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HIStalk Interviews Jay Katzen, President, Elsevier Clinical Solutions

March 31, 2015 Interviews No Comments

Jay Katzen is president of Elsevier Clinical Solutions.


Tell me about yourself and the company.

I’ve been at Elsevier for just about eight years now. Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals. The goal is to empower them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries.

From a clinical solutions perspective, our goal is to deliver solutions to improve health across the care continuum, which goes to students, clinicians, and the extended care team as well as patients.


Elsevier’s offerings cover a lot of depth and breadth, ranging from research journals to point-of-care content. How does that help reduce the gap between knowledge discovery and actually putting information into practice?

One of the key things about Elsevier is that we cover research through action. It covers the educational side as well. Our #1 goal is to provide the right information to medical students and nursing students to help them be the best practitioners. We deliver our solutions to primarily the provider setting, although we also go into the commercial setting, which is retail pharmacies and things like that.

Generally, we provide our information to the enterprise for use by clinicians and the staff at any point of need. There are referential solutions to look up information about what’s the diagnosis, what’s the best treatment, what is the evidence supporting the information. Delivering information to be deeply embedded into their CPOE system or electronic medical record with a goal of providing the information at the point of need to make a better decision.

Part of the way we are closing the gap is that we cover across the spectrum. We also ensure that we localize it or customize it to the individual hospital’s practices.


Do you ever review what information people are looking up to detect trends, such as how Google Flu Trends works?

We do. I would say it’s in the early stages of some of that. We’re looking at some new products that help us analyze that more.

There’s obviously a lot of work going around big data and analytics, but we continually review a couple of things. Number one is what people search on in general. We look at click-through patterns and things like that to try to figure out if there are ways we can optimize the system to help individuals get to the answer faster. It’s also to understand whether there are gaps in what we’re providing because people may not be finding what they need. That’s on the clinical practice side.

On the research side, we look at this to see if there are areas where they want to perform new research or areas where we need to invest from a general standpoint.


Are users looking beyond just finding information to instead have it made actionable by presenting it automatically at the point where they might need it?

The industry is going much more towards point-of-need information. That’s not just for clinicians — that’s for patients as well.

As our customers evolve, they’ve made significant tens of millions or hundreds of millions of dollars of investment in their infrastructure, such as CPOE systems. The reality is that investing in systems alone is not improving quality across the care continuum. It’s not standardizing care. They need content to be embedded into their systems to drive improvement in care and to improve quality.

At least from what we’ve seen and in working with our customers, number one, they want the information more actionable. They want it embedded into the systems and tied to patient context. But they also want to make sure that it’s meaningful and that it can be impactful. Lots of research around alert fatigue. Our goal is not to alert the physician, pharmacist, or nurse on every potential thing out there — it’s to ensure that we deliver the information and that it’s going to be meaningful to them to make a better decision.

The same thing applies and is applying more to patients. We have a segment focused on patient engagement. If you look at Meaningful Use Stages 1, 2, and 3, more and more information has to be delivered to the patient with the goal of empowering the patient to take control of their care. The way to do this is not just to send general information about diabetes or Crohn’s or hip replacements — it is around customizing it to the individual needs as well as their specific instances.

The actionable information applies not only to clinicians, but applies to patients, but it also has to be delivered in the workflow, whatever the workflow might be, so it’s valuable to them versus having them be proactive and go search it. It has to be pushed down to the individual.


How do your products support care teams, including those that are virtual?

This is one of the benefits and differentiators we have as an organization. Our products are designed around interdisciplinary care teams, especially our care planning products, our order set products. We’ve put a lot of focus on how teams are working now and how they’re going to work in the future.

From a collaboration standpoint, some of the things we’re testing now are around patient engagement. Not just delivering information to an individual patient, but it’s also creating a seamless connection for the patients back to their clinicians. We’re looking at testing some products with some heart failure patients where they can flag things on their mobile device. That sends an alert back to their primary care physician, who can make a call and connect with the patient. There’s collaboration on the care team, but also an increased need for collaboration between the patient and the provider.


That sounds like your Tonic platform, where consumers can enter information on a mobile device. What kind of information can they enter and how does that flow through to the provider?

It’s a couple of things. One is the Tonic platform and one is a pilot we have which is called Digital Dialogues, which we’re doing with IMS.

Digital Dialogues is around congestive heart failure. The patient can capture information that is then sent back to the physician to create that connected network. 

Tonic is a tremendous platform that has a lot of potential to expand what we can deliver and when we can deliver it. Initially, patients go into a hospital and it’s around capturing information about that patient. The unique thing about the Tonic platform it’s a gaming-type system where it makes it fun for the patient to answer questions. Based on the questions, we can then deliver information that is more specific to them. If they have Crohn’s and we have information videos or other information on Crohn’s, we can direct it to them right at that point of need or action.

The platform allows us a lot of flexibility as far as when the patient or consumer is interacting with the platform and what we can deliver to them based on what their specific requests are, right at the point of need.


Is it a change in the company’s direction to go beyond supplying reference material for providers to supporting consumers who are seeking their own information, perhaps as an alternative to Web searches?

Absolutely. First of all, our primary market is to the institution for use by clinicians. But the reality is that in today’s healthcare market, the patient or consumer has to play a significant role in their care. We’re working with hospitals to implement the Tonic platform, which includes our content and information solutions. It’s the trusted provider — patients going into the hospital will get the same information that the hospital is using internally as well as when patients go home.

We cover the information needs across the spectrum, whether it’s a physician or pharmacist looking up information about a disease, what’s the best treatment, what’s the best plan of care, are there interactions, and things like that. We deliver all that from a clinical perspective, but just as importantly, we need to deliver similar type of information geared toward the patient so they can understand it and they’re empowered from a care standpoint.

If you look at the statistics today, there’s almost a trillion dollars of waste in healthcare. Big chunks of that are because patients don’t understand their care, they’re readmitted, they don’t follow the regimen that’s provided to them. It’s pretty critical that patients or consumers understand what their needs are, how to improve their care, and why it’s important to follow it, as well as what the implications are if they don’t, so that we can reduce the overall waste in the healthcare system.


Do you see any possibility of a single shared care plan where all of a patient’s providers and the patient themselves can contribute to it, perhaps wrapped around standard evidence-based content and some sort of workflow capability?

We’ve looked at that in the past, whether it was for care plans, order sets, or other type of content — a collaborative content creation or updating mechanism. What we’ve found is that while things are standardized across the US healthcare system or other systems, the reality is each healthcare system wants to put their own stamp on it or have their own tweaks, whether it’s care plans or order sets.

We provide mechanisms inside of an institution to collaborate across different kind of committees, whether it’s on care plans or order sets. We’ve talked to people outside to see if they want to do it in a more community-based environment, but so far, that hasn’t gotten a lot of traction.

I think it comes down to the fact that there are a lot of complexities around that, from a standpoint of keeping them current, ensuring that if evidence changes or a drug is removed, that’s propagated throughout everything. How do we reduce liability but ensure that people have access to the best information they can? Those are some of the challenges to the community-based infrastructure.


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

My goal and the vision of the company is to lead the way in science, technology, and health. Healthcare is still in a state of disarray. Based on the stats from a study that came out, a thousand people die every day in the US from preventable medical errors. It’s just not acceptable. It’s our responsibility as a company to deliver our solutions to students and professionals to improve the quality of care.

If I look out at the next three to five years, it’s just continuing in the current strategy. We can significantly improve healthcare and reduce errors by ensuring that our care planning products and our order set products are implemented in these systems, utilized, and that the right training is delivered to the institution to ensure standardization of care. We’ll be delivering more and more of our information deeply embedded into our health HIT partners.

Another big component for us is around patient engagement. We talked about that already and how the patient is playing a much larger role in their care. That’s a focus for us. I see that continuing and evolving and increasing over the next three to five years.

We’re a global company. From a clinical solutions business standpoint, a significant part of our revenues comes from outside the US. We continue to invest in many countries outside the US. As the evolution of the infrastructure increases in the UK, Germany, Spain, China, Japan, etc. we continue deliver the same types of solutions and the same type of impact outside the US as well.


Do you have any final thoughts?

Whether it’s Elsevier or any company out there, it’s our responsibility to partner with our hospital customers, physician offices, and clinicians better to look at co-development and other ways to deliver our information. It’s our responsibility from an Elsevier perspective, and from the industry’s perspective, to solve this problem.

We’re not there. We haven’t done it yet. If you look at the stats, if anything, they’re going the wrong way. We need to be more successful in ensuring that our information and the evidence is delivered at the right point of time to improve care. It’s something that has to happen in this marketplace. It’s not sustainable and we shouldn’t accept it.

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March 31, 2015 Interviews No Comments

Morning Headlines 3/31/15

March 30, 2015 Headlines No Comments

HHS CTO steps down

Bryan Sivak will step down from his position as HHS chief technology officer at the end of April. Sivak joined HHS in 2012 and oversaw the Entrepreneurs in Residence program as well as the HHS IDEA Lab.

Scripps Selects Epic For New EHR

Scripps Health (CA) has chosen Epic as its next EHR vendor, replacing GE Healthcare’s Centricity Enterprise on the inpatient side and Allscripts Enterprise in its outpatient clinics.

Canadians Losing Out On Benefits Of Electronic Health Records

A C.D. Howe Institute report finds that widespread interoperability challenges are hindering efforts to reduce healthcare costs and improve care coordination. “Survey findings revealed that in primary care only 12 percent of physicians are notified electronically of patients’ interactions with hospitals or send and receive electronic referrals for specialist appointments,” says Denis Protti, the report’s author.

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March 30, 2015 Headlines No Comments

Readers Write: Your Interfaces Suck Because You Want Them To

March 30, 2015 Readers Write 4 Comments

Your Interfaces Suck Because You Want Them To
By T. Ruth Hertz

Your interfaces suck because you want them to. Yup, that’s the stone cold reality. 

I am looking at you Mr. /Ms. CIO. You may talk all day about interoperability, data normalization, HIEs, standards, etc. but unless the right data in the right format gets to the right place at the right time, you are wasting time and money and possibly risking patient safety.

But wait, you say. We insist that all applications have HL7 interfaces – we even put it in the contract! Yes, maybe you do, but do you take the time to get and review detailed specifications before you sign the contract? Do you require the vendors to demonstrate interfacing their application with the ones you already have? Not just give you a list of other clients that have “the same systems as you” but actually connect their system to your engine and downstream application test environments? How well would the physicians at your institution react to being given a list instead of a demo and / or site visit?

Do you let your interface experts ask the tough questions during due diligence? If you do, does it matter when the answers are wrong or evasive? Or do you just accept it when the vendor says, “You can fix it in the engine?” Do the interface experts get to go on the site visit, see the interface in action, and talk to the folks that have had to actually make the interface work?

