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Morning Headlines 3/3/15

March 2, 2015 Headlines No Comments

CMS announces release of 2015 Impact Assessment of Quality Measures Report

CMS publishes a report measuring progress made on quality measures since 2006, finding that improvements have been made in 95 percent of the 119 publicly reported performance measures reviewed.

NantHealth and Allscripts Join Forces to Develop Precision Solutions at Point of Care in This Era of Genomic Medicine

Allscripts and NantHealth will partner to develop genome-based clinical decision support features within Allscripts’ EHR that will help oncologists create  personalized cancer treatment plans.

VA boosts telehealth budget for 2016

The VA has requested $1.2 billion for telehealth services in its 2016 budget request, up $126 million over last year.

AMA continues push for MU changes

AMA applauds CMS’s decision to extend the MU attestation deadline for eligible providers, but complains that even with the extension the program is too rigid and still needs to be overhauled.

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March 2, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 3/2/15

March 2, 2015 Dr. Jayne No Comments

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I received an email from ONC on Thursday that they were extending the deadline for nominations to the HIMSS Interoperability Showcase, citing “feedback that organizations needed more time to submit nominations for participation.” From the time the email arrived, that’s a whopping three business days until the deadline. It made me wonder exactly why the deadline was extended and what their current applicant pool looks like. If they were delaying because they didn’t have many applicants, then they hardly gave much of a window for organizations that weren’t already prepared. Was the announcement a way to raise awareness about the Showcase rather than being designed truly to solicit participants?

Perhaps organizations didn’t apply because they didn’t want to spend $8,000 to participate. That’s just for the kiosk at the Showcase, which includes a monitor, keyboard, mouse, power, and Internet connectivity as well as two exhibitor badges. Travel, meals, and lodging will be on top of that. We’re doing some cool things with interoperability at my health system, but they’re not about to spend upwards of $12K for developers to go show it off at HIMSS.

Whatever the reason, I can’t help but think about the ongoing list of government initiatives that have to be delayed, extended, or otherwise modified because they don’t seem to be achieving the desired results. Being a process improvement person, I’m always looking for the root cause when outcomes are not achieved or when projects run off the rails. Recently, we’ve had delays in ICD-10, Meaningful Use, and Healthcare.gov. Some of us, however, remember delays in the implementation of the 5010 claim standard and those of us deep in the weeds know about dozens of lesser-known parts of HIPAA and other omnibus legislation that are virtually unimplementable.

In medicine, we have a doctrine about ordering laboratory and diagnostic tests: don’t order it if it’s not going to change your plan for the patient. I do a lot of work with reporting from our EHR data and we have a similar dictum: don’t run the report if you’re not equipped to act on it. You’d think there would be a similar mantra about not making rules that people can’t actually follow, but that doesn’t seem to be a factor for those happily engaged in rulemaking. Only in healthcare do we come up with creatures like the “Two Midnight” rule and other similar nonsense.

My extended family is always asking about some of the wacky things that go on, such as provider-based billing, which allows hospital-owned practices to charge both a professional fee and a facility fee for outpatient visits. I’ve become as expert at explaining the Medicare Part D “donut hole” as I am at teaching patients to use a home blood glucose monitor. In trying to find some method to the madness, I stumbled on an article that attempts to explain why healthcare regulation is so complex. The first paragraph opens with a perfect summary: “Health care professionals may feel that they spend more time complying with the rules that direct their work than actually doing the work itself.”

The author contends that “regulation arises largely from a set of confrontations between opposing interests that created the system.” I agree that there are clashing agendas and learned that first hand as a young physician when the hospital’s chief of staff wanted to know why he wasn’t getting my referrals. It felt more than a little like a shakedown. He wasn’t aware that I sent nearly all of my referrals in his specialty to one of his partners, so at least his practice was seeing volume if he wasn’t personally. It didn’t matter, though, since it was apparently all about his ego. These conflicting agendas are ongoing, and “Doctored: The Disillusionment of an American Physician” talks about one physician’s struggle.

Although there are certainly turf wars at play, the regulatory soup includes rulemaking at so many levels that it’s nearly impossible to keep track of what needs to be done. I have to follow the rules of multiple hospital medical staff organizations, two state licensing boards, two specialty certification boards, one professional society, dozens of payers, the city, the county, the state, and the federal government. These rules (and non-rules that often have the force of law) sometimes conflict each other and often fail to make sense.

Several times in the last few decades, studies have looked at everything a primary care physician should be doing for his or her patients and how long that would take. An article in the Washington Post summarized the most recent data from the Annals of Family Medicine, which found that for a typical panel of 2,300 patients, the physician would have to spend nearly 22 hours a day to provide all the recommended care. That’s just delivering the care itself – it doesn’t factor in the time needed to comply with everything else a physician does such as arguing with payers, managing staff, dealing with regulations, worrying about compliance with programs, and trying to stay current with medical knowledge.

That’s what we’re dealing with in the ambulatory setting. Hospitals and health systems deal with many more rules and countless regulatory bodies. Similarly their IT departments are trying to keep the systems up and running, prevent breaches, avoid breaking something that’s required for Meaningful Use, and so on. It’s no surprise that people are not coming out of the woodwork to sign up for the Interoperability Showcase.

What regulations keep you hamster wheel spinning? Email me.

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March 2, 2015 Dr. Jayne No Comments

HIStalk Interviews Phil Kamp, CEO, Valence Health

March 2, 2015 Interviews No Comments

Philip H. Kamp is CEO of Valence Health.

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Tell me about yourself and the company.

We’ve been around since 1996. The vision of the company is that providers should be in charge of how healthcare is delivered, and for them to be in charge, they have to be at risk financially. Our job is to help provider organizations decide on the level of risk, help them figure out how to organize around the risk, and then manage the risk.

We have products around analytics. We operate all the way to a provider-sponsored health plan. We manage those things, so we pay claims, we do care management, customer service … all the functions you would do to run a health plan. It’s moving groups through the value-based care spectrum to any level of risk that they want to be.

 

How do you think HHS’s seemingly ambitious goals in moving quickly toward value-based payment will go?

I think it’s good. The general issue for us has been that their approach to doing training wheels was a problem. The old version of the shared savings models — we don’t think they were good enough or strong enough. They tried getting into risk, but what’s happened is those organizations –  from funding it and actually operating — are finding they are not being successful, most of them, and they just need to assume more risk. We would like to see more risk in those rather than less risk. We think the moves that they’re making now make a lot more sense.

 

Insurance companies and doctors have always been blamed for healthcare costs, but people are recognizing that hospitals and their increasing clout in driving favorable contract terms are a lot of the problem. Do you see HHS or CMS addressing the cost role of hospitals?

It’s interesting because the hospitals can play a major role in this if they do it right. You’re right that if they get market share, they certainly can drive pricing from that perspective. But I think if you get into more risk, where you’re actually getting a PM/PM amount, the hospitals are a large part of the cost and they’re going to be the organizers.

Hospitals should play a major role, but it’s not on a fee-for-service basis. They’re the ones who can organize the doctors and pull together an organization that can assume the risk, so I see hospitals having a major role. The market share issue is an important one, but if you’re getting into competitive PM/PM insurance-type rates, that’s where you need to go with this.

 

Back in the HMO days and attempts at moving to a capitated model, assembling risk pools that made actuarial sense was also politically awkward because you had to decide who you could afford to cover. If you’re a hospital and you’re trying to figure out the steps toward accepting risk, how do you define and measure your risk for the population that you have?

We still have conversations with some insurance companies that are saying, I get a PM/PM and I want the healthy people, I don’t want the sick people. I think that’s what you’re getting at. From a risk entity perspective, as provider groups get into risk, the population that really needs to be taken care of are those more expensive people. 

What we need to do is make sure that the PM/PM that we’re getting for that population is the right PM/PM. That was a problem in the old models. You had in a market where say the commercial PM/PM was $200 and you had an academic medical center taking in a population and got adverse selection, their cost might have been $300 PM/PM. We need to make sure that for the population that you’re responsible for, we’re looking at the dollars that are being spent on that population, then managing for that as compared to the old insurance model. That’s an important element of this.

 

Nobody wants the high-cost patients, but it’s not usually acceptable to charge those patients more. How many ways can the buck be passed?

Somebody is paying for it now, right? Those people are getting coverage, or they’re not getting coverage and they’re just using the ERs and hospitals to get their care. It’s recognition of that population and making sure that they have coverage. There’s great opportunity to manage that population better than it’s being managed now and the overall dollars will go down.

You just need to make sure you tie the actual expense for an individual, so if X-person costs $1,000 PM/PM, that should be the basis for the risk of that particular patient or that particular population. You need to tie the cost of the person to the actual risk that you take, or the cost of the population to the risk that you take, as compared to saying, “The overall population is $200 PM/PM, so let me try to get all the people that are $100 and leave the $300 people out.” 

Somewhere, that $300 person is getting healthcare. We just have to do a much better job of making sure that the dollars that we’re spending per person is where you take on the risk for that population at that dollar base.

 

As health systems and insurance companies start looking more alike, what technologies and information do each have that the other needs?

From a health system perspective, very few have the technology and the information to actually manage the population. A hospital has its information and each individual physician may have his or her information. The hard part has been aggregating the data for a population. 

If you take any given market, you probably have some physicians that are employed by a hospital, you have independent physicians … they all have different EMRs and different practice management systems. One of the keys is data aggregation. Maybe 10 years from now it will be different, but right now the key is tying all those systems together into one platform. It sounds like an HIE, but it’s the analytics behind that data that becomes important. There’s got to be ways of collecting that data from everybody and then doing the analytics around that. It’s the pharmacy data, it’s the lab data. There may be 300 different practices that may have 70 different practice management systems and EMRs.

