Monthly Archives: October 2015

The Rise in Electronic Prescription of Controlled Substances (EPCS)


Post by Mike Willingham


Vice President of Quality Assurance and Regulatory Affairs, Caradigm

Healthcare organizations are facing a serious societal problem that has become more pronounced in the last 15 years – the widespread abuse of prescription drugs. Controlled substances now account for approximately 10% to 11% of all prescriptions in the United States.[1] Deaths from prescription painkillers have quadrupled since 1999, killing more than 16,000 people in the United States in 2013.[2] Nearly two million Americans, aged 12 or older, either abused or were dependent on opioids in 2013.[3] More than 12 million people reported using prescription painkillers non-medically in 2010 (i.e. without a prescription or for the feeling they cause).[4] The misuse and abuse of prescription painkillers was responsible for more than 475,000 emergency department visits in 2009, a number that nearly doubled in just five years.[5] High profile news stories involving prescription drug abuse (e.g. Brett Favre, Heath Ledger) have also seemingly become more common.

In response to the rapid increase in both the prescribing and abuse of controlled substances in recent years, the Drug Enforcement Agency (DEA) has set a number of regulatory requirements for healthcare practitioners and organizations that want to prescribe those controlled substances by electronic means. In order to be able to prescribe controlled substances electronically, the DEA requires a secure, auditable chain of trust for the entire process. In addition, several states are mandating the use of EPCS, including Ohio, Florida and New York (with its I-STOP law).

Overall, it’s hard to argue that EPCS is anything but a positive for the healthcare industry. E-prescribing is a tool that increases efficiency and reduces risk of fraud and errors. A study has estimated that e-prescribing resulted in a decrease in the likelihood of prescription errors by 48%.[6]

So far though, healthcare providers have been slow to adopt EPCS thus far because most states have not had a mandate for it yet, and there are no penalties for non-compliance. However, it is inevitable that more mandates are coming, and I believe that EPCS will inevitably become the de facto standard of prescribing controlled substances. While overall adoption is currently low, it is growing fast as an average of 287 clinicians are adding this capability every month.[7]

Caradigm offers a comprehensive EPCS solution that is a seamless extension of our industry leading Identity and Access Management portfolio. We are actively working with our customer base to help them address EPCS, and are looking forward to partnering with more organizations to help them do their part in tackling this important societal issue. In a follow-up blog post, I will dive deeper into the technical solutions required for EPCS. For additional information, please visit our EPCS page.

[1] Meghan Hufstader Gabriel, PhD; Yi Yang, MD, PhD; Varun Vaidya, PhD; and Tricia Lee Wilkins, PharmD, PhD, Adoption of Electronic Prescribing for Controlled Substances Among Providers and Pharmacies. The American Journal of Managed Care. 11.17.14. http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies
[2] Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2015) Available from URL: http://www.cdc.gov/nchs/deaths.htm.
[3] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series
[4] http://www.cdc.gov/VitalSigns/PainkillerOverdoses/index.html
[5] https://www.atrainceu.com/course-module/2270162-118_oregon-pain-module-11
[6] Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc. 2013; 20(3):470-476.
[7] Meghan Hufstader Gabriel, PhD; Yi Yang, MD, PhD; Varun Vaidya, PhD; and Tricia Lee Wilkins, PharmD, PhD, Adoption of Electronic Prescribing for Controlled Substances Among Providers and Pharmacies. The American Journal of Managed Care. 11.17.14. http://www.ajmc.com/journals/issue/2014/2014-11-vol20-sp/adoption-of-electronic-prescribing-for-controlled-substances-among-providers-and-pharmacies

Four Steps To Make Population Health Analytics Actionable


Post by Neal Singh


Chief Executive Officer, Caradigm

Last week, I had the pleasure of moderating an analytics roundtable at the Caradigm Customer Summit (CCS), which took place on the Seattle waterfront. CCS was a fantastic event where provider organizations from around the country came to learn and share best practices as they lead the way with population health. You can read more about CCS in these posts - Day 1 recap and Day 2 recap. As this week is National Health IT Week, it’s an ideal time to share some of the discussion points from the roundtable to help raise awareness on the impact of data and analytics in transforming healthcare.

There were four key recommendations that came up during the discussion:

1. Build a Data Foundation

A population health analytics strategy starts with a data foundation. We heard in the roundtable that population health forces organizations to bring together a variety of data types including clinical, claims data from multiple payers (CMS and commercial payers), internal billing data, lab, pharmacy, etc. Aggregating clinical data continues to be a challenge as large health systems often are using dozens of EMRs and or are part of a clinically integrated network (CIN) that will likely always utilize many EMRs. Attendees said that while all EMR vendors publicly claim neutrality, it continues to be a challenge to get all the data that they need. Using a vendor neutral solution to aggregate data from disparate systems is one way to help overcome interoperability issues.

