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Morning Headlines 10/31/14

October 30, 2014 Headlines No Comments

Epic Systems makes strategic next moves for expansion

Epic confirms that it has constructed a data center on its Verona, WI campus that it will use to begin offering hosted Epic systems to new customers. A backup data center is currently being constructed in Western Wisconsin.

PwC pitches open-source electronic health records

FWC analyzes the VistA EHR bid that PricewaterhouseCoopers and General Dynamics are proposing for the $11 billion DoD deal.

McKesson’s CEO John Hammergren on Q2 2015 Results – Earnings Call Transcript

In its Q2 earnings call, McKesson CEO John Hammergren highlights its $45 billion quarterly revenue, but notes that revenue from its health IT business dipped six percent.  He also mentions plans to monetize its involvement in the CommonWell health data exchange through the expanded use of RelayHealth, the McKesson-owned exchange suite powering the network.

Lockheed Martin to buy health technology firm Systems Made Simple

Lockheed Martin acquires health IT vendor Systems Made Simple for an undisclosed sum. Systems Made Simple targets government contracts, providing data analytics and systems integration support to federal health IT projects, generating $278 million in revenue in 2013.

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October 30, 2014 Headlines No Comments

News 10/31/14

October 30, 2014 News No Comments

Top News

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Booz Allen Hamilton acquires Boston-based Epidemico, stating its intention to delve deeper into population health analytics and following the recent trend of consulting companies getting into the software business. The company – a 2007 spinoff of Boston Children’s Hospital, Harvard Medical School, and MIT – analyzes large population health datasets to look for problems such as disease outbreaks, drug safety problems, and supply chain vulnerabilities. The company’s HealthMap shows disease outbreaks and alerts, which surely caught the Ebola interest of suitors. One of the founders, Clark Freifeld, is a PhD candidate and was a software developer at Boston Children’s, now apparently working for MIT Media Lab.


Reader Comments

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From Capezio: “Re: CMS MU request website. Any idea why they took it down? We used it to get MU clarification until a week or two ago. A message says to use CMS’s main site instead, which has been improved but is infrequently updated and doesn’t cover emerging issues. Can you find out if this is a temporary hold or whether it’s gone for good?”

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From The PACS Designer: “Re: end of Windows Server 2003 support. Just eight months away — migration planning should already be in the works.”

From Blue Hawaiian: “Re: service management best practice. Would love to see more. Healthcare seems slow to move in that direction, just as it was for quality management best practice (aka patient safety) for so many years.” It would be fun if a CIO with expertise on this topic would write something up about what they’re doing.

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From See Sh*t: “Re: CCHIT. Funny that they’re leaving their minimal assets to the HIMSS Foundation.” My macro view is that HITECH money is losing impact and the hangers-on created to tap into it (certification bodies, HIEs, RECs, even ONC itself) are finding it tough to pay the bills as the taxpayer trough dries up. As I said in reacting to CCHIT’s bizarre January 2014 announcement that it would exit the certification business and turn into a thought-leader non-profit with unstated revenue streams, “The most recent Form 990 I could find was from 2011, at which time it was paying Chairman Karen Bell $409K, Executive Director Alisa Ray $250K,  and five other employees over $100K. It would seem to me that given CCHIT’s genesis, mission, and name, it should just go away rather than trying to morph itself into the already overcrowded thought leadership business. It probably would if HIMSS wasn’t riding in on a white horse to save it, not surprising given that HIMSS formed CCHIT (along with partners AHIMA and NAHIT) in 2004.” Consulting firms and software vendors have already moved on from MU to the next government-incented shiny object: analytics and population health management, emboldened by the continued willingness of providers to focus their entire agenda on whatever Uncle Sam is writing checks for at the moment.

From Sponsor President: “Re: your site. You mentioned our company in a post that just went out a few minutes ago at 10 at night Eastern time. I’ve received 12 emails in the past 15 minutes. You are the best marketing value in all of HIT.” I appreciate that, although all I’m doing is putting out concise, factual information that I think is relevant and readers are free to use it however they like. Their response means the company has interesting offerings. 

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From Tipper: “Re: Epic. This week, Judy Faulkner said, ‘We do not like to participate with organizations that are going to sell the data because we’ve always felt the data is confidential. That’s another thing that has always bothered us about CommonWell.’ This seems to be CommonWell’s response.” A CommonWell blog post says the notion that it would sell data is “absurd” and “especially inaccurate,” adding that it will never sell personal health data and in fact as a broker doesn’t even have access to clinical data. The post adds that CommonWell will charge fees of 0.1 percent of each member’s annual revenue above and beyond membership dues.


HIStalk Announcements and Requests

This week on HIStalk Practice: Day 1, 2, and 3 show updates from MGMA. Dr. Gregg takes healthcare IT to the land of Oz. MGMA members show no love for Medicare’s quality reporting programs. Spring Creek Family Medicine goes live on its eCW patient portal. HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers Chicago’s newest digital health accelerator, Matter, and its first class of startups. Google unveils its newest X Labs project: a nanoparticle-filled smart pill programmed to enter the blood stream and search for early-stage cancer tumors. Fitbit releases two new activity trackers and a full blown smartwatch with a focus on health metrics. Salesforce is rumored to be optimizing its customer relationship management platform as an outreach and population health tool.

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Welcome to new HIStalk Gold Sponsor Clockwise.MD, which is also sponsoring HIStalk Practice. The Atlanta-based company’s online reservation system lets patients skip the wait – they make an appointment (online or mobile), show up on time knowing their place is reserved, and then watch the wait times and queue order in real time on an iPad (I really like that idea – nothing is worse that fuming in a crowded waiting room wondering if you’ve been forgotten). Providers users gain interesting benefits: they can fill in their less-busy schedule times, keep patients informed about wait times via automatic text messages, and target delayed patients via a real-time dashboard so that appropriate customer service actions can be taken (like furtively slipping a slowly fuming Mr. H a current-issue Popular Science magazine that will otherwise age for months in the practice’s climate-controlled magazine cellar until it’s ripened enough for the waiting room coffee table). Here’s a fun idea: when a patient cancels their appointment, the open slot is broadcast by text message and whoever jumps on it first can take that appointment. The company’s founder and CEO is Mike Burke, who founded informed consent system Dialog Medical and sold it to Standard Register in 2011. Thanks to Clockwise.MD for supporting HIStalk and HIStalk Practice.

A quick YouTube search turned up this brand new Clockwise.MD explainer video.

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My task following Dim-Sum’s amazing HIStalk webinar “DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project” (over 1,000 people have watched the YouTube recording) was to see if there’s interest in the sub-topic of military theater medicine, and if so, to enlist experts from Epic, Cerner, and Allscripts to join Dim-Sum in a follow-up webinar panel discussion. He doesn’t have a horse in the DoD’s EHR race, but is passionate about the topic as a military health advocate and veteran. Your thoughts are welcome.


Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.


Acquisitions, Funding, Business, and Stock

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Lockheed Martin will acquire privately held government health IT provider Systems Made Simple for an undisclosed sum. The company does a lot of work for the VA and had $278 million of revenue in 2013.

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From the McKesson earnings call:

  • The company’s quarterly revenue was $45 billion.
  • John Hammergren says he’s pleased with improved margins in Technology Solutions business, although revenue was down 6 percent in the quarter.
  • Hammergren says CommonWell Health Alliance is demonstrating real-world interoperability progress in adding new members, and running four successful pilots.
  • Hammergren said of the Technology Solutions business that “We’ve had the biggest challenge with in the EMR kind of space,” repeated that growth won’t return to previous levels until the transition from Horizon to Paragon is complete, and says that McKesson’s imaging business has been hurt as customers focused on buying products to meet Meaningful Use requirements.

 

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In an apparent admission that CommonWell’s work will be commercialized as he hinted in the last earnings call, Hammergren said in the McKesson earnings call that CommonWell has signed “a multiyear agreement for nationwide commercialization of the services, with the core services being provided by RelayHealth.” I don’t know if CommonWell is the altruistic, non-profit, vendor-driven interoperability project it claims to be or a way for McKesson to sell RelayHealth services through Epic-scared EHR competitors anxious to launch a pay service for interoperability. The fact that it came up in McKesson’s earnings call suggests that the company is looking forward to new RelayHealth revenue.

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BIP Capital sells its original fund’s stake in Ingenious Med to another private equity firm for a nine-fold gross return, but will continue to hold company equity in a second Fund.

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Merge Healthcare posts Q3 results: revenue down 6 percent, adjusted EPS $0.05 vs. $0.02, beating expectations for both.  

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MedAssets turns in Q3 results: revenue up 5.6 percent, adjusted EPS $0.34 vs. $0.31.

IBM and Twitter, both desperately seeking new revenue sources, announce a partnership in which IBM will analyze tweet data for “business decision-making.” I don’t have access to big data that would support my theory that this project will go nowhere – tweets are such a uncategorized, free-text mess that surely no sane business would pay IBM to sell it Twitter-powered business advice.

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MedStar Health (MD) expands its Cerner relationship with a seven-year agreement.


Sales

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North Shore-LIJ Health System (NY) chooses Explorys for Hadoop-based analytics and risk models.

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St. Luke’s University Health Network (PA) picks Nuvon for medical device integration.


People

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Member engagement software vendor Healthx names Michael Gordon (iTriage) as chief product and strategy officer.

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Voalte hires Suzanne Shifflet (ONR, Inc.) as CFO.

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Randy K. Hawkins, MD (Glytec) joins Connance as chief medical officer.

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Eric Johnson (Informatica) joins DocuSign as SVP/CIO.


Announcements and Implementations

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Allscripts introduces Sunrise Mobile Care, an iPhone/iPad app that lets nurses review and input patient information (allergies, vitals, I&O) with alerts and bi-directional updates from Sunrise. It’s curious that the vendor claiming to be the most “open” (whatever that means) supports only Apple devices.

Kaiser Permanente adds what it calls “medical selfie” capability to its patient portal, which allows patients to securely send digital pictures to their doctor for review. A copy also goes into their patient record. Patients can also send PDF files, such as scans of work-related forms that require the doctor’s signature.

RazorInsights will offer its laboratory information system customers instrument interfaces and workflow tools from Data Innovations.  

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In India, the renovated Sir HN Reliance Foundation Hospital will deploy Google Glass to its ED doctors, who will be able to review the patient’s history (including images) without looking away. SAP connected Glass to the hospital information system for two-way information exchange. According to SAP, “With the help of the Google Glass, doctors can attend to multiple patients, engage with them and see almost twice as many patients during the rounds. Doctors can take accurate notes on the Google Glass itself. The data is stored automatically and can be accessed when required.” Another hospital in India is creating a Glass-powered telemedicine application.

EClinicalWorks chooses Exostar’s ProviderPass SaaS-based identity proofing and second-factor credential authentication to meet the DEA’s e-prescribing requirements for controlled drugs. The company uses Experian-provided identity challenge questions or live webcam video.

In Canada, Nova Scotia’s Meditech hospital information system will go down next Tuesday and Wednesday for a software upgrade, with hospitals and clinics shutting down all non-emergency services, including surgeries, lab work, and diagnostic imaging.

Audacious Inquiry and Johns Hopkins Community Physicians sign a collaboration agreement to enhance the company’s encounter notification service.


Government and Politics

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Former Massachusetts “Obamacare czar” Sarah Iselin, who in February was drafted to try to save the failed Massachusetts Health Connector health insurance exchange, quits to become executive-in-residence at Optum, which was awarded a no-bid contract to fix the exchange. She says there’s no conflict of interest since she hasn’t been involved in the project for the past six months, she was hired before Optum got the business, and technically she worked for the governor rather than Health Connector.

