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Morning Headlines 12/19/14

December 18, 2014 Headlines No Comments

First real-world trial of impact of patient-controlled access to electronic medical records

In a small study, 105 patients are given the ability to hide certain parts of their medical record from their doctors, with a “break incase of an emergency” feature built in so that doctors could bypass the lock if needed. By the end of the six-month study, 49 percent of the patients had decided to hide some portion of their record.

Many say meaningful use Stage 2 is disastrous, but the data say otherwise

While the numbers on Meaningful Use Stage 2 seem grim, Advisory Board Senior Consultant Tony Panjamapirom says that 65 percent of the hospitals scheduled to attest to stage 2 this year have already done so, with many more expected to attest before December 31. He says that between these attestations, and those that are pursuing hardship exceptions, more than 95 percent of stage 2 eligible hospitals will be in compliance by the end of the year.

Medfusion names Allscripts and M*Modal vet as CEO

Medfusion founder Steve Malik will step down as CEO of the company, passing the reigns to Vern Davenport, formerly of MModal and Allscripts. Malik will stay on as the executive chairman.

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December 18, 2014 Headlines No Comments

News 12/19/14

December 18, 2014 News 4 Comments

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The research wasn’t all that great, but the methods were pretty cool. A Regenstrief study finds that half of urban clinic patients who were able to selectively hide parts of their EHR information chose to do so. That’s from a ridiculously small study cohort of 105 patients, so don’t get excited about the results just yet. What was interesting is that Regenstrief developed a system in which patients can lock clinicians out of specific sections of their own EHR information, such as as those involved sexually transmitted disease or mental health. However, the system also contains an audited  “break the glass” button that allows clinicians to override the patient’s preference in urgent situations. I like the elegance of that solution, although the challenge would seem to be adding granularity so that specific types of clinicians could see information without having to use the “break the glass” option (allowing a gynecologist to see the STD information, for example).


Reader Comments

From Sell Sider: “Re: JPMorgan healthcare investor conference in early January. Half of healthcare is there. HIStalk should have coverage or attendee Q&A or something.” The San Francisco conference is by invitation only, so I would have to rely on an attendee to write up their experiences. I’m up for it if someone is willing to share their experience. JPM covers all of healthcare, but I’m sure plenty goes on related to IT. Ben Rooks provided some background in an “Investor’s Chair” post five years ago (where has the time gone?) JPM is also one of the scumbag “too big to fail” banks that ripped off American taxpayers in creating the 2008 financial crisis through greedy speculation, earning it massive profits, $25 billion in bailout money, a $13 billion slap on the wrist, and no criminal charges.

From Tilde Squiggle: “Re: fertility clinic competition. Efforts to reduce cost appear to be stymied by The Man. What happened to free markets?” A dozen doctors and other professionals from University of Vermont Medical Center open a fertility clinic whose costs are 30 percent less than UVM’s, which is great for everybody except UVM, which is suing the group. UVM says the clinic’s employees have access to its EHR and could be using that information to poach its patients, which the clinic denies.


HIStalk Announcements and Requests

I’m interested in running a regular column by either a startup CEO or a venture capitalist who wants to share their keen insight and sharp writing skills with the world. Let me know if you are interested.

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There’s only so many ways companies can try to stand out at the HIMSS conference. Most of them are expensive and don’t work anyway, so here’s an alternative: sponsor the highly anticipated HIStalkapalooza event. I’m offering three sponsorship levels: Platinum (includes 100 invitations for customers, prospects, and employees; an information table in the welcome area; and a private opera box for entertaining); Gold (50 invitations and an information table); and Silver (a private opera box and invitations for 12-14 guests). Sponsors at all three levels will be recognized at the event and on HIStalk before and after. I don’t usually announce the venue until later, but here’s the scoop: I bought out the entire House of Blues Chicago (just off the river on North Dearborn behind the Trump) and the deal includes the ultra-swanky, members-only Foundation Room. Your company is spending a fortune to exhibit at HIMSS, so spend a little bit extra and you’ll get major exposure to the industry’s movers and shakers who read HIStalk. Contact Lorre and she’ll send information, but hurry because we’re about to close the window on new sponsors. The event is break-even at best for me and is frankly a pain in the butt to put together (I swear every year that I’m done with it), but people seem to enjoy it and I got sucked back in again in a weak moment.

This week on HIStalk Practice: Compleat Rehab and Sports Therapy Center and Hot Springs Sports Medicine select Clinicient services. CMS consultants travel to Micronesia. Fremont Family Care receives the HIMSS Ambulatory Davies Award of Excellence. Sony and Snapchat get into smartglasses. Dr. Gregg pontificates upon pain, EMRs, and appreciation. Toby Sadkin, MD puts plans for EHR replacement in perspective.

This week on HIStalk Connect: Google Ventures goes all in on digital health, quadrupling its investments in the sector during 2014. Investment funds and startup accelerators focused on digital health companies are also on the rise. In Colorado, the Quality Health Network, one of the nation’s first health information exchanges, forms a trade group with 20 other HIEs to advocate for the struggling HIE industry and explore new revenue opportunities.


Acquisitions, Funding, Business, and Stock

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Online doctor visit provider American Well closes an $81 million Series C round, raising its total to at least $128 million. I was thinking about the popularity of those $49 visits and had the same reaction as when I see two of four corners of major intersections taken up by chain drugstores and pharmacy-containing grocery stores: where are they getting all those professionals? The schools aren’t cranking out doctors and pharmacists any faster, and yet the retail demand for them keeps going up.

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Analytics vendor Predilytics raises $10 million in a Series C round. I’m trying to stay interested in the analytics marketplace, but everybody and his brother are starting up companies with splashy websites and buzzword-laden assurances of competence. This one is a real company, but I suspect that the only revenue many of the newcomers will book will come from investors rather than customers. Check back on the HIMSS15 exhibitor list of analytics vendors three years from now and I bet 80 percent of them will have failed.

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First Opinion, which offers 24×7 access to a permanently assigned physician via text messaging, raises $6 million in Series A funding. The service costs $9 per month for a guaranteed service level of 5 minutes, but is free otherwise. I downloaded the app, submitted a profile consisting only of age and gender, and was connected to Dr. Kia in India. Her profile didn’t say where she went to medical school, but it did offer that she has “1 kid” (I’ve eaten curry goat several times on Indian buffets, but I don’t think she was talking about that). I texted that I was sneezing and congested, which is true since I’m getting over a cold. She asked some questions that sounded like they were composed in advance by an English as a second language layperson to avoid wasting the doctor’s time. I received responses quickly, just like a real text messaging conversation except with oddly excited reactions to my responses (like “Alright!” and “Oh okay!”). Our conversation ended with a little personal note: “I love to take some chicken soup when I am down with a cold. With a dash of pepper the soup can make you feel much better.” She promised to check on me later and I did indeed eat (take?) a can of Progresso Light Chicken Pot Pie soup onto which I added many dashes of pepper, although in full disclosure I had already done that before I texted Dr. Kia. My analysis of First Opinion is reasonably positive, but the service has significant limitations:

Pluses

  • The app was quick to install and use. It looks like text messaging, but it’s a separate app that vibrates the phone like a new text message when the doctor responds.
  • Connection and the doctor’s response were nearly instantaneous.
  • The doctor was about as interactive and caring as you can get when texting with a stranger half a world away.
  • Her suggestions, while somewhat generic, were pretty good.
  • Promising to check back later was a nice touch regardless of whether she actually does.
  • I would have felt comfortable asking prevention-type questions: diet, exercise, etc.
  • When I restarted the app, the previous conversation was still there, plus it offered to sync with Apple Health and push the information to Dr. Kia, which was pretty cool even though I don’t know what she would have done with it.
  • I don’t know if I could have texted a photo of one relevant body part or another if the situation warranted (I was snickering at the idea of texting over something inappropriate and getting a computer-assisted “Oh okay!” from Dr. Kia.)

Minuses

  • The doctors aren’t licensed in the US, so they can’t prescribe or diagnose. The user agreement suggests that even though you’re chatting with a doctor, they’re only offering personal, anecdotal suggestions and not medical advice.
  • I’m not sure what happens for anything but the simplest conditions other than “contact your doctor,” like if I claimed to be coughing up blood or running a 104-degree temperature.
  • The doctor has zero information other than age and gender, although perhaps she would have asked if she needed anything additional.
  • She recommended decongestants and antihistamines without asking about allergies, hypertension, glaucoma, etc. A Walgreens pharmacist would have ruled those out before suggesting potentially conflicting non-prescription meds.

People

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Quality Systems names Zachary Sherburne (Spectrum Brands) as global CIO.

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LifeLabs Medical Laboratory Services hires Brian Forster (OntarioMD) as SVP/CIO.

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Medfusion promotes Vern Davenport to CEO. Founder Steve Malik, who sold the company to Intuit and then bought it back, will stay on as executive chairman. The company says it has 10 million patients using its portal.


Announcements and Implementations

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Premier, Inc. joins the Coalition for ICD-10.


Government and Politics

Tony Panjamapirom, PhD with The Advisory Board Company says hospital Meaningful Use Stage 2 attestation numbers are being misinterpreted to mean the program is failing. He says it’s true that only 35 percent of all Eligible Hospitals have met Stage 2 standards through December, but 66 percent of hospitals that were scheduled to attest in 2014 have done so. He concludes that the flexibility rule that allows hospitals to attest to Stage 1 requirements in 2014 if they have software problems means that 95 percent of hospitals will attest in 2014. The EP numbers are too preliminary to call since most of them will use the October – December 31, 2014 reporting period. In a nice finish, he says, “The MU program is not just about what providers can or should do. It is about all of us. We all need to keep in mind that the ultimate goal of the MU program is to promote better care and better health for consumers/patients, including ourselves.”Actually, the ultimate goal of the MU program was to defibrillate a wheezing US economy and get providers to buy EHRs they weren’t willing to spend their own money on, but I’ll go with Tony’s more poetic words.


Privacy and Security

The CEO of Sony Pictures was warned about IT security problems three weeks before hackers gutted its systems. The company had software problems that it blamed on software bugs and incompetent IT people, the CEO himself sent his passwords to his assistant in unsecured email, sensitive documents were stored unencrypted, and company policy required employees to keep too many old emails. An email from the CFO to the CEO (exposed, ironically, by the hackers) noted, “significant and repeated outages due to a lack of hardware capacity, running out of disk space, software patches that impacted the stability of the environment, poor system monitoring, and an unskilled support team.”

With regard to Sony, which is worse: (a) having such sloppy IT processes that a 100TB hack wasn’t noticed, or (b) buckling to demands and threats from anonymous hackers that a major film be pulled just because they invoked 9/11? As Newt Gingrich said in a tweet, “With the Sony collapse, America has lost its first cyberwar. This is a very very dangerous precedent,” although a waggish response tweet said maybe it’s Japan that lost since Sony isn’t an American company. Skeptics doubt that it was really North Korea behind the breach since the hackers didn’t mention the movie until later and the extent of the hack make it likely that it was initiated long before anybody heard about now-mothballed and apparently awful “The Interview,” of which no trace remains on the company’s site. In any case, if you needed further motivation beyond never-ending announcements of breaches and unencrypted laptops to review your organization’s security, this should do it.


Innovation and Research

A physician-authored editorial explains why most healthcare IT startups are neither disrupters or the Uber of anything: they are focusing on the wrong patients and wrong problems using technology that has limited ability to benefit the sickest and most expensive patients. He likes the Swasthya Slate diagnostic testing add-on for Android devices (which I was fascinated by and mentioned a few weeks ago) and the “hot spotting” concept of providing intensive outreach therapy to the most expensive patients.


Technology

This might make Dr. Jayne’s Christmas wish list: the $125 lab coat of travel vest company SCOTTeVEST, which contains 16 technology-enabled pockets, a system of distributing weight so that heavy pockets don’t pull, and a personal area network that connects headphones to pocketed devices.


Other

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Consumer Watchdog urges Californians to opt out of the insurance company-backed Cal Index HIE, saying that it hasn’t explained its privacy policy clearly.

Lt. Dan writes a nice piece called “HIE 2.0: Data Exchanges Face Consolidation or Elimination” on HIStalk Connect. Lt. Dan (he’s a veteran and chose that nom de plume to avoid getting fired by his full-time employer) also writes the morning headlines on HIStalk, so if you like those — and many people do, according to my reader survey results — then he’s the guy to hat tip.

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Epic claims it doesn’t market itself, but this DoD pitch on its site suggests otherwise. I get the feeling that Epic is bending quite a few of its previously sacred rules (lobbying, press contact, non-compete clause) to pretty itself up in vying for the massive federal contract.

I was thinking about continuity of care and EDs for some reason. It’s tough to be both an ED patient and an ED doc because it’s the medical version of speed dating. The patients show up unannounced, they are quickly evaluated based on mostly physical characteristics, and just enough medicine is practiced to patch them up and get them out the door quickly and into someone else’s office later for the tougher slog of managing their costly and lifestyle-crippling chronic conditions. The fact that EDs exist means that both patients and doctors accept several principles: (a) it’s OK that physician practices keep 9-5 hours and let someone else deal with problems that arise the other 16 hours of the day; (b) ED docs have confidence, misplaced or not, that they can safely and accurately decide who can go home vs. who needs to stay; and (c) patients assume that given their particular symptoms and their brief narrative, the faceless provider who may have access to little of their medical history can fix them up just as well as anyone else. We’re trying to move the industry toward doctors and patients having an ongoing, committed relationship, but patients who aren’t really sold on the benefit seem to prefer zipless, unemotional encounters via video apps, kiosks, and doc-in-the-box drugstore clinics (that in fact have only the box, not the doc). Either we’re polarizing toward two radically different kinds of encounters or some serious marketing needs to be performed to help consumers understand the value of each (never underestimate the power of convenience over everything else, as evidenced by the drive-through breakfast line at McDonald’s).