Let’s face the facts:

  • It is in the application software vendor’s best interest to not interface well with other vendors’ apps. Selling a suite of apps that work well together but not well with others makes buying their products as a set look like the smart thing to do.
  • Application software vendors can make their interfaces work. They have the source code and the underlying database. They just need a very good reason to do so – like “no sale” if they don’t.
  • Your interface staff time isn’t free. All the time spent on analyzing, designing, and building workarounds to compensate for deficiencies in the sending and/or receiving applications costs hard money. That time is also time lost from other projects.

It’s time that the decision-makers who buy healthcare apps put a stop to this madness and insist that true interoperability be delivered by the software vendors – or no sale.

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March 30, 2015 Readers Write 4 Comments

Readers Write: A Prescription for Getting Face Time with Doctors at HIMSS

March 30, 2015 Readers Write 1 Comment

A Prescription for Getting Face Time with Doctors at HIMSS
By Chris Lundgren


It’s no secret that it’s getting harder and harder to get face time with doctors. But I’m a sales guy, so I always see a silver lining in everything.

In this scenario, the silver lining is that doctors are just like you and me. They can’t live without their gadgets. Recent studies have shown that 75 percent of doctors own a smartphone and 55 percent use both a tablet and smartphone in their daily work. So while you may have a more difficult time connecting in person with doctors, you can still be very much connected.

The key to engaging doctors today is to use technology when the time is ripe. The upcoming HIMSS conference is the perfect example. It has a huge audience and nearly 60 percent of the attendees are healthcare providers. Let me repeat: thousands and thousands of doctors gathered in one space to live and breathe technology for five days. If that isn’t a jackpot waiting to happen, I don’t know what is.

Problem is, doctors are going to be running from one panel to another at HIMSS, so you can’t expect to get face time with them if you haven’t engaged them prior to the conference. And the way to do that is – you guessed it – through their gadgets. Here’s what I recommend:

  1. Ask them how they’re doing. Doctors are always asking others how they’re doing. Now that the pressure is on doctors to improve patient outcomes and reduce healthcare costs in measurable ways, it’s time to ask doctors how they’re doing and what’s on their minds. A quick and easy way to do that is a survey that asks 1-3 questions such as, “What topic(s) are you most interested in at HIMSS?”, “What do you hope to gain from learning about that topic?”, and “What other concerns are on your mind?”
  2. Make them a HIMSS-only offer. Limited time offers work time and time again because they create a sense of urgency. If you want to ensure that you get some face time at HIMSS, make sure you’re prepared to make offers that will only be available at the conference. Use the results of the survey to develop the offer or gather qualitative insights from your sales reps – what have their conversations revealed about doctors’ needs right now? Take advantage of email marketing for its quick response, analytics, and segmentation capabilities.
  3. Impress them with knowledge. A recent study showed that doctors are always hungry for new research, case studies, and other clinical knowledge that can help them in their work. But here’s the catch (and also the opportunity): they’re often too busy to look for it on their own. Do the work for them by delivering valuable content. Remember, they’re busy, so don’t deluge them with a library of links. Try a short list of statistics or a link to an article to get the conversation started. Tip: Information related to patients is hot right now and there’s a treasure trove of relevant content with a quick search.

Digital engagement is an essential component to any physician communication strategy. However, to maximize the results of such a strategy, the focus should be on quality rather than quantity. In addition, integrating a quality digital campaign with the right mix of print, mail, and telemarketing can optimize any effort. Be sure to get your reps to follow up with doctors on the phone or via email after a campaign goes out. Using this multi-channel approach can boost revenue by more than 10 percent. Good luck at the conference.

Chris Lundgren is VP of strategic sales for Healthcare Data Solutions of Lincoln, NE.

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March 30, 2015 Readers Write 1 Comment

Curbside Consult with Dr. Jayne 3/30/15

March 30, 2015 Dr. Jayne 3 Comments


I mentioned that we are having budget meetings this week. One of the hot topics is how we’re going to manage office space and various leases as we reorganize to consolidate onto a single vendor platform. The health system’s goal is to move everyone under the IT umbrella, so we’ll need more space at the mother ship.

We’ll also have to figure out what to do with existing office space leases at our regional campuses and how to transition people from one location to another in a timely fashion. Certain functions such as desktop support and provisioning will continue to be somewhat regional, so there’s going to be some delicate negotiating while we figure out which spaces to keep and which to let go.

I hadn’t given much thought to the new space they’ll be outfitting for the project. The last time I was involved in a significant office move was seven or eight years ago and we were going into a largely completed space. The biggest thing we had to decide was which staffers would be placed into which rows of cubes.

Late last week, I had the dubious pleasure of attending a half-day session to discuss design and construction of the upcoming office build-outs. Given some of the complaints we’ve gotten about the open office design at some of our newer facilities, I thought the topic might be contentious, but I had no idea just how much.

One faction came to the meeting armed with copies of a recent article in The New Yorker called “The Open-Office Trap.” It details the perils of the open office, citing examples of reduced productivity and higher levels of employee stress. Reports have also chronicled higher use of sick days and reduced cognitive performance. One study from Cornell University found that workers exposed to typical open-office noise had higher levels of the stress hormones that are typically associated with the fight-or-flight response. Another from Finland looked at whether younger employees did better with the open office platform and concluded that although they might seem to, there are trade-offs.

As we started the meeting, another attendee hastily emailed links to the Washington Post piece on the topic. The author mentions employees who have difficulty with the transition the open office paradigm and laments the lack of huddle rooms to be used when private conversations are required.

I know that the first time I had to transition from a private office to a cube, I had a hard time adapting. As a newly-minted medical director, I was given a “supercube,” which was essentially double sized with a small table for meetings. It was on a main thoroughfare in cubeland however, which seemed to invite people to plop around the table for impromptu conversations.

I was often interrupted with requests to borrow my chairs or by people just saying hello on the way to the bathroom, icemaker, elevator, or coffee pot. It was also difficult to have confidential conversations about physician behavior, especially since we didn’t have enough smaller meeting rooms. This led me to hide out in a poorly-lighted and recently-vacated office in the basement near hospital engineering, at least until that space was reassigned. The experience definitely strengthened my support for allowing staff to work from home.

Halfway through today’s already-rowdy meeting, another colleague emailed around a piece entitled “Open-Plan Workspaces Are the Work of Satan.” The meeting quickly spiraled out of control after that since it’s hard to take Formica samples and color swatches seriously after someone has invoked the Prince of Darkness. The design and construction team had brought along an intern and I’m sure she found the meeting to be highly educational, just not in the way it was originally intended.

I’m just glad I kept a low enough profile to avoid being volunteered for the subcommittee that will meet again to “continue the dialogue.” I’ve spent the last two months fretting about the future of my team and of my own career and it didn’t even occur to me that serious choices needed to be made on whether we want an aquatic color scheme or one that is desert-inspired or how many “rolling-wall” whiteboards we might need to order. I’m glad there are people that care and are thinking about these things, but at this point it feels frivolous.

The positions for our new clinical project were posted last week. It’s hard to watch my highly-qualified staff fret over whether they’ll be chosen. They’ve heard that they have to take a personality test and that there may be a preference for younger workers without “bad habits” gleaned from working with other vendors and systems.

I’m not part of the hiring decisions at all, but I certainly hope we don’t shoot ourselves in the foot by throwing away all the non-software knowledge we have amassed regarding how to effectively serve our physicians and their practices. In the mean time, I’ll have to amuse myself by running the betting pool on aquatic vs. desert color schemes.

What do you think about open offices? Email me.

Email Dr. Jayne. clip_image003

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March 30, 2015 Dr. Jayne 3 Comments

HIStalk Interviews Randy Campbell, President, FormFast

March 30, 2015 Interviews No Comments

Randy Campbell is president of FormFast of St. Louis, MO.


Tell me about yourself and the company.

I started my career as a biology major in pre-med. I graduated, but didn’t go to med school for various reasons. My roommate, who was studying computer engineering, asked me a question one night. I thought, "Wow, this is really interesting. IT is where I need to be."

I started out in IT, software development in particular. I moved on from software development to a systems integrator, which is a company that provides hardware, software, and services to enterprises. I learned a ton in that field. Ultimately I decided I wanted to get back to a software development company in a area that I’ve always enjoyed. That was healthcare, so I ended up at FormFast.

FormFast is a privately held software company that only sells to hospitals. We’ve been in business for 23 years and have a very large market. We’ve sold to a lot of hospitals over the years.


How have hospitals improved care or efficiency using workflow or process automation that they couldn’t have done with an EHR alone?

That’s the sweet spot we’re in. We’re helping hospitals with all the stuff that supports their EHR and is part of the ecosystem of the hospital.

Our legacy products are electronic forms, in particular on the registration side. Being able to take the information that’s collected by the registrar and, without the expense and maintenance of paper forms, collecting that information, getting signed by the patient when necessary for consents or release of information forms, and then getting that information into a document repository. You would think that process would be core to an HIS or an EHR, but it’s not, because those vendors are more worried about the clinical processes and clinical workflow.

There’s plenty of examples elsewhere in the hospital, whether it’s in the back office, in materials management, and even with some major HIT vendors, with applications or workflows between their own applications that they don’t provide or have the capability to address. Physician coding query is an example, where the coder is able to communicate with the physician in a secure way to ensure that the appropriate codes are applied and that all the documentation is there to support those codes.


Hospitals that claim to be paperless still have a lot pallets of Office Depot paper and pre-printed forms coming in via the loading dock. What are the benefits of making paper processes electronic and workflow driven?

There’s the obvious cost of printing the forms themselves. A hospital is a very regulated environment, and even for forms that are part of the back office that don’t fall under particular government regulations, those forms change. 

Our traditional market has been the community hospital, but with the changes that are happening in healthcare now where so many hospital systems being purchased by larger systems or by IDNs, we’re finding ourselves in larger and larger hospital systems, including the very largest IDNs. It’s really about efficiency and being able to support their core business — which is delivering care — with systems and processes that are as sophisticated as the clinical processes need to be.

For instance, we are working with a number of hospitals around HR kinds of processes. Hospitals have a lot of transitions of staff and employees, people coming and going with mergers and acquisitions of facilities and people changing jobs. Being able to easily onboard, offboard, promote, and transfer employees becomes a major problem. It slows down their ability to focus on the more fundamental mission that they’ve got, which is providing care.

Not only do we provide software that enables hospitals to use those forms in an electronic version that easily integrates with other systems and provides the kinds of automated processing of that information and storing and archival of that information, but we also provide services to many hospitals to do the change management of those forms. That information is always changing, especially as organizations are being bought and sold.

