Recent Articles:

Curbside Consult with Dr. Jayne 8/31/15

August 31, 2015 Dr. Jayne No Comments

clip_image002 

A reader recently contacted me about strategies for dealing with providers that are struggling with chart completion:

My outpatient physician group is struggling with chart completion after conversion to an EHR. Some physicians have no issues, but others are having considerable problems. Not surprisingly, the ones struggling are the same physicians who had trouble on paper and had stacks of charts in their offices before EHR. Our policy is that charts need to be completed within two days. However, we have physicians who have hundreds of charts open and are months old and therefore not billed.

We are considering a policy that states charts over two weeks old will result in fines, which is similar to one of our competitors. We are estimating over $100,000 of accounts receivable that we will not be able to collect due to the age of the charts. There is another $25,000 in incomplete charts being added on a weekly basis. I wonder if any of your readers can share their approach.

The reader wanted to remain anonymous, which shouldn’t be hard because there are probably hundreds of organizations in this same position. I’ve personally worked with dozens of them.

Ideally, this problem is best addressed while the organization is still on paper. This allows leadership to get a handle on undesirable behaviors without physicians blaming the EHR. I can count on one hand the number of physicians I’ve seen who were delinquent on paper charts but got faster with the addition of an EHR, so confronting it head on is the best way to handle it.

Unfortunately, many organizations don’t have the resources to optimize their workflows before implementing an EHR. This leads to one of two things: either the EHR implementation team is forced to deal with problems and behaviors that are potentially outside their area of expertise or the behaviors simply don’t get addressed and the EHR takes the blame.

Like the reader, many organizations are motivated to action when the delays start to impact the revenue cycle and some let it get significantly out of control. The last client I helped with this problem had almost $6M in unbilled encounters before they realized they had a problem. Needless to say, they also had other revenue cycle issues which led to it getting that bad.

Meaningful Use throws another wrench into this process, particularly with the need for eligible providers to send out clinical summaries with pertinent information within a set number of days. Although some organizations go ahead and send out the incomplete summaries (a reader shared his or her own story with Mr. H) others hold the summaries which will cause the provider to fail attestation if they can’t meet the threshold.

Generally most approaches to this problem fall into either the carrot or stick categories. In the incentive space, physicians may receive cash bonuses for timely documentation or receive advantages in the creation of on-call schedules or vacation requests. Although some physicians (particularly ones earlier in their careers or with young families) respond well to this, not everyone cares about extra money or call schedules. Some physicians also aren’t motivated by the desire to get information to patients in a timely manner (via MU-required clinical summaries) either, so that may be off the table.

When organizations decide to employ a stick, usually it is a financial one. My residency program did this to the faculty and it was successful. (The residents had their grades withheld if charts were delinquent, so they weren’t a problem.) Charts older than five business days resulted in a fine, which came directly out of the faculty member’s paycheck. It took months to get it set up with the accounting and payroll departments and the physicians had to sign a contract addendum agreeing to it. The faculty did it grudgingly and most of them waited until the last hour, but at least the charts stayed current.

Another group I worked with also made it contractual. Physicians had to meet chart-completion standards in order to be eligible to receive a bonus. They also had to use the EHR in a prescribed way (entering data discretely rather than free texting) in order to reach the bonus round. Bonuses were then calculated based on clinical quality measures, patient satisfaction scores, and a couple of other factors. It was successful because it could completely block the physicians from getting any bonus at all, but again took a contract amendment to give it teeth.

I’ve seen two clients hire scribes for physicians that had documentation issues. Whether or not they charged the cost of the scribes back to the physician depended on the physician’s impact on the bottom line. For example, a high-volume surgeon who was bringing in millions of dollars in revenue was not charged for the scribe because the money recouped from non-delinquent charts more than paid for the extra overhead. At another group, a primary care physician who swore up and down that the EHR was at fault was charged for the cost of the scribe because all of his partners were getting their charts done on time and were unwilling to subsidize or reward his lack of compliance.

This does come up in my consulting practice all the time, so I’m also interested in hearing other approaches. If someone has a great way to do it that doesn’t require a major overhaul of dozens (if not hundreds) of employment agreements I’d love to hear it.

How do you deal with delinquent charts? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
August 31, 2015 Dr. Jayne No Comments

HIStalk Interviews Tom Zajac, CEO, Wellcentive

August 31, 2015 Interviews No Comments

Tom Zajac is CEO of Wellcentive of Alpharetta, GA.

image

Tell me about yourself and the company.

I’ve been in healthcare for a little over 30 years. I’ve had the great fortune to be on this journey of transformation. My first role at Jefferson Health in Philadelphia was when DRGs first came out. I moved on to things like cost accounting and looking at efficiency of care and effectiveness of care management. 

At Wellcentive, our focus is on population health, which we’ve been doing since 2005. We don’t focus on the technology as much as the outcome. We try to help our customers drive true quality improvement; revenue growth, especially with the value-based care initiatives that are going on now; and business transformation, which is where I think the marketplace needs to be.

A Wellcentive tagline is “quality equals revenue.” What aspects of quality can be defined and measured and how should the patient’s point of view be incorporated?

Quality has historically been something of need for healthcare, but now with reimbursement, fiscal incentives are sitting there in the system to be able to drive those kind of capabilities. We have that tagline of “quality equals revenue” because the programs are now driving people to make better decisions. What are gaps of care? How can we look at patient engagement? How can we make sure that there’s better compliance for our patients to try to keep them out of our EDs? At the same time, it’s also driving them to look at better ways to focus on population health, not just on care.

The early years of my career were focused on how well we delivered care. Now with population health and this movement to value-based care, the focus has to be on how we’re treating holistically the entire needs of the patient. As healthcare organizations expand, their focus is not just on a hospital. There are multiple modalities of care among the primary care providers, specialists, urgent care centers, hospitals, etc. How do we best move a patient through that process so they not only get the most effective care, but also the best outcomes? Because it’s not just all about financial outcomes and not even just about clinical outcomes. It’s about human outcomes as well.

Is there enough incentive for providers to manage population health instead of just cherry-picking a particular metric or element they can latch onto to generate income?

You always wind up with that case. Sometimes the industry gets driven by federal mandates or insurance mandates. Typically the industry actually does the transformation. Healthcare has been very viable from that point of view. Exactly what you were saying … with some of the programs that initially come out, you’ll have a rush to revenue. I would almost make an argument some of the early ACOs were like this. Their interest was more in how to maximize revenue.

The more recent model that we’ve started seeing has an example the Delaware Valley ACO, one of customers. It’s a super ACO formed by trading partners in the Philadelphia area, such as Jefferson Health and Main Line, who are bringing together the right intentions — focus on care, focus on population health, making sure that you’re driving the best access, the best experience, and the best capability of healthcare for patients going forward. That is usurping just running for dollars going forward.

Even though a lot of these programs have been formed, we’re in a situation where organizations are forming with the right intent and the right purpose going forward. A lot of times, it’s Maslow’s hierarchy. PQRS is a perfect example. It’s a starter set, a gateway into focusing more on quality. It started out as a carrot, but now it’s starting to become a stick, and as the MIPS program is going to drive people to make sure that they’re measuring the right levels of quality.

One area we work with our customers on – and one that most healthcare organizations have to consider — is that you shouldn’t just be reactive to what programs and approaches are out there. By looking at population health, assessing data, and bringing together great analytics, you can start assessing where you operate best and how you can best treat those patients. Then use that in your dialog with payers going direct to employers to be able to set up better reimbursement approaches and better focal points.

If I were a skeptical consumer, which I often am, I would say that hospitals and medical practices could have been managing my overall health all along but didn’t until someone wrote them a check. Does population health management need to to be explained to consumers?

This is not a one-stakeholder issue. All stakeholders have to participate. We as patients have to take active participation in our health as well.

You can look at that and say that the healthcare system historically has been more fee-for-service based, so therefore they’ve only been interested in volumes. That’s not true. There are huge numbers of people in the healthcare process who’ve been trying to make sure that we put the right care together. However, now with better data and better analytics, we’re starting to be able to look at what decisions we should be making earlier. 

For a 50-year-old hypertensive diabetic, how do we make sure that they don’t wind up trending into a case for stroke? How do we get ahead of that? It’s not just the physician’s responsibility or the hospital’s responsibility. The patient has to be part of that responsibility as well, making sure that they’re complying with their treatment protocols and having active discussions with their physicians and their providers.

The one thing I worry about is the consumer or the patient being passive in this model. Nothing should be more active than your own health.

Most of what constitutes health doesn’t involve the medical establishment, such as consumers who make unhealthy choices. Are we giving providers health responsibility without authority?

Providers are now in a role of trying to also be mentors for patients to take more control of this situation. There’s a huge amount of data out there and sometimes it can be purposed in the wrong ways. A lot of the point about population health is to try to create better dialogs, better outreach, better collaborations among patients, providers, physicians, and payers as we go through this overall process. 

Hospitals are trying to focus on quality. Quality creates revenue. They also need to focus on access. They’re starting to look at where to treat patients. They’re starting to look at their markets. Where else they should compete? How should they keep an affinity with their overall practice?

For the patient, they’re trying to decide how to apply their affinity — their relationship with all of those various stakeholders — and how to get the best information. There must be a mentoring capability between providers and physicians with their patients to get the best overall outcomes.

We’re starting to hear more about the idea of consumer workflow. We focus quite a bit on physician workflow, maybe a provider workflow or payer workflow. You’re starting to see the rise of the CVSs of the world. They’re able to be successful because they’re focusing on consumer workflow — when healthcare is needed, when it’s convenient, how to get information out to patients, and how to help them focus on compliance.

Population health has to wrap that all together. It’s basically got to be able to help providers, organizations, and even payers focus on how we get the best information and aggregate information about longitudinal care, not just episodic care. Those are two different DNAs. An EMR being able to track episodic care is obviously focused on the episode. Population health has to also focus — not in conflict with — on the entire longitudinal path. What clinical data do we have? What claims data do we have? What personalized data might we be able to pick up for the patient to be able to use that to hone the best approach and the best knowledge you have with the patient? If you do that, then you’ll start to get a win-win strategy.

Employers and employer-led coalitions were not long ago seen as the best hope for influencing cost and outcomes using their purchasing power. Do they still have a role in what now constitutes trying to manage the health of populations?

Yes, absolutely. There’s been a lot of conversation, especially with the ACA, around what the employer’s role will be. Employers are still extremely important and they’re acting that way.

For example, we’ve got a customer, Blanchard Valley, who is working a care management program for Whirlpool in the Ohio area. Their role is to try to engage patients in their health. What we were just talking about before — making sure everybody has active participation. To do that, though, they’re putting in an active care management plan. They’re doing outreach, they’re following up with patients, and they’re making sure they’re complying with the visits that they need. 

It’s not just that the employers are the stopgap for the cost of health. They’re getting directly involved in that. You’ve probably read recently about Boeing’s message that they’re going to look more as an employer direct to provider or employer direct to health system to try to make sure that they create the best cycle and the best access for their patients. They are in direct dialog, for example,with Evergreen Health to be able to talk about how to best treat their patients. They continue to be active participants, but not only from a dollar point of view. 

The consumerism you were talking before has both of those relationships as well. With higher deductible plans, patients are now starting to focus on the financials and some of the decisions that relate to financials, but they also have to focus on compliance to their overall care patterns. It will impact employers and employees not only with regard to productivity, but also the well-being of their employees, which is an affinity or retention between the employee and the employer.

Are you seeing that analytics tools have improved but the underlying data are still of questionable quality?

