Partners HealthCare announced its selections for the fifth annual “Disruptive Dozen,” the 12 emerging artificial intelligence (AI) technologies with the greatest potential to impact healthcare in the next year. The technologies were featured as part of the World Medical Innovation Forum held in Boston to examine AI in clinical care including a range of diseases and health system opportunities.
“Understanding state-of-the-art medical technologies enables us to anticipate the future of clinical care,” said Gregg Meyer, MD, chief clinical officer, Partners HealthCare and 2019 World Forum co-chair. “The Disruptive Dozen technologies can offer physicians and patients a renewed sense of optimism about Artificial Intelligence and its impact on diagnosis and treatment.”
The 2019 Partners HealthCare Disruptive Dozen are:
1 Reimagining medical imaging – AI is transforming radiology and imaging, including mammography and ultrasound, to bring improvements in clinical care and diagnoses to patients worldwide. Researchers envision AI transforming mammography from one-size-fits-all to a more targeted tool for assessing breast cancer risk, and further increasing utility for ultrasound for disease detection and rapid acquisition of clinical-grade images.
2 Better prediction of suicide risk – Suicide is the 10th leading cause of death in the U.S. and the second leading cause of death among young people. AI is proving powerful in helping identify patients at risk of suicide (based on EHR data,) and also examining social media content with the goal of detecting early warning signs of suicide. These efforts toward an early warning system could help alert physicians, mental health professionals and family members when someone in their care needs help. These technologies are under development and not cleared for clinical use.
3 Streamlining diagnosis – The application of AI in clinical workflows such as imaging and pathology is ushering in a new era of AI-enabled disease diagnosis. From identifying abnormal and potentially life-threatening findings in medical imaging, to screening pathology cases according to the presence of urgent findings such as cancer cells, AI is poised to aid the diagnostic, prognostic, and treatment decisions that clinicians make while caring for patients.
4 Automated malaria detection — Nearly half a million people succumbed to malaria in 2017, with the majority being children under five. Deep learning technologies are helping automate malaria diagnosis, with software to detect and quantify malaria parasites with 90 percent accuracy and specificity. Such an automated approach to malaria detection and diagnosis could benefit millions of people worldwide by helping to deliver more accurate and timely diagnoses and could enable better monitoring of treatment efficacy.
5 Real-time monitoring and analysis of brain health – a window on the brain – A new world of real-time monitoring of the brain promises to dramatically improve patient care. By automating the manual and painstaking analysis of EEGs and other high-frequency wave forms, clinicians can rapidly detect electrical abnormalities that signal trouble. Deep learning algorithms based on terabytes of EEG data are helping to automatically detect seizures in the critically ill, regardless of the underlying cause of illness.
6 “A-Eye”: Artificial intelligence for eye health and disease – Not only is AI is helping advance new approaches in ophthalmology, it’s demonstrating the ability of AI-enabled technologies to enhance primary care with specialty level diagnostics. In 2018, the Food and Drug Administration approved a new AI-based system for the detection of diabetic retinopathy, marking the first fully automated, AI-based diagnostic tool approved for market in the U.S. that does not require additional expert review. The technology could also play a role in low-resource settings, where access to ophthalmologic care may be limited.
7 Lighting a “FHIR” under health information exchange — A new data standard, known as the Fast Healthcare Interoperability Resources (FHIR) has become the de facto standard for sharing medical and other health-related information. With its modern, web-based approach to health information exchange, FHIR promises to enable a new world of possibilities rooted in patient-centered care. While this new world is just emerging, it promises to give patients unfettered access to their own health information — allowing them to decide what they want to share and with whom and demanding careful consideration of data privacy and security.
8 Reducing the burden of healthcare administration — use of AI to automate routine and highly repetitious administrative functions. In the U.S., more than 25 percent of healthcare expenditures are due to administrative costs, far surpassing all other developed nations. One important area where AI could have a sizeable impact is medical coding and billing, where AI can develop automated approaches. The goal is to help reduce the complexity of the coding and billing process thereby reducing the number of mistakes and minimize the need for intense regulatory oversight.
