Recent Articles:

Monday Morning Update 7/25/16

July 24, 2016 News 2 Comments

Top News

image

University of Mississippi Medical Center (MS) will pay $2.75 million to settle HIPAA charges related to the 2013 theft of password-protected laptop by a visitor to the hospital’s medical ICU. OCR’s investigation uncovered the fact that entry of a generic WiFi username and password provided access to an unsecured Microsoft Access database that contained the information of 10,000 patients.

OCR concluded that UMMC’s “organizational deficiencies and insufficient institutional oversight” prevented it from undertaking risk management activities even though the hospital knew it was vulnerable. It also noted that the hospital did not perform the required patient notification following the laptop’s theft.


Reader Comments

image

image

From Sieve Crusher: “Re: US Digital Service. They’re actively recruiting. Experience in the EHR world is applicable to government work in many ways – long-time employees, legacy systems, and a culture of poor user interfaces. Silicon Valley experience isn’t needed – the government can use folks of talent. There’s also 18F, an earlier companion effort that allows remote work instead of relocation to DC, but they are backlogged with applicants.” It sounds pretty fun for someone without a family or already in the DC area since no relocation assistance is provided – it’s a one-year commitment with benefits provided and a casual work environment. Not everybody can say they spent time working for the White House.

From HER Auto Correct: “Re: article saying that EHR use decrease costs. I don’t believe it.” The 2014 article concludes that per-admission costs are 10 percent lower in hospitals that use advanced EHRs. I really dislike studies in which Database A is linked to Database B to reach a lofty conclusion implying causation vs. correlation. This is one of those. The authors sampled a 2009 inpatient treatment database and matched it up to the sometimes-accurate HIMSS Analytics database of what EHR each hospital uses. “Cost” was derived from applying the cost-to-charge ratio of each hospital to its billed charges, which is a pretty blunt measure of a hospital’s actual incremental cost, although it’s usually all we have to work with. There’s also the question of ensuring a representative sample of hospitals in all sizes and locations and selecting patients of similar complexity. All that aside, correlation is not causation and most hospitals are already using advanced EHRs, so I don’t see any practical application of the conclusions. A better study would have been to choose 10 hospitals that implemented EHRs and see how their individual costs changed afterward, although the huge problem persists in trying to factor out all other variables. One last observation: bias exists in even the topic of the study – do hospitals really expect to reduce costs by implementing EHRs? The fact that even the financially distressed hospitals don’t de-install them and go back to paper suggests a self-assessed positive ROI that may or may not be financial.


HIStalk Announcements and Requests

image

Poll respondents were evenly split on their opinion of the Affordable Care Act. Comments suggested that it worked fairly well if the goal was to people insured rather than to control costs or influence personal health choices. Mary C notes that ACA didn’t provide healthcare reform, only insurance reform, while Dave says insurance companies have had to resort to high-deductible plans to shield themselves from the unaddressed issue of cost control, although he also notes that individual patients benefited since ACA eliminated coverage denial of pre-existing conditions and lifetime limits. Most commenters noted that the “affordable” part is a misnomer since ACA policies cost a lot more with fewer choices and it’s just not possible to cover all of those newly insured people for the same cost, especially given that a lot of care involves expensive, late-stage interventions of limited value. HIT Project Manager boldly opines that Medicare and Medicaid should gradually phase out paying for treatment of chronic conditions that are caused by preventable behaviors, using EHRs to identify patients who ignore advice related to obesity and smoking and making them pay fully out of pocket for their treatments. Bill says just buying insurance for a bunch more people is running up the federal deficit without any evidence that quality or cost has improved. The most positive thread of commentary is that while ACA is a long way from perfect, it can be fine tuned over time.

New poll to your right or here: for those with a recent hospital visit: does the hospital allow you to electronically submit your own data into their records? I’m sure some hospitals provide a way to import wearable or questionnaire-type patient information to populate their EHRs, but I doubt it’s the 37 percent of them that a recent AHA survey found.

I was thinking as I reviewed the journal article above that I really bristle at using the word “reimbursement” to define payments to providers. You aren’t getting reimbursed – you are sending a bill and someone pays it. Especially if you run a private medical practice, a business no different than a auto body shop in expecting insurance companies to pay up.

image image

We bought a robotics kit and books for the North Carolina gifted class of Ms. S, who explains the photos above in describing how she put the materials to work immediately. “I gave the kids the option to participate in a district competition at the end of May, explaining that many students had a big head start on them — they had begun working last fall, whereas we had started months later. However, my students were willing to take on the challenge! They competed their work through a combination of quick understanding (impressive!) and teamwork. I’m pleased to say that the construction claw project won first place in the competition! All of my students said they enjoyed the experience and would like to participate in robotics again next year. That is wonderful news, especially from students who may not be able to attend robotics camps or programs outside of the school setting.”


Last Week’s Most Interesting News

  • ProPublica begins publishing the  letters OCR sends in summarizing and closing HIPAA complaints.
  • Philips acquires Wellcentive.
  • An HHS report to Congress identifies the lack of applicability of HIPAA to non-covered entities, such as app vendors, and outlines the non-HIPAA enforcement authority of the Federal Trade Commission.
  • ONC publishes an online tool that grades the interoperability readiness of a submitted C-CDA document.
  • The VA hires KLAS to provide an overview of the EHR vendor landscape.
  • AMIA cautions the FDA that EHR information is not necessarily of research quality, suggesting that it focus electronic data collection efforts on clinical data warehouses or HIEs.
  • Hacker The Dark Overlord posts for sale the digital assets of integration vendor PilotFish Technology and says he pushed an update to all of its clients that allowed him to steal their EHR information.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Louis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketchum, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.


Acquisitions, Funding, Business, and Stock

image

The newly formed Providence St. Joseph Health acquires doctor house call scheduling app vendor Medicast, which had previously raised $2 million but hasn’t had new funding in the past two years.

image

Athenahealth announces Q2 results: revenue up 17 percent, EPS $0.34 vs. $0.32, falling well short of expectations for both.  The company also announced that EVP/COO Ed Park will leave his position by the end of the year, but will likely join the company’s board. Park holds $2.3 million in stock after selling $2.2 million worth so far in 2016. ATHN shares dropped 9 percent Friday following the announcements, having shed 3.1 percent in the past year.

From the Athenahealth earnings call:

  • The company has converted 40 percent of its clients to AthenaClinicals Streamlined, with those clients averaging a 10 percent improvement in same-day encounter close rate. The company notes, however, that it is working closely with a “minority” of clients who liked their old workflow better and hints that it expects to take a short-term hit on its Net Promoter Score.
  • Eighty hospitals are using AthenaOne for hospitals.
  • The company launched AthenaInsight.com to share information collected from its user network.
  • The company admits that it’s not sure whether sales are tracking against target due to seasonality and a bottleneck in servicing inpatient demand, but also notes that the HITECH wave of “I need an EMR or I’ll be shot” is ending and that it has to adjust to the pre-HITECH world of developing by its own schedule rather than just hitting MU-driven functionality dates.
  • Athenahealth notes that its population health management product has provided “a lovely little tailwind on our growth” since it can work with Epic and Cerner and that has allowed the company to add those users back to its prospect list.
  • The company’s hospital win rate is 32 percent.
  • Jonathan Bush says the company made a “terrible operational miscalculation” when it started allowing senior support reps to travel to client sites to provide go-live support, which caused longer telephone hold times just as Streamlined was being rolled out.
  • Of the Streamlined rollout, Bush said, “Streamlined’s big mistake was that it was not an agile deployment. This was not, you get a skateboard, and then you put it back out with a handle on it, then you put it back out with a little motor on it, then you put it back out with sides, and eventually it’s a car. This was, take a skateboard, hide it, and show back up two years later with something you think will be a car, and all of the feedback that all of the customers would have had along the way comes raining down on you at once. So, we’ve had to do a lot of tuning of Streamlined once it came out of the garage. We will not be doing that kind of hide it away for years and then do a great reveal of something radically different any more in the future.”
  • Bush allowed Ed Park to summarize his career in ending the earnings call, introducing him as, “The man who brought me here, who made every theoretical PowerPoint promise I made either go away or turn into actual functioning reality at scale, Ed Park.”

People

image image

CTG CEO Cliff Bleustein, MD resigns “by mutual agreement” after 16 months on the job. He has been replaced by SVP/GM Bud Crumlish. I interviewed Bleustein two months ago. CTG shares are down 18.5 percent in the past year, giving the company a market value of $88 million.

image

Video visit vendor MDLive names Sanjay Patil, MD (Care Connectors) as EVP/GM of health systems strategy and transformation.


Announcements and Implementations

image

A new Peer60 report on cardiovascular information systems finds that hospitals expect their procedure volume to increase significantly, with the biggest driver by far being their addition of service lines, but also due to adding more providers, population growth, an aging population, and better insurance coverage. Epic and Philips are the most-recommended CVIS vendors, although nearly half of respondents say they are considering replacing their current system. Epic is the most-often considered new system by far, while McKesson is equally dominant as the vendor most likely to be displaced.   


Government and Politics

image

The Department of Justice charges the owner of 30 Miami-area skilled nursing and assisted living facilities with running a $1 billion Medicare fraud scheme, the largest healthcare fraud case in US history. Philip Esformes, who is also a noted philanthropist, is accused of placing patients in his facilities who didn’t quality for that level of care, then billing Medicare and Medicaid for medically unnecessary services. He and his two co-conspirators are also charged with taking kickbacks to refer those patients to community mental health centers and home care providers who also rendered medically unnecessary services. Esformes paid $15.4 million to settle charges of exactly the same thing 10 years ago, but was able to hide his identity until HHS-OIG and the FBI used advanced data analysis and forensic accounting to unravel his current operation. His father, Rabbi Morris Esformes, was charged with taking kickbacks in 2004 when he boosted his $4,000 investment in a pharmacy to $7 million in profit when its was sold two years later by sending the pharmacy all of the business from his Chicago nursing homes, which were also the subject of complaints about poor care that he attributed to anti-Jewish sentiment.

image

British Columbia’s health minister orders an immediate third-party review of Island Health’s $132 million Cerner implementation following physician complaints that the system is endangering patients and the switch back to paper of one hospital’s ICU and ED in one hospital nine weeks after go-live.

image

Acting CMS Administrator Andy Slavitt is apparently not impressed with the EHRs out there.


Privacy and Security

Laser & Dermatologic Surgery Center (MO) notifies 31,000 patients that their information was exposed when its computer systems are hit with ransomware. The clinic declined to pay and instead successfully restored its systems.

The health information of nearly everybody in Denmark was exposed last year when a state office mailed two unencrypted CDs that the post office instead delivered to a China-owned bank. The CDs contained the cancer, diabetes, and psychiatric information of 5.3 million people. The bank employee realized the postal service’s mistake and took the package to the intended recipient.

Police arrest two Florida paramedics who were fired after posting pictures of themselves in their ambulances with incapacitated patients, sometimes posing them in humiliating fashion in attempting to one-up each other.

It appears the Twitter account used by hacker The Dark Overlord has been deleted and he hasn’t been heard from in a few days. I don’t know what that means


Technology

image

Microsoft adds appointment-booking capability to Office 365, allowing users to choose the service they need, search for for available dates and times, and book the appointment from their PC or mobile device with confirmation and reminders to follow. Users can also cancel or reschedule their own appointments. Microsoft stuff doesn’t always catch on and I doubt this product would pass HIPAA muster, but otherwise it cold be interesting for healthcare.

image

The Gates Foundation creates Chronos, a tool to help grantees meet the foundation’s open access requirement that their research be published broadly and with unrestricted access and re-use, including the underlying data sets. The service will pay publisher article processing charges, check compliance with policies, and track the impact of publishing activity, all to allow grantees to focus on their research rather than the processing of publishing it.


Other

image

The Cleveland business paper covers MetroHealth’s use of 25 EHR scribes in its ED, which reports higher-quality and more timely documentation completion.

An editorial in the Lancet ponders the role of peer-reviewed medical journals in a publishing world turned upside down by the Internet, the endless quest for profitable eyeballs, and technology that “has transformed artisans into professionals.” It frets about open access journals, research misconduct, and the lack of reproducibility in many scientific studies.

The government of Indonesia arrests 23 people, including three doctors, after finding vials of vaccine that actually contained only sterile saline in 37 hospitals and clinics. An estimated 5,000 children have received fake vaccine, inciting parents to mob a Jakarta hospital and beat one of its doctors. The government caught one person who had adulterated vaccines years ago, but fined him only $100, and had not acted on vaccine manufacturer complaints of counterfeit products going back to 2011. The government vows to re-vaccinate millions of children at no charge and has established a vaccine distribution oversight group. 