You’ve got to be able to tie that data together to do the analytics. To me, that’s the biggest gap that exists today — pulling that data together, figuring out what it’s actually costing for that population, and managing that data to manage the care better for that population.

 

What health system metrics will be important to monitor for long-term success?

Today they’re focused on a patient entering their system and how they manage that patient who’s sick. They have to move to a higher level of managing the population as a whole. They’ve got to get a whole different level of data.

Once you’re within a system and you’ve determined how care should be provided for that population, you now have to determine if the services that are needed are actually getting done within that village. If you have multiple health systems in a marketplace, which is usually the case, how do you make sure that the services are all getting done, especially if people leave the system? The physicians in that particular organization have agreed on how care should be provided. You need to push those services to within that organization and make sure that you’re tracking it and making sure things are getting done. 

If a diabetic is supposed to get an eye exam, we need to make sure that the eye exam is done by the ophthalmologist that’s in the network and not outside the network, because if it’s done outside the network, we probably don’t have that information. It gets back to the data aggregation piece and managing the population as a whole.

 

Explain what “narrow network” means.

I think of it as a village of hospitals and physicians that have come together to agree on how care should be provided and agree on the level of risk that they’re going to take. Do they become a health plan, do they just do risk contracting with health plans, do they do a combination of things? It’s that organization that’s made that decision and then it’s got it technology that it needs to manage that in its operation.

What’s really important is that you don’t separate the technology from the operations. There are a lot of smaller technology firms or single-source technology firms that are doing one piece of this thing. But there really needs to be an overarching perspective on how the technology relates to the actual performance on these risk contracts. There’s operational pieces, there’s technology pieces, and then there’s just network development pieces.

For people on the IT side, the biggest thing is around data aggregation, the management of that data overall, and how that helps the operational people succeed in making sure that you’re caring for that population as best you can so you’re managing that population and the best quality of care is given at the lowest possible cost. Getting that information that’s not just from the hospital, but from these other independent sources, and getting it on a daily basis so that you can track what’s actually going on and manage the population going forward and helping your physicians and their practices figure out what needs to happen in the next six months with a population of people.

 

Do you have any final thoughts?

The main thing to me, and one of the things that I hear in the marketplace, is that as a health system doing this, you have to be really big. I don’t think that’s the case at all. There is a certain life threshold that you need to manage and there’s no question about that, but that life threshold doesn’t require you to be a mammoth system at all.

Groups, provider organizations coming together to cover a state is certainly an approach to do this, but again, I don’t think you need to be a 5,000-bed system in a particular marketplace. You don’t want to be a 50-bed hospital. There’s a certain size that you need to be to do this, but it’s not huge. 

The level of risk for a provider assuming risk is very different than the level of risk for an insurance company to assume risk. If you’re UnitedHealthcare and you have a patient in a hospital and that patient cost $50,000, UnitedHealthcare has a direct expense of $50,000 for that patient. Now you take a health system that has that same patient in their hospital, what does it actually cost that health system to provide care for that patient? Eighty percent of the costs in a hospital are fixed. It’s much less costly for them to assume that risk as long as the care stays within that network. If it leaves the network, they have the same situation as United has. But as long as they stay within the network, it is much less risk for a health system to assume risk. 

Another way to say that would be, if you’re a billion-dollar health system and I told the CFO tomorrow they were going to get a billion dollars in revenues next year, would they assume that’s more risk or less risk? I would say that everyone would say that it’s less risk. That’s full capitation from that standpoint. The concept of risk on the provider side is much less risky.

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March 2, 2015 Interviews No Comments

Morning Headlines 3/2/15

March 1, 2015 Headlines No Comments

Oracle sues Oregon officials in healthcare website dispute

Oracle escalates its legal battles with Oregon over the failed insurance exchange it was hired to develop by filing personal lawsuits against five Oregon campaign advisors to the state’s former governor, saying that they worked behind the scenes to kill the site for political reasons.

Allscripts Healthcare Solutions’ (MDRX) CEO Paul Black on Q4 2014 Results – Earnings Call Transcript

Allscripts CEO Paul Black acknowledges that the company is disappointed in its year-long revenue, citing lower patient portal sales and overall client fatigue driven by MU as primary reasons for sluggish sales.

Banner merger with UA Health Network effective tonight

Banner and the University of Arizona Health Network complete their merger. No decision has been made over whether UA will be allowed to keep their brand new $100 million Epic system, which experienced go-live delays and cost over-runs, or if they will be migrated onto Banner’s Cerner system.

Letter: Re: Rideout computer problems

A patient’s spouse writes an open letter calling out Rideout Health (CA) CEO Robert Chason for publically claiming that a recent EHR system failure did not result in patient harm. In the letter, a spouse states that his wife was treated at Rideout during the unplanned downtime and was sent home because test results indicating that she had a minor heart attack did not make it back to her cardiologist until two weeks after she was discharged. Hospital representatives contacted her to schedule additional tests and told her that the delay was caused by the EHR system crash.   

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March 1, 2015 Headlines No Comments

Monday Morning Update 3/2/15

February 28, 2015 News 6 Comments

Top News

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Oregon and Oracle keep suing each other over the state’s health insurance exchange and its Medicaid system, but now Oracle takes things to another legal level as it files personal lawsuits against five staff and campaign organizers of former Governor John Kitzhaber, who Oracle warns may also find himself sued shortly. Oracle says the five were politically motivated in trying to shut down Cover Oregon and then blamed Oracle as a smokescreen.


Reader Comments

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From Lab Retriever: “Re: microbiology interfaces. I’m looking for something that will interface with our three blood culture instruments – Bactec, VersaTrek, and BacT/Alert – to get the data into our LIS.” My first thought was Data Innovations, just acquired by Roper Industries and paired up with Sunquest, but I’ll invite more knowledgeable readers to offer their suggestions.

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From Maple HIZZ: “Re: University Health Network, Toronto. Not proceeding with their HIS replacement project in which Epic was the preferred vendor due to the $600 million cost, including interest. Annual operating expenses are projected to be an additional $50 million per year even when legacy IT systems are sunset. Glad to hear that UHN decided not to write the cheque and spend taxpayer dollars wisely.” Unverified.

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From Interoperability Blues: “Re: SMART project. Every vendor talks a big game about interoperability, but the public availability of C-CDA samples for each vendor is non-existent. The SMART project gathered several, but you will notice one major vendor is missing and most vendors provided only one or two. If there were thousands of C-CDAs available, the gaps would be more clear. Heck, it would even be helpful if all vendors just posted what they used to get through certification.”


HIStalk Announcements and Requests

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Two-thirds of poll respondents say Epic’s App Exchange is a PR move to support its DoD bid. New poll to your right or here: is a health system CIO’s article or presentation always more believable than that of a vendor VP? Surely your vote deserves clarifying comments (which you are welcome to add).

Attention HIStalk sponsors: we’ve made contacts about attending the sponsor networking reception event Sunday evening of HIMSS week in Chicago, but have received few RSVPs. Contact Lorre if you want to meet your industry peers and enjoy great food and drinks. Otherwise, I may just start inviting random readers since I’m stuck paying the facility’s minimum anyway.

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Our five patient advocate scholarship winners (along with Regina Holliday) have run into a HIMSS snag. They had anticipated that Chicago hotels would be expensive and planned to share a room to minimize cost, but they are now finding that availability is nearly non-existent. Let me know if you have ideas of a place that would be available for at least Sunday and Monday nights – I’m thinking perhaps someone’s occasionally rented apartment. They are even exploring couch-surfing options, so they could use some help. We’re checking VRBO and Airbnb.

I swear I’m going to throw up the next time some inspiration-impaired “thought leader” tries to draw parallels between anything healthcare-related and Uber. Or for that matter, who can’t come up with anything more original than drawing strained healthcare inferences from the death of Leonard Nimoy or something else they saw on TV. As Mark Twain said, “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.”

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I say a lot of good things about Walgreens, but here’s a first-person “fail” experience. I had to switch pharmacies because of an insurance change and was initially thrilled at the apparent ease of transferring prescriptions to their store using its cool-looking app. Upon my first attempt at getting the prescription filled, it wasn’t on file there when I called for some reason, so I made another request via the app – it looked successful and the app told me to pick up the prescription any time after 2:00. I showed up at around 2:45 and the pharmacist on duty got snotty, saying he had been too busy to call the other pharmacy, that “the computer doesn’t work back here” in flatly declaring that the stated 2:00 time wasn’t his problem and he’d get around to it whenever he could because he was backed up with both in-store and telephone to-do items. He then suggested going back to the competitor’s pharmacy and paying cash since it would be faster. The pharmacist promised to call me when the prescription was ready – it’s now 24 hours later and nobody has called, but I drove to the store and it was ready. Lesson one: it takes only one unpleasant personal experience to wipe out a lot of corporate-level goodwill. Lesson two: the technology isn’t impressive when the people aren’t (I bet the store cuts staffing to the bone since he seemed to alone behind the counter). Lesson three: shop around (as I did) before buying electronic items at Walgreens since the Sony earbuds I was about to pick up for $20 were only $12.99 on Amazon and even better ones were just $5.99.