We were having a conversation just this week around our checks application. Somebody asked, "What is the need in hospitals for an application to be able to process checks and generate financial reports and documents and so forth?" They’re changing banks, they need to change the logo, they’re part of a new hospital system, or they’re getting information from a different system. It’s amazing how dynamic the back office systems are.

Hospitals are becoming enterprises like in all other sectors. They have the same enterprise problems. With HITECH and Meaningful Use, more and more money is going into IT, and making sure that that information is in a form that it can be used, shared, and reported on is important. That’s true for the back office as much as it is for the clinical side.


More information is being collected from patients and families, some of whom might not be comfortable entering it using the same applications that clinicians use. Are hospitals using more electronic or scanned paper forms so that the patient-generated information isn’t just sitting in a drawer somewhere?

Yes. Hospitals are asking us to be able to present forms to patients directly, whether it’s for pre-registration or for getting consents signed before coming in.

With fee-for-value rather than fee-for-service, care is being pushed down more and more to clinics, primary care physicians, and even retail environments. That requires more ways of interfacing directly with patients instead of the traditional contact with the registrar or clinicians on the floor. We’re doing a lot of work on that because customers are asking us for more ways to engage patients.

We facilitate the ability to collect information in a very organized fashion using an interface called the form — but it could be a web application — that meets particular requirements and is easy to change. Other enterprises need to do that, and as hospitals add these additional touch points with patients, they’re going to have the same demand.


Is anyone doing anything interesting with barcodes?

It’s pretty exciting to be able to ensure that documents are properly identified, that they’re filed in the appropriate document management repository, and that information is not lost, misfiled, etc. A lot of our business still comes from barcoding forms. We can put not just the old style of barcodes, but 2D barcodes that can be read by the lab system and pharmacy system. We’ve worked with some major hospitals to use different kinds of barcodes that other applications within their clinical environment need to ensure that they’re able to identify that patient 100 percent accurately. The same goes for the forms themselves, the ability to ensure that those forms are stored with the appropriate medical record.

That continues to be a problem. It really is amazing that some of these very fundamental processes within a hospital still seem to have some real inefficiencies. I think it’s just because of inertia. All of the focus has been on getting electronic health records in place. Some of these other important supporting processes have been somewhat neglected. But I think that’s changing.


Do you have any final thoughts?

IT can help enterprises and hospitals are becoming enterprise organizations. They’re operating more like businesses.

We and other healthcare IT companies can help hospitals, especially with these new initiatives, become more efficient. They’ve got a lot of systems. They’ve got a lot of applications. There’s a lot of change in their environment. There’s a lot of things that IT can do to help improve their ability to operate as a business. The more they can operate efficiently as a business, the more they’re going to be able to focus on their core business of providing care to patients.

It’s exciting to see what we can bring to hospitals, perhaps things things they weren’t aware of or weren’t exploiting. It’s exciting for me and for FormFast to be part of that.

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March 30, 2015 Interviews No Comments

Morning Headlines 3/30/15

March 29, 2015 Headlines No Comments

Senate delays vote on Medicare payment fix for two weeks

The Senate will not vote on the House-approved SGR repeal bill until mid-April, after its two-week recess ends.

Johnson & Johnson Announces Definitive Agreement To Collaborate With Google To Advance Surgical Robotics

Google and Johnson & Johnson will partner to develop a surgical robot that will leverage Google code to support surgeons.

Nearly Seven in 10 Patients Would Avoid Healthcare Providers That Experience a Data Breach

A Transunion Healthcare survey finds that 65 percent of respondents would avoid a healthcare provider that had experienced a data breach. Younger respondents were less forgiving than older respondents, with 73 percent of 18 to 34 year olds reporting that they would likely switch providers over a data breach.

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March 29, 2015 Headlines No Comments

Monday Morning Update 3/30/15

March 28, 2015 News 4 Comments

Top News

The Senate won’t review or approve the House-passed doc fix bill until after its two-week recess ends on April 13. You may recall that 2014’s one-year ICD-10 delay was inserted when the Senate, working hours before the previous SGR patch was set to expire, couldn’t muster enough votes to pass its own version of SGR bill that didn’t include the delay.

Reader Comments


From Raygun: “Re: Epic. They’ve never posted in social media, but I got this in my LinkedIn stream.”

From Hanoi Hotel: “Re: [vendor name omitted.] Supposedly laying off 300 people. Trying to get better intel.” I’ve omitted the name of the publicly traded company. Update: a second reader confirmed the first reader’s statement that the company is Allscripts.

HIStalk Announcements and Requests


The least-trusted interoperability organization is CommonWell, according to 50 percent of readers. If you add the totals of its members that are listed in the poll, the distrust number increases to 78 percent vs. Epic’s 22 percent. Respondent James explained his thought: “McKesson’s CEO has said in quarterly calls that he expects CommonWell to gush licensing money any day. Cerner’s documentation is near impossible to find. Epic’s HL7 documentation is there for all to see but that doesn’t do much in the expense department. Athena’s API is non-healthcare-industry-standard, which is a good thing, but it can’t move the market.” A third of the votes came from the Madison area, although Epic was hosting a bunch of customers there and there’s no way to separate their votes from those of Epic employees. New poll to your right or here: what’s the #1 reasons you would decline to do business with a startup?


A year ago I donated most of the proceeds from the Top Spot banner ad at the top of every HIStalk page (it mostly ran during the HIMSS conference) to classroom projects via Teach for America teacher Ms. Moore sent photos this week of her students enjoying the 50 library books we as HIStalk readers donated to her school (with matching funds from the Bill & Melinda Gates Foundation). Her school, in which 65 percent of students get free or reduced price lunches, is the sixth-highest performing school in North Carolina, with 97 percent of students performing at or above grade level and 100 percent of seniors accepted to college (85 percent of those are the first in their families to attend college). The Top Spot banners are still available if your company wants HIMSS exposure and to help me fund more classrooms in need.


Our networking event for HIStalk sponsors will be held Sunday evening (April 12). I’m offering great food and a premium open bar at a nice venue not far from the river and Miracle Mile. I had this last-minute thought: if you’re the CEO of a non-sponsor startup and want to network with some great folks, tell me why you’d like to come and I’ll choose up to five to join us at my expense.

Last Week’s Most Interesting News

  • The House passes an SGR doc fix bill that is free of ICD-10 delay language.
  • HHS publishes drafts of Meaningful Use Stage 3 and 2015 certification requirements.
  • Industry leaders John Halamka and Micky Tripathi question the direction and value of ONC’s Meaningful User and EHR certification programs.
  • Vermont’s governor threatens to shut down the state’s floundering health insurance exchange and move to
  • The head of the Department of Defense’s EHR project suggests that it will choose the bid group that offers the best services, not necessarily the best EHR.

HIStalkpalooza Sponsor Profiles


Do you need a little Tonic to help face those Healthcare Challenges? Visit Elsevier booth #2207 to witness how our innovative solutions and services empower patients and providers and improve clinical outcomes embedding trusted medical content at every stage in the patient journey. Participate in our exciting Healthcare Challenge and win special event giveaways. Are you curious to learn about extreme patient engagement? If that doesn’t convince you, than how about cocktails and mocktails served with a flair? Please join us for our daily in-booth happy hours. We look forward to seeing you there.


Mark your calendars… HIStalkapalooza gold sponsor Divurgent will be bringing back their ever-popular Children’s Hospital Charity Drive to the HIMSS exhibit floor to raise monies for Ann & Robert H. Lurie Children’s Hospital of Chicago. Divurgent’s booth #1891 will feature a fast-paced, interactive Trivia Charity Drive, inspired by the explosively popular mobile app game, Trivia Crack. It will be hard to miss the vibrantly-colored Trivia Charity Wheel as HIMSS attendees spin to see what trivia category they will land on, along with what donation value Divurgent will contribute on the attendee’s behalf. Make sure to visit booth #1891 to help Divurgent meet their goal of raising $5,000 for Lurie Children’s.To view all of Divurgent’s exciting events and happenings during HIMSS, click here.


March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

Acquisitions, Funding, Business, and Stock


Valence Health will move to a new Chicago location as it plans to add 500 jobs by 2019.

Vince continues his 2014 review of health IT vendors in covering those that serve large health systems – Cerner, McKesson, Epic, Allscripts, and GE Healthcare.  



Public Hospitals Authority of the Bahamas chooses Surgical information Systems for perioperative systems.

Announcements and Implementations


EClinicalWorks subsidiary Healow announces integration with several wearable and fitness tracker products.

Government and Politics

Programming website GitHub is hit by a distributed denial of service attack from what appears to be the Chinese government, which is unhappy about GitHub tools that allow China-based users to bypass their government’s censorship.

Privacy and Security


A TransUnion Healthcare survey finds that two-thirds of recent patients (with a heavy representation of younger ones) would avoid a provider that has experienced a data breach. Half of the consumers expect to be notified within one day of the breach (hopefully of its announcement rather than the actual event since it’s foolish to announce a breach before doing preliminary investigation) and about the same percentage expect a dedicated phone hotline and website to answer their questions.



The local TV station profiles Seattle Children’s use of software from local startup Luum, which tracks how employees commute to work so that the employer can reward the use of sustainable transportation. Seattle Children’s gives employees a free fancy coffee if they don’t drive to work in a car.

Johnson & Johnson-owned medical device vendor Ethicon signs a collaboration agreement with Google to develop a robot-assisted surgical platform.


I’m interested in a couple of new apps (Meerkat and Periscope) that allow someone to stream a video broadcast from their smartphones to their chosen Twitter followers. It would be kind of cool to watch a live stream of the HIMSS keynotes or to show a first-person view of what’s going on at HIStalkapalooza.


The City of Baltimore uses its Netsmart EHR to remind employees who are treating heroin addicts to test them for HIV and refer them to HIV care if positive.

I missed this until @Farzad_MD tweeted it out: great investor advice presented as quotes from venture capitalist Paul Graham:

“What investors are looking for when they invest in a startup is the possibility that it could become a giant. It may be a small possibility, but it has to be non-zero. They’re not interested in funding companies that will top out at a certain point.  A startup is a company designed to grow fast. Being newly founded does not in itself make a company a startup. Nor is it necessary for a startup to work on technology, or take venture funding, or have some sort of  ‘exit.’ The only essential thing is growth. Everything else we associate with startups follows from growth.… To grow rapidly, you need to make something you can sell to a big market … If you want to start a startup, you’re probably going to have to think of something fairly novel. A startup has to make something it can deliver to a large market, and ideas of that type are so valuable that all the obvious ones are already taken…. Usually, successful startups happen because the founders are sufficiently different from other people – ideas few others can see seem obvious to them.

