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Nearly 90 percent of healthcare organizations have experienced data breaches, and for the second year in a row criminal attacks are the leading cause of breaches in healthcare, according to the Sixth Annual Benchmark Study on Privacy and Security of Healthcare Data.

Patricia Flatley Brennan, a professor at the University of Wisconsin at Madison, and a former practicing nurse with a Ph.D. in industrial engineering, will take the lead as director at the National Library of Medicine. The NLM is the world's largest biomedical library and the producer of digital information services used by scientists, health professionals and members of the public worldwide. National Institutes of Health Director Francis S. Collins, MD, announced the pick today. Brennan is expected to begin her new role in August 2016. "Patti brings her incredible experience of having cared for patients as a practicing nurse, improved the lives of homebound patients by developing innovative information systems and services designed to increase their independence, and pursued cutting-edge research in data visualization and virtual reality," Collins said in a statement. For seven years, Brennan worked in both critical care and psychiatric nursing. As Collins sees it, Brennan's combination of skills makes her ideally suited to lead the NLM in the era of precision medicine. She will take charge of the library as it becomes the epicenter for biomedical data science, not just at NIH, but across the biomedical research enterprise, he noted. At the University of Wisconsin-Madison, she is a professor at the School of Nursing and College of Engineering. She also leads the Living Environments Laboratory at the Wisconsin Institutes for Discovery, which is developing new ways for effective visualization of high dimensional data. Brennan is recognized as a pioneer in developing information systems for patients.   She designed ComputerLink, an electronic network to reduce isolation and improve self-care among home care patients. She directed HeartCare, a web-based information and communication service that helps cardiac patients at home to recover faster, and with fewer symptoms. Brennan also directed Project HealthDesign, an initiative designed to stimulate the next generation of personal health records. She also conducts external evaluations of health information technology architectures, and works to repurpose engineering methods for healthcare. She received a master of science in nursing from the University of Pennsylvania and a Ph.D. in industrial engineering from the University of Wisconsin-Madison. Following seven years of clinical practice in critical care nursing and psychiatric nursing, Brennan held several academic positions at Marquette University, Milwaukee; Case Western Reserve University, Cleveland; and the University of Wisconsin-Madison. NLM Acting Director Betsy L. Humphreys led the NLM over the past year, after Donald Lindberg, MD, retired having served more than 30 years. Twitter: @Bernie_HITN Email the writer: bernie.monegain@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

LOS ANGELES — Building on several best practices and basic blocking and tackling of cybersecurity, healthcare organizations must also take a higher-level view to effectively address the problems of today. “Cybersecurity could not be more important. The breaches continue to happen, in the federal government, the private sector, it’s all over,” said Ronald Ross, a fellow and data scientist at the National Institute of Standards and Technology here on Monday at the Privacy and Security Forum. In addition to outlining the new security engineering guidance document that NIST released on May 4, 2016, which he described as “the most important, most transformational,” he has worked on at NIST, Ross offered that high-level solution. “Leadership, governance, and accountability will solve 90 percent of our cyberbreaches,” Ross said. Sign up for the Healthcare IT News Privacy & Security Update newsletter. Symantec health information technology officer David Finn agreed, saying that a strong leader with governance in place can then hold people accountable when those policies and procedures are not working. “Governance has to include the CEO, CFO, the board,” Finn added. “Because that’s the only way it works.” That approach should take into account: expenditures, insurance, regulatory compliance and “all the things that companies do to mitigate risk,” said PwC managing director Lisa Gallagher. Kyle Gilliland, director of information security at Huntington Hospital said that healthcare entities cannot simply buy security. “It starts with taking a look at your business needs and trying to build security into those,” Gilliland said. Ross also said cybersecurity needs to be proactive, not reactive, and that healthcare organizations should build security into every facet of their business — and explained that when NIST was working on the new document, it reached out to engineers who build bridges, planes and other large systems to understand and incorporate their best practices.  [Also: NIST to release new guidance for strengthening hospital cybersecurity] “When a plane crashes or a bridge collapses, the first thing we do is call the engineers to find out why it happened,” Ross explained. In the event of a data breach, however, healthcare organizations typically collect more threat intelligence, rather than actually understanding their own weaknesses to improve upon those. NIST’s new guidelines can help lead entities in that direction, though Ross said regardless of which framework a hospital chooses, the best tactic is to pick one the organization understands, is comfortable with, and can execute against. “The only way to improve security is to architect and engineer your system,” Ross said. “You have to use engineering techniques to limit the damage adversaries can do.” Twitter: @SullyHIT Email the writer: tom.sullivan@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

(SPONSORED) There is an unprecedented convergence occurring between healthcare and technology – and telemedicine is an increasingly important initiative in the connected health market.