Sponsor Updates

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 24, 2016 News 2 Comments

Morning Headlines 7/22/16

July 21, 2016 Headlines No Comments

The Secret Documents That Detail How Patients’ Privacy is Breached

ProPublica publishes 300 previously undisclosed warning letters that OCR sent to healthcare organizations found to be in violation if HIPAA in an effort to help the public “review details of these cases and track repeat offenders.”

Star Spangled Geeks

Backchannel profiles some early successes coming out of the US Digital Service, a group of Silicon Valley heavyweights recruited to help the government improve its technical infrastructure.

$42 Billion Saved in Medicare and Medicaid Primarily Through Prevention

A CMS blog describes how each dollar invested in Medicare fraud prevention programs returned $12.40 for taxpayers, resulting in a $42 billion savings over the past two years.

Chinese scientists to pioneer first human CRISPR trial

Next month, a team of researchers from China’s Sichuan University will begin administering a new treatment comprised of human cells modified using CRISPR-Cas9 gene-editing techniques to lung cancer patients that have not responded to conventional treatment.

View/Print Text Only View/Print Text Only
July 21, 2016 Headlines No Comments

News 7/22/16

July 21, 2016 News 4 Comments

Top News

image

ProPublica begins posting OCR’s “closure letters” indicating the resolution of HIPAA-related complaints, noting that most of the letters involve the VA and CVS Health.


Reader Comments

From Sharing CIO: “Re: Velocity Technology Solutions. My hospital was down also. They acknowledged a hardware failure that was exacerbated by human error, poor judgment, and a failed communication strategy. This is our second outage this year – the other one was Dell, who also had hardware failure combined with the fact that humans are not perfect.” More and more people are realizing that “cloud” is synonymous with “someone else’s data center” plus the hopes that a focused vendor will operate it better than they themselves. Most of the time that’s the case, but when things go wrong, the IT department is like end users in being stuck trying to get status updates, pestering the technicians who should be trying to restore systems rather than explaining why they’re down, and backseat driving the process.

From Stealers Wheel: “Re: my article. See this link!” I never know what to do when someone sends me the PDF of a book they’re working in, a LinkedIn article they wrote, or a link to a something they’ve written for a competing healthcare IT news site. I don’t really want to read someone else’s articles or using HIStalk to promote them, so I usually don’t reply because I know someone’s ego is involved.

image

From LinkedInGuy: “Re: Epic. An ex-Google VP disses it.” At least he’s assertive in his cluelessness in smugly dismissing the entire healthcare IT industry on the basis of a single screenshot he doesn’t consider pretty. He’s awfully proud of his former Google background (working on games and products I’ve never heard of), so perhaps he should consider the rousing failure of Google Health, or for that matter, the horrendously awful UI and user-unfriendliness of Gmail and Google Docs, which make most healthcare software look positively cool by comparison. He seems confused  by the screen shot that he found on the Web since “most docs” don’t use a single specific EHR and the screen he illustrates is not Epic –  it’s actually a 2011-era screenshot of the Chart Talk EHR, a minor EHR player. He probably felt well informed with his tweet, but anyone who knows healthcare would infer the opposite.

From Pointy Head: “Re: work-life balance. Shouldn’t you be willing to sacrifice early in your career for later payoff?” That’s reasonable as long as you realize that the payoff might never come. There’s also that point in your career where you have to accept the reality that your career altitude has reached its zenith unless you change employers or jobs. I once worked for a health system executive who gave rather blunt but accurate advice to director-level people that applies to most everyone: if you yearn to be a C-level executive and either (a) your employer has already passed you over; or (b) you’ve hit 40, adjust expectations accordingly or perhaps start your own business if you feel your potential has been overlooked. Right or wrong, people in their 40s and certainly 50s shouldn’t confuse the hamster wheel they’re on with a career ladder in thinking they’ll get called up to the big show since the odds aren’t great. Those are the folks I hate to see busting their humps thinking they’ll somehow be rewarded accordingly.


HIStalk Announcements and Requests

image image

We funded the DonorsChoose grant request of Ms. McMahon, who requested maker space materials for her North Carolina elementary school media center. She reports, “The STEAM activities in our media center have ignited the creative spirit in my students. They just can’t wait to show me what they have created and just love to have their creation up for display or to see their picture on our website or news program. I have noticed a great improvement in the children who were often discipline problems in the past. They are engaged and excited and just hate it when its time to leave. There is high time on task and with a few rules in place – they abide by them well so that they don’t lose the privilege of working in our Creation Stations!”

I’ve been busy un-following dozens of people on Facebook who keep droning their heartfelt but one-sided and sarcasm-heavy political commentary. I really, really wish for enhancements to Facebook and Twitter that would force users to categorize their emanations into “work,” “politics,” and “114 photos of my angelic child,” allowing me to focus on the limited segments of their thought stream that I care about instead of just muting them completely. Social media have dumbed a lot of people down in filtering the news and opinion they follow, making them believe that nearly everybody thinks like they do and emboldening them to react with vitriol and personal contempt when faced with the inevitable other side of the argument. It’s like modestly talented executives who mistake the butt-kissing of their carefully chosen yes-men underlings as confirmation of their inherent brilliance. Unfortunately, real life is beginning to more and more resemble high school.

This week on HIStalk Practice: NASA deploys telemed technology in deep-sea expedition. HHS announces $9 million in grants to help improve opioid-addiction treatment in primary care practices. AHIP points to telemedicine to help alleviate physician shortages in certain states. R-Health launches independent, physician-led ACO in Southeastern Pennsylvania. Consumer sentiment reaches underwhelming levels of outrage over latest HHS privacy/security report. Surprise, surprise: Physicians do have favorite patients (and they aren’t even the most compliant.)

This week on HIStalk Connect: 2bPrecise Chief Medical Officer Joel Diamond, MD shares his thoughts on the future of precision medicine.

Listening: Cloves, who is actually 19-year-old Australian singer-songwriter Kaity Dunstan. I would say that she reminds me a lot of Adele, other than the fact that my fastest reflex is hitting “scan” on the car radio when a song by the ubiquitous Adele comes on and I’d actually stick around for Cloves.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

Oncology precision medicine decision support vendor N-of-One raises $7 million in a Series B round, increasing its total to $11.7 million. CEO Christine Cournoyer used to be president and COO of Picis.

Theranos hires a chief compliance officer and VP for regulatory and quality, the former being McKesson assistant general counselor for regulatory law Dan Guggenheim.


Sales

image

Tampa General Hospital (FL) chooses LogicStream Health’s sepsis bundle and clinical process measurement to reduce central line-associated blood stream infection.

image

Adventist Health System chooses MModal’s transcription and front-end speech recognition for its 41 facilities, where it will also pilot MModal’s computer-assisted physician documentation system. .


People

image

Pharmacy kit restocking software vendor Kit Check hires Cameron Ferroni (What’s Next Consulting?) as chief product officer.

image

Solid state storage array vendor Pure Storage hires Vik Nagjee (Epic) as VP/CTO of global healthcare solutions. He helped develop Epic’s hosting business.


Announcements and Implementations

Cambia Health Solutions will merge its HealthSparq and SpendWell Health offerings under the HealthSparq name, offering users the ability to compare procedures and providers and then use SpendWell’s “buy now” technology to book appointments.

image

University of Pennsylvania Health System (PA) will build a 540,000 square foot, 18-story Center for Healthcare Technology in downtown Philadelphia, with Penn Medicine’s IT department being a major tenant.

image

Scotland’s Digital Health & Care Institute innovation center hires Scottish tennis star Andy Murray as its ambassador.

image

The PillPack pharmacy uses APIs from PokitDok (Pharmacy Plan and Pharmacy Formulary ) to help its Medicare customers understand drug coverage and co-pays.


Government and Politics

image

A fascinating article profiles the White House’s  US Digital Service, a group of mostly former Silicon Valley engineers that bypasses government red tape and contractors in saving taxpayers many times its $14 million annual budget by creatively solving IT problems that have long stymied federal IT lifers. It mentions Digital Service at VA (photo above), another skunkworks project that developed a new VA benefits appeals system, created a consolidated website at Vets.gov, and figured out a way for the VA and DoD to exchange scanned documents. Everybody loves the groups except fat cat IT contractors and the internal federal government bureaucracies that created the messes the kids are sent to clean up. I liked this passage about how the group broke the VA-DoD document logjam in just a few weeks:

They did not pick a toy task, but embarked on a challenge that had bedeviled the military for years. Unbelievably (except for in government), the DoD and VA use different systems for medical records, and the two systems get along just about as well as North and South Korea. Moving a medical history from one to the other — a pretty common task, since service people by definition become veterans upon discharge or retirement — could only be done by physically scanning the military records and sending files to the VA. But even that often failed, because the VA system was very finicky about file formats … “We had good people working on that, some of our best people,” says Secretary Carter. But they hadn’t cracked the problem, and indeed, hadn’t shipped anything for over a year. Nor were they thrilled at the idea of a bunch of hacker-types appearing in medias res. “At first the people who were working on the program were insulted at the suggestion they needed help,” admits Carter. “So some of them needed to be nicely helped to understand that was a good thing.”


Privacy and Security

A corporate payroll employee of the Phoenix-based Sprouts supermarket chain falls for a phishing scam in sending the 2015 W2 statements of all 20,000 employees in response to an email disguised to look as though it came from a company executive, with some employees already reporting that the scammers are trying to steal their IRS tax refunds.


Technology

BIDMC CIO John Halamka, MD touts third-party apps that layer on top of EHRs, listing three cloud-based systems BIDMC will deploy:

image

The Right Place (electronic referrals for moving inpatients to post-acute care facilities).

image

PatientPing (encounter notification).

image

Collective Medical Technologies (team communication for managing patients who are regularly seen in multiple settings, such as EDs).


Other

South Shore Hospital (MA), whose proposed acquisition by Partners HealthCare was nixed last year due to anti-trust concerns, tries to raise $222 million in donations to pay for a campus expansion ($62 million) and its Epic implementation ($160 million).

Four noted experts offer their ideas for fixing healthcare:

  • Change the all-or-nothing FDA review of drugs into a a Consumer Reports-type rating of safety, efficacy, and degree of available evidence and let physicians and patients decide how to use them.
  • Give patients control of their electronic information as a “consumer-mediated health information exchange.”
  • Improve drug competition by speeding up FDA approvals and holding drug companies responsible for cost effectiveness by putting them at risk for outcomes.
  • Publish provider performance and cost data similarly to how businesses publish standardized accounting reports.
  • Pay hospitals based on quality in a more consistent manner, incorporating patient-reported outcomes and collecting data electronically.

Sponsor Updates

  • Winthrop Resources creates a light-hearted video about its new offering, a financial service for IT infrastructure for healthcare data centers.
  • GetWellNetwork announces that 35 hospitals and clinicals implemented its Marbella mobile rounding and patient experience solution in the first six months of 2016.
  • ZeOmega integrates Forecast Health’s patient risk analytics into its Jiva population health management product, adding the capability to perform predictive modeling based on social determinants of health.
  • Optimum Healthcare IT is recognized as one of Northeast Florida’s fastest-growing companies.
  • The St. Louis Business Journal profiles TierPoint CEO Jerry Kent.
  • Valence Health will exhibit at the MAHP Summer Conference July 20-23 in Acme, MI.
  • Verisk Health publishes the latest edition of The Globe newsletter.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 21, 2016 News 4 Comments

EPtalk by Dr. Jayne 7/21/16

July 21, 2016 Dr. Jayne No Comments

clip_image002 

I’m always on the lookout for FDA alerts on drug recalls and other issues of interest to my clients. Usually those come as a “Dear Health Care Provider” letter and often involve contaminated biologicals, poorly compounded pharmaceuticals, or counterfeit prescription medications. This notice caught my eye, however, because it notified health care providers of hair loss, itching, and rash caused by a cosmetic product rather than a drug. Sometimes we forget that the FDA does more than approve prescription drugs, so this was a good reminder.

clip_image004

Although the majority of providers hanging around the typical physician lounge don’t have a working knowledge of MACRA or MIPS, those of us who are knee-deep in the transition to value-based care have some pretty detailed conversations. One of my colleagues has been in a discussion group about how Accountable Care Organizations submit their quality measures. I have to admit that I haven’t been deep into the ACO regulations, so I was surprised to learn that submission using the CMS Web Interface typically uses the first 284 Medicare patient encounters of the year. How do they even come up with a number like that?

The discussion group had been spurred by some kind of advertising piece targeting practices that see a lot of snowbirds, since those patients (who are often more physically and financially healthy than their peers) typically head south after the holidays. This could theoretically skew quality numbers in the less-temperate zones based on the demographics and clinical status of the remaining patients. Of course, depending on the size of the practice and the number of snowbirds, the skew could be negligible. But it makes one wonder about the rationale behind such an arbitrary number as well as taking the sample from the first encounters of the calendar year rather than as a random sampling. I’d be interested to hear opinions from those that know more about ACOs.