Yes. When we start an implementation or a partnership with one of our customers, one of the key issues is trying to focus on that longitudinal DNA. Most of the larger healthcare organizations that are creating their future success are a combination of the original hospital as well as physician practices, urgent care centers, and extended care. All of that comes with disparate modalities of care and disparate data within that.

All of that data needs to be brought together and it has to be as complete a picture as possible. It can’t just be EMR data or specific EMRs and their data. It’s got to be all of the data sources that are out there – EMR, clinical, patient claims data — to try to build the richest picture that you can for those patients.

Realize that for some organizations, this is the first time they’re bringing together that type of disparate data. It’s not just aggregating the data. You have to focus on data quality and making sure it’s complete, it’s contextual, it gives you the best picture of those patients, and it’s accurate. A normal conversation I have with physicians is whether or not they trust the data they’re seeing.

Data quality is such that, as we’re going through an implementation, you’ve got to look at grabbing and aggregating that data together. Normalize it so somebody can use it in a focused pattern, and then from that point of view, figure out where the holes are.  We’re not getting allergy information. Maybe the information that we have on patient outreach is weak. How do we improve that information?

Then we can go to the quality set and look at the measures we’re trying to attack. Are those measures, in fact, giving us the right information? Are they complete? How do we now turn them into programs?

Data quality is actually a journey. Sometimes people think that integrating the data is simple and it’s going to happen overnight. More times than not, it’s a journey to try to not only aggregate the data, but make sure we’re focusing on creating the best set of data and the most complete set of data. That does take work.

What’s on your technology capability checklist when you choose your own medical insurance and providers?

I may shift that question just a bit. Let me try this, anyway. In a lot of ways, there’s been a lot of conversation about big data and analytics and the technologies behind it. Those things are important and they’re necessary for this next step, but the real importance has to be transformation.

When I look at providers or I look at health systems that I want to work with, I want to make sure that they have a comprehensive view of care management. The Holy Grail for healthcare in general is true integrated care coordination. So many of us are polychronic at this point. How do all of those things interact? How do the various physician and the various caregivers we have interact with that information so that there is a holistic view of me going forward? 

I don’t necessary look at an organization based on the technology they have, but rather the intent and the capability. It’s important to have big data and analytics to be able to drive a comprehensive approach to things like care management, being able to focus on quality, making sure we’re looking at transitions of care, and trying to figure how to best interrelate with me from a patient engagement and provider engagement point of view.

Where do you see the company in five to 10 years?

Population health has been a term. It’s turning to truly support value-based care. In supporting value-based care, Wellcentive has the ability and the intent to be the command and control across the longitudinal pattern for population health and value-based care. What we’re looking to be able to do is focus on quality programs and make sure that organizations are optimizing revenue. Focus on readmission, cost, and utilization so patients are getting the best experience. Focusing on care management and patient engagement so we know we’re getting the best compliance. Making sure that we’re combining the stakeholders — employers, payers, providers, and patients — so the communication is creating the best clinical, financial, and human outcomes that we can possibly create.

People have been saying, "We understand population health and value-based care. I’m not sure if it’s time for me to get into it." From what HHS and the commercials are doing, the incentives to move and the incentives to act are now. People have to realize that we’re losing time. We have to be able to act on value-based care now. The incentives are in place. Healthcare can be, because of what we deal with — privacy, patients, etc. — a little bit risk averse.

Really strong examples are forming on how organizations are putting care management in. The super ACOs that are forming. The trading partnerships, trying to figure out how to work between employers, payers, and other trading partners. The examples are there. Your peers are starting to work through that. This is really our time. I keep telling my staff that it’s not only our opportunity, but it’s our responsibility to drive the transformation in healthcare, and our time is now.

View/Print Text Only View/Print Text Only
August 31, 2015 Interviews No Comments

Morning Headlines 8/31/15

August 30, 2015 Headlines No Comments

Mutual self-interest leads to antitrust concerns

Paul Levy, the former CEO of Beth Israel Deaconess Medical Center, publishes a blog calling for an anti-trust investigation into Epic as Partners goes live and pressures affiliated practices to do the same.

Epic traffic jams on tap

A local paper warns Madison residents of the upcoming traffic nightmare that Epic’s UGM conference will bring this week.

A Mouthguard That Could Measure Concussions

Former Arizona State University rugby player Anthony Gonzalez invents a mouth guard that measures impact force and combines that data with the users age, gender, and medical history to predict the likelihood of a concussion.

View/Print Text Only View/Print Text Only
August 30, 2015 Headlines No Comments

Monday Morning Update 8/31/15

August 29, 2015 News 11 Comments

Top News

image

Former BIDMC CEO Paul Levy urges the attorney general of Massachusetts and her counterparts in other states to launch an anti-trust investigation into Epic, saying that agreements such as the one between Partners HealthCare and Epic “box out the competition” as the organizations act on their own mutual self interest. He gives this play-by-play:

  1. Partners spends $1.2 billion to implement Epic.
  2. Partners and Epic tell affiliated (not owned) medical practices that they have to replace their existing EHRs with Epic because they won’t be interoperable with the Partners (Epic) systems otherwise.
  3. Partners tells those practices that it won’t work with them if they don’t use Epic.
  4. Partners locks in its affiliated practices and dominates its market even further, while Epic forcefully displaces its EHR competitors, benefitting both organizations.

I hadn’t heard much about Levy since he parted ways with BIDMC (a Partners competitor) in January 2011 several months after admitting to an inappropriate relationship with a female employee (his MIT academic advisee hired as his chief of staff). Levy is working for a negotiating company, married his former chief of staff, and co-authored with her How to Negotiate Your First Job: 8 Steps That Will Create Value for You and Your New Employer.

Levy adds interesting commentary in response to a reader’s question: “Note above that BIDMC desire was to provide interoperability to the Atrius doctors. Brigham and Women’s Hospital, part of Partners Healthcare System, had had a referral relationship with Atrius for the previous 20 years. They had often promised to give Atrius that capability but stubbornly refused to provide it. There was nothing about what Halamka set up in roughly 60 days that BWH could not have at some point during the two decades. But providing interoperability was counter to the PHS strategic plan. This point was actually made by PHS at a financial briefing to bond investors in NYC–where they used the fact that interoperability was NOT available as a feature securing their finances–by making movement of patients out of their network more difficult. Folks on Wall Street found that an attractive strategy, too.”


Reader Comments

From Skeptical Shrink: “Re: blood test and app to predict suicide risk. Many promising genetic findings and biomarkers have been touted in the past, but failed to replicate. The app just incorporates known risk factors, so there’s nothing new there, although one unique thing is that it doesn’t rely on the patient’s self-report about suicidal ideas or plans. The bigger caveat is that the app won’t be helpful because it predicts suicide ideas in the next year, but in the ED, you need to know what’s going to happen soon to decide whether to hospitalize them. You’ll already know if they need a mental health referral, so the app doesn’t help you there. The study may or may not be a starting point in predicting suicidal behavior, but I don’t see the genetic test or app as ready or helpful for clinical use.” It does seem odd to think that suicidal behavior has a genetic basis that can be measured with high correlation. I like the behavioral apps that measure mood or that allow patients with known suicidal or depressive thoughts to “check in” each day with an assessment of their well being to allow outreach when indicated. 

image

From I Want My Taxpayer Money Back: “Re: getting a clinical summary. I received a clinical summary after my specialist visit, hoping to use it to remind me about what we talked about and what I should be doing. It contained only the information I already knew from previous visits (meds, allergies, problems). I asked how I could get a copy containing his actual notes from this visit and they said I wasn’t the first person to ask. What good is CMS making sure EPs provide a clinical summary if the doctor’s notes aren’t included since they haven’t otherwise documented anything yet? Am I supposed to call or send a portal message days later to get the comments he made?” CMS’s Meaningful Use standards define a clinical summary as containing “relevant and actionable information and instructions” that mostly involve updated copies of the same basic information (meds, vitals, procedures, problems, and future visit instructions) along with “instructions based on clinical discussions that took place during the office visit.”  I don’t believe CMS requires sharing physician notes (that would be more the purview of the OpenNotes project, which I wholeheartedly support) although your doctor might be falling short of the documentation requirements if your summary didn’t include the instructions you were given verbally. Readers most likely can elaborate further, but from a technical and personal experience standpoint. I’ve been pretty happy with those I’ve received even though I don’t find much useful information in them, but I wouldn’t say they include every suggestion, observation, or aside that comes up in conversation. My suggestion would be to ask your specialist if it’s OK if you record your visit on your phone for later review, although some doctors will resist due to malpractice liability concerns. A good compromise would be to bring paper and a pen and take notes of what your doctor is saying – that creates shared ownership, and since most of us have kinesthetic and visual learning styles and therefore need more than just spoken words, you’ll remember almost everything even before you leave the office.

From The PACS Designer: “Re: Universal Data Link. You will be hearing about the Universal Data Link (.udl) application. Microsoft will be leading this effort since Windows Server 2003 reached end-of-life support last month with Windows XP next. Using the Microsoft Universal Data Link will simplify connecting to the numerous databases in existence today when doing database software upgrades of servers.”

image

From We’ve Always Been At War With East Asia: “Re: Glens Falls de-installation of Epic. Judy Faulkner has been saying to large audiences that it doesn’t count as Epic’s losing a customer since they had only ambulatory. How does a company lose a customer while claiming its record is still unblemished?” I think Epic’s “we’ve never lost a customer” statement should be retired. It was already asterisked with “except in the case of acquisition” and now would require a second asterisk to say “and except for ambulatory-only sites.” Glens Falls will replace Epic ambulatory with Cerner, which it was already using on the inpatient side.


HIStalk Announcements and Requests

image

Poll respondents say the ICD-10 switch in 4 1/2 weeks could go just about any way, with 29 percent saying CMS won’t be ready and payments will be delayed, the same percentage stating that providers won’t be ready, and 18 percent each predicting that just a few providers won’t be ready or that the conversion will occur with no major problems. Joe says the real problems will surface on October 15 as providers see reduced payments due to incorrect or non-specific ICD-10 coding, with the latter being acceptable to payers because non-specific codes pay less. New poll to your right or here: have you personally seen a health IT vendor software contract that contained a non-disparagement (“gag”) clause?

Dr. Jayne’s description of a practice scrambling to recover from a bad ICD-10 related update raised questions – email me with your experience:

  • Have you seen problems as Dr. Jayne described where an ICD-10 software  change will cause clinical (rather than billing) consequences?
  • For vendors, when was your final ICD-10 software update released?
  • For vendors, how many of your customers have installed the latest ICD-10 software update?
  • For customers, are you scrambling to get consulting help or your vendor’s attention as we wind down the last month of ICD-9’s existence?