FCW covers the odd open source pitch of PricewaterhouseCoopers and General Dynamics in bidding on the $11 billion DoD EHR contract by offering up VistA, the very mention of which probably causes Pentagon brass to make mock retching sounds given that the VA developed it. They wouldn’t even interface to it, so the odds they’ll implement it surely are near zero, especially when they want a commercial system whose single vendor is committed to supporting and enhancing it. PwC and GD obviously were late to the taxpayer-funded party and found all the available EHR dance cards filled (those bidders that chose Meditech and Siemens later pulled out of the running). If the bid were being handicapped as a Presidential election, it would be Epic (Democrat), Cerner (Republican), Allscripts (Libertarian) and VistA (Green Party).

The AMA should probably just call up Sylvia Burwell instead of issuing a daily statement about ONC, but for what it’s worth (not much), AMA says it’s happy (or at least as happy as AMA can get) that Karen DeSalvo will still lead ONC in whatever fashion HHS decides is necessary to prevent pundits from predicting ONC’s impending irrelevance. It feels like HHS panicked at the ONC-negative response to her transfer and came up with a lame “she’ll do both jobs” excuse.

The House Science Committee on Science, Space, and Technology subpoenas former US CTO Todd Park to describe the security capabilities of Healthcare.gov.

The United States sues New York City and CSC for Medicaid billing fraud, claiming that the city used the default settings of CSC’s billing system to bypass Medicaid’s secondary payor requirement and used generic ICD-9 codes that they knew Medicaid would pay more quickly. 


Technology

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The 100-researcher team of Google X Life Sciences is developing a Tricorder-like early warning disease detection system in which patient-swallowed sensors send notice of tracked nanoparticles to a wristband. The project is being run by a renowned molecular biologist who used to work for LabCorp, in partnership with MIT, Stanford, and Duke. He says that healthcare is reactive and transactional, with diagnosis – especially for cancer – coming too late once symptoms are apparent (he calls this the “wait until you feel a big lump in your chest before you go to the doctor” approach). He also suggests that the big data possibilities could be enormous as therapies can be targeted to molecular profiles. This is tied into the company’s Baseline Study, in which it is attempting to quantify the measurements that signify good health. The technology is nearly ready for human testing, a flurry of new patents will come out in the next month, and the company expects widespread usage in 5-10 years. Google will license the technology as they did for their smart contact lens. Another Google group, Calico, is attempting to extend longevity, which he explains as, “We’re helping you live long enough so Calico can make you live longer.”

A Canada-based startup receives approval to sell its on-demand DNA testing device in that country, where frontline providers in any care setting (including pharmacies) can instantly determine whether a patient should receive the anticoagulant drug Plavix based on a known genetic problem that renders it less effective. More test types will follow. The company has earned FDA approval to sell its product in the US, but only to hospitals. The device costs $9,000 and each test is $225, but the company says it will tweak the price to make it affordable.

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Microsoft announces Microsoft Health, a platform and app for collecting information from fitness wearables, planning to eventually add connectivity to share the information with providers via HealthVault. It claims its Intelligence Engine will provide insights such as fitness performance by time of day and after meals. In other words, it’s Microsoft’s answer to Apple’s Health and HealthKit with equally limited capabilities given that the information it can collect isn’t worth a whole lot except to quantified self fitness fanatics –your doctor doesn’t really have the time to monitor your step count or sleep patterns that have minimal immediate effect on the current problem list.

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I’m not excited about Microsoft Health, but Microsoft also announces its $199 Microsoft Band, which is immediately available (kudos for not pre-announcing stuff that won’t be out for months – looking at you, Apple Watch). Kudos, too, that Band works with Android and iOS devices in addition to Windows-based mobiles and includes a GPS, heart rate monitor, and a two-day battery life vs. the imaginary Apple Watch’s one-day charge. It also uses a Bluetooth phone connection to display text messages, emails, and social media updates. It looks like a winner to me, with the only real competition being Apple (its fanboys are both loyal and patient) and Android Wear. I haven’t been tempted by any fitness tracker since my Fitbit Force was recalled, but Microsoft Band seems worth a look for those willing to pay for extra capabilities beyond the usual tarted-up pedometer.


Other

A piece in Madison’s hippie weekly (as I always call those left-leaning papers that feature mostly music reviews, sex-related ads, and pathetically predictable anti-establishment rants) covers Epic without saying anything new or insightful except one thing: the company confirms that it has built a data center in Verona for client hosting. That’s a pretty big deal: Cerner has gained many small or remotely located customers (and made a lot of money) from its remote hosting services, while Epic, like Meditech that inspired it early on, has stubbornly avoided the obviously smart move of making its systems available as a service to let hospitals avoid the capital costs and personnel requirements of running it from their own data centers. That policy made sense when Epic sold only to academic medical centers with big IT budgets and big IT egos, but now that it’s moving down-market, hosted systems are likely to be a hit. I’ll follow up for more information.

The iMDsoft Metavision software bug that was characterized in a risk assessment as being potentially lethal to ICU patients in Australia turns into a political issue. Opposing political parties in Queensland debate the extent to which patients have been warned and invoke unpleasant memories of Queensland Health’s 2010 payroll system implementation, in which IBM turned a $5 million fixed-price bid into a billion-dollar project with a little help from company-friendly bureaucrats (which got the company banned from future Queensland work). It’s one of three health-related examples that come to mind when enumerating the biggest IT debacles in government IT history, along with England’s NPfIT and Healthcare.gov. Meanwhile, iMDsoft says Queensland Health is testing a fix it provided, explaining somewhat mysteriously that the problem came up during testing, perhaps tactfully declining to throw its client under the bus for their role in going live with a known problem.

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Cerner expects 11,000 participants from 26 countries at its annual conference in Kansas City, MO next week, with attendance up 20 percent over last year.

Columbiana Family Care Center (OH) closes temporarily after the computer system of its owner, Salem Regional Medical Center, goes down after an unspecified software problem.

The Chinese engineer charged with stealing proprietary MRI programming information from his former employer GE Healthcare and sending it back to China will plead guilty to stealing trade secrets, facing 10 years in prison, a $250,000 fine, and deportation.

It’s not completely health IT related, but Genentech angers hospitals by changing the way it distributes three cancer drugs – Avastin, Herceptin, and Rituxan – to six regional distribution centers rather than the usual drug wholesaler, citing the need to increase drug supply chain security. Hospitals say they won’t be able to get those meds daily as they always have so they’ll have to stockpile the expensive drugs, they’ll have to rely on overnight shipping companies in emergencies, they will lose traditional discounts, and on the data side won’t get wholesaler-provided benchmarking information and convenient 340B accounting. Similar events have happened on the consumer side, where drug companies declare an expensive item a specialty drug, meaning patients have to get their supply from mail-order pharmacies that focus on expensive drugs for chronic conditions.

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Louisiana state health officials tell doctors planning to attend a New Orleans tropical medicine conference this weekend to stay home if they have visited Liberia, Guinea, or Sierra Leone within the past 21 days. The conference, ironically, was to feature presenters talking about their work in fighting Ebola in Africa, but now those experts won’t be allowed to attend. The letter admits that even infected people don’t spread the disease if they aren’t showing symptoms, but adds that, “We see no utility in you traveling to New Orleans to simply be confined to your room.” Science and politics just don’t mix.

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California’s attorney general issues her 2014 data breach report, which finds that the number of records exposed in healthcare breaches was higher than in all other sectors except retail. The AG points out nicely that healthcare is an outlier because most of its breaches involved stolen hardware that wouldn’t have been a breach at all had their owners simply encrypted the devices. Here is my advice to healthcare CIOs: if you aren’t encrypting all laptops because you haven’t asked for the money, you should be fired. If you aren’t encrypting all laptops because administration won’t give you the money, you should quit. Either way your name is going to be up in quite embarrassing lights when someone loses a laptop (probably after violating a hospital policy in taking it home after storing PHI on the local drive) and your boss has to sheepishly admit to the local community that it wasn’t encrypted. On the bright side, that one exposure usually results in the board coming up with encryption project money, albeit after the fact.


Sponsor Updates

  • Forward Health Group will participate in the IHI National Forum on Quality Improvement in Healthcare December 7-10 in Orlando.
  • Clinovations shares Dennis Glidewell’s thoughts on areas of opportunity in the revenue cycle in Ask the Expert.
  • IHT2 announces the speakers and topics for Health IT Summit Houston December 10-11.
  • EClinicalWorks signs an additional 37 CHCs and FQHCs.
  • Washington Business Journal names GetWellNetwork to its “50 Fastest Growing Companies of 2014.”
  • CareTech Solutions will discuss hospital website security threats at the 18th Annual Greystone.Net Healthcare Internet Conference November 3-5 in Scottsdale, AZ.

EPtalk by Dr. Jayne

Cleveland Clinic announces its list of top medical innovations of 2015. Since the list was compiled by people in the patient care trenches, it’s not surprising that it was heavy on drug and treatment technologies and light on health IT.

We hear a lot about alarm fatigue, so I was interested to see this article on “decision fatigue” as showing that physicians prescribe more antibiotics later in their workdays, even when the drugs may not be appropriate. It’s a research letter that doesn’t have the same weight as some other studies, but it is interesting nevertheless. I know I get tired at the end of a full day of seeing patients and definitely don’t feel as sharp as when I start. I’d be interested to see an analysis of allergy and interaction alerts stratified by time of day and how our physicians reacted to them.

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I had the privilege of moderating a hospital community forum last Saturday morning. I posted some of the questions/comments in Twitter, but I can’t say I’m a fan of live tweeting. I was impressed by the level of patient engagement (and the knowledge) around Ebola. To be fair, there were plenty of questions about other key community health priorities, including diabetes and a couple of questions about childhood vaccinations.

Discussing a disease for which there is no vaccine in the same session as diseases for which there are vaccines that people refuse was a bit surreal. A couple of the attendees mentioned the polio scares of the 1950s and hearing the perspective of people who watched their schoolmates become ill and disabled was moving. I found this NPR piece the other day that talked about the polio vaccine trials and why they could never be done today. If nothing else, we live in interesting times.

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I finally registered for HIMSS this week. I waited too long last year and am happy to report that there are still plenty of good hotels left. Although I’m not crazy about Chicago as a site for conferences, it’s a fun town. I’m already scheming with a good friend for some potential pre-conference fun and am keeping my eye out for just the right HIStalkapalooza shoes (although this charming Louboutin handbag is a little out of my price range).

In the Breach of the Week, hundreds of medical records were lost when they blew out of the back of a truck in Omaha, NE. Apparently the medical waste disposal company didn’t secure them properly. I was impressed by volunteers that were helping pick them up, even reaching into a storm sewer to gather documents. The news report indicates they were on their way to be “stored” in Lincoln, NE which makes the fact that a waste disposal company was transporting them a bit curious.

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I’m off to CME this weekend and have blown my conference budget for the year. I wish I had saved up some cash to attend the mHealthSummit in December and particularly the Gala Reception for Disruptive Women in Healthcare. If nothing else, it would be a great opportunity to pick up swag and take pictures for my desk that would drive my boss crazy. Maybe someday I’ll make the list of Disruptive Women to Watch.

Who are your favorite disruptive women? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 30, 2014 News No Comments

Morning Headlines 10/30/14

October 29, 2014 Headlines 3 Comments

Big health records firm Epic raises DC profile

Epic CEO Judy Faulkner gives a rare interview to Politico to discuss the company’s interoperability performance, explaining “If we don’t speak up, people will believe what others say about us, and an unanswered accusation becomes seen as the truth if you don’t respond.”

Google is developing cancer and heart attack detector

Google unveils its latest X labs project, a pill that delivers millions of antibody-coated nanoparticles into the blood stream where they will live indefinitely, hunting for signs of early-stage cancers, monitoring for concerning blood chemistry changes, and pushing alerts to a wrist-worn health tracker.