Last Week’s Most Interesting News

  • CMS reports that it correctly processed 81 percent of ICD-10 claims in its most recent testing round and says it is ready for the switch.
  • Merge Healthcare acquires DR Systems.
  • New York’s mandatory electronic prescribing date of March 27, 2015 will likely be delayed for a year, with only the governor’s signature remaining to make it official.
  • The FBI says it is close to identifying those responsible for Anthem’s breach.
  • Cerner offers voluntary separation to its older employees.
  • CTG says its services business is suffering as the EMR market cools.
  • A study finds that Googling medical terms sends personal information to third party websites 91 percent of the time.
  • A delayed $670 million EHR implementation in British Columbia involving IBM, Deloitte, and Cerner is rumored to be headed toward arbitration.

Webinars

March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

  • CEO Paul Black says Q4 sales were down due to lower patient portal sales driven by Meaningful Use Stage 2 timing.
  • Black says the company is disappointed both with its year-long revenue as well as the unrealistic Wall Street expectations the company allowed to be created.
  • The company will collaborate with MaineHealth on population health management projects.
  • Allscripts says that Meaningful Use Stage 2-required upgrades have caused client fatigue, with many of those clients deferring other upgrades.
  • When asked about the “barbell” effect in which Allscripts ambulatory clients either love or hate their products, Black says the company is offering them everything they need to manage populations and accept risk and that attrition won’t have a huge impact.
  • Black says the company loses clients to acquisition-related system replacements or a missed deliverables, but the list of reasons it loses a customer is a lot shorter now than than when he was hired two years ago.
  • Black said of the performance of the company’s professional services work, “Nobody’s pleased with it and we do still have some work to do. We’ve changed some of the talent that’s managing that organization.”
  • The company quoted KLAS numbers indicating that 453 provider organizations will buy acute care systems in 2015 and that Sunrise is “overlooked” despite being more competitive than when he was hired.

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From the Merge Healthcare earnings call:

  • CEO Justin Dearborn says the acquisition of DR Systems gives Merge the #1 KLAS-ranked solutions in cardiovascular information systems, hemodynamics monitoring, and radiology information systems and consolidating providers want to deal with fewer vendors.
  • The company believe that attention will swing back from Meaningful Use and ICD-10, releasing pent-up demand for other solutions.
  • Merge put the DR Systems deal together so quickly that its debt holder didn’t have time to perform due diligence and DR Systems was reluctant to share information with competitor Merge, so if the due diligence doesn’t pan out, the company will have to find alternative financing to close the deal, “which could be challenging.”
  • The company expects to see opportunities given that providers who are going at risk know that a significant portion of unnecessary and redundant healthcare spending is related to imaging.

People

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Vanderbilt University Medical Center promotes Titus Daniels, MD, MPH to executive director of Vanderbilt Medical Group and COO for adult clinical operations at the hospital. His new responsibilities include clinical documentation and coding and EMR design, adoption, and support.

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Rex Adams (Children’s Healthcare of Atlanta) joins PaySpan as CEO.

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Leidos Health hires Douglas Herr (Logic Healthcare) as VP of its Epic practice.


Announcements and Implementations

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ADP AdvancedMD offers the free “ICD-10 Toolkit” app. 

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American Family Children’s Hospital (WI) is piloting Epic’s MyChart Bedside. The tablet-powered app providers patient-caregiver communication, a scheduling display, and the display of EHR information.


Privacy and Security

Security experts at ThreatConnect say evidence from the Anthem breach suggests that a Chinese espionage group is responsible. “They made an effort to hide, but they messed up,” says one of the experts, who also implicated a Chinese university professor who works with a China-based government contractor.


Technology

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HP is rumored to be close to acquiring Aruba Networks, with speculation of a Monday announcement.


Other

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Central Peninsula Hospital (AK) will replace its “clunky” Meditech system with a new system from Meditech, Cerner, or Epic. They’re planning to spend $5 million to $15 million.

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Texas-based for-profit hospital operator University General Health System files Chapter 11 bankruptcy, blaming poorly chosen acquisitions and unfavorable managed care contracts. The hospital’s website shows plush facilities and boasts that it provides “exceptional personalized care in a luxurious, five-star environment” and declaring that its sole hospital of 69 beds offers “private rooms, where meals are served on fine china, comfortable, flat screen televisions, oil paintings, wood accented and marble flooring all compliment the hospital room, while a baby grand piano and soothing waterfall with valet parking greet each patient and guest.” Shares are trading at $0.004, having dropped 76 percent after the announcement. The corporation is run by pain management anesthesiologist Hassan Chahadeh, MD.

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Banner Health was set to take over Tucson’s University of Arizona Health Network this weekend, prepending “Banner” to UA’s existing hospital names and most likely thinking about replacing UA’s Epic system with Banner’s Cerner one. The money-losing UA spent $115 million on Epic through June 2014, of which $32 million was unbudgeted due to a go-live delay. At the time, UA said installing Epic was “the biggest operational change this organization has every undertaken,” possibly failing to foresee that just a few months later, UA’s red ink would force it to sell out to Phoenix-based Banner. Every hospital operator should want to buy an academic medical center – easily identified waste and bureaucratic incompetence fertilize a lot of low-hanging financial fruit.

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A letter to the editor by a patient of Rideout Health (CA) accuses the hospital’s CEO of lying when he claimed that its recent computer downtime caused no patient harm. The man says his wife had a cardiac test whose results indicated a possible heart attack and the need for intervention, but she didn’t receive them until two weeks afterward because of the computer problems, the hospital person told her.

The local North Carolina TV station profiles the use by Vidant Health and ECU Physicians of Epic’s Canto and Haiku mobile apps to share information.

A Florida nephrologist is accused of inappropriately touching an elderly patient, who explained that he had no reason to touch her since all he does during her visits is to read her kidney function levels to her from his computer.

The State of Washington indefinitely suspends the medical license of an anesthesiologist who repeatedly sent sexually explicit text messages during surgeries, used medical images for sexual gratification, texted a nude selfie to a patient, and had sex on the job.

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A posthumous Los Angeles Times editorial by reporter Laurie Becklund, who died last month of metastatic breast cancer, says to forget Susan G. Komen-type “cures” and expensive pink ribbon awareness campaigns and instead treat every patient as a one-person clinical trial and store their information in a cancer database to which both doctors and patients can contribute.

Surely this is either a hoax or massively wishful thinking: a surgeon in Italy says he’s just two years away from being able to plant a person’s head on a donor body. Somehow I don’t think insurance companies are going to pay for that.


Sponsor Updates

  • Zynx Health VP of Clinical Informatics Victor Lee, MD writes about “Medicare Reimbursements for Value.”
  • ESD celebrates its 25th anniversary.
  • ZirMed will exhibit at the Pay for Performance Summit March 2-4 in San Francisco.
  • The Sandlot Solutions-powered MetroChicago HIE reaches 1 million patient records.
  • Tamara St. Claire, chief innovation officer for commercial healthcare at Xerox, offers a recap of the company’s recent presentation on patient engagement.
  • Frisbie Memorial Hospital Healthcare Project Director Sally Gallot-Reeves, RN writes about “Achieving an 82% ROI with smartphones” in the latest Voalte blog.
  • VitalWare President and CEO Kerry Martin will speak at the HCP Hospital and Healthcare IT Conference March 3 in Orlando.
  • Verisk Health creates the Idea Hub, a virtual library that collects the company’s research, solution information, and social buzz.
  • ZeOmega Chief Strategy Officer Nandini Rangaswamy defines population health management in the first of a blog series.
  • Sunquest Information Systems and Summit Healthcare will exhibit at HIMSS UK March 3-4 in London.
  • Huron Consulting Group recaps the activities of its Huron Helping Hands program in 2014.
  • T-System summarizes its experience at the HFMA Dixie 2015 Institute in its latest “Informer” blog.
  • Sagacious Consultants offers “5 Things a Billing Office can Learn from Toyota.”
  • PMD’s Elise Lewyckyj offers answers to PQRS questions in the company’s latest “Charge Capture” blog.
  • Qpid Health will participate in the inaugural Innovation Lab at the HIMSS SoCal Annual Healthcare IT Conference March 2 in Los Angeles.
  • Orion Health’s David Boerner breaks down FHIR fundamentals in a new company blog.
  • Medicomp System posts a HIMSS15 preview video featuring its Quipstar game show (watch for the Dr. Gregg cameo).
  • NTT Data’s Srikanth Devarajan writes about “The Guaranteed Uncertainties, Wearable Futures.”
  • Nordic offers the first episode in its “Making the Cut” video series on Epic conversion planning.
  • The New York eHealth Collaborative will host “DSRIP: Moving from Application to Implementation” March 4 in New York City.
  • Patientco’s Patrick Creagh writes about “Having All of Your Medical Bills in One Place.”
  • Oneview Healthcare posts “What it Takes to Meet Consumer Expectations in Healthcare.”

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 28, 2015 News 6 Comments

Morning Headlines 2/27/15

February 26, 2015 Headlines No Comments

Merge Reports Fourth Quarter Financial Results and Announces the Acquisition of DR Systems, Inc.

Merge reports Q4 earnings: revenue remained flat at $53 million, EPS $0.02 vs. $0.00, missing analyst’s expectations for both. The company also announced that it has acquired medical imaging vendor DR Systems for $70 million.

The 11 Best U.S. Companies for Students to Get Summer Internships

Epic takes seventh place on the 11 best US companies to intern for, down from their fifth-place finish last year.

ICD-10 Medicare FFS End-to-End Testing: January 26 through February 3, 2015

CMS reports that it accepted 81 percent of the ICD-10 test claims that were submitted during end-to-end testing earlier this month.