I was thinking about the WDBJ shooting and the guy’s long record of work-related performance and anger issues, wondering if his previous employers disclosed his known problems when they were asked for a reference. My experience in hospitals is that you never say anything negative when asked for a reference (except perhaps acknowledging “not eligible for rehire”) for fear of being sued, even if the employee was caught stealing drugs, committing shocking medical errors, or threatening co-workers (it’s the HR version of software contract gag clauses). The best example is nurse Charles Cullen, whose several hospital employers strongly suspected he was killing their patients but let him quit with no blemishes on his record just to get rid of him quietly, allowing him to ply his trade by killing patients at new hospitals. He confessed to murdering 40 inpatients using common Pyxis-stored drugs (digoxin, potassium chloride, and insulin), but experts think he really killed hundreds.

image

We’ve booked nearly all of the available sponsorship spots for HIStalkapalooza except the top one, the “Rock Star CEO” package that includes a bunch of invitations, an on-stage role, all-access passes, and a swanky private lounge in the House of Blues Las Vegas for entertaining prospects and guests. Contact Lorre.

image

Ms. I sent photos of her Washington state kindergartners using the Microsoft Surface Pro 3, iPad Mini, and related accessories for math skills review that we bought via the DonorsChoose project (made possible by vendor donations – thanks!) She says the students use them every day. Companies can contact me to donate and have their money matched by an anonymous vendor executive who loves supporting STEM education in schools.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, or HIStalk Connect. Click a logo for more information.

image
image
image
image
image
image
image
image
image
image
image
image
image
image
image


Last Week’s Most Interesting News

  • CMS says its latest round of ICD-10 claims submission tests indicate that it’s ready for the October 1 switchover.
  • The VA awards Systems Made Simple and Epic a seven-year, $624 million contract to implement Epic’s Cadence patient scheduling system.
  • Banner Health confirms that it will convert its acquired University of Arizona Health Network from Epic to Cerner.
  • Health Catalyst shuffles its executive team in what appears to be preparation for an IPO.
  • CVS announces plans to extend its telehealth reach via pilot projects with American Well, Teladoc, and Doctor On Demand.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Announcements and Implementations

image

Providence, RI-based Sproutel will introduce Jerry the Bear in September, a “smart teddy bear” that gives kids a medically validated curriculum for diabetes and other chronic conditions. They learn by feeding Jerry a healthy diet, matching insulin doses to carb intake, administering insulin, and listening to Jerry describe how he feels when his blood sugar is high or low.

Twenty-five bed Aspen Valley Hospital (CO) will implement Epic through Denver’s University of Colorado Health.


Technology

image

A former Arizona State University rugby player who suffered an on-field concussion develops FITGuard, a smart mouthpiece that uses a player’s medical history and the measured force of hits to the head to light up concussion warnings. The connected app then automatically walks coaches or medical personally through a concussion assessment to make sure they get medical care if warranted.


Other

image

The Madison, WI paper predicts Carmageddon-level traffic this week as Epic’s user group meeting brings in 9,000 visitors and local schools begin classes on Tuesday. It’s going to be warm in Verona, with highs near 90 each day and high humidity.

Yelp, which will now feature more information about hospitals, admits that it’s hard for the company to manage Internet shaming that poses as reviews, such as those reviling the dental practice of lion-shooting dentist Walter Palmer by non-patients (removal of which triggered a free speech protest despite their irrelevance to his dental capabilities) and a “review war” of Democrats vs. Republicans on the Yelp page of a pizza restaurant whose owner was photographed hugging the President. The insightful article predicts the creation of a “shame economy,” where consumers threaten business with negative reviews and businesses hire reputation management firms to fight them. Yelp claims it, too is a victim since it’s at the mercy of user-generated content, but it didn’t complain about making money for doing little more than creating a platform for free contributions.

Bankrupt Hutcheson Medical Center (TN), which re-opened its closed OB unit this past December with fancy hardwood floors, Wi-Fi, HDTV, and iPads, shuts the unit back down again after the upgrades failed to attract enough business.


Sponsor Updates

  • The SSI Group and TeleTracking will exhibit at the California Association of Healthcare Admissions Management event through September 2 in Sonoma.
  • Surgical Information Systems recognizes clients and partners including Abington Health (PA), Robert Wood Johnson Health Network (NJ), Susquehanna Health System (PA) and CapsuleTech with its Perioperative Leadership Awards.
  • T-System will exhibit at the 2015 GHIMA Annual Meeting September 2-4 in Jekyll Island, GA.
  • Recondo Technology integrates its BenefitPlus patient estimation tool with Epic’s Benefit Collector, increasing point-of-service collections by an average of 12 percent in a multi-state health system.
  • The Children’s Home Society of Missouri honors TriZetto with its Visionary for Children Award.
  • Valence Health releases results from its annual US Attitudes Towards Health Insurance and Healthcare Reform survey.
  • Forbes ranks Verisk Analytics the 18th most innovative company in the world.
  • Vital Images will exhibit at HIMSS AsiaPac15 September 6-10 in Singapore.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
August 29, 2015 News 11 Comments

Morning Headlines 8/28/15

August 27, 2015 Headlines 2 Comments

ICD-10 Medicare FFS End-to-End Testing: July 20 through 24, 2015

CMS publishes the latest results from ICD-10 end-to-end testing: 87 percent of submitted claims were accepted, while the remaining rejected claims were attributed to submission errors. There were zero rejected claims associated with CMS systems issues.

Insurers Win Big Health-Rate Increases

Despite assurances from the White House that insurance premiums would remain stable, several states have approved 2016 premium hikes running as high as 36 percent to cover the cost of insuring a higher mix of sick ACA patients than initially anticipated.

A Blood Test and App May Help Identify Patients at Risk of Suicide

Researchers at the University of Indiana School of Medicine and the Indianapolis VA Medical Center have created an app-based mental health survey that, when combined with recent blood test results, can predict a patient’s likeliness to experience suicidal ideation within the next year with a 92 percent accuracy rate.

Administrative Investigation Improper Use of Web-based Collaboration Technology Office of Information and Technology

The VA OIG finds that VA employees, including its former CIO, had been inappropriately using Yammer, an online messaging and file-sharing system without formal VA approval or monitoring.

View/Print Text Only View/Print Text Only
August 27, 2015 Headlines 2 Comments

News 8/28/15

August 27, 2015 News 6 Comments

Top News

image

CMS provides results from its July round of ICD-10 testing in which no claims were rejected due to CMS software problems. Around 2 per cent of submitted claims had invalid ICD-10 codes, less than the number of claims that had incorrect ICD-9 codes. It’s important to note that the overall 87 percent claim acceptance rate includes claims that were submitted with intentional errors just to make sure CMS would kick them out. Also, the claims originated in test environments, which created errors that would not have occurred in real life.


Reader Comments

From Beltway Bandido: “Re: VA and Lockheed/Epic. I hear from talking to multiple groups that there’s a real risk to the success of the VA’s MASS scheduling system. Mainly concerns about the program’s long-term viability and the risk of adding a best-of-breed bolt-on for scheduling vs. a wholly integrated solution. Somewhat related, I’ve heard that the Coast Guard’s move to InterSystems for interoperability could be a transitional play as they downshift away from Epic. Lots of moving parts in DC right now.” The VA’s very existence was threatened by their appointment wait time scandal, so they had to fast-track their selection of a commercial solution even though, as is nearly always the case, the problem was caused by the VA’s people and the incentives provided to them rather than their technical tools. The VA neatly sidestepped Congressional demands for firings, reorganization, and funding decreases by simply throwing its scheduling system under the bus and signing up for Epic. I don’t know what it will take to compartmentalize Cadence to run without any other Epic apps and then integrate it with the VA’s systems, but I do know that standalone healthcare scheduling systems have fallen by the wayside given the need for integration. It also seems that $624 million is a lot to spend for automating a single function, but then again both the VA and DoD are used to squandering mountains of taxpayer money on systems that are often failures in every way except as never-ending revenue streams for the chosen contractor. Epic now has a foot in the VA’s door should it ever decide to part ways with VistA. The other unspoken aspect of both the VA and DoD is that a lot (most?) of the care received by current and former service members is delivered by the private sector using non-government IT systems, creating a big information flow problem no matter which systems are used internally. I’ve often argued that the VA’s hospitals and clinics should be closed or privatized since it seems unnecessary to run a separate domestic healthcare system for civilians whose history includes military service, as long as their special needs are recognized and accommodated (which even the VA struggles to do).

image

From Lavosh: “Re: VA scheduling announcement. How did you get the information before anyone else? Leaks?” There were no leaks, but readers tipped me off that the announcement would be made that day and also provided the unstated major point that Epic is the subcontractor. I try to deliver only three things via HIStalk: (a) well curated and highly condensed news; (b) ideas that someone might use to create or improve something in healthcare; and (c) occasional entertainment.

From Beefy Goodness: “Re: healthcare IT contract gag clauses. I saw proof they exist in an online summary.” Of course they exist – any of us who have signed contracts on behalf of hospitals know they are common. You could have looked them up in CapSite’s database of signed contracts (obtained under Freedom of Information Act requests) until HIMSS bought that company in 2012. The most restrictive, controlling, and sometimes irrational terms I’ve seen were in Epic contracts, copies of which are almost impossible to get since Epic tells customers to forward any FOIA requests to its attorneys to be fought tooth and nail (or at least that used to be the case). The important aspect to note is that clients sign the contract willingly and knowingly, so any muzzling is voluntary and nobody else’s business. Still, I’ve always been amazed in looking at contracts from all vendors that hospitals don’t negotiate well and just accept the vendor’s favorable boilerplate.

image

From HIT Wannabe: “Re: CHIME. So disheartening to come across this tweet. Aare they so hurting for cash that they are willing to go to any lengths on social media for a vendor? Forget that this vendor’s solution isn’t certified for any of the leading EMRs used by CIOs that follow CHIME.” Tweeting a link to a vendor’s promotional material is a pretty lame thing for a non-profit member organization to do. The vendor in question is equally stupid – they require anyone interested in their crappy white paper to provide 15 data fields of information, some of which are maddeningly clueless, like asking which industry the requestor works in (maybe they get a lot of hospital white paper requests from people in the mining and entertainment sectors.) CHIME is apparently in cahoots with a big media company and is now shilling for it, judging from some of its tweets. I feel equally violated when I get webinar and white paper spam from HIMSS, to whom I’m paying dues for the privilege of having them pimp out my electronic access to any willing vendor.

image

Speaking of CHIME tweets, this one about the AMDIS Fall Symposium showcases either atrocious spelling or keen wit.


HIStalk Announcements and Requests

I’ve been frustrated for months with iPhone charging problems. The Lightning socket seemed to be loose, forcing me to use one specific cord (of the handful I have) and wiggling it just right. Googling seemed to indicate that the most likely problem was gunk in the port, so I dug around with a toothpick even though I couldn’t see anything in there with a flashlight. I figured I needed a socket replacement since it seemed quite loose, but the Genius Bar guy at the Apple Store fixed it by doing what I had tried only more professionally — he used a small tool to clean the port out and then blew it clean with canned air. The looseness was caused by the cable not being able to seat itself. He also cleaned out the microphone and speaker holes that were stopped up. This is apparently a frequent, gender-related problem caused by guys like me who carry their phones in linty pockets.

This week on HIStalk Practice: HelloMD CMO Perry Solomon, MD explains the company’s pivot from telemedicine to digital health for medical marijuana. The FSMB relaunches Docinfo database. Jaan Health secures $1 million for its Phamily care coordination platform. Arete Urgent Care goes with DocuTap tech, while The Iowa Clinic selects VirtuMedix for telemedicine services. Texas physicians just can’t catch a break. DuPage Medical Group CEO Mike Kasper details the impact BCBSIL claims data will have on patient care. Telemedicine comes to Ghana cocoa farmers. Patchy EHRs could be Precision Medicine Initiative’s biggest stumbling block.

This week on HIStalk Connect: Google shuts down its Google Flu Trend project, but will continue to provide public health researchers with access to its data. Bayer unveils the second class of startups to join its Berlin-based Grants4Apps accelerator program. Researchers with UC San Diego develop a fish-shaped microrobot with forward propulsion and sophisticated remote steering capabilities. Cambridge, MA-based PillPack raises a $50 million Series C funding round to expand its online pharmacy and add brick and mortar locations.


Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

image

Medical Specialties Distributors acquires VerbalCare, whose app allows inpatients to communicate with nurses.


Sales

image

Adventist Health System (FL) chooses MyRounding’s patient feedback collection tool.