Weird News Jeff channels WNA in providing this family-unfriendly story. Two UC Berkeley researchers develop SmartBod, an adaptive biofeedback app that manages the most personal of wearables in order to guarantee a happy ending, tracks performance over time, and allows proudly sharing the results with social media. If that’s not enough, the last names of the scientists (who are in fact a couple) are Klinger and Wang.

Sponsor Updates

  • Zynx Health client Meritage ACO (CA) achieves successful reduction of at-risk patient readmissions.
  • Senator Lois Wolk (D-CA) recognizes Geni Bennetts, MD of WeiserMazars as one of the Third Senate District’s “Women of the Year.”
  • Huron Consulting Group will sponsor and exhibit at the 2015 Cancer Center Administrators Forum March 29-31 in Lexington, KY.
  • Verisk Health offers “How the Boomers will Change the Shape of Medicare.”
  • T-System President and CEO Roger Davis weighs in on EHR interoperability.
  • Shareable Ink names Chris Buckley as regional sales director of the year.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.


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March 28, 2015 News 4 Comments

Morning Headlines 3/27/15

March 26, 2015 Headlines No Comments

Cost Estimate and Supplemental Analyses for H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015

The CBO estimates that the House-passed SGR repeal bill will increase the federal deficit by $141 billion over the next ten years. The bill is now with the Senate.


John Halamka, MD weighs in on the recently published MU3 rules, concluding “The sheer number of requirements may create a very high, expensive and complex set of barriers to product entry.  It may stifle innovation in our country and reduce the global competitiveness for the entire US Health IT industry.”

Rethinking Radiology Informatics

An article in the American Journal of Roentgenology suggests that the ongoing shift to centralize IT services in hospitals has left radiology departments, which were often early health IT adopters, with fewer clinical IT experts and less control over the direction of innovation in their specialty.

Introducing TeleMED Assist from Seniors Wireless

Seniors Wireless launches a $30 per month telehealth service that promises unlimited 24/7 access to physicians by telephone or video for anyone over the age of 55.

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March 26, 2015 Headlines No Comments

News 3/27/15

March 26, 2015 News 6 Comments

Top News


The Congressional Budget Office says the Medicare doc fix bill that passed the House Thursday and moves on to the Senate will add $141 billion to the federal deficit. The cheers you may have heard came from people getting the money, not those providing it. Somehow “reform” always ends up costing taxpayers more. At least nobody has slipped in another ICD-10 Easter egg like last time, although Congressman Gary Palmer (R-AL) tried to work in another one-year ICD-10 delay Wednesday that was rejected in committee.

Reader Comments


From Lemmy: “Re: Children’s Hospital Boston. The EMR is down, clinics are cancelling appointments, and the labs are sending samples out.” I contacted CIO Dan Nigrin, MD, who explains:

“We recovered yesterday (Wednesday) from an extended, unplanned downtime caused by a failed segment of a storage array for the database underlying our EHR, and which caused significant database corruption. As you would expect, the hardware was architected to be fully fault-tolerant with complete redundancy, yet nonetheless it failed us. So we’re still figuring out root cause with the vendor. We used our disaster recovery system and paper-based processes to run the operation. To be on the safe side, we postponed a few elective admissions (for less than 48 hours), but otherwise care was delivered normally at the hospital.”

From DoDEHR: “Re: US Coast Guard. Considering scrapping their $40 million Epic rollout as the DoD selects its vendor. Funding is frozen and USCG hasn’t gone live in any of its 42 clinics after four years with no dates projected. They are in danger of reverting back to AHLTA/VistA.” Unverified. 


From Booth Babe: “Re: HIMSS exhibitor tips. Can you recap those you’ve run before?” You can use the search box to find them, but here’s my #1: confiscate the cell phones of employees while they’re working the booth. They are hopelessly addicted and will start by slipping furtive glances at email, but before you know it, they will be heads-down immersed in screwing around instead of paying attention to the prospects milling around their expensive telephone booth. I’ve seen guys playing with their phones while standing at an airport restroom urinal, so I guarantee people (especially the shorter attention span younger ones) won’t make it through a multi-hour booth shift unless you remove the temptation. I also suggest making it clear that booth employees aren’t allowed to talk to each other unless they’re collaborating on an attendee question because they’ll end up socializing, with is a huge turn-off to a prospect who might want to ask a quick question or who has a reasonable expectation of being welcomed without feeling like they’re intruding. It’s depressingly easy to find expensive booths staffed by inattentive employees. If your carrot needs a stick enhancement, mention that every year I take candid photos of inattentive booth employees and it will be pretty embarrassing to be memorialized on HIStalk that way.

From Job Hunter: “Re: taking a new job. Can you give me the link to what you ran previously about company danger signs?” I don’t think I’ve ever run such a list, but I would try to steer clear of companies with these characteristics:

  • The CEO is a well-traveled hack who has left a trail of corporate destruction behind him or her or is a private equity hired gun whose primary job is to boost the bottom line by whatever short-term means are necessary to get the company sold before the wheels come off.
  • The CEO can’t be bothered to relocate to the city where most of the employees work.
  • The executive job you’re being offered is not housed at the home office. Out of sight means out of mind, which is great until your ambitious peers conspire to stab your absent back.
  • The company requires new hires to sign a restrictive non-compete agreement that will harm your ability to find their next job. My favorite strategy is from Dilbert: scan the non-compete into Acrobat, change the wording, then print it and sign it. Chances are the always-clueless HR department won’t notice that what you signed isn’t what they handed you.
  • Budget and travel freezes are common. That means lazy executives don’t have a clue about what is essential, so they just penalize everybody equally regardless of corporate consequences.
  • They’ve laid people off in the past couple of years. Layoffs are a symptom of executive failure (either in hiring choices or in strategy) and indicate that the company would rather jettison people who have been loyally working in their assigned roles instead of retraining them even though they have a lot of reusable positive attributes beyond specific product knowledge. That or they don’t have the guts to fire people for cause and instead conduct a layoff of losers.
  • Executives with reserved parking spots. I loathe big shots  who think they’re better than everyone else.
  • Your interviewer is late, distracted, or someone you wouldn’t hang out with after work. They’re on their best behavior during your interview, so it can only get worse.
  • You get a vague answer when you ask what happened to your predecessor or the company declines to name them for fear you’ll solicit their honest opinion about why they left.
  • Your prospective boss talks about himself or herself instead of you.
  • Two people who are related serve on the executive team, especially if the position you are considering is also on the executive team. You, Sammy Hagar, serve at the pleasure of the brothers Van Halen.

HIStalk Announcements and Requests

I’m doing a video interview series at the HIMSS conference along with DrFirst and we need interviewees. We’ll probably ask simple questions, such as what interesting things you’re seeing at the conference or who has the best giveaways. Let me know if you’re willing to participate and we’ll set a time to connect in the exhibit hall.

Welcome to new HIStalk Platinum Sponsor Engage. The Spokane, WA-based company, a division of Inland Northwest Health Services, is one of the largest Meditech hosting partners in the country and offers four service lines: hardware integration, hosting services, Meaningful Use, and professional services. Its 225 application analysts provide Meditech implementation and support to 130+ customers, among them some of the first hospitals to successfully attest for MU Stage 1 and Stage 2. Its infrastructure solutions include hardware refresh, virtualization, data migration, and data center migration, working with partners such as HP, NetApp, IBM, and BridgeHead. Engage provides its customers with a 24x7x365 US-based help desk that covers both infrastructure and application support. Thanks to Engage for supporting HIStalk.

This week on HIStalk Practice: MUS3 proposed rules take the air out of one rural physician’s HIT sails. The Physicians Alliance expands its Wellcentive partnership. A new study confirms that urgent care and retail clinics are overtaking primary care practices in terms of patient preference. Aledade partners with WVMI and Qsource to establish ACOs in West Virginia and Tennessee. One MD makes the case for pulling primary care out of the insurance system. Practice Fusion integrates with Medi-Span. New study finds that the ACA did not flood physician practices with appointments. Dr. Tom offers practices tips on thinking like retailers. Dr. Gregg snapshots the technology-induced workloads of today’s busy physicians. Thanks for reading.

This week on HIStalk Connect: Meaningful Use 3 preliminary rules are published and include some aggressive patient engagement goals. Researchers from Mayo Clinic analyze potential use cases for drones in healthcare. A new Rock Health report finds that women are still sorely underrepresented in health IT leadership positions. In England, the NHS launches a mobile app library with clinically-vetted mental health apps.

Listening: the fairly new rarities boxed set from Seattle’s amazing grunge rockers Soundgarden. If you like Black Sabbath (and how could you not?) then you probably like Soundgarden. And since I’ve already mentioned Van Halen, they (including on-again, off-again singer David Lee Roth) will be touring heavily starting July 5, mostly doing the amphitheater circuit, and releasing a made-in-Japan live album from their 2013 tour. I called it nearly perfectly on that last tour when I said on February 13, 2012 that I wouldn’t buy tickets for shows after mid-March because I expected them to storm off mad and cancel the tour and sure enough they did, although not until a few weeks after I predicted. Eddie’s voice is mostly shot (just like DLR’s kicks only go about knee-high these days) but he can still shred the guitar and he looks a heck of a lot better at a slightly chunky 60 than a couple of years ago when could have passed for a homeless crackhead. 



Thanks to the fun folks at DrFirst who have volunteered to provide a videography team to cover HIStalkapalooza. That was one of the features we were going to eliminate since we are too buried in other event details to deal with it, but DrFirst is filming (not literally, since there’s no actually film involved) and will produce a YouTube video we can all enjoy after the fact. DrFirst’s stepping up so enthusiastically restored my enthusiasm and faith in humanity since I was pretty tired and frustrated dealing with all the not-so-fun parts of putting on HIStalkapalooza. They’re a fun bunch.

The only thing we haven’t arranged is someone to shoot still photos, so we will probably ask attendees to send us those they take.

I invited each of our event sponsors (which I’ve listed in a link box to your right for ongoing reference) to provide a little background on what they do and what they’re planning for the HIMSS conference and for HIStalkapalooza, which seems fair given that they are paying for your food, drinks, and world-class band. Here’s what the folks at Falcon Consulting Group have to say.


Soaring into HIMSS15, Falcon Consulting Group looks forward to showing attendees and exhibitors alike that we are no ordinary flock of consultants. Falcon brings together specialized EHR technical and clinical talent, Big-4 operational and industry expert leadership, and avant-garde strategies and technological solutions. We are landing in a reserved meeting room inside the Lakeside Center Building (MP-7), and we would love for you to stop by and let us show you how we can help your organization fly to new heights. In the event has worn out your wings at the conference, we will also be hosting nightly events throughout Falcon’s home city of Chicago. For more information, contact Steven Stull at 312.751.8900 or by email.