I’ve seen a definite shift in the scope of consulting requests that I’ve seen over the last couple of years. Where they used to be strongly flavored with the need to find an EHR, replace an EHR, or optimize an EHR, I’m not getting many of those these days. Most of my potential clients want help transforming their practices, either into a patient-centered medical home model or in helping with general office efficiency. One of the most common discussions I get into during these projects is the idea of panel size, or how many patients a primary care physician should have under their care.

When I first came into practice as a solo primary care physician, the hospital that sponsored me wanted to target a panel of 4,000 patients. That was partly based on the demographic of the area, knowing that many of my patients would be young and healthy and wouldn’t need more than one or two visits a year. However, since I was the only physician within a 10-mile radius taking new Medicaid patients, the ridiculousness of that panel size quickly became apparent as my schedule was loaded with patients who would come in 12 or more times per year. Helping clients determine what the right panel size for their providers is can be tricky, and I try to keep up with articles that address it.

One of the first things I look at the wait for a patient to get an appointment. Regardless of your panel size, if your patients can’t get in, you have too many patients (or not enough appointments – either way something isn’t right). I also look at provider scheduling habits and whether they run on time or double book and how they cope with that. If they’re getting through the day by double booking and praying for cancellations, it’s more likely to lead to burnout, employee dissatisfaction, and patient dissatisfaction. I also look at whether the practice is running using a care team model or whether they’re running as a more traditional physician-run practice.

Unfortunately, income goals tend to drive visit volume more often than other factors such as clinical quality or perceived workplace stress. I was recently wearing my EHR hat in a conversation with a practice management consultant whose opening comments to the physician asked how much she wanted to make per hour because that was going to drive patient volume and panel size. Although income is certainly a factor for most of us, I thought it was insulting to use that as the primary discussion point rather than asking the physician what kind of practice she wanted to have and how she saw herself and her team delivering care. My sense was that if this physician was about the money, she would have chosen something other than family medicine as a specialty, and leading with that aspect of practice management really put a damper on our ability to have a good discussion.

I came across an article this morning that addresses the concept of panel size as an issue in physician workforce planning. It addresses the idea that a panel size of 2,500 patients is often cited with little evidence to back it up. How far that is from my initial 4,000 patient target! The article goes on to look at practices that actively manage panel size (such as Kaiser Permanente and the VA) whose numbers are more in the 1,200 to 1,700 range. It also mentions that physicians in a “concierge or boutique” model care for between 900 and 1,000 patients, but my experience shows these to be even smaller – typically in the 500-600 range in the Midwest.

It’s no surprise that smaller panel sizes lead to reduced wait times and improved quality of care, as mentioned in the article. The trick is ensuring that primary care compensation allows smaller panel sizes so that physicians can truly get off the volume-driven hamster wheel. Compensation also has to allow for utilization of diverse clinical team members such as dieticians, social workers, care coordinators, and more, if that’s what our “value-based” system requires. I guarantee that if primary care physicians were compensated to the same degree that procedural subspecialists are (even if you adjust for years of training), you’d see people flocking to primary care.

We’re not there yet though – and we’re trying to use figures like $10 per member per month to drive change. It will be interesting to see what the next few years hold as we transition to new models of care and new models of payment.

What do you think about the transition to value-based care? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
July 21, 2016 Dr. Jayne No Comments

Morning Headlines 7/21/16

July 20, 2016 Headlines No Comments

Tackling Workers’ Mental Health, One Text at a Time

The Wall Street Journal notes the rise in companies offering their employees smartphone apps that allow them to find and receive mental health treatment, but also quotes those concerned about the potential privacy implications.

Failed merger doesn’t stop South Shore Hospital’s planned expansion

South Shore Hospital (MA), whose planned merger with Partners HealthCare failed last year after anti-trust objections, seeks $220 million in donations to cover $60 million in new construction costs and $160 million to implement Epic.

Philips to Expand Its Population Health Management Business with the Acquisition of Wellcentive

Royal Philips acquires population health management software vendor Wellcentive for undisclosed terms.

A Socio-technical Approach to Preventing, Mitigating, and Recovering from Ransomware Attacks

A new paper emphasizes user-focused strategies such as simulation and training.

View/Print Text Only View/Print Text Only
July 20, 2016 Headlines No Comments

Philips Acquires Wellcentive

July 20, 2016 News 5 Comments

image

Royal Philips announced this morning that it has acquired population health management software vendor Wellcentive. Terms were not disclosed.

Atlanta-based Wellcentive and its 115 employees has been placed within the Population Health Management group of Philips, which Wellcentive CEO Tom Zajac will lead.

Philips CEO Connected Care and Health Informatics CEO Jeroen Tas was quoted in the announcement as saying, “With this strategic acquisition, we will strengthen our Population Health Management business and its leadership, as health systems gradually shift from volume to value-based care, and provide more preventative and chronic care services outside of the hospital. Our sweet spot is at the point of care as we give consumers, patients, care teams, and clinicians the tools, such as remote monitoring solutions and therapy devices, to optimize care. Wellcentive’s solutions will provide our customers with the ability to collect data from large populations, detect patterns, assess risks, and then deploy care programs tailored to the needs of specific groups.”

I interviewed Wellcentive CEO Tom Zajac in August 2015.

View/Print Text Only View/Print Text Only
July 20, 2016 News 5 Comments

Morning Headlines 7/20/16

July 19, 2016 News No Comments

Examining Oversight of the Privacy & Security of Health Data Collected by Entities Not Regulated by HIPAA

An HHS report to Congress points out the lack of applicability of HIPAA privacy and security to non-covered entities such as app vendors, saying it will work with stakeholders to address gaps and adding that the FTC has some enforcement power.

Individuals’ Ability to Electronically Access Their Hospital Medical Records, Perform Key Tasks is Growing

An American Hospital Association survey finds that more than 80 percent of hospitals allow patients to view and download their medical record information, a significant jump since 2013.

How ‘digitizing you and me’ could revolutionize medicine. At least in theory

Eric Topol, MD of Scripps Research Institute defends the administration’s decision to give Scripps a $120 million precision medicine grant to collect and study the data of 1 million volunteers.

C-CDA Scorecard (Beta Release)

ONC creates an online tool that allows testing a C-CDA document to see how well it performs against certification criteria and advanced interoperability rules.

View/Print Text Only View/Print Text Only
July 19, 2016 News No Comments

News 7/20/16

July 19, 2016 News 3 Comments

Top News

image

A new HHS report prepared for Congress notes the obvious fact that non-covered entities such as wearable and app vendors are not regulated by HIPAA, a situation it calls “a gap in oversight” that people (including vendors) don’t always understand. That gap can’t be addressed by HHS since it has no power to regulate anyone other than covered entities.

The report suggests that the FTC identify best practices. It notes that FTC’s authority includes protecting consumers from possible relevant unfair or deceptive company practices such as not following their own privacy policies, failing to disclose how consumer information is used, or failing to secure the consumer information they collect.

It’s surprising to me how often knowledgeable industry insiders cry “HIPAA violation” when the party involved is clearly not a covered entity, such as when ESPN ran a photo of an NFL player’s medical records. Anyone can violate your privacy, but only a covered entity or their business associate can violate HIPAA.

The report notes that people who share their information with non-covered entities aren’t clearly protected by federal law. It also references the little-known FTC Health Breach Notification Rule that requires PHR vendors that are not covered entities to report breaches of their systems.


Reader Comments

From Lawson CIO: “Re: downtime. We experienced almost a week of downtime with our Lawson system running on Velocity Cloud starting July 1. It must have have hit many hospitals. How many others experienced it?” Affected readers using Velocity Technology Solutions are welcome to report. I reached out to the company but they declined to respond, saying they are contractually prohibited from disclosing information to anyone other than customers.

image

From Security Officer: “Re: The Dark Overlord’s most recent hack. The hacker gained access to a specific PilotFish dataset, but not for our environment. Do you have more information?” The Dark Overlord says he “used their [PilotFish’s] code to find exploits in all their clients … I signed a backdoor to get into their clients because I had access to their certificate signing. It got pushed out in an update a few weeks ago.” He also showed samples of the client EHR records he claims to have taken. The Dark Overlord has not previously overstated his accomplishments, so while there’s no proof so far that he breached every PilotFish client and took their PHI, I would operate under the assumption that he has and take action accordingly. I would expect his next move to be approaching those individual clients to demand payment since PilotFish turned down his demands. Confounding the issue is that some of PilotFish’s clients are HIEs and thus the information he claims to have stolen may have come from many providers, although maybe it cross-references a client table that he won’t bother linking to figure out the source.

image

From Kyle Smith: “Re: VA hiring KLAS to advise it on commercial EHRs. It was a sole-source selection, claiming that only KLAS can do the job. I’m sure KLAS loves the kind words, but this doesn’t really sound like an accurate reflection of the work of other folks in the industry.” What we taxpayers will get for our $160K VA payment to KLAS is a six-month membership and bringing in three KLAS people for four, half-day overview meetings. Apparently the VA thinks it needs KLAS to tell it to choose between Cerner and Epic. It is probably not realistic that they would just ask DoD how its Cerner implementation is going before deciding.

From Mr. Buyer Beware: “Re: Definitive Healthcare. For those using it as their hospital data source, they are doing automatic renewals, but they increase the price without notice. Thoughts, Mr. H?” I would have to see your agreement, but I would be surprised if it doesn’t include at least some provision for increases pegged to cost-of-living percentages or something like that. They can adjust the price however they want if the contract doesn’t name a fixed price for the agreement’s term, which then might be a good indication that you as a customer shouldn’t have signed it. Ditto the automatic renewal – if the contract doesn’t say it renews automatically, then you can refuse to pay assuming that you’re willing to stop using their services. Either way, it’s a nice courtesy (and good business) for a company let customers know about the new price well in advance so they can budget for it.

image

From Lifeline: “Re: taking time off from work. Like Dr. Jayne said, too many people associate their job with their identity and can’t give it up.” Job titles are like clothes – we hide behind them to prevent people from seeing us as we really are. When someone asks, “What do you do?” they are really asking, “Who are you?” with the assumption that your job defines your persona, and people often answer in that same mindset (especially executives who can’t bear the thought of not decisively differentiating themselves from us less-accomplished rabble). Folks who brag on being fully engaged in their jobs while on vacation have deathbed lessons to learn: (a) your employer and co-workers care much less about you than you think; (b) you are going to be devastated when you get fired or retire and realize all of that one-sided loyalty was misplaced as your work goes on without missing a beat in your absence; and (c) for the 99 percent of people who work at a particular job only because they need the money but would really rather be doing something else, spending more time working means spending less time living. It’s sad that people allow their identity to be subsumed into that of their employers in a form of self-enslavement. Employers have learned to maximize profits by swindling employees out of what should be their free time, now demanding their nearly undivided attention via an ankle bracelet posing as a smart phone and paying what seems like OK money for a job as long as you don’t do the per-hour math. We only think we’re immortal and the people crying graveside won’t be co-workers or customers (or in my case, readers). Welcome to the grand illusion.


HIStalk Announcements and Requests

image image

The DonorsChoose grant request of Ms. Hughes from South Carolina was simple: her fourth graders just needed dry erase boards and markers, which we provided. She reports, “The resources provide an easy way for the students to practice drawing models, pictures, and equations all of which are used to solve a variety of math problems. The students were so excited to see the new materials when they arrived. They kept going on about how nice it was of someone to give them to us!”


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

Cerner names its $4.45 billion, 10-building Kansas City office park that’s under construction the Innovations Campus. The first of 3,000 software engineers will move in next year, although the project won’t be finished for 10 years. The 4.7 million square foot complex — Cerner’s seventh campus outside its headquarters — was designed to house 16,000 workers. The company announced several campus design features:

  • A staircase whose metal perforations contain quotes from Cerner’s founders in binary code form (I assume one of them won’t be “Tick, tock.”)
  • A 100-person staircase “collaboratorium.”
  • A metal panel for each of the company’s 340 patents.
  • A 188-foot tall outdoor statue depicting DNA.

image

Sweden-based exercise and diet tracker Lifesum raises $10 million.


People

image

Alan Eisman (Information Builders) joins HBI Solutions as SVP of sales and business development.

image

Cerner hires Jeff Hurst (Florida Hospital) as SVP of RCM and president of RevWorks.

image

LifeImage names Janak Joshi (Deloitte) as CTO.

image

Santa Rosa Holdings promotes Tom Watford to CEO. He replaces company founder Rich Helppie, who will remain board chair. The company’s businesses include Santa Rosa Consulting, Santa Rosa Staffing, InfoPartners, and Fortified Health Solutions.

image

Gerald Greeley (Lahey Health) joins Signature Healthcare (MA) as CIO.

image

Janet Guptill (Tatum) joins the Scottsdale Institute as executive director. She replaces Shelli Williamson, who will become vice chair of the board.


