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Morning Headlines 7/29/15

July 29, 2015 Headlines No Comments

Harvard tech guru funds collaborative medical software

A Harvard Business professor invests $8.4 million in digital health startup ACT.md, a company focused on building collaboration tools to improve handoff communications and care coordination among providers.

NantKwest a huge IPO, but watch the small float

In the largest biotech IPO in a decade, Patrick Soon-Shiong, MD’s NantKwest started trading on the NASDAQ today, opening at $37 per share for an initial market capitalization of $2.6 billion. Soon-Shoing acquired the company less than a year ago for just $48 million.

Community Hospital EHR  – 2015

Peer60 publishes survey results from 277 community hospital providers, finding that 20 percent of community hospitals are actively looking to replace their current EHR, with Epic, Cerner, and Meditech most frequently named as likely replacement vendors.

UMass Memorial Health Care plans big patient record upgrade

UMass Memorial Health Care CEO Eric Dickson, MD reports that the health system will invest $700 million over $10 years in its transition from Sorian to Epic, representing the largest capital investment in its history.

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July 29, 2015 Headlines No Comments

News 7/29/15

July 28, 2015 News 4 Comments

Top News

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An investment firm founded by Harvard professor and disruption author Clayton Christensen invests $8.4 million in ACT.md, a care coordination platform developed by Zak Kohane, MD, PhD and Ken Mandl, MD, MPH from the informatics department of Harvard’s Boston Children’s Hospital, both of whom are also on the company’s board. The advisory board includes Mark Frisse of Vanderbilt and John Halamka of BIDMC.


Reader Comments

From GraySky: “Re: [hospital system name omitted]. Will announce on July 30 that it will spin off several hospitals and its management and consulting company.” Unverified. I’ve left out the system’s name for reasons that will become apparent if the rumor turns out to be true.

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From WikiStiki: “Re: Wikipedia’s hot mess entry on ‘electronic health record.’ It really needs to be rewritten.” The page is pretty much a disaster, an unfocused collection of facts (and quite a few opinions) written by people who don’t understand the big picture. WikiStiki offered to rewrite it if a sponsor will help cover some of the cost of her time, so I’m wondering if anyone thinks it’s worth doing. The page is probably read only by non-industry people, but that might make it even more important that it be accurate, timely, and clear (it’s none of those things now).

From Polite Spokesperson: “Re: startups. Another responsibility of startups is to create jobs.” Not true. Companies don’t hire people just to be nice or to bolster the local economy. The last thing I want as an investor or shareholder is for a company to pad its payroll with unnecessary employees since that just makes the company non-competitive. We’re just starting to realize in America that we have more people who need jobs than we have companies who need employees given farm and manufacturing productivity increases caused by technology (not to mention citizens who have prepared themselves poorly for decent jobs). However, I’ll return to your assertion to agree that people who find themselves unemployed or underemployed need to consider an alternative to wage slavery, such as jumping on the 1099 economy by starting a small business or contracting themselves out. People gripe endlessly about their employers, but don’t position themselves to do anything more than find another job working for someone else to be unhappy about. We don’t raise entrepreneurs like they do in hungrier countries, but that seems to be slowly changing. The future of our economy is small businesses, especially those that can turn impressive per-employee revenue.


HIStalk Announcements and Requests

Here’s how a monopoly behaves from an example I was reading about. Electric companies whose customers install solar panels are required by law to buy back any excess energy that customer generates, allowing solar customers to lower their monthly electric bills to a very low rate that will eventually offset the high cost of the initial installation. Electric companies, alarmed at the possibility of widespread consumer choice, are now lobbying to change the laws to not only eliminate the requirement that they buy customer-generated power, but they also want to charge those customers more than their actual electricity usage because they see solar users as freeloaders who use their grid without paying their fair share (the entitlement attitude is rampant among utilities). Electric companies are worried that as more customers use less of their product in favor of cheaper alternatives, they will have to spread their high fixed costs over fewer and fewer full-paying customers, feeding the cycle all over again as solar panels become even more cost effective. That’s the same problem the post office can’t figure out. You might well find similarities in healthcare. Government and monopolistic organizations never graciously accept getting smaller and instead find more desperate ways to protect their government-granted fiefdoms against declining market demand.


My Medical Records Saga Update

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A reader asked for ideas about how hospitals and providers could respond more effectively to patient requests for electronic copies of their records. Send me your thoughts via this quick online form (it saves you from having to compose an email) and I’ll summarize them. My main takeaway is that records requests go to the hospital’s HIM department, which is usually clueless about anything electronic such as the hospital’s patient portal and not all that user friendly when it comes to patient requests. It’s also bizarre that a business case even exists for release of information companies to place themselves between patients and providers, but that’s another issue. Meanwhile, here’s what I came up with.

  1. Records requests should be automated via online form for folks who have that access and technical knowledge. PDF downloads, scanning, and faxing are not reasonable.
  2. ID verification should be by "what you know" rather than "what you have." No scanned driver license or form — just DOB, last four digits of SSN, address, etc. Or, use SMS messaging to send a text message to a mobile phone number and then use the generated coded to validate that the phone number is active and in possession of the requester.
  3. The request form (hopefully online) should be tailored specifically to patients requesting their own information, with a separate form available for other entities making similar requests.
  4. The form should not require medical record number (hospitals are ridiculous in making it the patient’s job to memorize their assigned MRN).
  5. The form should provide information for using the provider’s portal. It should offer a phone number or email address for signing up or getting a password/userID reminder (providers should like the idea of increased portal usage) and should compare paper copies, online access, and an electronic download and how to request each. It’s not reasonable that the HIM department handles medical records requests without having any knowledge or interest in their own employer’s patient portal that might be more appropriate for the patient’s needs.
  6. The request should open some sort of help desk ticket so it can be tracked by the patient. I can imagine patients giving up in frustration unless someone feels pressure to close the ticket to the patient’s satisfaction (possibly measured by a follow-up survey link).
  7. The form should include the records charges and how those are calculated. I really don’t see how a provider can justify charging for an electronic copy that surely already exists in their systems, but naturally hospitals rarely turn down the chance to create a charge.

If you want to critique your own provider, here are some ideas. Email me your experience. You don’t even need to actually make the records request – just see what’s involved.

  • Is information about record requests available online where it can be easily found by patients?
  • Is the form or process easy to understand?
  • How does the provider validate the requestor’s ID?
  • Does the request spell out what the patient will be charged for copies? Does it involve a “per page” figure that doesn’t make sense for electronic records?
  • Does the request form indicate that data can be sent electronically or does it offer only paper copies?
  • Does any step involve a physical trip, a fax machine, or information the average patient won’t have (like MRN)?
  • Does the request form indicate the existence of a patient portal, explain why that might be a better option than requesting records copies, and describe the steps needed to gain access to it?

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I decided to randomly choose a hospital and see how they handle records requests from patients. This is from Beth Israel Deaconess Medical Center, which accepts requests only via a mailed form and offers only paper copies of records, taking up to 14-21 business days (it’s odd to count business days in seven-day full-week increments) and costing the requestor around $600 (!!) for copies of a full chart. The “internal only” portion of the form suggests that the patient must produce a photo ID. I bet John Halamka’s IT group has nothing to do with this process and he’s probably not even aware of it since the chasm between HIM and IT is wide in hospitals.

I’ve noticed that other hospital sites say that HIPAA prevents them from providing records without the patient’s signature, meaning electronic requests can’t be accepted. I’m not so sure this is true, but perhaps a HIPAA expert can weigh in.

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Florida Hospital’s medical records page tells patients upfront that they can get a lot of their information from their portal, to which it provides a link. Every hospital should do this. Hospitals need to get with the 21st century and realize that the HIM department is no longer the obvious and sole gatekeeper for patient records requests. All of this presumes a patient has Internet access and capability – I can only imagine the roadblocks they would find calling the hospital switchboard.


Webinars

July 29 (Wednesday) 11:30 ET. “Earning Medicare’s New Chronic Care Management Payments: Five Steps to Take Now.” Sponsored by West Healthcare Practice. Presenters: Robert J. Dudzinski, PharmD, EVP, West Healthcare Practice; Colin Roberts, senior director of healthcare product integration, West Healthcare Practice. Medicare’s new monthly payments for Chronic Care Management (CCM) can improve not only patient outcomes and satisfaction, but provider financial viability and competitiveness as well. Attendees will learn how to estimate their potential CCM revenue, how to use technology and clinical resources to scale up CCM to reach more patients, and how to start delivering CCM benefits to patients and providers by taking five specific steps. Don’t be caught on the sidelines as others put their CCM programs in place.

July 30 (Thursday) 3:00 ET. “De-Silo Your Disparate IT Systems Around the Patient with VNA.” Sponsored by Lexmark. Presenters: Steven W. Campbell, manager of diagnostic applications and interfaces, Piedmont Healthcare; Larry Sitka, VNA evangelist, Lexmark. The entire patient record, including both DICOM and non-DICOM data, should be available at the point of need. Disparate, aging systems that hide data inside departmental silos won’t cut it, nor will IT systems that can’t integrate medical images meaningfully. Learn how Piedmont Healthcare used a vendor-neutral archive to quickly and easily migrate its images and refocus its systems around its patients.

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

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NantHealth founder Patrick Soon-Shiong, MD takes cancer drugmaker NantKwest public Tuesday in the biggest biotech IPO in several years at a $2.7 billion market cap. He bought Conkwest less than a year ago for $48 million, renamed it, and kept 60 percent of shares, valuing his newly IPO’ed holdings at $1.6 billion or 33 times what he paid for the company a few months ago.

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Small practice EHR vendor Kareo raises $55 million.

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Israel-based home telehealth sensor vendor TytoCare raises $11 million in a Series B funding round.


Sales

Prestige Emergency Room (TX) chooses Wellsoft’s EDIS.

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Covenant Health (TN) chooses Strata Decision’s StrataJazz for decision support and budgeting.

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UF Health Shands Hospital (FL) selects Lexmark’s vendor-neutral archive.

The Banner Health Network (AZ) ACO chooses eClinicalWorks EHR and population health management systems.

Abbeville Area Medical Center (SC) will implement Medhost’s EDIS.


People

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Jason Friedman (Ascension Information Services) joins Oneview Healthcare as VP of solutions.


Announcements and Implementations

Stella Technology announces Inspector of Quality Healthcare Data, developed with New York’s HealthElink HIE to evaluate the quality of HIE-collected data.


Government and Politics

ONC awards $29.6 million in grants to 12 state entities to expand adoption of HIEs, $2.2 million to Academy Health to create population health strategies, and $6.7 million to six colleges and universities to update HITECH’s workforce development curriculum.


Privacy and Security

A security researcher finds a flaw that lets hackers take over Android phones by simply sending a self-destructing text message, meaning all they need is the victim’s cell phone number to launch a Stagefright trojan attack that can’t be detected or prevented.