Taxpayers have spent more than $1 billion on a digital health record that doctors won’t use

In Australia, the nation’s $800 million Personally Controlled e-Health Record project is still sitting unused three-years after its launch. Just 10 percent of the general public has a medical record on the system.

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February 26, 2015 Headlines No Comments

EPtalk by Dr. Jayne 2/26/15

February 26, 2015 Dr. Jayne 2 Comments

I literally had almost 100 people forward me news articles about the CMS announcement pushing the Medicare Meaningful Use attestation and PQRS reporting deadlines to March 20. Although no specific reason was announced, possibilities include winter weather emergencies, the fear (or reality) of attestation site glitches, the complexity of preparing reports and audit documentation, and lack of vendor readiness as possibilities. Buried below the fold of several articles was the fact that this does not impact the Medicaid Incentive Program, so I hope those practices realize they’re still on the hook for the original deadline.

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The hideous cold and repeated snows pounding a good chunk of the country have put a cramp in the style of many fitness enthusiasts. Although I once had a serious dislike of treadmills in general, I’m glad that I finally got one at home at least to be able to get some miles in despite the cold. I might have been more fond of treadmills sooner had I known about iFit, which allows compatible fitness equipment to automatically deliver uphills and downhills to match real-world routes while showing pictures from Google street view.

I’ve now run through Ireland, Paris, Norway, and my own neighborhood and definitely like it better than the standard programs on the treadmills at the gym. Once people’s New Year’s resolutions start failing, used equipment will start popping up for sale and I’m glad I have something to talk about with patients who think walking on a treadmill is boring. I also found a National Geographic “Everest” video workout on the site and although it bested me the first time, I’ll be back for more. Having the ability to track and quantify my efforts to stay in shape has been a benefit for me, although I draw the line at sharing every workout to Facebook.

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A reader who has picked up on my running habit shared these high-tech socks from Sensoria that use sensors and conductive fibers to gather information about a runner’s speed, distance, steps, and how their feet strike the ground. They debuted at the recent Consumer Electronics Show and are from the same people who brought us shirts and running bras to sync with heart rate monitors. A magnetic anklet communicates with Android and Apple devices to provide real-time feedback. I’m not sure I want my socks to coach me and they aren’t cheap, so I think I’m going to take a pass this time. I do enjoy reading about wellness-related tech, so keep sending your finds.

I do some volunteering at a local school and they asked me to speak at an upcoming career day. When I get requests like that, I always have to ask whether they want me to talk about my “doctor job” or my “computer job” or both. When I decided to become a family physician, I never imagined myself on the cutting edge so I was happy to come across this piece on physician informaticists to help explain exactly what it is that I do all day. Apparently UCLA is thinking outside the box and is making their informaticists available for consultation with other Epic customers. It looks like a win-win situation to me – in addition to assisting other organizations, their team can also bring back successful approaches from other sites.

NCQA is offering the opportunity for the public to provide feedback on proposed change to 2016 HEDIS measures. There are a handful of proposed new measures and changes to several existing ones, so plan to get your comments in before the March 18 deadline.

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Speaking of deadlines, Friday is the cutoff for HIMSS hotel changes. I’m mixing it up this year and staying somewhere swanky with a couple of my gal pals since I was able to get ridiculously cheap airfare. Although registration for HIStalkapalooza is closed, I know Mr. H is poring over the guest list and I’m looking forward to seeing many of you there (anonymously, of course). The event is one of the most fun parts of being on the HIStalk team, although I am feeling the pressure when it comes to finding a pair of outstanding shoes. Maybe Sensoria should make an insert to gather data on what happens to the feet of fashionable ladies and gents out for a night on the town.

Have you put together your HIMSS wardrobe plan yet? Email me.

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February 26, 2015 Dr. Jayne 2 Comments

News 2/27/15

February 26, 2015 News 3 Comments

Top News

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Merge Healthcare announces that it has acquired DR Systems for $70 million.


Reader Comments

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From Weapons of Mass Distraction: “Re: DoD EHR bid. Pretty sure Epic has already won and that’s been known to insiders since back in January. Not saying that as an Epic advocate, just saying it because this process of press releases, vendor elimination, etc. reminds me of watching a movie my friend already told me the ending of.” DoD is planning to announce the winner in June, so they should be far along in the process. Maybe an anonymous expert can help us understand what should be going on behind the scenes right about now.

From Mad City: “Re: Epic’s AppExchange. It’s funny that so many respondents in your poll believe it’s related to the DoD bid when it’s been discussed in Epic user groups for years and was announced last fall at UGM.” My sources say early adopter customers have already completed the paperwork and submitted their items, with developers coming up next once Epic locks down processes to review security and handling of PHI and most likely figuring out how to support turnkey installation. They’re working with Apple to understand the best ways to run an app store. Epic didn’t announce the AppExchange – sites picked up as “news” a third party’s comment about it that was followed by Epic’s confirmation of its plans, but customers have known about AppExchange for many months.

From Clinic Director: “Re: Meaningful Use audit hell. We started receiving pre-payment audits for MU in early January, with 96 requests for 139 providers. So far we have been able to pass all of them, but the amount of work necessary to provide the requested additional data has been a huge burden. So much so that we are unable to configure our system to start seeing how we are doing in 2015. In looking at the Epic user web, there are A LOT of other organizations experiencing the same thing. It is certainly a focused effort by the government to delay the payments and look for all options to penalize 2016 reimbursements for Medicare. This is ridiculous.”


HIStalk Announcements and Requests

This week on HIStalk Practice: MGMA welcomes new CEO. Physicians balk at the not-so-hidden costs of interoperability. Rock Health breaks down telemedicine. Illinois Telehealth Initiative launches at Matter Chicago. Practices worry payers won’t be ready for ICD-10. Partisan bickering stymies healthcare cost transparency efforts in New Mexico. Horizon House and Tidewater Physicians implement new HIT. Thanks for reading.

This week on HIStalk Connect: The FDA relaxes its regulatory oversight on personal genetic tests and clears 23andMe to resume marketing some genetic screening tests. DARPA announces that it is working on an implantable computer chip that will deliver headset-free augmented reality. TraceLink raises $20 million to bring serialized tracking to the pharmaceutical supply chain. 

I was thinking about how EHRs are blamed for turning previously interactive doctor-patient conversations into form-filling exercises, where not only are physicians forced to restate their complex thoughts as fill-in-the-blank items, but even patients themselves are forced into that same mode by the doctor who just wants to feed the EHR screen’s demands and steers the encounter accordingly. Studies show that doctors interrupt patients quickly and often, which I suspect is due not only to the short encounter time allotted, but also the doctor’s need to complete forms (it’s like your tax guy – he wants documents and short answers rather than a deep financial discussion because he’s sitting in front of federal tax forms, not a freeform word processor). We’ve devalued the rich, nuanced doctor-patient conversation into a mutual form-filling exercise, which probably seems ideal to everybody except doctors and patients. I like the idea of having the patient complete intelligent questionnaires before the visit starts and send that information to the EHR to reclaim some of the lost encounter time for less-discrete activities.


Webinars

March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.

Here’s the video of the “Cloud Security Primer” webinar that was presented by Sensato CEO John Gomez last week.


Acquisitions, Funding, Business, and Stock

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Merge Healthcare announces Q4 results: revenue flat, EPS $0.02 vs. $0.00, missing expectations for both. Shares dropped 12 percent Thursday following the announcement before the market opened. Above is the one-year MRGE share price chart (blue, up 57 percent) vs. the Nasdaq (red, up 16 percent).

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Allscripts announces Q4 results: revenue down 3 percent, adjusted EPS $0.09 vs. $0.08, missing revenue expectations but meeting on earnings. Above is the one-year MDRX share price chart (blue, down 31 percent) vs. the Nasdaq (red, up 16 percent).

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Orion Health opens an office in Glasgow, Scotland. The company also begins hiring another 100 people for its Scottsdale, AZ office.


Sales

Tidewater Physicians Multispecialty Group (VA) chooses Lightbeam Health Solutions for population health management.

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GetWellNetwork announces several sales of its recently acquired Marbella data collection product.

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In Australia, Cerner wins a New South Wales tender for a medication management system for Millennium-using hospitals. Districts that don’t use Millennium, such as those that use Orion Health, will be able to choose a different system.


People

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Cureatr names three vice presidents: Kent Hiller (Indiana HIE), Karl Kiss (InteHealth), and Jay Smith (Sparta Systems).

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Joining PerfectServe are Terry Hayes, RN, MSN (OptumInsight, above) as VP of client experience and Michelle McCleerey, PhD, RN (TeleTracking) as VP of product marketing.


Announcements and Implementations

SRSsoft launches its Essentials EHR for specialists and new EHR users, labeling it as “an alternative, non-MU EHR” that allows users gain benefits without having to change the way they practice.

InterSystems releases Cache’ 2015, which doubles the scalability of previous releases. Epic benchmarked the new release and was quoted positively in the announcement.

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Convurgent Publishing releases the third edition of “Clinical Integration: Population Health and Accountable Care.” One of its editors is Divurgent CEO Colin Konschak.

Caradigm will include Cohort Designer in implementations of its Caradigm Intelligence Platform.


Government and Politics

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CMS extends the date for Medicare EPs to attest for Meaningful Use to March 20, 2015, giving providers an extra three weeks for unspecified reasons.