Announcements and Implementations

image

In England, Wrightington, Wigan and Leigh NHS Foundation Trust  goes live on Allscripts Sunrise.

Catalyze earns HITRUST CSF certification for Amazon Web Services.

Meditech implements Access Passport for its internal electronic forms and signatures.


Government and Politics

The VA awards Leidos a prime T4NG contract in which 24 contractors are eligible to compete for $22 billion worth of IT services, network engineering, cybersecurity, and other IT work. Leidos was not included in the original list of 21 winners announced in March 2016.

image

An American Hospital Association survey finds that 92 percent of hospitals allow people to view their medical records online, up from 43 percent in 2013. The most widespread adoption of technology for patients is the ability for them to pay their bills online, which is offered by 74 percent of hospitals, and two-thirds of hospitals say patients can securely message providers.

A Health Affairs blog post notes that while insurers can’t be required to submit their claims to a state’s all-payer claims database, many still will do so, giving researchers a good-enough set of information. It also notes that there never was an “all” claims database since they don’t include services for which insurance wasn’t billed.

AMIA warns FDA that while most providers are using EHRs, their data is not necessarily of research quality. AMIA suggests that FDA focus its research data collection on data warehouses, whose information has been better standardized and encoded, as opposed to relying on EHR information that was intended primarily to support individual patient encounters.

image

ONC offers a C-CDA Scorecard that evaluates an electronically submitted C-CDA document in two ways: providing a pass/fail score to indicate whether it meets 2015 Edition Health IT Certification for Transitions of Care, and (b) issuing a letter grade indicating conformance with HL7’s advanced interoperability rules, which means the system’s vendor is more likely to be able to support interoperability.


Technology

Drug maker GlaxoSmithKline launches a mobility study of 300 rheumatoid arthritis patients using Apple’s ResearchKit.


Other

image

The San Francisco paper finds that UCSF Medical Center CEO Mark Laret earns an average of $556,000 each year from serving on the boards of two of the hospital’s vendors, Varian Medical Systems and Nuance Communications, who have paid him more than $5 million on top of his $1.6 million annual compensation from the hospital.

Eric Topol, MD answers tough questions about precision medicine and the $120 million in NIH grants his employer, Scripps Research Institute, has received to recruit volunteer study participants. He says about the idea of  addressing patient-specific health risks instead of sequencing their genomes,

Look, we’ve had all this risk factor and lifestyle knowledge for decades. Do we have everybody practicing a healthy lifestyle? No. I don’t want to diminish the importance of it, but a lot of people have the healthiest lifestyle in the world and they get struck by things like autoimmune diseases and Alzheimer’s.  It’s not either/or, but we need to take advantage of the fact that we can know so much about any given human being — what they are at risk for, or the environmental factor that’s causing the risk.

image

Kaiser Health News notes the upswing in micro-hospitals that offer EDs and primary care services but only a few inpatient beds. Sounds swell except they are usually built by big health systems trying to squeeze out competitors and bolster their bottom lines since companies that buy fancy medical equipment or build new buildings always find a way to create the demand to pay for them (not to mention the inherent inefficiency in staffing an always-open but potentially low volume building in the unfocused factory model). Walmart puts profit-boosting, scaled-down versions of their stores only where well-off people shop and hospitals are no different, so don’t expect to see mini-hospitals springing up in the downtrodden part of town. As one of my previous health system employers always said, we serve all, but market to few. As much as everyone likes to think it isn’t true, you won’t find the best hospitals and best doctors in poor or rural areas. Also true is that we’re all paying for those fancy health system buildings, the big salaries they hand out, and the enormous employee headcount that sucks up all the parking spaces for miles.

A report finds that 70 percent of physician assistants are working in specialties rather than primary care.

image

A drunk, off-duty NYPD officer is charged with running over four pedestrians, killing 21-year-old MIT student Drew Esquivel, who was also working on an EHR for underserved areas.

HIMSS is running a hospital CMIO’s video pitch that claims to answer the question of why being named EMRAM Stage 7 was valuable to the hospital. The answer: it let the hospital’s IT employees feel good about their accomplishments. In other words, the hospital received no value whatsoever except IT bragging rights, about which the locals who are footing the bill could not care less. Magazines and websites create a lot of vanity-driven contests and awards that providers puzzlingly don’t see as pointless.

image

Maine’s HHS typos the hotline number on the debit cards it gives to food stamp recipients, with the listed number actually ringing up a telephone sex line. Most surprising to me (beyond the fact that food stamps are now issued by debit card, which is a great fraud-tracking idea) is that such services still exist, although they apparently now charge directly via toll-free numbers instead of those 1-900 lines that funded a lot of late-night TV advertising in the 1990s.


Sponsor Updates

  • Bernoulli Enterprise is nominated for the Health 2.0 10-Year Global Retrospective Awards in the category of Tech Company.
  • Besler Consulting releases a new podcast, “Skyrocketing Costs and the Emergence of Rate Setting.”
  • CapsuleTech and Direct Consulting Associates will exhibit at MHealth + Telehealth World 2016 July 25-26 in Boston.
  • The local business paper features CoverMyMeds in a profile on startup jobs and spending.
  • Galen Healthcare Solutions publishes a new case study, “Critical Clinical Information Demystified with Database Training.”
  • Healthfinch joins the Matter community of healthcare entrepreneurs.
  • Meditech recaps its history in the acute care market in Canada.
  • Forbes interviews Healthgrades SVP and Head of Digital Mayur Gupta.
  • InstaMed publishes a new case study, “Pediatric Practice Automates 90 percent of Patient Payment Collections with InstaMed.”
  • Medecision CMO Ellen Donahue-Dalton joins the Women Business Leaders of the US Health Care Industry Foundation’s advisory board.
  • ITx honors Orion Health Product Strategist David Hay with the Excellence in Health Informatics award.
  • Patientco funds treatment for six patients through a partnership with Watsi.
  • The local business paper profiles the applicants for Cincinnati health commissioner, including Robyn Chatman of Sagacious Consultants.
  • Stella Technology announces its rebranding.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 19, 2016 News 3 Comments

Morning Headlines 7/19/16

July 18, 2016 Headlines No Comments

AMIA Sees Value, Complexity in Using EHRs for Clinical Investigations

The American Medical Informatics Association applauds the FDA’s interest in mining EHR data to advance clinical investigations, but warns “we strongly caution the FDA from assuming EHRs are readily configurable for clinical investigations, even among more advanced institutions.”

How ‘digitizing you and me’ could revolutionize medicine. At least in theory

In an interview with STAT, Eric Topol, MD discusses the administration’s Precision Medicine Initiative and the role he will play leading a $120 million project at Scripps Research Institute focused on recruiting, collecting, and analyzing health data from 350,000 volunteers.

An Insurer’s Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs

A Health Affairs study finds that a CVS Health-run care transition team offering medication reconciliation support to discharged patients reduced relative risk of readmission within 30 days of discharge by 50 percent, saving two dollars for every one dollar spent on the program.

Providence notifies 5,400 Oregon patients of records breach

Providence Health & Services (OR) notifies 5,400 patients that a former employee inappropriately accessed their medical records between 2012 and 2016. The employee has been fired, and the health system is reiterating that the employee used or shared the information.

View/Print Text Only View/Print Text Only
July 18, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 7/18/16

July 18, 2016 Dr. Jayne 6 Comments

clip_image002 

I recently spent a week off the grid. I have to say that it was one of the best things I’ve done with my time this year. Six nights in a tent will definitely give one a new perspective on things, especially when you’re used to being connected 24×7.

Most of my work lately involves being barraged with a continuous stream of issues that my clients feel are critical, but that often turn out to be blips in the grand scheme of things. I spend a lot of time talking people out of high-stress situations and putting together plans to mitigate potential disasters. That kind of work takes its toll on you after a while, so I was looking forward to my trip.

During my week away, the biggest plans I had to put together revolved around keeping the area clean of bear-preferred smellables and helping newbie campers get through the week. While some of my colleagues elected to do some hard-core rock climbing, trail building, and even a trip to the summit of a neighboring peak, I spent a good chunk of time watching clouds reshape as they came around the mountain and listening to the aspens quaking in the breeze.

I hiked to a couple of overlooks and just sat, doing nothing, until I was done. There was no time-boxed agenda, no deliverables, and no follow-up meeting planned. I enjoyed responding to the question of, “What did you do today?” with, “Hiked over there, then sat, then came back.”

While sitting quiet and still, I had some wild turkeys come within feet of me, pronounce me uninteresting, and go on their way. That’s definitely something to think about for those of us in high-pressure jobs who are used to being in the thick of things. Guess what? The rest of the animal universe doesn’t care who we are, what we do, or how many deals we’re closed this quarter. Nor do they care about the number of email messages accumulating back home or the number of meetings we’re missing. And maybe for our own human sanity, it would be better if we stopped caring so much too.

For the first couple of days, we had a couple of people obsessively checking their phones and trying to get a signal, hiking here and there to see if they could pick something up. None of them were trying to catch up on anything truly critical like a sick family member. They generally just couldn’t disconnect from work enough to enjoy where they were and who they were with.

I’m fortunate to have coverage I can trust when I’m out, but it takes a lot of work to get ready to leave and there’s always a mountain of work waiting when I get back. Not everyone has that level of trust with their coverage, but still, most of us would be better off if we could get back to being able to put it aside at least for a short period while we are away.

Many of the clients I work with offer to call in to meetings when they are on vacation. They’re so afraid of missing something at work that they miss the point of getting away. I’ve been known to resend invites and drop those people off so that they don’t have an excuse to put their vacation on hold. There are rarely meetings that are truly critical enough to abandon your R&R. But it’s hard to make those determinations when you don’t have perspective on what happens outside your circle of work.

Over the past year, I’ve watched my friends be laid off, reorganized, repositioned, reclassified, and generally run through the corporate wringer. I don’t think any of them wishes they’d been more loyal to their employers or that they’d have attended more meetings while they were supposed to be on vacation. Most of them wish they had worked less and had better balance, because even their best efforts didn’t make a difference in how things ended up.

It’s increasingly rare for people to spend their entire careers with a single employer, or even with two or three. As corporations churn and our industry evolves, people are constantly forced to reassess where they stand and whether they still want to be doing what they’re doing in a year, or three years, or even in a month. Being away from civilization definitely helps with that introspection, especially if you’re willing to give yourself over to the moment and watch what is happening around you.

The place where we camped had been involved in a forest fire in 2013. Since the fire hopscotched across the property, it spared certain features while destroying others. Sitting under untouched pines and looking at devastation 20 yards away reminds you that life is truly unpredictable and that if we think we have everything under control, we’re kidding ourselves. Out of the ashes of the fire, new plants are coming that haven’t been seen in years due to the overgrowth of certain species that the fire took out. It’s gratifying to see the new growth and wonder what things will look like in a decade, or two, or three.

I can’t say that my entire week was stress free. This was my first time having to deal with bear precautions, and although I was confident in my preparations, I wasn’t sure the people camping in the tents next to me were as diligent with their own. I was also keeping an eye out for altitude sickness and trying not to get sunburned while also having fun. There was a brief interlude involving a camp-style cooking contest, but if that was the most major stressor I faced, I’m good with that. And as an aside, mixed berry cobbler cooked in cast iron over charcoal doesn’t need high-altitude modifications (although the sheer amount of butter used might just have made any baking problems irrelevant).

Although it’s good to be sleeping in an actual bed again, I miss having deer surprise me on the way to get water every morning. I also miss having hummingbirds buzz me while I contemplate the mysteries of the universe. It was a great trip. We didn’t have any wildlife problems and I might have even returned home with a cooking prize.

What’s your strategy for getting off the grid? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
July 18, 2016 Dr. Jayne 6 Comments

Readers Write: ACO, Heal Thyself

July 18, 2016 Readers Write 3 Comments

ACO, Heal Thyself
By Stuart Hochron, MD, JD

image

I was recently asked to comment on the success (or lack thereof) of Accountable Care Organizations (ACO) and why I thought ACOs haven’t lived up to expectations and what additional incentives will be required for them to be successful – if, indeed, they ever will be.

The questions gave me pause. Certainly ACO performance to date has left much room for improvement. According to an analysis published by the Healthcare Financial Management Association, just over a quarter of ACOs were able to generate savings in an amount sufficient to make them eligible to receive a share of those savings.

But the implication that ACOs are biding their time until new incentives or perhaps a new business model emerges is alarming. This is not a situation where good things will necessarily come to those who wait.

I work with a number of ACOs, hospitals, and physician organizations. While I am not at liberty to share their financial performance data, I’ve distilled what I believe to be the best practices employed by those that will be successful.