Other

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A new report from Peer60 finds that 20 percent of community hospitals are planning to replace their EHRs, with the major complaints being poor usability and missing functionality. Meditech is the dominant product, followed by McKesson Paragon, Cerner, and Healthland, but the hospitals are focusing on Epic, Cerner, and Meditech in considering new systems.

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Fortune magazine seems to have dumbed itself down considerably in the past few years, but it also seems to believe its readers are getting stupider along with it as it sleuths out an under-the-covers scrappy healthcare startup called McKesson (#11 on the magazine’s own list of largest US corporations). John Hammergren surely grimaced at the writer’s obvious lack of industry knowledge in trying unsuccessfully to pose insightful questions.

In Canada, Nova Scotia stops further hospital EHR rollout amidst physician complaints about inefficiency, lack of consistency between practice and hospital EHRs, and worries that practices maintain information that they don’t share. The province issued a “One Person, One Record” RFP in April 2015 with hopes of replacing the three hospital EHRs it had previously approved, use of which the government says is “beyond what we can sustain in a province the size of Nova Scotia.”

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A study finds that hospital checklists, which delivered dramatic clinical results when first introduced several years ago as described in Atul Gawande’s “The Checklist Manifesto,” often fail to deliver similar results when rolled out on a broad scale. A 101-hospital study that found no improvement after checklists were mandated suggests that the problem isn’t the concept but rather its implementation, which is dependent on rollout methods, localization, and staff resistance. In other words, as is often the case, hospitals manage to mess up projects that seem foolproof via their stubborn culture of accepted mediocrity and lack of accountability.

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The CEO of UMass Memorial Health Care (MA) says the system will spend $700 million over 10 years to implement Epic, its largest capital expense ever. He adds that Epic cost 10-20 percent more than its competitors, but 500 employees voted Epic as their top choice following demos.

QPID Health posts a pretty funny video called “Squirrelnado 2, the QPID Edition” that has some fun pop culture references that include, “You’re going to need a bigger nutcracker” and the “Nut Bucket Challenge.”

Former Stanford hospitalist turned concierge medicine provider ZDoggMD creates a superb, non-humorous (angry, in fact) video called “Ain’t the Way to Die.” It should serve as a call to action for the half of my recent poll respondents who unwisely haven’t created an advance directive. You might as well do it right now since insurance companies are increasingly requiring it since they otherwise have to eat the cost of long-term ventilator care that patients probably don’t want anyway. I keep watching it over and over. A sample of the lyrics:

Let me go, I’m leaving you—no I ain’t
Tube is out, you put it right back, here we go again
It’s so insane, ’cause though you think it’s good, I’m so in pain
I’m more machine than man now, I’m Anakin

But no advance directive, I feel so ashamed
And, crap, who’s that nurse? I don’t even know her name
You lay hands on me, to prolong my life again
I guess you must think that this is livin’…

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Weird News Andy is fascinated that new guidelines for healthcare mobile device security were published by NIST just as the DEA investigates the explosion of an apparent meth lab running inside NIST’s headquarters, leading WNA to question the security of NIST’s immobile devices. He also likes the article description of NIST as "the federal agency responsible for setting standards for precise measurement of just about everything.”


Sponsor Updates

  • An imaging site reviews the VA Midwest’s deconstructed PACS project that includes an imaging viewer from Visage Imaging, vendor-neutral archive from Lexmark, and a work list module from Medicalis.
  • Zynx Health adds Android support to its ZynxCarebook mobile care coordination solution.
  • Video clinical pathways vendor ViiMed will use InterSystems HealthShare to integrate with provider EHRs.
  • Voalte will hold its inaugural Voalte User Experience conference (VUE15) in Sarasota, FL on November 10-12.
  • AirStrip CEO Alan Portela pens “A Ray of Hope from Washington? Don’t Rush Meaningful Use.”

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.

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July 28, 2015 News 4 Comments

Morning Headlines 7/28/15

July 27, 2015 Headlines No Comments

Senate panel will push HHS to delay Stage 3 MU rules

The Senate Health, Education, Labor, and Pensions Committee will submit a series of recommendations to the Obama administration focused on expanding EHR use through directives and rule changes, rather than legislative actions that can take years to pass. Lamar Alexander (R-TN), who chairs the committee, reports that the submission will include a recommendation that MU3 be delayed.

Health care will have its own Internet soon, Athenahealth chief says

CNBC interviews Athenahealth CEO Jonathan Bush, who predicts that “the lion’s share of routine health care” will be managed online in the future. Bush cites Amazon’s transformation of the retail market as an example of how to build consumer trust.  “Amazon took a piece of the Internet and made it safe enough, reliable enough, and connected enough that Main Street Americans use it for retail. We’re going to do the exact same thing. We know how to do this now. We’ve done it in other sectors."

Number of 5-star hospitals doubles in updated CMS ratings

CMS updates its five-star rating system for hospitals, which is based entirely on patient-satisfaction surveys, to reflect newly collected survey results. The scores will be updated quarterly moving forward.

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July 27, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 7/27/15

July 27, 2015 Dr. Jayne 3 Comments

There are many reasons to use consultants. Sometimes an organization needs an expert resource that they don’t have on staff or don’t have time to develop. Sometimes they need staff augmentation for a critical project. Sometimes they need an outside opinion to validate their goals and the plan to achieve them.

At least in my current consulting practice, however, most of the organizations I’m working with just need a consultant to save them from themselves.

Healthcare has always been a fairly dysfunctional business. The emphasis on shifting models of care and the relentless pursuit of technical tools has added stress to an already challenged system. Although a couple of my clients were referred to work with me early when things started heading in the wrong direction, my newest client waited until they hit rock bottom. I’m never one to shirk a challenge (particularly during the slow summer months when other clients don’t want to do much because too many key staffers are on vacation) but this one is a doozy.

This client was referred by one of my existing clients, who I had worked with on creating policies and procedures for Meaningful Use-related workflows and making sure that they had solid workflows prior to their reporting period. They had been a dream to work with. I knew that the physician owner had a brother who was also a physician, but in a different specialty.

Scope of practice not withstanding, the two practices couldn’t be different. My existing customer was a dream to work with. The new client called me incessantly demanding we set up an initial call. He apparently didn’t listen to my outbound greeting which explained that I was on vacation and would not be returning any calls until a certain date.

One of the benefits of working for yourself is being able to set your rates however you feel is appropriate. From the tone of this physician’s calls (increasingly desperate), I suspected he would be in my top billing tier. I also knew before even talking to him that if I did decide to take him on as a customer, it would be for an extremely limited engagement.

When we finally were able to have an initial discovery call, he had calmed down quite a bit and our discussion was entirely reasonable. We discussed the services he was requesting and what an engagement would look like.

His situation is not unusual. He is an independent physician who accepted subsidies from a health system to implement the EHR they were offering. Now he has decided to move off that platform and needs assistance with selecting a new system and actually making the transition.

One red flag, though, is that he wants to leave the hospital’s EHR system due to “philosophical differences,” which can mean a variety of things when you’re a high-profile surgeon. As far as finding a replacement, he’s already been largely swayed by a couple of vendors who should be easy to work with. I’m always happy to take any complications out of the mix.

Despite his desperation in trying to contact me initially, he had no problem dragging his feet when it was time to execute our consulting agreement. My standard contract is pretty simple – less than two pages – and spells out exactly what will be done and on what timeframe. He wanted to argue about the duration of the engagement (as a rule, I never do more than a six-month engagement the first time I work with a client) and didn’t seem to understand that in this situation, the consultant has the power. I don’t have to work for him and don’t have to agree to his terms.

He eventually figured that out and agreed to my proposal, so we jumped right in to his system selection problem. If I thought my contract negotiation with him was a challenge, I can’t imagine what it’s going to be like for him to execute a software agreement. I haven’t worked with either of his top choices (both are specialty-specific offerings) so am not able to give him much guidance in how best to work with them.

He’s still trying to decide and hasn’t been very receptive to my advice on how to weigh the pros and cons of different vendors and features. He refuses to use checklists or document his thoughts immediately after demos. When he can’t remember what he saw or what he thought about it, he just demands another demo, which results in a lot of schedule juggling. I’m fortunate to have a retired project manager I can throw at the problem so we can start to document for him and reduce the overall craziness.

In the mean time, we’re working to clean up the data in his existing system and create a plan to extract the data he wants to load into his new system. A good chunk of his documentation was dictated and he still has the original text files, so those will hopefully be easy to add to the new system. It’s the first time I’ve ever been grateful to not have very much discrete data.

He also didn’t attest for Meaningful Use yet, so I’m grateful to not have to deal with archiving that data for audits or dealing with how to synchronize his reporting period with the migration to the new system. I’ve got a young informaticist working with me who is excited about dealing with what data there is, so that is off my plate as well.

It’s a little strange to be delegating this work when I’m used to doing so much of it myself. It was one thing to delegate when I was a CMIO and working for a large health system, but it’s another thing to delegate when your name is on the door and it’s your company. Right now, though, my main function is to “handle” the customer and make sure we meet his needs. I’m OK with that. I’m not sure the people assisting with his engagement feel the same way, but we’ll have to see how things unfold. If nothing else, it’s putting experience under our collective belts.

How do you handle difficult customers? Email me.

Email Dr. Jayne.

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July 27, 2015 Dr. Jayne 3 Comments

Startup CEOs and Investors: Bruce Brandes

All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part VII – Showmanship, Double Dipping, and the Timeless Art of Seduction
By Bruce Brandes

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Are there any classes in business school where we are taught to learn to take yes for an answer? Evidently not, because so few do. 

Over the years, we have all been in meetings or presentations that went exceedingly well. In fact, often, the objectives are achieved long before the time allotted for the discussion has expired.  

I was in a meeting just last week when an entrepreneur seeking funding got to a “yes” from our team 45 minutes into an event scheduled for an hour and a half. To his credit, he asked if we had any other questions or topics for discussion. When it was clear we were content, he confirmed next steps, thanked us, and got up to walk out. He exited on a high note for sure! And with my newly-found free half hour, I got inspired and started to write this column.

Not surprisingly, the first thought entering my mind as I sat down at the keyboard was of George Costanza developing a plan to end every conversation on a "high note" and "leave them wanting more."

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George: "I had ‘em Jerry. They loved me."

Jerry: "And then?"

George: "I lost ‘em. I can usually come up with one good comment during a meeting, but by the end it’s buried under a pile of gaffes and bad puns.”

Jerry: "Showmanship, George. When you hit that high note, say goodnight and walk off."

Unfortunately, in business, showmanship has a different meaning than it does in comedy. Many companies can put on a great show to distract from disappointing or alarming realities. HBOC’s yada yada we discussed earlier comes top of mind.

How would our world, and healthcare specifically, be different if we applied Jerry’s version of showmanship to our healthcare business? Think of your favorite legacy vendor, say one who has built and sold a medical device or an EMR for decades, whose business is clearly waning as they desperately cling to their diminishing ongoing maintenance revenues.  