Booz Allen buys Boston health analytics start-up Epidemico

Booz Allen Hamilton will buy Boston-based analytics startup Epidemico for an undisclosed sum. Epidemico is the Harvard and MIT spinoff behind HealthMap, a data analytics project that tracks the spread of infectious diseases on a map by analyzing public health data from a variety of sources. HealthMap was recently credited with picking up on the Ebola virus first, weeks before the World Health Organization noticed it.

Top 10 Medical Innovations for 2015

The Cleveland Clinic publishes its list of the top 10 medical innovations set to disrupt healthcare in 2015, with telemedicine-enabled, ambulance-based stroke units coming in at number one.

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October 29, 2014 Headlines 3 Comments

Readers Write: Answering Your Questions about Electronic Prescribing of Controlled Substances

October 29, 2014 Readers Write No Comments

Answering Your Questions about Electronic Prescribing of Controlled Substances
By David Ting

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Last week, Imprivata sponsored a webinar with HIStalk about electronic prescribing of controlled substances (EPCS) during which we reviewed the DEA requirements, the benefits, and the scope of work involved in implementing an EPCS solution. I was joined by Sean Kelly, MD, an emergency physician at Beth Israel Deaconess Medical Center in Boston and chief medical officer at Imprivata, and William Winsley, MS, RPh, the former executive director of the Ohio State Board of Pharmacy.

The webinar was very well attended. We received a number of excellent questions. Here are a few of them.

Q: Which two-factor authentication method is most often used for EPCS?

A: This depends on the clinical workflow requirements, but we are finding that many customers want to use a combination of solutions. For example, in high-traffic, high-use areas of the acute care hospital, many customers are opting for fingerprint biometric identification combined with passwords for ease of use. However, many prescribers also want the ability to e-prescribe outside the hospital walls, so customers are also enabling the use of one-time password (OTP) tokens for EPCS.

Q: Is there a process one must follow to register as the person who will credential and enroll prescribers for EPCS?

A: The DEA allows hospitals that are DEA registrants to do this on their own through their credentialing office. This is referred to as institutional identity proofing. Private practices must undergo individual identifying proofing. In this case, the designated physician works with a third-party Credential Service Provider (CSP) to obtain the necessary approvals to receive the proper credentials for EPCS two-factor authentication.

Q: Does the DEA allow EPCS signing in batches?

A: Yes, by patient. A provider can sign multiple prescriptions for a single patient simultaneously whether they are controlled or non-controlled substances. Many EMRs and prescribing systems will separate controlled and non-controlled substances, so if a provider is prescribing controlled substances, it will automatically prompt them to enter the necessary two-factor authentication credentials.

Q: The DEA ruling is “interim.”Is it likely to change?

A: Although the DEA ruling allowing EPCS is “interim,” it is unlikely to change. The DEA and other agencies have a number of rules that have been in interim status for quite some time, and in this case, the DEA has not given any indication that it will change anytime soon if at all. This is especially true for the two-factor authentication requirements.

David Ting is founder and chief technology officer at Imprivata. The webinar recording can be viewed here.

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October 29, 2014 Readers Write No Comments

Readers Write: Stuff Doctors Leave on Workstations in the Doctor’s Lounge Late at Night (And Other Times)

October 29, 2014 Readers Write No Comments

Stuff Doctors Leave on Workstations in the Doctor’s Lounge Late at Night (And Other Times)
By anotherdoctorgregg

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The image above caught my eye when I sat down at a workstation in the doctor’s lounge. I bet whoever left it there thought he or she was making a completely anonymous search, though I could see everything, including visited hyperlinks. We do try to teach our medical staff about using shared workstations, but there is a strong feeling of anonymity even as we are told there is no privacy at work.

One of our gastroenterologists is unhappy with his current employment, at least as judged by the number of versions of his CV on various workstations, complete with cover letters to other institutions. I don’t know whether he is unaware his CV and job hunt letters are on not only one, but multiple workstations, or if he is making a not-so-subtle statement about his job satisfaction to his current employers. I have also seen bankruptcy documents, child custody agreements, wrong-headed letters of complaint to Audi dealerships, and adorable pictures of kids dressed up for prom.

If you think you can’t be tracked and you are not leaving a trail of the most personal information on semi-public workstations, you are probably wrong. In 1997, a graduate student was able to identify Massachusetts Governor William Weld’s health information — even though the state medical database was supposedly de-identified — by correlating the elements of the medical database with voter registration rolls in Cambridge. Although this was probably a fluke, re-identification in a doctor’s lounge might be easier.

We do try to clean up the desktop screens of hospital workstations, mostly so it is easy to find the icons that we want to be found. In a parallel effort to raise awareness about not leaving personal (sometimes very personal) information on workstations through saved files and browser histories, I collected a little data.

The doctor’s lounges require keycard access, so the workstations in there are used almost exclusively by physicians. The information I gathered came from the histories of Internet Explorer (purged every couple of days) and other browsers (Chrome and Firefox) installed by users as non-administrators. With those disclosures, here is a sampling of what doctors look at, at work.

There were 1,052 entries over three days. The first thing to notice is the complete absence of porn. Overall, searches were at worst only mildly embarrassing, with nothing to trigger HR’s attention.

Forty-eight percent of visits were to a practice portal or billing system, 21 percent were to sports sites (cricket scores beating football scores, which either speaks to our physician demographics or penetration of the ESPN mobile app), and 13 percent were visits to medical sites (UpToDate and Medscape being the most common.) The remainder were visits to Google and foreign language and news sites that reflected our demographics.

There were a few visits to the county probate court, checking on malpractice and divorce cases (the search terms are displayed if you reopen the window from the history). One person Googled, “I have water coming into my basement right now.” I know it was a she since she discussed night call plumber’s fees at lunch the following day.

I could also identify my plumber-needing friend by her search history. Users leave sequences in their histories like <foreign language site><another site><same foreign language site>, narrowing the presumptive visitors to just the doctors who speak that language. Also, site visits bracketed by practice EMR portal visits linked the sites in between to specific individuals if you look at the call schedule. The call schedule will generally narrow down the potential users to just one.

Overall, I estimate about 40 percent of the browser history in doctor’s lounges can be associated with a specific person. This is an estimate since I only asked a few directly. The message is that even an otherwise anonymous Google search can probably be linked directly back to a hospital user, even by non-administrators, so surf accordingly.

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October 29, 2014 Readers Write No Comments

CIO Unplugged 10/29/14

October 29, 2014 Ed Marx 7 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

The Art of Saying Goodbye

How you say goodbye is more important than the first hello.

We only get a chance to make a first impression once. It is hard to recover a blown opportunity at saying hello. When I start at a new organization, one of my top priorities is meeting with as many individuals as I can as quickly as I can. I call this “hit the ground listening.” It is amazing how you can accelerate your adoption in a new company by asking questions and showing genuine interest in others and how things work.

I don’t recall all of my interactions. But I do recall every interaction where the first impression was blown by either party. In fact, those relationships rarely recovered despite reconciliation attempts.

Based on that, how can I assert that saying goodbye is more critical than that first impression?

While the first impression is typically a moment between two people, the last goodbye is often public. People watch, observe, and take note. They make impressions that, like first hellos, leave an indelible mark whose impact is irreversible.

How we treat an associate as they leave says more about the culture of an organization than anything else. We need to perfect the goodbye. There is an art.

There are a variety of valid ways to say goodbye. First, I do not believe that title dictates the extravagance of a goodbye. Why do we reserve champagne just for executives? Often the departing analyst may have had equal or greater impact! A rock star is a rock star.

I recall one farewell reception where a fellow executive who was walking by our festivities was wondering which of our peers was retiring. He seemed aghast that is was just a farewell for an analyst who had been with us for five years. I told him that the impact that analyst had in five years was greater than the impact of some execs who had been there twice as long. It is not about title or length of service, it is about material impact. The greater the impact, the greater the celebration.

Second, make sure you understand how the departing person wants to say goodbye. While I am all about big celebrations, others prefer a sedate getaway. Always do what that person prefers — it is their party! I recall lavishing praise on someone for the amazing work they had done. Afterwards, they texted me that they dislike that kind of recognition. My attempt to bless backfired. When someone prefers an understated affair, I think it is important that this is shared with those observing.

The next time this situation presented itself, I simply let the team know that we really appreciated the person who was leaving, but they specifically asked for a quiet exit and we would honor that. A card or small luncheon may be perfectly appropriate.

There are many ways to say goodbye and this is by no means an exhaustive list. My favorite thing to do is to verbally affirm others. We bless them with a reception full of friends and family, but the thing people have told me time again as having the most significant impact is the verbal praise received from those they worked with for so many years.

As the leader, you start this. You surround the person, look in their eyes, and speak truth. Dependent on their comfort and your relationship, I recommend including touch. You don’t need to prepare a speech — this should be spontaneous. Just speak what is in your heart and perhaps include an anecdote. Try to include something light to counterbalance the sorrow that everyone will naturally feel. As you lead, others will follow.

To be able to say goodbye like this clearly requires something of you. That you have relationship with your entire team. That you know them by name. That the stories are natural to come by because you have shared experiences.

What if the person leaving was a poor performer? All the more reason to celebrate!

And if anyone tells me they have no time to celebrate and say goodbye in an artful, thoughtful way … you need a new career.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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October 29, 2014 Ed Marx 7 Comments

Morning Headlines 10/29/14

October 29, 2014 Headlines No Comments

Office of the National Coordinator update

The ONC reports that National Coordinator Karen DeSalvo, MD will continue to lead the organization as she simultaneously takes over her new responsibilities as HHS’s Acting Assistant Secretary of Health.

UnitedHealth Group Unit to Acquire Alere Health

UnitedHealth Group’s Optum Health will acquire Alere Health for $600 million. Alere will bring its population health expertise to Optum and will help implement wellness programs aimed at reducing overall health care costs.

Addenbrooke’s Hospital paperless system goes live

Epic goes live at Addenbrooke and Rosie hospitals, the company’s first live sites in the UK.

Health software brings risk of death

In Australia, a risk assessment of IMDsoft’s ICU application calls the system a threat to patient safety after finding that software bugs were contributing to a significant number of near miss medication errors at the nine hospitals using the system. The report predicts that the likelihood of the system contributing to a patient’s death sits between 60 and 90 percent.

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October 29, 2014 Headlines No Comments

News 10/29/14

October 28, 2014 News 3 Comments

Top News

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An ONC blog post says that National Coordinator Karen DeSalvo, MD will continue to lead ONC while under reassignment as Acting Assistant Secretary of Health, saying she will continue to chair the Health IT Policy Committee and work on ONC’s Interoperability Roadmap. ONC seems to be trying to reassure observers of its leadership exodus in adding, “The team that is ONC is far more than one or two leaders. The team of ONC is personified in each and every individual – all part of a steady ship and a strong and important part of HHS’ path toward delivery system reform and overall health improvement.”


Reader Comments

From Pedro Fumar: “Re: hospital handwashing video. This kind of thing gives me a douche chill, but I’m sure it can be effective.” It’s awful but annoyingly hard to turn off, sort of like “All About That Bass,” but anything that elicits an obscure “Arrested Development” reader quote is OK with me.


HIStalk Announcements and Requests

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Jenn’s magnificent daily MGMA conference recaps on HIStalk Practice will make it feel like you’re there, especially if you actually are. I’m enjoying them.

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Welcome to new HIStalk Platinum Sponsor TransUnion Healthcare. The 46-year-old Chicago-based company offers patient-centric patient access and collections systems that create a better, more transparent financial experience and reduce bad debt. Hospital solutions include ID and address verification, eligibility, patient payment estimation, ability to pay determination, medical necessity, and charity care determination. For collections and reimbursement, the company offers insurance coverage discovery for self-pay accounts, reimbursement optimization, Medicaid re-verification, presumptive charity care, and claims statusing. Most of these services are offered through strategic partners as well. TransUnion also offers data breach services – they will get a campaign up and running within two days that provides a case manager to identify and report fraud, notify affected patients, provide customer notification templates, and optionally stand up a toll-free telephone breach hotline. TransUnion has a #1 KLAS-ranked solution, five HFMA peer-reviewed solutions, 1,000 hospital clients, 75 partners, and 500 million consumer credit histories under management. Thanks to TransUnion Healthcare for supporting HIStalk.