Netsmart executives are meeting this week with their Kansas legislators to discuss HITECH’s exclusion of behavioral health providers for Meaningful Use incentives.

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It appears that New York’s mandatory e-prescribing scheduled for a March 27 live date will be pushed back a year, or at least that’s the impression from an email sent by Healthcare Association of New York State, which is pushing for the delay. The governor seems inclined to sign S.2486/A.4274 that has already passed both houses, which would reset the date to March 27, 2016.  

The US Supreme Court rules that state professional licensing boards can’t use their authority to limit competition, finding that North Carolina’s dental board (made up mostly of practicing dentists) can’t prohibit non-dentists from whitening teeth since the board’s motivation was to protect the income of dentists rather than the safety of the public.

Massachusetts Governor Charlie Baker replaces the four of 11 board members of the state’s health insurance exchange that were appointed by his Republican predecessor, among them MIT economist and Affordable Care Act key player Jonathan Gruber.

CMS reports that it successfully processed 81 percent of 15,000 ICD-10 claims in a week-long test, with 6 percent rejected due to invalid ICD-9 or ICD-10  and 13 percent rejected due to non-ICD problems such as missing information or invalid service dates.

The FCC rules on an open Internet, banning providers from blocking content, throttling traffic, or prioritizing traffic to give higher-paying content sources a “fast lane.” Chairman Tom Wheeler said of the 3-2 vote, “The Internet is too important to allow broadband providers to make the rules.”


Privacy and Security

The FBI closes in on the Anthem hackers and is trying to decide how much information about them to reveal publicly. China-sponsored hackers are the likely culprit, but naming them would require technical proof that might compromise future FBI cybercrime investigations.


Innovation and Research

Facebook releases tools to support suicide intervention that will be used when a user reports seeing a troubling post.

Healthbox changes its accelerator model so that participating companies won’t have to give up equity and “studio programming” won’t require full-time participation.


Technology

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LG announces a new smart watch that doesn’t require a cell phone running Android Wear – it will connect directly to an LTE network to play streamed music, make device-to-device voice calls, and make mobile payments.

Orion Health adds FHIR support to its Rhapsody Integration engine.


Other

Epic is named #7 of “The 11 Best US Companies for Students to Get Summer Internships,” although the listicle’s methodology is shaky (reading intern ratings from Glassdoor). Facebook led the list.

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The Pew Charitable Trusts highlights New Mexico’s NurseAdvice telephone hotline that is free for all state residents, saying it keeps 65 percent of its 15,000 monthly callers out of the ED. The hotline also generates real-time public health data, with CDC recommending that other states adopt a similar model.

The bond rating agency of Baptist Health Care (FL) notes that the health system may borrow money to replace its McKesson Horizon system in 2016.

Sovita Chander was inspired by Ted Reynolds’ recent HIStalk article about healthcare delivery in Europe vs. the US and wrote a Canada-focused piece titled “7 Reasons Why Healthcare Companies Get Stuck at the Border.” Item #1: “Canada is 10 markets (plus three). Healthcare delivery is driven by ten different provincial governments (and three territorial governments serving a population of about 100,000), so you have 10 different sets of IT-related requirements, regulatory frameworks, and buyer landscapes to address. Sales cycles are longer in Canada than in the US. You have more hurdles, and you will go to RFP in some provinces on just a $25,000 deal.”

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Aetna sues a for-profit 139-bed Texas hospital that takes in $1.5 billion annually, claiming that the physician CEO pays doctors kickbacks disguised as “ownership interest” and has overcharged Aetna $120 million in the past six years by treating patients out of its network. The hospital says a similar Aetna lawsuit against it has already been dismissed and that the company is trying to strong-arm providers into participating in its network.

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In Australia, the local paper calls out the $800 million (USD) Personally Controlled e-Health Record (PCEHR) that has been live for three years with minimal use by doctors and patients. The government blames its predecessor opposition party for a rushed implementation.

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Moffitt Cancer Center (FL) sues one of its surgical oncology residents over a Google Glass-powered tumor visualization tool he invented. The hospital says it made the doctor sign over his rights for anything he developed while working there, but he reneged on the deal while filing for a patent. Since then, the resident and his partner formed a company and then sued the hospital for demanding credit for an invention in which it wasn’t involved.

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Google buys 70 iPads for MUSC Children’s Hospital (SC) so that hospitalized children can use Google Hangouts to video chat with friends and family.

New York City eliminates a nearly universally ignored requirement that parents sign consent forms before their newborn boys undergo “oral suction circumcision,” an Orthodox Jewish ritual in which mohels suck blood from a baby’s circumcision wounds. Mayor Bill de Blasio says the consent requirement was offensive to some community members even though 17 babies have contracted herpes from the procedure and two of them died. The agreement requires mohels suspected of infecting babies to undergo DNA testing, although in previous incidents parents refused to name the person involved and parents can’t avoid them anyway because the city refuses to name those already identified as carrying herpes.


Sponsor Updates

  • Capsule Tech added 190 hospital users and 35,000 beds to its SmartLinx medical device information system in 2014.
  • Divurgent is in the running for the US Chamber of Commerce’s Community Excellence Award (voting is here) and will make a donation to the Shriners Hospital for Children if it wins.
  • E-MDs posts a preview video for its users group conference June 18-20 in Austin.
  • Greythorn offers a sneak peek of its HIMSS15 plans (and giveaways).
  • Ingenious Med President and CEO Hart Williford calls for “All Hands on Deck.”
  • Hayes Management Consulting’s Robert Freedman offers three steps to drive a compliance checkup.
  • The HCI Group will sponsor the Future Stage at the HIMSS UK Annual Innovation Conference March 3-4 in London.
  • Steve Zeller of Logicworks writes about “The Healthcare Cloud: A Journey.”
  • Influence Health will exhibit at the ACO & Payer Leadership Summit Spring 2015 March 5-6 in Las Vegas.
  • Tracy Kimble of Galen Healthcare Solutions asks “Are You Ready for the Shift to Value-Based Payment Models?”
  • The latest Healthfinch blog points out the ironic twist of technology as a cure for physician burnout.
  • Iatric Systems will exhibit at the Hospital and Healthcare IT Reverse Expo March 2-4 in Orlando.
  • Extension Healthcare is nominated for the Health Tech Award and Tech Company of the Year Award.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 26, 2015 News 3 Comments

Morning Headlines 2/26/15

February 25, 2015 Headlines No Comments

CMS Pushes MU Attestation, PQRS Reporting Deadlines to March 20

CMS has announced that both the Meaningful Use attestation and PQRS reporting deadline for eligible providers has been extended to March 20.

Pentagon Narrows Down List Of Contenders For Multibillion-Dollar Health Records Contract

The DHMSM EHR procurement has moved to its final stage and the list of vendors has been narrowed to three finalists: CSC/HP/Allscripts, IBM/Epic, and Leidos/Accenture/Cerner. Sadly, the VA’s VistA platform, proposed by PwC, was eliminated.

Anthem: Hacked Database Included 78.8 Million People

Anthem reports that 78 million records were exposed during its recent cyber attack, including up to 19 million non-Anthem customers, and 14 million “incomplete” records. The newly released data also breaks down records breaches by state.

FBI Is Close to Finding Hackers in Anthem Health-Care Data Theft

In other Anthem news, the FBI reports that it is close to identifying the group responsible for the attack, with signs pointing to a Chinese state-sponsored hacker group.

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February 25, 2015 Headlines No Comments

Readers Write: Want to Read the Briefs in the Epic vs. Tata Consulting Case? That’ll Cost $0.10 Per Page (Unless We Do Something About It)

February 25, 2015 Readers Write 6 Comments

Want to Read the Briefs in the Epic vs. Tata Consulting Case? That’ll Cost $0.10 Per Page (Unless We Do Something About It)
By Reluctant Epic User

As Americans, we tend to assume that we have the most open and transparent courts in the world.  Unfortunately, that probably isn’t the case. The reality is that all of the public documents filed in a court case are locked behind the world’s largest paywall. Including the Epic Systems vs. Tata Consultancy Services Limited case

It doesn’t have to be this way. The courts give every person in America $15 per quarter in free downloads. The Free The Law project has created a clever workaround which places these documents in the public domain. 

Five of 82 documents in the Epic vs. Tata case are available to the public. You can increase that number. Follow these steps:

  1. Install the “RECAP the law” Firefox Extension.
  2. Open a PACER account as a view user (credit card required).
  3. Once you have an account open, go to the Western Wisconsin Court District site and log in.
  4. Click Query and enter 3:14-cv-00748 in the case number field.
  5. Click Docket Report, accept the default values, click run.
  6. Click on one of the document # hyperlinks which doesn’t have a “RECAP the law” logo by it (examples in green boxes).
  7. Read the document if you’re interested. If you aren’t, click back and find another one. At most, a document will cost $3.00. Therefore, don’t open more than four documents and you’ll stay under the $15 free limit.

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Some of you may be wondering, why do this?  To date, documents like Epic’s Standard Consulting Agreement (circa 2005) have been unavailable to the general public. The case offers us the chance to get a glimpse behind the Epic’s veil of secrecy, something any HIT observer should happily support.

Since this will be an ongoing case, we’ll need people to regularly contribute. If you comment on this post, you’ll be updated on an ongoing basis as we gather all the documents we need.

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February 25, 2015 Readers Write 6 Comments

Readers Write: Working Around Health IT: The Nurse, the Workaround, and the Question You Need to Ask

February 25, 2015 Readers Write 4 Comments

Working Around Health IT: The Nurse, the Workaround, and the Question You Need to Ask
By JoAnne Scalise, MSN, BSN, RN

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Are nurses just BAD? (That’s not the question.)

