in the world, compared to 21 similar accelerators. The ranking was based on 10 different criteria including access to customers, investors, government, and support for innovation.


But we’re hardly done. This fall, the New York eHealth Collaborative will be soliciting applications for the next round of companies to participate in the accelerator. Big data, as you can see, also means big business.


What questions do you have?


Nirav R. Shah, MD, MPH, is the commissioner of health for the state of New York.

One of the ways that hospitals and health systems are attempting to woo independent doctors into their camp is by offering sweet deals on electronic health records (EHRs).


Here’s how it works: the hospital has negotiated a package price from an ambulatory EHR, typically as a hosted or cloud based model (which means that you will be accessing it via the internet as opposed to installation on a local server). They have deployed it among their employed physicians and theoretically have the kinks work out.


To increase “alignment” with independent physicians, they begin offering the EHR often at attractive prices (usually on a per provider per month charge). Should you bite?  


Maybe. Besides a good price, a hospital sponsored EHR typically offers a nice local service package consisting of hospital staff available both via phone and on-site. Additionally, these EHRs often include an integration package of hospital interfaces to labs, HIEs, or ADT systems. If the lion’s share of your lab business and inpatient admissions are directed to the hospital sponsor of the EHR, subsidized integration is a real advantage from a cost, convenience and support perspective. Additionally, hospital-sponsored EHRs may offer advanced analytics in terms of quality and outcome reporting that will increasingly become a part of medicine as we transition from fee-for-service to accountable care. Hospital sponsored EHRs allow you to outsource a complex task to a competent third party.


What’s the downside? The primary disadvantage is that you are giving up a good deal of your freedom and independence on a mission-critical portion of your business. Example 1: While a hospital sponsored system will offer some flexibility in configuration, you are likely to be bound by certain conventions and standards established by the hospital. It is also likely that meaningful changes will either be impossible or time consuming, since they have to be considered in the context of the system as a whole. Example 2: What if your relationship with the hospital sours? Certainly the value of hospital interfaces diminish if you are no longer doing much business with the hospital. Getting hospital staff to craft new interfaces to competing labs or hospitals may be both problematic and expensive. Switching EHRs is never easy; a troubled relationship with the hospital is not going to help.


Finally, while hospitals are increasingly getting in business of supporting ambulatory practices—for many it is a new thing. There is no guarantee that hospital service will be great.


How do you decide? Independent of any of the details of the offer, the decision primarily rests on the type of relationship you wish to have with the hospital/system. If you see your future inextricably entwined with the hospital (including the possibility of a buy-out), then purchasing an EHR from them is worth pursuing.


If on the other hand, maintaining the independence your group is paramount and you have the wherewithal to assume the burden and responsibility of independence, then buying an EHR from a hospital is probably not a good idea.


What questions do you have?

In 2012, Epic added Red Hat Enterprise Linux (RHEL) running on x86 servers to its list of supported platforms for its mission critical Electronic Health Record (EHR) database (previously, Epic only supported database software on UNIX servers).


To learn about this solution and key benefits firsthand, I encourage you to register for the upcoming webinar, How TriRivers Health Partners Optimized and Virtualized Its Electronic Records Infrastructure. In this space, however, I will provide an overview of the solution and describe the top three benefits over alternative, RISC-based, database platform architectures.


Epic’s solution for Linux on x86 is virtualized, and subsequently provides the benefits that HIT organizations have come to expect from virtualized infrastructure. Intel and VMware have collaborated closely over the years to ensure that software runs in virtual machines with near-native performance. Barriers that may have prevented some mission critical workloads from being virtualized in the past are reduced or eliminated with each passing generation of Xeon and vSphere (for example, VMware recently announced that the host-level configuration maximum for RAM has doubled from 2TB to 4TB with the introduction of vSphere 5.5).


With this background, here are the top three benefits of an open, standards-based, server architecture for Epic EHR:


Supportability: From 1996 to 2016 (estimated by IDC), the installed base of x86 servers will have increased from 56 percent of the overall server market to 98 percent. Accordingly, the number of administrators qualified to support and maintain these systems has also increased, making it easier to find qualified staff. Furthermore, the “end-user computing” side of the Epic EHR has already moved to x86.  Standardizing on one server architecture can simplify the support model by reducing training and headcount requirements)


Reliability: Not only is RHEL running on x86 a proven platform for hosting mission critical applications, but the Epic solution further improves reliability by virtualizing the infrastructure with VMware vSphere. The solution includes a virtualized cluster of x86 servers running the database (and associated capabilities that enable reporting, disaster recovery, etc). Should one of the hosts fail, advanced vSphere capabilities such as Distributed Resource Scheduling (DRS) and High Availability (HA) will automatically move affected VM’s to another host in the cluster


Flexibility: When there is an ecosystem of vendors/OEMs developing compatible (x86) systems, the end-user (HIT organization) benefits. Competition provides choice and leads to improved quality and reduced cost through economies of scale.