March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock


Analytics vendor Ayasdi, which offers a healthcare-specific package for identifying clinical best practices among its other non-healthcare products, raises $55 million in a round led by Kleiner Perkins, increasing its total to $100 million.

Orion Health’s US sales leader Paul Viskovich describes what it’s like being a New Zealand-based company selling predominantly to a US market and opening an office in Scottsdale, AZ: “It’s hard. You’re not from here. You talk differently. It wasn’t possible for us to go meet the CIO of UCLA — it was a good day if we talked to the security guard. Healthcare as a whole is largely not good with innovators either, and when you combine those two things, it’s very difficult … Our teams are cross functional. People in New Zealand are also working on projects at the same time as people in the United States, and if you manage that correctly, it can be a real benefit.”



Six-hospital Cone Health (NC) chooses Phynd to manage its 16,000 physicians in a single provider profile that crosses Epic and ancillary systems.



Jitin Asnaani (Athenahealth) is named executive director of CommonWell Health Alliance.


The Integrated Healthcare Association hires Jeff Rideout, MD (Covered California) as president and CEO.

Announcements and Implementations


Seniors Wireless announces TeleMed Assist, a $30 per month, contract-free program ($40 for couples) that offers unlimited 24×7 access to physicians by telephone or video. Being a cynic and wondering how all these virtual visit companies will find reasonably competent doctors willing to take calls in real time, I’m picturing those 1990s 976-number dial-a-porn services where the hot Brazilian dominatrix you’re talking to is actually an obese, hirsute, 60-year-old Medicaid recipient whispering sweet nothings with Cheetos breath and a genetically confused grandchild on her knee while watching the muted “Jerry Springer Show.” I would be interested to talk to a physician who provides services through companies like this since I’m curious how it works.

Practice Fusion adds the Medi-Span drug database from Wolters Kluwer Health to its free EHR.

The Florida HIE announces that 200 hospitals have signed up for its event notification service for admissions, discharges, and ED visits.

GetWellNetwork announces that it added 58 new facilities and 10,000 new beds in 2014, with a 13 percent growth in employees to 250.

Government and Politics


Even the ever-optimistic and supremely knowledgeable John Halamka and Micky Tripathi seem to be fed up with the endless Meaningful Use parade, concluding of the latest MUS3 and certification requirements:

”… each incremental proposal is tolerable, but the collective burden is making practice impossible … the sheer number of requirements may create a very high, expensive, and complex set of barriers to product entry. It may stifle innovation in our country and reduce the global competitiveness for the entire US health IT industry by over-regulating features and functions with complicated requirements that only apply to CMS and US special interests …  The certification criteria are often not aligned with what EHR users ask for. In some cases, the criteria are completely designed to accrue benefits to people who aren’t feeling the opportunity cost … There needs to be a very public discussion with providers as to who should prioritize EHR development — ONC and the stakeholders they’ve included or EHR users.“

I’ll add my counterpoint, however. Providers who whine about irrelevant and burdensome MU requirements can ignore them completely, but rarely do. You sold your soul to the federal government, but you can buy it back by accepting the Medicare penalty and then start following your own agenda instead of someone else’s. MU money is either worth it or it’s not – your participation indicates that you think it is, and that acceptance drives the user-unfriendly development agenda of EHR vendors. You don’t even need to use an EHR at all if you truly (questionably) believe it has a negative impact on quality or revenue – it’s your business and your patients. I cite “Lost Boys” in reminding that a vampire can enter your home only if you invite them.


A great tweet from US Surgeon General Vivek Murthy, MD, MBA: “The levers for health aren’t in hospitals, they are in communities.” What Vivek didn’t tweet: “On the other hand, the hospital levers are raking in untaxed billions and thus they have little incentive to make communities healthier.” In the US, “public health” is export-only compassion and outreach to all who need help; domestic healthcare services delivery is a big business dominated by special interests that threatens to bankrupt the country; and never the twain shall meet.


Rep. Phil Roe, MD (R-TN) reintroduces a bill that would require the DoD and VA to develop a shared EHR using criteria established by a temporary panel that would be given 90 days to complete its work. The contract winner would get a flat $50 million upfront and then $25 million per year for five years to develop and implement the custom system, which Roe says would complement the $1 billion already spent by the DoD and VA in trying to create the integrated EHR. My opinion: the DoD-VA interoperability challenge is more about willingness and less about technology (the same as in the civilian world made up of uncooperative competitors, in other words). Those groups, despite how ridiculous it seems to taxpayers, distrust each other and refuse to stoop to each other’s level for the good of the serviceperson turned veteran. Perhaps they should be assessed a 1 percent CMS-type annual budget penalty for failing to interoperate.


Here’s an interesting quote from the head of DoD’s DHMSM project: “I’ve visited a number of facilities that have gone through this, and their message routinely is, it’s all about the change management and the training. It’s not about the tool. It’s about how you use that tool.” Maybe that’s a hint that DoD will choose whichever of the three bidding groups offers the best training, implementation, and optimization services rather than just the best EHR.

The Economist calls out inept US government financial management as chronicled by the GAO, including $125 billion in improper Medicare payments in the last fiscal year. The Brits seem to be enjoying our admittedly questionable DoD-EHR dual (or dueling) EHR projects:

”The GAO has few kind things to say about the government’s approach to information technology (IT), on which it plans to spend $79 billion in this fiscal year. Fragmented data storage and needless duplication have wasted billions of dollars. For example the Department of Defence—which accounts for around half of federal discretionary spending, and so may well not notice when billions of it vanish like loose change between sofa cushions—and the Department of Veterans Affairs are both now developing, from scratch, two separate electronic health-record systems, even though they will basically serve the same people. But the most common problem with the government’s IT ventures is a mix of grand ambitions and incompetence, as the launch of in 2013 handily showed.”



Michael Archuleta, IT director at 25-bed Critical Access Hospital Mt. San Rafael Hospital (CO), tweeted out this photo in announcing that the hospital’s server infrastructure is 99 percent virtualized. Nice.


Amazon announces unlimited consumer cloud storage for a flat fee of $60 per year with a free three-month trial.


Among the reasons University of Mississippi fired its chancellor is the medical center’s signing of contracts without board approval, with an audit finding that its EHR RFP process in which Epic was chosen contained incomplete cost breakdowns.


An article by three prominent radiology informatics leaders questions whether IT centralization and standardization has caused radiologists — who were among the first hospital informatics practitioners — to lose control of the domain. It says early and profitable hospital radiology departments were able to hire clinical IT specialists that the IT department didn’t have, giving those departments the technical freedom to innovate that has since been revoked. The authors suggest that subspecialist informatics radiologists find a place at the hospital IT table despite current underrepresentation. My experience is similar – the other pioneering clinical departments (lab and pharmacy) integrated well into the IT environment because of share order entry systems that were used by a general audience, while radiology had its own pseudo-IT systems that were used by minimally visible doctors and techs working alone in dark rooms, often ignoring sound IT processes. The above graphic is correct – IT’s focus is on reduction of corporate risk exposure through standardization, centralization, and budget control, which usually extinguishes rather than encourages innovation. Whether that’s good or bad depends on whether you have a visionary CFO (is that an oxymoron?)


Reading Health System (PA) reorganizes its IT department and eliminates 33 positions after completing its $150 million Epic implementation.

Eighty percent of the 1,000 children and teens who have used Kurbo’s $25 per month weight management app and email-based coaching service have lost weight, the company says.  

Group brainstorming meetings don’t work, says Harvard Business Review. Reasons: people expend less effort when working within a group, introverted and less-confident attendees participate less, stellar performers are dragged down to the level of the least-competent ones, and groups larger than 6-7 people have logistical problems getting everyone’s ideas on the table.

Sponsor Updates

  • A family practice improves hypertensive control rates from 78 percent to 94 percent in the year after implementing Forward Health Group’s PopulationManager.
  • The Health Management Academy partners with MedCPU to identify solutions to overcome point-of-care challenges.
  • ZeOmega Founder and CEO Sam Rangaswamy describes how ZeOmega’s acquisition of HealthUnity positions the company.
  • A new Healthcare Data Solutions case study confirms that pharmacies using its Prescriber Validation Subscription Service have saved millions in potential hydrocodone fines.
  • Ivenix produces a video that highlights how its Infusion Management System is designed to help nurses improve patient safety and workflow efficiency for infusion therapy.
  • Hayes Management Consulting offers “10 Tips to Create a Workflow Manual That Your Users will Love.”
  • Valence Health announces that its Further 2015 annual conference will be held in Chicago September 23-25.
  • Galen Healthcare Solutions CEO Jason Carmichael welcomes the new GHS leadership team in the latest company blog post.
  • Impact Advisors offers early impressions of Meaningful Use Stage 3, plus looks at data center trends.
  • Healthwise offers “Creating a Group Health Culture Where Shared Decision Making is the Norm.”
  • LifeImage posts “Medical Image Exchange for Cardiology Care.”
  • InterSystems writes “Salty Cookies, Sweeter Outcomes: Shared Healthcare Decision Making.” 
  • The Atlanta Journal-Constitution names Navicure as one of its “Top Workplaces” for the second year in a row.
  • The New York eHealth Collaborative will exhibit at HxRefactored April 1-2 in Boston.
  • The latest episode in Nordic’s Making the Cut video series covers preparing for cutover and the role of operational management.
  • Patientco offers “Supergroup: Connecting the Stakeholders of Healthcare for a Rockin’ Future.”
  • Porter Research posts a blog on networking at HIMSS 15.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.


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March 26, 2015 News 6 Comments

EPtalk by Dr. Jayne 3/26/15

March 26, 2015 Dr. Jayne 1 Comment


I read with interest Mr. H’s summary of Chicago’s April weather over the last several years. One of my friends was in Chicago this week and posted pics of snow. Right now I’m still planning a ball gown for this year’s Histalkapalooza, so I’m crossing my fingers against rain, snow, sleet, hail, and slush. I do have an opera length coat at the ready, but I am not looking forward to figuring out how to pack it all. The fact that I’m thinking about HIMSS planning right now underscores the fact that I’m procrastinating the continued reading of the Meaningful Use Stage 3 documents that were released last Friday.

I’ve only received a couple of pre-meeting mailers, but there have been a couple of ads in healthcare IT publications that caught my eye. Sponsor ChartMaxx is giving away some Chicago pizzeria gift baskets in their “Grab a Slice of the Windy City” promotion. Winners could receive a gift basket and pizzas delivered to their home – sign me up for that one. The two mailers I did receive both mentioned Apple Watches, but I’m not an iPhone girl, so they didn’t engage me. Additionally, one had my title wrong and another botched the address. It never ceases to amaze me when a mail merge goes awry or that people don’t proof things before they go out.