It takes a platform

Fundamentally, ACOs require wide-scale patient-centric collaboration – that’s what underpins the hopes of achieving more-efficient, more-effective, less-wasteful, non-redundant care. But collaboration doesn’t just happen automatically, even when everyone on the team works in the same building. And for ACOs, comprised of multiple entities that don’t necessarily have any prior joint operating experience or relationship of any kind, the challenge is greater still.

Based on extensive discussions with healthcare executives and real-world performance analysis, it is clear that successful ACOs must make an investment in robust groupware tools, the kind that professional services organizations have had in place for decades to ensure that members of a distributed workforce can collaborate and coordinate as easily as if they were in next-door offices.

In the healthcare context, these tools will facilitate everything from patient scheduling to real-time sharing of PHI to charge capture and invoicing. Far beyond secure messaging, such platforms underpin the ACO’s activities, giving providers a common workspace for all manner of collaboration and ensuring that all providers across the care continuum are aware of and working towards a single set of organizational imperatives. The ACOs that don’t invest in the transformation – that try to piggyback on existing infrastructure – will ultimately find that their people don’t make the transformation either.

Patients at the center

All healthcare systems need to become more patient-centric and this is particularly true of ACOs, whose compensation, of course, is based on how successfully they treat (and, ideally, reduce the need to treat) patients. Thus, successful ACOs will make patient-centric collaboration and communication the centerpiece of an organization-wide operating system. 

Ideally, collaboration and communication won’t stop there. ACOs will implement population health initiatives by empowering patients, giving them the ability to take a more active role in keeping themselves healthy. This will be accomplished via tools such as mobile apps that enable people to access care services before they get sick and enable ACOs to reach out to the community, helping guide patients towards good lifestyle choices and, if they have received acute treatment, helping patients follow post-discharge instructions. So that same collaboration platform that will help care professionals work together better – it will need to extend seamlessly into the community as well.

Without aligned physicians, there’s no accountability

Technically, any organization that agrees to be “accountable for the quality, cost, and overall care of Medicare beneficiaries” can qualify under the definition of an ACO. But what all successful ACOs will have in common is tight alignment of physicians and care teams. I don’t simply mean financial alignment. Theoretically, all the physicians in an ACO are financially aligned. Nor do I just mean alignment around a patient.

True alignment means the physicians who form the core of the ACO understand the goals and priorities of the organization and feel invested in its success. Physicians make dozens of care decisions every day. They need to be making those decisions against the backdrop of the stated policies of the ACO. That requires being literally as well as figuratively connected to the organization, receiving regular communications such as educational materials, opinion, and thought leadership, being part of the daily give and take.

The financial incentives and disincentives under which ACOs operate change regularly, meaning the ACO’s organizational goals are updated all the time. The challenge is for providers to understand those incentives fully and to be able to adjust their practice methodologies and for that to happen on an organization-wide basis. Achieving and maintaining alignment requires an institution-wide collaboration platform. In a distributed entity such as an ACO, there’s no physician’s lounge. But with modern groupware, we can simulate one in a virtual environment and realize the same benefits.

Networks don’t build themselves

In my work with ACOs, one hurdle encountered by all is introducing and socializing the concept that the ACO establishes a new network of providers to which to refer cases. Intellectually it isn’t that hard to grasp. But as far as changing ingrained habits, that is much more of a challenge – not least because providers have no way of knowing which other providers are also members of the ACO, nor how effective any of those providers might be as physicians contributing to the stated financial goals (savings as well as revenues) of the ACO.

The only way to keep referrals within the organization – to combat the challenge of referral leakage, which will sink an otherwise effective ACO – is the ensure that every physician in the ACO is connected to a physician referral directory that lists all providers by specialty.For good measure, it will include a rating quantifying each provider’s service.

Improving clinical documentation

In the minutely quantified world of ACO financial performance, every dollar counts. The ACO’s income is based, in part, on costs saved, along with other metrics. As is well known, incomplete clinical documentation leads to tens of billions of dollars in disallowed reimbursements every year, a situation that only grows worse in a distributed organization such as an ACO. 

While we are imagining the infrastructure of the successful ACO of the future, let’s not neglect to include capabilities for crisply identifying and documenting treatments and procedures and thus enabling the medical billing professionals – who may have no physical or organizational connection to the care delivery professionals – to complete the paperwork correctly and maximize reimbursement revenue.

Conceptually, ACOs are the heart of the Affordable Care Act. Accountability – enforced by incentives and penalties – is central to our concept of how healthcare ought to work. If ACOs aren’t delivering on their promise, then that has ominous implications for the healthcare system overall. With the right communications infrastructure used as directed, ACOs can lead the way to the bright healthcare future we all want. Rather than stand on the sidelines as spectators, waiting for new incentives to come down from on high, ACOs can and must take action now.

Stuart Hochron, MD, JD is the chief medical officer of Uniphy Health of Minneapolis, MN.

View/Print Text Only View/Print Text Only
July 18, 2016 Readers Write 3 Comments

Morning Headlines 7/18/16

July 17, 2016 Headlines No Comments

HL7 firm hack compromised clients’ EHR records: The Dark Overlord

Hacker The Dark Overlord claims to have breached the servers of healthcare IT vendor PilotFish Technology and is selling access to the company’s database for $500,000.

Children’s hospital using ‘Pokemon Go’ to get patients out of bed

C.S. Mott Children’s Hospital (MI) is using Pokemon Go as a tool to get sick patients out of their rooms and interacting with staff members and other patients.

Jeremy Hunt remains as Health Secretary after earlier reports he’d been sacked

NHS Health Secretary Jeremy Hunt is reappointed to his position by incoming Prime Minister Theresa May.

Fancy amenities woo patients while insurers cry foul

Aetna sues 175-bed North Cypress Medical Center (TX) claiming the physician-owned hospital accepts no forms of insurance and instead charges all payers out-of-network rates while discounting the patient responsibility portion of the bill to in-network prices. A judge ultimately denied Aetna’s demand for $225 million in refunds.

View/Print Text Only View/Print Text Only
July 17, 2016 Headlines No Comments

Monday Morning Update 7/18/16

July 17, 2016 News 8 Comments

Top News

image

image

Hacker The Dark Overlord, who has breached at least three healthcare organizations and then listed their patient data for sale when they refused to pay him, advertises for sale the digital assets of a healthcare IT vendor that appears to be PilotFish Technology, which offers integration tools and middleware to several industries that include healthcare. He’s asking $500,000 for HL7 source code, signing keys, and a licensing database. He says he stole the information by gaining full root-level access to the company’s servers. The Dark Overlord listed the information for sale after the company declined to pay him the $500,000 to keep quiet.

image

The hacker says he has inserted a backdoor in PilotFish’s software that was pushed out in its most recent update and has since stolen the EHR records of all of the company’s customers.

Not only is PilotFish’s business at great risk, so is the information of its customers, among them Utah Health Information Network and the State of Connecticut. PilotFish launched its healthcare business in February 2014.

image

The Dark Overlord breaches systems using Remote Desktop Protocol exploits, so I’ll recommend again that everybody either secure it or shut it down. He also seems to prefer targeting SRS EHR clients. His latest round of tweets suggests that at least one of the providers he hacked paid him to keep quiet last week.


Reader Comments

From Sharon M: “Re; LabCorp. I’m surprised HIStalk did not cover the IT crash that affected five states. Are you so biased that you only print the favorable reports about HIT?” This comment comes from a frequent anti-EHR troll who assumes multiple identities in unsuccessfully trying to avoid being called out, which even without the technical clues would be obvious since 99 percent of readers complain that I’m too critical of health IT instead of accusing me of being a cheerleader for it. I haven’t seen any mention of LabCorp problems anywhere, so given that I did not personally have tests performed recently in those five states, I have zero information about any downtime and have received nothing from users (including the phony Sharon M). In other anti-technology news, a traffic light went out for an hour recently, so it’s time to replace all of those unreliable devices with stop signs.

From Lysander: “Re: redirects. Why do you redirect the link from HIStalk.com to HIStalk2.com? I know it was originally related to a hosting switch, although if I know your style, that inside joke might be part of the fun.” It’s been nearly 10 years since I switched from a proprietary-technology web host while temporarily running both sites to prevent readers from getting lost. That change isn’t easy to undo, I’ve learned. I had my web host look into it yet again Friday night after your inquiry and they messed things up a bit temporarily, plus the change would probably screw up links to years’ worth of articles. I’ll add that to my inside joke collection (along with smoking doctor logos) and the list of things I’m too lazy to worry about.

image

From Little Bit: “Re: mission and vision statements. I remember an academic medical center whose mission didn’t have one word about patients in it. There’s also an EHR vendor who talked a lot about their ‘Do Right’ principle, although I think they veered away from that one.” I’ve worked for executives who turfed off creation of mission and vision statements (they didn’t even understand the difference) to their underlings and it was a disaster. The back-stabbing, suck-up directors fought for attention in trying to distill a large, complex operation into a single overinflated, pithy sentence (it ended up with a lot of commas).  My takeaway: leaders without vision and character might as well have a crappy, eye-rolling vision statement that will be forgotten immediately because it’s not going to help anyway. My other takeaway is that committees are a poor substitute for leadership since they suck the life out of everything they do, and as such, should be limited to an advisory role to a clearly defined leader rather than to have actual power themselves. Give the buck a place to stop.


HIStalk Announcements and Requests

image

Three-quarters of poll respondents don’t think levying HIPAA fines improves privacy or security. New poll to your right or here: what is your overall opinion of the Affordable Care Act? You can’t just leave us hanging by voting without explaining, so click the poll’s Comments link afterward to elucidate.

image

Welcome to new HIStalk Platinum Sponsor Evariant. The Farmington, CT company offers enterprise-class CRM platforms for patients, consumers, and physicians that empower the marketing and physician relations teams of leading hospital networks. Evariant’s patient and consumer marketing CRM system drives targeted service line growth with attributable ROI, while its patient acquisition and engagement platform allows hospitals to target appropriate audiences for marketing as well as for education and wellness programs. Hospitals use its physician engagement technology to track referral patterns and physician loyalty in designing effective physician outreach activities. The company offers a free e-book titled “Creating Extended 360° Patient and Physician Views with Big Data Analytics.” Client success stories include Orlando Health, Wake Forest Baptist Health, University of Chicago Medicine, and Dignity Health. Thanks to Evariant for supporting HIStalk.

I found this Evariant client testimonial from University of Chicago Medicine on YouTube.

image image

Mrs. Roepke in Missouri had never had a DonorsChoose grant request fully funded until we provided her elementary school class with interactive math stations. She says her students cheered when they opened the box and saw the electronic flashcards and are using the many tools that were included in their small group work, to the point that they even refer to the game while working in other groups, which she calls “a proud teacher moment.”

I’ve realized what I hate about the phrase “pop health,” other than the fact that it’s an annoying shorthand for “population health,” which in this industry is invariably misused in describing “population health management” or “population health management technology,” which are entirely different things. Reporters and bloggers who bandy the term about from their cheap seats in their unwillingness to enunciate the daunting four syllables of “population” haven’t earned the right to lapse into jargon. Just like it’s insulting to Marines when people who have never served in the military shout out “Semper Fi.”

Listening: the almost-new album of one of my favorite bands, the highly listenable and brilliant Nada Surf, whose stock in trade is thoughtful lyrics, sweet harmonies, and ragged independence. Their catchy, sometimes jangly power-pop is hard to beat and they exhibit the maturity of a band whose lineup hasn’t changed in nearly 25 years. I’m offsetting that with the hard-rocking operatic Finnish metal of Nightwish, who I didn’t realize has commendably added the incomparable Floor Jansen (After Forever) as lead singer.


Last Week’s Most Interesting News

  • The VA takes more Congressional heat for lack of DoD interoperability and hints harder at replacing VistA with commercially available software in a Senate Appropriations Committee hearing.
  • A survey finds that most doctors haven’t heard of MACRA and hate the idea of tying their income to their quality.
  • OHSU pays $2.7 million to settle two HIPAA charges involving only 7,000 patients in incidents involving a stolen laptop and residents using Google Docs to store patient information.
  • Imprivata and Valence Health are acquired.
  • HHS issues ransomware guidance in declaring that a reportable HIPAA breach has occurred any time PHI is encrypted by malware.
  • CMS levies a death sentence on lab processor Theranos, banning Elizabeth Holmes from clinical laboratory ownership for two years and halting Medicare and Medicaid payments to the company.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

GE Healthcare’s management consulting group signs a five-year collaboration agreement with ThoughtWire, which offers machine intelligence software that GE Healthcare will roll out as real-time process alerting and decision support.


Sales

image

University of Virginia Health System selects Evariant’s Physician Relationship Management and Physician Market Solver solutions for physician alignment.