People

image

Ted Schwab (Strategy&) joins Huron Healthcare as managing director.

image image image

Health Catalyst hires Dan Strong (Control4) as CFO, moves co-founder/EVP Tom Burton from product development to client operations, and promotes Dale Sanders to EVP of product development.

image

Jim Pesce has retired from McKesson Enterprise Information Solutions after over 50 years in healthcare IT. Industry historian Vince Ciotti provides this review of Jim’s career: “Jim started his career in the mid-1960s with GE’s Medinet product in Boston – he actually had Larry Polimeno of later Meditech fame working for him as a night-shift computer operator. He went to McAuto in the 1970s, where he ran implementations in their Northeast region. He left McAuto for Micro Healthsystems in NJ, where his major mistake was to hire me to head up sales of their MedTake bedside system – I failed miserably! Graham King took over Micro after leaving SMS and the two of them then went to McKesson when it acquired Microin the late 1990s. Graham sent Jim to Charlotte to shut down the failing Paragon project in 2001, but Jim was so impressed by it he went back to Atlanta and told Graham they should save it. Graham said OK, then you head it up. The rest is HIS-tory.”


Announcements and Implementations

CVS will expand its in-store telemedicine capabilities and is working on pilot projects with American Well, Doctor On Demand, and Teladoc.


Government and Politics

image

CMS announces that William Rogers, MD, director of its physician regulatory issues team, will serve as its ICD-10 ombudsman.

image

The White House has always downplayed concerns that insurers would jack up rates following implementation of the Affordable Care Act, but state regulators are approving big increases that include a 36.3 percent hike by BCBS Tennessee and a 25.1 percent jump for Kentucky Health Cooperative. Experts say insurance companies bid low in the first two years of the ACA but have incurred losses because enrollees were sicker than they expected. Everybody else, being wary of insurance companies, assumes it’s just greedy business as usual. So much for “affordable.”


Privacy and Security

A KPMG survey finds that 80 percent of healthcare organizations have experienced at least one cyber breach, but the survey’s methodology is too shaky to earn the big headlines it’s getting: (a) only 223 healthcare executives responded and the method of their selection was not stated; (b) the survey mixed providers and payers, with fewer than half of respondents working for non-profits; (c) seventy percent of respondents were from companies with more than $1 billion in revenue, meaning either large health systems or large vendors. Perhaps the lack of a valid respondent cohort is responsible for the survey’s most questionable finding – employees (via theft, breaches, and negligence) came in at only #3 on the list of greatest vulnerability concern despite the fact that nearly every large healthcare breach is caused by successfully phishing employee emails.

image

The VA OIG finds that VA employees are using the Yammer collaboration tool without approval, to the point that its former CIO broke the VA’s rules in conducting an open chat using the Microsoft-owned platform. OIG notes that the Yammer setup had no defined administrator, the access of departed employees wasn’t removed, it encouraged employees to break VA policy by sharing files, and it gave employees a convenient way to waste time much as they would using Facebook. The report says the Yammer “network” was created inadvertently when the first VA employee signed up for it using their @va.gov domain without approval. The VA had considered buying an enterprise license before Microsoft bought the company, but said it wasn’t worth $30 per seat.


Technology

Microsoft announces that Windows 10 is running on 75 million devices just four weeks since its release. My experience has been perfect since I had to get an expert to fix the networking DLLs that were trashed in a Windows update. I can’t say Win10 has changed my life, but my laptop seems to run more smoothly with lower CPU and disk utilization and some of the app replacements (the Edge browser and whatever the new media player is called) work much better.


Other

image

image

Fast Company profiles Zoom, an ambitious, design-focused company that has expanded from walk-in clinics to offering full medical care and insurance from 28 locations in Portland, OR. The company focuses entirely on tech-savvy young people in offering its lifestyle product, saying that “one of the weaknesses of healthcare is trying to be all things to all people.” Founder Dave Sanders, MD admires Apple’s philosophy of not letting someone else control the user experience, saying that “we have to own you” as contrasted to the fragmented, wholesaler-like approach of health systems.

North Shore-LIJ Health System (NY) posts patient survey-generated ratings of its doctors online.

A study finds that medical students who were asked to evaluate their instructors rated a fictitious one, not noticing that the instructor name and photo were unrelated to their coursework. The authors conclude that basing faculty promotions and course design on student evaluations is probably not a good idea. Perhaps they will next look at how patients review doctors and hospitals.

image

Weird News Andy headlines this article“Suicide prevention? There’s an app for that.” Researchers find biomarkers that when used with a mood questionnaire, can predict suicidal thoughts with 90 percent accuracy. Most interesting is that the questionnaire alone was 80 percent predictive, but just the blood analysis by itself was correlated with suicidal thoughts with 70 percent accuracy. However, WNA questions the results of a researcher who, judging from the photo, “is apparently not wise enough to close a freezer with valuable samples inside.”


Sponsor Updates

  • Medicity offers “Keeping the Data Thieves Away.”
  • Wolters Kluwer Health will exhibit its Health Language solutions at Epic UGM next week.
  • Hayes Management Consulting posts “The Imperfect Checkout Process: 6 Steps to Enhance Patient Experience.”
  • MEA/NEA offers “How to Encrypt Email Attachments, and Why You Should.”
  • MedData posts “The ABC’s of ICD-10: Comparing ICD-9 to ICD-10, Code Structure and Organization.”
  • Navicure offers “The Importance of Price Transparency – and How to Achieve It.”
  • Nordic publishes “Super users forever! Setting up an Epic super user program and keeping it running.”
  • NTT Data offers “The Transition to Data Science Architecture.”
  • NVoq asks “Are you ready for ICD-10? SayIt can help!”
  • Orion Health oposts “The Role of Open APIs in Healthcare Interoperability.”
  • Patientco offers “Consolidating Patient Payment Channels for Revenue Cycle Success.”
  • PatientKeeper writes “Big Data, Big Company, Big Possibilities.”
  • PatientPay releases a video showcasing its services (and Sharpie prowess).
  • PerfectServe offers “Patient Centered Medical Home model – Rewards of a successful transformation.”
  • PeriGen’s PeriCalm CheckList is named a finalist in the Annual Innovations in Healthcare ABBY Awards.
  • Phynd Technologies offers “The Differences between Phynd’s Unified Provider Management Platform and a Data Warehouse.”
  • PMD offers “It Takes a Village: Shared Accountability in Patient Care.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
August 27, 2015 News 6 Comments

EPtalk by Dr. Jayne 8/27/15

August 27, 2015 Dr. Jayne 2 Comments

clip_image002 

For the last several months, people have been asking me what I think is going to happen on October 1. Will vendors be completely ready? Will customers have time to take upgrades and patches? Will users have enough time to test and practice new workflows as well as learning new documentation standards? Will things come to a screeching halt? Or will it be like Y2K and turn out to largely be a non-event?

I’ve been telling them that I think the majority of systems are going to be ready, but I think that there will be some glitches. Although I don’t anticipate complete chaos and the breakdown of civilized medicine, I have been recommending to my small practice clients that they should prepare for delays in cash flow and consider having access to a line of credit to cover expenses if there are lags in payments. I’ve helped most of my clients develop business continuity plans so they’ve already thought through various scenarios and it’s just a question of applying ICD-10 problems to existing plans.

Larger practices, especially those owned by or affiliated with hospitals and health systems, appear to be pretty well prepared. Several that I’ve worked with have fleets of staffers dedicated to ICD-10 preparedness, from coders and compliance officers to EHR trainers. Nevertheless, most of them have increased the amount of cash they have on hand. They have also prepared to bring on extra staff to help them power through the glitches through a combination of manual data entry and brute force if it is needed.

All of the groups I’m working with have come to accept that the odds of a delay or reprieve are miniscule. I’m encouraging them to be cautiously optimistic but to continue preparing and drilling. There are so many moving pieces in the medical billing process and so many different systems and vendors involved. Although a practice might be prepared, what if their billing clearinghouse drops the ball? Or what about failures on the payer side? There are bound to be glitches.

Unfortunately, there will also be catastrophic failures. I came across one of those situations today when I received a frantic phone call from a prospective client. They’re using a specialty-specific EHR that started behaving erratically this week after turning on the ICD-10 dual-coding functionality. Apparently the system didn’t have the level of code mapping they anticipated, but it wasn’t discovered before it went live because they didn’t thoroughly test it.

They are unable to revert the feature and were told by the vendor that they need to very quickly do a code mapping and setup project. Due to the number of providers, the complexity of the build, and the skills of the IT support team, there is no way the practice can fix it in time for ICD-10, let alone fix the issues they’re currently facing.

Several of the problems are patient safety issues. On a pediatric chart, selecting a simple diagnosis of sore throat in ICD-9 is recording an ICD-10 diagnosis for Ludwig’s Angina, which is not only uncommon in children but also life-threatening. Needless to say, the physicians are struggling and the practice is in full freak-out mode. Although I’ve not worked with this specific system, I told them I was willing to take a look under the hood and see if I could help.

I had to wake up my database guy early on a Sunday morning, but luckily he’s always up for a challenge. After a couple of hours of massaging the data in their test system, we put together a plan and the client agreed to our proposal. We extracted the data from the relevant tables and I’ve spent most of the day comparing it to the CMS General Equivalency Mapping data. Our goal is to very quickly identify the data that is correct and stage it against their historical diagnosis patterns. We’ll validate their most frequently used diagnoses first and load it back into the system in batches every night. Then we’ll work our way through the rest of the data in order of frequency of use.

Although we can’t turn the dual coding feature off, we’ve completely wiped out the ICD-9 to ICD-10 crosswalk so that they can at least code without fear of adding incorrect data to their charts. Once we start adding data back in, if there isn’t a clean ICD-9 to ICD-10 map, they just won’t get an ICD-10 code. I was able to juggle some of my other commitments and hope to be ready to test the first batch of data later tonight. In the mean time, we’ll have a contract coder going through the charts where ICD-10 codes have already been applied, suggesting corrections as needed.

Due to the volume of codes that we need to examine and the premium they’re paying me to do it quickly, I’ve been chained to my laptop most of the day. I see code tables when I close my eyes and I’ve started to feel like an ICD-10 apocalypse might be on the horizon. I found some tips from AHIMA on how to survive such an event.

Do you have your medieval mace and leather armor ready? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
August 27, 2015 Dr. Jayne 2 Comments

Morning Headlines 8/27/15

August 27, 2015 Headlines No Comments

CVS Health to Partner with Direct-to-Consumer Telehealth Providers to Increase Access to Physician Care

CVS announces that it will partner with three national telehealth vendors, American Well, Teladoc, and Doctor on Demand to offer remote visits to patients and to connect its MinuteClinic providers with specialists available for real-time consults.

Fusing Randomized Trials With Big Data: The Key to Self-learning Health Care Systems?

A JAMA article proposes that randomized control trials be fully embedded in EHRs, including functionality to support identifying trial participants, facilitating enrollment, and randomly assigning a treatment.

Recommendations for a National Medical Device Evaluation System

An FDA workgroup tasked with evaluating the agencies approach to post-market surveillance of medical devices publishes a final report recommending that a national, integrated network of registries be established, wherein each registry would be tasked with gathering post-market data about a certain device.

Medicare ACOs Provide Improved Care While Slowing Cost Growth in 2014

CMS publishes ACO performance data for 2014: total Shared Savings Program savings remained flat at $804 million, while Pioneer ACO savings climbed 24 percent to $120 million.