9 A revolution in acute stroke care — Stroke is a major cause of death and disability across the world and a significant source of healthcare spending. Each year in the U.S., nearly 800,000 people suffer from a stroke, with a cost of roughly $34 billion. AI tools to help automate the diagnostic journey of ischemic stroke can help determine whether there is bleeding within the brain — a crucial early insight that helps doctors select the proper treatment. These algorithms can automatically review a patient’s head CT scan to identify a cerebral hemorrhage as well as help localize its source and determine the volume of brain tissue affected.
10 The hidden signs of intimate partner violence – Researchers are working to develop AI-enabled tools that can help alert clinicians if a patient’s injuries likely stem from intimate partner violence (IPV). Through an AI-enabled system, they hope to help break the silence that surrounds IPV by empowering clinicians with powerful, data-driven tools. While screening for intimate partner violence (IPV) can help detect and prevent future violence, less than 30 percent of IPV cases seen in the ER are appropriately flagged as abuse-related. Healthcare providers are optimistic that AI tools will further complement their role as a trusted source for divulging abuse.
Guest post by Kate Jester-Brod, vice president of client success, EoScene.
Since Hurricane Katrina, the healthcare industry has been pushing towards maintaining comprehensive EHRs. The concept of an EHR combined with the concepts of the health information exchange (HIE) creates a means for patients and providers to always have a 30,000-foot view of the patient’s health. Which then begs the question, ‘what about the actual healthcare facilities?’ What does their 30,000-foot view look like? Are facility and staff doing their part to support exceptional and safe patient care?
In the most basic of explanations, enterprise risk covers the overall opinion of others towards your organization. It can affect revenue, staff retention, grant funding, and much more. In the healthcare industry, the enterprise is at risk at many levels. Drug safety, staff and patient safety, clinical outcomes, facilities maintenance, public relations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are some but not all of the components of enterprise risk.
Moreover, reducing enterprise risk in any industry includes reducing not only overhead and operational costs but also consumer costs. In healthcare reducing costs for consumers can increase patient satisfaction, which is an obvious connection. More interesting, however, are recent news stories reporting on suits against major hospital systems for frauds and schemes—or applauding them for lowering healthcare costs.
While telemedicine and home health are increasingly major components of healthcare, much of healthcare operates in a facility like a hospital or clinic. Facilities, along with structural integrities and heating, ventilation, and air (HVA) systems, also include patient equipment and a state of cleanliness. All of these components comprise the environment of patient care and healing, and the enterprise. By taking control of these areas a hospital or healthcare facility becomes one step closer to protecting the enterprise.
The best way to protect it is to predict and manage risk before problems happen. This is even more critical as the healthcare industry works towards the Institute for Healthcare Improvement’s Triple Aim as a means to optimize care. The three components of the Triple Aim complement and overlap the need to reduce enterprise risk.
Fundamentally, the Triple Aim works towards creating system-level metrics to measure success. Enterprise risk is at the center of these metrics that ultimately drive decision making. Understanding the policies and procedures that make up facilities management, patient safety, accreditation, and the overall health of the system can significantly reduce enterprise risk while supporting more effective decision making.
Taking control of facilities management can directly impact the reduction of enterprise risk. Facilities Management holds many different responsibilities in a healthcare system, including emergency management, fire safety, patient and staff safety, infection prevention, environmental services, utilities and equipment, accreditation, and many others.
Improving patient-centered care with consideration for facility compliance results in tangible ways to improve the Triple Aim. The electronics health record is assumed to document all the components of the Triple Aim, but this clinically based monitoring system focuses on provider-patient experience and overlooks other components of the healthcare environment.
Utilizing facilities information technology plays a critical role in establishing the foundation necessary to achieve positive results in achieving the Triple Aim. Recent innovation in health facilities IT has resulted in quality improvement and measurement from the ground up and has the potential to address an often overlooked component of that we all strive for in Triple Aim.
In virtually every context that question might be asked, we struggle to give an honest, accurate answer.
It Works If You Believe It Works
Is the medication working? Difficult to say–it may be the placebo effect, it may be counteracted by other medications, or we may be monitoring the wrong indicators to recognize any effect. Is “working” the same as “having an effect,” or must it be the desired effect?
Alternative medicine confounds the balance of expectations and outcomes even further. Right at the intersection of evidenced-based medicine and naturopathy, for instance, we have hyperbaric oxygen therapy, or HBOT. These devices are as much in vogue among emergency departments (to treat embolisms, diabetic foot ulcers, and burns) as holistic dream salesmen (to prevent aging and cure autism, if you believe the hype). When the metric being tracked is as fluid as the visible effects of aging, answering whether the treatment is working is about as subjective as you can get.