Two southeast Missouri healthcare organizations – SoutheastHEALTH, in Cape Giradeau, and Missouri Delta Medical Center, in Sikeston – will each install a Cerner Millennium EHR system. The platform provides an integrated digital record of a patient's health history, including clinical and financial data. Also, by using the online patient portal, patients will be able to securely message their physicians, schedule appointments and access their health history. "SoutheastHEALTH prides itself on being a high-tech, high-touch hospital focused on making a positive impact, and the EHR will help fulfill that mission," said Ken Bateman, president and CEO of SoutheastHEALTH, in a statement. Besides transitioning to Millennium, Missouri Delta Medical Center will also deploy Cerner's CommunityWorks technology, a prescriptive and remote-hosted IT platform tailored to support community healthcare organizations that provide care to rural communities. [Also: Cerner taps John Glaser to lead EHR company's population health efforts] More than half of Cerner clients that are live with the CommunityWorks model have achieved Stage 6 of the HIMSS Electronic Medical Record Adoption Model. "As a rural community hospital, we have been recognized with top performing patient satisfaction scores and clinical process of care measures," said Jason Schrumpf, president and CEO of Missouri Delta Medical Center, in a statement. Both organizations expect to benefit from advanced interoperability capabilities, which will enable the transfer of patient data between the organizations and among health systems across the country. Twitter: @Bernie_HITN Email the writer: bernie.monegain@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

"With respect to some business practices: It's time to lead, follow or get out of the way," CMS Acting Administrator Andy Slavitt said at the 2016 Health Datapalooza in Washington, D.C. "If you want to lead the way with innovations that help consumers, great; if you want to follow by using established standards for data and measurement and technology, also great," he added. "If you have a business model which relies on silo-ing data, not using standards or not allowing data to follow the needs of patients – pick a new business model or pick a new business." On the heels of the April announcement of the proposed MACRA ruling, Slavitt spoke to healthcare innovators, industry leaders and developers early Tuesday evening. And while he had no further news to share with the specifics of the proposal, it was clear his intentions were firm. "What Vice President Biden said should stick with us: As taxpayers, we did not spend $35 billion so companies could build their own silos," Slavitt said. "At this stage, there's no room for business practices that don’t match the need of patients." On the forefront of Slavitt's thoughts were patients with the least access to care and an "obsession with a plight of the independent physician." However, "physicians are baffled by what feels like the 'physician data paradox.' They're overloaded on data entry and yet rampantly under-informed," Slavitt said. And the majority of providers are seeing a chasm between the time needed to invest in making the IT work and the actual positive results within their practices. "Technology isn’t doing the things we know it can," he added. "Help us make smarter decisions, reduce our wasted time, help us communicate or understand what to expect next." While these issues are troubling, according to Slavitt, the solution isn't the need for more IT inventions. But rather five crucial steps to initiate change in the healthcare industry: the massive release of data; changing incentives to reward providers for patient outcomes; creating "core" quality measures across all payers; advancing interoperability; and the proposed replacement of meaningful use. "These steps are designed to make it easier for you to innovate, to open up competition and to move the focus from designing around regulations, to allowing you to design around patients’ and physicians’ needs," Slavitt said. "The opportunity for you to transform healthcare into an information industry has never been more ripe or more urgent." Twitter: @JessieFDavis Email the writer: jessica.davis@himssmedia.com Like Healthcare IT News on Facebook and LinkedIn