Do any of you have experience yet deploying the Epic database tier on Linux/x86? Please feel free to share your observations and experiences below. You can follow me on Twitter @CGoughPDX.

As a healthcare CIO, interoperability is probably on your radar when it comes to the thousands of devices in your organization. With more of these devices connecting to the internet, it’s important to know which vendors and products will help you coordinate your strategy. In August 2013, the United States Food and Drug Administration (FDA) updated its list of Recognized Standards that can be used for premarket reviews.  In this update, several of the IEEE 11073 Personal Health Device (PHD) standards are now recognized for increasing the opportunity to produce interoperable health care solutions.


Two of the eight standards that were adopted were 1) a base standard defining common data formats and the exchange protocol and 2) an update to the base standard.  The remaining six standards are “specializations” that define how to utilize the base standard to implement specific device types.  The supported device types include: thermometers, weighing scales, pulse oximeters, peak flow meters, glucose meters, and basic electrocardiograph (1 to 3 lead ECG) devices.


These standards were created through the consensus driven processes of the Institute of Electrical and Electronics Engineers (IEEE) and are also recognized by the International Organization for Standardization (ISO).  With dual recognition from ISO/IEEE, the standards have applicability worldwide.


Further, the Continua Health Alliance references these standards in their Interoperability Guidelines and has a rigorous test and certification process to ensure interoperability between these devices and a receiving device (i.e., PC, tablet, phone).  Continua has certified 77 devices that comply with the newly recognized standards.


The IEEE 11073 PHD team continues to generate standards for additional personal health device types such as INR, insulin pump, and body composition analyzer.  In addition, there are standards for the health & fitness space (e.g., cardiovascular fitness and activity monitoring) and independent living categories (e.g., medication monitoring).


For device manufacturers interested in creating any of the above mentioned six device types or receiving data from such devices in a standardized fashion, reviewing the FDA Procedures for the Use of Consensus Standards in the Premarket Application Review Process, would be useful.  Utilizing these standards may help simplify and streamline the premarket review process and minimize the amount of data and documentation needed in a 510(k) submission.


For healthcare providers planning to purchase personal health devices, these standards, and the IEEE/ISO/Continua/FDA acceptance of them, means it is possible to require interoperable devices utilizing open standards so the best-of-breed devices can be selected from any number of vendors and integrated into the infrastructure.


What questions do you have?

Genome resequencing in patients is an important step in the detection of mutation for congenital diseases. Traditionally, genomics software has been run on High Performance Computing (HPC) architectures.


Hadoop and MapReduce technologies are slowly transforming the Life Sciences arena by allowing parallel read-mapping algorithms to scale effectively and resulting in shorter execution times and lower costs (from software execution and hardware). Michael Schatz (University of Maryland) and Ben Langmead (John Hopkins University) have introduced various software applications like Crossbow into the Hadoop ecosystem, enabling gene resequencing to run on Hadoop clusters as well as on the cloud (Amazon Web Services via Elastic Map Reduce service). Crossbow provides a scalable software pipeline that can analyze over 35x coverage of the human genome on a 10-node Hadoop cluster in about one day.


However, being open source, Hadoop seems less polished in some areas and can be difficult to manage in others. Companies like Intel Corporation have started with the Apache Hadoop Distribution and added components to it for better manageability and performance – optimized for Intel Xeon processors, in order to provide businesses with an open enterprise Hadoop platform for next generation analytics and life sciences, called the Intel® Distribution for Apache Hadoop Software.


In this new paper, we demonstrate how to install and configure Crossbow and its required components – Bowtie, SOAPsnp and SRA toolkit within Intel® Hadoop Distribution. Read the full paper here.


Technological advancement is far outpacing our knowledge and abilities to interpret genomic information.  However, technology is allowing newer opportunities to interpret more and more information about humans and other animals.


What are your thoughts on the usage, benefits and side-effects of these technologies?

Many of the benefits of personalized medicine depend on sharing genetic and other healthcare information. For example, deriving meaning out of healthcare data and in particular genetic data requires sharing sensitive information for research, often conducted by third party organizations separate from the covered entity or other organization that originally collects the genetic data. Collaborative care for patients, involving primary care physician as well as multiple specialists, requires sharing sensitive healthcare information. Healthcare organizations may also be motivated to derive revenue from massive databases of such information through de-identifying / anonymizing and then sharing it, within compliance with applicable healthcare regulations and data protection laws, such as the HIPAA Privacy Rule.


Healthcare breaches have reached alarming levels, both in frequency as evidenced by the HHS Breaches Affecting 500 or More Individuals, as well as business impact as evidenced by the Ponemon 2013 research on the Cost of a Data Breach which shows an average total cost per breach event of $5.4 million in the U.S. in 2012. Many of these breaches occur with healthcare data in transit, or where healthcare data is shared with third parties, also often known as a Data Processor in the EU or Business Associates in the U.S. These business impacts have ”naturally selected” a proactive approach (in contrast to a “wait and see” approach) as the only practical approach to privacy and security for safely sharing sensitive healthcare data.