I was also thinking about labeling people as “patients,” which I struggle with every time I write. Are you a practice’s patient if you choose them as your PCP but haven’t seen them yet? If you were last hospitalized 10 years ago, are you still considered to be that hospital’s patient? We’re all patients at one time or another, so maybe the term should be retired in favor of something more descriptive of the many flavors of healthcare delivery. Or maybe less descriptive, since all patients are people or (arguably) consumers. My mental reaction to the word “patient” after decades of working in hospitals is, unfortunately, of someone who is dumped involuntarily into a confusing, paternalistic medical system that was designed for providers, not them, and where their job is to do as we tell them without complaining, wasting our time, or even participating so we can make everybody happy by sending them out the door at first opportunity. Even people who have spent a lifetime working in a hospital or practice feel vulnerable, marginalized, or poorly treated when forced into the temporary role of someone’s patient, no different than the rude awakening law-abiding citizens get when encountering the wrong side of law enforcement for the first time. I’m interested in hearing stories about what it’s like being a hospital employee who is hospitalized. I’ve only spent one night in a hospital and my reaction was somewhere between appreciation (toward caring individuals) and frustration (being treated impersonally like a widget and annoyed by the ever-present and sometimes smug inefficiency).

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Lodi Health (CA) will affiliate with Adventist Health as the latter promises to invest $100 million in an EHR and to help the hospital meet earthquake requirements.

HIMSS runs yet another list of all-too-obvious (and self-serving) tips for attending its annual conference. Here are some from me.

  • Don’t attend any educational sessions that feature even one vendor presenter because it will end up being a sales pitch. In fact, given the quality of educational sessions over the past years, seriously consider not going to any educational sessions.
  • Bring a cheap external battery charger for your phone because it will run down trying to find a signal among a zillion attendees.
  • Don’t make appointments to see vendors. You’ll regret having a fixed slot messing up your day, especially with it’s a 20-minute hike away. You’re the prospect – they’ll free up time when you show up.
  • Don’t believe anything you see or hear in the exhibit hall.
  • Use your phone’s tethering capability in the convention center for a better and faster connection. Use it in the hotel to avoid the ridiculous $15 per day charge tacked on to an already overpriced room (unless HIMSS negotiates free service again this year, which is nice.)
  • Use the opportunity to pitch yourself for your next job. It’s a target-rich environment with all those companies and employees casting lustful glances at each other and it’s always nice to feel wanted even if you spurn the employment advances.
  • Lunch options in the exhibit hall are poor, unhealthy, and overpriced (unless you’re enjoying the CIO-only luxury track for the same registration fee the rest of us peons pay for steerage class). Book a hotel that offers a free breakfast (if such a thing exists in Chicago), then graze through the day at booths giving away snacks.
  • Load up on enough sticky notes, lip balm, and thumb drives to last until next year.
  • Don’t hang around the exhibit hall until late in the afternoon just to get free happy hour food. The lines can be long and the snacks aren’t usually that great.
  • Guys, don’t flirt aggressively with women working the booth. You’re putting them in an extremely awkward situation and as hard as it is to believe, they’re not that into you.
  • Providers, don’t do anything you wouldn’t want your ED patients to see. They’re paying for your junket.
  • Don’t wear a suit unless you’re at the C level because you’ll look like a self-important douchebag. On the other hand, don’t (even on the last day of the conference) show up wearing shorts or leading toddlers.
  • Leave all the handouts you took just to be nice in your hotel room’s trash, along with your conference tote, badge, and other useless crap you accumulated. It’s not worth hauling home.
  • Stop by the microscopic HIStalk booth, which is always in almost-affordable exhibit hall Siberia near the restrooms. It’s the size of a Yugo, but usually has fun people stopping by since it gets lonesome back there.

Weird News Andy says we should fight global warming by eating chocolate chip cookies. A new study answers the age-old question: where does the fat go when you lose weight? Answer: most of it is breathed off as carbon dioxide. The author says that doesn’t contribute to global warming because humans don’t exhale ancient carbon atoms.

Vince put together a Christmas special “CIO Letters to Santa.”


Sponsor Updates

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  • RazorInsights celebrates its Founder’s Day by donating solar-powered study lamps, books, and snacks to students in a school near Bangalore, India.
  • HDS offers a white paper called “6 EHR Trends to Watch in 2015.”
  • E-MDs becomes the first EHR to exchange provider information with the infectious disease registry of the Kansas Health Information Network, helping users comply with Meaningful Use Stage 2 requirements.
  • EClinicalWorks congratulates Fremont Family Care (NE) for winning a HIMSS Davies Award of Excellence, the twelfth eCW user to win in the past seven years.
  • Greenway Health will sponsor pro golfer Blayne Barber, who will wear the company’s logo on his shirts.

EPtalk by Dr. Jayne

I ran across this piece on facility fees today. For those who have not yet encountered them, you’re lucky. The basic theme is that when hospitals employ providers to work in an “outpatient department,” they are billing in a way that charges both a facility fee and a provider fee. This may occur even if the provider’s office is not within the hospital proper, but is still identified as a department of the hospital. The principle is that the charges are to cover what CMS requires of hospitals rather than offices. The problem is that patients wind up paying on two different deductibles.

This reminded me of something that is glaringly missing in most EHR systems – easy access to cost data for tests and procedures. Most systems have formulary information that displays pricing – even if it’s just $, $$, $$$, and $!$!$!$!$ like a restaurant guide. What we really need to keep costs down is that kind of information for everything we order, including laboratory and diagnostic testing. The proliferation of so many insurance plans and product offerings makes it technically challenging to display the information in a usable fashion without negatively impacting system performance. The difficulty is compounded by the way that some of the costs are less than intuitive.

For example, if I want a glucose level and a potassium level to monitor drug therapy, it’s actually cheaper to order a basic metabolic profile (seven tests that include the two I want) instead. Now I’m forced to order tests I don’t want and that might have incidentally abnormal values that lead to more tests and greater overall cost. How do you represent that in the EHR? We’re trained to only order tests if the results will change the plan for the patient or influence the outcome, but here we are being pressured to violate that for financial reasons.

There is also a generalized concern that having cost information at the point of care will influence physicians to withhold care rather than using the information as a tool to discuss the pros and cons of a particular approach with the patient to arrive at a mutual decision. Of course such a discussion also requires time that we don’t have during a typical office visit, which skews the cost curve even further. With the potential for Meaningful Use Stage 3 requirements about to be dropped on us, I don’t look for software vendors to spend their development dollars helping us solve this problem.

In other news, Glassdoor published its list of the Top 50 places to work as determined by employees. Interesting members of the top 10 include Google, Nestle Purina PetCare (bring your dog to work!), In-N-Out Burger, and Mayo Clinic. Although several major health systems and pharmaceutical firms made the top 50, health IT vendors were decidedly missing.

Speaking of lists, results are out for the subspecialty certification exam in Clinical Informatics. Although one of my protégés reported a pass, the other two have been noticeably silent. I’ve been keeping my eye out for the full list but haven’t seen one yet. Looks like AMIA still has last year’s cohort listed on their website. If anyone has the full list, I’d appreciate being pointed in the right direction. I’d like to have my celebratory champagne (or sorrow-drowning bourbon) at the ready.

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I’ve written quite a bit about wardrobe choices for conference attendees and presenters. Several readers shared from The Atlantic a piece about physicians and their clothing choices. The author specifically mentions primary care and being somewhat put off when her new physician “clicked into the room in stilettos and a tailored expensive-looking suit.” Primary care physicians in our medical group run the gamut, from jackets and ties to wrinkled scrubs. The residency program faculty members who are women tend to favor Birkenstocks and broomstick skirts, which although stereotypical, seems to work for them. My favorite physician wears scrubs from competitor hospitals just to be ironic.

The author links out to a New York Times piece that discusses enclothed cognition, which describes the way clothing can impact thought processes. Researchers studying the phenomenon note that wearing a white coat that you believe is a physician jacket increases attention. Believing it belongs to a painter does not. Apparently it’s a subset of embodied cognition, where thought processes are based on physical experiences (including clothing) that can influence abstract concepts.

I had never heard of it using those terms, but admit it’s something I’ve experienced. Back in the days of pagers and being on call every third night during residency, it was almost a dressing ritual to receive sign-off from the outgoing call team. They’d hand off the code pager, the on-call pager, and any other pagers they might be holding while talking about the patients on the service. By the time you were done hearing about all the patients, you felt like you were wearing Batman’s utility belt and could handle whatever came your way.

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At one of the offices where I see patients, the physicians wear matching scrubs and have desk space in a shared bullpen. As I pull on my white coat and head out to see patients, it’s like readying for a sporting event. Some days are definitely more of an athletic contest than others, that’s for sure. On the flip side, I’m a sucker for black-tie events – there’s just something about putting on a floor-length ball gown that is transformative, whether you spent your day knee-deep in flu patients or up to your eyeballs in EHR documentation. Add a pair of killer shoes and a little bling and it’s even better.

Are you ready for some holiday sparkle? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 18, 2014 News 4 Comments

Morning Headlines 12/18/14

December 17, 2014 Headlines No Comments

HHS awards more than $665 million to design and test state-led efforts to improve health care quality, accessibility and affordability

HHS announces that it has awarded $665 million in grants to fund 32 state-level initiatives working to implement experimental health care payment models or service delivery models that could improve health care quality and lower costs.

More hospitals moving to improved EHRs, CMS reports

CMS releases the latest MU attestation numbers: 1,681 eligible hospitals have attested for MU Stage 2 as of December 1, up from just 840 that had attested by November 1.

Open Enrollment Week 4: December 6 – December 12, 2014

2.5 million people have used healthcare.gov to enroll in an insurance plan since the start of the 2014 open enrollment period, 52 percent are renewing policies they signed up for last year, while the rest are new customers.

State-Based Marketplaces Using ‘Clearinghouse’ Plan Management Models Are Associated With Lower Premiums

Health Affairs analyzes the premiums for health plans listed on state health insurance exchanges and finds that states that are more selective about which plans they list on the exchange, even if done in an effort to protect consumers, have significantly higher premiums than states that allow any qualifying health plan to be listed.

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December 17, 2014 Headlines No Comments

Readers Write: Review of the mHealth Summit

December 17, 2014 Readers Write No Comments

Review of the mHealth Summit
By Norman Volsky

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Last week I attended the mHealth Summit in Washington, DC. I met with 25 vendors over a two-day period and came away with several takeaways regarding mHealth industry trends and the companies that correspond to each.

 

Changing Patient Behavior

Many companies are trying to change a patient’s behavior and inspire them to participate in their own rescue. If you can change a patient’s behavior that resulted in them getting sick (eating unhealthy, not exercising, smoking, etc.), that patient has a better chance of staying healthy.

  • Telcare. Mobile diabetes solution that allows patients to manage their condition more effectively by providing them with timely and actionable information. Their enterprise glucose monitoring solution enables the entire care team to be connected so they can make a difference.
  • Propeller Health. FDA-cleared asthma and COPD management vendor that helps patients and physicians better manage chronic respiratory conditions. Digital products that have therapeutic benefit.

Reducing Cost and Readmissions

These two themes go hand in hand. Health plans, ACOs, and employers are looking to treat patients outside of the four walls of a hospital. Telehealth in the form of online doctor visits is helping reduce cost significantly for the healthcare system. Monitoring patients remotely and making sure the entire continuum of care is informed can prevent readmissions, reduce the cost of care by treating patients in the appropriate care setting, and prevent catastrophic events.

  • MDLive. Consumer-focused telehealth vendor that provides concierge connected care for customers of all socioeconomic backgrounds. MDLlive has the potential to become the Uber of telehealth by providing a fully integrated end-to-end solution to its customers.
  • Twiage. Communication platform that improves clinical workflow and outcomes by allowing first responders to deliver real-time data from an ambulance to an emergency department physician.
  • Ideal Life. End-to-end remote patient monitoring vendor that has been in the space for 12 years. Allows patients to self-monitor using a wearable device.
  • TruClinic. Medical Skype on steroids. Telemedicine services vendor that allows physicians to use the same workflows they are already using daily.
  • Wellpepper. Patient engagement vendor that provides personalized mobile care plans to patients. Reduces cost by using video capabilities that reduce need for multiple physical therapy visits.
  • SnapMD. Telemedicine vendor that enables doctors (particularly specialists) to develop a digital practice in addition to their core business. Leverages built-up trust with a patient’s personal physician.
  • Lively. Personal emergency response vendor that provides non-invasive wearable device and activity sensors that monitor an elderly person’s behavior and alerts family members if their behavior changes to prevent falls and emergencies.

Managing Risk Effectively

Government regulation has changed how patient care is being paid for. The healthcare industry is morphing from a fee-for-service to a pay-for-performance environment. If a health system can effectively manage risk, they are much better positioned in the new environment.

  • Wellbe. Guided episode management vendor that helps organizations manage risk more effectively and transition into value-based care and bundled payment environment.
  • Acupera. True population health management vendor that created unique workflow engine that guides physicians on a minute-by-minute basis and assigns tasks to the appropriate care team members.

Communication, Interoperability, and Secure Messaging

Patient information is extremely sensitive and confidentiality is paramount. HIPAA compliance is required. Companies have used secure texting, communication, and interoperability to improve medication adherence, referral management, clinical workflows, and many other issues in the healthcare market.