Why are they so adamant about working around health information technology (HIT)? Is it to give the CIO chest pain? Annoy the IS people? Give their nurse leader heartburn?

How can a simple process — do this, then do this (perhaps multiplied a few or many more times) — turn into a spin with the Mad Hatter (teacup optional)?

It would be easy to leave it that “nurses don’t follow directions,” “nurses are difficult to deal with,” or my personal favorite, “nurses don’t like change” (of course, everyone else likes change!) Those crazy nurses are still wearing disco-era bellbottoms and a mullet. And if you are, that’s ok – it works for you. With 55 percent of the RN workforce at age 50+ (from a 2013 survey reported by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers), that may have been some of the best of times.

But what about making right now better? So much HIT is intended to make life better: for patients, for healthcare systems, and yes, for those crazy nurses. Better, as in efficient and safer for everyone – and in getting paid so we can take care of people tomorrow.

Even knowing that, why do nurses choose to work around the very things that could save their patient, their colleagues, their organization – and themselves? Why does an expert nurse scan a contraband wristband or label instead of the one on the patient for medication administration or specimen collection? Why circumvent the EHR when guidelines for use have been given? Why take that patient  (and personal and professional) risk?

This is the opening of dialogue. Not to defend what many call “the bad apple,” “the bad actor,” or those who just act “bad,” as in, “I don’t care about people” people. I’m not talking about nurses or specific roles. I’m referring to those outliers who are clear that they don’t care about patient safety or care, their colleagues, or healthcare. Those people are the rarest of the rare because they don’t last long in our system – we can’t tolerate bad apples or bad care. Bad is about behavior and not the person.

As a perennial patient safety student, I know that the professionals who have chosen to be entrusted with providing care to every one of us who enters the healthcare system do not take their responsibility lightly. As a nurse, I know (as do my clinician colleagues) that we have chosen wisely. Our responsibility to our patients and the healthcare system are our primary motivators. Care excellence is the goal we must fulfill in every patient encounter every day. Safety never sleeps.

Why then, the confounding issue of the workaround?

I have been fortunate to work with nurses around the country to help them keep their patients and themselves safe. I have had other departmental staff stand up and point their fingers at me and ask, “How are you going to make these nurses BEHAVE?” And this is with nurses in the room. On occasion, I even get the same question from the nurse leaders. Laboratorians, CIOs, and patient safety and quality professionals have other direct questions on the same topic. I’ve even been invited to speak to groups of lab leaders on “how to communicate with the nursing suite.” When presenting on the topic in national forums, the topic is often addressed in hushed tones by nursing and other leaders who share that the workaround is an “epidemic.”

Indeed, the workaround is a real and persistent danger and with exponential significance: the possible patient safety breach, the trust eroded for collaboration and communication, and the financial loss from the wasting of resources of the healthcare organization.

Health information technology spending was projected to top $6.8 billion in 2014, with individual hospitals and healthcare systems spending millions annually. Not using the purchased technology causes challenges in safety, in culture and process, in data collection and analysis, and in budgets. When enough end users simply “end it” and stop using the technology, the technology can end for that organization. With that end comes significant loss.

At the same time, some organizations decide to not engage the nurse or other end user for a variety of reasons, often because of time for conflict (“we can’t get caught up in nursing demands — they’re going to have to do it.”) I’ve been in meetings where the issue came up of end users (who were not represented or in attendance) and the statement was made, “We’re just going to ram it down their throats.” Tough love, but probably not so effective in the long run. Fortunately, they were eventually receptive to the benefits of end user inclusion and engagement in the decision process, with a very positive outcome.

When nurse and hospital leaders ask me, “What is the most important lesson you’ve learned about adoption?” I tell them that the most important lesson may seem to be a simple one. Engage your end users. You must engage them as you decide that you have an issue to solve. You must engage them before any technology decision is made. If you don’t, they will use the only opportunity that they have to influence this decision – and that is not to use it.

Some technology doesn’t make life easier. Not all technology is the best it can be. We all need to help make these products better through objective feedback and end user engagement in the decision process and ongoing use.

I believe we can support clinicians in moving from compliance to commitment, and not just in technology. I’ve developed a MAP (mindful leadership, authentic communication, personal accountability) to help you do just that so we can do less “around” and more “work.”

I’ll leave you today with what I think is the best question for responding to a workaround. So many times we ask, “Why won’t you do this?” The question implies resistance, and depending on how we say it, frustration and even accusation. The answers may tend to be defensive and deflect the true reason.

Ask instead, “Why can’t you do this?” You will get thoughtful and real answers that may benefit your practice and eventually improve the technology. And the work.

Let’s continue the conversation on how we can work through the workaround. I’ll bring my MAP.

JoAnne Scalise MS-Patient Safety Leadership, RN is the manager of nurse consulting for Sunquest Information Systems.

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February 25, 2015 Readers Write 4 Comments

Morning Headlines 2/25/15

February 24, 2015 Headlines 1 Comment

Cerner offers select associates voluntary departure program

Following its acquisition of Siemens, Cerner is encouraging some employees to consider “voluntary departure,” despite the company’s plans of hiring 16,000 new employees over the next 10 years.

Navicure Survey Reveals ICD-10 Optimism despite Minimal Preparation

An ICD-10 readiness survey finds that 81 percent of practices feel they will be ready when the ICD-10 transition goes into effect, but that only 67 percent believe the transition will happen on October 1, 2015, without further delays.

Marketing chief Sona Chawla says Walgreens is both on and in your corner.

The Hub interviews Walgreen’s chief marketing officer Sona Chawla, who says “I think of our customers as shoppers, unless they want to be patients. When they are in our clinics and they are sick, they want to be patients and we recognize them as patients. But no one is in a constant state of being a patient, and we have to be very sensitive to that because we offer a wide range of trip missions. So, when they are coming in to shop for lipstick, they are shoppers. That’s how they want to be recognized, and that’s how we recognize them.”

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February 24, 2015 Headlines 1 Comment

News 2/25/15

February 24, 2015 News 5 Comments

Top News

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Cerner offers “select associates” an opportunity to “consider a voluntary departure.” The company didn’t define “select,” but it wouldn’t be too surprising if many of them are located in Malvern, PA and are older (one report says employee age plus years of service must exceed 65 to be eligible). 


Reader Comments

From Dim-Sum’s Little Brother: “Re: DHMSM down-select. Two of the five bids were eliminated. According to my network, IBM (Epic), CSC/HP (Allscripts), and Leidos/Accenture (Cerner) made the down-select. InterSystem (TrakCare) and PwC/GDIT/DSS (Medsphere) were eliminated from the competition.” Unverified, but reported by multiple readers. I said upfront that the chances of DoD choosing VistA from their IT rival VA were zero. A couple of sites reported just in the past week that DoD would choose an open source solution, although I doubt you’ll see a “we were wrong” follow-up if indeed VistA has been shown the door as it appears. That also means the late and sexy addition of Google to the PwC bid didn’t impress DoD (and rightly so since their participation, as described, was minimal).

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From Stanley Kowalski: “Re: HIPPA. I was surprised to see such a bold subject line.” Not only was HIPAA spelled wrong, a hyphen should appear between the first two words. At least they didn’t say “complaint” instead of “compliant.”


HIStalk Announcements and Requests

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Regina Holliday and Lorre have chosen our five HIMSS15 scholarship winners and they all seem excited. I’ll be running a short bio of each shortly, along with their description of what they hope to accomplish at the conference.


Webinars

March 4 (Wednesday) 1:00 ET. “5 Steps to Improving Patient Safety & Clinical Communications with Collaborative-Based Care.” Sponsored by Imprivata. Presenters: Robert Gumbardo, MD, chief of staff, Saint Mary’s Health System; Tom Calo, technical solutions engineer, Saint Mary’s Health System; Christopher McKay, chief nursing officer, Imprivata. For healthcare IT and clinical leadership, the ability to satisfy the clinical need for better, faster communication must be balanced with safeguarding protected health information to meet compliance and security requirements.

March 5 (Thursday) 2:00 ET. “Care Team Coordination: How People, Process, and Technology Impact Patient Transitions.” Sponsored by Zynx Health. Presenters: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health; Siva Subramanian, PhD, senior VP of mobile products, Zynx Health. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.


Acquisitions, Funding, Business, and Stock

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CTG reports Q4 results: revenue down 4 percent, EPS $0.08 vs. $0.22, not including a $0.07 expense associated with the October death of CEO James Boldt and a $0.06 write-down of the company’s investment in poor-selling medical fraud, waste, and abuse software. CTG expects its healthcare revenue to drop 14 percent in 2015 and says the year will be a ‘transitional” one for its healthcare business as the EMR market cools. Above is the one-year CTG share price chart (blue, down 49 percent) vs. the Nasdaq (red, up 15 percent).  

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Imprivata announces Q4 results: revenue up 34 percent, adjusted EPS –$0.04 vs. $0.84, meeting revenue expectations and beating on earnings. IMPR shares are trading down around 14 percent from their June 2014 first-day trading price. 


Sales

Horizon House (PA) chooses CoCentrix for EHR, care coordination, and billing.

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Temple University Health System (PA) chooses Strata Decision’s StrataJazz for financial planning, rolling forecasting, capital planning, and capital equipment replacement.


People

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Xifin hires Jim Malone (American Well) as CFO.

Bobbie Peterson (Medsphere) joins Apprio as EVP of health IT.