Imagine the implications of them one day frankly telling the market long before they ever reached that point of decline, “Thank you, everybody. That’s it for me! Goodnight, everyone.”  

In some ways, this does happen, just not as obviously and directly. Is this what Siemens was essentially saying when Cerner bought them last year? Or is that actually what SMS tried to express back in 2001 when they sold the company to Siemens in the first place?  

In the late 1960s, SMS took their first dip into the market by pioneering shared computing for hospitals and helping revolutionize the business of healthcare. Decades later, SMS would try to “double-dip” their way to restored relevance with the  introduction of Soarian. What would the market have missed if SMS had instead taken a page from Jerry’s playbook and stepped off the market stage in 2001 (or earlier)? Would their clients have been better off moving then to another vendor, unencumbered by the pressure to protect legacy maintenance fees, with more clear promise for the future?

You may be thinking that many of these established companies (Philips, IBM, Stryker, etc.) reinvent themselves regularly by acquiring innovative, growing companies with better solutions. Some large companies do indeed make successful integration of acquisitions a core competency.  

However, more often than not, legacy culture extinguishes the spark which made that group they acquired successful in the first place. Established vendors with historical encumbrances find it very difficult to bring innovations to market that may disrupt those legacy revenue streams. So generally they wait until some other entrepreneur with a more agile organization does it for them.

For example, who was better positioned 20 years ago to understand people’s preferences for taking, viewing, and sharing photos than Kodak or Polaroid? Many of you know the story about Kodak inventing the digital camera but shelving it out of fear it would cut into their revenue from selling film. Who would have bet instead on an arrogant, hoodie-wearing, college dropout to put these companies out of their misery?  

When was the last time you shunned Facebook or Instagram in favor of taking your film to the Kodak Photomat so you could share photos like this one?

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Of the companies on the Fortune 500 from 1995, 57 percent are no longer on the list. Eighty-seven percent of the Fortune 500 from 1955 are now completely out of business.    

Which healthcare vendors are poised to become the next Kodak? And might the industry be better served for some of those organizations to accept their inevitable fate, sparing the industry a ride on their death spiral?  

Preferably, the industry would benefit if these legacy EMR and device companies would realize their proper place in the new, boundary-less healthcare ecosystem. Replacing incumbent vendors unnecessarily will only take time and money which healthcare organizations do not have.

To truly add value to the marketplace, legacy vendors must commit to interoperability completely and unreservedly as if their lives depended on it. Historical interoperability initiatives driven by the government or the vendors themselves have left us with little more than brochure-level integration.  

Healthcare executives are now taking control of their own destiny. Through the new Center for Medical Interoperability, the CEOs of the most influential health systems in the country are turning the tables on vendors to open up and play nice with others or seal their fate to follow in Kodak’s footsteps.

I implore those legacy companies who may resist, perhaps greedily trying to hang on, to take metaphorical advice from Timmy, who once rebuked George for trying to double-dip his chip. "From now on, when you take a chip, just take one dip and end it!”

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Personal note: I have often wondered how one day I could apply my endless hours of Seinfeld study to somehow support my career. Having fallen short of my dream job as a sitcom writer, the chance to periodically pen this column has been great fun for me. I sincerely appreciate the kind words and encouragement I have received from old friends and new colleagues through the HIStalk community.

I plan to take my TV friend Jerry’s advice and end this series — hopefully on a high note — with this post, possibly leaving a few of you wishing for more rather than becoming stale and redundant. As a child of the 70s, I vividly recall how the phrase “jumping the shark” was coined. So, good night everybody. That’s it for me!  

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Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

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July 27, 2015 Startup CEOs and Investors 1 Comment

Morning Headlines 7/27/15

July 26, 2015 Headlines 1 Comment

Electronic Health Records on Mobile Devices

Cybersecurity experts at the National Institute of Standards and Technology publish a draft guide on securing mobile devices for use in the health care industry.

Another Big Earnings Beat for Athenahealth, Inc.

Athena publishes Q2 results: revenue climbed 21 percent to $224.7 million, EPS $0.32 vs. $0.32, missing revenue projections but beating earnings estimates. Stock prices, which had jumped five percent earlier in the day on news that Athena signed NewYork-Presbyterian Physician Services Organization, lost two percent of those gains in after hours trading.

The Health IT Safety Center Roadmap: What’s Next?

In a Health Affairs blog, Dean Sittig and Hardeep Singh publish an assessment of ONC’s Health IT Safety Center Roadmap.

Modernizing Medicine to acquire Weston electronic medical records firm

Cloud-based dermatology EHR vendor Modernizing Medicine acquires gMed, a gastroenterology EHR vendor, for an undisclosed sum.

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July 26, 2015 Headlines 1 Comment

Monday Morning Update 7/27/15

July 26, 2015 News 6 Comments

Top News

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NIST publishes a draft guide for securing medical information on mobile devices that includes a risk assessment. It’s pretty geeky in places, which is a good thing since the last thing anybody needs is more feel-bad security hysteria that isn’t actionable. This is a must-read for health system CISOs and network engineers and probably their vendors as well.


Reader Comments

From Jack: “Re: Meaningful Use payments to providers. Explain it like I’m five: how can I tell if mine has been paid for MU2? CMS also doesn’t seem to have a good way to see which providers have invested in their Continuity of Care bits. I’m trying to empower my community, remove hassle, and get rid of impediments to care and this seems like a major ‘all of the above.’”

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From The PACS Designer: “Re: Windows 10 readiness. With the launch of free Windows 10 sometime after July 29, it’s a good time to get existing systems ready for the 3GB install. Best thing to do before that date is to go to Control Panel and enter Defrag, and Remove in the Search Box to review what should be removed to make room for the upgrade. For Defragmentation, if percentage is more than 5 percent,  run the option. Also for Win7/8, enter ClearType to improve the crispness of text in documents.” I thought it was smart of Microsoft to drop the Windows icon in the taskbar to click for notification when Win10 is ready for download sometime after Tuesday. It’s also nice that the upgrade is free. I’ve signed up.

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From Petty Officer: “Re: Catholic Health Initiatives. Minimizing Wipro in choosing Cerner ITWorks.” CHI contracts for Cerner’s managed IT services even though it signed a $200 million IT outsourcing agreement with India-based Wipro in 2013.

From Linky: “Re: Military Health System. CIO David Bown may have spilled the beans on DoD’s EHR selection when he said they are working on EHR infrastructure in the Pacific Northwest. January news stories said that IBM/Epic are piloting their system at Tacoma, WA-based MultiCare.” It is interesting, although perhaps IBM/Epic was aware of the initial rollout plans early (maybe it was mentioned in the RFI) and smartly planned their own pilots for the same region.

From NantWhere?: “Re: NantHealth. Purchased Harris healthcare division for $50 million and agreed to keep 170 employees for at least a year in addition. Nant is clearing house to make way for a floundering organization with no sales for over a year. Where is NantHealth going and who will be left to do the work?” Unverified. Harris must have really botched its healthcare business that it bought for $155 million (in the form of Carefx) in 2011 if it really did dump it for just $50 million after deciding to remove its tentative toe from the healthcare waters and focus on big government defense contracts (I apologize for the redundancy – all government defense projects, and in fact all government projects, are “big” and usually grow a lot bigger before they’re either finished or abandoned, which happens with roughly equal frequency.)

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From Robert Lafsky, MD: “Re: New Yorker article. Somehow this made me think of you.” The article urges people to “communicate your needs and desires via email that doesn’t require the use of ‘please find.’” I like it, although “please find” irritates me less than the smarmily obsequious “please know.” I blame teachers for telling students they shouldn’t write like they talk, which results in artificially flowery and awkward phrases that are painful to read.

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From Ashley Madison: “Re: Ashley Madison breach. Lots of adulterers getting nervous out there!” The site — which proclaims itself “the most famous name in infidelity and married dating” with 38 million members — is breached, with all of its members’ records now in the hands of cyberhackers who are already spamming them and threatening to take their information public if the site isn’t shut down. The company is providing no updates to its users, most of whom are probably just curious without seriously contemplating extramarital relationships. Men, who make up most of the paying customers, spend up to $300 per year hoping to contact women that are in many cases literally unreal (one woman sued the company for wrist injuries she sustained in manually creating thousands of fake female subscriber profiles). A few users have anonymously threatened suicide on various sites. Parent company Avid Life planned an IPO following steady profits that rose to $55 million in 2014, but selectively moral potential investors steered clear.


HIStalk Announcements and Requests

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Most poll respondents will take 10 to 19 paid days off in 2015, although a healthy number (pun intended) will be away from work for 20 to 29 days. Shockingly to some of those folks, their employer will not descend into chaos due to their absence, that same reality that sets in when your appreciative, associate-friendly employer suddenly lays you off without even a blip in corporate output as less-expensive replacement hamsters are brought in to keep the wheel turning. A couple of readers noted that despite their alleged time “off,” they are still tethered and sometimes pulled back into “I need you now” situations. Readers also suggested the follow-up poll to your right or here: how often do you check work email or voicemail on a vacation day? Thank the dearly departed Steve Jobs for inventing the iPhone and thereby eliminating the “I’m out of the office not checking email” concept that worked just fine when we all had email access only from our work desktops and we could therefore vacate the office both physically and virtually rather than only the former.

I’m back from vacation, facing thousands of emails and the infuriating “you didn’t reply within a day or two, so I’m sending it again” messages from people (all of them, not coincidentally, from PR companies) who obviously don’t read HIStalk, which is exactly why I don’t set an “out of office” message since readers and sponsors already know I’m offline, selectively responding to anything critical but otherwise not sharing anybody else’s urgency. Jenn admirably covered for me on the Tuesday and Thursday posts, which I read to make sure nothing earth-shattering occurred. I’ll be catching up this week.


A “My Medical Records Saga” Update

I still haven’t heard from the hospital or the Office for Civil Rights regarding my complaint that the hospital refused to provide electronic copy of my records. I used CareSync to request my PCP’s records and the company uploaded and transcribed the information quickly, giving me both discrete data elements and the practice’s scanned reports. CareSync also fixed the technical handshake between its system and Carebox and I was able to effortlessly shoot those records over to Carebox via a Direct message, which required only that I click CareSync’s “share” button and provide my Carebox-assigned Direct address. It was maybe two minutes later that I received Carebox’s “got it” email and was able to view a  nicely formatted record, including a beautiful BlueButton extract. The process was immensely satisfying on both ends.

CareSync is a deeper and richer application than I expected and having real humans assemble and upload the records makes it painless. They will even initiate the process of correcting information that the provider has recorded inaccurately (like the hospital flagging me as a smoker for some reason). I haven’t really explored what else CareSync does, but I see that it allows bringing in data from wearables, adding personal and insurance documents, scheduling appointments, setting medication reminders, assigning health maintenance tasks, and viewing a nicely formatted health timeline. You can add a family member as a user, allowing them to view and manage your information.