Listening: new from Johnny Marr, who was the other songwriter (with Morrissey) of The Smiths and guitarist for Modest Mouse. It’s not amazing and his singing isn’t great, but he gets a pass for being a semi-legend.


Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

November 12 (Wednesday) 1:00 ET. Three Ways to Improve Care Transitions Using an HIE Encounter Notification Service. Sponsored by Audacious Inquiry. Presenters: Steven Kravet, MD, MBA, FACP, president, Johns Hopkins Community Physicians; Jennifer Bailey, senior director of quality and transformation, Johns Hopkins Community Physicians; Robert Horst, principal, Audacious Inquiry. Johns Hopkins Community Physicians reduced readmissions and improved quality by implementing a real-time, ADT-based encounter notification service (ENS) to keep the member’s healthcare team informed during transitions in care. Johns Hopkins presenters will describe the clinical, operational, and financial value of the ENS for care coordination along with its technology underpinnings.


Acquisitions, Funding, Business, and Stock

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Optum will acquire Alere Health for $600 million, with Alere President and CEO Namal Nawana stating that the company wants to focus on the rapid diagnostics market. The Alere Health business includes clinical decision support, care management, home monitoring, and connected device technologies acquired over the years from DiagnosisOne, MedApps, and Wellogic.  

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Revenue cycle and analytics solutions vendor MediGain receives $38 million in funding from Prudential Capital Group.

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Portland, OR-based Bright.md closes a $1 million funding round to further develop its telemedicine platform. Co-founder Ray Constantini, MD was formerly a regional medical director for Providence Health & Services.

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Bellevue, WA-based corporate wellness platform vendor Limeade receives a $25 million investment from Oak HC/FT’s venture fund. That might be the best startup name ever, chosen purely because it’s memorable though irrelevant.

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IBM shares have dropped sharply in the past few weeks. Above is the one-year share price of IBM (blue, down 11 percent) vs. the Dow (red, up 7 percent). Maybe they can get Watson to develop a new corporate strategy (or maybe they already did).

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Sunquest parent Roper Industries announces Q3 results: revenue up 7 percent, adjusted EPS $1.55 vs. $1.42, missing expectations on revenue but beating on earnings. Chairman, President, and CEO Brian Jellison said in the earnings call, “We had great performance, just great performance in both Sunquest and MHA. Sunquest continues to drive execution around the Meaningful Use implementations and upgrade which is finally getting us out at some of the backlog that we had experienced last year with Sunquest. So productivity is up sharply here.”

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In New Zealand, Orion Health registers for its IPO of $119 million, valuing itself at around $792 million. However, the company declined to provide financial information in its prospectus, which the COO justified by saying that only a third of its revenue is recurring, making forecasts unreliable due to its ongoing reliance on big-dollar new sales.

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McKesson announces Q2 results: revenue up 36 percent, EPS $2.79 vs. $2.30, beating analyst expectations for both. Horizon Clinicals continued to drag down the Technology Solutions segment, whose revenue was down 6 percent.

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CCHIT has shut down effective immediately after 10 years and will donate its assets to the HIMSS Foundation.

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Cerner co-founder Cliff Illig joins Neal Patterson as the second Cerner-created billionaire as the company’s shares hit an all-time high that values it at $22 billion.


Sales

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Beaufort Memorial Hospital (SC) replaces pagers with the Imprivata Cortext communications platform.

Palmetto Primary Care Physicians (SC) selects the eClinicalWorks EHR and care coordination system for its 250 providers and 34 locations.

Priority Management Services (LA) chooses HCS Interactant for three of its long-term acute care facilities in Louisiana and Texas, which will implement the company’s revenue cycle, financial, EMR, mobile, and Insight modules.  

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Wake Forest Baptist Medical Center (NC) chooses Omnicell pharmacy, nursing, and analytics tools for medication management.

Agnesian HealthCare (WI) joins Premier, Inc. to make group purchasing, supply chain analytics, and ASCEND available across its enterprise.


People

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Experian promotes Scott Bagwell to president of Experian Health.

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Payment solutions vendor Altegra Health names Bob Drelick (Lovelace Health System) as CIO.

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Analytics vendor Clearsense hires former PeaceHealth CIO Ryan Ball as CEO.

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David Miller (University of Arkansas for Medical Sciences) joins Optimum Healthcare IT as CIO.


Announcements and Implementations

Emdeon announces retirement of the CaparioOne technology platform brand, replacing it with Emdeon One following its just-completed $115 million acquisition of revenue cycle vendor Capario. The company also added a denials management service to the system.

CareCloud launches an analytics suite for its medical practice users.

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Cambridge University Hospitals-affiliated Addenbrooke’s Hospital and The Rosie Hospital go live with Cambridge’s $355 million Epic system, stated to be the first Epic go-live in the UK.

SCI Solutions releases a new version of its Schedule Maximizer enterprise scheduling system.

Vocera launches two products — appointment reminders and delivery of 12-lead ECGs to physician smartphones — and announces new EHR integration with its Vocera Collaboration Suite.

ADP AdvancedMD launches a patient portal, financial dashboard, and mobile e-prescribing capabilities.


Government and Politics 

An AMA statement says that the mass departure of ONC officials “leaves a significant leadership gap which could jeopardize the growing momentum around interoperability,” adding its stump speech components that EHRS are “poorly performing” and that ONC should follow its recently announced framework to improve Meaningful Use.

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Perhaps self-proclaimed public health expert New Jersey Governor Chris Christie should be focusing on this instead of traveler quarantines: 98 percent of New Jersey’s hospitals have been fined for readmissions, by far the largest percentage in the US.

Meanwhile, The New Yorker runs a satirical piece called “Christie Sworn In as Doctor”:

Dr. Christie said that, beginning on Monday, he would begin a series of random “house calls” to check New Jersey residents for Ebola and assign them for quarantine. “I can usually diagnose someone with Ebola in under a minute,” Dr. Christie said. “Even faster if I don’t actually see them.” The doctor said that before moving forward with his plan to quarantine scores of New Jersey citizens he suspects of having Ebola, he consulted with other prominent epidemiologists, including Dr. Rick Perry of Texas.

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An MGMA survey of 1,000 medical practices find that around 85 percent of them think Medicare’s quality reporting programs detract from patient care and reduce physician productivity. More than three-quarters of respondents say the programs are too complicated, irrelevant to specialty care, expensive to implement, and include unachievable thresholds.


Innovation and Research

A Netherlands university graduate student designs a defibrillator-carrying drone that can be quickly dispatched in response to 911 calls. The device’s GPS allows it to land at the patient’s location, where it will initiate a live video session with emergency services to provide instructions. The student says the drone’s faster response (since it isn’t impeded by traffic) will increase the heart attack survival rate from the current 8 percent to 80 percent. He estimates that the “flying toolbox” will cost $20,000, but adds that  it will take a few years to fine-tune its object avoidance system. It’s also not legal to fly automatically directed drones in his country.


Other

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St. Bernard Parish Hospital (LA) blames Healthland’s systems for its failure to collect $3 million, with the CEO explaining, “We have two systems, a billing system and a patient system, and those two systems didn’t communicate with each other.” The hospital’s lawyers are negotiating with Healthland to get some of their money back.

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The CVS and Rite Aid pharmacy chains stop accepting the week-old Apple Pay, joining several large retailers that are developing their own mobile payment network to avoid paying Apple Pay’s 1.5 to 3 percent fees. They likely also have an unstated interest in continuing to collect data on shoppers using systems they control, possibly reacting to this Apple statement to consumers: “We are not in the business of collecting your data. So, when you go to a physical location and use Apple Pay, Apple doesn’t know what you bought, where you bought it, or how much you paid for it,” which of course is because it really can’t since it only knows who was paid and how much, not what items were purchased.

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Cerner’s Neal Patterson pays $200,000 for the prize-winning steer at the American Royal Association’s Junior Premium Livestock Auction fundraiser. No word yet on whether he pardons it like a White House Thanksgiving turkey, turns it into a freezer full of beef, or sends it to Judy Faulkner to live out its days grazing on Epic’s farm.

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CHIME’s Leslie Krigstein tweeted out this picture of conference attendees volunteering at the San Antonio Food Bank.

Queensland, Australia’s health minister releases a report stating that iMDsoft’s Metavision ICU software, installed at nine of its hospitals, creates a 60 to 90 percent chance of contributing to a patient’s death in the next 30 days. The report, citing several near misses, says that “monitoring of patient records by pharmacists has revealed several potentially serious prescription errors specifically caused by the system.” Queensland Health is manually overriding the system and reviewing charts daily for problems while waiting on a vendor fix.

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Jenn picked up this fascinating tidbit on HIStalk Practice: University of Texas Southwestern Medical Center is using Tabasco sauce in its Ebola precautions training for employees. Mock Ebola patients are anointed with hot sauce to simulate their bodily fluids, and if the skin of doctors and nurses burns as they remove their protective apparel, they know immediately that they’ve done something wrong. I use a similar technique to validate my hand-washing after chopping jalapenos for salsa, usually receiving a painful reminder of my sub-par technique conveniently close to the bathroom sink.

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Weird News Andy likes the idea of an announced iPhone-powered cancer detection device, adding his intrigue that the company is also release 3D-printable versions of the sample trays it requires. It’s interesting, but surely will never see the light of day in the US unless a bigger company with money to spend on FDA-required studies buys it.


Sponsor Updates

  • T-System client Dosher Memorial Hospital (NC) completes its pilot of a new version of EV that includes ICD-10 capabilities.
  • Medhost is showcasing its emergency care solution at ACEP14 this week in San Antonio.
  • Hamilton General Hospital (TX) meets Meaningful Use Stage 2 requirements using Medhost solutions to pull Q2 2014 data.
  • Health City Cayman Islands is featured in a documentary “From the Heart: Healthcare Transformation from India to the Cayman Islands.” Appearing is Dale Sanders, former CIO of Cayman Islands Health Services Authority, now SVP of Health Catalyst.
  • BJC HealthCare (IL/MO) is live on ZeOmega’s population health management solution Jiva.
  • Consulting Magazine recognizes Paula Elliott (Impact Advisors) and Nicola Johnson (Deloitte Consulting) in its “8th Annual Women Leaders in Consulting Awards” list.
  • ZirMed announces its User Group Conference and Partner Forum theme November 10-12 will be “Shatter Expectations.”
  • Craneware will co-present with NorthBay Healthcare at the 2014 HFMA MAP Event in Las Vegas on November 3.
  • Levi, Ray & Shoup will participate in the 2014 SAP TechEd && d-Code event in Berlin, Germany November 11-13.
  • Sutter Health (CA) describes how Validic helped get patient/client steps, heartbeat, and sleep patterns into Epic.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 28, 2014 News 3 Comments

Morning Headlines 10/28/14

October 28, 2014 Headlines 2 Comments

Practice Fusion Rebuilds Its Electronic Health Record For Apple And Android Tablets

Practice Fusion unveils a new tablet-based version of its EHR, which CEO Ryan Howard says will differentiate it from competitors because “Most vendors’ mobile electronic health record is a half-assed version of desktop.” The company will now shift its focus toward creating a smartphone version.

A Letter from Dean Klag to Governor Chris Christie

Johns Hopkins School of Public Health Dean Michael J. Klag, MD, MPH writes a letter to NJ Governor Chris Christie criticizing his newly instituted 21-day involuntary quarantine for care workers returning to the US from West Africa.