Announcements and Implementations

NextGen adds the CompletEPA electronic prior authorization solution from Surescripts.

Cleveland Clinic and the VA will provide “seamless access” to each other’s EHR information starting this month. The clinic uses Epic Care Everywhere.


Government and Politics

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The Federal Trade Commission fines two developers of melanoma detection apps for falsely claiming that their products work. MelApp and Mole Detective didn’t have the evidence to prove that taking a photo of a mole and then specifying its characteristics can reliably detect melanoma. It’s interesting that the companies were charged by FTC for false marketing rather than by FDA for providing medical advice.

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An FDA-funding Brookings Institution report recommends that FDA strengthen its post-market medical device surveillance system to include tracking those devices by a unique ID. EHRs would provide device usage information for national safety surveillance, with such capability being required to meet ONC certification and Meaningful Use requirements. FDA says the system “will require significant financial resources to be sustainable” and recommends paying data contributors.

FCC and FDA will convene a March 31 workshop on test beds for wireless medical devices, saying that the “hospital in the home” concept requires wireless co-existence.

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New York Governor Andrew Cuomo wants to close NYDoctorProfile.com, a state-run doctor search tool that he says is too expensive to taxpayers at $1.2 million per year given that similar information is available elsewhere.


Privacy and Security

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Researchers find that Googling diseases and medical terms sends information to undisclosed third parties 91 percent of the time, most often because company servers are set up to use free tools such as Google AddThis social sharing as part of Google Analytics. Even CDC.gov and May Clinic pass along search results with user-identifying information such as IP address. WebMD, for instance, sends disease search data to 34 sites including those of data brokers Experian and Acxiom. Healthcare.gov was found to be doing the same, probably due to technical negligence.

A new report finds that medical identity theft jumped 22 percent in 2014.

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Anthem says its giant data breach included information on up to 19 million non-Anthem patients who were seen out of network in addition to that of its own customers.


Technology

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Microsoft adds a cycling module and a virtual keyboard for its Band fitness tracker, also introducing a Microsoft Health-powered dashboard of Band-collected information.

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@AlexRuoff tweeted this screenshot from an AHRQ Meaningful Use Stage 3 readiness webinar, which finds that 71 percent of participants use non-electronic means to share information. You’ll probably be in good hands if you keel over in the fax machine section of Office Depot since odds are it’s a healthcare person browsing them.


Other

Former CIO and current vendor SVP Dale Sanders says in his personal blog that taxpayer-benefiting EHR vendors are intentionally obstructing interoperability via prohibitive contract terms and add-on interoperability license fees while publicly proclaiming their support of open standards (he doesn’t name Epic specifically, but they seem to be the target). He says EHR vendors should offer open APIs and that courts should intervene to stop interoperability-impeding terms and conditions. He quotes a peer who doesn’t think FHIR in its planned form is the answer:

Several EHR vendors are banning together around a new magic bullet technical standard called HL7-FHIR based on JASON technology. While this new standard is great from a technical perspective (XML, REST, etc.), in its current form, based largely on existing HL7 v2, v3 and CDA concepts, it does not improve the accessibility of proprietary EHR data types, and those data types are needed for quality and cost performance improvement in healthcare. While FHIR could be expanded to include this type of data, it appears the first efforts are focused on reinventing the technology for currently defined interoperability data types.

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An interview with Walgreens Chief Marketing Officer Sona Chawla contains some interesting quotes, the last of which is pure genius and a useful lesson for providers trying to become more consumer friendly:

  • “I think the concept of ‘well’ is broader than ‘wellness.’ It really encompasses the ‘happy and healthy’ feeling. ‘Wellness’ has a more specific meaning than ‘well,’ which is limited to the ‘health’ part.”
  • “The service that’s delivered online or in the store should be the same and feel the same in spirit. If you are in the store, you can have face-to-face interaction. If you are online, we offer things like 24/7 pharmacy chat. Those elements of customer service happen in a very specific way based on the channel, but when we put it all together it should feel like one Walgreens.”
  • “We have an all-in-one app that is a connecting point between the physical and the virtual for us, to really serve our customers. Our mission was to think about what customers were doing and how we could improve it.”
  • “With digital health, it’s really about reinventing the core experience. For example, we launched an immunization app within our main app which records your immunization history and also reminds you to immunize as well as take your pills on time. Technology is changing the way customers behave and we are leveraging the technology to make things easier, but at the same time, enhanced. Then there is the concept of unification, which is connecting these experiences not just within Walgreens, but also with our partners. It gives us a great platform to think of our customers, wherever they are.”
  • “I think of our customers as shoppers unless they want to be patients. When they are in our clinics and they are sick, they want to be patients and we recognize them as patients. But no one is in a constant state of being a patient and we have to be very sensitive to that because we offer a wide range of trip missions. So when they are coming in to shop for lipstick, they are shoppers. That’s how they want to be recognized and that’s how we recognize them.”

A Navicure survey finds that 81 percent of physician practices are optimistic that they’ll be ready for ICD-10’s October 1, 2015 implementation date and two-thirds of respondents don’t think it will be delayed again. Practices say their main concern is that payers won’t be prepared. 

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A newly built hospital in England issues bells to patients housed in treatment rooms to use as a call system, explaining that it didn’t expect to need electronic call buttons in that location but will now add them.

Weird News Andy wants to know who will pay the CT scan bill. A Chinese statue of Buddha from 1100 BC is found to contain the body of a mummified Buddhist master.


Sponsor Updates

  • CTG’s Managing Director of Data Analytics Joseph Eberly will co-present “Using Data Analytics to Improve Care Valuation, Management, and Outcomes” at the Hospital & Physician Relations Executive Summit March 1-3 in Scottsdale, AZ.
  • Fujifilm’s Synapse RIS earns ONC HIT 2014 Edition Complete EHR certification.
  • PerfectServe will participate in two March annual conferences, the Society of Hospital Medicine and American Medical Group Association.
  • Cumberland Consulting Group donates laptops to Back on My Feet to assist the nonprofit’s residential members look for jobs and permanent housing.
  • CitiusTech will exhibit at SCOPE Summit 2015 through February 26 in Orlando.
  • Clinical Architecture posts a video on “Temporality” as part of its blog series on the road to precision medicine.
  • CenterX CEO Joe Reinardy will speak at the 2015 Emdeon Pharmacy Insights event in Nashville on March 4.
  • CareSync offers “Ten Ways Medicine Today can Outrun Every TV Doctor You’ve Ever Seen.”
  • Besler Consulting’s Jim Hoffman offers an “Overview of CMS Readmission Penalties for 2015.”
  • Divurgent will exhibit at the HIMSS SoCal Annual HIT Conference on March 2 in Los Angeles.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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February 24, 2015 News 5 Comments

Morning Headlines 2/24/15

February 23, 2015 Headlines No Comments

Strengthening Patient Care: Building an Effective National Medical Device Surveillance System

The FDA publishes a report outlining its $250 million plan to roll out a national medical device surveillance system over the next seven-years.

Epic vs. Cerner Competition Heats Up

A KLAS report on acute EHR purchasing decisions asks hospitals that are in the market for a new system who their likely next vendor will be: 25 percent reported Epic, 14 percent reported Cerner, 13 percent reported MEDITECH, and 5 percent reported McKesson, while 41 percent are undecided.

Mobile app with evidence-based decision support diagnoses more obesity, smoking, and depression, Columbia Nursing study finds

A Columbia University study published in the Journal of Nurse Practitioners finds that diagnosis rates for obesity, smoking, and depression were much higher when nurses used a smartphone app that explained evidence-based guidelines and triggered clinical decision support prompts during routine exams.

Kaiser tests video visits to cut waits

Kaiser Permanente experiments with telehealth visits as a possible way of reducing ED utilization and wait times.  

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February 23, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 2/23/15

February 23, 2015 Dr. Jayne No Comments

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I’m leaning heavily towards staying with my current employer as we move to a single platform for all our hospitals and practices, but lots of people keep sending opportunities my way. Today a juicy CMIO position came across my desk. It’s in a great location and with a well-known health system that I’ve had some dealings with previously.

It looked pretty exciting until I got to the part about the heavy inpatient focus and complete disregard for those of us who have come up through the ambulatory ranks. I started to move it to my recycle pile until something caught my eye. They’re looking for someone “politically savvy with a high tolerance for ambiguity… who can put all the pieces together and deliver on time and on budget.”

I’ve got a lot of experience delivering the undeliverable and creating successes despite some of the people I work with. Usually hard work and pixie dust are involved, but we never admit it. My general rule of thumb is that organizations are typically 30-50 percent more dysfunctional than they admit, so I’m wondering what that looks like when they’re already warning candidates about ambiguity and the need to be able to patch things up to get a project out the door. They also mention frequent interruptions and constantly changing priorities. I’m not rushing to submit my CV.

Another prospective position (thanks to the reader who sent me an opportunity in a warm climate) looks like it’s much more up my alley. The nine responsibilities bulleted in the job description are things I’ve been doing for years. I’m less sure, however, about the tenth one – supervising and assigning projects to physician informaticists on the CMIO’s team. Sometimes it feels like I’m lucky to get an administrative assistant to support me, so the idea of multiple physicians helping deliver value from healthcare IT is awfully tempting. They’re also looking for someone either board certified in clinical informatics or with a masters degree in the field, so that tells me they value the education and training that many of us can bring to the table.