Best practices in a proactive approach include holistic security which involves applying administrative, physical and technical safeguards, as well as a multi-layered security, also known as defense in depth where multiple security controls are applied together in layers to progressively minimize risk. Administrative controls in such an approach include a privacy notice to patients that enables them to be fully aware of the benefits and risks including specifically what sensitive healthcare information is collected, and how it will be used, retained, shared and disposed of. This enables patients to make informed choices such as opt-in or opt-out, and enables provide their consent. Another key risk mitigation in this approach includes the minimization of sensitive information based on the type(s) of processing stated in the privacy notice to the patient. Minimization involves the healthcare organization collecting the sensitive healthcare information for personalized medicine to minimize the Personally Identifiable Information (PII) in this information before sharing with a third party. For example if a research use case doesn’t require any PII, the healthcare organization should fully de-identify, or remove PII, from the genetic / healthcare information before sharing with that third party.


HIPAA, for example, provides guidance on specific PII elements required for safe harbor de-identification. Such de-identified information has low risk, although not zero risk, of re-identification of the patient. Further, some use cases require either full PII, or partial PII. Therefore it is highly recommended to supplement de-identification with other safeguards including tokenization, where any residual PII is stored separately in a secure database with access controls ensuring only authorized access. Encryption is a key safeguard to protect confidentiality of information being shared, or in transit. Hardware assisted security such as encryption acceleration enables encryption of large genetic data sets in transit with high performance.


Last, but not least, appropriate access controls should be used to ensure only authorized access to sensitive healthcare information that is shared, with appropriate auditing to ensure compliance with policies. The healthcare organization collecting the sensitive healthcare information should also vet the privacy and security of the target organization(s) for sharing, to ensure adequate protection. Contractual controls are needed between the healthcare organization sourcing the sensitive healthcare information and the target third party with which information will be shared. Key elements of these contractual controls include service level agreements (SLAs), business associate agreements (BAAs) and security incident response plans (SIRPs), in particular to outline procedures for timely response and collaboration in the event of security incidents such as breaches.


What kinds of strategies are you using to safely share sensitive data for personalized medicine?

Below is the second in a series of guest posts from Nirav R. Shah, MD, MPH, the commissioner of health for the state of New York. Look for more of his blogs in the Intel Healthcare Community in the coming months.


A woman on methadone for unrelenting pain goes to the Emergency Department, complaining of anxiety, heart palpitations and trouble sleeping. Exhausted and disoriented, the patient neglects to tell the doctor that she recently started taking methadone. The ED doctor checks the patient’s records, sees nothing about her new medication, and prescribes valium to settle her nerves.


Without knowing that she’s on methadone, the doctor has just created a dangerous combination of medications. Taken together, valium and methadone can exaggerate dizziness and drowsiness, and cloud the patient’s already fragile judgment.


It’s hard to imagine, but such a scenario is a potential reality at a hospital in New York, where the health IT system in the methadone maintenance clinic is unable to communicate with the systems in the rest of the hospital. As we all know, poor communications between any two parties – spouses, business partners, roommates – has the potential to spell disaster.


It’s no different in the world of health IT. The ability of any IT system to communicate with another is known as interoperability. Simply put, it’s the ability of different systems to speak the same language.


Because interoperability is so critical when it comes to health information, the New York eCollaborative – also known as NYeC (pronounced NICE) has launched the EHR/HIE Interoperability Workgroup. NYeC is a non-profit founded in 2006 in partnership with the New York State Department of Health that helps health care providers transition to electronic health records while also working to create a network that links health care providers across the state.


Even though NYeC is based in New York, we knew that interoperability was more than a regional issue. This was an issue with national ramifications. Think of all the people who require medical treatment on vacation or all the snow birders who live in New York but spend their winters in Florida.


So far, 19 forward thinking states – including New York, California, Illinois, and  Oregon – and leading vendors in EHR and HIE have joined the work group, with the shared goal of increasing the adoption of such services. Part of doing that involves making sure that the interfaces between health systems are compatible, so that they can communicate with one another, even across and between states.


At the moment, there is no single set of universal standards to connect various health information exchanges. As a result, custom interfaces must be developed every time a hospital or practice adopts a new EHR or HIE. Developing these interfaces drastically increases the amount of time and money spent adopting and learning new EHRs and HIEs, which as you might imagine, becomes a deterrent to adoption. To address this issue, the EHR/HIE Interoperability workgroup has developed a set of interoperability standards and a compliance testing program which will certify EHR and HIE products against these standards.


Having a set of common standards creates the potential for a larger market and gives vendors a clear roadmap for interoperability. By collaborating and committing to common APIs and a shared HIE platform, it creates bigger opportunities for all vendors involved.


Most important, it means better care for patients.


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