I think I read somewhere that CareSync offers a “break the glass” one-time password  option for emergencies, although I haven’t figured that out yet (it would be cool to have an emergency bracelet thingy to solve that “unconscious in the ED” problem that RHIOs failed to fix). In fact, CareSync could be an opt-in HIE if it could just solve the legal and logistical challenges of polling the user’s defined providers regularly to automatically update information from new visits — you have to request them each time.

I recall that in China, each person maintains their own paper medical records, bringing them along every time they have an encounter and then taking them back home afterward with the new information added. Most people here would think that’s a Luddite system, but I’ve always thought it’s pretty smart given the pathetic state of interoperability in this country, where your ED or hospital outcome will probably already have been decided one way or another before your medical history ever arrives (assuming that the ED or hospital even bothers to try to get it, which I seriously doubt). I would much rather give a provider access to information that  I’ve already reviewed with my own comments added, hoping they review it right then and there to avoid errors, conflicts, and expensive duplicate testing. That’s also the logical place to store an advance directive and power of medical attorney since a shocking number of those are ignored because nobody knows they exist or they can’t be found when needed.

Maybe someday we’ll figure this provider-to-provider interoperability thing out despite competing special interests, but until then, the only sure thing is for patients to collect and share their own information. CareSync happened to be the application I tried and I can see great possibilities in providers using it to provide ongoing care management and communication, but I’m sure competing products also do a good job. It has been an eye-opening experience for me to see health IT from the other side of the provider-patient relationship, to take control of my records, and to see what’s been recorded about me by providers, sometimes incorrectly.


Book Review: The Lean Startup

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I’m short on time having been away, so I will simply summarize the startup advice as suggested by “The Lean Startup,” which was recommended to me by DrLyle. Quite a bit of it is relevant to healthcare IT and software development in particular, even for large companies interested in increasing their innovation and creating new growth. It’s like an MBA program for startups in highlighting the difference between running a big business and starting a small business with big ambitions.

  • Most startups fail not because they lacked a good idea, didn’t have the right stuff, or had poor timing, but rather because they don’t follow a process that seems too much like the much-maligned “management” that the corporate world embraces.
  • The prime focus of a startup isn’t to develop or sell products – it’s to learn via validated experiments that force the entrepreneur to test individual elements of their vision, resulting the measurable discovery of truths that keep the company optimally focused and moving forward.
  • A startup’s activities should revolve around the Build-Measure-Learn cycle that tells the company whether to stick it our or to pivot (“pivot” being defined as changing direction with one foot planted in the current state, not abandoning the concept for something unrelated).
  • While management methods used by established companies – such as market research, forecasting, and accounting – don’t work for startups and result in “achieving failure,” just diving in while merrily abandoning any sort of managerial discipline is also likely to ensure failure.
  • Success results from the ongoing measuring and tuning of the “engine of growth.”
  • Products should be developed in small batches or even via continuous deployment (which is counter-intuitive in a production-oriented environment), tested with a subset of customers, and negative changes backed out or fixed quickly. Startups don’t have much of a reputation to be tarnished, so it’s OK to fail.
  • Ongoing customer contact and behavior monitoring is critical.
  • The customer will tell a company what they need or want, which might not be what the company originally thought. Assumptions are often wrong, but the time spent chasing the wrong objective still results in valuable learning.
  • Companies need to understand which activities add measurable value and eliminate those that don’t.
  • It’s paradoxically easier to raise money with zero revenue and zero customers because small numbers eliminate the possibility of overnight success.
  • The initial product release should be the minimum viable product that can be released and tested quickly even without features that may seem essential, followed by intense measurement of product use and customer response to see if the “leap of faith” assumptions on which the company was based are accurate.
  • Startups have to manage by non-vanity metrics that portray the true growth trajectory.
  • Customer behavior should be tracked by cohort rather than in aggregate to understand how each demographic group responds to product attributes and to design a sales funnel-type process.
  • The paid engine of growth is to either increase revenue from each customer or reduce the cost of getting a new customer.
  • Companies can fail by efficiently making changes that inflate vanity metrics without changing customer behavior, which then creates a crisis when the growth tapers off with no new activities underway to replace the inevitable slowdown.
  • Deciding which incremental investments to make can be done by the Five Whys, addressing a given problem by asking incremental “why” questions five times to arrive at the root cause.

Last Week’s Most Interesting News

  • Anthem finalizes its deal to acquire Cigna for $54 billion.
  • UCLA Health announces that a September 2014 cyberattack exposed the information of 4.5 million patients.
  • An ONC-commissioned consultant’s report outlines a five-year plan for a $20 million, 10-employee Health IT Safety Center whose focus will be “convening, researching, and disseminating.”
  • Ascension Health offers to buy revenue cycle services vendor Accretive Health — which gets half its revenue from Ascension — for half its stock market value, sending shares down 50 percent as the company rejects the uninvited offer and issues a “seek strategic alternatives” cry for help.
  • UMass Memorial Health care (MA) announces that it will replace the former Siemens (now Cerner) Soarian with Epic, abandoning a bizarre $100 million best-of-breed project announced in 2010 that had the organization trying to cobble together systems from Allscripts, Siemens, Picis, IBM, and Hyland as planned by then-CIO, now-resigned George Brenckle.

Webinars

July 29 (Wednesday) 11:30 ET. “Earning Medicare’s New Chronic Care Management Payments: Five Steps to Take Now.” Sponsored by West Healthcare Practice. Presenters: Robert J. Dudzinski, PharmD, EVP, West Healthcare Practice; Colin Roberts, senior director of healthcare product integration, West Healthcare Practice. Medicare’s new monthly payments for Chronic Care Management (CCM) can improve not only patient outcomes and satisfaction, but provider financial viability and competitiveness as well. Attendees will learn how to estimate their potential CCM revenue, how to use technology and clinical resources to scale up CCM to reach more patients, and how to start delivering CCM benefits to patients and providers by taking five specific steps. Don’t be caught on the sidelines as others put their CCM programs in place.

July 30 (Thursday) 3:00 ET. “De-Silo Your Disparate IT Systems Around the Patient with VNA.” Sponsored by Lexmark. Presenters: Steven W. Campbell, manager of diagnostic applications and interfaces, Piedmont Healthcare; Larry Sitka, VNA evangelist, Lexmark. The entire patient record, including both DICOM and non-DICOM data, should be available at the point of need. Disparate, aging systems that hide data inside departmental silos won’t cut it, nor will IT systems that can’t integrate medical images meaningfully. Learn how Piedmont Healthcare used a vendor-neutral archive to quickly and easily migrate its images and refocus its systems around its patients.

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

Marketing company Physicians Interactive acquires Qauntia, which offers the QuantiaMd collaboration platform and mobile community for physicians.

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Dermatology EHR vendor Modernizing Medicine will acquire gastroenterology EHR vendor gMed.

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Athenahealth reports Q2 results: revenue up 21 percent, adjusted EPS $0.32 vs. $0.32, falling short of revenue expectations but handily beating on earnings with shares spiking upward on the news. Above is the one-year price chart of ATHN (blue, up 2.8 percent) vs. the Nasdaq (red, up 14.5 percent).

From the Athenahealth earnings call:

  • The company is approaching $1 billion in annual revenue.
  • Athena expect to receive 75,000 applications for the 1,500 positions it will fill in 2015.
  • CEO Jonathan Bush says the under-50 bed hospitals that are prospects for the RazorInsights product it acquired don’t have a strong balance sheet or deep IT talent, which the company will approach as it did small practices originally as in, “We’re not just going to sell you a system, we’re going to give you a system and we’re going to do the crap work that you hate and struggle with that gets in the way of treating patients for you. And so, instead of charging you X hundred thousand or million dollars upfront, we won’t charge you upfront, and we’ll take over these functions, get you more cash faster. And in the course of doing so, give you the clinical and financial systems that you need and keep them current forever.”
  • Bush says value-based care is a great opportunity for the company, and while ACOs are “a really badly written risk contract,” Athenahealth can move its focus from Meaningful Use compliance towards portal adoption, care coordination, and system scheduling.
  • Bush says the expansion of AthenaCollector to the hospital market is “incredibly synergistic” since a hospital claim has “all of the information on an ambulatory claim with three times the money on it and maybe 10 percent more information” and the company’s ambulatory claims experience allows it to reduce hospital collection cost using the information hospitals already have.
  • Bush says of its Enterprise segment, “We are getting access into the Cerner and Epic systems that we’ve never had before and are able to provide an integrated view of the patient’s experience inside and outside of AthenaNet. You’ve always been able to see where a patient’s been inside of AthenaNet even if it’s a different practice, but you’ve never been able to see very cleanly and reliably stuff that’s gone on in the hospital … we’ve always had major Cerner customers, but now we’ve got major Epic customers, not just throw out all of Epic, but you deal with the 50 percent of their admissions that come from outside of that directly-employed inner circle, maybe even some of the guys in the inner circle that are enraged and frustrated and are flight risks to the hospital for being on a hospital-controlled flow-centric system.”
  • RazorInsights will disappear as a separate product by next year as it is rolled into AthenaOne, while its acquisition of BIDMC’s WebOMR was scarcely mentioned in the call.
  • Bush describes the company’s transactional revenue of 250 information exchanges per doctor per day as, “You’ve got eligibility checks, claims submissions, claim status inquiries, lab accessions, lab results, referrals, authorizations, get me another one, in-office exchanges. So, every time somebody uses an integrated blood pressure cuff, and so the thing goes off from AthenaNet to Welch Allyn and back, each one of those counts on the server. Each one of those is a tick.” The company is measuring that as its total automation rate, which it says is at 57.2 percent.

Besler Consulting acquires the transfer DRG recovery business of DRG Review.


Sales

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SCL Health (CO) chooses Phynd for profiling and credentialing its 25,000 physicians across multiple IT systems.

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Charleston Area Medical Center (WV) will convert from the former Siemens Soarian to Cerner’s other product (Millennium) by next July, saying they are “first in line” to make the move. The health system also says only 25 of its 1,200 doctors have completed ICD-10 training and those who haven’t done so my Monday will have their Soarian access removed.


People

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Dan Critchley (University of Arizona Health Network) joins Optimum Healthcare IT as CEO of managed services.

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Roy Moxam (McKesson) joins Sunquest as VP of client experience.

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Impact Advisors hires Scott Pillittere (Huron Consulting Group) as VP.

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Nick van Terheyden, MD (Nuance) joins Dell Healthcare as chief medical officer.


Announcements and Implementations

Medidata will integrate patient-generated data into its clinical trials platform using Validic’s digital health platform.

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Harvard licenses its sleep apnea monitoring software to startup MediCollector.