By Anna Gorman, Kaiser Health News Lacee Badgley, the mother of a seven-year-old, works full time as an insurance adjuster. Like most working parents, she finds making time for doctor’s appointments a challenge. “I don’t have the time or energy to drive around town and then wait,” she said. That’s why Badgley, 36, switched from her previous doctors to Zoom+, a medical provider and health insurer that aims to give patients more control and transparency. She can make same-day appointments through a mobile app, and she’s usually in and out within 30 minutes. “It’s one-stop shopping,” she said. “I am a big fan of getting everything quickly … I get my medication, my tests, everything in one visit.” Zoom, which serves patients in Portland, Seattle and Vancouver, Washington, is trying to buck the traditional health care system by offering what it bills as convenient, affordable care in a hip and user-friendly environment. The retail clinics, painted a vibrant turquoise, are stylish and simple. The prices are posted on the walls. Zoom was created by doctors Dave Sanders and Albert DiPiero to address problems that have plagued medical care for decades: rising costs, poor service and low quality, Sanders said. “We fundamentally wanted to change the system,” he said. The company targets millennials, who have been at the forefront of change in other industries. Zoom is designed for an imaginary patient named Sarah, who is in her early thirties and wants to get her health care the same way she gets other services in her life — quickly and efficiently. The waiting rooms clearly illustrate that dynamic: There are no magazines because patients don’t typically wait long enough to read. Zoom started as a single clinic in Portland 10 years ago and now has more than 30 locations. Last year, the company expanded in Portland and now offers dental care, mental health services and chronic disease management, as well as appointments with cardiologists, dermatologists and other specialists. It also opened a “performance studio” to help people reach their fitness goals and a clinic that treats emergencies such as broken bones and concussions. This year, Zoom began selling insurance through the Oregon health exchange. Sanders said that by having insurance members of its own, Zoom will be able to better assess its success at controlling expenses and improving care. Only about 2,500 have signed up for Zoom’s insurance, Sanders said. He hopes to expand the insurance arm over time and believes the overall model could be replicated in other cities. In some ways, Zoom is similar to Kaiser Permanente, which also provides medical care and insurance. But Kaiser is a closed system: It only accepts Kaiser members. Zoom is more of a hybrid, treating not only Zoom insurance members but people with other health plans and self-paying patients as well. As a result, the company is both a partner and a competitor to some other insurers. Of course, Kaiser is also a health care giant that operates in multiple states, while Zoom is much smaller and regionally contained. People covered by Zoom insurance can get care at Zoom medical facilities or with Zoom partners, including Oregon Health & Science University hospitals. In recent years, more health care providers have been offering insurance, but the vast majority of them are hospital systems, said Katherine Hempstead, director of coverage for the Robert Wood Johnson Foundation. It’s unique for a network of retail clinics to add an insurance arm, and Zoom’s model is distinct because it is selling a branded experience to a specific population, Hempstead said. One Zoom poster says the complete health system is “designed to make you happier, healthier, smarter, faster, sexier, creativer.” Hempstead said Zoom seems to be betting on the idea that young people are brand-loyal and view health much more broadly. As a result, they may be coming to Zoom not only to see a doctor but also to work with a fitness coach, get therapy or take cooking classes. “It’s a totally new-school approach,” she said. “A company like this is saying, ‘We will be the destination of everything you think of when you want to stay healthy.’ The question is: Will the economics work out?” That could be a challenge given how saturated the Portland insurance market is, said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. And some insurers on the exchange are much more established. In addition, millennials aren’t typically heavy users of the health care system, though many come for regular checkups, she said. Zoom’s success as an insurer depends in part on convincing young people that insurance “is a valuable thing for them to get and maintain,” Corlette said. Attracting young, healthy consumers also helps balance out any older, sicker members. Other health care companies are marketing to millennials also, including New York-based insurer Oscar, which attracts younger consumers with its user-friendly technology. Oscar started selling coverage through Covered California this year. Harken Health, a subsidiary of UnitedHealthcare, assigns members in Chicago and Atlanta to a personal health coach, and — like Zoom — it also offers classes in cooking and yoga. Darcy Hoyt, a veterinarian, said she signed up for Zoom insurance after regularly using the clinics for the past few years. The monthly premiums to cover her and her two children are lower than what her previous insurer charged, and she appreciates knowing in advance how much everything will cost. “So far, so good,” Hoyt said. “For the relatively young, healthy families with kids falling off bikes and getting common colds, it’s very streamlined.” The model appeals to people who want a different approach to medicine that doesn’t have the “vestigial appendices of a health care system that has been around for 50 years,” said John McConnell, director of Oregon Health & Science University’s Center for Health Systems Effectiveness. “It’s like the iPhone,” McConnell said. “Zoom changed the paradigm … The whole way of delivering care is very different.” Zoom is selective about its patient population. While it sees privately insured patients and uninsured ones with the ability to pay, it doesn’t accept people who are on Medicaid or Medicare. By limiting whom they serve, McConnell said, the company’s providers may be cherry-picking the least costly patients and leaving other medical groups and hospitals to deal with medically needier people. Sanders countered that one company can’t be all things to all people and Zoom has decided to invest its resources in serving a population that was ignored by the health system before the Affordable Care Act came along. Zoom keeps costs low by providing care in neighborhood clinics and avoiding unnecessary tests and procedures. It relies heavily on nurse practitioners and physician assistants, and maintains small staffs. It also has its own electronic health record system. “The whole process has been stripped,” Sanders said. “We took out a lot of the people, we took out all the paper, we took out the whole Taj Mahal.” To advance its mission, Zoom has taken on regulators and state policymakers. It successfully lobbied for laws in Oregon allowing nurse practitioners to dispense medication and insurers to reimburse for more telemedicine. The emergency clinic is one place where doctors said they are able to avoid overhead and pass savings along to patients. For patients paying out of pocket, a visit costs under $300. Badgley, who has private insurance, came in to the clinic recently because she had been in bed for days with what she thought was the flu but still felt horrible after returning to work. She only had to explain once why she was there. In the exam room, Dr. Aviva Zigman pulled out a pen and wrote Badgley’s symptoms on an oversized white board, along with the tests she might need and how long the appointment would take. Soon afterward, Zigman quickly determined that Badgley had an ear infection and gave her some antibiotics. Zigman said that as a provider, the Zoom model is much more efficient than a typical emergency room for routine ailments and her patients can get what they need quickly. Another Zoom patient, Amy Cannon, 45, goes to the company’s new primary care clinic for management of her high cholesterol, prediabetes and high blood pressure. The clinic, which has a kitchen in the lobby, offers cooking and yoga classes on site. Cannon said it feels more like a private club than a doctor’s office, and the assistant greets her with a hug. “It’s ‘Cheers’ for health care,” Cannon said. “Everybody knows your name.” This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.    