  • CareSync. Facebook for your health. Mobile health platform that helps build a unified patient record and a common care plan. Allows doctors, family members, and friends to monitor a patient’s chronic condition and overall health.
  • Memotext. Medication adherence vendor using a secure messaging platform and behavioral questionnaires to improve patient compliance to medication regimens.
  • Health123. Patient engagement platform that allows HIPAA-compliant communication.
  • Carevia. Telecommunication platform that helps organizations with interoperability.
  • Doc Halo. True mobile health platform that improves workflows and reduces readmissions by enabling secure communication throughout the continuum of care.
  • Mobile Health One. Communication platform that allows validation at the point of registration. Solution has real-time fluidity that improves clinical workflows.
  • Shift Health. Mobile patient engagement platform that addresses survey fatigue by customizing surveys for a healthcare facility.
  • Zoeticx. Sells a middleware solution that addresses patient medical information flow. They help improve outcomes and workflows by overcoming the problems of effective health information exchange and poor EHR interoperability. Their mobile platform has care coordination tools as well as a secure messaging platform that is triggered based on events.

Miscellaneous Emerging Technology

There were several vendors I met with that were doing some unique things that did not fit into the above industry trends.

  • VisualDx. Specializes in diagnostic clinical decision support. They differentiate from other clinical decision support vendors because they are using visual diagnostics to help physicians arrive at the correct diagnosis. They also have a search tool to isolate common infectious diseases based on specific countries. The recent news surrounding misdiagnosed cases of Ebola has moved this type of technology to the top of mind of C-levels at hospitals.
  • Validic. Industry-leading digital health platform that delivers easy access and actionable data that healthcare companies can analyze effectively. It is a back-end solution that provides maintenance and integration for the entire digital health ecosystem.
  • J Street Technology. Scheduling software that automates the process of backfilling cancelled appointments. Securely texts patients to confirm appointments and makes sure doctors’ schedules are optimally filled.
  • Care Connectors. Back-end integration vendor that provides bi-directional communication and coordinated care solutions to enable the healthcare ecosystem.

Overall, I saw a lot of awesome technology. This is a growing, exciting space and I am very fortunate to talk to interesting people throughout the industry daily. It is not surprising that private equity and venture capital firms are investing heavily in the mHealth market and I think they will continue to do so for many years to come.

Norman Volsky is director of the mobile healthcare IT practice of Direct Recruiters, Inc. of Solon, OH.

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December 17, 2014 Readers Write No Comments

HIStalk Interviews Frank Fear, VP/CIO, Memorial Healthcare

December 17, 2014 Interviews No Comments

Frank Fear is VP of ancillary cervices and CIO of Memorial Healthcare of Owosso, MI.

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Tell me about yourself and the health system.

I’m the vice president of ancillary services and the chief information officer at Memorial Healthcare in Owosso, Michigan. Owosso is about 20 miles from Lansing, 25 miles from Flint, and 25 miles from Saginaw. We’re a 150-bed hospital with 1,100 employees and a medical staff of about 120. Employed physician offices totaling about 15 offices and 50 providers that are sprinkled throughout about a 20-mile radius from the hospital. 

Although we’re considered a community hospital, we have a lot of competition with hospitals in Lansing, Saginaw, and Flint. We’ve leveraged technology as a differentiator for us. Utilizing IT to approve efficiency, quality, safety, and frankly, trying to attract doctors. It’s very competitive for not only patients, but also attracting good doctors. I think we’ve been really successful. We’re very proud of our ability to recruit physicians. We haven’t had a lot of challenges there.

I really enjoy working here. We’re a size where we have some resources to get things done, but we’re not so big that it takes time to get things done. There’s not a lot of bureaucracy. It’s a lot of fun to work with our executive team and board. They see IT as a strategic asset and not an expense. The ability to go right to the exec team and the board and say, hey, I want to do this new, next idea that I think will have a positive impact, work with them. Apple Health integration is an example of that.

 

How will you use Apple Health integration?

We’ve had a patient portal for a while and we’ve attested for Meaningful Use Stage 2 in the hospital. As we all know, patient portal is one of those requirements. We’ve seen some mild success there, but it’s one of those things where we’re asking the patient many times to go out and access that. It’s almost passive patient engagement. We’re putting your data out there it’s available for you to better manage your care and and be more informed as a patient. But we’re really looking for the patient to go out and get that data.

We’re trying to figure out, how can we be more actively engaged with our patients? I like to think that there was some like grand, great vision that goes into this stuff. [laughs] I started thinking about and working with Frank Fortner, president of Iatric Systems, and said, you know, we’re always looking down at our phones. It’s almost embedded in our work flows now that you look at your smartphone. People are using Fitbits and they’re using different apps on their phone. Is there a way that, instead of us building an app or developing something and asking the patient to go look at it like we build a portal, can we somehow engage patients actively and leverage what they’re already doing and making it a richer experience?

We’re in the beginning phases of it. There’s no fully developed product or anything. I don’t want to give any misconception there.

Ever since I upgraded my iPhone to the 6, I pull up how many steps have I had today and say, I have to put a few more thousand steps in to keep myself at that average. How can Memorial Healthcare get in that workflow and enrich that experience for the patient?

 

The doctor can’t really do much with step counter information. Do you see the Apple Health-powered patient engagement going beyond that?

That’s our vision. [laughs] If a patient’s looking at that app on a regular basis to do steps, could we push vital signs to it? Could we push blood pressure to it? Diabetes is such an epidemic in our country. Could we push blood sugars to it and not ask the patient have to type that in? We’ve already captured some of that information at their office visit. Could we enrich that Apple Health application to make it more valuable for the patient and connect them or tie them back to their care provider? 

That’s how we’re envisioning Apple Health. Enriching that app so it’s more useful for the patient.

We look at Apple Health as just a starting point. We want to leverage that the tool that we’re developing with Iatric to push data to the next app. Let the patient choose what apps that they’re going to want to utilize. Apple Health, we thought, was a natural starting point. It’s already on the phone. You don’t have to install it. Apple’s done such a good job with usability.

Whatever comes next, we have this integration tool that would push data to these apps to make them more useful, more valuable. That’s our vision. We want to push data that we think that will make that application more usable, more valuable for them. If they’re already actively looking at it, we’ve somehow dealt with that hurdle of getting people to utilize it. They’re seeing some value there at some level. How can we extend that?

 

When you look at your IT capital budget over the next few years, where will you be making investments?

Next year we’ll be focused a lot more on real-time analytics to improve quality at the point of care. We’ve got dollars budgeted to look at data in real time as patients are in the hospital or an office visit to say, we know you have an office visit. We know you have certain chronic conditions. We see that there are certain labs being done, certain meds. Start prompting providers to query the patient or suggest something that they need to order.

On the hospital side, with Core Measures, value-based purchasing, clinical quality metrics, it’s looking at the data and then suggesting actions to providers. Starting to alert them as the discharge comes near. Or some sort of time parameter … certain antibiotics need to be given so many hours before a surgery. We start suggesting.

We’ve built a lot of that stuff into order sets, but now we want something that’s a little more dynamic that is notifying a nurse or notifying a doctor. Sepsis is a big focus for us. Having some automated tools that start looking at different data elements and notifying the nurse of potential sepsis and then notifying a physician as it escalates that they take certain actions. 

For us, the analytics is going to be more of a real-time nature. We’re already doing some stuff with population health and tools there that look at a population and look at risk stratification, identifying higher risk patients and engaging them. We’re doing some stuff there already. I don’t know if we’ll continue that investment, but when you talk about net new, it’s going to be more of that real-time actively engaging patients based on data that we already have in our systems.

 

You’re feeling good about your Meditech and Allscripts systems?

We’re on Meditech Magic. It’s a tool that we’ve had for going on 21 years at Memorial. We know we’re going to need to do something with it. But we’re spending quite a bit of time trying to understand what value will be created and what business problem will be solved by upgrading our Meditech Magic system to the latest and greatest Meditech platform or another platform.

It’s a significant capital expense, but it’s also a significant resource drain on the entire organization. It pulls us away from other projects that we could be doing that are non-IT related. We’re spending a lot of time understanding the value proposition for us before we decide to go down that road.

Meditech has not announced the end of life of Magic. There’s been some recent announcements I think that actually extend the life of our Meditech Magic system. We’re trying to leverage third-party systems to do some of the analytics that our Meditech system is challenged with since it’s a 20-plus year platform for us.

 

Which health system priorities and challenges will have the most impact on IT?

There’s a laser focus from our board all the way down to the frontline staff on clinical quality. It’s critically important that we provide the safest care, highest quality care, and frankly, the most efficient care that we can provide. We’ve hired a vice president that’s focused on process improvement and efficiency. We’re seeing cuts in reimbursement. We’re heavy Medicaid and Medicare in our region, so we need to figure out a way to be able to be sustained on that Medicare or Medicaid type of reimbursement. There’s a real focus there.

There’s a definite role that IT plays there and can play a big part. We have played a big part up to this point, but we need to elevate our game to another level and try and move away from so much implementation mode and spend a lot more time in optimization. Then when we are in implementation mode, that it’s clear to us that there’s going to be an impact to an outcome measure that’s going to improve quality and efficiency. We’re going to play a big role there. 

Employee engagement, physician engagement, and leadership development are three key strategies for us. They all center around people and engaging people. These systems that we’ve implemented directly impact our day-to-day physician workflows, directly impact our employee workflows. Really, truly engaging those folks to understand how we can improve those tools and improve their quality of life at work.

Not have the tools be an annoyance factor, to be something that enriches their work and they feel strongly about it. I’m not suggesting that they don’t feel that way, but there’s more work we can do there to ensure that we’re enriching the patient experience and not causing frustration. 

When a physician is frustrated and struggling using a system, it impacts their overall engagement. It impacts their satisfaction and ultimately impacts how they deliver care. Spending a lot of time with our physicians and staff and engaging them and improving and optimizing these tools. Making sure that we truly hear their concerns, respect them, and are sensitive to them. That doesn’t mean we can fix everything or make every change they request, but a two-way engagement where they’re bought in and they understand the limitations.

 

What should vendors know about your job and your challenges as a CIO that perhaps they don’t?

For our vendors, as much as I have a love-hate relationship with them, they’re critical to my success and the organizational success. If our systems don’t perform well and work well, it’s very difficult for an organization to be successful. It’s just the reality of it. They have a huge responsibility for being just good for basic things — good support, attentive. 

I know they’ve been tremendously pressured with Meaningful Use to deliver applications in such a short turnaround time. But it’s critical, beyond just being responsive and providing good customer service, that in that partnership that truly is a strategic partnership, that they spend some time understanding not just Meaningful Use, but what some of the key drivers or key focus areas that the executive team is focused on and that our board is focused on. Then working with us to try and develop applications or optimize applications to try and move whatever outcome measure that we’re focused on, that our board is focused on, our community is focused on. That takes time.

We’ve had a wonderful relationship with Iatric and I think this is an example. Frank will come up and sit down with me and we’ll have conversations about what are the main things that you’re focusing on right now. We’ve built tools in the past with them to address our strategic priorities. That’s so important, that they stay in touch and in tune with what’s going on with our organization and providing solutions that will address some of those challenges. 

Easier said than done. I know they’re under tremendous pressure to deliver regulatory compliance functionality, but if we focus just purely on the regulatory stuff, we’re not going to be successful. We need to be able to make sure that we’re addressing some of the strategic priorities that go well beyond Meaningful Use and ICD-10. That’s so tough with limited resources, but we have to find ways to address that stuff. That’s what this Apple Health thing is that we’re trying to do. Actively engage our patients to keep them connected to organization to improve quality and better care.

 

Do you have any final thoughts?

Behind the Apple Health piece, we’re spending a concerted amount of effort on the security side of the tool. Part of this implementation is going to be educating our patients on what it means to use a tool like Apple Health or any other application where they’re sharing their health data and what that will mean and implications for that. It’s tremendously powerful tools, but we’ve got to make sure that our patients understand some of the potential risks with pushing that data to a centralized repository. 

We’re developing goals for the project right now with Iatric and ensuring that the application that we’re going to leverage to push data to Apple Health that is SSL encrypted, that data isn’t stored on the actual device. Of course, once it gets pushed to Apple Health, it’s going to be stored at some level on the device, but making sure that the rigor is done there to educate patients on the risk and then do everything in our power to secure the application and ensure that the transmission process and the review of the data process is done securely.

Another piece that I feel very strongly about as we go down this Apple Health path is that data isn’t necessarily just automatically pushed. A patient is notified that, hey, there’s new data available, evaluate it and determine whether you would like this data in Apple Health. Having the patient be more actively engaged in making decisions about the data that they own. Having it notify them goes beyond that passive engagement where they have to go out to a patient portal. There’s new data there.

They may not even be sometimes be aware of it. You go to the physician office, they take your vitals, your blood pressure. Sometimes the doctor may not share the vital information or they may not share all that information with you. This is notifying the patient, here’s your data, take a look at it, and you may decide to push it to Apple Health or whatever app. Having them be more involved in the process and not just having it all push to different tools and not understanding those risks. 

Great concern and care is being placed on the sensitivity of this data and the security of it. It’s really important as anybody explores some of these commercially available tools.

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December 17, 2014 Interviews No Comments

Morning Headlines 12/17/14

December 16, 2014 Headlines No Comments

Sony Pictures Data Breach

Sony writes a letter to its employees to inform them that their names, social security numbers, addresses, and personal health information may have been compromised when hackers breached the company’s security system and stole internal files.

Sharing is caring? Not for medical records

The post-mortem analysis of a failed EHR interoperability project in Oregon finds that interoperability simply isn’t good business when revenue is tied to a fee-for-service reimbursement model. OHSU’s chief health informatics officer explains, “There’s no financial incentive for the providers. In fact, in many cases, the financial incentive is reversed. Better I don’t know that the patient had an MRI a month ago and repeat it because in a fee-for-service world we get paid for the procedures we do, not the ones we avoid.”