Patient-To-Physician Messaging: Volume Nearly Tripled As More Patients Joined System, But Per Capita Rate Plateaued

A study conducted at Beth Israel Deaconess Medical Center finds that patient-to-physician email traffic has tripled in the last 10 years, but that the per capita rate has stabilized at around 18 messages per month, per 100 patients.

Mass. HIT survey shows high rates of EHR adoption; enthusiastic public

A government run health IT adoption survey soliciting opinions from a group of Massachusetts hospitals and practices finds positive physician support of EHRs, with 82 percent reporting that EHRs improve care, 80 percent reporting that EHRs reduce errors, and 75 percent reporting that EHRs enable better decision making.

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October 28, 2014 Headlines 2 Comments

Readers Write: Hospitals Move to Define Role of Secure Texting in Clinical Alarm Management

October 27, 2014 Readers Write 1 Comment

Hospitals Move to Define Role of Secure Texting in Clinical Alarm Management
By Todd Plesko

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In 2010, The Joint Commission identified improvement in staff communication as a National Patient Safety Goal. A recent Spyglass survey found that 67 percent of hospitals, despite forbidding the practice, report that nurses are using personal smartphones to support clinical communications and workflow because they are dissatisfied with the options provided by hospital IT.

Of those exchanging data, 80 percent of the messages are not secure nor HIPAA compliant. Hospitals found guilty of a data breach can be fined $1.5 million per incident, so it’s not surprising that hospitals are acting swiftly.

There are more than 70 vendors today competing to solve this need. They are primarily segmented by the markets and users they are targeting; e.g. physician-to-physician, physician-to-nurse, physician-to-patients. These single-function secure text messaging apps were initially an attractive fix to HIPAA anxieties because they are cheap and quick to implement, but their myopic view of communications often contributes to the burgeoning problem of alert and alarm fatigue.

As of July 1, hospitals seeking accreditation from The Joint Commission are required to prioritize clinical alarm safety. Even though the new National Patient Safety Goal recommends that hospitals begin with the largest offenders – patient monitors and medical devices – forward-thinking hospitals are taking a closer look at the full gambit of interruptions experienced by front-line nurses and asking how solutions designed to address alarm fatigue will impact overall clinical workflow.

Alarm fatigue is rooted in more than just patient monitors and medical devices. It is the result of multiple systems communicating alarms, alerts, text messages, and phone calls simultaneously without regard to priority or urgency. Really, “interruption fatigue” much more accurately describes today’s care environment.

Hospitals have traditionally viewed alarm fatigue and secure text messaging as two unrelated pain points with separate solutions. This has resulted in an accidental architecture embodied by multiple solutions with overlapping functionality that have become increasingly difficult for hospital IT and users to manage.

Single-purpose integrations often lack sophistication and the intelligence necessary to serve as the traffic cop between multiple systems that compete for attention, interrupt workflows, and contribute to alarm fatigue. They are concerned with the singular goal of delivering the alarm, alert, or text message they were designed to transmit.

Consider that most clinically relevant communications originate from a patient event: a nurse call alert, a smart IV pump, a patient monitor alarm, a bed exit, critical lab, or stat order alert. When a clinician is texting about a patient, they must ensure that the subject of the conversation is properly identified, an important feature that single-function texting apps are incapable of providing automatically. All text messaging apps targeting healthcare are secure, but few are centered on the patient and their role in the overall communications workflow.

If a healthcare provider organization is going to be successful with patient-centric text messaging, then this is only possible with an enterprise platform that delivers relevant information with patient context along with the alarm, alert, or text message that the recipient receives. Optimally, alarms and alerts would include a dynamically-generated list of possible staff members to call or message about the patient event to further enhance communications. Patient-centric messages need to be displayed properly based on priority level and integrated into the overall communications workflow to ensure that the recipient is able to identify and respond effectively to the most critical needs first.

Hospitals are beginning to recognize that identifying improvements in staff communications and managing the interruptions generated by alarms, alerts, and text messages are twin problems that should be addressed as a single project. A next-generation alarm safety and event response platform is required to support this level of clinical collaboration.

Todd Plesko is CEO of Extension Healthcare of Fort Wayne, IN.

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October 27, 2014 Readers Write 1 Comment

Readers Write: Navigating EHR Disillusionment: Strategies for Maximizing Value

October 27, 2014 Readers Write 1 Comment

Navigating EHR Disillusionment: Strategies for Maximizing Value
By Joel French

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EHRs are a necessary but small component of what provider networks require to financially prosper in competitive markets being rapidly transformed by narrow networks, contracting reimbursement rates, and risk-bearing payment arrangements. As digitization proliferates, acute and ambulatory providers have become more vocal with EHR criticisms, including a lack of interoperability, workflow disruptions, and adverse impact to physician productivity. Many physicians now view themselves as data entry clerks.

Research from the American College of Physicians, Deloitte, and Physician’s Foundation finds that physicians have mixed opinions on EHRs, with significant downside sentiment. In the Deloitte study, 75 percent of physicians say EHRs are not cost-effective and do not save time.

One might assert the US health industry is suffering from Gartner’s Trough of Disillusionment regarding EHRs, defined as the period when “interest wanes as experiments and implementations fail to deliver.” This disillusionment exists because individual and organization expectations of EHRs exceed what they were actually designed to do. History abounds with examples of beliefs that were widely (if not universally) viewed as true, only to be later disproved by practical experience or fuller knowledge.

The point of view that integrated EHRs should be central to a health systems’ competitive strategy is one common view that is easily disproved by examining this assertion under the lens of basic business logic. By definition, a competitive advantage gives an organization an edge over its rivals and an ability to generate greater value (value is generally expressed in terms of market share growth, profitability, or enterprise value). The more sustainable the competitive advantage, the more difficult it is for competitors to neutralize the advantage.

As it relates to EHRs, once most or all hospitals in a geographic market have implemented such a tool, that tool itself ceases to be a competitive advantage. It should be better understood as a fundamental business input or asset, not materially dissimilar to facilities, medical equipment, or business licenses. Table stakes, as some might say.

Executives who have invested in EHRs hoping to derive investment returns above their cost of capital must first come to grips with the following truth: EHRs were designed to solve specific problems within the confines of a health system, but nearly all incremental revenue and contribution margin opportunities originate outside health systems in care communities. Trying to retrofit or adapt EHRs designed for use inside the walls of an enterprise for use outside the walls and across a community is fraught with risk and tantamount to believing the world is flat.

In 1837, Hans Christian Andersen wrote a fairy tale, now widely known, called “The Emperor’s New Clothes.” The metaphorical point applies to any situation wherein the overwhelming majority of observers willingly share in a collective ignorance of an obvious fact, despite individually recognizing the absurdity. The notion that implementing the same EHR as your competitors or peer group would somehow provide a sustainable competitive market advantage is completely devoid of classical business logic any first semester college freshman understands.

Today, an increasing cackle of honest voices are murmuring that the Emperor is naked. Those voices will only get louder as more organizations experience bond rating downgrades or executive removals attributable to expensive and unsuccessful EHR experiences.

To be sure, EHRs are necessary and are typically superior to the analog predecessors they replaced. They can be effective tools for clinical documentation, intelligent alerting, retrieval of patient data, and order entry/results return within the setting for which they were intended – the hospital or the clinic. Their deficiencies are exposed when care teams need to coordinate across not just physical settings, but differing organizational boundaries.

The migration to value-based care is accelerating, requiring fundamentally news ways of working to increase revenue while simultaneously keeping populations healthy. Nearly all at-risk payment models – such as episodic bundling, avoidable readmission penalties, Medicare Shared Savings, and ACOs – require better orchestration of care transitions across organizational boundaries. Successful health systems in the new health economy must therefore utilize technologies to integrate electronically and economically with scores of market trading partners, many of whom will have heterogeneous technologies and fragmented corporate ownership.

To grow, health systems must exploit all their channels – not just employed physicians, but also independent providers and other stakeholders – in order to access new referral sources, effectively coordinate care for patients with chronic conditions, and reduce unit costs. There are key EHR deficits critical to health system business objectives. These will require supplementary tools to bridge functionality gaps.

With average revenue from inpatient admission volumes down 4.9 percent in 2013, health systems need a technology strategy to support outpatient revenue growth. Health systems will live or die based on their ability to find technology solutions beyond the EHR, enabling them to uncover the economic value of independent providers in their communities by delivering differentiated value to those practices.

Introducing a network layer that smartly aligns the hospital’s capacity with the community’s demand for services is not only possible, but necessary. Today’s cloud-based tools for functions such as referrals, scheduling, and analytics can create attractive investment returns against EHR cost centers that some have come to view as permanent sink holes.

These tools extend the life of EHRs and introduce accretion by supplying what they lack – the ability to quickly grow outpatient volume, curtail network revenue leakage, and lift contribution margins. Integrating these tools with EHRs adds new value to the EHR, potentially creating the investment returns originally hoped for at the time of purchase.

The industry is still a long way from experiencing Gartner’s Plateau of Productivity with EHRs, but progressive health system executives are realizing limitations of EHRs and are increasingly turning to complementary cloud technology solutions that complement them and unlock value. Health systems that survive and thrive will be those that innovate to meet industry demand, which at this point requires thinking beyond EHRs. 

Joel French is CEO of SCI Solutions of Campbell, CA.

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October 27, 2014 Readers Write 1 Comment

Readers Write: Driving Interoperability by Putting People at the Center of Health Technology

October 27, 2014 Readers Write 3 Comments

Driving Interoperability by Putting People at the Center of Health Technology
By Joseph Frassica, MD

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During a recent earthquake in Charlottesville, VA, people heard the news of the earthquake long before they actually felt the tremors. In healthcare, even getting information to travel across departments in a hospital, or from a hospital to a primary care physician, can sometimes be challenging.

Many healthcare organizations present “interoperability” as the silver bullet that will resolve an organization’s data problems. But how can the industry implement effective, interoperable solutions that allow clinicians to get the information when they need it most, and no matter where they are?

I see three key steps the healthcare industry must take in order for information to travel securely and seamlessly to improve interoperability:

  1. Embrace collaboration. As a first step, the healthcare industry – including hospitals, specialists, practice groups, vendors, home health agencies, and so on – needs to work together to provide the best possible care for patients. For too long, we kept our blinders on and treated patients when they entered into the hospital domain. Instead, the industry needs to change its mindset to think of the patients’ journey throughout the health continuum and work with other caregivers to make that process seamless. Accountable care models are already helping usher in this important change.
  2. Encourage openness. Vendors of all types and sizes must work toward openness and subscribe to open standards. Vendor-agnostic and flexible technologies allow critical patient information to travel faster and get where it’s needed. By embracing open standards wholeheartedly, the industry can begin to lay the foundation necessary to drive innovation in healthcare technology and in patient care. Open standards can enable providers to share EMRs securely and can also provide greater access and insights.
  3. Think beyond the EHR. Hospitals and health systems have made big investments in getting their EHRs up and running, and the technology is important for modernizing health care. But EHRs are not the be-all and end-all of patient data. They barely scratch the surface. To improve population health, healthcare organizations need to think beyond data collection and more about how this data can be used to improve patient outcomes across the health continuum. Healthcare systems need to think about how this data can be analyzed to present a more comprehensive, complete, and integrated picture of a patient and their medical history. Providers can then begin to use this data for predictive analytics, which will enable them to identify and manage trends across a population. By analyzing this data, physicians can make more confident diagnoses and develop preemptive treatment plans.

As healthcare becomes more and more connected, the amount of data and information entering the healthcare picture will only increase, and will become even more critical to realize the promise of interoperability as time goes on. By taking steady steps toward interoperability, the healthcare industry can fully liberate and share data seamlessly, giving physicians the quality insights they need to predict, prevent, and treat disease with better results.

Joseph Frassica, MD is CMIO/CTO, Patient Care and Monitoring Solutions, of Philips Healthcare.