When Leapfrog released its Spring 2016 patient safety grades recently, 15 hospitals got slapped with a very public 'F' grade casting a spotlight on them that no institution wants. But with more patients weighing public hospital grades, experts, as well as a few hospitals that have faced down bad grades, say denial is the last thing a poorly marked hospital should do. Despite varied methodology among ratings programs, consumers are using these rankings to judge the institutions charged with healing them when they are at their most vulnerable, said Rita Numerof, president of healthcare strategy consulting firm Numerof & Associates. Consumers are also paying far closer attention to these types of rankings because they are shouldering increasingly larger portions of their healthcare costs, and are far more scrutinizing about where they spend those dollars, she said. "As organizations have moved to high deductible health plans and payers have incentivized consumers to go to organizations or have a benefits package that shifts choice to higher value organizations, consumers follow the money, she added. "They've never had this kind of information readily available to them before, and the bottom line is when the consumer is forced to spend more of his or her own money this choice matters." That's great news for those who scored well, but those who didn't make the grade must confront the fallout while fixing the issues that ail them. [See also: Leapfrog out with troubling hospital safety numbers.] Damage control Stony Brook University Hospital, located in Stony Brook, N.Y., was one of 15 hospitals to receive a failing grade from Leapfrog, capping what has been a years-long slide in the rankings. From the fall of 2013 through spring 2015 Stony Brook earned four B's in a row. This past fall it slipped to a C, and then bottomed out in the most recent rankings. The hospital profile on Medicare.gov shows  data to support Stony Brook has issues with patient safety. It has been penalized for the past two years by Medicare for patient safety incidents, and ranked "worse than the national average" on Medicare's Hospital Compare for serious surgical complications, healthcare associated infections, including catheter associated UTI's, and intestinal infections, and several readmission categories as well. According to its website, the New York State Department of Health lists the hospital as high quality performers when it comes to hospital mortality for common conditions and average performers for its rates of hospital-acquired bloodstream and surgical site infections, and timely and effective care. The state lists its patient satisfaction rating as 68.44 percent. However, it was rated as poorly perforning when it came to common patient safety problems, emergency department timeliness, and 30-day hospital-wide unplanned readmissions. Why did Stony Brook perform poorly? Officials responded it was due to errors and misinterpretations on the voluntary portion of the Leapfrog survey, which the hospital took for the first time this year. "Due to a misunderstanding of the Leapfrog survey questions and electronic query processes, several operational and systems measures were given ratings that do not accurately reflect our current practices. This had a significant negative impact on our overall grade," Stony Brook officials said in a statement. "The areas where there was confusion included questions about operational, processes and reporting, not in the clinical outcomes. When the errors in interpretation were discovered and brought to the attention of Leapfrog, they advised that the review period had closed and the data could not be corrected and grade could not be changed," They did not address other questions with regard to some of the publicly available data that support's Leapfrog's grade, or whether they thought the alleged survey errors were the only reason for the poor grade. They also did not specify any measures currently underway to improve patient safety. Leapfrog said that while they had been in contact with Stony Brook over the survey issues, there may have been other issues at play. According to Missy Danforth, vice president of hospital ratings for Leapfrog, Stony Brook reviewed its survey results and the CEO explained there were practices the hospital is compliant with that his staff didn't know about and did not report on. Leapfrog said they encouraged them to take a different approach to completing the survey "as it is really a gap if there are policies and practices the CEO knows about that the front-line staff and senior managers are not aware of, particularly if they are related to patient safety." Leapfrog said Stony Brook informed them they are committed to improving this process for next year and that they are "working hard on many fronts related to patient safety." [See also: Leapfrog: Hospitals still falling short on maternity care.] However, Leapfrog also asserted that the errors could have been avoided if their review process had been followed appropriately. They explained that Leapfrog gives hospitals technical support through a help desk and hospitals have opportunities to review their submitted responses and make corrections while the survey is open. The survey is open from April 1 - January 31 of each year.  