Becker's Hospital Review

35 CIO / HEALTH IT Defective EHRs suffer little in fraud probes: 'They're almost too big to fail' By Andrea Park E HR soware vendors and healthcare providers have consistently overstated the abilities of their medical records soware to receive undeserved millions in government subsidies, according to an inves- tigation by Fortune and Kaiser Health News. Nine takeaways from the investigation: 1. Government incentives were set aside as part of 2009's HITECH Act, which en- couraged the implementation of EHR sys- tems to improve efficiency, make patients' health records more easily accessible and foster data-sharing between healthcare or- ganizations. As of September 2018, CMS had paid out subsidies collectively totaling around $38 billion. 2. Subsidies were awarded based on specific meaningful use criteria outlined to vendors and providers ahead of time, government re- viewers told Fortune and KHN, so they were able to "game" the system by superficially programming soware to seemingly meet those criteria without actually being opera- tional. ree vendors have struck settlement deals, totaling $357 million, with the U.S. De- partment of Justice over allegations of these fraudulent practices, and at least two others are currently under investigation. 3. John Halamka, MD, newly named presi- dent of Rochester, Minn.-based Mayo Clin- ic's digital health and analytics efforts and former chair of the ONC standards commit- tee behind the certification rules, defended the process. "e only problem [with cer- tification] is that it presupposed that the product the vendor certified would be the same product they sold," Dr. Halamka told the news outlets. "It presupposes that peo- ple will go into the certification process and participate in good faith." 4. e ONC also said in a statement that it takes steps to ensure medical soware systems "are safe for patients and usable by providers." 5. Beyond barely meeting mandated criteria, some soware had even deeper and more po- tentially dangerous flaws, the investigation found. One EHR specialist-turned-whis- tleblower from Franklin, Tenn.-based Com- munity Health Systems told the outlets phy- sicians worried their Medhost-developed EHR system failed to track some drug pre- scriptions and dosages properly, presenting a "huge safety concern." 6. Several meaningful use lawsuits have subsequently been filed by whistleblow- ers, physicians and hospitals against their organizations and software vendors. One such 2018 suit alleges that CHS covered up dangerous software flaws in more than 120 hospitals, resulting in its receiving mil- lions of dollars in federal subsidies, and that Medhost also concealed defects during government safety reviews. CHS has since said the allegations are "without merit"; DOJ lawyers reportedly wrote in Novem- ber court filings that the matter is still under investigation. 7. Furthermore, Fortune and KHN found that hundreds of millions of dollars in subsidies went to hospitals and physicians that did not show any evidence at all of meeting the re- quired criteria: Almost 28 percent of physi- cians and 5 percent of hospitals that attested to having met government standards ulti- mately failed audits. 8. e government has rescinded approxi- mately $941 million in improper subsidies, officials told the outlets. Additionally, the ONC has revoked certification from about 100 pieces of previously approved soware products, and another 132 have reported- ly been flagged for corrective action due to "nonconformities." 9. However, much of the technology that was allegedly certified fraudulently is still used by healthcare organizations around the U.S., due in large part to the immense cost and effort required to switch EHR vendors. "ONC does seem to have a stance that removing some of these players from the market would be very disruptive," Brad Ulrich, a Tennessee-based health IT expert, told the outlets. "ey are almost too big to fail." n Brigham and Women's, Mass General test AI-driven patient safety platform By Andrea Park A clinical decision support platform using machine learning to prevent medication-related risks and errors could result in cost savings of more than $1 million, suggests a study from Boston-based Harvard Medical School. In the study, published in The Joint Commission Journal on Quality and Patient Safety, researchers deployed MedAware's artificial intelligence-enabled sys- tem in outpatient clinics of Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston, to retrospectively flag potential errors and adverse drug events in the data of 373,992 patients. Based on the platform's ability to identify easily overlooked medication-related errors and prevent avoidable adverse events, the researchers concluded that, over the course of the study, had it been operational, the system would have saved the hospitals an estimated $1.3 million when extrapolated to include the full patient population. More than 90 percent of the warnings generated — two-thirds of which would not have been flagged by existing decision sup- port systems — were determined to be accurate, and nearly 80 percent were considered clinically valid. n

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