Speaking of proofreading, I wonder if 1-800-Contacts realizes that their most recent mailing provides a possible time-travel option for customers? Although it was mailed earlier this month, it invited me to place an order through January 2013. I guess it’s not just conference marketers who can’t get it straight, but I’m wondering if I can call and see if they’ll honor their 2013 pricing.

Procrastinating on the Meaningful Use documents also means catching up on journals this week. I’ve been doing a better job of keeping the pile on my entryway table to a minimum, but still am not current. A blurb about using Fitbit devices to predict recovery from back surgery caught my eye, however. Researchers at Northwestern University, New York University, and the University of California-San Francisco are looking at patient activity four weeks prior to a procedure and six months after. Preliminary data shows that patients not only reach their pre-procedure activity level after about a month, but continue to increase to levels that weren’t possible prior to surgery. Although they’re only looking at a subset of spine surgery procedures, I like the idea of capturing that data to model real-world results.

I’m glad I went through the journal pile because nestled in the back pages of American Family Physician was a “Patient Oriented Evidence that Matters” (POEM) segment answering the question of whether computerized decision support systems linked to EHRs improve patient outcomes. The ‘not really’ response cites a recent meta-analysis and I’m glad I read the original article. It was a little less pessimistic than the “bottom line” summary provided in the POEM. I printed a couple of copies of the actual paper to keep on my desk because I’m sure someone will bring the summary in next week as support for why we should not have an EHR. I’ll be ready when they do because at this point EHRs are not going away, but I do love a good medical literature spitting match.

Going back to January in the stack, I also found reference to an editorial in the Annals of Family Medicine that talks about allowing medical students to use EHRs so that they’ll be ready for later phases of training such as residency. Our students get a lot of experience with EHRs in our academic hospitals, but very little when they’re on their community-based rotations. The barriers cited by our sponsoring physicians include licensing issues with EHR vendors, lack of dedicated training for students, inability to separate student documentation from rendering physician documentation, and the transient nature of clinical rotations. Most of these were echoed in the editorial, which also mentions the need for students to learn how to manage populations using registries and other analytic components of EHRs.

I’ll be interested to see how the current generation of medical school and residency grads use EHRs after completing their training. In many parts of the country, we’re to the point where students may not even be exposed to paper charts. In my area, even our community free clinics are using EHRs. I’d love to do a study of new physician interactions with patients in an EHR-enabled exam room vs. physicians who transitioned from paper charts.

Got grant money? Email me.

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March 26, 2015 Dr. Jayne 1 Comment

HIStalk Interviews Jay Savaiano, Director, CommVault

March 26, 2015 Interviews No Comments

Jay Savaiano is director of worldwide healthcare business development for CommVault.


Tell me about yourself and the company.

CommVault is a data and information management company. Not only do we move data for purposes of data management for backup recovery, archive duplication, replication, disaster recovery, and continuity planning, at the same time, we take an index of all the associated content within that data so it can be used for e-discovery, information management, legal situations, any other reason that you feel that you would want to search against all your data in your environment from an unstructured perspective.


You hear a lot about big data, but hospitals already create a lot of data they don’t use. What examples have you seen where a hospital found something useful in what they already had?

The big part of it is the unstructured data. It’s easy enough when you have a solution that has a database back end and you want to search for “Jay Savaiano.” You can search for “Jay Savaiano” and you can get all the data from that solution. What you don’t get is the unstructured data that resides in your environment — Excel spreadsheets, Word documents, PDFs, all this content that’s residing out there that you don’t have an actual database that indexes all the pieces.

That’s the challenge any time we bring up dark data to the healthcare space. We have a ton of it and we don’t know what’s in it. It’s what scares us the most.

We understand exactly what’s in the EMR. We can search that all day and get all the data points we needed. It’s all those unknowns that are the scary part, especially all the way out to the edge, all the way out onto a laptop. Not knowing what type of documents that any one particular individual has — whether it’s a doc or whether you’re in a hospice scenario — data resides on those edge devices that can be snagged.

That’s always everyone’s concern, even from a perspective of what’s in email. How many times is a doc or an individual taking something, attaching it to an email, and sending it to their Yahoo account? Those are always the concerns of not knowing if PHI is all of a sudden traversing outside of the network, going to unsecured areas that leave them open to issues.

An examples would be outright broad compliance. To tap into that unstructured content, especially even in an email scenario. A situation such as an employee who is also a patient. That individual has taken data from the organization, emailed it outside to themselves to their Gmail account, and now all of a sudden there’s an issue from an employment perspective with that individual. They’re trying to come back and say they weren’t treated fairly or anything that could have been brought up. We’ve had organizations that have gone back and done searches against all the email content as well as the unstructured content that resided on their laptop that was on the edge and be able to understand all the data points of possibly where they opened up the organization to step outside of compliance and not be properly managed across the board.

The flow of what we do is taking data and ingesting it and moving it to support the needs of data management. At the same time, fully indexing the content to be able to make sure it’s queryable and searchable is one fluid component of having a complete data and information management strategy. Not just in the data center, but all the way out to those edge devices.


The examples that you’re giving are mostly from a compliance and regulatory retrieval type aspect. Is that the focus of the product or are there other elements such as clinical data searching?

It is more of a compliance-based play. It’s backup and recovery at its core. You have a data management component, but at the same time, organizations have to buy two or three other products to do the indexing of their email so they can turn around and do e-discovery and search. Or they have to buy another product to take and ingest any of the unstructured data that sits out there in shared directories or in private directories. Then they have to buy another product to turn around and support the laptop backup, the edge-based backup, or going all the way out to the iPhone for that matter. They sign up with a variety of different products.

Our whole strategy is one common architecture. It is just that core product. We’ve expanded the technology to be able to support cross platforms into all those areas. We go into environments and we’ll work with their data from a virtualization perspective as well as from a physical perspective. We’ll support their Epic environment, their McKesson environment, and their Allscripts environment, but you can minimize the silos that comes with a number of those solutions from a data perspective.

Too many times McKesson or Allscripts has made recommendations that our organization should buy X hardware and install it and it needs to run on this virtualization platform and run it. You get these data silos that, from an operational aspect, become very challenging in healthcare, which is already challenging when you have hundreds of clinical applications that IT is trying to support. We just minimize that overhead on the back end.


What CIO mindset has to change when they start thinking about using the cloud?

Too many times when organizations are utilizing the cloud, they’re looking at it as just a target for data. Whether they’re going to push data to it to support a disaster recovery scenario or they’re looking to utilize cloud-based solutions so edge-based components can connect. A clinician can push data up from their laptop and access it on their iPhone or access it on their iPad and get other content. This is with unstructured data once again. All the structured data. Everybody has applications. Epic has applications for the phones and all those devices.

Too many times you have cloud vendors that have to create another silo of data. In order to get the data up into those cloud vendors, you’re creating some sort of replicated copy that pushes that data up to the cloud and doesn’t work fluidly with the existing data policies of what you’re trying to do.  In a scenario of, you’re trying to archive content off, and before you actually archive the content out of whatever that content might be, you create another copy of it. That copy then gets pushed out to the cloud as opposed to just tiering that content at its root of what you’re looking to send out and putting that other copy fully out in the environment. Not creating multiple sets, multiple copies in the data center local as well as pushing a replicated copy out to the cloud. You want the application to be able to bring it back in fluidly and not just have another copy that’s residing out there.


What will the health system data center of the future look like?

It will have a lot of cloud components. That’s evident by a lot of the solutions are evolving more and more into SaaS-based models. Software as a service is pretty consistent in this space more and more, especially within the EMR space. I don’t ever see that there will be a limitation in the fact of the clinical applications and how they continue to grow. It’s not that you can ever run into just having a server shop. There’s always going to be, in any of the ‘ologies, specialization. Associated with specialization comes specific applications to support the clinical needs of those particular ‘ologies. There’s still to this day constantly new apps that are created that are a little more specific, that are a little more detailed, that a cardiology department would prefer to have in their environment that some of the larger entities won’t be able to take on. It will always be a dynamic growth. There will always continue to be multiple applications.


Infrastructure is back on the strategic list for health systems because of big data needs, system breaches, and mobile workforce requirements. How are CIO’s responding to those needs?

With a lot of those challenges around the infrastructure, organizations are trying to play catch-up. They are challenged. That’s why simplification of the application set is always a positive piece. That’s why people are interested in talking with us and what we do because it is simplification. It is not adding multiple layers to do an operational component. They have enough complexities with the clinical applications and the dynamics of what those pieces need. To add to that mix with an overly complex infrastructure with operational tools that run on top of that infrastructure only exacerbates the problem to the HIT organization that has to manage and operate the solutions to support the clinical environment.

It’s always top of mind and that’s why we’re having so much momentum and so much growth in the healthcare space, not just in the US, but  globally as well. We have HIPAA but across the board. Everyone sees that as the direction that they need to manage and maintain from a compliance standpoint in their given country. The EU has their approach just as much as you have the compliance components that they’re attempting to do in South America. That has definitely driven some organizations to want to minimize the issues of operational and infrastructure, to start to simplify that, as opposed to making it more complex like the clinical applications continue to do.

Do you have any final thoughts?

We’re seeing a lot of points around the whole BYOD piece. The bigger concern becomes the BYOC component, the “bring your own cloud.” Everybody can sign up for a free 5 gig of their local provider. We’ve had a number of organizations that want to start to collapse that and start to bring that back inside. It has a lot to do with that compliance component of the unstructured data, because when you have any of those free 5 gigs, it is only unstructured data that usually gets pushed up into there. Spreadsheets with patient information, PHI residing in it, documents that are really more in the unstructured context. We’ve seen a lot of conversations that come up around that.

Another area is retention policies. The challenge with healthcare is there’s a variety of policies that are out there depending on the age of the patient and the retention of the data, but because the policies are so tiered and varied and they’re very specific to a patient, it becomes challenging to turn around and do anything when it comes to retention. With that, the retention policy for basically everybody we talk to seems to be forever. They don’t just have retention policies for the age of the patient or if the patient is deceased after a certain amount of time. This just complicates that data growth in the data center. That means data is never going to pare down –it’s only going to get bigger and larger. The data centers can only house so much. It comes back into that cloud message of how do you drive that one.

I work with the ISVs in the clinical app space. I work with the servers, the Epics, the Meditechs, all these organizations. I will say that the conversations have picked up more to the fact of understanding how to support retention and how to pare data off, where in the past, it was really the brute force approach of, " The data’s going to get bigger, so just throw more storage at it." Now the conversation has shifted to the fact of, "How can we truly start to minimize storage costs for our customers?"