Government and Politics

Researchers Dean Sittig and Hardeep Singh post a Health Affairs review of ONC’s plan for a Health IT Safety Center, saying that it’s a step forward given the absence of any other form of clinical systems oversight but suggesting that a VA-type safety events analysis service is still needed. ONC’s proposal calls for the Health IT Safety Center to avoid doing such investigations, which the article says will probably have to be performed internally by individual health systems with the Center possibly aggregating and reporting their findings.

HHS’s OIG posts a job opening for CIO, with applications due today (7/27).

A San Diego newspaper article questions whether Medicare can afford personalized medicine as patients demand more expensive custom treatments and tests. However, proponents expect cost avoidance in finding drugs that work for a given patient, citing the fact that cancer drugs fail 75 percent of the time. A health policy researcher says Medicare should change its payment model so that successful treatments for a given patient carry a higher price tag than the same drug, test, or procedure that delivers a less-impressive result for another patient.


Technology

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The New York Times profiles the Lively safety watch, a stylish alternative to the “I’ve fallen and I can’t get up” one-push alert button that also counts steps and provides medication alerts via an in-home cellular hub with sensors for pill containers and the refrigerator. The watch costs $50 and the monitoring service is $30 per month. It looks a lot like the Apple Watch.

Nike will pay $2.4 million to purchasers of its FuelBand following a class action lawsuit claiming that the company sold the fitness trackers even though they knew its measurements were inaccurate. It appears the wearables fad is tapering off as users don’t find their habits changing and the devices capture information that is a primitive health marker at best. I have at least a couple of them tossed aside in drawers and I bet you do, too.


Other

Global Health Limited sues the government of South Australia, claiming that the state is using its Chiron patient management software despite holding an expired license. The state has been the last user of the outdated software since 2008 but had asked Global Health for permission to keep using it since its implementation of Allscripts Sunrise Clinical Manager for the new Royal Adelaide Hospital is behind schedule.

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Western Australia has IT problems of its own as the new Fiona Stanley Hospital reports problems with IT systems that include lack of integration and a 15-minute delay after a physician logs in. Clinicians and patients also report problems with the hospital’s in-room interactive patient entertainment system. The hospital, which was supposed to be paperless, is running well over budget and behind schedule on its $150 million IT project.

A group of fund managers who invest in drug companies launches a US campaign calling for clinical trials to be registered and all data published within a year of study completion. AllTrials recently sued FDA to force it to release clinical trials data for two new, expensive drugs for hepatitis C. Its call to action petition can be signed here and it seeks volunteers to post its videos, host website buttons, and distribute flyers.

Insert your own punch line here: analysis of CMS payment data finds that Dr. Oz made $1.17 million from a hemorrhoid treatment he shilled, albeit at least with disclosure that he was involved in its development, which is about as ethical as he’s ever going to get.

Weird News Andy says he knows Bay Area real estate is expensive, but $2,000 for a bag of dirt might be a bit much. A fake doctor running a fake California cancer treatment center is charged with giving patients treatments consisting of baggies of expired medications and dirt, telling his patients to mix and swallow them with any resulting burning sensation meaning his concoction was working.


Sponsor Updates

  • Medicity client Great Lakes Health Connect surpasses its goal of having 1,000 medical practices using its referral application and will soon exceed 1,000 practices that are linked to Michigan’s immunization registry.
  • Huntzinger Management Group expands its technology service offerings to include technical advisory, security, operational improvements, and end user services.
  • Forward Health Group joins CMS’s Health Care Payment Learning and Action Network, charged with moving Medicare toward more value-based payments.

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.

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July 26, 2015 News 6 Comments

EPtalk by Dr Jayne 7/23/15

July 23, 2015 Dr. Jayne No Comments

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This week has been chaotic. It’s amazing how being out of the swing of things even for a couple of weeks can interfere with our habits and processes. I thought I had this week’s EPtalk nearly written and saved it out to the cloud, only to now be unable to find it (along with another presentation I was working on). A keyword search wasn’t helpful nor were some of the other tricks I tried, so those thoughts will have to wait until they turn up which will hopefully be before next week.

Luckily the presentation is for something several weeks out, so I have time to rebuild it if I can’t find it. I’m also traveling and my laptop’s wireless has been on the fritz, which might have played a role in the mystery of the missing documents. At one point today I was working at a blazing fast 512 kbps, which I haven’t seen in a long time. There’s nothing quite like cloud storage gone wrong.

I’ve also been tunneling through more than a thousand emails that came in while I was away. Many are related to social media and things like LinkedIn, so shame on me for not having adequate filters set up to prevent it my inbox from being an overwhelming mess. I’m grateful for the legitimate mail from readers that keeps me soldiering on.

From Commanding Officer: “You wrote about an ICD-10 code for the psychotic reaction you were going to have when kids were playing games on your flight without headphones. My recommendations are:

  • R45.4 Irritability and anger
  • F63.81 Explosive disorder, intermittent; Aggressive episodes frequently result in physical or verbal assaults or property destruction (for example, road rage). The individual may report feeling tension prior to the episode, immediately followed by relief.”

I agree with the reader’s suggestion of leaning towards the road rage code. Although we occasionally hear about airline passengers behaving badly, the more I fly the more I continue to be amazed that there are not even more incidents occurring.

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From Jimmy the Greek: “With the number of conference calls I’m sure you’ve been on in your career, I thought you’d get a kick out of this quote of the day. A coworker actually said, ‘That’s impossible for us to do, because we’ve never done it before.’ I resisted the urge to ask how she managed to get out of her cave.” Hearing stories like that always makes me feel better about the places I’ve worked. No matter how bad you think it is, the grass isn’t always greener elsewhere. The fact that this comment is from a technology professional at a company known for communications solutions makes it all the funnier.

As for summer adventures, several readers have written to share theirs: hiking, camping, and a safari were included on the list. At least three readers plan to spend time at scout camps with their children. One reader noted that although it was great to unplug, it was not so great to have to spend two whole days reading emails after returning to work. Another travels every year to a working ranch in Montana that I have to say looks pretty incredible.

From High Adventure: “I’ve enjoyed several treks to places with minimal cell phone coverage and what was there, was enough to get the occasional text message or phone call out to family to let them know we’re safe. Not enough to download email or anything like that. As an IT professional who deals with the daily deluge of electronic communications, I find these trips refreshing. But, I’ll confess, you need to learn how to unplug and let go of the work. It’s not easy but you have to trust your team and co-workers to do the right thing. As a leader, if you can’t trust them to do that, you’ve failed in one of your key jobs.” I remember reading a blog piece attributed to Jonathan Bush where he talked about taking a month off for summer vacation with his family. He cited the need to let his team have the experience of managing without him as one of the reasons for taking an extended vacation. That’s great when leaders have seasoned teams below them, but as a consultant, I see a fair number of dysfunctional teams where that would never be an option.

Speaking of vacation, several readers responded to my piece about vacations in modern business culture. One mentioned that his company, Lexmark, went to an unlimited vacation policy in 2013.  One reader suggested SCUBA as a great vacation since cell phones don’t function well underwater. Another offered tips for vacationing as a corporation of one:

I also have my own solo business as does my twin sister in the legal field. When one of us is going to be seriously out of touch, we cover each other’s voice and emails just scanning for “must do now” things and sending reassuring messages to those who can wait until the owner gets back. We also have a deal that the person vacationing knows that the other will contact them if something comes up but that they are supposed to relax and not check since they have a proxy on duty who is filtering. You do have to trust the person you partner with (and I know it is harder to get closer than an identical twin) but perhaps something like this would be helpful to you.

That’s a great story. My brother is also an independent business person, but given his entrepreneurial tendencies, he’d probably charge me for the coverage. Luckily right now my file of consulting clients is small enough that I was able to tell everyone my plans in advance and most know me well enough that even if anything urgent came up I’d be able to turn it pretty quickly on my return. I’m sure it won’t be that way forever and I appreciate the idea.

Email Dr. Jayne.

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July 23, 2015 Dr. Jayne No Comments

Morning Headlines 7/24/15

July 23, 2015 Headlines 1 Comment

UMass Memorial’s medical records upgrade won’t be cheap

UMass Memorial Health Care (MA) announces that it will replace its Sorian EHR with Epic, with CEO Eric Dickinson commenting that it was “one of the most important contracts I have signed since becoming CEO.”

Clinical, Technical, Organizational and Financial Barriers to Interoperability Task Force

ONC launches its new Clinical, Technical, Organizational and Financial Barriers to Interoperability Task Force, which will develop a report on interoperability challenges by October 2015.

Cerner Announces Industry-First, EHR-Agnostic Tool to Improve Accuracy of Fall Risk Detection

Cerner releases a vendor-agnostic EHR tool that identifies fall-risk patients with a 90 degree accuracy.

NewYork-Presbyterian Selects athenahealth as the Technology Platform for Its Physician Services Organization

NewYork-Presbyterian Medical Group will implement Athenahealth’s EHR, practice management, and patient portal solutions across all of its practices, servicing 800 physicians.

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July 23, 2015 Headlines 1 Comment

News 7/24/15

July 23, 2015 News 2 Comments

Top News

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The local business paper dives into UMass Memorial Health Care’s expensive decision to transition from Soarian to Epic. In making the announcement to employees earlier this week, CEO Eric Dickson, MD noted that his decision came down to “one thing: hundreds of our caregivers tested the options available to us and they resoundingly selected Epic as the best system. We can’t expect you to make UMass Memorial Health Care the best place to give care and the best place to get care if we don’t give you the best electronic health record system available and so you will have it — Epic is coming.”


HIStalk Announcements and Requests

This week on HIStalk Practice: Ancestry.com gets into the digital health record business. The Federation of State Medical Boards receives grant funding to kick start the Interstate Medical Licensure Compact. Private equity firms get aggressive with Texas physicians. Ruby Raley considers solutions for physician frustration with EHRs. Dr. Gregg eavesdrops on an illuminating conversation between Dr. Happy and Dr. Mad. Bright.md raises $3.5 million. Modernizing Medicine acquires GMed. PCORnet project nets $142.5 million for patient-centered outcomes research.


Webinars

July 29 (Wednesday) 11:30 ET. “Earning Medicare’s New Chronic Care Management Payments: Five Steps to Take Now.” Sponsored by West Healthcare Practice. Presenters: Robert J. Dudzinski, PharmD, EVP, West Healthcare Practice; Colin Roberts, senior director of healthcare product integration, West Healthcare Practice. Medicare’s new monthly payments for Chronic Care Management (CCM) can improve not only patient outcomes and satisfaction, but provider financial viability and competitiveness as well. Attendees will learn how to estimate their potential CCM revenue, how to use technology and clinical resources to scale up CCM to reach more patients, and how to start delivering CCM benefits to patients and providers by taking five specific steps. Don’t be caught on the sidelines as others put their CCM programs in place.