The Medical Information Network – North Sound (WA) HIE adds Jiva Population Health Management to its ZeOmega rollout.


People

image

Commonwealth Health (PA) names Denis Tucker (Main Line Health) as CIO.


Government and Politics

image

England’s Secretary of State for Health and digital health supporter Jeremy Hunt is reappointed under new Prime Minister Theresa May.

The Defense Health Agency awards a five-year, $70 million to EHR Total Solutions. I found next to nothing about the company, which seems to exist purely to get military contracts. It previously reported $9 million in annual MHS contracts, so this will raise its total a lot.

image

A US District Court orders MedSignals CEO Vesta Brue to pay $4.5 million for grant fraud. Her Lexington, KY companies received five NIH grants to develop electronic pillboxes, but she spent the money on plastic surgery, jewelry, and massages. She will also pay restitution and serve jail time for grant fraud related to Telehealth Holdings, Inc., a company operated by her partner Jerome Hahn.



Other

GE Healthcare sues 23-bed West Feliciana Parish Hospital (LA), complaining that it unfairly chose Hitachi Medical Systems to provide imaging equipment at a price below GEHC’s bid.

image

I’m tiring of the Pokemon Go phenomenon as quickly as I did other pointless, imitative fads like the Ice Bucket Challenge and the phrase “threw up in my mouth a little bit,” but this is cool: C.S Mott Children’s Hospital (MI) is using the game to get hospitalized children to leave their beds and interact with employees and other patients. That won’t be offset by the hospital influx of dolts who are hurting themselves in their rare interactions with their actual physical surroundings while staring at their phones, but it’s a small plus. Speaking of which, as I predicted last week, game developer Niantic announces monetization plans in which it will offer retailers the ability to sponsor locations on a cost-per-visit basis in hopes of boosting their foot traffic. I predict the game will be a cringingly-recalled embarrassment in six months, just like Second Life and Google Glass.

image

The former IT administrator of an Alaska health system faces 99 years in prison after pleading guilty to  possessing and distributing 2 million images and 13,000 videos of child pornography that obtained using the hospital’s network. He was not charged for distributing another disturbing image, the photo above from his LinkedIn profile.

image

The Houston paper covers the “cost versus choice” out-of-network conundrum in describing a 175-bed, oncologist-owned hospital that brings in annual revenue of $1.5 billion despite not accepting any form of insurance. Aetna sued after finding that the hospital was reducing the patient responsibility portion of its bills to in-network levels by applying a “prompt pay discount,” but was sticking Aetna for their full part of the out-of-network charges (such as $200,000 to treat an abscess). Aetna claimed racketeering, while the hospital counter-sued for being blacklisted. The judge denied Aetna’s demand for $225 million in refunds, saying it’s up to Aetna to decide what part of medical costs it pays in applying usual and customary limits.

image

Bizarre: several doctors in India, one of them a government official, are arrested for running a child trafficking ring from their hospital, caught as they tried to sell a four-month-old. Police are also investigating whether the doctors are running their hospital legally and whether they have actual medical degrees.


Sponsor Updates

  • T-System will exhibit at the FHIMA Annual Meeting July 18-21 in Orlando.
  • Stella Technology is sponsoring and exhibiting at the Redwood Mednet conference in Santa Rosa, CA this week.
  • Datanami.com profiles TransUnion’s management and use of big data.
  • Valence Health will host its value-based industry conference, Further 2016, September 14-16 in Chicago.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 17, 2016 News 8 Comments

Morning Headlines 7/15/16

July 14, 2016 Headlines 1 Comment

Hearing to Review the VA Electronic Health Record Network

Testifying before the Senate’s Committee on Appropriations, VA executives field pointed questions about the lack of interoperability between the VA and DoD, and confirm speculation that the agency will likely move to a commercial EHR system.

Health IT & Health Information Services: 2016 Mid-Year Market Review

Healthcare Growth Partners publishes its 2016 Mid-Year Market Review, a dense and informative report on M&A activity in the health IT marketplace.

Obamacare, the secret jobs program

Politico reports that the ACA was intentionally written to save healthcare jobs during the recession rather than reduce healthcare costs. While healthcare advisors lobbied for language aimed at improving care delivery efficiencies to reduce costs, more influential advisors from the job creation team successfully argued that during the recession the country needed “more middle-class jobs and the best place to create them was in health care.”

Thune Leads Senate REBOOT Members in Introducing Legislation to Improve Meaningful Use Program

Six republican senators introduce a bill that would limit the Meaningful Use reporting periods to 90-days, expand availability of hardship exemptions, and eliminate the “all-or-nothing” structure of the attestation process by allowing hospitals to satisfy MU requirements as long as they attest to 70 percent of the required metrics.

2016 Survey of US Physicians: Physician awareness, perspectives, and readiness for MACRA

A Deloitte survey measuring MACRA awareness among US physicians finds that 50 percent of non-pediatric physicians have never heard of MACRA, and 79 percent do not support tying compensation to quality.

View/Print Text Only View/Print Text Only
July 14, 2016 Headlines 1 Comment

News 7/15/16

July 14, 2016 News 5 Comments

Top News

image

VA CIO LaVerne Council, testifying to the Senate’s Committee on Appropriations about the future of VistA, defends the status of interoperability with the DoD. She is grilled about why the military’s diagnostic images of newly discharged veterans can’t be viewed by the VA, forcing them to start over, and why Cerner’s suicide prevention algorithms can’t populate the Joint Legacy Viewer. She answers a pointed question about why the VA and DoD can’t use the same system by saying that no existing system can meet the needs of both. Council confirms that every VA VISN has a customized instance of VistA, meaning it’s really 130 similar but not identical systems.

VA Chief Information Strategy Officer David Waltman phrased an answer to a question as “until we move to a COTS solution on the digital health platform,” leaving little doubt that the VA hopes to buy a commercial product. Senator Bill Cassidy, MD (R-LA) was impressive in asking insightful questions about interoperability and federated data capabilities.

Council says the VA has engaged KLAS to build its business case (at a cost of $160,000, Politico reports) in reviewing products and options, hoping to give the next administration a business case by the end of the year. I’m not sure what KLAS has to offer that everybody doesn’t already know (it’s either Cerner or Epic – skip the RFI/RFP and just visit some sites, negotiate hard, and swallow the urge to rule out Cerner just because DoD chose it).


Reader Comments

image

image

From Dr. Nicholas Van Helsing: “Re: Theranos. I posted a few weeks ago that it was clear the Emperor had no clothes. But put a mysterious woman dressed in black turtlenecks and a somewhat strange alto voice out front and people buy it. A similar image was creatively groomed 15 years or so for Kim Polese of Marimba. Every industry rag had a story about her every month, and then she complained that the press never left her alone. She hasn’t amounted to much, but at least Marimba sold for $239 million and only deal with software, not lives. Her next venture tanked – anyone know what she’s doing today? I think Liz is headed the same way. QED.” Polese made a lot of covers because of her appearance (despite holding a biophysics degree and being influential at Sun Microsystems for coming up with the name Java) and because women-led tech companies were rare back then. That was a reflection of widespread industry chauvinism more than any ego failings she might have had. Marimba created Castanet, a technology to allow fast downloads, but the company’s fame never approached her own, especially after it hired a PR firm who decided to make her the real story. You’ll be interested to know that she landed in healthcare as board chair of ClearStreet, which offers technology to help employers and employees manage their healthcare spending.

From Dilettante: “Re: HIStalk. I don’t believe that it’s just one person writing and reading every item that appears. Tell me who is on the team and where the company offices are located.” I get that a lot. I write every word of every news post myself, with the rare exception when I take a day off and Jenn covers. I don’t leave the otherwise empty spare bedroom (no schmoozing, speaking engagements, or sucking up – that’s the beauty of being anonymous) until I’ve written something that I’ll still be proud of years later, long after thousands of readers have forgotten it. Until I lose the ability or interest to continue doing that in a way that I think is better than anyone else, it’s just me alone feeling like I’m whispering in the ear of a single reader who is just like me in having a short attention span, a low threshold for BS and corporate incompetence, and a strong interest in doing the right thing for patients and those who pay their bills. Everybody has some weird, questionably useful talent (wiggling ears or solving a Rubik’s cube, for example) and this happens to be mine.


HIStalk Announcements and Requests

image image

We funded a significant DonorsChoose project (donating $500, which was matched by Chevron) in providing Mrs. Veltri’s Pennsylvania elementary school class with an iPad Mini and STEAM tools, books, and games. She reports, “Packages came to our door and our students could not contain their excitement. You should have seen their faces as they began to open boxes that gave them tools to explore new aspects of education. At this young age students need to explore science, technology, engineering, and mathematics to set their foundations for later on in their schooling. The blocks and tiles get them learning about these concepts at a young age and in a very exciting way!”

I asked Jenn to write an article about the return on investment vendors get for exhibiting at the HIMSS conference. Contact her if you would be willing to give some company perspective (anonymously if you would rather).

This week on HIStalk Practice: Enli Health Intelligence partners with Dell Services. Hawaii hopes to ease physician shortage with expanded access to telemedicine. Relatient partners with Uber. Flatirons Practice Management adds Mediware billing tools. HealthTap acquires Docphin. Drchrono partners with AHIMA to help HIM students. Colorado Springs Health Partners rolls out Clockwise.MD at urgent care facilities.

This week on HIStalk Connect: Involution Studios debuts digital healthcare cards. Tel Aviv University develops temporary emotion-mapping electronic tattoos. Eleven year-old helps Boston Children’s Hospital promote telemedicine legislation. Avizia and Progyny secure new funding rounds. Drones help coordinate care for wild ferrets.

Listening: new from Anderson/Stolt, a collaboration between former Yes singer Jon Anderson and former Flower Kings/Transatlantic guitarist Roine Stolt. Yes is on its sad last cash-cow legs, even more pathetic than the so-called Beach Boys with no original members left and a tribute band singer mangling its classics, so this is a pretty good substitute for the band’s prime 1970s years with Anderson / Squire/ Howe / Wakeman / White (or maybe Bruford if you’re a purist). Prog fans will be transported to the years when Yes and Genesis ruled the airwaves and concert stages. Anderson sounds great for a guy who’s 71 and who got fired from Yes in 2008 after serious lung problems kept him off the road and thus from playing the aging band’s primary keyboard instrument (the cash register). He’s also touring this fall with fellow Yes alumni Rick Wakeman and Trevor Rabin.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

Teladoc obtains a $25 million loan and $25 million line of credit.

image

Care coordination software vendor Caremerge raises $14 million, increasing its total to $20 million.

image

Telemedicine software and services vendor Avizia raises $11 million, increasing its total to $17 million.

image

In Canada, Telus Health announces that it will acquires the Canadian EHR business of Nightingale Informatix, which is used by 4,000 physicians.

Patient experience software vendor Docent Health raises $15 million in a Series A funding round, increasing its total to $17 million.

Publicly traded Alere recalls all of its PT/INR blood coagulation testing systems as mandated by FDA, which found that the company’s software update did not fix a previously documented problem with incorrect results. Abbott had agreed to acquire the company for $5.8 billion last year but then tried to back out after Alere was investigated for foreign corruption probes, so naturally they’ll be trying even harder now. 


People

image

Randy Fusco (Change Healthcare) joins patient engagement system vendor HealthGrid as EVP of product R&D.

image

ID Experts hires Kimberly Holmes, JD (OneBeacon Insurance Group) as SVP and counsel for cyber insurance, liability, and emerging risks. 

image

Johns Hopkins All Children’s Hospital (FL) names John McLendon (MedStar Health) as VP/CIO.

image

Chris Hammack (Patientco) joins population health management consulting group Aegis Health Group as SVP of sales and business development.


Announcements and Implementations

image

In Singapore, Farrer Park Hospital goes live on Meditech 6.0.

image

Medecision launches Aerial for Medicaid and Medicare Advantage, a population health management system.

image

Colorado Springs Health Partners (CO) goes live with online check-in by Clockwise.MD at all three of its urgent care facilities.

image

PMD adds real-time discharge alerts to its software, allowing practices that participate in Medicare’s Transitional Care Management program  to be paid for performing follow-up within 48 hours of discharge. The company offers software for charge capture, secure messaging, health information exchange, and care coordination.


Government and Politics

image

Six Republican Senators introduce the EHR Regulatory Relief act that would mandate a 90-day Meaningful Use reporting window in trying to “pull the electronic medical records system out of the ditch, transforming it into something that doctors and hospitals look forward to rather than dread.” The proposed legislation would also modify the all-or-nothing MU requirements and extend the availability of hardship exemptions. Senators John Thune (R-SD), Lamar Alexander (R-TN), Mike Enzi (R-WY), Pat Roberts (R-KS), Richard Burr (R-NC), and Bill Cassidy (R-LA) are members of the Senate’s working group Re-Examining the Strategies Needed to Successfully Adopt Health IT, which somehow ended up with the contrived, catchy non-acronym REBOOT.