We have more and more conversations that are, in business development, at a partnership level with those ISVs in the clinical app space as well, not only on the EMR but on the PACS space, to come up with an approach of, how do you truly start to let them pare data off? How can we have content-aware policies that aren’t just policies that you set against a date and say, "After three years, we’re going to push it over here?" Specifically, it’s three years old and it’s for a 40-year-old male who tore his ACL because we’ve haven’t seen that particular patient in 10 years — now we’re going to take and move that data.

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March 26, 2015 Interviews No Comments

Morning Headlines 3/26/15

March 25, 2015 Headlines No Comments

Health Care Payment Learning and Action Network

President Obama and HHS Secretary Silvia Burwell announce a new initiative  tasked with bringing private and public stakeholders together to broker agreements that will push the industry toward value-based reimbursement models faster. A large cohort has joined the initiative, including Anthem, Cigna, Dignity Health, Kaiser Permanente, Partners Healthcare, Rite Aid, Walgreens, and Walmart.

Roe Reintroduces Electronic Health Records Legislation to Help Veterans, Military

Representative Phil Roe, MD (R-TN) re-introduces a bill that would establish a $50 million innovation award for anyone that develops an integrated DoD/VA EHR. Oddly, the announcement makes no mention of  the DoD’s ongoing $11 billion EHR procurement.

NHS Mental Health Apps Library to increase access to psychological therapies and help to improve mental health outcomes

In England, the NHS launches a mobile app library of clinically-vetted mental health apps. The new site is the first in a larger effort to consolidate digital health apps for a broad range of conditions.

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March 25, 2015 Headlines No Comments

Morning Headlines 3/25/15

March 24, 2015 Headlines 1 Comment

Fake patient data could have been uploaded through SAP medical app

SAP fixes an SQL injection vulnerability in its mobile EHR that allowed hackers to access and insert erroneous records into patient charts.

98.2 Percent of Participating Providers Using athenahealth’s EHR Have Successfully Attested for Meaningful Use Stage 2

Athenahealth reports that 98 percent of its customer base has attested for MU2. The company is also announcing that it will extend its ICD-10 and MU guarantees to also include PQRS and Shared Savings Program support.

This is why you shouldn’t believe that exciting new medical study

Vox analyzes medical research findings over the years, finding that only six percent of published medical studies are well-designed and relevant enough to influence patient care, but that despite this the number of published studies has increased 300 percent in the last 25 years.

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March 24, 2015 Headlines 1 Comment

Readers Write: Twenty Things Vendors Need to Know About ONC’s New 2015 (Stage 3) Certification Program, But Were Afraid to Ask

March 24, 2015 Readers Write 7 Comments

Twenty Things Vendors Need to Know About ONC’s New 2015 (Stage 3) Certification Program, But Were Afraid to Ask
By Frank Poggio

On March 23, late on a Friday afternoon, ONC published two drafts of the proposed revisions to the 2015 Test Criteria along with new Stage 3 provider MU attestation requirements. Two separate large documents were published:

  • Electronic Health Record Incentive Program, Stage 3 Draft Rule, (300+ page PDF)
  • 2015 Edition Health Information Technology (Health IT) Certification Criteria, ONC Health IT Certification Program Modifications (400+ page PDF)

The first covers the proposed rules for MU Attestation for Providers under Stage 3. The second addresses proposed test criteria and requirements for vendors and revised operating rules for the Accredited Certification Bodies (ACB).

Already there has been a great deal of discussion on the first MU requirements document since it impacts all providers, while the second document is aimed at vendors and system developers and has received little attention . I commented on the MU provider piece on HIStalk earlier this week and will focus now on the impact on vendors and system developers. Some of my vendor clients have been calling and emailing me asking, “What’s changed for us?” Others are afraid to ask.

Suffice it to say there are some major additions and revisions to the test criteria and process that will give system developers heartburn, or maybe a K51.914 (ICD10=ulcer).

Before I dive into the document, let’s remember that back in 2013 ONC disconnected the MU Stages from the certification test versions. The concept that a vendor is Stage 2 or Stage 3 certified is almost meaningless since a provider could MU attest to Stage 2 using either modified 2011 test criteria or the 2104 criteria. With the eventual issuance of these new 2015 criteria, for a short period providers can Stage 2 attest using a vendor’s 2014 certified product, or if available, the vendor’s 2015 certified product.

All 2015 Test Criteria are now referred to as the 170.315 regulations. At this time, these are just draft proposals that will be formally published in the Federal Register on March 30, 2015. Then after a 90-day comment period, some revisions will be made, with the final regulations issued in the July-August timeframe.

Using the last two cycles of draft rules versus final issued regulations, I predict that some 90 percent of what is now proposed will be adopted into law. So fasten your seat belts — here we go. Some highlights (or lowlights? are:

  1. Privacy and Security (170.315 d1-d7). There are some minor changes in several of these tests, such as access, time outs, integrity, device encryption and audit logs. But now under 2105 testing, they have become mandatory if a vendor wants to test out on other criteria, such as Demographics. The P&S tests were mandatory under 2011 (Stage1), then ONC made them optional for 2014, now they are back in the mandatory column. To paraphrase ONC, it’s all due to the never-ending march of data breaches. An added requirement to P&S which is stated in the MU regs, but not in any specific test criteria, is vendors now must attest to having completed a HIPAA risk analysis of their product whenever they install new releases or updates. Here’s why. In order for providers to be compliant with MU and HIPAA, they will have to get an attestation from the vendor before they install any update, the provider MU regulations state on page 64: EPs, eligible hospitals, and CAHs must conduct the security risk analysis upon installation of CEHRT or upon upgrade to a new Edition of certified EHR Technology.
  2. Demographics 170.315a4. ONC wants coding for language and ethnicity to support all 900 OMB codes and all RFC 5646 ethnicity codes. But ONC acknowledges that a drop-down list of 900 data elements might cause workflow problems, so they have said a full drop-down list is not required. You just need to show in a test you support all the codes and can tailor the list for each provider client.
  3. Vital Signs 170.315 a6. All values must have LOINC codes. Data elements have been expanded and pediatric vitals have separate criteria.
  4. Advance Directive (170.315 a17). Now you have to electronically capture and track the AD. No more just check a box and who cares what file drawer it’s in.
  5. Medical Implants (170.315 a20). Must now be tracked and reported.
  6. Social, Psychological, and Behavioral data must now be captured and tracked using LOINC and SNOMED coding. (170.315 a21).
  7. Clinical Decision Support tools must be linked to Knowledge Artifacts formatted in the HeD standard Release 1.2. (170.315 a22).
  8. New “decision support – service” (170.315 g6) certification criterion requires technology to electronically make an information request with patient data and receive in return electronic clinical guidance in accordance with an HeD 1.2 standard.
  9. New CDA standard (170.315 b1). The C-CDA standard is now the single standard permitted for certification and the representation of summary care records. An updated version, HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templates for ClinicalNotes (US Realm), Draft Standard for Trial Use, Release 2.076 includes the following changes: addition of new structural elements: new document sections and data entry templates: New Document Templates for: Care Plan; Referral Note; Transfer Summary. New Sections for: Goals; Health Concerns; Health Status Evaluation/Outcomes; Mental Status; Nutrition; Physical Findings of Skin, etc.
  10. CDA system performance (170.315 g6). As part of the focus on interoperability, ONC is requiring performance standards for data transfers of CCA/CCR. Data transmission of CDAs will be tested for volume and response times.
  11. XDM packing of View/Download/ Transmit and CCR/CCD with incorporation of industry APIs using the IHE-IT infrastructure standard.
  12. Data Portability has been broken out into Send /Receive as separate components (170.315 b6).
  13. Care plans (170.315 b9). ONC proposes to include the “assessment and plan of treatment,” “goals,” and “health concerns” in the “Common Clinical Data Set” for certification to the 2015 Edition. The “assessment and plan of treatment,” “goals,” and “health concerns” are intended to replace the concept of the “care plan field(s), including goals and instructions” which is part of the “Common MU Data Set” in the 2014 Edition.
  14. CQM (170.315 c1). Has been expanded into separate segments: filters, create, import, and calculate.
  15. Quality Management System (170.315g4-g5). Now includes an “access-ability technical component” in accordance with ADA. The QMS must be mapped to a federal guideline or industry standard. (No more home-grown QMS process/tools.)
  16. Safety Enhanced Design – SED (170.315g3). Expanded and requires specific and detailed usability test documentation. ONC recommends following NISTIR 7804176 “Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records” for human factors validation testing of the final product to be certified. They recommend a minimum of 15 representative test participants for each category of anticipated clinical end users who conduct critical tasks where the user interface design could impact patient safety.
  17. Authorized Testing Bodies (testing agencies) are now required to conduct surveillance (audits) on at least 5 percent of vendor installs (or max of 10) every year to verify that the certified system in fact meets each certified test criteria.
  18. Attestation for Price transparency. ONC wants vendors to disclose on their web site and in marketing materials material system limitations. The vendor must also disclose any material add-on costs such as transaction fees to support interfaces/interoperability, etc. and supply any requesting entity a reasonably accurate cost estimate of total system costs. That’s ANY requesting entity, not just prospects or for bid requests.
  19. ONC wants monthly reports from the testing agencies on provider complaints and counts of vendor updates and modifications. If the number of updates/modifications exceed a set number, ACB is to call vendor back in for re-testing.
  20. ONC predicts the rules and test criteria will be finalized by mid-summer and vendors will work “aggressively” in 2016-17 to modify products and meet the target date of 2018 to support Stage 3 provider attestations, which will require a full year of calendar data from providers.

ONC estimates that all vendors together will have to invest approximately $300 to $400 million to effect all these changes. They calculate there are 81 unique vendors with certified products, hence an average cost of $4-5 million each, which does not include the time and cost to go through the test process.

ONC states they will continue with the “Gap” test process, meaning if you passed a test criteria under 2014 and there were no (or minimal) changes for the 2015 criteria, you get a bye. Given the preceding, my advice is if you’re a vendor that is not yet 2014 certified, you really want to get it done sooner rather than later. My experience tells me that being 2014-certified for as many criteria as you can before the 2015 criteria are cast in stone will be a better place to be.

Lastly, ONC states that the 2105 Test Criteria and Stage 3 Provider MU Attestation rules will be the last Stage for MU, but that the rules and test requirements will continue to be revised and expanded as ONC deems necessary. I guess we can next expect Stage 3.1, along with revised test criteria 2015 dot 1,dot 2 … can anyone see a light at the end of this tunnel?

Frank Poggio is president of The Kelzon Group.