As though the science of pharmaceuticals and clinical medicine weren’t confounding enough, you can hardly go anywhere in healthcare today without politics getting added to the mix. In the wake of Trump’s victory in the 2016 presidential election, you have observers and stakeholders asking of the Affordable Care Act (ACA): is it working?
There’s Something Happening Here
It is definitely doing something. It is measurably active in our tax policy, for instance: 2016 returns are heavily influenced by the incremental growth of the ACA’s financial provisions. Of course, the point of this tax policy (depending on who you ask) is to influence behavior. As to this point, there are some signs that, again, something is happening: among young people, ER visits in general are down, while emergency stays due to mental health illness are up. We changed how healthcare is insured, and that changed, in turn, how we access our care. But is it working?
The lack of EHR interoperability continues to pose a serious threat to healthcare initiatives, according to a recent report published by the American Hospital Association (AHA). The report discusses the various aspects of the healthcare industry and care delivery that are negatively impacted by a lack of interoperability.
The report notes that the exchange of health information is critical for the coordination of care. When patients receive care from multiple different providers, physicians should be able to securely send relevant patient information to the practicing physician. However, that tends not to be the case because EHR systems are not interoperable and cannot exchange information.
Last year, the ECRI Institute released a survey outlining the Top Ten Safety Concerns for Healthcare Organizations in 2015. The second highest concern was incorrect or missing data in EHRs and other health IT systems caused by interoperability. For the second year in a row, EHR data is identified as a concern.
The Partnership for Health IT Patient Safety, a branch of the ECRI Institute, has released safe practice recommendations for using the copy and paste function in EHRs that can adversely affect patient safety, such as the use of copy and paste that can overpopulate data and make relevant information difficult to locate, according to the partnership’s announcement.
Meanwhile, a survey of 68 accountable care organizations conducted by Premier, Inc. and the eHealth Initiative found that despite steep investments in health information technology, they still face interoperability challenges that make it difficult to integrate data across the healthcare continuum.
The survey found that integrating data from out-of-network providers was the top HIT challenge for ACOs, cited by almost 80 percent of respondents. Nearly 70 percent reported high levels of difficulty integrating data from specialists, particularly those that are out-of-network.
User Frustration Over Lack of HIE and Interoperability Standards
The Office of the National Coordinator for Health Information Technology (ONC) is once again asking the healthcare community for its thoughts on establishing metrics to determine if or to the extent to which electronic health records are interoperable. The push to achieve interoperability is in response to last year’s mandate by Congress, contained in the Medicare Access and CHIP Reauthorization Act (MACRA). Among provisions of that law is a requirement to achieve “widespread” interoperability of health information by the end of 2018.
When it comes to how Health Information Exchanges (HIEs) handle the challenges associated with interoperability, a recent Government Accountability Office (GAO) report cites the following barriers–insufficient health data standards, variations in state privacy rules and difficulty in accurately matching the right records to the right patient. In addition, the costs and resources necessary to achieve interoperability goals, and the need for governance and trust among entities to facilitate sharing health information.
In its annual interoperability survey of hospital and health system executives, physician administrators and payer organization IT leaders released in April 2016, Black Book Research found growing HIE user frustration over the lack of standardization and readiness of unprepared providers and payers.
Of hospitals and hospital systems, 63 percent report they are in the active stages of replacing their current HIE system while nearly 94 percent of payers surveyed intend to totally abandon their involvement with public HIEs. Focused, private HIEs also mitigate the absence of a reliable Master Patient Index (MPI) and the continued lack of trust in the accuracy of current records exchange.
Public HIEs and EHR-dependent HIEs were viewed by 79 percent of providers as disenfranchising payers from data exchange efforts and did not see payers as partners because of their own distinct data needs and revenue models. Progressive payers are moving rapidly into the pay-for-value new world order and require extensive data analytics capabilities and interoperability to launch accountable care initiatives.
Those looking at touted standards such as Fast Healthcare Interoperability Resources (FIHR) point out that it is only capable of connecting one medical facility to another and requiring specific end point interfaces to even do that. For every additional facility, a customized interface must be built. At the end of the day, FIHR is really a point-to-point customized interface requiring extra steps and ties developers to specific hospitals or EHRs and without universal access.