View/Print Text Only View/Print Text Only
August 27, 2015 Headlines No Comments

HIStalk Interviews Richard Helppie, Chairman and CEO, Santa Rosa Holdings

August 26, 2015 Interviews 4 Comments

Richard Helppie is chairman and CEO of Santa Rosa Holdings, chairman of Sandlot Solutions, and founder and managing partner of Vineyard Capital Group.

image

With Meaningful Use implementations winding down, ICD-10 almost done, and the Department of Defense EHR bid issued, is the industry poised to contract?

No. The reason would be — anticipating your follow-up question of “why is that” — I sense that healthcare pivoting to business needs now away from some of the forced march on regulation. That is a ripe opportunity.

Which of those business needs will create the most need for products and services, such as consulting?

On the provider side, you have legacy and very well-run organizations that are designed around fee-for-service and volume. They have been constructed in the way that the business is organized, the way people are trained, the way that their IT systems are designed and deployed, and have been around fee-for-service. Those systems are mostly passive. They’re mostly tabulation systems. They wake up when there’s an admission or a registration, then they count stuff or they move a little bit of information around.

Then you have this other tower over here on the payer’s side that is also set up just for fee-for-service. It says, "Gosh, you shouldn’t have done that service that you want a fee for or maybe you should have done another service." But again, those systems — pre-authorization and registration aside — wake up when there’s a claim, then they do their thing and try to process it.

When I talk to CEOs in this industry, on both the payer and provider sides — which as you know are coming together — I pose this question to them. I ask them how many employees they have. The last one told me he has 28,000. I say, “You have 28,000 people today coming to work who don’t really know it, but they’re doing fee-for-service medicine.” One hundred percent of the time, I get the nods. “Yes, that’s exactly what my problem is.”

You’re going to see very rapid change in the next few years. I’m very excited to be part of it at this stage.

Hospitals have performed poorly in doing what’s now expected of them, managing costs and health. Will they be able to change their direction and stay on top or will new competition overcome their money and influence?

This will sound like I’m avoiding the question, but I’m not. The answer is “and both.” When you think about what that healthcare enterprise of the future is going to look like, you’ve got to have hospitals and facilities to put the very sick and the very injured in. You need to have a well-developed physician network. You need to have some kind of risk-bearing entity.

Those components are going to come out of the traditional, hospital-centered health systems who have evolved their businesses a lot in the last couple decades. Some will come out of physician groups, some will come out of payers, and certainly there’s going to be new players. As you turn to IT and you think about the confluence of those factors along with the change in the payment methods and the availability of technology, there’s going to be new players out there on the frontier for both care delivery and technology.

I’m sure other folks have views on this, I look at it around that adage that IBM didn’t invent Google. They were the largest computer company in the world. Why didn’t they invent Google? It went against their old business model. You’re going to see some of that in care delivery, in risk management, and certainly with IT.

What factors determine which technology startups will have the best chance to succeed?

It’s always going to come down to scale. Scale is going to come from distribution. Distribution is going to come from dealing with that very specific business issue.

By way of example, you see some things on the periphery that I don’t think are going to work. Somebody made a little app for the Apple watch. You say, "How big can that market be?" Well, first of all, how many people are using an Apple product versus an Android product? How many people are going to buy the watch? How many people are technologically adept to do that? It getting smaller and smaller. You go, that’s going to be an interesting project, it’s going to contribute to the body of experience and body of knowledge that we have as an industry, but it’s not going to be something ubiquitous that’s going to move the needle.

The frontier is about true interoperability. Many people have said that we have mountains of data, but what we don’t have is interoperability. We have folks that have business models that aren’t built for that, both folks that are using those systems — the traditional healthcare industry participants — as well as the vendors. Both of those have been in a fee-for-service type of mentality, so it’s not in their business model to go to interoperability.

People want to talk about interoperability. They talk about bi-directional. Interoperability is omni-directional. It’s not planned interfacing. I’m Vendor A and I’m going to go communicate with Vendor B and vice versa. Interoperability is this: I use my systems, you use yours, and our information is translated seamlessly and it’s done in real time.

The operative question that I like to ask when it comes to interoperability is this. The person you love the most is in front of the doctor. What information do you want the doctor to have? What do you want the doctor to have to do to get that information?

That’s what we have to be driving toward as an industry. Long way around, when I think about things that are going to be very successful in the future, they’re going to address that question of making all that data interoperable and in a contextually relevant way and serving it up where it does the most good, which is at the point and the moment of care.

I asked Grahame Grieve what his one wish would be for interoperability and he said it’s that clinicians would consider it a clinical problem and apply the same level of enthusiasm as the IT people. I also asked him who creates the demand and incentive for sharing data and he didn’t have a clear answer.

First of all, I love the quote. I think he’s really on to something. That’s a terrific insight.

You’ve got two questions there. Looking at it as a clinical issue, I’m chairman of a company called Sandlot Solutions, arguably the best interoperability play in the industry today. One of our physicians, who’s been a pioneer in it and is a GI doctor, says this is the most important invention in the time that he’s been practicing medicine, and he’s well into his 60s. He goes through all the different medical devices. It comes down to, when he goes to treat a patient, he knows about them.

One of his many stories is a fellow coming into get polyps removed form his colon. He’s a Medicare patient, very well organized, and he hands the physician a list and says, “Here are all the meds I’m on.” The doctor, because he’s on Sandlot, looks in his own EMR, and he says, "Hmm, I’ve got something here that says you were put on Coumadin two weeks ago, the blood thinner." He says, "You’re right. I forgot to add that to my list." That is a medical disaster avoided because of interoperability. Even well-organized patients don’t do a great job of transferring that information. I’m above average at it and I don’t do a great job at it. I’m not an MD or a DO.

That’s where the demand can come from. From doctors saying, give me a full suite of information, a full payload, and give that to me at the point and moment of care. Give it to me in my workflow. Give it to me within my EMR. You guys quit fighting. I don’t care what enterprise it came from. I don’t care what brand of system sourced it. I want to be able to know where it came from, but I don’t want to go find it. I don’t want to have to go look in five or six places for it, which is what a lot of this first wave of so-called interoperability did.

Now to your second part of your question, which is how do you get people to participate? My experience in doing this now for almost four years is that everybody wants to be first to be last. Let me explain that. If you go to any provider in Memphis and you say to any provider, we want you to connect to a system that has all the other providers in town seamlessly moving information around. Right in your EMR you’ll get all of the data from the other folks within your enterprise, and within your affiliations, and with any public health data we have. It will be delivered into your EMR in the format you’re used to looking at it.

In exchange, as you treat this patient, within the consent laws, your information will be shared. One hundred percent of people would agree to do that. That’s the barrier right there.

It’s less about incentives and more about leadership. There are some good stories forming out there about leadership, so back to your first point, who creates the demand? It’s going to come down to leadership in our industry.

What did you think about the DoD contract and what are your thoughts on how Leidos will execute it with Cerner and the other partners that are involved?

It was a very thoroughly vetted process. They certainly had the right players that were going down the stretch drive.

Everybody in the industry wants to see them be successful. We don’t want some of the fits and starts like we’ve seen in the NHS experience. I just hope that they go about it in a methodical way and create value along the way.

I do hope that they have an open mindset and enough openness in the architecture to connect to the information systems stacks that are out there. I hope that we’re able to demonstrate better healthcare for our veterans and our service men and women.

What does the future hold for Allscripts, Cerner, Epic, and Meditech?

Individually, clearly Cerner, Epic, and Meditech are the three that we see in the market doing well. All are vigorously competitive. All three have very substantial customer bases. They all have their very loyal fans. They all have the ability to engineer and deliver product. 

It’s going to be the ones that operate in conjunction with all the other technology out there are going to be the most successful. Again, I’d go back to the IBM-Google type of dynamic that is coming up in our industry.

This industry needs to start paying today’s price for IT. That’s not client server, that is cloud. Secure, private cloud, not just random cloud because of the privacy and security that we have. When those players — the major ambulatory and physician-based vendors — are truly operating in an interoperable world, open to the other data sources and places they need to provision data, especially down to the patient level, I think they’ll all be very successful.

All three of those companies are going to be part of the fabric of the next wave of healthcare. There will be other technologies that will leverage them and make them even more value, but all three of those are going to do rather well.

IBM is doing a lot with Watson. Will precision medicine have a significant impact on healthcare or is IBM just trying to find a lucrative market?

Time will tell on that. It’s a grand scheme and I’m wondering how they can bring it down to a granular level.

You asked at the top of our conversation if things were going to stall and I think not. Business requirements are going to drive IT. The question will be whose business requirement is going to bite off something that big, that complex, that far out on the edge, and that unproven?

I hope that they can move the needle and we get the best research driven to the point of care, but I see that there’s a gap between the demands of the market that I see arising today and the power of what may — but isn’t guaranteed — to come out of that collection of that technology. I think we have to wait and see.

Along those lines, NantHealth is investing a lot of money to nibble around the edges of healthcare IT. Do you think they are for real?

It’s an interesting collection of point solutions. Period.

Have you seen any startups that will be able to work their way into the enterprise?

Let me tell you what we haven’t seen. I don’t see anybody out there that is necessarily the silver bullet. I think what the industry is driving for right now is meaningful information in a contextually relevant way – both in the clinical setting and in the management of risk — and in dealing with the financial case. This is something that goes beyond the boundaries of the enterprise.

The way I look at it, there’s a continuum of that data capture. On the back end is analytic reporting. We have a number of analytic companies that are doing quite well, but they’re analyzing data that’s really bad. Healthcare has been accustomed to having data that is incomplete, developed for another purpose, and old. But now we have on one end of the spectrum analytic companies developing reports around that. Now we have better reports on really bad data.

I’ve been in the IT business 41 years and it’s still garbage-in, garbage-out. We see now the awakening for, "Let’s get to better sources of data." If one end of the spectrum is analytic reporting, the other end — the front end — is the interoperability, the capture, the curation, the collection, and the merging together of data, both at a patient level and at a population level. Between those two points, you have care coordination, referral management — both being done in very archaic ways — and care management for your chronically ill patients.

That’s the continuum that I see. I see a lot of work being done on the analytical reporting end, though I do see the folks that have been using those awakening and saying, "We’ve got better reports, but we still don’t have very good data." That’s what we have to do as an industry — connect from that source during that workflow of that actual patient encounter back through the big data analytics.

What should small companies know if they’re going to succeed in healthcare IT?

Innovation comes before standards. We have people that chase standards and regulation, and if standards ever did what they should do — which is make things cheaper and faster — it would work, but they rarely do.

I would encourage them to look more at innovation and look at a business reason for doing something versus trying to define a standard or drive a regulation and then answer that. That would be my advice to them — innovation before standards. Standards should fall out of innovation, not innovation being driven toward a standard, because we don’t know exactly how we’re going to get there.

Do you have any final thoughts?

We have a very important mission to do in healthcare. It’s not only demographic with the aging of the country, but it’s also very personal. Ultimately, this is the system that will take care of us and our loved ones. We need to make sure that we do a great job so that we have the best healthcare system possible.

View/Print Text Only View/Print Text Only
August 26, 2015 Interviews 4 Comments

Morning Headlines 8/26/15

August 25, 2015 Headlines 3 Comments

Medical Appointment Scheduling System (MASS)

The VA awards Lockheed Martin-owned contractor Systems Made Simple and its software supplier Epic a seven-year contract worth as much as $624 million if all contract options are exercised.

Banner aims to cut costs from UAHN as earnings lag

Banner Health will convert its newly acquired University of Arizona Health Network from its existing Epic systems to Banner’s Cerner platform. UAHN implemented Epic in 2013 at a cost of $115 million.

Pacific Northwest Health Care Organizations Join CommonWell Health Alliance

Five Cerner customers in the Pacific Northwest will begin exchanging health records with local AthenaHealth and Greenway practices through the CommonWell Health Alliance.