July 30 (Thursday) 3:00 ET. “De-Silo Your Disparate IT Systems Around the Patient with VNA.” Sponsored by Lexmark. Presenters: Steven W. Campbell, manager of diagnostic applications and interfaces, Piedmont Healthcare; Larry Sitka, VNA evangelist, Lexmark. The entire patient record, including both DICOM and non-DICOM data, should be available at the point of need. Disparate, aging systems that hide data inside departmental silos won’t cut it, nor will IT systems that can’t integrate medical images meaningfully. Learn how Piedmont Healthcare used a vendor-neutral archive to quickly and easily migrate its images and refocus its systems around its patients.

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

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The Florida Partnership for TeleHealth receives a $100,000 HRSA grant to establish telemedicine programs in North Florida including rural communities surrounding Tallahassee.

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Patientco announces plans to move into larger office space at its current Atlanta headquarters and triple its workforce over the next 18 months.

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Dallas-based Anthelio Healthcare Solutions acquires HIM and RCM vendor Pyramid Healthcare Solutions for an undisclosed sum.

Noridian Healthcare Solutions agrees to pay $45 million to Maryland to avoid legal action after failing to deliver a functional state health insurance exchange.

Harvard’s Wyss Institute for Biologically Inspired Engineering licenses its bedside data-acquisition software to MediCollector, a startup spun out of the institute last year. MediCollector plans to integrate the technology, originally developed as part of a larger infant sleep apnea prevention program, into clinical alarm systems.


Announcements and Implementations

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Hackensack University Medical Center strengthens its existing partnership with Infor, becoming a lead adopter in implementing FHIR DSTU 2 Patient Resources to communicate with mobile devices using Infor Cloverleaf technology.

NewYork-Presbyterian Medical Groups will implement Athenahealth’s EHR, PM, and patient engagement solutions via the NewYork-Presbyterian Physician Services Organization. On a related note, NewYork-Presbyterian CIO Aurelia Boyer and associate chief innovation officer and anesthesiologist Peter Fleischut, MD take to the Huffington Post to share the many ways in which healthcare IT is positively impacting the organization.

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Massena Memorial Hospital installs two telehealth units through their affiliation with the North Country Initiative, an affiliation with five local hospitals that qualifies each for state funding and group-purchasing discounts.

Envision Healthcare offers telehealth services from InTouch Health to its network of physician-led companies including American Medical Response, EmCare, and Evolution Health. 


People

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HIMSS North America nominates several new members to its Board of Directors including Dana Alexander, RN (Divurgent) who joins as chair, and Fred Rachman, MD (Alliance of Chicago Community Health Services) who joins as vice chair.


Government and Politics

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ONC’s new Clinical, Technical, Organization, and Financial Barriers to Interoperability Task Force meets for the first time to discuss organization and goals. Chaired by Paul Tang, MD from the Palo Alto Medical Foundation, the 10-member task force will meet 12 times over the next several months, and is scheduled to submit final recommendations in mid October.


Technology

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ScImage adds secure image-sharing capability to its Picom365 enterprise PACS.

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RightCare Solutions introduces the RightCare Touch app for post-discharge patient communication.

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AHRQ unveils a new online tool that enables users to analyze 2014 hospital discharge information from 17 states and multiple payers, as well as the uninsured. The Fast Stats website includes data on categories of conditions such as surgical, mental health, maternal, injury, and medical.

Lexmark launches ICD-10-compliant Kofax Claims Agility software that automatically processes professional and institutional medical claims and supporting documents.

Cerner debuts an EHR-agnostic tool that, when combined with its fall-risk algorithm, improves fall-risk detection with a 90-percent accuracy rate. The news comes hot on the heels of Epic’s announcement that it is working on a clinical decision tool to help providers reduce the risk of falls in unsteady patients.


Privacy and Security

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A McAfee Labs report finds that cybersecurity executives are not optimistic when it comes to their collective ability to stem the tide of security breaches. Seventy percent noted the number of threats against their organizations are increasing, while nearly half feel a serious attack "affecting critical services and causing a loss of life" is likely within three years. It’s worth noting that respondents cited user error as the number-one reason for successful attacks on critical infrastructure.


Other

President Obama sits down with Jon Stewart on the Daily Show to discuss his time in office. Naturally, the conversation turns toward interoperability, the VA, and the government’s slow adoption of anything related to IT.


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.

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July 23, 2015 News 2 Comments

Morning Headlines 7/23/15

July 22, 2015 Headlines No Comments

Anthem Nears Deal to Buy Cigna for $48 Billion

Anthem and Cigna are, once again, nearing an acquisition deal.The deal will be worth $48 billion, or $188 per share for Cigna. Cigna shares closed at $151 per share Wednesday, but climbed eight percent in after hours trading following the acquisition rumors. An announcement could be made as early as Thursday afternoon.

2015 Top Markets Report Health IT

The Department of Commerce releases a report on health IT, calling it a strong export opportunity for the US, and forecasting that the top five markets over over the next three years will be: Finland, Germany, Japan, Netherlands, and Switzerland.

Contractor for Maryland health exchange website to pay $45M

Noridian Healthcare Solutions agrees to pay $45 million to Maryland to avoid legal action after failing to deliver a functional state health insurance exchange.

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July 22, 2015 Headlines No Comments

Morning Headlines 7/22/15

July 21, 2015 Headlines 1 Comment

Break the Red Tape: Electronic Health Records Town Hall (video)

AMA of Georgia holds a town hall-style meeting hosted by Rep. Tom Price (R-GA) and AMA President Steven Stack, MD  to discuss ongoing usability issues with EHRs and looming MU3 regulations.

UVA, MITRE partner to improve health data analysis

University of Virginia Health System and The MITRE Corporation have partnered to develop advanced warning systems to help identify early changes to hemorrhages or lung failure.

Thomas Verbeck: Sharing medical data saves lives

Thomas Verbeck, a retired US Air Force brigadier general and CIO, calls for a to halt the DoD EHR procurement until a congressional review can be conducted to evaluate the problems that a non-integrated system will cause for soldiers, veterans, and care providers across the DoD, VA, and civilian health systems.

Virtual Reality Now Being Used To Treat Bipolar Disorder

In England, Oculus Rift Virtual Reality headsets are being piloted by the NHS to help patients with mental health disorders learn to cope with environmental stressors. Using VR, researchers are immersing patients in everyday scenarios, such as riding the subway or the bus, in hopes of triggering controlled emotional responses that can then be analyzed.

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July 21, 2015 Headlines 1 Comment

News 7/22/15

July 21, 2015 News 11 Comments

Top News

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Physicians converge on a town-hall meeting hosted by the AMA and Medical Association of Georgia to express their dissatisfaction with EHRs and Meaningful Use. Rep. Tom Price (R-GA) and AMA President Steven Stack, MD hosted the 90-minute event, which they used to raise awareness of AMA’s Break the Red Tape campaign to delay finalization of MU Stage 3 regulations.


Webinars

July 22 (Wednesday) 1:00 ET. “Achieve Your Quality Objectives Before 2018.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; Dennis Swarup, VP of corporate development, CitiusTech. The presenters will address best practices for building and managing CQMs and reports, especially as their complexity increases over time. They will also cover quality improvement initiatives that can help healthcare systems simplify their journey to value-based care. The webinar will conclude with an overview of how CitiusTech’s hosted BI-Clinical analytics platform, which supports over 600 regulatory and disease-specific CQMs, supports clients in their CQM strategies.

July 29 (Wednesday) 11:30 ET. “Earning Medicare’s New Chronic Care Management Payments: Five Steps to Take Now.” Sponsored by West Healthcare Practice. Presenters: Robert J. Dudzinski, PharmD, EVP, West Healthcare Practice; Colin Roberts, senior director of healthcare product integration, West Healthcare Practice. Medicare’s new monthly payments for Chronic Care Management (CCM) can improve not only patient outcomes and satisfaction, but provider financial viability and competitiveness as well. Attendees will learn how to estimate their potential CCM revenue, how to use technology and clinical resources to scale up CCM to reach more patients, and how to start delivering CCM benefits to patients and providers by taking five specific steps. Don’t be caught on the sidelines as others put their CCM programs in place.

July 30 (Thursday) 3:00 ET. “De-Silo Your Disparate IT Systems Around the Patient with VNA.” Sponsored by Lexmark. Presenters: Steven W. Campbell, manager of diagnostic applications and interfaces, Piedmont Healthcare; Larry Sitka, VNA evangelist, Lexmark. The entire patient record, including both DICOM and non-DICOM data, should be available at the point of need. Disparate, aging systems that hide data inside departmental silos won’t cut it, nor will IT systems that can’t integrate medical images meaningfully. Learn how Piedmont Healthcare used a vendor-neutral archive to quickly and easily migrate its images and refocus its systems around its patients.

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

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Act.md announces an $8.4 Million Series A funding round led by Rose Park Advisors. The Boston-based startup will use the funds to continue development of its cloud-based care coordination platform.

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Baptist Health Corbin (KY) receives a $15,500 grant from AT&T that it will use to expand its mental health services to surrounding areas via the purchase of a telemedicine cart.

GE Foundation funds the Project ECHO initiative with a $14 million, three-year grant designed to help the project keep growing. Project ECHO is a Web-based forum that helps community providers address complex conditions in their local populations by connecting them with experts who provide disease management education sessions and patient-specific treatment advice.


Announcements and Implementations

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The University of California-San Diego Moores Cancer Center implements the InfuSystem Express EHR connectivity solution from InfuSystem Holdings.

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Bon Secours Richmond Health System (VA) rolls out Pro Charge Capture technology from MedAptus for adult hospitalist and pediatric hospitalist intensivist providers at St. Mary’s Hospital.

Western Colorado HIE Quality Health Network and eHealth Technologies partner to enable Aspen Valley Hospital to share diagnostic images with providers across the region.

The University of Virginia Health System partners with the nonprofit Mitre Corp. to develop improved health data analysis tools. As part of the agreement, Mitre will advise UVA on researching innovative bedside monitoring capabilities and optimizing a new computing system. UVA will in turn provide expertise on clinical analytics, complex data environments, and “smart” hospitals.

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Bassett Healthcare Network (NY) selects StrataJazz Equipment Replacement technology from Strata Decision Technology.

Rite Aid installs HealthSpot telemedicine kiosks at 25 locations in Ohio. Patients will be able to connect to providers from Cleveland Clinic, Kettering Health Network, and University Hospitals.


People

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John Glaser (Cerner) joins Aventura’s Board of Directors.

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WellSpan Health (PA) promotes Thomas McGann, MD to executive vice president for clinical practice, a role in which he will oversee the health system’s Project One evaluation of EHRs.