Do patients mind if their healthcare data is shared? It depends

According to a new ethics study, patients view having their health data used to support medical research, but without their consent, as morally superior to having their health data used to support marketing efforts, even if their consent was given.

Making the Cut: Which surgeon you get matters – a lot. But how do we know who the good ones are?

Researchers at Memorial Sloan Kettering have developed a software system that quantifies and compares patient outcomes across all of its surgeon, with the goal of providing detailed feedback to each surgeon about their performance.

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December 16, 2014 Headlines No Comments

News 12/17/14

December 16, 2014 News 4 Comments

Top News

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The massive Sony Pictures data breach forces the company to warn employees that hackers have their personal information (including Social Security numbers, government identifiers, and compensation information) as well as HIPAA-protected health information collected by the company’s health plans. Celebrity PHI was among the information downloaded, which should provide interesting gossip when it inevitably leaks out. A worksheet listing the company’s highest-cost health plan patients (above) was one of the documents hackers posted to the Internet as a warning. Sony Pictures hires a law firm to threaten newspapers and websites that might otherwise post embarrassing hacker-released information, a tactic that legal experts say probably won’t work since the publications would be obtaining the information legally.

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Meanwhile, the movie that apparently stoked the ire of the North Korea-based hackers premiered in LA Thursday night, with early mediocre reviews of “The Interview” raising the question of whether it was worth it, especially since the breach exposed emails in which a Sony Pictures executive griped to peers that the film is “desperately unfunny.” At least the movie will get curiosity box office revenue. Perhaps as the ultimate closing of the loop, Sony Pictures can make a movie about its own breach, featuring the “minimally talented spoiled brat” Angelina Jolie. After all, she starred in 1995’s “Hackers” before donning jewelry containing Billy Bob Thornton’s blood and then finally rebranding herself into a pouty-lipped Mother Teresa. Sony Pictures could use the ticket sales to help pay for the fines, privacy lawsuits, loss of business from exposure of its trade secrets and intellectual property, and general damage caused by incriminating emails. If they survive, that is, which should be in serious doubt at this point. The job you should be glad you don’t have is that of David Buckholtz, SVP of corporate IT at Sony Pictures Entertainment, who will never work in that town again.


Reader Comments

From Shag Dancer: “Re: HIStalk. How long does it take you to write it?” I spend at least eight hours on Tuesdays and Thursdays, sometimes more and sometimes less on the Monday Morning Update, since I research and write every word. That’s only for the heads-down writing and not all the stuff in between … I’m a fast writer, but it takes forever to wade through all the meaningless junk that I don’t mention and to make sense of the sometimes poorly presented information that I do. My job as I see it is to make it look easy and to disguise a lot of work into a quick and entertaining read.


HIStalk Announcements and Requests

I decided to add a new subcategory called “Privacy and Security” to each post since breach and threat news is frequent. I’ve placed it below the “Government and Politics” section below.

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I’m running an end-of-year special on promoted and produced webinars for those signed by December 31, so it’s a great time to contact Lorre to book a slot before the HIMSS conference.

Some company tossed a telephone book in my driveway this morning, reminding me that they still exist even though I haven’t opened one for at least five years (and when I did, I was only seeking pizza coupons). It reminded me of my first cell phone, which was not only large and sporting a walkie talkie type antenna, but also came with an downsized phone book for stashing in the glove box (where, curiously, no gloves have ever been placed).

Listening: new soulful and honest R&B crooning from K. Michelle. I listened unaware that she’s been in some trashy reality TV shows, thankfully, since the music soars despite her iffy career and lifestyle decisions.

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I’m a recent coffee convert after years of making fun of Starbucks lines and bizarre morning rituals, so I need to know whether I’ve found belated enlightenment or whether I’ve instead crossed over to the dark side. Take my poll here – what do you enjoy drinking most at work? I usually hit all the hydration checkboxes with coffee, water, and soda in the mornings and I’d still find it hard to choose a favorite, although there’s nothing like coffee to get me going (and it’s not just the caffeine – there’s something about the warmth that just works). I’m not a snob about it, though – the giant $1 cup at McDonald’s is fine.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

December 18 (Thursday) 1:00 ET. Virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy,” a new book by “CIO Unplugged” contributor Ed Marx. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.


Acquisitions, Funding, Business, and Stock

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Google’s venture capital fund is moving its investments from consumer Internet startups  to healthcare and life sciences, with a special interest in companies that focus on health data.

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Orion Health completes its New Zealand IPO, raising $97 million.

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Neos Technologies acquires wearables monitoring vendor AFrame Digital. I don’t know anything about the former except that it writes a bad press release, including misspelling its own name. I’ve only heard of AFrame when it received a 2011 NIH grant to study falls in the elderly. Its “About” page obscures whoever is involved with the company, so my initial “who cares” reaction is that two unsuccessful companies are trying (against all odds) to merge into one better one. I lose nearly all interest in a company whose website fails to (a) list its executives; (b) indicate the location of its headquarters; (c) showcase recent announcements; or (d) make it clear on the home page exactly what it does in a succinct, buzzword-free tagline or paragraph. If they can’t accomplish those trivial tasks, why would I want to buy anything from them?

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Lightbeam Health receives an unspecified capital investment from former Allscripts executives Glen Tullman and Lee Shapiro.

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A report published by Good Jobs First names Cerner as #3 on the list of companies linked to the Forbes 400 list of richest Americans (Neal Patterson at $1.55 billion) that have received more than $1 billion in subsidies from state and local governments trying to boost economic development. Cerner at $1.7 billion worth of taxpayer gifts trails only Intel ($5.9 billion) and Nike ($2 billion). I say blame politicians rather than the companies that were voluntarily offered taxpayer money for reasons that may or may not make good fiscal sense.

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Singapore- based RingMD, which offers consumers live video access to a global network of doctors, will establish its North American headquarters in Charleston, SC in preparation for an expanded US presence. Former programmer and founder Justin Fulcher, who is 24, started the company with the financial support of the Singapore government.  


Sales

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Massachusetts Eye and Ear (MA) chooses Medarchon’s Quarc for secure messaging.

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Hunterdon Healthcare (NJ) will use secure communications from Practice Unite.

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Genesys Health System (MI) signs up with PerfectServe for clinician communication.


People

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Mary Jahrsdoerfer, PhD, RN (Philips Healthcare) joins Extension Healthcare as chief nursing officer.

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Remote monitoring vendor Sentrian hires Lance Myers, PhD (Vivonoetics) as CTO.


Announcements and Implementations

The non-profit American Telemedicine Association launches an accreditation program for providers offering direct-to-consumer consultations, with the cost and requirements of the three-year certification disclosed only after submitting an application. Part of the package includes being able to use ATA’s accreditation seal and being listed in its consumer guide.

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Allscripts certifies the Patient Engagement Solution of non-profit Healthwise for integration with its TouchWorks EHR.

Kaiser Permanente Hawaii launches a teledermatology service in which primary care physicians can send patient photos to dermatologists for diagnosis. 

The 300th hospital goes live on Medhost’s YourCareCommunity vendor-agnostic patient portal.

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The folks at Forward Health Group got permission for me to use the above summary graphic from KLAS’s just-released “Population Health Performance” report in which Forward Health Group scored at the top of several categories and #2 overall. Phytel, Forward Health Group, and i2i Systems led the pack, while eClinicalWorks and McKesson were the only two vendors in the low-performing category.

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Wellcentive joins the CommonWell Health Alliance.


Government and Politics

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The Senate finally confirms Vivek Murthy, MD, MBA as surgeon general, filling a position that has been vacant for 17 months. President Obama nominated him in November 2013, but his statements labeling guns as a public health hazard drew opposition from the influential National Rifle Association, which ended up on the rare wrong side of a political decision.


Privacy and Security

An interesting study seems to suggest that patients think the specific use of their health information is more important than whether their consent was given in advance. That’s surprising given that our entire desired state is is driven by opt in/opt out via consent signatures. Respondents said research use is OK in most cases, but using their information for marketing (even with their consent) is not OK.

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Clay County Hospital (IL) calls the FBI after receiving an extortion email demanding cash to prevent stolen patient information from being disclosed (of which a sample was included as proof of possession). The 22-bed hospital says its servers haven’t been hacked, which would suggest that responsibility rests, as it often does, with an employee.

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Virginia Commonwealth University Health System (VA) notifies patients that the used CDs donated by one of its employees to a children’s art project contained PHI, including full clinical records and Social Security numbers. 

In Canada, Ontario’s privacy commissioner orders Rouge Valley Hospital to upgrade its computer systems, appalled that a year after several employees were found selling patient information, hospital still can’t review access records going back further than two weeks. A fun tidbit from the article: one of the employees who was selling information to Registered Education Savings Plans (RESPs) changed jobs and lost his access to the computer, after which he pulled the brilliant move of sending a formal request to IT asking to have his access restored so he could look up patient phone numbers to “sell them to RESPs in the course of his part-time employment.”


Innovation and Research

A tongue-in-cheek observational study finds that physician waiting rooms contain old, boring magazines because patients steal the others, especially newer celebrity gossip magazines. A couple of years ago I picked up a new-looking travel magazine in the lobby waiting room of one of our hospitals while waiting for a co-worker. I wondered why it featured now-defunct countries and photos of vintage automobiles until I checked the cover date, which was 1995. If only it could talk.

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”Which surgeon you get matters – a lot,” says a profile of surgical outcomes software Amplio, developed by Memorial Sloan Kettering Cancer Center. The system combines post-op patient feedback with EHR information to tell surgeons how they’re doing, which they rarely know since they assume all similarly trained surgeons have similar outcomes with any variation explainable by how sick their patients are. The article references an earlier study in which it observers could easily and accurately determine who was the better surgeon by simply watching videos of their procedures. It also cites the startling results of a 2007 study: cancer returned in 10 percent of patients whose prostate was removed by inexperienced surgeons vs. in only 1 percent of those operated on by experienced surgeons. A snip from the brilliantly written article:

There’s something powerful about having outcomes graphed so starkly. Vickers says that there was a surgeon who saw that they were so far into the wrong corner of that plot — patients weren’t recovering well, and the cancer was coming back — that they decided to stop doing the procedure. The men spared poor outcomes by this decision will never know that Amplio saved them.
 
It’s like an analytics dashboard, or a leaderboard, or a report card, or… well, it’s like a lot of things that have existed in a lot of other fields for a long time. And it kind of makes you wonder, why has it taken so long for a tool like this to come to surgeons?
 
The answer is that Amplio has cleverly avoided the pitfalls of some previous efforts. For instance, in 1989, New York state began publicly reporting the mortality rates of cardiovascular surgeons. Because the data was “risk-adjusted”—an unfavorable outcome would be considered less bad, or not counted at all, if the patient was at risk to begin with — surgeons started pretending their patients were a lot worse off than they were. In some cases, they avoided patients who looked like goners. “The sickest patients weren’t being treated,” Vickers says. One investigation into why mortality in New York had dropped for a certain procedure, the coronary artery bypass graft, concluded that it was just because New York hospitals were sending the highest-risk patients to Ohio.


Technology

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The CEO of Withings apologizes to purchasers of its Aura sleep device, acknowledging that in its rush to get the product on the market, the company left out important features such as heart rate tracking and the ability to view results immediately. They’re trying to fix some of the problems with updates.


Other

The Portland, OR newspaper covers the failure of a local interoperability project that started eight years ago, concluding that it didn’t work even though most hospitals are on Epic because: (a) hospitals bear the cost while insurance companies reap the benefit; (b) hospitals get paid for the procedures they perform rather than those whose duplication they avoid; (c) even information that is successfully exchanged doesn’t always make sense to the recipient. Thus reads the boilerplate RHIO epitaph.

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A new Consumer Reports survey of recently hospitalized patients finds that those who didn’t feel respected by staff during their stay were 2.5 times more likely to experience a medical error, with an alarming 30 percent of those surveyed saying they actually did. A third of respondents say they weren’t treated like responsible adults, while 40 percent report that doctors and nurses interrupted them instead of listening. The article, which will appear in the February 2015 issue, suggests that patients choose a hospital carefully, invite doctors to sit down and talk, write things down, and bring along a trusted ally to help. I asked Consumer Reports about the survey’s methodology, with the positives being that it was a national representative sample with a high confidence level. The negatives that I can determine (without seeing the actual survey instrument that I asked for) are that patients self-reported whether an error occurred and nothing was mentioned about error significance (getting a daily aspirin an hour late might be reported as a medical error by some patients). Interesting but not surprising to me is that all of the lowest-safety, lowest-respect hospitals (listed above) are in big metro areas, with a heavy Chicago representation. As I always say, go to a big academic medical center if you require tricky diagnosis or surgery; otherwise, a mid-sized community hospital that does a lot of whatever you need is your best bet.

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The latest article in the New York Times series “Paying Till It Hurts” reviews the cost of diagnostic tests, which it describes as “what liquor is to the hospitality industry: a profit center with large and often arbitrary markups.” Example: an outpatient EKG done by a community hospital’s technician took 30 minutes and was billed at $5,500, while the same test performed by a Harvard hospital and cardiologist over 1.5 hours was billed at only $1,400 (the article should have mentioned what the graph shows, that Medicare didn’t pay the funny money in either case, instead reimbursing around $400 for each). Eric Topol, MD summarizes the economic incentive as, “At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart.”

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The bonds of 109-bed Mayers Memorial Hospital District (CA) are downgraded, primarily because of EHR-related capital expenses and resulting lower cash collections. The hospital, which implemented McKesson Paragon, is down to 3.5 days of cash on hand.

A New Zealand coroner warns doctors to pay attention to the clinical warnings generated by their EHRs after ruling that a patient died after his doctor prescribed quinine inappropriately. The coroner also noted that hospital records aren’t available to physician practices.