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October 27, 2014 Readers Write 3 Comments

Curbside Consult with Dr. Jayne 10/27/14

October 27, 2014 Dr. Jayne 2 Comments

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In this week’s Monday Morning Update, Mr. H mentioned the UberHEALTH promotion where customers could use the Uber app to summon a nurse to administer a flu shot. The idea came from John Brownstein, a Harvard epidemiologist who saw the mismatch between importance and convenience of getting a flu shot. After the success of the program, he feels it might be a possible delivery model for basic preventive care as well.

Given the ebb and flow of my happiness as a CMIO of late, I decided to run the math and see what it would look like to take to the road.

Although as an Uber promotion the nurses had a driver, I could certainly drive myself. That would cut costs right there. I’d be seeing fewer patients each day, which would actually lower my professional liability insurance premiums. I wouldn’t be paying rent or utilities either.

I have a friend who has a retainer-based practice and does only house calls, so I know that I’d have to trick out a decent-sized vehicle that could handle vaccine and specimen storage, various equipment, and more, but it would still be cheaper than paying for office space.

EHR costs would be about the same, although if I ran it as a cash practice they would be significantly less due to the savings in billing services, audits, etc. I went back and forth thinking about a cash practice. Looking at the percentage of cash-pay patients I see at a local urgent care, it may be more realistic than one would think. There are increasing numbers of patients with high-deductible health plans, which may make a reasonably-priced cash practice very attractive.

Having limited equipment would actually help to keep costs down. There’s no temptation to order x-rays because it’s convenient if you don’t have a machine.

Several countries in Europe offer house calls as part of standard medical care. One of my medical school classmates who lives in Germany recently had a baby and was telling me about her benefits. Rather than cutting services as payers do here, plans offer generous coverage and even things we wouldn’t think about. She was able to get “homemaker” services to perform light housework while she recovered from her delivery and had home visits from a lactation specialist and a pediatrician with very little out-of-pocket cost.

Her family physician actually takes “first call” at night, alternating with other physicians, rather than screening the calls through an answering service. My friend asked her family doc how he liked that. He said the patients are respectful because they know they’re waking the doctor up and they only call if it’s an emergency. Because he’s the one on the phone with them, it’s easier to negotiate an office visit the next day or even a house call, rather than potentially just sending everyone to the emergency department.

It’s certainly not inexpensive to deliver care this way. Coverage is funded by a flat percentage of each worker’s income that is paid to a non-profit coverage fund. It’s mandatory, but due to the flat percentage, it varies by income, with higher wage earners paying more. Although most Americans would balk at paying 8-10 percent of our gross income individually for healthcare, when you do the math and look at what employers are paying, the cost of individual insurance, and the level of service, it seems like a contender.

Although she’s a physician, my friend isn’t licensed in Germany and works part-time as a medical editor. She did mention that highly compensated employees can opt out of the requirement and purchase “private” coverage from a for-profit plan, but she doesn’t personally know anyone who has.

My friend isn’t an expert on healthcare finance, but that model of care brings up some interesting concepts. She didn’t have a lot of feedback about EHR use among physicians other than to say that they’re significantly less stressed out about it than most of her friends in the States.

I’d love to hear from readers that have deeper knowledge on those topics or who have experienced that type of health system first hand. I’d also love to hear from providers in the US who have incorporated health IT into either mobile or direct/cash primary care practices.

In the mean time, I’m going to start shopping for a vehicle worthy of a diamond-plate accessorized vaccine refrigerator.

Got a sweet ride for patient care? Email me.

Email Dr. Jayne.

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October 27, 2014 Dr. Jayne 2 Comments

Morning Headlines 10/27/14

October 27, 2014 Headlines No Comments

Cerner Q3 2014 Results – Earnings Call Transcript

In its Q3 earnings call, Cerner representatives address its recent Siemens acquisition, the upcoming DoD EHR deal, and its goal of having “the most open EMR.”

New York-New Jersey Quarantines Fuel Ebola Debate

After a doctor returning from Guinea is diagnosed with Ebola in New York, the state governments for both NY and NJ enact a mandatory 21-day quarantine order for any US aid workers returning from the affected areas. On Friday, a non-symptomatic nurse returning through Newark Liberty International Airport was involuntarily detained and is now being held under quarantine at Newark University Hospital.

FDA Approves Two Faster Ebola Tests

Two new Ebola tests that reduce the time it takes to run an Ebola screening from four hours down to just two hours have been approved for use by the FDA.

Salesforce to make big push into healthcare industry

Reuters reports that Salesforce will begin pursuing sales in the healthcare market, with a formal announcement expected in November.

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October 27, 2014 Headlines No Comments

Monday Morning Update 10/27/14

October 26, 2014 News 8 Comments

Top News

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From the Cerner earnings call:

  • Bookings hit an all-time Q3 high at $1.1 billion and backlog increased to $9.34 billion.
  • The company predicts that its margins will drop from around 25 percent to the low 20 percent range due to the Siemens acquisition, but expects them return to normal by 2017.
  • Cerner expects the Siemens acquisition to close on February 2, 2015.
  • Adjusted EPS was $0.42 per share. The company expects a post-Siemens earnings growth of 27 percent. I’m not much of a stock analyst, but that seems to indicate an EPS jump to around $0.53, and with 341 million shares out, that means the acquisition will add $38 million of profit per quarter or around $150 million per year, meaning the acquisition will pay for itself in no more than eight years. I expect it will be perhaps half that time given the opportunity to upsell and convert existing Siemens customers. Cerner would have to make as many mistakes as Siemens did to mess up this deal given the fire-sale price they paid.
  • The company says it is committed to “having the most open EMR.”
  • Cerner says best-of-breed registry suppliers aren’t getting value because they haven’t aggregated clinical and financial information across systems, leading some of them to look to Cerner’s offerings.
  • The company expects the DoD EHR selection to occur in the first half of 2015 and the contract to be signed in the second half.
  • Cerner observes that Siemens offers to the global market “relatively low-end solutions” that “played at a little bit of a lower end in terms of scalability,” giving the company a chance to put Millennium in place outside the US.
  • President Zane Burke suggests that non-Soarian legacy Siemens users (Invision, MedSeries4) have a three- to five-year horizon (“horizon” being related to “sunset.”)
  • CFO Marc Naughton explains the Soarian opportunity: “When you look at a Soarian client, their clinical solutions were not very broad. They were focused on EMR orders and a very core set of solutions. All of those clients are paying a third party — in many places a niche supplier — a fair amount of money for their ancillary solutions. One of the key rationales for this business, obviously, and the reason we want to retain that client base is, like for like, exchanging Millennium for Soarian. We have a lot of additional solutions we can sell onto that base.”
  • Zane Burke stated, “I don’t see Meaningful Use driving any buying behavior today.”
  • Burke says that population health could be bigger market than EHRs.

Reader Comments

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From Tony M: “Re: Psychology Today article. Says EHRs are a farce.” A sleep medicine doctor writes a not very convincing anti-EHR piece that still manages to make a few good points. He wanders around in fretting (usually anecdotally) about health vs. healthcare, privacy breaches in healthcare and other industries, wasted physician time inputting EHR information, and lack of interoperability. Where he misfires is in failing to identify the real problem: EHRs drive billing (I assume he’s not against billing for his services) and therefore reflect the requirement of those who write the checks, not those who send the invoices. He takes a turn toward the bizarre in his concluding recommendation: give taxpayer money to public health schools to create non-profit EHR companies that will license EHRs from “civilized countries that have worked cheaply and effectively for decades.” Hopefully he is sincere about the “working cheaply” part since he would be doing just that in running an EHR that works in Denmark or Australia – unless he launches an all-cash practice, he’s not going to see a dime of revenue. It is nearly always the case that those complaining about the clinical intrusion of EHRs are confusing the symptom with the disease and the disease isn’t easily cured – the US healthcare system is a world-class, special-interests disaster and EHRs were designed to support it effectively. Doctors are smart but were unwisely obedient over the past few decades – they turned healthcare over to insurance companies, government, and profitable non-profit healthcare systems without a peep, but now misdirect their ire toward whatever’s sitting right in front of them rather than the far more complex hole they compliantly helped dig themselves into.

From Moderated: “Re: anti-EHR comments. I think we’ve heard enough of the same parroting anti-EHR crowd, both about THR and otherwise.” It’s actually a crowd of one. The same poster users a variety of phony names –  Not Tired of Suzy RN, Jenny Dimento MBA, Gopal Singh MD, Keith McItkin PhD, and several others. Sometimes I approve his or her comment if it adds value or is entertainingly strident, but often I delete it because I agree that the incessant “bring back paper charts” droning gets old.

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From Country Coder: “Re: EHRs and Ebola. Everybody is glomming on with their uninsightful insights. Anything to get your name in the papers even if it’s not related — I’m calling it the Tori Spelling effect.” Tori Spelling has zero chance of getting Ebola, but that doesn’t stop her from turning a case of bronchitis into possible Ebola infection as she coincidentally shows up at Cedars-Sinai right before her new reality show premieres. The TV rags claimed “quarantine,” but she was really just put with other feverish, coughing patients until they decided to admit her for some reason, just in time for her to tweet out a dramatic message complete with photo. I would bet money she uttered the word “Ebola” enough times to make sure she wasn’t just sent home where the cameras aren’t. She pulled the same stunt a couple of weeks ago in falsely claiming she was pregnant in a teaser for the new show. I can never figure out how celebrities can “check themselves” into a hospital while everybody else who is really sick gets sent home because their insurance won’t pay for an admission.


HIStalk Announcements and Requests

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The vast majority of poll respondents don’t think the names of Ebola patients should be publicly announced. New poll to your right or here: what is the weakest link in diagnosing Ebola in the ED based on travel history? (I say “travel history” specifically since unfortunately in the absence of such history, no immediate and accurate diagnostic method exists). Vote and then click the “Comments” link to pontificate further.

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Welcome to new HIStalk Platinum Sponsor Healthgrades. The Denver-based company’s online provider database – searchable by disease, condition, or procedure – is used by a million people per day who are making trusted, informed decisions about their care in choosing the right provider, more than half of whom follow up by scheduling a physician appointment. The company just enhanced its free physician search to let consumers choose factors that are important to them, such as experience, the quality of the hospitals in which they practice, and patient satisfaction. It  also offers services to hospitals that include business intelligence, marketing, and clinical communication solutions that increase consumer and physician engagement and improve service quality and utilization. I interviewed President Jeff Surges a few weeks ago, who told me, “We’re going to be releasing a lot of data and analytics about our ratings in the fall and using very expressive ways to show how our methodologies can partner with quality and outcomes within a hospital.” Thanks to Healthgrades for supporting HIStalk.

I always cruise YouTube to research new sponsors and found this recently posted 15-second Healthgrades TV commercial.

Listening: new from Brooklyn-based The Budos Band, instrumental Afro-Soul that sounds like sweet, funky 1960s horns and wah-wah guitar without the vocals — think the opening theme from “Hawaii Five-0” or “The Horse” by the underappreciated Cliff Nobles – although it sometimes moves into psychedelic rock territory with molten guitar and a smoke-filled room backbeat. They’re on Daptone Records along with the equally magnificent and musically similar Sharon Jones and the Dap-Kings. I’ll also be listening to Cream (and possibly West, Bruce & Laing and Manfred Mann) in noting the death of bassist Jack Bruce at 71 on Saturday.