After the survey closes, no changes can be made. "We publicize our deadlines and make clear how our measures are scored. We also have a CEO attestation of accuracy that every CEO must sign off on, or designate a delegate to sign off on, for each submitted section of the Leapfrog survey. This hospital submitted their 2015 survey on December 22nd, and their results were publicly reported on our website on January 5th. We encourage all hospitals to review their publicly reported results to check for data inaccuracies. If the hospital had noticed discrepancies in reviewing their publicly reported results, they could have updated their survey at any point throughout the month of January prior to the survey closing." Whether the survey errors were the major culprit or not, the fact that they offered no other explanation coupled with existing public data, which doesn't paint an entirely flattering picture of the institution, casts doubt on the true significance of the survey issue and moreover plants a seed of doubt in the public's eyes, said Numeroff. "The worst approach is blame, denial or rationalizing away the numbers. Even if you don't like the measures, and there's lots of complexity behind the measures and they're far from perfect, knowing that you still have to perform against them. Taking this as a wake-up call and a lesson and recognizing that there is work to be done would be really helpful. You have to get your own house in order and to do that acknowledging mistakes is a starting point," Numerof said. Other hospitals who received F's didn't delve into enormous detail, but were willing to admit there were things they needed to do better. For Clarion Hospital, a small facility in Pennsylvania, this is the fourth failing grade they've gotten from Leapfrog, and they haven't scored better than a D since fall of 2013. They said there were not surprised that this spring brought their 4th 'F', but stress that they have been making improvements and are committed to patient safety. "Patient Safety is very important to us here at Clarion Hospital.  We are aware that our score is below average and have developed internal processes to make the necessary improvements.  It is our mission to improve our Leapfrog grade within the next quarter," said CEO Byron Quinton. They said their rates of hospital-acquired infections, patient harm incidents and avoidable deaths are all in line with state averages, and cited outdated data as a potential contributor to their poor grade. "We are small community hospital and have lower numbers in comparison to many hospitals. The timeframe for the data, in some cases is greater than 3 years old and has not been updated, which reflects poorly on us even as improvements have been made," Clarion said in a statement. Saint Michael's Medical Center in Newark, New Jersey also doesn't have a history of high scores to refute their current 'F'. Four straight D's in a row starting in fall of 2013 were followed by a peak C in Fall of 2015. Then came the bottom this spring. They did not participate in the actual survey portion and said based on public data their performance is on par with state averages, so the failing grade was a surprise. According to Medicare.gov, St. Michael's is rated as a two-star hospital and is on par with national benchmark's when it comes to complications, and most readmissions/deaths categories except for unplanned readmissions for heart failure patients, where it was scored worse than the national average. While St. Michael's Chief Medical Officer Claudia Komer also pointed in part to outdated data as having influenced their grade, it was not a flat-out denial, and stressed that the issues they do have are being addressed. "The publicly reported data for two key areas used in the Leapfrog report, central line-associated bloodstream infection and catheter-associated urinary tract infections does show higher than average rates for the reporting period from April 2014 to March 2015.  The hospital, however, having already identified the issue, developed a corrective plan of action to reduce both types of infections. We are happy to report that in the first quarter of 2016, we had zero CLABSI and CAUTI infections." She said they have also addressed another shortcoming, the lack of a computerized physician order entry system. They said they received a zero in this category, but have since implemented such a new system. Finally, Komer said the hospital is under new ownership, having been acquired by Prime Healthcare in early May. She said the new parent company will open doors to better patient care for their hospital, and in the future they will definitely participate in the Leapfrog survey. "Prime brings extensive resources to Saint Michael's that the hospital just didn't have before, including the sharing of best practices with other Prime hospitals nationally. Prime also has a stringent internal quality reporting process and each hospital is held accountable to those standards. Saint Michael's will have the resources to achieve an entirely new level of intense focus on patient quality and safety. It's what our patients deserve." [Also: Leapfrog: 798 hospitals earn A scores for patient safety; See the list] Turnaround stories For Van Wert County Hospital in Van Wert, Ohio, the fall of 2014 and the spring of 2015 were bad months. The 70 bed nonprofit in northwestern Ohio received two failing grades in a row from the Leapfrog Group for patient safety, and staff there felt like they had been blindsided, having been under the impression that they provided safe and quality care. It was a bad assumption, Interim president and CEO Mike Holliday said, that had bred a culture of disconnect. "We really didn't have that top-down focus because everyone assumed that we didn't have those kinds of issues. Once the information came out from Leapfrog, that hit us in the face and made us stand up and take notice," Holliday said. His plan: fess up. There was no blaming their grades on survey errors or old data, Holliday said. They simply owned up to their problems. "We took it at face value that it is what it is. It's not a very pleasant situation to find ourselves in. We had some work to do and we were going to roll up our sleeves and address those issues," he said. Holliday said they got senior leadership involved from the start, and over time, invested in several programs that would help them discover where the issues were. They also instituted measures that brought staff closer together and opened the