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In England, a lead nurse in an endoscopy unit hangs himself after expressing concerns about staff shortages and the introduction of a new hospital computer system that was causing a patient backlog, forcing him to work 80 hours per week.

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Also in England, doctors at Royal Free Hospital warn that patients are being endangered by its implementation of the OpenText document management system that has created scanning backlog, causing patients to arrive for new visits while their paper records are still piled up in a scanning contractor’s warehouse. The hospital was bragging just a few months ago about the problems that OpenText solved in sending scanned records to its Cerner EPR system.

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Duke University Health System (NC) hospitalist Ricky Bloomfield, MD provides the remote chronic monitoring billing codes he mentioned at his mHealth Summit session on Apple HealthKit: the new E&M 99490 for  monthly chronic care management ($42.60 per month) that could be combined with CPT 99090 or 99091 to yield $99.52 per month. He warns that nobody has actually tried billing Medicare or any other insurer using these codes yet, so it’s a work in progress.

Only in America: the family of an Ohio inmate who raped and killed a woman who was 30 weeks pregnant sues just about everybody for his painful execution that was performed using the untested two-drug combination of midazolam and hydromorphone. Named in the lawsuit are the manufacturer of the drugs (Hospira) and their distributor (McKesson), companies the family says should have known would cause suffering. In an interesting twist, a prison guard says the inmate told him before he died that his attorney urged him to feign suffocation with a prearranged “thumbs up” signal as the injections were started in the hopes that the governor would stop the execution.

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Weird News Andy says, “They really do have skin in the game.” Scientists develop artificial skin for prosthetics that can feel warmth and other attributes. Or as WNA adds, “for Terminator v0.1.”


Sponsor Updates

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I invited sponsors to send photos of their holiday activities since I like to put faces with company names. The folks from Direct Consulting Associates providing shots of their company gathering.

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Employees of PerfectServe collected donations for the Florence Crittenton Agency in Tennessee, donating clothing and 10 suitcases for the agency’s “Wheels of Hope” campaign that allows children who arrive carrying their belongings in a trash bag to leave with their own suitcase.

  • Visage Imaging posts its “RSNA 2014: Visage’s Top Five.”
  • RazorInsights doubled its client base, increased revenue by 200 percent, and hired 80 new employees during 2014.
  • GetWellNetwork Ambulatory earns ONC-ACB 2014 Edition Modular EHR Certification. The company also announces that CEO Michael O’Neil will present at the 2014 HIMSS Middle East Integrated Health Innovations Conference this week. 
  • Nuance announces that KLAS rated it #1 for regulatory reporting in “Quality Management 2014: The Race Gets Closer.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 16, 2014 News 4 Comments

Morning Headlines 12/16/14

December 15, 2014 Headlines No Comments

Senate confirms Vivek Murthy as surgeon general

The Senate confirms Vivek Murthy, MD as the next US Surgeon General. Murthy previously worked as a Brigham and Women’s internal medicine physician.

The Antidote to Fragmented Health Care

A Harvard Business Review article describes the problems patients experience when receiving care in poorly coordinated health care systems and then calls for payment reform, a shift toward promoting wellness, and a universal EHR as key steps that could help the problem.

Personal Health Record Reach in the Veterans Health Administration: A Cross-Sectional Analysis

Researchers measuring the reach of the VA’s patient portal find that 19 percent of all veterans that receive healthcare from the VA had registered for the portal, 11 percent had refilled prescriptions via the portal, and two percent had sent secure messages to providers. However, the study also found that patients with certain mental disorders, a history of alcohol or drug abuse, or a history of stroke had lower rates of adoption.

Tennessee Governor Moves To Expand Medicaid Coverage

Tennessee Governor Bill Haslam will expand Medicaid coverage to low-income residents using federal funds made available through the Affordable Care Act. Tennessee is the third state to expand Medicaid coverage since last month’s midterm elections.

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December 15, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 12/15/14

December 15, 2014 Dr. Jayne No Comments

I wrote last week about a “Forbes Style File” piece that offered fashion tips for women presenting at and attending conferences. The topic has generated more comments and emails than anything I’ve written about in the last year, which in itself is an interesting commentary. Although to be fair, it’s a pretty slow time of the year for healthcare IT news.

I asked for readers who were attending the mHealth Summit to send their thoughts and observations. Cindy Wright, president of Thomas Wright Partners, offers her own take on the event.


MHealth Exhibitor Fashion to Go

I want to thank Dr. Jayne for adding a little additional fun to the mHealth Summit by sharing Forbes’ fashion advice column, written specifically for the mHealth Summit. It made me wonder why in the world Forbes is giving advice on how to build a wardrobe. Just for women, not men? And why this particular conference?

I attended last year and did not see any atrocities that might have provoked such a story, but found myself on high alert for any over the top offensive dress as I attended a number of really informative sessions and presentations. All presenters were very professional, and yes, dressed appropriately. Darn it.

However, being in the business of marketing and communications — which includes public relations — I concern myself with brands and images. Fortunately, I work with adults who mostly have good common sense and know how to dress themselves and even know where to go for help when in doubt of appropriateness. I am not so much concerned with choice of kitten heels or flats, but how you and your company might best reflect your brand.

Being the good marketing professional and huntress that I am, I spent some quality time in the exhibit hall visiting with business owners and hard-working entrepreneurs. Among the large hall of exhibitors, I did find a number of really creative dressers who stood out among the crowd. They were great representatives of their brand. Fun and engaging. Confident in their lively attire. Most importantly, they drew me to them and were engaging. So important, especially if you are new to the arena and maybe even a startup. Oh yeah, and these fashionistas did not follow the rules brought to you by the good people at Forbes.

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Men in Kilts traveled "across the pond" from Nugensis to share their "views" that improve patient care. The clan of four offered Scotch whisky and fun demos for takers.

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Dapper European Milan Steskal, proud founder and COO of Mentegram, punches up his gray pinstripe suit with a blast of orange, picking up the color palette in company brand. His app helps keep mental health patients connected with professionals and support team and so much more.

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Mother and daughter team Glenda and Brittany Gerald, co-founders of MobiDox Health Technologies, not only engage patients in disease management and drug safety, but also engage attendees having fun with coordinated outfits that reflect their business offerings. Where do you find a dress that looks like a keyboard or pharmaceuticals? Not just anyone can pull this off and yet Brittany does while mom plays it cool Chanel style.


Thanks again to Cindy for sharing her thoughts. I hope to spend some time with her stalking the halls at HIMSS. It will be interesting to get a professional opinion on what hits the runway (ahem, trade show floor) in Chicago.

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From Met My Match: “So clearly the issue here is inappropriate dress.” Thanks for steering us back to a piece on the larger issue, which is that women speakers are “still few and far between” at conferences. The piece highlights a Rock Health exploration of the gender gap in speaker counts.

One reader commented on the original piece that, “A far more interesting topic is the dynamics of power in professional dress. The trainer can show up in jeans and t-shirts, but the trainees need to present a more polished look. How common is it to have different rules for the executive level? I’m curious how many of you see this power divide or double standard in your organizations.”

With regard to the trainer in jeans and a t-shirt, I think that has a lot more to do with organizational culture than it does with a true power divide. One of the vendors we work with has a very casual culture, which is reflected in its employees’ attire even when they go out to client sites. That’s been a problem for some of our offices and we have had to include a “dress code” request whenever staff comes on site. We don’t need them in suits, but a collared polo-type shirt is the minimum of our brand of business casual.

When we conducted our ambulatory rollout a decade ago, we were worried about members of the team having too much personal variation in dress and also wanted our staff to be easily recognizable when out in the practices. We bought each implementation team member polo shirts with our project logo on them, to be worn with the brown, black, or blue pants of their choice (no jeans). Although not cheap, it was money well spent as we didn’t have to deal with any dress code issues on the team. The biggest problem we had was being made fun of by our trainees, because it turned out that the particular shirts we picked out were also chosen by a local auto parts store.

Even looking at similar organizations, the dress code for similar job roles varies dramatically. While we get away with polos and khakis here, implementers at large medical group I visited in Texas wear dresses and heels every day (they are all women). While that may seem unusual to some, in their corporate culture if they showed up in anything less formal than that brand of business dress, they might lose respect. Who knows what would happen if they tried to show up in scrubs, which is what implementers at our hospital wear? They have a different color than any of the other staff members (who are categorized by color – nurses navy, techs blue, doctors green, etc.). They also wear safety green vests and look like a roadside hazard crew, but they’re definitely easy to find.

Looking at our corporate environment, I think the president of our medical group is perceived as too casual. He often wears open-collared shirts when most of our male physicians wear shirt and tie, if not a jacket also. He’s also not a physician, so it’s hard to tell whether dressing up a bit more would help him be more respected.

Most of the women in our corporate environment wear skirt suits or dresses. I personally prefer pants, and on one rare occasion when I did wear a dress, one of my analysts announced to the team that indeed Dr. J did actually have legs. The old adage about dressing for the job you want rather than the job you have is still out there, and when I see people that are too informally dressed for the situation, it always crosses my mind.

Thinking too much about wardrobe can sometimes backfire. I attended a vendor user group last year and they had decided to put the staff in more casual attire to try to appear more accessible to their clients. It was a calculated move and I felt bad for them when I overheard clients mentioning that they didn’t like it since most of the clients were wearing suits. I’m not sure the power dynamic worked in the right direction. Instead of feeling more powerful, some of the clients felt anxious or annoyed.

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We’ve all heard that “clothes make the (wo)man” and one of my favorite Broadway tunes (“My Strongest Suit” from “Aida”) is a great play on that. The number occurs at a point in the story when Princess Amneris realizes that she’s been groomed to focus her efforts on appearance when she has the skills to do more for the people around her.

As the year winds down and people go into a more thoughtful and potentially resolution-making state of mind, I challenge everyone to think about how appearance and dress influence our thoughts. What can we do to focus more on material, meaning, and message? And where can I find that pill-print dress? Email me.

Email Dr. Jayne.

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December 15, 2014 Dr. Jayne No Comments

HIStalk Interviews Peter Kuhn, CEO, Influence Health

December 15, 2014 Interviews No Comments

Peter Kuhn is CEO of Influence Health (formerly Medseek) of Birmingham, AL.

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Tell me about yourself and the company.

I was employee number three. I’ve been with the company since 1996. I’ve had a variety of roles — sales and marketing, product management — and became the CEO in 2008.

At Medseek, our original business model was essentially building physician- and hospital-based websites. Then as the web became more and more interactive in the early 2000s through 2005, the websites moved from online brochures to far more transactional-based websites, where we were connecting to a lot of different back-end systems, credentialing systems, call center software, HR-related software for job postings, etc. 

As the web evolved to being more personalized and more transactional, our business evolved from building those kinds of websites, but also building more customer-facing websites. Some of our earlier clients started building enterprise patient portals in 2004, so we could allow people to look at their lab results, message their doctor, and do an e-consultation with a physician. We’ve evolved as the marketplace and the demand for this kind of technology has evolved.

Most recently, in the last 10 years we’ve made a significant investment, more on the clinical side, through a couple of acquisitions that we’ve made. The most recent one being a year ago, where we acquired a population health management platform from a company called Symphony, a corporation up in Wisconsin. 

The new name Influence Health reflects a different company that’s doing what we think are very different things in the marketplace, although a lot of people claim to be in the space of population health these days.

 

I wanted to ask you about the Symphony Care acquisition and also the relationship with Sage Technologies, where you added a population health management capability. How are those technologies integrated and how are customers using them?

Sage is a great partner of ours. They offer an outsourced or managed solution for population health management. They will supply actual care managers to assist health systems and actually manage populations of patients. 

They’re using the Navigate product that we acquired from Symphony Care to make those people more efficient. They use it for analytics to identify who in a population would be low-rising and high-risk patients. Then we have a very specific platform that allows a care manager to perform very specific tasks on a daily or weekly basis, depending on how much attention those patients need.

Sage is using it in that way, and out in the marketplace, we’re getting a lot of traction with accountable care organizations and larger IPAs. Our traditional base of hospital customers are already starting to show a lot of interest in population health analytics, but also in the actual care management capabilities associated with the platform.

 

How would you distinguish the overlap and the differences between population health management versus customer relation management?

They’re blending together quite rapidly. Our larger, more sophisticated customers are starting to see that they need a holistic view, not just of their highest-risk patients or their rising-risk patients that are potentially going to cost them the most amount of money. They need to be able to manage and have a view of the entire patient population, including those that are healthy. 

One of the products that we offer is Predict, consumer analytics — a lot of hospitals call it CRM — where we can tell the hospital marketer at the household level who’s in the household, what the household income is. We can tell them what kind of insurance they have. We also build a behavioral profile of that household and predict for the hospital marketer the likelihood of their household leveraging specific service lines at their facility. It’s used for preventative care. 

Hospitals today that are still in the fee-for-service world use that to drive service line revenue. More and more, as our clients move into population health, they want to combine the capability of understanding what’s going on in their marketplace with their existing patients, but also prospective patients who might be in their ACO, along with very specific tools like care management platforms that allow them to reach out to those patients in an automated way. Something that marketers do quite well, but a lot of people on the clinical operations side don’t have a lot of experience with.

We have a combination of both. We have a CRM platform. We have a population health platform. We’ve combined those platforms so that a hospital marketer or a clinician that might be in charge of the care management program can have a complete view of the entire population, whether that be the rising-risk patients, the lowest-risk patients, or the highest-risk patients, something we think is pretty unique.

 

What are hospitals learning as they start to move into that role of establishing and maintaining a customer relationship versus just completing an episode of care?

