Aetna pulls out of another exchange

Aetna announced Thursday that this would be the last year it participates on the Obamacare exchange in Iowa, where it is the dominant insurer. The move comes days after Wellmark Blue Cross Blue Shield announced it was leaving the state's market after this year. Both insurers also will stop selling individual market policies outside of the exchange in Iowa.

Aetna and Wellmark are the latest carriers to exit Obamacare for 2018. They cited financial risk and uncertainty as the reasons behind their decisions.

DOD reveals Cerner implementation timeline

During a Senate appropriations subcommittee hearing on March 29, the U.S. Department of Defense presented an updated timeline for its Cerner implementation rollout.

Here are five things to know.

1. Stacy A. Cummings, a program executive officer for defense healthcare management systems, testified on behalf of DOD at a hearing on the defense health program budget for fiscal year 2018. She said rollout of the new EHR system, MHS Genesis, will follow a "wave model," ultimately replacing DOD's legacy healthcare systems, which encompass more than 9.4 million beneficiaries.

"This approach allows DOD to take full advantage of lessons learned and experiences gained from prior waves to maximize efficiencies in subsequent waves," Ms . Cummings said during her testimony.

2. The EHR system uses a commercial platform by Cerner as part of a $4.3 billion DOD contract awarded to Leidos, Cerner and Accenture in July 2015.

3. The first wave of facilities to receive MHS Genesis began on Feb. 7 in the Pacific Northwest, when the DOD implemented MHS Genesis at Fairchild Air Force Base outside Spokane, Wash.

4. The next three implementation sites will be Naval Hospital Oak Harbor, Naval Hospital Bremerton and Madigan Army Medical Center outside Lakewood, all located in Washington state. This MHS Genesis roll out will begin at the end of fiscal year 2017.

5. From there, deployment will proceed with 23 waves across three continental U.S. regions and two regions overseas through 2022. The typical wave will include three hospitals and 15 physical locations and will last for roughly one year.

Click here to view the full testimony.

Doctors demand extreme EHR makeover... right now

Electronic health record vendors are making the software more user-friendly, but not nearly fast enough. Doctors weigh in on what they need for a better EHR experience.

Just about every week or so there’s a new report chronicling doctors’ frustrations with electronic health records. Drill down a bit and the source of discontent becomes clear: poor usability, clunky interfaces, ineffective search and too many clicks. 

So what would actually make doctors like their EHR?

“They need a tremendous makeover with lots of clinical input to make it easy to do not only the right thing, but the things you do all the time,” said Robert Wachter, MD, a professor of medicine at the University of California, San Francisco. 

Incremental improvements needed now

Wachter said that a makeover would include injecting next-generation EHRs with the ability to bolt on new applications that solve specific problems, including an advanced search function, easier copy-and-paste functionality as well as customizable views. 

But Charles Webster, MD, said what doctors want most is an EHR that fits with their workflow, not disrupts it.

Webster is president of EHR Workflow and his response is on point with widespread aggravations many physicians are expressing. What they really want, it seems, is efficient workflow – that enables them to spend less time wrangling with the software and more time focusing on patients. 

“The workflow of even workflow-oblivious systems can be tweaked and made marginally better,” Webster said. “However, at some point, the effort and cost of straining toward more automatic, transparent and flexible workflow within systems not specifically designed to make that possible, will be greater than the resulting improvements.” 

Michael Hodgkins, MD, who is CMIO at the American Medical Association, said EHRs must stop adding to the stress of burnt-out physicians and make the so-called desk work spent documenting in the EHRs after the workday considerably less burdensome. 

Physicians want to provide high-quality care but tending to the EHR takes up a disproportionate amount of their time, Hodgkins said. 

Long-term, it’s about interoperability

While nothing short of a time machine would make today’s EHRs better, Webster said, vendors are improving the software today, albeit slowly. 

Wachter said the Epic EHR he uses at UCSF now has moderately good interoperability with other Epic systems in that notes can be automatically imported and the software offers what he called modest decision support for conditions such as sepsis. 

Indeed, EHR makers Allscripts, Cerner and Epic have been building third-party developer programs that use APIs that enable software to run on their platforms and use their data. 

Wachter said that EHRs should one day take on doctors’ busy work so they can concentrate on medicine and patients. 

“It would learn from the user experience and customize views and actions to anticipate your moves.” 

AI, machine learning will shatter Moore's Law in rapid-fire pace of innovation

"I've never in my career seen the acceleration of technology as fast as what we've witnessed in machine learning during the last two years," said Dale Sanders, executive vice president at Health Catalyst.

Sanders, it's worth noting, has a U.S. Air Force background working on stacked neural networks and fuzzy logic, which used to be called deep learning, as well as serving as the CIO of both Northwestern University and national health system of the Cayman Islands.

"The rate of improvement happening in machine learning," Sanders added, "is way beyond what Moore's Law is to chips."

Hospitals already deploying AI
As the next generation of both patients and caregivers – including clinicians, doctors, nurses, specialists, even executives and administrators – starts taking a foothold in the healthcare workforce, hospitals looking for a first-mover advantage already know that AI is on the verge of becoming a critical component across the entire organization, and not just IT.

"AI and machine learning are exciting opportunities for us to accelerate," Carolinas HealthCare Chief Information and Analytics Officer Craig Richardville said. "To be successful you have to understand how that will fit within your market and your patient population, and you have to be knowledgeable about how to use it."