2. Increase Use of Predictive Analytics

The group also talked about how they are taking steps to evolve analytics efforts beyond retrospective reporting to predictive analytics that can have greater impact of patient outcomes. Most providers are still in the early stages as they have been focused on being able to report on and attain required quality metrics. Some are now starting to leverage predictive analytics in order to proactively impact patient care. For example, one attendee explained that they are giving care managers a patient readmission risk score along with the reasons for the score, which helps them take action with high-risk patients before they are discharged.

3. Surface Analytics in Workflows to Make Them Actionable

One of the most important considerations in a population health analytics strategy is to embed analytics in clinician workflows at the point-of-care. We heard repeatedly at CCS that clinicians are already faced with too much information, and that it’s not effective to present them with yet another report. What clinicians want is additional information presented in their existing workflow and tool that can help support clinical decisions. A great example of this that we heard about was surfacing a predictive Sepsis risk score for clinicians to see at the point-of-care. The Sepsis algorithm calculates a risk score based on real-time data (vital signs, lab results, medications and dates/times) and then stratifies patients as “At Risk”, “High Risk” and “Very High Risk”. Clinicians see the risk score including aggregated clinical data in their customary EMR and then examine at-risk patients to determine if they meet the criteria for severe sepsis treatment according to established protocols.

4. Establish Data Governance

Lastly, the group discussed how important it is to have a data governance structure with executive support representing all modalities of data such as quality measures, HCAHPS scores, fall risk, readmissions, hospital acquired conditions, etc. It’s critical to get different parts of the organization on the same page because there are inevitably many initiatives in motion at the same time. One attendee shared that they have built a dashboard for each modality, which helps align the different stakeholders.

CCS was an engaging event for industry leaders who are all striving to get to the same goal of population health. If you’d like to have a discussion about how to augment your population health analytics strategies or see the list of best practices we developed in conjunction with the analytics roundtable, then drop us a note here.

Leaning in on Population Health (Part 2): Caradigm Customer Summit 2015


Post by Christine Boyle


Chief Marketing Officer and Senior Vice President, Caradigm

On Day 1 of the Caradigm Customer Summit (CCS), we heard multiple provider organizations talk about how they are leaning in on population health, and are seeking to build the best practices and health IT to successfully scale their programs. On Day 2, we continued to explore the strategies and tools that can help organizations succeed with new value-based reimbursement models. Here are the highlights from another great day of learning at CCS.

Neal Singh Chief Technology Officer, Caradigm and Kendra Lindly VP, Global Product Management, Population Health and Analytics, Caradigm

Neal and Kendra provided insights into the overall vision of Caradigm’s product strategy as well as the collaborative development approach they take with customers. They also highlighted new applications and features that are in the roadmap across Caradigm’s four pillars of integrated solutions (Data Control, Healthcare Analytics, Care Coordination and Management, and Patient Engagement & Wellness).

Nicholas Greif, Project Manager Virtua and Jill Manz, System Integrator Virtua

Nicholas and Jill talked about how Virtua, a leading provider in South Jersey, is using Caradigm’s information security and population health tools to help improve patient care within their VirtuaCare ACO. They explained how over time, Virtua has continued to mature its population health IT infrastructure, and will be delivering actionable predictive analytics such as Sepsis risk scores to clinicians in their native EMR so they can take proactive action.

Federal and State Driven Programs Panel

Vicki Harter, VP of Care Transformation moderated a panel made up of John Supra from Greenville Health System, Scott Anderson from MyCareCoach and Todd Ellis from KPMG. They discussed how to succeed with the variety of Federal and State Funded programs that are available to providers today. The panelists agreed that although providers don’t have to have all the answers right now, they do need to start thinking about who they’re going to align and partner with, and how they’re going to get their hands on the right data and share it.

Michael Robinson SVP, Global Services, Caradigm and Mike Macedo Director, Application Services, Caradigm

The closing presentation was from Michael Robinson and Mike Macedo who talked about how to drive user adoption of new population health technologies. It’s an important consideration for providers when seeking new health IT because acquiring technology is only part of the journey. It takes deep collaboration between a technology partner and a provider to train and engage employees who are learning about new organizational strategies, workflows and IT systems. While it does take much effort to train users and drive adoption, Mike and Mike explained that the payoff is when employees become fully engaged in the process. They talked about the collective excitement that they’ve seen in recent customer deployments that energizes the entire organization. With that level of employee engagement, a provider is well positioned to succeed with their population health initiatives.

Day 2 also included more outstanding peer-to-peer discussion during roundtables on patient engagement, physician engagement and IT security organizational engagement. As mentioned in the Day 1 post, we’ll share best practices from those sessions in a upcoming blog series.

In addition to learning and sharing about population health, CCS is also about having fun and building relationships in the industry. It’s not always sunny in Seattle, but it always seems to be sunny during CCS. Our attendees were treated to a couple of beautiful days of weather on the Seattle waterfront, and were able to relax and get to know each other at evening events.

It was an amazing two days at CCS 2015. Caradigm is extremely proud to be collaborating with so many of the top provider organizations in the country and around the world. We look forward to helping our customers with their key initiatives as they continue to lean in on population health.

Wheel Cropped

The Seattle Great Wheel lit up in Caradigm mulberry.