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March 24, 2015 Readers Write 7 Comments

News 3/25/15

March 24, 2015 News 9 Comments

Top News


A brief preliminary statement from the American Hospital Association on the Meaningful Use Stage 3 draft says the government “continues to create policies for the future without fixing the problems the program faces today,” referring to the 2015 flexibility rules. Nobody else has had much to say about the draft, probably because it’s mind-numbingly long, was released late on a Friday yet again, and is increasingly irrelevant to providers who realize the strategic advantages they lost just to collect relatively small taxpayer handouts.

Reader Comments


From Opie: “Re: RelayHealth. Is in negotiations to sell their nursing call center and care management business to a private equity firm. The division has struggled with the business model and profitability for many years. The business has lost several key management members over the past year and they have deployed Rod O’Reilly to make a determination if McKesson can grow RelayHealth or if they should sell the entire business.” Unverified.

From Clinic Director: “Re: MU audit hell update with 96 of our 139 Epic-using providers audited. CMS was responsive and the auditor, Figliozzi and Company, offered to instead perform a fast-track pilot sample. If a EP doesn’t meet MU, the sample will be expanded, but if all EPs in the sample meet MU, the remaining audits will be cancelled and all EP payments will be released. Since we had already gone through so many audits, the remaining audits were cancelled. Great news!” I was impressed with the professional and reasonable response of Peter Figliozzi and CMS following up on the practice’s request. Well done all around.


From HIStalk Fan: “Re: BJC. Their website finally confirms their Epic project.”

HIStalk Announcements and Requests

Let us review 2009’s stellar “HITECH: An Interoperetta in Three Acts” by Ross Martin, MD, MHA and The American College of Medical Informatimusicology. Ross usually makes an inspired appearance at HIStalkapalooza, so perhaps you’ll see him on stage there.

I rarely look at readership stats, but for some reason noticed that Monday’s page views were the second-highest in the seven months since I had to switch stats counters, with 11,084 page views and 8,291 unique visits. January 20 had 13,509 page views for reasons I don’t understand since I hadn’t posted anything unusual.

I don’t consume many healthcare services since I’m healthy (and having worked forever in hospitals, I’m anxious to avoid them), but a recent experience reminded me of why the billing process is so frustrating to consumers. I went to the ED in March 2014 after being urged to go there by the urgent care center doctor (who was of questionable clinical skill) checking out my dizziness that turned out to be nothing, was kept overnight and tested endlessly because I had insurance and the malpractice-wary hospital was reluctant to send me on my way without commendably trying to answer the unanswerable (via a head CT, nuclear stress test, and tons of labs and EKGs, all of which showed nothing abnormal). I received the first bill from the hospital’s contracted ED doctor service nine months later in December 2014, which claimed I needed to pay $1,500 immediately since my account was being reviewed for collection due to the non-response of my insurance company. I left phone and email messages for the ED doctor billing company and was promised a quick response that still hasn’t come. I contacted my insurance company, whose nice lady said the ED doc billing company hadn’t even requested my medical records until nine months after my visit, which violates some sort of policy or law, so they basically told them to take a hike. The insurance company said they would talk to the ED doc billing service, so we’ll see what happens. I have to wonder what’s going on with that billing company that it took nine months to send a bill, but again, inefficiency abounds in healthcare.  


What I dread most at the HIMSS conference: as a non-coffee drinker, I’ve always made fun of the mile-long line at Starbucks, which looks like a well-dressed morning rush at the methadone clinic. I’ve started drinking coffee in the morning, so I’ll have to decide if I want or need it badly enough to stand in that line myself. Thank goodness for in-room coffee makers.

The process of getting an HIStalkapalooza invitation hasn’t changed since 2008 – watch for the extensive notices in HIStalk, sign up, and hope you get picked before we run out of spots. Sponsor support allowed me to invite 1,400 people this year vs. 600 last year. Great, I thought – unlike last year, maybe I can get some actual work done instead of arguing with entitled people who think they should have been invited psychically since they didn’t otherwise express interest until after registration was closed. This year’s invitations went out and Lorre has already received over 100 emails from people requesting (sometimes demanding) additional invitations for guests, clients, and executives. They will all be politely turned down as will walk-ins that night – the count has been turned in, badges are being printed, and I’m on the hook personally for the $200 per attendee event cost if we run over our guarantee (like if the traditionally high no-show rate drops unexpectedly below the SWAG estimate we’ve built in). The massive HIStalk organization is maybe two FTEs total and we’re buried in our own pre-HIMSS work, so we don’t have time to individually debate the clearly explained process that 95 percent of people seemed to follow just fine. Last year I was so disgusted I was just going to give some whiner my ticket and hit a bar alone instead, which isn’t off the table for this year either.

I was thinking about the overuse of the word “disruptive,” usually by startups trying to convince investors and prospects that their lack of size and market traction is only temporary. I’d like to see the adjective reserved for companies that not only have the self-assessed potential to disrupt, but have actually done it.

Listening: YelaWolf, small-town rap from Gadsden, AL. I need to listen more to make sure I really like it, but my first impression is positive (other than his apparent need to have his hand planted firmly in his crotch for emotive rapping).


March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock

Humana reconfigures some of its existing population health businesses under the Transcend name: Transcend, which will offer management services (the former Humana MSO) and Transcend Insights, the IT group (the former Certify Data Systems, Anvita Health, and Nnliven Systems).


Continuum Health Alliance (NJ) selects Caradigm for population health management.

MedStar Mobile Healthcare (TX) chooses the Infor Cloverleaf Integration Suite.


Maury Regional Medical Center (TN) will implement Professional Charge Capture from MedAptus.


image image image image

Galen Healthcare Solutions promotes Jason Carmichael to CEO , Mike Dow to CIO, Erin Sain to COO, and Justin Campbell to VP of marketing.


Paul Holt (Quality Systems) joins NantHealth as CFO.


Englewood Hospital and Medical Center (NJ) names Dimitri Cruz (North Shore Long Island Jewish-Lenox Hill Hospital) as VP/CIO.


Barnabas Health (NJ) hires Stephen O’Mahony, MD (Norwalk Hospital) as CMIO.

Announcements and Implementations

The Physician Alliance (MI) expands its rollout of Wellcentive’s population health management solution.

Athenahealth says 98.2 percent of its AthenaOne users successfully attested to Meaningful Use Stage 2 in 2014. It also extends its MU and ICD-10 guarantee program to PQRS reporting and MSSP quality measures.

Hearst Health and the Jefferson School of Population Health of Thomas Jefferson University create a $100,000 award for outstanding achievement in managing or improving wellness.

Privacy and Security


SAP fixes bugs in its EMR Unwired mobile clinician app that would have allowed hackers to add phony information or change existing data.

Innovation and Research


I missed this item from a few weeks ago: Walgreens adds information from PatientsLikeMe to its personal health dashboard, allowing people who are taking a particular medication to see what side effects others have reported. Most side effects are subjective and questionably attributed to a drug that has no physiologic rationale (“Tylenol makes me hungry”), so this development is both brilliant and worrisome as patients may fail to consider that every drug has side effects, most side effects are rare and transient, and the prescriber has already weighed the risk vs. benefit. Yelp is great for finding a restaurant based on the sometimes iffy reviews of people you don’t know, but I’m not sure the science of medicine is improved by patients reacting to anecdotal reports.


Robert Wood Johnson Foundation gives Partners HealthCare a $468,000 grant to help people choose, buy, and use fitness trackers to create a personal fitness plan, which will be followed by a study of volunteer users that will look at outcomes. .



Richmond-based lab vendor HDL will pay $50 million to settle DOJ charges that it gave doctors $20 per blood sample in kickbacks. HDL made hundreds of millions of dollars running cardiac biomarker tests, claiming that it paid doctors only because its competitors did. The company’s three co-founders pocketed $50 million in distributions in three years, while the two owners of its contracted marketing company personally took home $173 million.

Vox questions whether the dramatic rise in medical studies leads to ungrounded public enthusiasm for miracle cures, nearly all of which never pan out. Stats: only 6 percent of submitted single-study journal articles are accepted; of 49 highly cited studies, 14 were later proven wrong or had less impact than originally thought; and 85 percent of annual global research spending is wasted on studies that are poorly designed or redundant. It partially blames news outlets that don’t understand that “new” isn’t definitive when it comes to medical research – it’s the old, unexciting studies that have been validated by further research that change the human health.

Someone tweeted out this brilliant article that has healthcare startup implications, “The Battle Is For The Customer Interface.” Uber doesn’t own cars, Facebook doesn’t create content, and Airbnb doesn’t own real estate. “These companies are indescribably thin layers that sit on top of vast supply systems ( where the costs are) and interface with a huge number of people ( where the money is). There is no better business to be in … Our relationships are no longer with the service providers … In the modern age, having icons on the homepage is the most valuable real estate in the world, and trust is the most important asset. If you have that, you’ve a license to print money until someone pushes you out of the way.”  

Sponsor Updates

  • RelayHealth Financial announces a new version of its RelayAccount online patient billing solution.
  • Meritage ACO (CA) announces that it has lowered its readmission rate to 10.2 percent using an evidence-based hybrid care model and ZynxCarebook care transition on mobile devices.
  • Impact Advisors posts “Meaningful Use Stage 3: Summary & Early Impressions.”
  • ADP AdvancedMD offers “6 facets of patient safety within a small private practice.”
  • Capsule Tech will exhibit at the HIMSS Middle East Conference and Exhibition March 31 – April 1 in Riyadh, Saudi Arabia.
  • Clinical Architecture offers the last installment of its blog series on precision medicine, plus a thorough summary of Stage 3 Meaningful Use objectives and measures.
  • Clockwise.MD Founder Mike Burke shares what he’s learned in the startup world at the #30in30 event at Atlanta Tech Village.
  • CompuGroup Medical will exhibit at the AMGA 2015 Annual Conference March 23-26 in Las Vegas.


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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 3/24/15

March 23, 2015 Headlines No Comments

ZeOmega Acquires HealthUnity

Population health vendor ZeOmega acquires HealthUnity, an HIE, MPI, referral management, and patient consent solutions vendor.

Statement on Meaningful Use

Reactions to MU3 are beginning to trickle out, with AHA’s senior vice president of public policy issuing a statement today saying “The release of today’s rule demonstrates that the agency continues to create policies for the future without fixing the problems the program faces today.”

Michael Bloomberg Backs Health-Data Push

Former NYC mayor Michael Bloomberg partners with the Australian government to launch a $100 million, four-year project aimed at implementing birth and death registries in countries across Africa, Southeast Asia, and Latin America in order to begin to analyze causes of premature death.

Humana to sell Concentra for $1 billion

Health insurer Humana sells Concentra, a chain of 300 clinics and urgent care centers, to Select Medical Holdings Corp for $1.05 billion.

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March 23, 2015 Headlines No Comments

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