Government and Politics

Retired U.S. Air Force Brigadier General and former CIO Thomas Verbeck takes to the local paper to urge citizens to demand a Congressional review of the DoD’s decision to spend $11 billion on a new EHR. “[T]he DoD’s plan will fail,” Verbeck explains. “That’s because most of today’s EHR systems, including the bidder finalists, are designed only to work within their own system. That allows them to charge physicians and hospitals outside their system for access to your data. DoD can demand a system that seamlessly connects health data with civilian hospitals – or the VA – but it has failed to do so. The solution is simple: DoD must delay this award pending a congressional review. Putting soldiers at the center of care and ensuring that clinicians have all the information needed must be a minimum requirement for any future expenditures on health IT systems.”


Technology

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Healthfinch adds the Chirp automated patient communication tool to its Swoop prescription refill technology


Privacy and Security

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St. Elizabeth’s Medical Center (MA) pays out $218,400 to settle HIPAA violations stemming from 2013 allegations that employees stored the PHI of nearly 500 patients without having performed an adequate security risk analysis.


Research and Innovation

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London-based King’s College Hospital incorporate Oculus Rift virtual reality headsets and motion-tracking sensors into its VR lab to study the effects of immersing bipolar patients into certain environments like the London Underground.

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Phoebe Putney Health System (GA) kicks off a six-month pilot program to offer employees at Phoebe Worth Medical Center and Phoebe Sumter Medical Center acute care via telemedicine. Once the pilot concludes, the organization will look at establishing additional telemedicine sites at various medical specialties across the region.


Other

The Guardian provides a snapshot of a day in the life of NHS clinical coder Jordan Smith, who likens his job looking up ICD-10 and OPCS-4 codes to being a detective looking for clues in patient medical records. He also seems to be a frontline defense against potential fraud, explaining to a colleague looking for the biggest reimbursement that, “We code for information; finance is a by-product.” 

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The Connected Health Group at Partners HealthCare announces the Connected Health ‘15 Pitch Off, a contest that invites providers and those in training to submit ideas on how emotion-sensing technologies can be used to improve healthcare. The contest will run through September, and winning ideas will be showcased at the annual Connected Health Symposium October 29-30 in Boston.


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.

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July 21, 2015 News 11 Comments

Curbside Consult with Dr. Jayne 7/20/15

July 21, 2015 Dr. Jayne 3 Comments

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Mr. H mentioned that I was away last week. I had the pleasure of spending it on a wilderness adventure and was able to seriously unplug for the first time in a long while. Being forced to make do with what you remembered to pack and what your companions are carrying definitely casts a different light on the idea of accomplishments. I wasn’t away very long before I had some experiences that made me question how important some of the things we all worry about on a daily basis really are in the grand scheme of things.

My active clients and my practice knew I was going to be away and to not expect any responses to email until today. Although our group had a solar charger with us, most of us were pretty serious about putting our technology away on day one. Being able to wake up without the blinking light on my phone was priceless. I went from a world of worrying about hundreds of minute details to a world where the key worries were having enough water, making fire, having adequate food, and staying dry were the real priorities (and not always necessarily in that order).

Teamwork has an entirely new meaning when you are depending on each other to share the load (literally) and look out for each other. Being in the backwoods means getting creative with solutions when you don’t have ready access to everything you wish you had. I administered some fairly primitive medical treatments – fortunately the standard of care doesn’t apply when you’re many miles from nowhere. Everyone made it home with all their limbs and most of their senses of humor, so I guess my wilderness first aid skills were OK. It was certainly nice to be in a world where I didn’t have to worry about documentation, although I did have to have my companions do a “sanity check” on my plan of care since my mind was trying to operate in a Level I trauma center while my patient was sitting on the ground in the dirt.

The best thing was being away from federal (and other) mandates. When your main directives are “Leave No Trace” and to not do anything stupid or that might get you dead, it’s a lot more simple. None of my fellow hikers were in healthcare and only one was in IT, so we didn’t get sucked into beef sessions about work or coworkers. I’ve spent the last decade and a half using the better part of my waking hours to deal with unhappy physicians, poorly functioning technology, and whether my employers were sane. It was nice to just worry instead about how far I could push myself mentally and physically and whether my feet were staying dry and happy.

I learned that I’d rather deal with venomous spiders and reptiles any day than with RAC audits and PQRS calculations. I also learned that having the right kind of supplies turn up at the right time makes all the difference (and indeed what I would do for a Klondike Bar, when presented with one that had been delivered in dry ice following three days with the heat index well over 100F). I shared my tent with a fascinating spider – do you know how long it takes her to eat a fly? I do. I also shared my path with a flock of wild turkeys (not the liquid kind), mosquitoes the size of hang gliders, and what one of my trail mates insists was a chupacabra (personally I think it was a raccoon).

I think the best part of the experience was being mostly without the need to keep track of time. You wake up when the sun comes up and go to bed when you feel like it. There are no double-booked meetings or back-to-back conference calls. You rest when you’re tired and pick up again when you’re ready. You have the luxury of watching spiders build webs because you don’t have anything else pressing to do.

Coming back to civilization was initially a rude awakening. The first person I encountered at the airport was a twenty-something man using voice-to-text for messaging his best friend about why the friend’s girlfriend was bad news. I got to hear all the gory details and doubt he even thought that everyone around could hear. (By the way friend – it’s going to backfire. Your friend needs to figure it out on his own.)

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Civilization did redeem itself, however, when I discovered I was sharing my flight home with the BYU Ballroom Dance Company. They were extremely courteous travelers as well as being classily dressed. I almost thought I had fallen into a 1960s air travel dream with the men in crested navy blazers and the women in matching tangerine travel dresses. I found it amusing that although the ladies’ jewelry matched, they all had their own choice of shoes.

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Nearly 70 miles of hiking later, I’m back in the saddle with quite a few emails and a couple of conference calls. It’s hard to be back, but I’m interested to see how my new perspective influences my day-to-day work. I’m exhausted but invigorated. I’ve already started planning next summer’s wilderness adventure and it’s great to have something to look forward to.

What’s your next adventure? Email me.

Email Dr. Jayne.

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July 21, 2015 Dr. Jayne 3 Comments

Morning Headlines 7/21/15

July 20, 2015 Headlines No Comments

How Not to Fix the F.D.A.

The New York Times Editorial Board publishes a piece critical of the 21st Century Cures Act, pointing out problematic provisions that weaken FDA oversight on medical devices and strip the drug review process of important safety measures, recommending that the Senate “either eliminate or rewrite the flawed provisions before passing its version of the legislation.”

Hacked? Big deal: I made my most personal data public

John Halamka, MD and CIO of Beth Israel Deaconess Medical Center, recounts his decision to publish both his complete medical record and sequenced genome, in an article he writes calling for a patients-centric platform that would allow anyone to voluntarily share their own health data.

Project ECHO: Force Multiplier For Community Health Centers

GE Foundation will fund the Project ECHO initiative with a $14 million, three-year grant designed to help the project continue growing. Project ECHO is a web-based forum that helps community providers address complex conditions in their local populations by connecting them with experts who provide disease management education sessions and patient-specific treatment advice.

Federal Grant Awarded to Support State Medical Boards in Developing Infrastructure for Interstate Medical Licensure Compact

The Federation of State Medical Boards announces that it has received a $225,000 grant to help states adopt the Interstate Medical Licensure Compact, an agreement it drafted last year that eases licensure restrictions on cross-state care delivery in an effort reduce barriers to telehealth expansion.

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July 20, 2015 Headlines No Comments

Morning Headlines 7/20/15

July 19, 2015 Headlines 2 Comments

UCLA Health Victim of a Criminal Cyber Attack

UCLA Health announces that 4.5 million patient records have been compromised after discovering that during a September 2014 cyber attack,  hackers had accessed secure parts of the network where medical records were stored.

Allscripts Shares Soar After Preliminary Results Beat Estimates

Allscripts reports preliminary Q2 results: expected revenue is projected at $350-$354 million, EPS $0.12, beating analyst expectations on both. Share prices climbed nine percent on the news.

Health IT Safety Center Roadmap

ONC publishes its Health IT Safety Center Roadmap which calls for the creation of a Health IT Safety Center where industry stakeholders would analyze emerging safety issues and generate evidence-based solutions and resources. The center is expected to generate $20 million in costs over its first five years of operation.

Drone Drug Delivery Flights Add International Research Element to Health Outreach

The first FAA-approved drone delivery system goes live, delivering pharmaceuticals  to a free health clinic running in the rural community of Wise, VA.

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July 19, 2015 Headlines 2 Comments

Monday Morning Update 7/20/15

July 18, 2015 News 7 Comments

Top News

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UCLA Health announces that its systems have been breached in a criminal cyberattack, exposing the information of 4.5 million patients. UCLA contacted the FBI in October 2014 when it noticed suspicious activity, but didn’t realize the hackers had gained access to patient information until May 2015. UCLA has hired additional IT security companies and expanded its internal security team in response to the breach.

The many recent healthcare breaches suggest that basically everybody who has ever been a patient or bought medical insurance should just accept the fact that their information could be exposed, causing nothing more than embarrassment other than in the case of identity theft. That makes me wonder which data elements are required to steal someone’s identity and whether providers should be storing those elements given their substandard security. Or if we’re really paranoid about someone finding out about our blood pressure or hemorrhoids (does anyone really care?), whether pre-Internet HIPAA laws should be extended beyond just providers to everybody.


Reader Comments

From Publius: “Re: DoD EHR bid. Will announce Friday 7/17 their selection of Epic/IBM for the DHMSM project. IBM is meeting with consulting firms on Monday 7/20 to deliver Statements of Work (SOWs). Seattle/Tacoma area is the first deployment, Washington DC, Europe, then Asia. Consultant pay rates are expected to be below market initially.” Unverified. My insider says Friday at 4:00 p.m. Eastern was the deadline for the DoD folks to turn in their scoring for tabulation following a two-day extension. Unless DoD ignores their stated methodology, nobody knows the winner yet. Maybe next week, although the week after seems more likely. Another source says the announcement date will be August 14. Gossiping about the outcome is fun and I’ve heard a bunch of wild, unverified rumors, such as one of the three bidders failing to make the final cut due to licensing and offshoring issues. I’m trying to picture the reaction in the three camps when the winner is named. Maybe the winner will become so distracted by DoD’s demands that the other two will gain non-governmental market share. Remember NPfIT, where every successful and initially giddy bidder nearly went out of business after failing to meet milestones tied to payments.

From Truven Watcher: “Re: Truven. Rumors are that TriZetto is in talks with Veritas Capital to buy it.” Unverified. TriZetto was acquired last fall for $2.7 billion by Cognizant, which has expressed interest in more acquisitions.

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From Mr. Black: “Re: NantHealth acquisition of Harris Healthcare. The best part of the NantHealth purchase is Allscripts gave them $200 million, which they in turn gave them $100 million, but since Allscripts essentially gave them their money back (and then some), they went and purchased a competitor. It’s just laughable.”