In the mean time, I’m still waiting to find out how my health system is going to handle the clinical leadership structure for the EHR consolidation project. I don’t have a lot of time to dwell on it, however, since we’re preparing more than a dozen practices to seek recognition as Patient-Centered Medical Homes.

The first time I went through the process was on paper. Although there are certain aspects of the requirements that are significantly easier with an EHR in place, there are still elements that are much simpler in the paper world. Some of our practice managers have actually laughed out loud when I ask them to use a simple three-ring binder for some of the requirements. Although I’m obviously a fan of technology, sometimes a manual process is quicker, easier, and doesn’t require anyone from IT to give it a blessing.

I’d estimate that three-quarters of our practices are ready, with stable processes and solid physician buy-in. The other few still need some work. We’re likely to urge the others to move forward while we continue to tweak workflows in those that aren’t quite ready. They also need some refinement in staff roles and responsibilities. We’re finally helping our administrators understand that PCMH is not a technology project so much as an operational initiative. I want to try to get as many of our joint operational and technical projects completed before the transition to the new system begins in earnest.

I’m also staying occupied looking for interesting ways to use some of my accumulated vacation time. As of January 1, our health system has gone to a “use it or lose it” philosophy and has capped the vacation hours we can have on the books. I’m dangerously close to the limit and certainly don’t want to leave any hours on the table. I’m planning a wilderness adventure for July, and if I don’t get eaten by a bear, I’m looking for a trip in the fall that will provide not only some R&R but some continuing education hours. I also hope to take some long weekends once the weather gets nice. The new policy should make for some interesting resource challenges as everyone tries to lower their balances.

What’s your plan for R&R in 2015? Email me.

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February 23, 2015 Dr. Jayne No Comments

Startup CEOs and Investors: Brian Weiss

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

A Tale of Two Healthcare Worlds
By Brian Weiss

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Many of my peers in the healthcare IT startup world, like me, are developing applications and solutions intended for a new world of consumer-centric healthcare IT, or CCHIT (I just made up that new CCHIT acronym as part of my contribution to world sustainability. Since what was formerly known as CCHIT has ceased operations, the acronym is ready for recycling.)

Have a seat and join me for a tour of CCHIT-land. You must be this tall to ride, keep your arms and legs in the vehicle at all times, and no flash photography, please.

Over on your left as you look out on the horizon, you can see deceptively colorful cloud-like structures. Those are high-deductible health plans and self-insured employers. See the little figures underneath them with the empty wallets that look like they are about to fall over? Those are consumers who are becoming more conscious of the costs of their healthcare.

Whoops! My mistake. Those are the ones on the right. The ones are the left are actually the physician practices dealing with 30 percent collection rates as the consumers on the right ignore their payment notices. You can tell them apart because the physician practices are the ones with the charts behind their backs titled “Same-Day Cash Discount Rates.”

Watch your head under the overpass. Now back over there, thrashing around between the various giant insurance company logos, are employee health plan benefit managers switching plans every year to get a better deal.

More Like Other Industries?

The CCHIT world is one in which high-deductible-plan consumers and self-insured employers increasingly seek to transact healthcare much as they transact travel services, retail purchases, and employee benefit programs.

Allegedly fueling this trend will be the availability of alternative forms of healthcare services – particularly those intended for people who are generally healthy – that were formally the domain of a traditional primary care physicians and hospitals. Telehealth services, pharmacy-based clinics, urgent care centers, home monitoring and testing kits, employer-provided campus clinics, and in-office wellness visits will compete for healthcare services wallet share.

Similar dynamics will occur in the area of high-margin routine testing from imaging centers and labs. The problematic but already well-established trend of stratification of healthcare services — from low-end, Medicare-reimbursed to high-end, spa-style luxury concierge — will continue. New forms of practices will appear, targeting various socioeconomic groups along the lines of the model of the different types of restaurants from “all the grease you can instantly eat for $1.99” to “hundreds of dollars for food you can’t really find hidden within the art-deco presentation.” An ever-increasing percentage of basic healthcare services will be transacted in cash.

Little Susie Has a Sore Throat. Where’s My Smartphone?

Whether it’s Big Joe tracking his type II diabetes or Little Susie’s mom deciding what to do with the sore throat Susie woke up with this morning, the starting point will be a smartphone for search, comparison shopping, advertising, online ordering, in-drive navigation, loyalty points, and all the rest of what makes us decide where to get our morning cup of coffee, which hotel to book in Barcelona, or how to get a ride somewhere.

In this world, notions like “Patient-Centered Medical Home” (in the sense of a doctor getting the new Medicare CCM reimbursements, not the home where the patient actually lives) takes on many flavors and meanings, from specialty patient advocate/consultant concierge services through “do it yourself” (at your real patient-centered home) with a mobile app.

In this CCHIT world, the idea that patient records are stored exclusively in big EHR systems — which have been networked together with patient matching algorithms (or someday, congressionally mandated national identifiers), record locator services, and on-demand copy-paste of entire EHR records from one system to another – seems about as relevant as the old mainframe-based travel agent systems that spit out those triplicate paper tickets with the red ink.

Fact or Fantasy?

If the CCHIT world is coming any time soon, these efforts seem a bit silly:

  • Five-year plans to achieve basic healthcare data interoperability via newly developed standards for provider-to-provider exchange.
  • EHR vendor-driven alliances.
  • Throwing more government money down the drain on more life support for state HIEs that will never be sustainable.
  • Trying to force competing healthcare providers to share their customer data with each other.
  • Waiting for acts of Congress to issue national IDs so we can create some grand interconnected database that everyone can access..

Of course, there’s absolutely no guarantee that world is coming any time soon. Even if it does eventually arrive, it’s not clear how it will coexist with the extensive parts of the healthcare system that will likely continue to operate pretty much as they do today.

What happens with the increasingly large percentage of consumers who are not “generally healthy” that can’t be taken care of properly in the CCHIT model? I’m sure many readers are aware of plenty of other flaws in the CCHIT thinking that we can consume healthcare services like online videos and taxi rides.

There are many complex variables impacting how things will play out. Anyone who wants to predict how things will look in three, five, 10, or 20 years is rather brave. No, they’re not brave if they write an article with their predictions — that’s easy. They are brave when they build companies based on those predictions and visions.

The HIT Startup Dilemma

Which brings me to the point of all this.

The innovative and disruptive healthcare IT startups of tomorrow are forced to do two contradictory things. They have to design solutions for a healthcare world that doesn’t exist (and likely will never exist exactly as they imagine and envision it today) while delivering revenue-generating solutions for the healthcare world that does exist today.

This gets surreal when you watch a startup founder with a CCHIT-intended solution pitching to a room full of big healthcare system execs who want to hear nothing about the CCHIT world. Suddenly the founder’s consumer-centric clinical data integration solution is ideal for provider-to-provider data exchange without patient involvement and consent. The directory service for consumer-centric provider or plan selection is ideal for keeping patients in-network. And on it goes. 

Why? Because that is what generates revenue, pays the bills, and justifies the next round of investment funding. For realizing the very different CCHIT vision.

One of the great things about the startup marketplace is that it drives creativity that never ceases to amaze me. I have seen some really great pitches from colleagues of mine that actually had me believing that you can do both at the same time. I’m still figuring out my “have your cake and I get to eat it too” story.

Though it’s not explicitly spelled out that way, I believe that’s what the venture capitalists I need to woo in the coming months expect me to deliver. They want a disruptive vision that offers the dream of future revenues. Value that will only be awarded to those who dare imagine and create solutions for the new CCHIT world, with a clear ROI-driven revenue model for today’s PPCHIT (provider/payer centric HIT) world (yes, I made that acronym up as well, but I don’t think it was ever used or ever will be again, although I just checked and the domain name is taken).

As noted, the CCHIT and PPCHIT visions are not “either-or” alternatives, so it’s not just a question of transition timing. That’s why despite some of my snarky comments that probably have me on the blacklists of some of the big EHR vendors I need to partner with in the future to be successful (hey, nobody said I was really any good at my startup CEO job), we need the incremental next steps along the current path driven by the experienced industry leaders, the established vendors, the standards organizations, and the government funding programs (I’m trying to correct a little, OK?)

In parallel, we also need to allow for the experimentation and disruption that comes from innovative challengers who think that the healthcare emperor’s clothes – which so distinguish him from all the other industries in the kingdom — are increasingly invisible, to the point where we need to question if they’re real.

It’s a tightrope walking act. I find that I regularly fall off the tightrope on one side or the other. Every day I feel the bruises of those falls. Fortunately, as a small early-stage company, the tightrope I’m on isn’t that high off the ground yet, so I can get still brush off the dust and take another step. Forward, I hope.

Brian Weiss is founder of Carebox.

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February 23, 2015 Startup CEOs and Investors No Comments

Morning Headlines 2/23/15

February 22, 2015 Headlines No Comments

$842-million health records project in B.C. faces delays, software dispute

In Canada, leaked documents reveal that a $670 million IBM/Cerner implementation may be heading to arbitration over delays and efficiency issues.

Healthcare Research Firm Toughens Survey Standards as More CIOs Reap the Profits of Reselling Vendor Software

Black Book adjusts its survey methods after discovering that some hospital managers had answered surveys on behalf of end users while at the same time overseeing efforts to resell hosted installs of the EHR to private practices and smaller local hospitals.

Texas Man Charged in $1 Million Fraud Scheme

A Texas man is facing fraud charges after posing as a Cerner representative and then selling an MRI machine to a Dallas-area hospital for $1.3 million.

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February 22, 2015 Headlines No Comments

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