[Laughs] Boy, how much time do you have? I think hospitals are learning that this is difficult. Switching from a fee-for-service world where they are responsible for their patient regardless if they are in one of their facilities or not takes a lot of mindset changing. A lot of operational changes.

We’ve been in the enterprise patient portal business for close to a decade. Just the basic interactions where a patient can now email a physician. Whether it’s a basic question, whether it’s an online consultation, whether it’s scheduling an appointment, these have created significant upheavals as it relates to clinician workflow. There’s a lot of anxiety around clinicians, some of it warranted and some of it being proven not to be so warranted.

Population health takes that to another level. How do you manage these patients across all these different settings where you may or may not control the technology in their doctor’s office? The physician may or may not be employed by you. How do you put true standards of care across all of those settings? It’s not just obviously companies like Influence Health that are providing solutions there. There’s a lot of dependencies on source system vendors, a lot of dependencies on the quality of data that’s in those source systems. 

People are learning that data is critical. Movement of data is critical. The ability to coordinate various groups across multiple specialties is critical. The ability to have the right platform partner that can sit on top of a lot of different systems and be good at extracting data out of those systems is another important function.

 

We’ve moved beyond the era where putting up a billboard was considered hospital marketing. Do you think hospitals or health systems will ever get as good as Amazon or even a grocery store chain at segmenting and engaging their potential customers?

We’re seeing a lot of our larger health system customers starting to hire chief experience officers, chief strategy officers, chief marketing officers, and chief innovation officers who come from outside of healthcare. Those people are applying a lot of experience that comes out of retail, travel, banking, and other industries that have figured this out. 

Healthcare’s got a long way to go. Everybody says healthcare is different and in a lot of ways it is. However, in the end, you still have a prospect, a qualified prospect, and a paying customer. 

There are companies like us that believe that leveraging traditional marketing techniques, leveraging marketing automation, leveraging CRM, leveraging multi-channel marketing across multiple channels like social, web, mobile, etc. that as these customers get more involved in their own healthcare because so much information is now available, that the ability for a hospital marketer and clinical operations –because we believe those two areas are going to have to come together to truly manage a full population — that the tools exist and you can create a highly individualized and personalized experience for these consumers that have come to expect it because we’ve been taught by other industries to expect it.

 

Where do you see the EHR fitting in among the technologies that are needed for success in a model that’s changing?

The EHR is obviously a critical component. There’s so much data that’s being collected inside of those tools. It’s critical for clinicians from a workflow standpoint, from a billing standpoint, to have these systems in place.

We also think it’s critical that in any kind of accountable care setting where there are multiple providers banding together to take care of a population of patients, there’s going to need to be a layer that sits on top of multiple EHRs. Where there’s an accountable care organization that’s being formed across multiple physician practices, we always find that there are multiple systems where patient data resides. It’s not just the clinical systems. It might be four or five different EMRs where we want to get a single patient identifier, a CCDA, or a set of claims data to get a holistic view of that patient, but there’s also data that’s sitting in the call center that’s highly relevant.

There’s data sitting based on these people visiting various websites of their credit profile in your website, and registering for an educational event, and they’re enrolled in a care program, and they’re enrolled in the patient portal, and they might have seen multiple physicians across multiple specialties. You need this holistic view of the patient that we don’t think the EHRs are architected to do today. 

What we’ve tried to do as a company over the last 15 years is architect our system where we get this holistic view of the patient, including data that’s sitting in these EHRs, but also data that’s sitting in a variety of other systems that the EHRs may not think about. Including device data, for example, being collected at the home. With all these wearable devices and blood pressure cuffs and Bluetooth weight scales, there’s a comprehensive set of data that’s being collected in the home that we think is very, very important to build that holistic profile of the patient. 

We’re architecting our systems to collect all of it. The EHR to us is one important component, but not the full picture.

 

A lot of health systems have exhausted their IT budgets and their IT capabilities buying EHRs and then chasing Meaningful Use money. Now they’re being asked to invest in analytics and customer-facing technologies. Will they be able to do that?

In a lot of ways, I don’t think they have a choice. I agree with you that Meaningful Use has driven some interesting buying behavior –  often very, very tactical — that has very little benefit to the patient besides giving them basic access to their data. But again, as I look at the leaders in healthcare, some of the larger IDNs or even the large single-hospital systems that we have as customers, they often get well beyond Meaningful Use at this point in time.

The Meaningful Use dollars are important to them, but perhaps they’ve launched a patient portal or maybe they’re got multiple patient portals. We see a lot of these systems reaching out, asking for deeper analytics, deeper engagement tools for their low-rising and high-risk patients. They’re asking for marketing automation tools where they can touch these patients on an automated way, but also in a personalized way on a regular basis across multiple channels, whether that be web, print, or targeted emails. If they’re a member of the patient portal, can we send them a personalized message?

I think as part of an IT spend, these kind of tools are going to be a cost of doing business over the next five years. Hospitals are going to have to reallocate money towards these kinds of tools in order to remain competitive in the new world.

 

What is the current state of patient portals and how are systems and providers in general using them or boosting participation among their patients?

We’ve got several customers that have already attested for Stage 2. They’ve been able to get the adoption. Quite a few of our customers have been able to attest successfully. 

I put patient portals in three different categories today. There’s the category of, "Let’s get speed to market," so I see a lot of folks just flipping on their EMR portals. They might have six or seven, and in some cases I’ve heard of eight different portals where a patient might have to register multiple times across multiple portals depending on whether they just had an inpatient visit or what specialty of physician they are visiting and what EMR is in place. Those folks want speed to market. They’re not very concerned about the overall customer experience. They just want to get their Meaningful Use dollars and they’re doing the bare minimum to check that box.

Another category would be folks that recognize that they’ve got a best-of-breed environment with multiple systems in place and have chosen to go down probably a harder part of deploying an enterprise patient portal, which might give that patient, if they have three or four EMRs in place, one logon. Again, we have a category of customers, even there, that are doing the bare minimum. They don’t want to do too much because operationally, it’s difficult, so they’re doing the bare minimum to achieve their Meaningful Use dollars.

Then we have clients that really want to change the entire customer experience. They want to create an experience that allows them to be differentiated. They want to use patient engagement as a competitive weapon in the marketplace against other facilities in order to create patient loyalty. We see customers doing that quite successfully as well, doing things like online consultations, real-time scheduling, deploying mobile applications that engage the patient in the way they’ve come to expect from banking, retail, and travel.

 

Where do you take the company from here?

Step One has been to integrate these technologies together. In the next two years, the marketplace for enterprise patient portals and care management are going to blend together. Hospitals are starting to realize that having a patient portal and a care management platform that are separate, that don’t engage the patient or the care team — and the care team is not just the clinicians, it might be supporting family members that are helping the patient in the post acute care environment — these two things have to blend to truly engage the patient in a cost-effective way. We see that over the next couple of years.

Our focus has been taking the acquisition and integrating that acquisition with our existing enterprise patient portal, but also integrating it with our CRM and marketing automation platform so that we can provide hospitals with an automated and cost-effective way to reach out and touch these patients. Our focus right now is around continuing to integrate the platform, because as I said earlier, we believe hospital marketers and clinical operations are going to need to cooperate tightly in order to engage an entire population. They’re going to need a comprehensive platform that includes marketing automation, CRM, enterprise patient engagement tools, and care management. We have all those pieces in place. Our job now is to integrate them and deliver them to our clients.

 

Do you have any final thoughts?

I really enjoy reading the blog. It’s a great source of information. 

We’ve got some very interesting times ahead of us over the next five years. Influence Health is excited to be in the middle of a fast-moving but exciting space where we think we can make a big difference.

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December 15, 2014 Interviews No Comments

Morning Headlines 12/15/14

December 15, 2014 News No Comments

Congress Moves on Federal Appropriations Bill

Congress passes the Omnibus spending bill that will fund the government through September 2015. The ICD-10 deadline survived intact, but the bill does impose limitations and more oversight on the DoD and VA as they work toward modernizing and integrating their EHR systems.

Federal defense contractors find a new profitable business: Obamacare

In the last decade, HHS has risen to the #3 contracting agency in the government, outspending NASA and the Department of Homeland Security, and drawing the interests of major defense contractors like Lockheed Martin, General Dynamics, and Northrop Grumman.

Tenet ends bid to acquire five Connecticut hospitals

Tenet walks away from its efforts to buy five hospitals in Connecticut after state officials set strict mandates governing staffing, services, and pricing as a condition of the acquisition.

Health Insurers Brace for Last-Minute Rush

Consumers who enrolled in healthcare over Healthcare.gov last year have until Monday at 11:59pm to change plans, or they will be automatically re-enrolled in their existing plan. Thus far, only 720,000 of the five million 2014 enrollees have returned to select a new plan, leading to some speculation that the site will see a surge of activity on Monday.

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December 15, 2014 News No Comments

Monday Morning Update 12/15/14

December 14, 2014 News 1 Comment

Top News

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The trillion-dollar FY15 Omnibus bill includes $32 billion for DoD health programs that includes its new EHR implementation and $4 billion for the VA’s IT program that allocates $344 million to modernize its EHR. ONC will get $60,367,000 of the $75,000,000 it requested, the same amount it was given in 2013 and 2014. ONC had planned to increase headcount from 185 to 191 FTEs in 2015, some of that most likely intended for launching its planned but not yet approved health IT safety center.


Reader Comments

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From George de Jungle: “Re: prescription information. I don’t like selling this data.” Drug companies are matching up “de-identified” (like that’s a foolproof method) prescription records with consumer website registrations to push targeted ads and to study physician prescribing behavior for marketing purposes. Example: Yahoo hires the medical information sales industry gorilla IMS to target ads to people who live in areas where specific medical conditions are common. None of this is new, of course – IMS and other companies have been doing similar work for years, but now have more (and more accurate) data to crunch. De-identifying data doesn’t earn anybody a dime except in avoiding HIPAA penalties, while re-identifying it through data matching is worth billions (guess which one IMS does?) HIPAA pre-dated the Internet and big data movements, having been around now for 18 years. While de-identifying patient data sounded swell back in those paper days, it is easily overcome by today’s sophisticated database techniques and widespread availability of electronic information. Americans make it worse when they squawk at how much they value privacy, but then voluntarily enter their most personal and valuable information to get access social networking or game sites without asking or caring how that information will be used. That leaves privacy as nothing more than an illusion held by people who aren’t aware of the degree of data plundering that’s done without their explicit knowledge or permission.


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MHealth Summit Review
By Plato’s Charge

  1. Keynotes. More vendor-agnostic than last year, no real revelations but a few anecdotes that didn’t suck. Grade: B+.
  2. Exhibit hall (aka leper hall). Yuck. Companies with a ‘q’ or ‘z’ in their name that all looked alike. Many were missing from last year having run out of money. Reminded me of India – a few wealthy power brokers like Qualcomm and the vast majority were small and poor. Grade: F.
  3. Breakout sessions. Panels were disorganized, lots of vendor pitches (some not too subtle, which was pure agony). Grade: D.
  4. Overall, what was missing was users of these great technologies, methods (geez, wonder why?), and sessions focusing on what is needed (it’s reimbursement and credentialing, stupid). The reimbursement session was packed, but it sort of sucked. Overall conference grade: D+.

HIStalk Announcements and Requests

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More than half of the respondents to my poll aren’t thrilled by going to work Monday mornings. The comments left suggest that major determinants are the quality of co-workers and the degree of direct contribution to a worthwhile mission. New poll to your right or here: what should ONC’s top priority be over the next few years? Your comments would of course add embellishment to your rather stark vote.

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The first book of “CIO Unplugged” contributor Ed Marx has been released and we’re holding a virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy” this Thursday, December 18 at 1:00 p.m. Eastern. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.


Last Week’s Most Interesting News

  • An Experian data breach forecast for 2015 warns that healthcare organizations will continue to be a major target.
  • ONC issues its strategic plan for 2015-2020 that calls for moving from EHR adoption to information sharing.
  • Alberta, Canada begins its search for a new EHR after an auditor’s report finds that the $260 million it already spent encouraged implementation of a larger number of systems that don’t talk to each other.
  • Several dozen hospitals in Australia go to downtime after a storage controller software upgrade in a central data center fails.

Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Ireland-based patient engagement vendor Oneview Healthcare raises $7 million to expand its presence in North America, where it hopes to win nine new contracts (along with six new customers in Australia) in 2015.


Sales

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In England, NHS chooses IBM for its new Electronic Staff Record HR/payroll system, replacing the incumbent McKesson in a contract worth up to $600 million. The Oracle-powered McKesson system is one of the largest IT implementations in the world.


Government and Politics

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OSHA orders Computer Sciences Corporation to pay back wages to two former nuclear power plant employees who were fired after reporting that the company’s EHR didn’t accurately track medical restrictions. CSC owned the occupational safety and health provider the power plant used.

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A Kaiser Health News story called “Federal defense contractors find a new profitable business: Obamacare” notes that HHS’s business purchases doubled to $21 billion in the last decade and are rising, making it the #3 contracting agency, beating out NASA, Homeland Security, and the combined spending of Departments of Justice, Transportation, Treasury, and Agriculture.

A behavioral non-profit in Alaska will pay $150,000 to settle an OCR HIPAA investigation that concluded that desktop PC malware allowed a breach involving the information of 2,500 people. The organization also committed two unpardonable OCR sins: it didn’t conduct a risk assessment and hadn’t updated its security policies and procedures in years (and wasn’t really following its existing ones, either).

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Jack Stick, chief counsel of the Texas Health and Human Services Commission, resigns following an investigation into his direction of $110 million in no-bid Medicaid fraud software contracts to 21CT, a defense contractor he favored for unstated reasons. In one case Stick convinced state contract managers to take a data warehouse contract away from Truven Health Analytics and give it to 21CT instead. The Austin-based 21CT had zero experience with Medicaid; a former business associate of Stick is 21CT’s official lobbyist. The company’s $90 million contract expansion has been cancelled.