“Progressive FHIR standards can allow EHRs to talk to other EHRs should standard definitions develop on enough actionable data points as we enter a hectic period of HIE replacements, centering on the capabilities of open network alliances, mobile EHR, middleware and population health analytics as possible answers to standard HIE,” said Doug Brown, managing partner of Black Book.
Guest post by Drew Ivan, director of business technology, Orion Health.
With such an enormous cross-section of the healthcare industry in attendance, the HIMSS Conference and Exhibition represents a comprehensive snapshot of the state of the healthcare industry and a perfect trendspotting opportunity. Here’s a preview of what I expect will be this year’s conference highlights.
Care coordination and population health and process improvement, workflow and change management are tied for the most popular category, with 29 educational sessions focused on each.
Representing 22 percent of the total number of sessions, this is clearly a focus area for the year’s conference, and it’s easy to see why. Changes in healthcare payment models are now well underway, and they are impacting payer and provider operations where healthcare is delivered, managed and documented.
Providers and payers alike are seeking information about how best to operationalize business processes and provide high quality care under new payment models, but it may be even more interesting to visit the Exhibition Hall to see what innovations vendors are bringing to the market to meet these needs.
Another topic related to changes in healthcare delivery is clinical informatics and clinician engagement, which is all about how new technologies, such as big data and precision medicine, can impact care decisions. The ability to make data-driven clinical decisions is one of the many dividends of widely adopted electronic health records. This is likely to be an important area for many years to come.
With 100 million medical records hacked last year, privacy and security is a hot topic at this year’s conference. The number of educational sessions in this category nearly doubled from 13 last year to 25 this year.
While preventing unauthorized access to records is the top priority, security will be a simpler problem to solve than privacy. As more sources of clinical data go from paper to electronic systems and more types of users have legitimate access to patient data, the problem of providing appropriate, fine-grained access in accordance with patient preferences, clinical settings and laws that differ across jurisdictions becomes very difficult to untangle.
Privacy and security concerns will need to be addressed with a combination of open standards and vendor products that implement them. Technologies from other industries, like banking, are likely to start making their way into healthcare.
This year, health information exchange (HIE) and interoperability educational sessions are combined into a single category, reflecting the fact that interoperability within a single institution is, at this point, more or less a solved problem. The next frontier is to enable interoperability across institutions to support improved transitions of care.
HIEs have a role to play when it comes to moving data between organizations; however, many HIEs are struggling or disappearing because of sustainability challenges. This year’s conference will provide an opportunity to learn best practices from the most successful HIEs. It will also be interesting to see what strategies HIE vendors will pursue as their customer base consolidates. In the Orion Health booth alone, we will have executives from HIEs talking about these same issues.
The long awaited road to true healthcare IT system interoperability is being implemented at Good Samaritan in Indiana, enabling the 232-bed community healthcare facility to better deliver on its commitment to delivering exceptional patient care. The system will also enable the hospital to substantially increase their practice’s revenue while containing healthcare system integration costs.
“We strive to be the first choice for healthcare in the communities that we serve and to be the regional center of excellence for health and wellness,” said Rob McLin, president and CEO of Good Samaritan. “We are proud to be the first hospital in the country to implement this great integrated health record system that will allow us to provide a much higher level of continuity of care for our patients, as they are our top priority.”
The integration is being made possible with Zoeticx’s Patient-Clarity interoperability platform that will integrate WellTrackONE’s Annual Wellness Visit (AWV) patient reports with Indiana’s Health Information Exchange (IHIE) and the hospital’s Allscripts EHR. IHIE is the largest HIE in the US, serving 30,000 physicians in 90 hospitals serving six million patients in 17 states.
Revenue Generator for the Hospital
WellTrackONE and Zoeticx will enable patient’s AWV data to flow from the application to Allscripts EHR and the IHIE system. With Zoeticx’s Patient-Clarity platform and WellTrackONE’s software, the healthcare IT integration passes on increased revenue from the Centers of Medicare & Medicaid Services (CMS) and decreased IT costs for medical facilities.
Medicare pays medical facilities $164.84 for each initial patient visit under the AWV program and $116.16 for each additional yearly visit. With the AWV integration in place, the hospital is now able to meet CMS’s stringent requirements for patient reimbursements.