Last Week’s Most Interesting News

  • ONC loses its two highest-ranking officials as HHS transfers National Coordinator Karen DeSalvo, MD to acting assistant secretary for health and Deputy National Coordinator Jacob Reider, MD announces his resignation. COO Lisa Lewis, whose non-medical, non-technical background is federal government administration, is named acting national coordinator.
  • HIMSS moves its 2019 convention from Chicago to Orlando after a squabble triggered by a guarantee given to RSNA that it gets the lowest available Chicago hotel room rates.
  • Details of the treatment given to Ebola patient Thomas Duncan by the ED of Texas Health Presbyterian Hospital Dallas show several inconsistencies with earlier reports, with contributions to the missed diagnosis including that a nurse’s failed to follow policy in telling the ED doctor about the patient’s travel to Africa, the doctor missed the nurse’s travel note in a nearly empty Epic patient record, and the patient provided conflicting history and symptoms.
  • HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, with health IT playing a key role.
  • The move away from document-based EHR information exchange to API-driven interoperability starting with Meaningful Use Stage 3 gains momentum as ONC and industry groups announced support for the change.
  • A survey of 14,000 RNs finds widespread dissatisfaction with EHRs and the IT departments that help choose and support those systems.

Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

Imprivata put on an excellent webinar last week on electronic prescribing of controlled substances. We had a lot of engaged attendees, but if you weren’t able to participate, the  YouTube video contains the complete 49-minute webinar, including the Q&A. The presenters cover the DEA rule, which requires EMRs to be certified and providers to use two-factor authentication (along with other technical requirements). New Yorkers should be especially interested since the I-STOP act requires EPCS starting in March 2015. HIStalk webinar questions can be directed to Lorre.


Acquisitions, Funding, Business, and Stock

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Small practice software vendor Kareo lands $15 million in funding, raising its total to $47 million.

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Cambia Health Solutions, which has held a few health IT investments in its portfolio of companies, is creating a collaboration space that it hopes will draw healthcare startups and providers to Seattle to launch pilot projects. It won’t be an incubator or accelerator – which the company says are hard to implement in healthcare – but will “raise all the boats in the Puget Sound market around healthcare.”

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A Reuters article says that Salesforce will make a big push into healthcare, hoping to create a $1 billion annual business despite the lack of success it and other technology companies have in similar attempts. The company’s healthcare head, whose background is as a drug company CIO, says they see a growth opportunity in care coordination, patient engagement, and analytics.


Government and Politics

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The states of New Jersey and New York impose an involuntary 21-day quarantine on healthcare workers returning from West Africa via Kennedy and Newark Liberty International Airports, even those who are free of Ebola symptoms. The “just to be safe” actions in which spacesuit-wearing workers quarantine and burn everything touched by people guilty only of a history of travel aren’t exactly calming a media-frenzied populace that is much better at being illogically scared than at understanding science. “We are no longer relying on the CDC standards,” said New Jersey Governor Chris Christie, who along with New York Governor Andrew Cuomo made their decision without consulting New York City’s health department. The first person detained, a nurse returning from work for Doctors Without Borders, says Newark airport officials treated her rudely, barked questions at her, reacted happily in claiming she had a fever that she was later found not to have, and forced her into an unheated tent wearing paper scrubs (rudeness, incompetence, and lazy union indifference were my strongest memory of my one international arrival at that airport, so I’m not exactly shocked.) She’s tested negative twice for Ebola but New Jersey is still locking her up for the full 21 days. She says healthcare workers are being treated like “criminals and prisoners.”

Good luck containing the outbreak to Africa if US-based aid workers face detention in return for helping there. If possible exposure is reason enough to lock people away, are all the Bellevue doctors and nurses going to be be quarantined for three weeks? Farzad Mostashari says it best: “Politicians suck at making public health decisions, especially when the public has lost their mind.” I’ll say it again: fast identification of potential Ebola carriers will be impossible if and when it starts spreading within US borders and the travel history becomes worthless, so someone better come up with a fast, early diagnostic tool since we can’t lock up everybody up for three weeks just because they have a fever.

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Update: in timely news, FDA just approved fast-tracked tests that can detect Ebola in one hour, which is a huge development with all of this hysterical Dark Ages quarantine nonsense. Salt Lake City-based BioFire Defense, a University of Utah spinoff, already won a $240 million defense department contract to turn its FilmArray product into a biological warfare detection system. It analyzes saliva or blood for genetic markers. The test has already earned FDA approval for respiratory and GI conditions. The instrument costs $39,500 and the tests are $129 each. Government comments suggest that the Ebola test may already be in use in Africa. I’m not clear from the product information if there’s a lag time between exposure and detection, which would be important in using it to detect pre-symptomatic infections.

Meanwhile, in New Jersey, New York, and everywhere else, use of the vaccine that protects against a far greater virulent killer – influenza – is optional (Governor Christie effectively vetoed a New Jersey bill earlier this year that would have required healthcare workers to get a flu shot, although he does urge everyone to get one). Contagious outbreaks can be contained only through herd immunity, meaning you need a critical mass of the overall population to be vaccinated to stop the spread and protect the unvaccinated. I got my flu shot yesterday – you’re welcome. Not making the headlines among the Ebola hype is that the first child of the 2014-2015 US flu season died the week of October 4; over 100 babies and up to 50,000 people overall died of influenza in the 2013-2014 season, although public health reporting tools have overlap between influenza and pneumonia that probably throws the count off.

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HHS posts Karen DeSalvo’s bio page for her new job. I thought of another reason HHS might have moved her into the position. Her predecessor, Wanda Jones (who was also in the “acting” role) holds a public health doctorate but isn’t an MD — the Assistant Secretary for Health has always been a medical doctor, at least was in recent years. Another HHS problem: the US has had only an “acting” Surgeon General since mid-2013, when the NRA stalled the appointment of the President’s nominee, Vivek Murthy, MD, MBA because he has labeled guns as a public health problem. Acting Surgeon General Boris Lushniak, MD, MPH has kept a low profile during the Ebola scare, so perhaps HHS wanted to have an MD who is credible, visible, experienced in actually practicing medicine, and free of political baggage. Whether the selection reflects HHS’s placement of ONC in its food chain is up for speculation.


Other

The family of a 12-year-old New Mexico student accused of shooting two of his classmates sues University of New Mexico Hospital after it told them that at least eight people inappropriately accessed his medical or mental health records.

Uber runs a one-day promotion called UberHEALTH in which customers in Boston, New York, and Washington DC could tap an app button to have a flu shot administered in their homes at no charge. The idea was suggested by a Harvard epidemiologist, who adds that “the model of delivering healthcare by car service could work to provide basic preventive care.”

A fascinating New York Times article profiles the decades-long work of psychologist Ellen Langer, whose experiments suggest that aging and the course of life-threatening diseases are influenced by how old the individual feels as triggered by their surroundings and the perceptions of others. In other words, to some extent you really are as old as you feel.

Partners HealthCare CEO Gary Gottlieb announces that he will resign with five years left on his contract to run the Partners in Health non-profit, just as his current employer faces unprecedented scrutiny of its expansion plans and its high pricing. He says he will take a pay cut from $2.6 million to $200,000 and will leave without a golden parachute.

Weird News Andy finds this story infectious, as scientists in China find a virus-killing penicillin in honeysuckle plants. WNA admits that he rarely sees bees and hummingbirds with the flu (although they possibly flew up the flue, he quips) but questions whether his employer will allow proof of honeysuckle tea consumption instead of a flu shot.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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October 26, 2014 News 8 Comments

News 10/24/14

October 23, 2014 News 11 Comments

Top News

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HHS Secretary Sylvia Burwell transfers National Coordinator Karen DeSalvo, MD, MPH, MSc to the position of acting assistant secretary for health — it oversees public health, including the Office of the Surgeon General — in response to the Ebola threat. DeSalvo replaces Wanda Jones. ONC COO Lisa Lewis (above) is named acting national coordinator, effective immediately. Ms. Lewis’s background is in grant management for ONC and FEMA, so her non-clinical, non-technical experience will contribute to ONC’s identity struggle in a post-Meaningful Use world. I would expect HHS to launch a search for a permanent and well-credentialed national coordinator quickly since its internal personnel stores have been recently depleted (assuming that DeSalvo’s move is permanent, which isn’t the stated case so far, which otherwise means Lewis may be keeping the seat warm for some time).

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Jacob Reider, MD would seem to have been the obvious choice for interim national coordinator since he is deputy national coordinator, but he confirms with me that he has resigned, having promised to his family several weeks ago that three years of commuting to DC was enough. That leaves only Jodi Daniel and Kelly Cronin from Farzad’s 10-member team of a year ago, at least barring any additional announcements.


Reader Comments

From Frank Poggio: “Re: Karen DeSalvo reassigned from ONC. If this does not signal the end is near for the MU fed program, I do not know what would. She was there for maybe six months, came up with the grand revelation that interoperability is a bus, issued a voluminous dissertation on what was wrong, then headed for the hills! Can’t wait to see ONC /DHSS press releases on what a great job she did.” ONC was all over the Ebola issue even though the EHR turned out to be non-contributory at THR, so DeSalvo’s interest and Katrina-related public health background put her in the right place at the right time. Physicians with practice experience and an MPH from a decent school will find many job opportunities as the industry matures from encounter management to population management. I think ONC’s best purpose once they’ve either handed out all the MU money or caused providers to lose interest in receiving it would be to (a) retool EHR certification to encourage interoperability and issue standards accordingly, and (b) run with the idea of the healthcare IT patient safety center if they can get Congress to fund it. They got EHRs out in the field, now it’s time to focus on using them for patient rather than provider benefit.

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From The PACS Designer: “Re: ultrasound emergency wireless app. Samsung has demonstrated an ultrasound wireless application for emergency situations. A test showed that life saving could be achieved through the immediate sending of ultrasound images to emergency departments from ambulances.” That’s a good reminder that sometimes creating new data elements isn’t as important as moving the existing ones around more effectively to increase their value to a wider audience.

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From Barry Black: “Re: Wellogic. Alere has divested the former company that was Alere Accountable Care Solutions.” Alere acquired Wellogic, founded in 1993 in late 2011. I interviewed President and CEO Sumit Nagpal a year ago. Alere ACS offers a PHR, EHR, HIE, decision support, analytics, and wellness and health coaching platforms. The company provided this response:

Based on strategic review by a leading consulting firm, Alere made a decision to refocus its energies on its main business market — diagnostics. As a part of this strategic refocus, Alere chose to divest certain assets, including those in connected health and health management. Alere ACS was the cornerstone of the Alere connected health strategy, and during its Alere tenure, enjoyed great investment that were mutually beneficial to Alere and Alere ACS — including tens of millions of dollars of enhancements to its core HIE platform. Alere ACS has now successfully separated from Alere into a new entity that will operate independently. This new entity has received a significant commitment of support and capital that will ensure continued operations and a sizable R&D investment for short- and long-term success. The new unit will continue to focus on the connected health market, including integrations with various diagnostics, mobile devices, and home monitoring opportunities. The new entity is financially robust and is armed with the necessary resources to achieve and support better healthcare and financial outcomes for the healthcare system. Executive leadership, engineering, and professional services  remain unchanged.

From Lazlo Hollyfeld: “Re: non-competes. No rank-and-file employee should be subject to these agreements, and certainly not for two years.” Jimmy John’s, which is my least-favorite sub chain next to Quizno’s and not in possession of any obvious meat and bread secrets, slips a two-year non-compete clause into its employment agreement that prohibits its $8 per hour sandwich makers and delivery drivers from working not only at competing sub chains, but for any business located near one of its locations that makes 10 percent of its revenue from sandwich sales. Lawyers in a class action suit say the chain’s 2,000 locations mean that an employee who quits can’t work in an area covering 6,000 square miles. It’s like every non-compete that claims to cover non-management employees: a load of repressive corporate crap dreamed up by paranoid management that wouldn’t withstand five minutes of scrutiny in court, existing only because non-management employees don’t have the time and money to challenge it.