Other

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This week’s PostSecret contains two submissions that will give CIOs a chill, with #1 being entirely justified since IT apparently isn’t monitoring logs to detect employees who look at information for patients without having a need to know.

Tenet shelves its plan to buy five Connecticut hospitals when the state proposes saddling the for-profit operator with 47 restrictions on staffing, services, and pricing. Waterbury Hospital says selling out to a for-profit company was its only hope for survival, while the hospital’s unions and an advocacy group said Tenet’s unwillingness to agree to the state’s terms showed that the company’s primary interest was “to plunder Connecticut’s hospitals.”

Partners HealthCare (MA) loses $22 million in its most recent fiscal year after earning a $158 million profit last year, the first time it has lost money. Partners, the state’s highest-cost health system, took in $11 billion in revenue, but its Medicaid insurance plan lost $110 million. Partners blamed the insurance loss on new patients, expensive drugs, and problems with the state’s health insurance exchange.

Weird News Andy calls this “Billing billing fraud.” A doctor whose last name is Billing faces fraud charges in Canada. WNA laments that the doctor’s first name isn’t William or that it didn’t happen across the border in Billings, MT, but he’s hoping that his item gets Monday’s top billing.


Sponsor Updates

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  • The employee-funded charity of Cornerstone Advisors donates $10,000 to the foundation supporting three-year-old Juan Carroll, Jr., who needs a liver transplant. The charity will also support Campbell County Healthcare, La Rabida Children’s Hospital, and Crossroads Community Center with $1,000 donations.
  • Cumberland Consulting Group partner Dave Vreeland publishes “PHM: Coming Soon to Health Systems Everywhere” in CIO Connection.
  • Versus Technology announces that Microsoft’s Bill Crounse, MD will provide the keynote presentation at its user group meeting in Chicago May 11-13, 2015.
  • A Florida TV station profiles Sarasota-based Voalte.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 14, 2014 News 1 Comment

Morning Headlines 12/12/14

December 11, 2014 Headlines 1 Comment

Data Breach Industry Forecast

Experian publishes its annual “Data Breach Industry Forecast,” which lists a “persistent and growing threat of healthcare breaches” as one of the top security trends for 2015.

Data centre outage hits all Queensland hospitals

In Australia, 40 hospitals lose EHR access and are now running on downtime procedures after a routine upgrade caused memory issues that eventually took out the network’s SAN.

VA Hospital Project Grinds to a Halt Amid Budget Overruns

Construction on VA hospital being built in Denver is suspended after federal judges ruled that the VA was in breach of contract and that the project was $400 million over budget.

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News 12/12/14

December 11, 2014 News 3 Comments

Top News

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Experian’s 2015 “Data Breach Industry Forecast” says increased EHR adoption, lax security, and the popularity of wearables will make healthcare an attractive target, although as in all industries the biggest security threat involves an organization’s own employees. The report also says that cloud-based user credentials are increasingly attractive to hackers, with a Twitter login being worth more on the black market than a credit card number.


Reader Comments

From Bimbo Ears at DOH Pa: “Re: Pennsylvania physician licenses. The Licensing Bureau deployed defective software that lost renewal documents for doctors, affecting hundreds if not thousands of doctors whose licenses expire 12/31/2014. The vendor is System Automation, which claims on its website to make government more efficient.” Unverified. I didn’t see anything mentioned.

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From Joey Cheesesteak: “Re: Dr. Michael Rosenberg of Health Decisions. Dies in a Maryland jet crash.” Michael Rosenberg, MD, MPH, CEO and founder of the Durham, NC-based contract research organization for drug and device companies Health Decisions, died when the business jet he was piloting crashed into a house in Gaithersburg, MD, killing all three occupants of the plane and a mother and two young sons who lived in the house.

From Ink-Stained Wretch: “Re: Epic’s Judy Faulkner. She never does interviews, but came out of her cloister to speak with VentureBeat and attempt to debunk a critical New York Times story. Perhaps Epic is feeling pressure from the Hill, where Epic is widely blamed for the perceived failure of EHR stimulus and is associated with the unpopular Obama.” Keeping a low profile (or declining all media contact) is great until there’s a PR problem. It appears that Epic is worried about being perceived as an uncooperative vendor of closed systems, especially with the Department of Defense’s EHR bid on the line. I’m guessing the VentureBeat “interview” with Judy was actually a quick email response since only a few sentences were quoted. VentureBeat isn’t the ideal platform for convincing either the industry or the federal government that a New York Times article was unfair or inaccurate, but odd publications seem to get through to Judy every now and then to get a couple of sound bites in the form of a quick denial of statements made in other publications.

From Dr. Herzenstube: “Re: new federal health IT strategic plan. It’s actually a pretty quick read at only 28 pages and a bit less platitudinous than one might expect. One item of particular note is the prominent acknowledgement by ONC that the potential safety hazards of HIT need to be better understood and addressed. Among the high-level objectives for the five-year period is, ‘Increase user and market confidence in the safety and safe use of health IT products, systems, and services.’ The document notes, ‘Evidence suggests health IT improves patient safety; however, health IT products can also lead to medication errors and other adverse outcomes. Additionally, poor implementation or improper use of otherwise safe systems can also lead to adverse outcomes. Clinical and other health providers and individuals must be able to rely on health IT systems to perform safely.” The optimist in me appreciates ONC’s recognition that the federal government’s healthcare IT bailout program has had both positive and negative effects on patients. The cynic in me wonders if this isn’t a pitch for ONC to save itself from irrelevance by elbowing its way into the health IT safety business via its self-proposed Health IT Safety Center, which Congress seems unwilling to support financially or otherwise.

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From ICD Lay No More: “Re: ICD-10. Someone started a petition on the White House website to “Implement ICD-10-CM/PCS on October 1, 2015 – no further delays.” The signature count so far is 239.


HIStalk Announcements and Requests

This week on HIStalk Connect: Happtique, a digital health startup that spent several years working to bring legitimacy to the mHealth market through its app certification program, is acquired by SocialWellth for an undisclosed sum. Doximity, the LinkedIn for doctors, hits 400,000 users, meaning that it has now penetrated more than 50 percent of the US physician population. Walgreens announces that it will partner with MDLive to begin offering telehealth visits through its digital health app. 

This week on HIStalk Practice: Health First selects PatientKeeper software. Allscripts inks an ePA deal with Express Scripts. Tandigm Health goes with Lumeris population health tech services. Johnson County Mental Health Center connects to the Kansas HIE. Wearables finally make it to the ear. Survey results highlight HIPAA’s education problem. Thanks for reading.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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McKesson launches a strategic venture capital investment fund that will take minority positions in early- and growth-stage companies, with rumored investment totals in the hundreds of millions of dollars range.

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Diagnostic device vendor Welch Allyn acquires the assets of Omaha, NE-based remote vital signs monitoring technology vendor HealthInterlink, saying it will offer US customers the FDA-cleared mHealth solution.

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Streamline Health reports Q3 results: revenue up 2 percent, EPS –$0.14 vs. –$0.50, missing analyst expectations for both. Above is the one-year share price chart of STRM (blue, down 40 percent) vs. the Nasdaq (red, up 19 percent).

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Madison, WI-based health IT incubator 100health, announced less than a year ago, shuts down, with the former Epic employees who founded it refocusing their energy on one of its startups Redox, which is working on APIs to access EHR information. One of those founders, Niko Skievaski, says the incubator’s model of taking 5 percent equity in very early startups didn’t provide cash flow, questions arose about how investors would be repaid when companies exited, and the founders of the participating startups relied too much on the partners as day-to-day managers.

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SocialWellth acquires what’s left of Happtique from Greater New York Hospital Association. The highly hyped application certification service Happtique outlived its questionable usefulness a year ago when some of the apps it had approved were found to have ridiculously obvious security flaws (like storing PHI as plain text). SocialWellth offers “balanced living apps” that it describes as murkily and buzzword-heavily as possible in the hopes of sounding like it offers whatever a prospect might want to buy:

DIGITAL HEALTH ENABLEMENT TOOL KIT. Delivering Connected Consumers with Contextualized Experiences. As a leader in consumer and prescriptive digital health, SocialWellth enables payers, providers, and employers by delivering a wide spectrum of white label experiences and facilitating a connected experience between members and their payers. SocialWellth enables the curation of digital health experiences by leveraging mobile health technologies that allow for integration and aggregation of all digital assets, which improve the overall consumer experience.

Sales

Hartford HealthCare (CT) chooses RightCare’s assessment, referral, and care coordination software to reduce readmissions.

Cook Children’s Health Care System (TX) chooses Strata Decision for budgeting, capital planning, long-range financial planning, rolling forecasting, and reporting.

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Health First (FL) selects PatientKeeper charge capture, expecting to go live with 90 hospitalists in January with integration to its GE Healthcare systems.

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University of Vermont Medical Center (VT) will replace pagers with Imprivata Cortext secure communications.

Banner Health (AZ) chooses Craneware’s Chargemaster Corporate Toolkit.

Physician management services vendor Women’s Health USA chooses athenahealth’s EHR, revenue cycle, and patient engagement services for its 250 providers. The companies will also jointly offer their bundled services to other physicians.


People

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Jamie Coffin, PhD (Clarify Healthcare) is named CEO of ambulatory surgery software vendor SourceMedical.

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Eric Poon, MD, MPH (Boston Medical Center) is named chief health information officer of Duke Medicine (NC).

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MedAssets promotes Mike Nolte to president and COO.

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ADP AdvancedMD hires Arman Samani (Medhost) as CTO.

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MedSys Group appoints President Steven Heck as board chair, replacing Luther Nussbaum, who will remain on the board.

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Leidos Health names Steven Russell (Quantros) as SVP of sales and strategic accounts.

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Philip Loftus (Aurora Health Care) joins SSM Health (MO) as CIO.


Announcements and Implementations

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Allscripts announces its eAuth electronic prescription prior authorization module for Express Scripts patients.

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Summit Healthcare offers the Express Connect web services adapter, allowing its interoperability platform customers to connect to applications using universal standards such as HTTP, XML, SMIME, SOAP, and JSON.

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Health Catalyst announces its collaboration with Microsoft centered around the latter’s Analytics Platform Services.

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Microsoft profiles the use of its technologies for the volunteer cleft palate surgery missions of Operation Smile, including Windows 8-powered Asus tablets running a digital patient assessment system, Slainte Healthcare EMR, Office 365, and OneDrive for Business.

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Time names “The Ebola Fighters” as its Person of the Year.


Government and Politics

Federal judges shut down a billion-dollar VA hospital construction project in the Denver area after finding that the poorly planned and managed project is so over budget ($400 million or more) that the agency can’t pay for. It’s the fourth huge VA construction project that failed to hit budget and schedule targets. The VA’s contractor says it is owed $100 million and suggests letting the US Army Corps of Engineers replace the VA in managing the hospital’s completion.


Other

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The New Orleans newspaper features the recent HIMSS EMRAM Stage 7 accomplishment of Ochsner Medical Center – North Shore (LA), an Epic user.

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A Madison news site profiles Epic’s 122-member culinary team, whose head chef says he’s “never worked with a more talented group of cooks,” of which only five have left since he arrived in 2009. He’s planning the opening of a new 51,000 square foot dining hall in May that will require 42 new team members to operate. The chef says kitchen working conditions are family friendly and nearly all menu items are made from scratch. This is the most interesting factoid to me: 80 percent of employees eat on campus at subsidized prices, saving the company $450,000 per day in otherwise lost productivity. That’s not so great for area restaurants, but brilliant in terms of keeping salaried employees at their desks longer.

Up to 40 hospitals in Queensland, Australia go to downtime procedures when a data center storage controller software upgrade fails. Some systems were set up to fail over, but those that weren’t include an endoscopy system that’s used by 33 hospitals.

Minnesota state investigators blame a resident’s death on a “cheat sheet” that incorrectly indicated DNR (do not resuscitate) and missing code status in the EMR. An aide notified nurses when she found the man gasping, but the licensed practice nurses who responded did not attempt to revive him because of confusion about his DNR status.

I like Practice Fusion’s eight tips for maximizing patient engagement while using a computer in the exam room.

Weird News Andy titles this article “Disappearing Docs.” Federal investigators find that half of the Medicaid providers listed in its directory either don’t exist or aren’t taking new patients.

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A federal judge sanctions Aetna and its subsidiaries ActiveHealth Management and Medicity for the company’s response to a patent infringement lawsuit brought by HealthTrio. Aetna’s attorneys designated 90 percent of the 862,000 pages of information it submitted as viewable only by its own outside attorneys, which the judge declared to be “absurd.”

Guam Memorial Hospital says it received inadequate training for its October conversion to NTT Data’s financial system, causing the CFO to have an uncertain picture of the hospital’s financial situation. It’s asking the company to send people back on site for a month.

Orlando ophthalmologist Jack Parker, MD sues his office’s former medical software specialist (and former fiancee, who moved out of his mansion in September), demanding that she return her $60,000 engagement ring, $70,000 Porsche, and a dog he spent $3,500 to train. She responded, “It’s my stuff.”

Jordain Shlain, MD pens (or keyboards) a completely brilliant poem that sums up the practice of medicine over many centuries that could be turned into perfect music as in REM’s “It’s The End of the World as We Know It (And I Feel Fine)”. An excerpt:

Arrays of genomes enable our cancer fight
microbiomes, proteomes, IBM Watson enable high-def insight
to support people suffering, needing a human light.
to comfort and treat; a data-enabled line of sight.