lines of communication wider than they had ever been. He said they sought education opportunities on how to improve their culture of patient safety, and put time and financial resources into the National Database on Nursing Quality Indicators program. The program's survey was provided to staff on a quarterly basis and the results helped steer their course in making needed improvements. Holliday said they fostered teamwork and communication through the implementation of daily patient safety huddles, where every morning staff got together to review safety protocols and identify opportunities for improvement. These huddles happened at the management and executive levels as well, with senior leadership meeting daily to review the past 24 hours of activity for needed improvements and look ahead to what might come up in the next 24 hours. "We can't fix issues if we don't know about them. So it gives staff an opportunity to raise those issues, raise those concerns and red flags and then give management the opportunity to address them in a positive educational learning process. It also helps make staff more comfortable with reporting those issues and then we can show that there's no negative culture about it." Finally, to fix safety issues related to medications, pharmacists became part of rounding. They went with physicians, nurses and other staff as they met with patients to allow the pharmacist to communicate with the patient about their medication and also follow up with nurses and physicians on any issues. Holliday said the turnaround happened faster than expected, and the 'A' they earned this spring was a much appreciated validation of all their effort. But it wouldn't have been possible if they had instead chosen to close ranks, deny they had issues, and opt for tight-lipped damage control to the public and the media. "The benefit was to show the community we serve that we're transparent, that we're very serious about these issues, and that we know that they're depending on us as they're giving themselves up to us to help them through their medical conditions. It gave us the opportunity to re-earn their trust. Had we approached it differently we would have been subject to a lot of skepticism within the community and the potential of more negative press." Wayne Memorial Hospital in rural Jesup, Georgia, also earned an F in fall 2014 rankings from Leapfrog, and it hit staff hard. "We were devastated and our first focus was to find out where we could do better," said Kathy Buchannan, chief nursing officer. The small 84-bed nonprofit facility had just lost two long-time trusted surgeons, and had been going through a difficult transition as replacements who Buchannan said lacked a focus on patient safety came and went. "We felt like that was our weak link at the time," she said. She also explained staff communication was a problem. But since they had close relationships with the members of their small rural community, denial wasn't an option for them either. "It was in the newspaper. I remember when we got the F. We get a lot of the same patients because it is a small community. Some people didn't believe the F. But we told people we are better than that. We are working on it. So community members were aware of of it but were understanding," Buchannan said. Buchannan and Lisa Boatright, Wayne's director of quality management, both said that many problems were solved once the revolving door of surgeons stopped turning and they were able to finally put in place a team that was the right fit and had the right focus, patient safety. They also took communication and accountability to a much higher level. Boatright said physicians started bridging the gap between them and nurses by having educational conversations about procedures with them. Boatright said this improved the rapport between the two groups and made everyone more comfortable, especially new nurses who Buchannan said can often be timid about reaching out to doctors when they need help. They also instituted an open door, anonymous reporting system whereby staff could contact supervisors or hospital leadership through a variety of channels to report concerns or problems. "If people saw something they thought was unsafe they could report it anonymously. They could come into my office, call or just write it down. Names wouldn't be mentioned so they felt comfortable voicing concerns," Boatright said. Finally, they brought patients into the process by interviewing everyone that came in for treatment about their experience. Boatright and Buchannan said they would generally wait until the second or third day of their stay, but everyone was given the opportunity to provide feedback and voice issues they had with their care before they left the hospital. Even though these may not seem like huge steps to take, for a small rural hospital they made all the difference. In fact, earning an 'A' from Leapfrog this Spring wasn't even the biggest pay-off. In 2015, Wayne Memorial Hospital won the Small Hospital of the Year award from the Georgia Hospital Association. No small feat for a small facility that just a year prior was in turmoil. Buchannan said collaboration and commitment to change from all levels was key. "It just let us know what kind of ownership our staff had of our facility. It made us happy to know that and also that so many people wanted to help make it better." Twitter: @BethJSanborn    

Many physicians have waited with bated breath for the end of meaningful use, looking forward to a new era of less burdensome compliance requirements and more realistic reporting guidelines. This may not be what they had in mind.

NantHealth, the personalized medicine company founded by Patrick Soon-Shiong, MD, has registered for a $92 million initial public offering. That number may seem low for a company used to securing nine-figure investments, but it is likely just a placeholder.