Meanwhile, CMS Acting Administrator Andy Slavitt tells the Senate Finance Committee that CMS is open to postponing MACRA and shortening its reporting periods.

image

A Politico article calls the Affordable Care Act “the secret jobs program” in which the administration–  facing a tanking economy and the loss of millions of jobs — chose preserving healthcare employment over controlling healthcare costs in deciding not to cap healthcare spending or address provider efficiency. Healthcare employment has grown 23 percent since 2005 vs. just 6 percent in non-healthcare jobs. The excellent article notes that the “poison pill” that’s included with all those jobs is ever-growing healthcare costs (healthcare creates its own demand) footed by employers, patients, and taxpayers, noting that doctors are outnumbered by non-doctors by 16 to 1, with nine of those being paper-pushers. Experts say the investment is a poor one if health doesn’t improve. Legislators have declined to face the issue because “every job is a good job” and all of them have big-employer hospitals in their districts, with healthcare and social assistance providing the highest employment in 56 percent of Congressional districts.

image

HHS lists a position for an IT security specialist, which contains mostly unsurprising duties except for the last two that cover prosecution and corrective action.

image

A Deloitte survey of physicians finds that only 50 percent of the non-pediatricians have heard of MACRA, with 32 percent of them saying they’ve heard of it but don’t actually know what it is (maybe CMS should hire drug salespeople to spread the word since they seem to get doctors to pay attention, at least when they bring lunch). Nearly 80 percent of respondents say they would rather be paid under fee-for-service or salary arrangements instead of value-based payments. Three-quarters think performance reporting is burdensome and 79 percent don’t like the idea of tying their incomes to quality (that might be the scariest number of all).

An HHS report says national health spending will hit the $10,000 per person mark for the first time this year and will continue to grow at around 6 percent annually through 2025 as the economy improves, healthcare prices rise, and baby boomers get older. It predicts that spending may be moderated by higher out-of-pocket costs and says insurers will increasingly narrow their networks in trying to avoid price increases.


Privacy and Security

Oregon Health & Science University will pay $2.7 million to settle charges stemming from two 2013 data breaches involving 7,000 patients, one the theft of a surgeon’s unencrypted laptop from his vacation home and the other caused by medical residents who stored patient information in cloud-based Google Docs. That’s a big penalty considering there’s no proof anyone actually saw or used the patient information.


Other

image

Healthcare Growth Partners publishes its mid-year health IT market review, which always dazzles me with its insight and brilliant writing. It notes the change since 2005 in which “solvers” (companies that do the right thing in generating profits while maximizing returns for many) now outnumber the previously dominant “exploiters” (companies that exploit inefficiencies to maximize returns for a select few), as the fee-for-service model rewards exploiters and value-based care rewards solvers. It notes that companies with just $10 million in revenue have a wide variety of investors to choose from in the immature health IT market. Respondents were mixed on whether an health IT investment bubble exists, but those who think it does point mostly at early-stage companies. There’s too much information to summarize adequately, so take a look – unless you are already an M&A expert, you’ll learn a lot by reading the report.

image

Greater Baltimore Medical Center (MD) celebrates its EHR go-live with what it calls a company barbeque (which it wasn’t – it was a cookout with no low and slow smoking involved). I assume it was Epic ambulatory that went live.

SNAGHTML22a6f2e

A funny spoof from the Gomerbloggers.

image

Weird News Andy helpfully provides ICD-10 code Y93.C2 (activity, hand held electronic device) for treating the idiots who are harming themselves by ignoring the real world in favor of the Pokemon Go variety. He provides examples: (a) two men fall off a San Diego cliff after cutting through a protective fence in their pursuit of a character; (b) a guy crashes his car and tears up a woman’s yard while driving and chasing an imaginary monster; and (c) a 21-year-old generously absolves the game’s maker for falling off his skateboard while hunting characters, saying, “I don’t think the company is really at fault.” Meanwhile, officials at the United States Holocaust Museum, Arlington National Cemetery, and Poland’s Auschwitz Memorial ask the game’s vendor to take their sites off its monster-hunting list to keep them from being overrun by disrespectful players. The CEO of the company that developed Pokemon Go says his goals were to get people to exercise, to encourage them to explore their neighborhoods, and to serve as an icebreaker in getting strangers together, all of which could allow the game to meet the definition of a health app except that people actually use it.


Sponsor Updates

  • Ingenious Med Chief Innovation and Product Officer Todd Charest speaks at the Gwinnett Chamber of Commerce’s Wearable Technology Forum.
  • InstaMed is featured in the Deloitte Health Care Current.
  • Fifty-nine Meditech customers achieve the “Most Wired” distinction for 2016.
  • Netsmart will exhibit at the ASU Annual Summer Institute July 19 in Sedona, AZ.
  • Experian Health will host its Northeast Regional User Conference July 19 in Philadelphia.
  • Following up on an Earth Day-related pledge, PatientPay donates to The Nature Conservancy for the restoration of longleaf pine forests in the North Carolina Sandhills.
  • Teknovation.biz interviews PerfectServe CEO Terry Edwards.
  • Sunquest Information Systems will host its 35th Annual User Group Conference through July 15 in Tucson, AZ.

Blog Posts

HIStalk sponsors named among the 100 winners of Modern Healthcare’s “Best Places to Work in Healthcare 2016” are:


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
July 14, 2016 News 5 Comments

EPtalk by Dr. Jayne 7/14/16

July 14, 2016 Dr. Jayne 1 Comment

clip_image002 

HIMSS has started planning for National Health IT Week, to be held September 26-30. Events include a “Virtual March” to allow participants to reach out to their representatives to discuss the benefits of health IT in advancing medicine. The “Activities & Agenda” section of the website still lists the 2015 content, so we’ll have to wait to see exactly what is on tap for this year.

A good friend shared a link to Stop Meeting Like This. which has some eye-catching headlines. My favorite was the link to the flow chart that answers the perennial question, “Are you about to have a crappy meeting?” Although it’s largely tongue in cheek, it made me smile. The fact that other people think about how soul-sucking meetings can be reminds me that I’m not alone.

Other topics include strategies for making sure 24-hour access doesn’t interfere with work-life balance and the “dark side” of collaboration. I’ve got some colleagues who could definitely benefit from the latter piece. I love the last line of the piece: “Make sure that the collaboration in your organization isn’t just a smokescreen allowing many to coast on the efforts of others.”

Another friend clued me in to Athenahealth’s take on “If You Give a Mouse a Cookie,” which appeared just a couple of days after my own mention of the classic tale. They did a really good job with it, ultimately calling on CMS to “avoid ending this sordid tale exactly where we started” and saying “it may be too late at this point to take back the cookie from CMS, but it’s not too late to push back on the milk.”

clip_image004

The AMIA 2016 Annual Symposium “early bird” registration deadline is approaching. It’s closer to home for me this year, but I’m not sure I’m going to make it. It’s nearly back-to-back with another conference I’m already committed to attend and even the early bird registration rate is nearly $1,000. Add in hotel, meals, and travel and it’s a good chunk of change.

I do enjoy going, though, and getting together with colleagues who work in different spaces within the clinical informatics universe. It’s good to be able to commiserate about some of the things we see in the field, but now that I have more responsibility with my practice, it’s harder to get away.

I’m also interested in attending the NCQA Patient Centered Medical Home Congress in October (and also in Chicago). Moving forward with PCMH efforts will clearly benefit physicians and practices as we move towards value-based care. However, NCQA is planning to update its recognition program, “planning an ambitious full redesign.” Public comments on the proposed redesign close Friday, so I hope people have been able to submit their thoughts.

Recently I came across a physician who wants me to come up with a strategy to “de-spam” his Direct interoperability solution. He’s in a part of the country where secure communications between providers is really taking off, but he’s not happy that pharmacy benefits managers and other organizations have started sending patient-related communications. He wants to restrict use of messaging to only physicians, which flies in the face of the idea of team-based and collaborative care. He also wants to figure out a way to make his address “unlisted” so that people can only reach him when he wants them to reach him. I’m not sure what to tell him, but I’m betting my informatics colleagues will have some ideas.

clip_image006

It’s not health IT-related, but it did make my day. The Apollo Guidance Computer code is making the rounds on the internet. There’s some pretty humorous bits and also a little Shakespeare included for good measure. The article is worth the read if you’re looking for a little distraction.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
July 14, 2016 Dr. Jayne 1 Comment

HIStalk Interviews Howard Messing, President and CEO, Meditech

July 14, 2016 Interviews 6 Comments

Howard Messing is president and CEO of Meditech of Westwood, MA.

image

Tell me about yourself and the company.

I’m CEO of Meditech, one of the founders of the EHR industry. I’ve been here for almost the entire history of Meditech. I have a very strong technical background. I think if you looked in the dictionary under “computer nerd,” you’d see my picture there. I’ve been here since 1974.

Combined with my computer nerd background, I’ve also dedicated my life to the healthcare industry and making sure that we can proceed and use our systems and electronic health records — although we didn’t call them that back in the early 1970s — to improve care, improve productivity, and hopefully control costs, though we know that’s been a continuing challenge for the entire industry.

I always like looking at those black and white 1960s pictures on your site, like seeing Neil Pappalardo up to his waist in water trying to save the data center.

Believe it or not, that was actually in Phoenix. People don’t think of floods in Phoenix, but that was a water main break.

How many hospitals run full-blown Meditech hospital-wide?

We actually have very few customers any more who have just one or two products. The vast majority of our customers are dedicated to our entire portfolio. We have somewhere around 2,300 or 2,400 hospital sites worldwide running our systems.

When we last spoke a few years ago, you priority was to move customers off older product versions like Magic. How is that progressing?

That was the priority then, and to be honest, it’s still a priority. The staying power of our older platform has surprised us. We still have approximately 800 customers on our oldest Magic platform and a similar number, perhaps even a few, more on our Client/Server platform. We have close to 600 on our 6.x platform.

We have a brand new platform. 6.x is the underlying technology, but we’ve redone the entire front end of our products to be Web- and mobile-based for the ambulatory solution and for the clinicians on the inpatient side. It’s really quite a brand new system.

Unfortunately, when many people think of Meditech, they think of our systems that were introduced 20 or 30 years ago because that’s still the bulk of our customers. Keep watching us, because we’re introducing brand new products that are quite different than the rest of the marketplace.

Do you still have to make the argument that customers should value the benefits of software rather than having the latest, coolest underlying technology?

I agree with that in general. One of the main issues right now in EHR, maybe the main issue, is while keeping patients safe, we want to make sure that clinician productivity is not hurt. For the last 10 or 15 years, the entire industry has been saying, “Go to our systems and you won’t lose any productivity.”

We think that’s the wrong message.  We want to say, “Go to our systems and we’ll improve productivity.” We think by adopting modern user interfaces — we’ve achieved that and have some numbers to back it up — that’s going to differentiate us moving forward as these products get adopted.

Articles that blame EHRs for physician dissatisfaction usually fail to differentiate between community-based providers who have occasional interaction with one or more hospitals and those physicians who work full time in a hospital. How did your studies measure productivity?

I’ll first add that the other issue we see with physician dissatisfaction is the change in what is required of physicians over the same period of time that we’ve been adopting EHRs over the last five to 10 years. It’s sometimes difficult for physicians — and it’s difficult for us — to understand how much of their dissatisfaction is due to poor implementations of software from vendors and how much of it is due to the fact that they are required to document more, provide more statistics, and do more inspection of data. Maybe some will view that as an excuse, and perhaps it has been.

When we look at productivity, what we look at is the very standard kinds of measures. How long does it take a physician or clinician to get through an encounter? One good measure of that is clicks or taps. We have a customer who has done a study looking at the older systems and then looking at our new Web-based product. They found there’s about half the number of taps or swipes than there were with the older systems’ clicks. The amount of time it takes them to get through an encounter is approximately half.

We don’t have the firm data to back it up yet because it’s a new system for us. We only have four or five Web-based ambulatory systems up and running. Our Web-based acute care system is actually just being delivered this summer. We’re pretty excited about the implications that will have for productivity of clinicians, of course while maintaining safety of the patients and providing the best possible care. Maybe as importantly, keeping costs within a reasonable realm.

How well is Meditech competing with Cerner and Epic in getting new customers and keeping existing ones?

We’re certainly keeping our old customers pretty well. We have a lot of old customers. Our maintenance revenue keeps going up.

We have seen a little bit of a pause over the last couple years in acquiring new customers as people wait for these newer user interfaces to be delivered. We’ve still managed to convince a fair number of our existing customers and a handful of new customers to join us in pursuit of this new product. We think that will pick up next year.