It is estimated that the Good Samaritan will be able to generate $500 to $1,200 per AWV patient from follow up appointments for additional testing and referrals for approximately 80 percent of the Medicare patients that are flagged by the AWV for testing, imaging and specialty referrals within the hospital.
This subscriber number is expected to trend upwards into 2050 and will create billions in new healthcare revenue through the US as the population ages. The hospital is not charged any costs for the system until it is reimbursed by CMS.
Overcoming Healthcare System Limitations
The hospital began offering Medicare’s AWV’s a few years ago, but had to develop its own tracking protocols, which impacted its budget and staff resources. The system it had created also operated poorly, allowing hospital staff to only view about 10 percent to 15 percent of patient data.
Good Samaritan medical teams were also constrained by interoperability, having to enter new illness findings and other medical info manually and fax PDFs to other facilities where they would have to again be entered into a different system. The hospital also had all of the data contained in WellTrackONE and Allscripts’ system, but no way to integrate the two, let alone achieve that integration with IHIE. Providers were also spending valuable patient face time trying to find specific patient data buried in the EHR system.
“Our systems were working fine, independently of each other,” said Traci French, director of business development and revenue integrity. “But we could not achieve true interoperability between the two systems. The best we could do was basically reshuffling PDF documents. The next challenge was to integrate that data with the exchange. We needed to get data to providers where they needed it, when they needed it.”
Reports state that only 39 percent of physicians share data using a health information exchange (HIE). There is even a lower number of only 14 percent who electronically share data with ambulatory care providers or hospitals outside their organization. While these numbers may seem astounding to some with Stage 2 fast approaching — the reason is clear. Because even though providers want to share health information electronically they are hindered by EHRs that can’t communicate with one another, lack information-exchange infrastructure, and the high expense of setting up electronic interfaces and health information exchanges.
Below are the top reasons why EHR sharing remains low for adoption:
Lack of Interoperability. The majority of providers and physicians have acknowledged lack of EHR interoperability and exchange infrastructure as major barriers to health information exchange. They have also identified the cost of creating and maintaining interfaces and exchanges as a major barrier.
Lack of Advanced Technology. Over the last few years, various HIE systems have been developed, but many have failed for technological and organizational reasons. High-level issues must be addressed to implement an HIE successfully, including disparate EHR and HIS systems. Most previous HIE research focused on high-level issues and evaluating impact on healthcare delivery, ROI, Syndromic Surveillance, etc.
Lack of Security and Streamlining. Quantitative measures are crucial to the long-term sustainability of HIEs. Interoperability of patient data doesn’t effectively address concerns on privacy, productivity, workflow and costs. Streamlining HIE access through integration with electronic health records to minimize workflow interruption, and keeping costs reasonably low for providers, may increase participation.
Lack of Affordability and Productivity. The cost and loss of productivity are major barriers to HIE adoption. While there are many compliant products on the market, not all of them provide cost savings and lead to efficiency or increased productivity.
The purpose of EHR and HIE is to make patient specific information available at the point of care to improve the delivery and quality of care. Interoperability of patient data no doubt has many advantages, including improved care coordination, elimination of paperwork, reduction in duplicate tests and reduction of medical errors. It is imperative to develop a long-term plan for standards and interoperability that will support competing public and private-sector Interoperability efforts. We should also encourage clear regulation on compliance with federal privacy and security laws. There should also be national benchmarking to share best practices and lessons learned. There should be significant cooperation among primary-care providers, medical specialists, long term care providers and hospitals to outline common information sharing needs promoting a value-based care.
Lindy Benton, CEO of MEA|NEA, has worked in the healthcare information technology for more than 20 years. Before joining MEA|NEA, Lindy served as divisional executive at Sage Healthcare, managing 1,400 employees, and prior to that she worked at Cerner for 15 years. MEA|NEA has nearly 20 years’ experience in providing revenue cycle enhancement solutions for payers and providers, as well as managing the secure exchange of health information, providing critical functionality to payers, medical and dental providers and other agents. Its solutions facilitate secure electronic requests for medical records and documentation to connected network providers for payment integrity, risk adjustment, audit tracking, performance/quality measures, claim attachments and more. Similarly, its technology enables providers to gain productivity via the electronic capture, storage and submissions of healthcare documentation – and to more effectively manage their revenue cycle and reduce claim denials.