Practice Fusion Surpasses 600th Partnership Deal Becoming the Most Integrated Cloud-Based EHR Platform

Practice Fusion announces that it will integrate lab results from Theranos and imaging results from RadNet into its freeware EHR.

View/Print Text Only View/Print Text Only
August 25, 2015 Headlines 3 Comments

News 8/26/15

August 25, 2015 News 1 Comment

Top News

image

image

image

The VA awards its Medical Appointment Scheduling System (MASS) bid to one of its often-used contractors, Lockheed Martin-owned Systems Made Simple, which earns a seven-year, $624 million contract. The software supplier will be Epic, which gives the company a big win following the Leidos-Cerner-Accenture DoD selection. The VA issued its RFP for a commercial patient scheduling system in November 2014 following a nationwide patient wait time scandal. Lockheed Martin acquired the government healthcare IT contractor in October 2014 for an undisclosed price.


Reader Comments

From 4nER: “Re: Optum’s international push. It has dwindled – their UK-based CEO has left, Brazil acquisition Amil is struggling, and Virgin Care has beaten Optum in many NHS bids.” Unverified.

From You Don’t Need a Weatherman: “Re: Meditech. Opinion is they got into ambulatory and Web too late. As sites wait for MU Stage 3 and evaluate their vendors, Meditech is being evaluated by those sites. The timing may be perfect as Web EHR and Acute will be rolling out of 6.X as Stage 3 progresses.”

From Mark Pro: “Re: marketing people. You complain a lot about them. Don’t they do anything well?” As in most professions, the few incompetent, inexperienced, or overworked ones give the others an undeserved black eye. My favorite MBA topic by far was marketing (my second favorite was finance, strangely enough) and I really enjoyed learning about product positioning, channels, how marketing differs from advertising, etc. Marketing done right is education, collaboration, and orchestrating the intersection of product supply and customer demand. What puts a healthcare IT marketing person on my bad side:

  • Putting out incomprehensible announcements that are a BS buzzword tsunami clearly assembled by a roomful of people who are trying to advance their personal company stature rather than create clarity.
  • Expecting instant responses to their banal emails, always “circling back” because I’m too busy doing something important (like writing HIStalk) to respond immediately to their unsolicited questions. Just because you sent something I didn’t ask for doesn’t mean I’m obligated to acknowledge that I received it or to do anything more than hit “delete.”
  • Trying to do everything by committee, bugging Lorre to get on a call with a roomful of their people and then flooding her inbox with emails from each of them asking and re-asking questions she already answered. Usually that happens after they fail to read what she sent them earlier, preferring instead to waste everybody’s time in having it read to them over the phone.
  • Not following my rules, such as checking off the Readers Write submission box that says the article hasn’t appeared elsewhere, but then I find it posted on their company blog (I always Google before I run a guest post). That usually gets them banned.
  • Asking me to interview a brand new CEO (who doesn’t even know where the restrooms are yet) or an executive involved in a product launch (gee, wonder if they’ll say anything controversial?)
  • Not understanding the dynamic that I alone decide what I write, who I interview, or which products or news I consider worthy of reader time. I’m fine with companies suggesting that I interview their CEO, but I won’t allow marketing or PR people to participate. Lorre books most of the interviews for me and warns them upfront, “If he gets on the interview call and people other than the CEO are on the line, I guarantee you he’s going to hang up.” I like that nobody can whine over my head about my decisions – it’s just me, I have a long memory, and I won’t even pretend to like people who annoy me.

The marketing people I consider peers:

  • Are not new to healthcare IT, having paid their dues and learned the business, which probably means they have lost their youthful, chirpy innocence and can communicate as professionals.
  • Enjoy HIStalk and follow it even after they change jobs, often keeping in touch afterward.
  • Offer me what I need instead of what the company wants, perhaps offering to arrange an interview with a customer instead of a company executive who I’d turn down (I only interview CEOs except in rare occasions.)
  • Know not to waste my time with ghostwritten, worthless Readers Write articles that I’ll reject anyway.
  • Apologize when I call out an announcement, a newly rebranded product, or a company action as idiotic – sometimes they agree it’s bad, but explain that were overruled by the empty suits above them.
  • Request and accept my advice about how to improve an announcement, design and promote a webinar, or eliminate obvious mistakes or omissions in their web pages. I don’t volunteer to do that sort of thing, but if if someone asks and then ignores my input, I’m not going to jump at the chance to do them another favor.

HIStalk Announcements and Requests

image

Jenn covered Monday’s post for me since I needed a long weekend, so I told her I’d set up a new poll when I returned. Last week’s poll respondents forced to make a big company investment would choose Health Catalyst by far, followed by NantHealth and Evolent Health. Mobile Man says Nant shows how little even smart people know about healthcare, while JR commented that some of the companies have decent prospects but he isn’t sure you’d get your money back investing in any of them at this point in their trajectory. New poll to your right or here: what will happen following the scheduled October 1 switchover to ICD-10?

image

image

Welcome to new HIStalk Platinum Sponsor Stanson Health, which is also sponsoring HIStalk Practice at the Platinum level. The Los Angeles-based company provides easily implemented intelligent clinical decision support delivered at the point of care. Evidence-based content targets unnecessary tests and treatments while supporting Choosing Wisely and PQRS, while analytics helps organizations understand ordering patterns and identify opportunities. Of particular interest is the company’s advanced imaging content that works with any source of appropriate use criteria to reduce unnecessary imaging, inspecting 30 patient-specific data elements to minimize interruptions while tripling the inappropriate order cancellation rate compared to competitors. Cedars-Sinai Health System is saving $6 million per year after adding Stanson-powered Choosing Wisely recommendations into Epic (example: ordering an antibiotic for a patient with bronchitis issues a reminder that they don’t work for viral infections). The company also understands that patients may resist the “less medicine is sometimes better” message and has licensed content from Consumer Reports to provide them with friendly educational material. Stanson Health was co-founded by Scott Weingarten, MD, MPH (formerly co-founder and CEO of Zynx Health, now SVP/chief clinical transformation officer at Cedars-Sinai) and Darren Dworkin (SVP/CIO of Cedars-Sinai). I notice that Rick Adam is president and COO – he’s been in the industry forever as founder of Recondo Technology and New Era of Networks as well as being an executive in the early health IT days of Travenol (later Baxter). Thanks to Stanson Health for supporting HIStalk and HIStalk Practice.

image

Thinking about Rick Adam sent me to the online archives, where I turned up this exclamation-point filled 1986 THIS ad from Computerworld. I haven’t been able to track down Frank Russo, who took the company through a few more gasping iterations before turning the keys over to Jeff Goodman, who was axed after the company was sold to HBOC in 1994.

image

Mr. S wrote that his third grade class in Herminie, PA benefited from our contribution of STEM learning material (with matching funds from Chevron) just as the school year ended, giving his students new materials to master tricky topics that had come up through the year. He adds, “It is very important to give students every means possible of succeeding in life. Not every child learns the same way and not every child is interested in the same topics. These materials have allowed my students to succeed in my classroom in new ways and new topics. Thank you for caring about education and specifically caring about my classroom!” I still have matching money available from a generous vendor executive for companies that would like to contribute to other DonorsChoose projects via HIStalk now that the new school year is underway.

image

Also from my DonorsChoose project, Teach for America teacher Ms. S in Illinois, who offers an extracurricular programming class that tries to boost the numbers of female, black, and Hispanic students interested in technology, says her kids responded with “soooo cool!” to see the MacBook accessories we purchased (SuperDrive, external hard drive, case, and cables). Our funding of $264 paid for the entire setup plus the optional donation to DonorsChoose.


Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Frank Poggio and Vince Ciotti delivered another brutally honest and opinionated HIStalk webinar on Tuesday, talking about the DoD EHR bid and how it will affect Cerner, Epic, and everybody else. I sponsored this one (meaning nobody paid anybody, in other words) and I’d be surprised if you don’t find it at least entertaining because people who’ve been in the business for a long time like Frank and Vince tend to have lost most of their muzzle and say whatever’s on their mind. If you have a non-commercial, informative, educational message that readers would enjoy, let me know and maybe you can do a webinar of your own.


Acquisitions, Funding, Business, and Stock

Cardinal Health will acquire 71 percent of Nashville-based post-acute care services and analytics vendor NaviHealth for $290 million in cash.

image

Zephyr Health, which offers drug companies analytics to predict new product success using public and private databases, raises $17.5 million in funding led by Google Ventures, increasing its total to $33.5 million.


Sales

image

The fire and ambulance services of Alameda, CA will use the Mediview patient care records, charting, and telemedicine pre-hospital application from Beyond Lucid Technologies.

Legacy Health (OR) chooses StrataJazz Continuous Cost Improvement as part of its five-year renewal for the full suite of Strata Decision’s products.

Missouri Delta Medical Center (MO) chooses PatientMatters for help with patient access, registration, and scheduling.

Vantage Oncology selects Wellcentive’s quality reporting and population health management solution for PQRS reporting.

Phynd Technologies recaps the six health systems that have recently signed for its Unified Provider Management Platform: Cone Health, Mount Sinai Medical Center, Kettering Health, Dayton Children’s Hospital, SCL Health System, and Presence Health.

Abington-Jefferson Health (PA) chooses the Paymode-X network from Bottomline Technologies to automate vendor payments.

Meridian Health (NJ) selects labor management solutions from Avantas.


People

image image

WeiserMazars LLP brings on Todd Heckman (PwC) and Jonathan Stromberger as consulting principals.

image

Northern Inyo County Hospital (CA) hires Kevin Flanigan, MD, MBA (MaineCare) as chief medical officer/COO/CIO.

image

Lisa McVey (McKesson) is named EVP for technology and operations at the newly opened Atlanta office of health improvement technology vendor BioIQ .

image

Thomas Graf, MD (Geisinger Health System) joins The Chartis Group as national director of population health management.

image

Renowned Texas surgeon James H. “Red” Duke, MD died Tuesday at 86. He was an Army veteran, professor, trauma program developer, TV personality, and cowboy folk hero. He treated President John F. Kennedy and Governor John Connally at Dallas’s Parkland Memorial Hospital on November 22, 1963 while a surgical resident. Those of a certain age will remember him from a riveting episode of the groundbreaking 1978-1979 NBC reality medical program “Operation: Lifeline” and his 15-year stint as a nationally syndicated health reporter.


Announcements and Implementations

Cerner and Hospira will further integrate the former’s EHR with the latter’s smart IV pumps using Cerner’s CareAware iBus.

Imprivata launches PatientSecure, the palm vein scanning biometric patient ID system it acquired as part of its April 2015 acquisition of HT Systems. 

Five Cerner clients in the Pacific Northwest will use CommonWell to exchange information with practices using Greenway, Athenahealth, and other systems connected to CommonWell.

Modern Healthcare names its 2015 Best Places to Work, which like every healthcare magazine’s “list” has as its primary objective selling advertising rather than conducting useful, scientifically valid research. Still, I’ll mention those HIStalk sponsor companies so named since (a) they like the recognition; (b) the awards really are driven by employee surveys; and (c) they’re good companies in multiple ways at least from the folks I know from each one: Burwood Group, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Divurgent, Galen Healthcare Solutions, Hayes Management Consulting, Health Catalyst, Impact Advisors, Imprivata, Park Place International, Santa Rosa Consulting, The Advisory Board Company, and The Chartis Group.