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From Wintry Mix: “Re: Allscripts. Trying to convince me that they have a truly integrated, single database, single code set acute and ambulatory offering along the same lines as Cerner, Epic, and Meditech. No interfaces, one patient/one record, etc. It wasn’t long ago that Allscripts included zero dollar interfaces between the Touchworks PM and EMR components in their ambulatory contracts since they hadn’t fully integrated the A4 PM system, let alone folding in Eclipsys. Can anyone validate their claim?”

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From ThePope: “Re: Ascension Health. The largest Catholic Health System in the world is making a coercive offer to buy one of its vendors at a 50 percent discount to market value, an unprecedented move for a faith-based, not-for-profit system.” Ascension Health makes a lowball offer of half the stock market value of revenue cycle vendor Accretive Health after announcing that it won’t renew the company’s contract, which accounts for half of Accretive’s total revenue. Accretive Health rejected the offer, but its shares tanked that same 50 percent on Friday, wiping out more than $250 million in equity. The company is “seeking strategic alternatives” as shares have dropped 71 percent in the past year. Former McKesson executive Emad Rizk, MD, who took the Accretive CEO job a year ago, saw his net worth plunge $3 million between Friday’s breakfast and dinner as the stock went down in flames following Ascension’s offer/threat.


HIStalk Announcements and Requests

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I was surprised that more than half of poll respondents haven’t completed an Advance Directive, meaning that if they’re lying brain-dead on a ventilator in a hospital bed (after an accident or stroke or whatever tragedy can happen at any time and at any age), they’re sticking someone else with the decision of whether to pull the plug or let them lie in expensive vegetative limbo indefinitely. Take charge before it’s too late – it’s easy to create an Advance Directive and Healthcare Power of Attorney that makes your wishes clear and legally binding. New poll to your right or here, in recognition of summer vacations: how many paid days away from work will you take in 2015? 

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Thanks to TeraMedica, now part of Fujifilm, which has upgraded its HIStalk sponsorship to Platinum.

A small “my medical records saga” update: I thought I would be clever in sending my CareSync records to my Carebox account using Direct messaging, but CareSync didn’t recognize my Carebox Direct address as valid for some reason even though it allows a Direct address as a “send to” option. I’ve let them know it didn’t work. I also requested to have my PCP’s records added, which is a one-button CareSync click followed by a quick provider database lookup.


Last Week’s Most Interesting News

  • NantHealth acquires Harris Healthcare Solutions.
  • A group that includes HIMSS and MGMA publish initial documents for their Virtual Clipboard project that will allow patient-entered demographic and insurance information to be collected electronically at registration.
  • ProPublica publishes a Surgeon Scorecard of complication rates derived from Medicare claims data.
  • AHA objects to the information blocking provisions of the 21st Century Cures Act that has cleared the House and now rests with the Senate, urging Congress to target non-cooperative vendors whose systems and fees make it impractical for providers to share data conveniently.

Webinars

July 22 (Wednesday) 1:00 ET. “Achieve Your Quality Objectives Before 2018.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; Dennis Swarup, VP of corporate development, CitiusTech. The presenters will address best practices for building and managing CQMs and reports, especially as their complexity increases over time. They will also cover quality improvement initiatives that can help healthcare systems simplify their journey to value-based care. The webinar will conclude with an overview of how CitiusTech’s hosted BI-Clinical analytics platform, which supports over 600 regulatory and disease-specific CQMs, supports clients in their CQM strategies.

July 29 (Wednesday) 11:30 ET. “Earning Medicare’s New Chronic Care Management Payments: Five Steps to Take Now.” Sponsored by West Healthcare Practice. Presenters: Robert J. Dudzinski, PharmD, EVP, West Healthcare Practice; Colin Roberts, senior director of healthcare product integration, West Healthcare Practice. Medicare’s new monthly payments for Chronic Care Management (CCM) can improve not only patient outcomes and satisfaction, but provider financial viability and competitiveness as well. Attendees will learn how to estimate their potential CCM revenue, how to use technology and clinical resources to scale up CCM to reach more patients, and how to start delivering CCM benefits to patients and providers by taking five specific steps. Don’t be caught on the sidelines as others put their CCM programs in place.

July 30 (Thursday) 3:00 ET. “De-Silo Your Disparate IT Systems Around the Patient with VNA.” Sponsored by Lexmark. Presenters: Steven W. Campbell, manager of diagnostic applications and interfaces, Piedmont Healthcare; Larry Sitka, VNA evangelist, Lexmark. The entire patient record, including both DICOM and non-DICOM data, should be available at the point of need. Disparate, aging systems that hide data inside departmental silos won’t cut it, nor will IT systems that can’t integrate medical images meaningfully. Learn how Piedmont Healthcare used a vendor-neutral archive to quickly and easily migrate its images and refocus its systems around its patients.

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

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Xerox takes a $145 million charge as it decides to cut back its Medicaid systems business within its Government Healthcare Solutions division.

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Mayo Clinic licenses its stress level software for physicians, residents, and medical students to Corporate Web Services, which developed the interactive versions of the tools and will market the products through its Med+Ed Web Solutions business.

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Consumer engagement platform vendor Accolade raises $22.5 million.

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Allscripts reports preliminary Q2 estimates that beat analyst expectations for both revenue and earnings, sending shares up 9 percent on Friday. Above is the one-year MDRX share price chart (blue, down 11 percent) vs. the Nasdaq (red, up 18 percent).


People

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Steve Wasserman (AppNeta) and Joy Schroeder (PatientKeeper) join Aventura as CFO and VP of business development, respectively.


Government and Politics

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ONC releases its consultant-developed roadmap for a Health IT Safety Center, estimating the cost of operating the public-private partnership at $20 million over five years. The safety center wouldn’t seem to do much actual work for that investment since the proposal says it won’t oversee or investigate anything, won’t collect data, and won’t serve as a Patient Safety Organization. It would mostly just try to get stakeholders together and share information within its core functions of convening, researching, and disseminating. The report suggests that initial funding could come from ONC or AHRQ (assuming the government doesn’t dissolve AHRQ, after which this report seems to suggest that the Safety Center be modeled) and the center would have to figure out how to fund itself by Year 5. It calls for at least 10 FTEs along with IT and travel costs. It’s way too touchy-feely to raise my level of interest and fails to address any pressing issues, such as the need for centralized data collection, incident investigation, and provider safety awareness. It seems like a waste of taxpayer money in the proposed form as it tries to avoid offending anyone, including those who need offending, and how it will eventually fund itself raises interesting questions. I don’t think this will help ONC’s case in trying to convince Congress to underwrite its search for post-Meaningful Use relevance.


Privacy and Security

A New York Times article notes the ongoing use of HIPAA as a healthcare provider “code of silence” in misinterpreting the law by either ignorance or indifference, such as when a woman called the ED to provide the medical history of her 85-year-old mother and was told they couldn’t take her information because of HIPAA, which led to the doctor ordering a drug to which the patient was allergic. A church stopped listing the names of ill members in its bulletin, with the minister claiming it had to stop because of HIPAA. The article also notes that patients can give consent verbally to allow their information to be shared even though hospitals often require them to sign a form.


Technology

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A rural Virginia field hospital set up by Remote Area Medical becomes the first US recipient of a package delivered by FAA-approved drone as medical supplies are flown in as a test that also involves NASA. The 10-pound drones were provided by Flirtey, which calls itself “the world’s first autonomous aerial delivery company” in offering last-mile logistics.


Other

A KQED analysis finds that the Bay area has the lowest rate of graduating medical students who continue on to residency in “Dropout Docs: Bay Area Doctors Quit Medicine to Work for Digital Health Startups.” A third of Stanford’s medical graduates effectively end their medical careers by not even applying to residency programs. The article notes that biotech and digital health companies offer opportunities that appeal to new graduates worried about excessive patient loads and lack of provider satisfaction, with one physician adding, “I loved working with patients, but I looked around me and realized that I didn’t want the jobs of anybody who had ‘succeeded’ as a clinician. Tech culture is very appealing when juxtaposed against the hierarchy and myriad hoops to be jumped through in clinical medicine.”

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Scottsdale Institute announces its Patient/Consumer Engagement Adoption Model that includes a self-administered assessment. It’s free to all US health systems and clinics.

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A new, free Peer60 report finds that two-thirds of providers consider image-sharing to be critical, with most of them a lot more interested in receiving images from outside facilities rather than sending them (obviously that’s a problem). Nuance’s PowerShare Network (the acquired Accelerad and SeeMyRadiology.com) had the top market share and market awareness.

Weird News Andy says this story is Finger Kissing Good, in which the CDC quite unnecessarily advises him to avoid kissing pet chickens due to potential salmonella infections. WNA adds some trivia in noting that Peach Melba and Melba Toast were both named in honor of Australian soprano Nellie Melba, which inspired him to christen his seafood creation in honor of his favorite singer Ella Fitzgerald as Salmon Ella.


Sponsor Updates

  • North Valley Hospital (MT) uses Summit Express Connect to consolidate 45 interfaces in its migration from Meditech to McKesson Paragon.
  • MedData offers “The Wait is Over: Welcome to ‘The Impatient Patient.’”
  • NTT Data Americas is named “Best IT Company of the Year in Services” in the 10th Annual 2015 IT World Awards sponsored by Network Products Guide.
  • NVoq offers “Your iPhone has Good Dictation. Why Doesn’t your Enterprise Application?”
  • Oneview Healthcare offers “Six Steps to Superior Patient Satisfaction.”
  • Patientco posts “Is the Location of Your ‘Pay My Bill’ Button Costing You Money? You May Be Surprised.”
  • VisionWare will exhibit at the MDM & Data Governance Summit July 22-23 in San Francisco.
  • PatientKeeper offers “Providers: Assess Your Charge Capture Needs.”
  • Paragon Development Systems (PDS) reports record monthly revenue in June 2015.
  • PerfectServe offers “Care Transitions – Tips for Bridging the Gaps.”
  • PeriGen supports the Association of Women’s Health, Obstetric and Neonatal Nurses with a $2,500 donation to the Every Woman, Every Baby program.
  • Phynd offers “Inaccuracies move the industry toward a Unified Provider Management Platform.”
  • PMD offers “Patient Satisfaction is Physician Satisfaction.”
  • Sandlot Solutions will exhibit at the Louisiana Hospital Association Annual Meeting and Summer Conference July 20-21 in Orange Beach, AL.
  • The SSI Group will exhibit at the Adventist Health System Revenue Cycle Conference July 21-22 in Altamonte, FL.
  • Sunquest Information Systems will exhibit at AACC 2015 July 28-30 in Atlanta.
  • The Dallas Business Journal features T-System CTO Hank Hikspoors.
  • Huron Consulting and Valence Health will exhibit at the AHA Leadership Summit July 23-25 in San Francisco.
  • Verisk Health offers “VHC is Back and Better Than Ever Before.”
  • Voalte CEO Trey Lauderdale is profiled in the Florida Business Observer.
  • ZirMed offers “CMS’ new ICD-10 transition plan and newly proposed reimbursement model.”

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.

 

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