Medicine is, has always been and will always be
a people business, predicated on humanity
In need of data and human support.
Not, as most data-gold diggers purport:
Medicine is a data business in need of people.


Sponsor Updates

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  • Medicomp is integrating Quippe and the MEDCIN Engine with the Soteria clinical management system of Infocare in South Africa. Above are Medicomp team members Jay Anders, MD (chief medical officer), Dan Gainer (CTO), Jason Valore (senior manager of solutions), and Dave Lareau (CEO) at the Cape of Good Hope.
  • Forward Health Group is designated as a “High Performing” vendor in a new KLAS report on population health performance, with a 100 percent “Would Buy Again” score and a top ranking in categories such as “Money’s Worth,” “Keeps Promises,” and “Ranked Client’s Best Vendor.”
  • SyTrue and nVoq will jointly market their respective smart data platform and speech recognition systems.
  • EDCO Health Information Solutions publishes a case study of the use by City of Hope National Medical Center (CA) of the company’s Solarity medical records scanning and indexing system, which is 50 percent faster than paper processing and adds HIM quality and productivity tracking.
  • Impact Advisors publishes an article titled “Population Health Management – Development a Roadmap.”
  • The HCI Group lists its “Top 10 Most Popular EHR Articles of 2014.”
  • The CoCENTRIX Coordinated Care Platform receives ONC-ACB EHR Complete 2014 Edition Certification.

EPtalk by Dr. Jayne

My inbox has been humming since this week’s Curbside Consult appeared. In addition to getting quite a few comments about the original Forbes piece, readers have had a lot to say about the overall idea of fashion advice for conference attendees and presenters.

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From Handbags Ta Di For: “Perhaps the mHealth ladies can purchase this ‘fussy’ purse. Space Cadet ?!?” Although it’s from Kate Spade, who is one of my favorites, it’s probably not going to make my holiday wish list.

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From Roy G. Biv: “Is it my imagination or are two of those accessories a stethoscope and doctor’s bag?” Not exactly. I think it’s a fussy necklace and a pretty big satchel. I’m pretty sure neither an otoscope nor an ophthalmoscope has ever seen the inside of that one.

From Mountain High: “There is a lot to be said on this topic beyond the presentation at a conference. Do people care about the dress of their provider? Do people look at their doctors and expect a certain amount of dress? Our hospital has banned ties for clinicians, which has resulted in a hodgepodge of male dress, and has almost completely eliminated dresses/skirts for clinical women as well, which has resulted in an army of khaki pants. Since nurses are still clad in scrubs, what is the expectation of your provider, should they wear their white coat? Many of ours are not donning the lab coats as they just don’t like them (and they come in three horrendous sizes unless you wish to buy, wash, and maintain your own). Currently my otherwise well-dressed partner is wearing a white muu-muu, as the sizes of lab coats run from men’s large to Andre the Giant XXXXXL.” A close friend of mine works at a prominent integrated health system that shall remain nameless. Several years ago they lived through “hosiery-gate,” which started with complaints about male physicians wearing loafers without socks. It ended up requiring “hosiery for all personnel.” She protested the idea that the hospital should dictate wardrobe to that degree by wearing various combinations of crazy socks with dresses so everyone could see them. Her patients know she’s a free spirit and got a kick out of it but the administration was not amused.

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From Mixed Marriage: “Can we please address the Dansko clog? There are now over 250 variations of them, from the basic black or brown, to the most artistic floral patterns. Does your hospital provide any shoe-cleaning service? Because it should. As an IT person, even though I limit my clinical area time to as little as possible, I still religiously clean and polish my shoes not to make them look good, but to eliminate bringing germs and hospital funk into my car and house. How many other people think that through?” If I’m going to wear clogs, my personal favorite is Medimex Plogs. They’re bleachable and you can even autoclave them, although I doubt my hospital would let me just throw them in. You do have to watch out, though, because some of them are vented on the sides, so if you’re going to be anywhere gooey, you need to wear shoe covers. They also have massaging nubbins on the inside which is great during a long shift in the ER.

From Selfish: “Dr. Jayne, I think you have it all wrong. Everyone knows the real reason that people – especially women – go to conferences is to network and be seen. It’s not about learning or selling or presenting. I mean, really, do people actually listen to all 55 minutes of a conference presentation? Of course not. While we are pretending to listen, we are really asking ourselves if the presenter’s hairstyle would look good on us or if we could pull off that color scarf. Everyone knows that what really matters is whether one’s eye shadow is coordinated with their belt. After all, we live in the world of Instagram, Facebook, and Match.com, where image is everything and where we spend hours a day just looking at pretty pictures. Don’t be fooled people: all those mHealth folks aren’t staring at their iPhones looking at medical apps – they’re checking Instagram to see how many likes they got for their latest selfie.”

I’m giving this reader the inaugural Jonathan Swift “Modest Proposal” award for using satire to make us think. For many attendees, networking is the only reason to go to a conference. Whether you’re looking for your next opportunity or wanting to solidify or renew business relationships, looking successful is a key part of the event. For those that are addicted to social media, it is taken to a whole new level. Of course HIMSS is the granddaddy of “see and be seen” events and I’m certainly no stranger to critiquing fashion, shoes, or booth attire at the show.

I’m still receiving feedback as I write this and have even received a special guest post photo essay straight from the halls of the mHealth Summit. Stay tuned for Monday’s Curbside Consult. You won’t want to miss it.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 11, 2014 News 3 Comments

Morning Headlines 12/11/14

December 10, 2014 Headlines No Comments

Congress reaches deal for $1.1 trillion U.S. spending bill

The omnibus spending bill making its way through Congress will not include an ICD-10 delay or Meaningful Use-related language. However, the bill does put stipulations on DoD and VA funding that requires both organizations to submit progress reports on their EHR integration efforts.

CMS reports rising Stage 2 attestations; CHIME says it’s not enough

CMS reports that 11,478 eligible providers and 840 eligible hospitals have attested to Meaningful Use Stage 2 thus far. CHIME quickly responded pointing out that the total stage 2 attestations represent just 35 percent of EHs and four percent of EPs. The deadline for hospitals to attest is December 31, while providers have until February 28.

Patients Increasingly Value Electronic Health Records, Eager for More Access and Features

A new survey measuring consumer interactions with health IT finds that online access to medical records has doubled from 26 percent in 2011 to 50 percent in 2014. 86 percent of the patients with online access to their medical records reported logging in at least once in the last year, while 55 percent report logging in more than three times per year.

Patient Engagement: Digital self-scheduling set to explode in healthcare over the next five years

An Accenture report finds that 77 percent of patients think that being able to book, cancel, and edit appointments online is important. The report predicts that by the end of 2019, 38 percent of appointments will be self-scheduled.

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December 10, 2014 Headlines No Comments

Readers Write: Automate Your Informed Consent Process: Lessons Learned from the Joan Rivers Tragedy

December 10, 2014 Readers Write 4 Comments

Automate Your Informed Consent Process: Lessons Learned from the Joan Rivers Tragedy
By Tim Kelly

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A number of errors have recently come to light in the investigation of the tragic death of Joan Rivers. The endoscopy clinic that treated the 81-year-old comedian was cited by the New York State Department of Health for numerous deficiencies, including failing to obtain informed consent for each procedure performed. Organizations should review the following processes and ensure that they are in place to avoid deficiencies such as those cited at Yorkville Endoscopy.

  • Append the consent to the electronic medical record at the time it is executed. A recent study published in JAMA Surgery found that signed consents were missing for 66 percent of patients at the time of surgery, resulting in delays for 14 percent of the cases. It is clear that Ms. Rivers agreed to a specific treatment when she presented at Yorkville Endoscopy on August 28. It also appears that the documentation of that consent may not have been adequate to address all aspects of the procedures that were ultimately attempted.
  • Ensure that the informed consent document states the exact procedure(s) or treatment(s) to be performed. Many hospital consents are one-size-fits-all consents or fill-in-the-blank consents. The former are of little value in verifying the patient’s understanding of the planned procedure if the document is reviewed retrospectively. The latter are frequently flawed by illegible handwriting or abbreviations. An analysis of the Rivers case suggests that consent may have been obtained for an esophagogastroduodenoscopy (EGD) but not the two nasolaryngoscopy procedures that may have resulted in complications that in turn may have contributed to her death. Automated systems can force the clear delineation of planned procedures while also documenting possible treatments and interventions that may be pursued intraoperatively.
  • Identify and confirm the providers who will perform the treatment or procedure. Many organizations employ electronic credentialing systems to identify which providers have privileges to perform certain procedures. Yorkville Endoscopy was cited for allowing a physician who was not privileged at the facility to participate in the treatment of Ms. Rivers. Automating the consent process, and integrating that process with a credentialing system, ensures that only providers authorized to perform the contemplated procedures are documented on the consent form. This practice can mitigate the potential for deviations involving non-credentialed providers.
  • Obtain the patient’s permission for observers and photography. It is vital to teaching organizations to allow for the presence of observers and sometimes the recording of surgical procedures. It is also essential that the patient give his or her permission to the presence of observers and use of photography. It appears in the Rivers case that unauthorized observers were present and unauthorized photographs were taken during the procedure. Automating documentation of consent, including allowance for observers, authorization for photography, preferred disposition of tissue samples, and similar permissions, allows for those preferences to be communicated to other HIT systems. This practice can help ensure that patients’ wishes are followed.
  • Leverage the consent in the time out. Yorkville Endoscopy was cited for not following an acceptable time out procedure. Review of the consent form immediately prior to the start of a surgical procedure is a key component of the Joint Commission’s Universal Protocol. Significantly, verification of informed consent documentation – documentation that lists the procedures and well as the surgical site – has been found to be the most effective mechanism for avoiding wrong person / wrong procedure / wrong site surgery.

It should be noted that informed consent documentation alone cannot correct all of procedural deficiencies that were identified by the Department of Health in the Joan Rivers case. However, a well-prepared, procedure-specific consent can serve as both a contract and a roadmap for how a procedure or course of treatment should be performed. When the consent process is facilitated electronically and that process is integrated with other HIT systems, including the EHR, the risk of deviations or errors may be minimized.

Many of the findings in the New York State Department of Health report were not that policies were lacking; it was determined that established policies were not followed. Automation, by its nature, helps ensure compliance with an organization’s policies and procedures.

An excellence policy on automating the informed consent process has been developed by the Department of Veterans Affairs.

Tim Kelly is director of marketing of Standard Register Healthcare of Dayton, OH.

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December 10, 2014 Readers Write 4 Comments

Readers Write: The Case for Smarter Clinical Workflows

December 10, 2014 Readers Write 2 Comments

The Case for Smarter Clinical Workflows
By Sean Kelly, MD

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The practice of evidence-based medicine can promote patient safety, increase quality of care, and improve clinical outcomes. Providers are increasingly being held accountable to abide by regulatory standards, Meaningful Use guidelines, and Centers for Medicare and Medicaid Services incentive and penalty programs.

The move toward measuring quality and patient safety as key performance indicators in healthcare makes sense, but accomplishing these goals relies in large part upon improving efficiency. Unfortunately, inefficiency is inherent in many of today’s clinical workflows, which detracts from the patient care process by bogging down providers and disrupting the care team’s collective thought process.

The answer is to implement technologies and processes to enable smarter clinical workflows that promote efficiency while also improving quality of care.

Take, for instance, clinical communication. As an emergency physician, I see firsthand the need for faster, more effective communications. If I am able to quickly receive information, share with colleagues and coordinate next steps, I can better care for patients. Unfortunately, relying on pagers and other outdated technologies creates barriers that can delay care and can have significant impact on patients, especially in critical care situations.

Consider a heart attack patient. It is essential that providers are able to diagnose and treat the patient as quickly as possible to ensure that no permanent damage occurs. In cases of ST elevation myocardial infarctions (STEMIs), streamlining clinical workflows to speed the time from door to balloon — the time from patient arrival to catheterization of the coronary arteries to alleviate the occlusion—can mean the difference between complete recovery and a life of struggling with congestive heart failure … or worse.

Cath lab activation is a coordinated effort which may involve many different care providers and care teams. This makes the workflows vulnerable to the negative impacts of inefficient communications. In this situation, invaluable time is potentially wasted from step to step, time that could substantially impact the patient outcome.

This scenario highlights the need for—and benefits of—a smarter clinical workflow. For example, if the care team could use secure communications solutions to send group messages to the care team, coordination and activation of the cath lab would be far more efficient. In this scenario, the smarter clinical workflow includes technology that allows:

  • Immediate, synchronous, bi-directional secure messaging with the ability to send high definition images to assist in rapid diagnosis and collaboration over best treatment option (resuscitate and open up the cath lab).
  • Direct integration into scheduling and on-call systems to facilitate tracking of team members, complete with read receipts, send receipts, and auditability to enable accurate, rapid messaging capabilities (ensure that the correct people are on call, aware they are on call, and rapidly respond when called, complete with escalation if any delays in response).
  • Group messaging capabilities to send code team activation directly to multiple devices so team members get alerted more quickly, simultaneously, and messages and responses are easily tracked and acted upon, instead of multiple pages (and waiting for callbacks).
  • Multi-site communication systems to allow the notification of other clinicians needed for complete care delivery, such as the patient’s primary care physician, specialist, or case manager, to provide notifications about the patient’s condition and follow-up instructions for care (which could also prevent unnecessary readmissions).

This is just one of many examples of how more efficient communication can impact the healthcare continuum. Giving physicians, nurses, and other care providers the tools to do their jobs more effectively can help hospitals meet quality and patient safety goals, support accountability, and most importantly, improve the overall quality of patient care.

Sean Kelly, MD is chief medical officer at Imprivata and emergency physician at Beth Israel Deaconess Medical Center in Boston.

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December 10, 2014 Readers Write 2 Comments

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