Practice Fusion will connect to Theranos for labs and RadNet for imaging in two states, collecting fees from those companies in return for connecting them with its users (that and selling supposedly de-identified patient data and pushing ads at doctors are its main revenue sources). We’ll see some interesting figures if the 10-year-old company ever does an IPO given its suggested market value of $700 million. All of that revenue requires keeping its free EHR users happy, so perhaps the incentives are well aligned for everyone.

image

Medical kiosk vendor HealthSpot will roll out a new Samsung blood chemistry analyzer that will give patients their results for certain blood tests in seven minutes. It’s fascinating how quickly the tedious lab draw and results reporting process is disintermediating, just as dramatically as when lab techs were mostly replaced with sophisticated high-volume instruments, which in return came about because of regulations and when big reference labs convinced individual medical practices to stop running their own labs. With Theranos already doing tests without a doctor’s order in Arizona, the whole process may soon be in the hands of consumers.


Government and Politics

A US appeals court says hotel operator Wyndham Worldwide can be sued by the Federal Trade Commission for allowing hackers to breach its systems in stealing the credit card information of 619,000 customers. Wyndham argued that the FTC had exceeded its powers similar to being allowed to “regulate the locks on hotel room doors,” while the court responded, “Were Wyndham a supermarket, leaving so many banana peels all over the place that 619,000 customers fall hardly suggests it should be immune from liability.”


Privacy and Security

An interesting article (with healthcare consumer implications) says future currency will be data, not money, and everybody’s personal data is being taken by social networking companies whose terms of service allow them to steal photos and files under the pretense of improving their product. The interesting conclusion: perhaps individuals (and patients) should create their personal API that puts the ownership and control of the information back into the hands of the person to which it pertains. The discussion was triggered by new terms of service from streaming music Spotify, which requires users to give the company access to their photos, contacts, and device locations.


Technology

image

A web ad piqued my curiosity about PillPack, a Boston-based online consumer pharmacy that just raised $50 million to expand its reach in offering individual prescription dose packs broken out into time due. The company manages all aspects of the prescription, from packaging and shipping to insurance, and will use its new funding to open brick-and-mortar storefronts and to roll out an app that will connect patients to pharmacists. The founder-pharmacist, described as looking like “the guy who you might buy pot from at a Dead concert,” says, “We should probably hire a finance guy.”


Other

A Tennessee company that runs skilled nursing and rehab facilities is forced into restructuring after implementing an EHR that caused billing delays and cash flow problems that led to its defaulting on a loan. The acting CEO, a partner with the company hired to turn the company around, says he’s seen paper-to-digital conversions cause financial problems across the country.

image

This is an unusual Craigslist ad.

BIDMC CIO John Halamka, MD says that in planning for FY16, clinicians spend too much time documenting in poorly designed EHR tools that were designed for capturing information, not managing customer relationships. He adds that consumer apps have raised user expectations and those will have to be bolted on to EHR transaction capabilities because “the difference between the $2 app and the $2 billion EHR is that the $2 app is easier to use, more convenient, and possibly even more useful.”

image

Phoenix-based Banner Health, which bought Tucson’s University of Arizona Health Network in February and isn’t happy with that organization’s losses, will convert UAHN from Epic to its own Cerner system as everybody expected and will cut $100 million of UAHN’s overhead over the next three years. UAHN spent at least $115 million implementing Epic with a November 2013 go-live, which may be the only case where an over budget EHR implementation caused such significant financial woes that an academic medical center had to sell out to a competitor.

Texas physicians will be paid for school-based telemedicine consultations with Medicaid-enrolled students whose parents have signed consent forms starting September 1. Proponents say it will keep kids in school and parents at work instead of sending them both home, while opponents question why non-Medicaid students are excluded and whether remote physicians will have enough information about the students to treat them properly.

image

Google shuts down its Flu Trends tracker, which got people excited for some reason back in 2008 even though its premise was ridiculous – that it could detect worldwide flu outbreaks by looking at search term patterns in a crude form of big data analysis. Not too shockingly, it didn’t work, and even if it had been able to identify outbreaks, the information would have done little to stop their spread. 

image

Stanford University offers its online-delivered, $3,500 Genetics and Genomics Certificate. Just added to the curriculum is the elective course “Personal Genomics and Your Health,” which can be taken for $495.

image

A bookkeeper of Buffalo, MN-based mammography informatics vendor PenRad Technologies is charged with stealing $700,000 from the company and using it to pay personal expenses and to buy silver bullion bars she stored in her house.

LA County’s second-highest-paid employee made $790,000 in 2014 without working a single day. The former chief medical officer of Harbor-UCLA Medical Center earned the money as a partial settlement after he was fired for unstated reasons (rumored to be related to his medical credentials), sued the county for defamation, then turned down its job offer and retired.

image

New York’s Beth Israel Medical Center wiggles out of a $95 million lawsuit brought by the family of a wealthy heiress who claimed she was detained in a private room for several years solely to extract money from her when the statute of limitations runs out. The lawsuit charged the hospital with keeping the perfectly healthy woman in a $1,200 per day private room while hitting her up constantly for donations, including a $3 million painting the family said she donated under pressure.

image

A state health department in Malaysia is investigating a doctor who posted a photo of herself flashing the peace sign along with a patient in labor whose genitals were fully exposed. The doctor had a reputation for taking perioperative selfies.

It’s not HIT-related, but if you need your spirits raised, check out this video sent over by The PACS Designer of the United States Navy Band performing hits by Frankie Valli and the Four Seasons.


Sponsor Updates

  • ZirMed Chief Data Scientist Paul Bradley, PhD will present at two upcoming big data conferences.
  • PatientSafe Solutions posts “Medication Reconciliation Safety Concerns Linger Even with EHRs.”
  • KLAS’s 2015 mid-year report ranks MModal’s Fluency for Imaging as the highest-ranking front-end speech recognition solution for diagnostic imaging.
  • Black Book Rankings names the Looking Glass enterprise content management system from Streamline Health Solutions as number one in financial management and content management solutions.
  • AdvancedMD offers “PRM Software Capabilities, part 2 of 2.”
  • Awarepoint offers a video on caregiver enablement via healthcare technology.
  • Besler Consulting offers “IPPS Advisor: In-depth review of the FY 2016 IPPS Final Rule.”
  • Bottomline Technologies will exhibit at the California Association of Healthcare Admissions Management event August 30-September 2 in Sonoma.
  • CoverMyMeds Director Julie Hessick is named a finalist for Technology Innovator of the Year at the Next-Generation Pharmacist awards.
  • Stanson Health will exhibit at UHC’s annual conference in Orlando and will participate in its Member Innovation Expo and Reception on October 1.
  • Culbert Healthcare Solutions offers “The Defining Moments Leading Up to ICD-10.”
  • MedCPU takes home the 2015 Interactive Media Award for Best Website in Healthcare from the Interactive Media Council.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
August 25, 2015 News 1 Comment

Morning Headlines 8/25/15

August 24, 2015 Headlines 4 Comments

Inovalon to Acquire Avalere to Drive Strategic Expansion Into Pharma/Life Sciences

Inovalon, a healthcare-focused data analytics vendor, will acquire Avalere Health, a data-focused consulting firm, for $140 million in cash and restricted stocks.

VA’s Backlog of Disability Claims Falls to 8-Year Low

The VA announced this week that its disability claims backlog has dropped 84 percent to 98,000, its lowest point since record-keeping began in 2007.

100 Most Influential People in Healthcare – 2015

Modern Healthcare unveils 2015’s Most Influential People in Healthcare list, which includes: Epic’s Judy Faulkner (#31),  ONC’s Karen DeSalvo, MD (#35), McKesson’s John Hammergren (#73), and Cerner’s Neal Patterson (#99).

July 2015 EHR Incentive Program

CMS publishes the July 2015 Meaningful Use update: 306,000 EPs and 4,400 EHs have attested to MU Stage 1, while 56,000 EPs and 1,500 EHs have attested for Stage 2. $31.3 billion has been paid out to date.

View/Print Text Only View/Print Text Only
August 24, 2015 Headlines 4 Comments

Readers Write: What Do National Patient Identifiers and Donald Trump Have in Common?

August 24, 2015 Readers Write 1 Comment

What Do National Patient Identifiers and Donald Trump Have in Common?
By Catherine Schulten

Over the past several years (decades?), the call for a national patient ID has moved beyond discontented grumblings by hospital CIOs to a hot button topic that has garnered national attention from the likes of CHIME, HIMSS, the US Congress, and practically everyone with an opinion who is involved in healthcare data exchange.

A HIStalk poll conducted 2/8/15 asked, “Should the federal government issue a national patient identifier?” The overwhelming response was yes, as 79 percent said yes while 21 percent said no.

Interestingly, a poll done by the Wall Street Journal asking, “Should patients have unique electronic identification numbers for their medical records?” revealed that 44 percent said yes while 56 percent said no.

Industry leaders who support the use of a national patient identifier point to the use of universal patient identifiers (UPIs) in the UK, Ireland, Canada, and elsewhere. They tout efficiencies gained, increased patient safety, the ability to easily pull together a longitudinal record across disparate systems, lower administrative costs, accelerated medical discovery, and the ability to preserve patient privacy. They also cite patient privacy advocates and the existing ban on any federal funding to study or promulgate a national patient identifier as the reason why no forward momentum on this issue has occurred.

Those opposed to the national patient identifier typically cite two primary deterrents: patient privacy and the role of the federal government in establishing an agency that has the ultimate authority to create, distribute, and manage these identifiers.

But before we get into the pros and cons of each side in this debate, let’s first agree on a few items that seem to be overlooked when we talk about a national patient ID.

First of all, let’s quit calling it a national patient identifier. In practicality, it is actually a national ID. From the moment we are born until the day we die, we all have the potential to be a patient. In all countries that have adopted this type of system, the ID is assigned to the patient by the government at birth. In some cases, not only is this ID used to identify an individual for healthcare purposes, but it is also used when securing other government benefits.

Secondly, healthcare is a service that applies not only to US citizens born in this country, but others who may be here legally or not. Nationalized citizens, foreign visitors, individuals with work or student visas, and even illegal immigrants would need to use the ID. Otherwise, how does one know for sure whether Jean-Luc Picard with an ID and the one without an ID are the same or different individuals? For this design to work, an ID process must be supported for non-US citizens as well.

Back to the question at hand: what do national patient identifiers and Donald Trump have in common?

Both are light on details and heavy on promises. We hear what we want to hear when told that a national patient identifier is the only option that solves for true data interoperability, that privacy advocates and their concerns stand in the way of this enlightened future, and that an ID, once introduced, will be used consistently and accurately.

We seem to forget that HIT systems, no matter how well they claim to be protected, are vulnerable to sophisticated security hacks and low-tech identity theft schemes. We forget that healthcare is a service that anyone can secure even if you purposefully choose to anonymize yourself or — in the case of an emergent care situation — are simply unable to provide identity credentials.

But here’s another way that a national patient ID is like Donald Trump. We are fed up with the status quo. We struggle for a way to achieve the promise of unencumbered health information exchange. We’ve invested millions, more likely billions of dollars into the systems and exchanges that are supposed to support data liquidity and yet we still stumble over the seemingly simple matter of accurate patient identification and record matching. We are fed up and we aren’t going to take it any more! We demand action!

As a result, the promise of a national patient ID takes the spotlight and many cycles are spent touting this concept as the deliverance we need. If only the federal government would get its act together and those pesky privacy advocates would quit proclaiming doom and gloom.

However, the truth – as is typically the case – lies somewhere in between.

A national strategy and design for health information exchange that considers the unique challenges of patient identity and record matching is required. The ability for a patient to manage his or her own credentials if they wish to promote or even prevent exchange is necessary. Ultimately, we need a design that doesn’t rely solely on a set of individual attributes to properly identify or match the patient (I refer to the oft-cited “Maria Garcia in Harris County, TX” study.)