Here she speaks about MEA|NEA, electronic attachments and secure health information exchange, how MEA|NEA serves healthcare and some of the most pressing issues facing healthcare’s leaders today.
Tell me more about yourself and your role at MEA|NEA.
I have worked in the healthcare information technology for more than 20 years. I am currently the CEO of MEA|NEA, a provider of electronic attachment and health information exchange solution.
Who uses the company’s products, and how are they enhancing their health systems and practices?
We have three major client sets. One is providers. They represent the point of origin for most medical records. One is payers or managed care organizations. They are often the requestors of medical record information about the members enrolled in one of their health plans. And the third we call partners who are those organizations who sit in-between the originators of medical record information and the requestors of medical record information. The enhancements you ask about are intuitive and real. We enhance the exchange of medical record protected health information – or phi – by making it 100 percent electronic, trackable and auditable.
In what ways is MEA|NEA evolving and where are you seeing the most change, the most rapidly?
With the increased focus on outcomes in healthcare in America, we are seeing an increase in the demand for medical record reviews. We see this increasingly being driven by the federal government, but the commercial sector is also participating. There are companies whose sole purpose is to audit the care being provided to patient populations and the reimbursement of charges related to that care. “Payment integrity” is commonly referenced in the industry today, and that wasn’t the case until recently. We are leading in process efficiencies to support these changes.
Tell me more about your involvement with CMS. How have the company and its strategy changed since the adoption of electronic claims submission through Medicare?
In January 2012 we began delivering medical records to Medicare contractors as one of a few organizations certified by CMS to do so. Today there are 23 certified organizations and we are the largest serving the acute-care hospitals of the nation. We are the 2nd largest overall. Since 2012 we have been selected by four organizations who are listed on the www.cms.gov website as their technology partner. We have a strong relationship with key leaders inside of CMS and we plan to continue to invest there. With 15 percent of US healthcare being tied to Medicare, this is a key component of our future in the medical marketplace.
Guest post by Judy Chan, president, HealthPro Consulting.
Burgeoning EHR implementations nationwide attributable to the meaningful use incentive program have created a surge in HIO and electronic health information exchange (eHIE).
Having health information available for electronic exchange is generally accepted as beneficial to patients, providers and payers. Providers can access patient information from other providers when they need it where they need it. Providers are able to avoid duplicating lab tests, scans and x-rays that save the payers dollars. Additionally, patients don’t need to remember what treatments were administered or drugs prescribed and can avoid unnecessary exposure to radiation.
In emergency situations, the benefits of having a patient’s health information available to emergency room staff are obvious. Patients who have experienced referrals in the course of diagnosis and treatment also readily see the advantage of not having to hand-carry all of their medical records from one doctor’s office to the next. The electronic exchange of health information among providers eliminates faxes, paper work and phone calls.
What makes the exchange of health information frightening to patients?
1. Your health information is available to others who have a legitimate need.
2. Consent must be given by the patient to share their information
3. You must trust the distributor of your information
4. You should monitor your data on a regular basis and make corrections when necessary
5. Information could be accidentally released without your permission.
6. Your consent is electronically recorded by multiple systems.
Do these risks sound familiar? They should because they are not very different from the risks that credit rating agencies that have recorded your financial transactions for years.
Received the following study recently that is quite interesting; thought it worthy of sharing:
Emergency department physicians are less likely to admit patients to the hospital when they have readily available electronic access to those patients’ health records, Weill Cornell Medical College researchers have found.
Its study, published March 12 in Applied Clinical Informatics, illustrates the value of combining multiple providers’ digital patient charts into a single source for health care providers – particularly in an urgent setting like the emergency department. With information such as previous test results, prescriptions and other patient history immediately accessible, providers are able to treat patients more efficiently and effectively than when they lack that data.
“New York State has made significant investments in health information exchange,” said Dr. Joshua Vest, an assistant professor at Weill Cornell and the lead author on the study. “Our study shows that providing physicians, nurses and allied health care professionals such as physician assistants real-time access to community-wide, longitudinal health records does in fact benefit patients.”
With federal and New York State government backing, hospitals and medical practices across the state are investing millions of dollars to make health records sharable among physicians when they need the information. The digitized charts contain doctors’ notes from every patient visit; family medical history; immunization records; lab results; medication history; allergies; reminders for preventative care and more.