How do approach the market knowing that you have to displace someone else’s product?

That’s a challenge. It is very much not a new market, it’s a replacement market. We go in making the case that both our products can help increase provider productivity.

Then we also make the cost-based argument. We think that we are far and away the most reasonable total cost of ownership vendor of the three major vendors. It’s a little bit obscene the amount of money that some of the healthcare industry is spending on some of these systems. We can make a good dollars-and-cents argument that going with Meditech will save them money. Particularly when you consider that no matter who gets elected in the next election, nobody’s expecting our government or payers to be paying more for healthcare episodes and for healthcare in the future. As we move to population health, that’s a way of achieving better health, but also controlling costs.

In general, there needs to be some ceiling placed on what is spent on electronic health records. We think we have the right answer with that and that’s the major argument we make. You can get a new, modern system; a system that will increase your physicians’ productivity; and you can do it for less cost than with the other vendors.

Is it hard to get someone who spent dozens or hundreds of millions of dollars to implement Epic or Cerner to admit that they made a financial mistake and go back and replace it with Meditech?

If they’ve just spent the money, it’s hard. We have to make the argument as these systems age, although we have had some success with people who have made that commitment and then realized what they’ve gotten themselves into.

The company’s product revenue has dropped by around half since 2013, which directly hit net income. What’s the cause and how do you fix it?

Net income is down. On the other hand, we are still strongly profitable, still paying a dividend, and still giving our employees raises and bonuses. We have a very strong balance sheet.

A lot of this was anticipated as we moved towards the new user interface that we’ve provided for our products. We’ve seen a lot of people waiting to buy that. We also have lost a handful of customers to consolidation, where people are acquired. There’s not much we can do if they’ve decided on going with another vendor’s system. We’ve seen a slowdown in that loss. 

This year, we’re doing relatively well. We expect that to turn around over the next 12-18 months as people start to see the effects of our new products.

Some of the market change involves hosting of client systems, which Cerner has built into a big business as Epic cautiously tests the waters. What does Meditech offer customers who want to turn over EHR system operations to their vendor?

We’ve actually offered, through third parties, the ability to do that for quite a while. There are a fair number of our customers who already are hosted by a third party, just not by Meditech. We’re also looking at whether we ourselves want to brand the entire system and provide it. We’re looking at some efforts, particularly at the smaller hospitals, and introducing that over the course of the next 6-12 months.

How do you see the potential change of ownership of McKesson’s Paragon product line changing the market?

I’m not sure it changes the market. I think everybody has been anticipating that McKesson was not very interested in pursuing their product line over the last 12 or 18 months. If this new arrangement involves a significant investment in R&D, perhaps they’ll be able to turn that around and become a significant force in the marketplace again. If they don’t do that, then I’m sure it will just be a winding down over time. I have no idea and am not privy to their deal to know what’s involved.

To be honest, we haven’t seen them as a very strong competitive force for two or three or four years. It’s very much a three-horse race on the acute care side among Epic, Cerner, and ourselves. Perhaps if you throw in the ambulatory side, there’s another couple of vendors that are strong and that we know are trying to get into the acute care space. The future clearly is in being able to provide services to the entire spectrum of healthcare — acute care, ambulatory, mental health, long-term care, urgent care, wherever healthcare is being provided. Particularly as population health begins to assert itself over the next few years.

Ambulatory was a perceived weakness of Meditech compared to Epic and Cerner. Is that changing?

Absolutely. I agree — we stayed away from the ambulatory sphere probably for too long. Then about 4-5 years ago, we acquired a long-term partner of ours, LSS Software, with the expectation that that might fill the gap for us. But we quickly began to realize that there were some issues with having a separate system. We bit the bullet, so to speak, and three years ago started developing our own ambulatory system and chose that as the testing ground of our new mobile and Web-based technology.

We’re happy to report that that product is now out in the marketplace. It’s live at four or five sites. We have orders for approximately 15 or 20 more of these systems. We see it as a big improvement on what our competitors offer, both in the functionality it offers specifically in the ambulatory space and also in the ability to integrate completely with the total healthcare enterprise.

Your Boston neighbors Athenahealth and EClinicalWorks are trying to push their way into inpatient from the ambulatory side. How do you see that developing?

Those were the two I was specifically thinking of when I said there are a couple of vendors trying to get into the acute care space. We’ll see what happens. They’re both good companies, both run by able leaders. We’ll see if they’re successful in getting into the marketplace.

Just as we’ve been learning about ambulatory and what it takes to provide an ambulatory system — and honestly there’s more to it than it seems when you first look at it –  we think they’ll have the same kinds of experience as they push into acute care and learn that there’s a whole lot to it. We’re welcome to take them on competitively.

Some people think inpatient systems are just EHRs, but Meditech offers complete departmental automation rather than just maintaining a patient record. Will companies like EClinicalWorks and Athenahealth need to get out into the hospital department operations to be successful?

They really have to get out into the departmental operations. They will discover that those are pretty complex and difficult to do.

To be honest, in the future, I believe that with the rise of FHIR and other API technologies, that might not be as important. Certainly as a technologist, I think that eventually that’s the right way to go. I still think we’re several years, if not the better part of a decade, from actually having that kind of capability as standard in the healthcare industry.

When that happens, perhaps it will be easier to provide an EHR that doesn’t also provide departmental systems. For right now, those particular integrations — particularly between pharmacy and the rest of the EHR — are very tightly coupled. It’s difficult to see how you can provide that without going into the departments as well.

How would you assess the interoperability capabilities of Meditech and its two significant competitors and their progress toward offering APIs as ONC is emphasizing?

I don’t like to comment negatively about my competition, so I’ll just say that you couldn’t be more dedicated to interoperability than we are. We’re involved in all the major industry efforts to do that. We are one of the founding members of the FHIR effort.

We currently do, I think, as much if not more interoperability than anyone else. There are hundreds of billions of data transactions a year going through Meditech’s systems interoperably. I think the last time we looked it was 300 billion, with 200,000 different interfaces. We’re well on our way to already supporting interoperability, both because it’s required and actually because it’s the right thing to do.

The CIO of one of your highest-profile clients told me he was shocked at how easy it was to turn on interoperability with Meditech compared to the systems of a couple of your competitors that his health system also uses. Would that surprise people?

I don’t know if that would surprise people. It doesn’t surprise me, although I’d like to know who that is [laughs].

We have from the get-go always had an interest in interoperability. I used to give a talk maybe 10 years ago about how in “Star Trek” they get your medical records on the other side of the galaxy. If we’re going to be able to do that in 200 years, we have to get started now. We’ve been pushing for that. 

It’s very pleasing to see that we’ve gotten as far as we have, particularly because the healthcare industry still doesn’t have, from my point of view, the right incentives in place to encourage people to interoperate. For the most part, it’s being done because it’s required as part of government programs. I think that that will change over time.

You mentioned the demand from customers for population health management and analytics. That market is pretty frothy, with a lot of companies popping up out of nowhere. How would you characterize the market for population health management and analytics and Meditech’s place in it?

I’m glad you asked that because we think we are a little bit different in our approach to population health.

First of all, it’s obviously currently one of the big buzzwords in our industry. It’s a clear trend to a way to manage patient population-based health. It’s going to become more and more important as our population ages and has multiple conditions and multiple chronic diseases. We think it’s an important thing.

On the other hand, there’s a lot of people playing on the fears of our customers and of the healthcare industry that if they don’t jump on the bandwagon right now with this particular model of population health, they’ll be left behind. We think population health needs to be a lot more integrated with the care delivery system than some of our competitors. Our approach is embedded in everything that we do. We’re taking a holistic approach to it, making sure that our customers can define and then manipulate and understand the various populations, no matter what their definitions are, as they practice their healthcare.

With the newly-announced MACRA regulations, it’s not even obvious that a physician can always tell which patients are in the population they’re responsible for and counting towards their statistics versus which ones are outliers that they are not responsible for. Our point of view is to give them that knowledge at the point of care, not on some separate list that someone has to compile and deal with on a different basis. We’re doing that by embedding that in their system. We have patient registries. We have a newly introduced analytics product that enables them to slice and dice the data about populations, but then build that into case management capabilities, build that into their revenue cycle issues, and maybe as importantly also relate to patient portal so that the patient can get involved.

One of the things about population health is figuring out how to get patients much more involved in their care. That’s been a Holy Grail. Nobody’s really achieved it very well yet. We want to make sure that we have all the tools in place to allow our customers to do that as we figure out how to get patients responsible for their own health.

Meditech’s executives all grew up within the company. How is their lack of industry experience outside of Meditech a strength when it comes to innovation?

It’s true that our most senior staff are from within the company, but we certainly do hire a lot of people who have not worked here before. We have a lot of smart people. There’s certainly no lack of outside ideas and influences.

In particular, over the last four or five years, we’ve hired a number of physicians into relatively senior positions here at Meditech. They certainly bring a lot of very interesting perspectives and ideas to us. We think that’s made a very big difference in the way that we approach development, implementation, and ongoing support. It’s been a bit of an eye-opener for a lot of us. That’s been a major factor in doing that.

There are both advantages and disadvantages to having long-term senior staff. We’re quite aware of that and try to capitalize on the advantages and make sure that we don’t get complacent about the things that are disadvantages.

How do you prepare for having executives and board members who have been with the company for 40 or 50 years turning it over to the next generation?

Obviously that’s one of the biggest discussions that our board has. We just appointed a new female board member. I wouldn’t be surprised if there were other board changes over time, looking for other people. We also just recently announced a new chief operating officer at the company, Michelle O’Connor, who is quite a bit younger than me and has not been here quite as long as I’ve been here.

We do talk about succession and the next generation. I’m not quite ready to retire. I don’t know that I’ll ever retire, but I certainly like to surround myself with a bunch of, I’ll say, younger people with good ideas. Talk about the future and make sure that the company traditions that are good are maintained and that the traditions that are not good are not maintained. Always ask the question when we do something. If somebody ever answers to me, “Because we’ve always done it that way,” I get very upset. We want to make sure that we’re justifying anything that we do and it’s not simply based on rote repetition of the past.

There’s quite a bit of overlap in the histories of Meditech and Epic, with one factor being that both companies have steered clear of the limelight with little interest in interacting with anyone other than customers and no real marketing or press presence. Epic seems to be opening up a bit. Is Meditech doing the same?

Absolutely. It’s one of the biggest things I’ve wanted to change in the five or six years I’ve been CEO. We’ve been working hard on it.

You touched on it yourself earlier when you pointed out that it’s a replacement market today, that it’s much more difficult to acquire customers. It’s also that the world in general is a much more marketing-oriented world. To be perfectly honest, we were founded by a bunch of MIT engineers, of which I’m one. I was here from the early days and we used to have the old mentality of, “If you build it, they will come.” Clearly that doesn’t work in the modern world, so we want to get our message out there.

Combine that with what I said early in the interview that we have a lot of older customers that we continue to support, but that means that many people continue to associate Meditech with our 20- and 30-year-old systems. We feel the imperative to get the word out that if you’re buying something new from us today, it is new. You’re not buying that 30-year-old Magic system.

All that has led us to believe we need to spend more time and more money on marketing. Hopefully, though, we’ll still be the relatively laid back, not overly slick vendor in providing that kind of information to the marketplace so they can make their decisions based on functionality and cost.

Where do you see the company going in the next five years?

In some ways, we’ll be doing the same things we do today. We’re dedicated to the healthcare market. We want to provide a complete, sophisticated solution for all the modalities of care.

There’s going to be a lot of challenges in healthcare no matter which direction our government takes. There’s going to be many challenges over the next few years. We want to make sure that our existing and prospective customers are prepared to handle that.

We need to polish off the new systems we have, extend those, then make sure that ancillary markets are also well served. In addition, I’d personally like to see our international share grow. We have close to half of the English-speaking market in Canada. The rest of the world is ripe to see the same kind of advances that we’ve had here in EHRs.

Do you have any final thoughts?

It will be interesting to see how the healthcare marketplace develops. We certainly intend to be a major player in how that transpires.

View/Print Text Only View/Print Text Only
July 14, 2016 Interviews 6 Comments

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Follow

Reader Comments

  • huckster: Re: Athena streamliner. Weren't we all told that athena doesn't have upgrades? That everyone is on the same software (th...
  • Healthcare Idiot Savant: Simple question. Just like you are not to spell Epic, EPIC, are you supposed to capitalize the first letter "a" in the n...
  • Bob: Ok @FCGeez, correct facts, just totally irrelevant to the article. Thanks for your contribution....
  • Justa CIO: The career advice is spot on. My success came from going after the roles I thought I was ready for, not waiting to be c...
  • ManagersSuck: @Pointy Head - you will never regret more time spent surfing, riding, sleeping, walking, carving, painting, home brewing...

Sponsor Quick Links