We need visionaries at the table who understand the nuances and challenges and can chart a new path forward. We need to be looking at the role of existing forms of patient identification such as insurance cards, driver licenses, passports, smart cards, and biometrics to assist in the process. National identity standards and concepts such as OpenID and NIST’s Levels of Assurance are paramount to the design. Finally, peer-reviewed pilot studies that reveal the strengths and weaknesses of different approaches will help ensure the best ideas rise to the top.

Catherine Schulten is director of product management with LifeMedID of Citrus Heights, CA.

View/Print Text Only View/Print Text Only
August 24, 2015 Readers Write 1 Comment

Readers Write: Connecting Mobile Health and Alarm Safety Strategies

August 24, 2015 Readers Write No Comments

Connecting Mobile Health and Alarm Safety Strategies: A Guide for Hospitals Managing Mobile Alarms and Alerts
By Mary Jahrsdoerfer, PhD, RN

image

As The Joint Commission’s National Patient Safety Goal on alarm safety inches closer to the January 1, 2016 compliance deadline, hospitals are discovering that long-term, meaningful reductions in alarm-related patient safety risks extend beyond medical device alarms. Although hospitals can satisfy TJC’s alarm safety deadline by presenting a solid strategy for reducing medical device alarms alone, there is an implicit understanding that managing patient monitors and ventilators are only part of a much larger problem related to clinical interruption fatigue.

In addition to medical devices, a comprehensive clinical communications strategy also includes managing the alerts (nurse call, EHR, labs), text messages, and mobile phones/devices that care team members use to facilitate collaboration around any of these patient events. A hospital should certainly follow guidelines that advise changing monitoring leads more often, implementing patient-specific monitoring thresholds, and configuring alarm delays, but these clinical interruptions only target a subset of the overall problem.

Clinical interruptions occur when a nurse continues to receive alarms and alerts while performing a patient-related task that could have escalated to another available caregiver with an integrated platform. The interruption may be an actionable, or even a critical event, but it’s still an interruption if the recipient is unable to respond with the sense of urgency required. Nurses have described frightening scenarios where they were engaged in administering life-saving treatment for one patient while an urgent alarm for another patient blared in the background. This situation could have been easily avoided with automatic escalation of that alarm to the next available nurse.

Preventing alarm collisions requires a holistic approach to managing clinical communications that must necessarily include the full spectrum of patient events. The challenge is integrating each system in each unit without overwhelming clinical users. Assimilation requires collecting input from affected users, measuring alarm and alert activity, and ensuring the right workflow.

The Joint Commission has provided a starting point for hospitals that are serious about reducing alarm-related patient safety risks. Middleware is the foundation upon which medical device alarm management is built — hospitals must utilize an FDA-cleared platform to deliver alarms to recipients on mobile phones. A long-term alarm safety strategy includes integrating all of a hospital’s clinical systems, which will require planning beyond TJC’s NPSG deadline.

The overall goal of TJC’s alarm safety goal is to reduce medical errors as it relates to medical device alarms, but nurses realize that the broader issue of interruption fatigue is a consequence of many workflow and communication inefficiencies. My admonishment for hospitals grappling with the alarm safety mandate, HIPAA compliance through text messaging, nurse call and EHR alert management, and smartphone and mobile phone deployment is to view them as subsets of the same communication architecture that require a common foundation to solve.

Mary Jahrsdoerfer, PhD, RN is CNO at Extension Healthcare of Fort Wayne, IN.

View/Print Text Only View/Print Text Only
August 24, 2015 Readers Write No Comments

Morning Headlines 8/24/15

August 23, 2015 Headlines 1 Comment

Mercy Health expands strategic partnership with Premier to advance population health management

23-hospital health system Mercy Health (OH) announces that it will implement Premier’s integrated pharmacy and care management program in an effort to further improve its population health management initiative.

Docinfo Tool Provides Consumers Physician Licensure, Disciplinary Data

The Federation of State Medical Boards launches an online search tool that presents consumers with licensure and disciplinary information on providers.

FY16 Strategic Planning

John Halamka, MD and CIO of Beth Israel Deaconess Medical Center posts a blog outlining the strategic objectives facing health IT in 2016. On BYOD and the use of apps in care delivery, he says “The difference between the $2 app and the $2 billion dollar EHR is that the $2 app is easier to use, more convenient and possibly even more useful.”

Google to launch life sciences company

Google co-founder Sergy Brin announces that the life sciences team within Google’s X Lab will spin off to form its own stand-alone business unit within Google’s newly created parent company, Alphabet. The new company will be led by renowned biologist and now CEO Andrew Conrad, PhD.

View/Print Text Only View/Print Text Only
August 23, 2015 Headlines 1 Comment

Monday Morning Update 8/24/15

August 23, 2015 News No Comments

Top News

image

Mercy Health (OH) implements Premier’s integrated pharmacy and care management program to advance population health management initiatives at its 23 hospitals across Ohio and Kentucky.


Last Week’s Most Interesting News

  • Practice Fusion promotes Tom Langan to interim CEO, replacing founder Ryan Howard, who will move to board chair.
  • The executive exodus continues at NYC Health & Hospitals Corporation, with Paul Contino departing following an investigation of its $764 million Epic implementation.
  • Gene-sequencing company Illumina forms Helix, a business that will offer free genome sequencing to consumers and then monetize the data by selling portions of it back to patients as they need it.
  • ZocDoc raises a $130 million funding round on a $1.8 billion valuation, making it one of the most highly valued venture-backed companies in New York.
  • Leidos wins a $900 million contract to support R&D efforts within the US Army’s Medical Research and Materiel Command.
  • Epic is selected as the replacement EHR vendor for Finland’s Hospital District of Helsinki and Uusimaa, in a $424 million contract budgeted to grow to $635 million over 10 years.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience.

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

image

San Francisco-based Zephyr Health lands $17.5 million in a funding round led by Google Ventures, with help from existing investors Icon Ventures and Kleiner Perkins Caufield Byers. The med device and biopharma analytics firm has raised $33.5 million since its founding in 2011.


People

image

James Rossiter joins NextGate as CFO.

image

Dawn Van Dyke (The Advisory Board) joins The Sequoia Project (fka Healtheway) as marketing director.

image

Dean Schorno (Adaptive Biotechnologies) joins 23andMe as CFO and head of operations.


Sales

Cone Health (NC), Mount Sinai Medical Center (FL), Kettering Health (OH), Dayton Children’s Hospital (OH), SCL Health System (CO), and Chicago-based Presence Health sign on to the Unified Provider Management Platform from Kearney, NE-based Phynd Technologies.


Announcements and Implementations

image

Cerner shop EvergreenHealth becomes the only hospital in Washington to avoid paying a hospital readmissions penalty for the fourth year in a row. The two-hospital provider achieved HIMSS Stage 6 recognition last month.

NHS facilities in Wye Valley and Salisbury announce plans to move from decades-old patient administration systems to “electronic patient record systems” over the next two years. Wye Valley will spend over $23 million on a system from IMS MSXIMS, while Salisbury NHS will continue spending money with CSC on its Lorenzo platform. CSC has earned a tainted reputation as part of the boondoggle that was the National Programme for IT (NPfIT), which imploded in 2011 due to project overruns, mismanagement,and resultant budget-busting.


Technology

ZeOmega releases an annual clinical content update for its Jiva population health platform.

Validic adds RxRevu prescription intelligence software, including prescription drug delivery options and a price transparency tool, to its digital health platform.


Government and Politics

A 68-page report from the President’s Council of Advisors on Science and Technology determines that more work is needed from federal agencies such as HHS, NIH, NIST, and the National Science Foundation to promote and utilize open standards and interfaces to leverage data analyses for healthcare delivery and biomedical research. The report recommends without a hint of irony that “NIH and HHS should create funding mechanisms that will encourage accelerated deployment, testing, and evolution of translational IT systems for clinical use.”

image

The White House issues a fairly broad call to stakeholders for ideas on how to move its Precision Medicine Initiative forward, outlining 10 potential categories of ways to treat disease and improve health that have precision medicine potential. Feedback is due September 21.

image

The American Red Cross honors female community leaders and volunteers who contributed significantly to the recovery of New Orleans and Louisiana after Hurricane Katrina at its inaugural Power of Women luncheon. National Coordinator and Acting Assistant HHS Secretary Karen DeSalvo, MD was among the honorees for her work as city health commissioner and senior health policy advisor to New Orleans Mayor Mitchell Landrieu from 2011-14.


Research and Innovation

Oregon Health & Science University’s Knight Cancer Institute partners with Intel to launch the Collaborative Cancer Cloud, a network that will enable providers to securely share genomic data for more personalized medicine and tailored cancer research. OSHU plans to go live in the first quarter of next year with two additional cancer centers to pilot the new technology, plus make open source its Trusted Execution Technology to ensure patient privacy.


Other

image

Nancy Snyderman, MD will make her first public appearance since leaving NBC earlier this year when she hosts a discussion next month with New Jersey hospital CEOs during the Princeton Regional Chamber of Commerce Healthcare Symposium. Snyderman left the network after facing criticism for violating a voluntary agreement with the CDC to stay out of public areas after reporting from Liberia during the Ebola epidemic. Keyspeakers.com notes that her speaking fees are nothing to sneeze at.


Sponsor Updates

  • Huron Consulting offers “A Modern Commentary on Medicare at 50.”
  • The SSI Group will exhibit at the 2015 MidAmerica Summer Institute Region 8 August 26-28 in Minneapolis.
  • Streamline Health rings the Nasdaq opening bell in New York City.
  • T-System offers “ICD-10 Leniency from CMS: What You Need to Know.”
  • TeleTracking offers “One Team … Unlimited Success.”
  • Verisk Health offers “Talking Cost Drivers: How Employers Can Stop Rising Medical Costs.”
  • VitalHealth Software offers “Healthcare Outcomes: Our First Executive Forum.”
  • Voalte offers “Lessons from mHealth History.”
  • Xerox “Helps State Medicaid Organizations Reduce Costs, Improve Care.”
  • ZirMed offers “Less Than 50 Days to ICD-10: Tips to Help You Prepare.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
August 23, 2015 News No Comments

Morning Headlines 8/21/15

August 20, 2015 Headlines 1 Comment

Inside Illumina’s Plans to Lure Consumers with an App Store for Genomes

Illumina, the worlds largest gene sequencing company, forms Helix, a company that will offer free genome sequencing to consumers, and then will monetize that data by selling portions of the genetic information back  to patients incrementally over time as they need it.

ZocDoc Valued at $1.8 Billion in New Funding Round

ZocDoc raises a $130 million funding round on a $1.8 billion valuation, making it one of the most highly valued venture-backed companies in New York.

Electronic medical records systems work, but not together

The Kansas City Star discusses the nations interoperability problems, asking “Why, then, does a windowless office in Truman Medical Center need to scan 2.9 million pages of paper medical records that started out as electronic ones?”

View/Print Text Only View/Print Text Only
August 20, 2015 Headlines 1 Comment

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

  • Ambulatory Lives Matter: Speaking for ambulatory clients I must confess some extreme frustration at Judy's comments, assuming that report is accu...
  • Boston Loafer: Paul Levy's background is important for those in the industry who don't know him -- likely b/c he's not done anything in...
  • Sid Vicious: Does EPIC even sponsor HISTalk?...
  • Obfuscator: I suppose if Phil Spector writes a dynamite new song, you all want the news articles to just gloss over all his "persona...
  • Disappointed: Its posts like this one that make me want to stop my 10 year readership of histalk. This reads as a personal attack and...

Sponsor Quick Links