From Deanna: “Re: Plato’s Cave. Made me think of you and why your contribution to HIT is so much better than anyone else’s. You have been outside the cave.” The outgoing editor of The Wall Street Journal’s CIO Journal says he left journalism to work for Oracle because “journalists are at least twice removed from the essence of what they write about … I also don’t want to watch technological evolution while imprisoned in a cave, forced to take someone’s word for how it’s made and how it’s used. I want to observe it for myself.” Diligent writers often do a good job covering complicated subjects of which they have zero first-hand experience for experts who live it every day, but I get annoyed when they get lazy and just dutifully reword press releases or stray over that already generous line and start editorializing or delivering podium speeches based entirely on their cheap-seats view, like a couch potato sports fan yelling instructions to a professional football coach or a secluded porn watcher providing relationship advice.

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From Clinic EHR Director: “Re: Epic staff rates. Most of the information out there is overpriced, inaccurate, or both. A friend put together a survey and will publish it free. I would love it if this could be made available to as many people in the industry as possible.” The Epic salary survey is here and the results will be published here.

From P.O. Garth: “Re: HIStalkapalooza. Just curious what night it will be?” This might set the record for the earliest inquiry about an event that’s still almost six months away. HIStalkapalooza will be Monday, April 13, 2015. It will be the best HIStalkapalooza, the last, or both since I’ve decided to take the planning out of a single sponsor’s hands and instead run it myself with the help of Lorre and Jenn and the financial support of five sponsors yet to be chosen (let me know if your company is interested – you’ll get lots of exposure and invitations). Last year was the breaking point for me since ticket demand far exceeded supply and people I wasn’t able to invite got personally rude even though I spend months every year from late summer to spring sweating details for no personal benefit, leading me to swear that I was done with it. For Chicago, the facility, band, and menu are all under contract – it should be pretty great. If it’s the last one, it will at least be legendary.   


HIStalk Announcements and Requests

This Week on HIStalk Practice: the DoD’s DHMSM RFP deadline is pushed back — again. Qualis Health achieves MU goal. Jerry Broderick suggests three questions to ask before joining an employed physician network. Tennessee Primary Care Association implements new pop health/analytics tools. HP interviews Rob Tennant, SVP of government affairs, MGMA. Modernizing Medicine co-founders win leadership award. Check out the HIStalk “Must-See” Exhibitors Guide for MGMA 14. Thanks for reading.

This week on HIStalk Connect: Doctors Without Borders is developing an SMS-based Ebola screening tool to engage with the local West African population. HealthTap announces that it has created a national telehealth platform that will provide virtual visits for $44 per session. XPRIZE announces 11 finalists in the Nokia Health Sensor Challenge.

Listening: new from Cold War Kids, bluesy indie rockers from Long Beach, CA.


Webinars

November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.


Acquisitions, Funding, Business, and Stock

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NextGen parent Quality Systems reports Q2 results: revenue up 9 percent, adjusted EPS $0.13 vs. $0.22, beating revenue expectations but missing on earnings. Above is the one-year QSII share price chart (blue, down 39 percent) vs. the Nasdaq (red, up 13 percent).

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Cerner announces Q3 numbers: revenue up 15 percent, adjusted EPS $0.42 vs. 0.35, falling short on revenue expectations but meeting consensus earnings. Above is the one-year CERN share price chart (blue, up 6 percent) vs. the Nasdaq (red, up 13 percent). The breathy reports of $XXX billion of healthcare IT startup investment hide the fact that most of the publicly traded HIT vendors aren’t exactly killing it on Wall Street, which the irrationally exuberant cheerleaders will spin as evidence of the changing of the guard rather than the historically difficult HIT business climate.

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Patient self-service app vendor Phreesia raises $30 million in funding.

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North Bridge Growth Equity becomes a majority stake owner in patient encounter platform vendor Ingenious Med with an undisclosed financial investment.


Sales

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Logicworks will host the Massachusetts Health and Human Services Virtual Gateway portal.

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Wyoming Medical Center (WY) selects Wolters Kluwer’s ProVation MD Cardiology for structured reporting and coding in it catheterization labs.

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DeKalb Medical  (GA) selects Connance’s Patient-Pay Optimization program to improve productivity and improve patient experience.


People

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MModal names Scott MacKenzie (Experian Health) as CEO and board member.

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Health Data Consortium, the group that runs Health Datapalooza, names Chris Boone, PhD (Avalere Health) as executive director.

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HDS hires Bradley Johnson (Caradigm) as senior executive of business development.


Announcements and Implementations

Strata Decision launches cloud-based StrataJazz Continuous Cost Improvement to help providers reduce waste and inefficiency.

Greythorn launches a healthcare IT salary survey and will donate $1 for each survey completed to Autism Speaks Foundation.

Long-term care EHR vendor HealthMEDX announces its iCare POE mobile care management system.

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Valley General Hospital (WA) goes live on Medsphere’s OpenVista.

HSHS Medical Group (IL) launches a pilot that will test the use of Apple Watch, due out next year, in its medical home program.


Government and Politics

HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, saying that healthcare IT will be a key component. Among the suggested strategies is daily review of EHR quality and efficiency information. Specifically listed is secure, standards-based, bi-directional communication with other providers.

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Three industry notables (Dean Sittig, David Classen, and Hardeep Singh) propose in a JAMIA article that ONC’s planned HIT Safety Center (a) create a post-marketing HIT patient safety event surveillance system; (b) develop policies and procedures for investigating those events; (c) design random safety assessments of large providers; and (d) advocate HIT safety. The surveillance function would look at system failures, inadequate design, improper user configuration or usage, interface problems, and missing or unimplemented safety-related features. I would be happy if someone would just implement an easy way (on-screen button?) for providers to communicate safety concerns directly to vendors with a CC: to a safety center. Several organizations (some of them governmental) claim to have such a system, but none get significant use because end users don’t know about them or aren’t willing to complete a pile of paperwork that doesn’t benefit them directly.

The Department of Homeland Security is reviewing possible cybersecurity flaws in medical and hospital devices (including IV pumps and cardiac devices) that could make them vulnerable to hackers, stating its intention to work with vendors to correct software problems. 


Other

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HIMSS will move its 2019 convention from Chicago to Orlando in a dispute over hotel room rates, citing its unhappiness that the RSNA conference obtained a “favored nation” clause that guarantees it the lowest room rates for events held from April through November. I surveyed readers in early 2013 about their preferred HIMSS conference cities and Chicago finished near the bottom, with only 6 percent choosing it as their favorite — New Orleans, Atlanta, Dallas, San Antonio, and Boston did as poorly or worse, while San Diego, Las Vegas, and Orlando topped the list. Chicago is easily my least-favorite convention city (even though I like visiting it otherwise) due to overpriced and indifferent hotels, surly union workers, poor public transportation to McCormick Place, and the near-certainty of cold, dreary weather in April (which of course exhibitors love since it keeps attendees inside looking at booths). HIMSS scratched its home city’s back by holding the conference there in 2009 after pushing the usual date back several weeks to avoid blizzards (which didn’t work), pulled the conference out again because of union-driven high costs of exhibiting at McCormick Place, and then ill-advisedly decided to return in 2015. Too bad their squabble comes too late to move HIMSS15 somewhere else.

Interesting: scientists nearly 10 years ago came up with an Ebola vaccine that was 100 percent effective in protecting monkeys, but the $1 billion plus cost of bringing a drug with minimal sales potential to the US market sent it to the shelf, where it remains.

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A Diagnosis article by the aforementioned Dean Sittig and Hardeep Singh, along with Divvy Upadhyay, looks at the treatment of Ebola patient Thomas Duncan at Texas Health Presbyterian Hospital Dallas, reviewing the patient’s record to find several discrepancies in THR’s announcements:

  • The patient presented with a temperature spiking to 103 degrees, dizziness, GI symptoms, headache, and a self-reported pain score of eight on a 10 scale, contradicting hospital reports that his initial symptoms weren’t severe.
  • The nurse documented his recent travel to Liberia.
  • The ED doctor prescribed Tylenol and antibiotics (the article didn’t question why he or she prescribed antibiotics for vague symptoms that could be non-infectious or viral, but antibiotic overuse and resistance is a topic for another day).
  • The authors speculate that the ED physician chose predefined phrases from EHR-suggested drop-downs that misled caregivers who read the notes later.
  • They also speculate that the hospital is located next to a high-immigrant population area that a county commissioner termed “a little Ellis Island” that could have caused employees to miss the red flag of “a black man with a foreign accent who reported he came from Liberia and presented with serious ‘flu-like’ symptoms to an ED which reportedly had received CDC and county health department’s guidance as early as July 28th, 2014.”
  • The article points out that clinicians often misdiagnose or miss common clinical conditions and it’s not the EHR’s job to replace their critical thinking and history-taking skills.
  • It adds that doctors tend to ignore nurse-generated documentation, both on paper and in the EHR. Sad, but true.

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THR previously submitted to Congress a timeline of Thomas Duncan’s ED visit with some interesting items:

  • Triage didn’t start until an hour after the patient’s arrival at 10:37 p.m. – he was sent to the waiting area (in contact with everybody else there) and wasn’t taken to the treatment area for for nearly 90 minutes.
  • The ED physician accessed the triage nurse’s report at 12:27 a.m., but the travel history question hadn’t been asked yet since it wasn’t the triage nurse’s responsibility.
  • The patient first reported his travel history to Liberia in a 12:33 a.m. question from the primary ED nurse, but she didn’t pick up on the importance of his answer and ignored the EHR prompt to verbally relay it to the ED doctor (big-time fail there).
  • Audit logs show that the ED doctor reviewed the Epic sections that included the patient’s travel history several times between 12:52 and 1:10 a.m. Remember that at that point, the EHR should have been basically a single screen of information since all that had been documented  was triage, the primary nurse’s initial workup, and a few vital signs. Specifically in Epic, the authors say, that includes screens for: ED lab results, Visit Navigator, related encounters, flowsheet, allergies, home meds, and ED patient history, all of which should have been pretty much blank.
  • The doctor later reviewed the patient’s history in which he said he was a “local resident,” had not been in contact with sick people, and had not experienced GI symptoms (contradicting the triage nurse’s recording of his chief complaint – in other words, the patient gave incorrect and misleading information for some reason).
  • The ED doctor discharged the patient with a diagnosis of sinusitis (not sure where that came from) and abdominal pain.

My conclusions: (a) Epic worked as it should have although the ED doctor still missed crucial information despite spending a lot of time looking at what should have been minimally populated Epic screens and possibly not the patient himself; (b) the hospital should have been asking travel questions at triage, which THR has since required; (c) the ED nurse missed an obvious red flag and broke hospital policy by documenting in the EHR but not reporting the travel information verbally; (d) the ED doctor either missed what should have been plainly obvious travel information or failed to note its relevance; (e) the patient told the ED doctor a very different story than he had told the nurse previously, eliminating or changing information that would have put the ED doctor on alert. All of this points out how unprepared the hospital was for detecting possible Ebola patients despite public health warnings, along with their lack of urgency to put new policies in place. My bigger conclusion: hospitals are not good at all with issues related to public health, and public health departments don’t seem to have the influence to drive sound infectious disease policy out of their ivory towers to the front lines.

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BIDMC CIO John Halamka, MD proposes that clinical documentation, which was designed for billing rather than care coordination, be redesigned around a team-based, story-oriented structure that eliminates redundancy, inaccuracy, and copied-pasted text that doesn’t convey (or even hides) the patient’s story. It resonates with me because I’m getting increasingly frustrated that EHRs are superior to paper in every way except that one – the tendency to generate a lot of worthless but structured information that masks the sometimes obvious issues, meaning those EHRs make care worse instead of better. It’s time to reclaim the EHR from administrators, bureaucrats, CMS, and malpractice attorneys and give it back to patients and clinicians. Halamka writes on his blog:

Imagine if the team at Texas Health Presbyterian jointly authored a single note each day, forcing them to read and consider all the observations made by each clinician involved in a patient’s care. There would be no cut/paste, multiple eyes would confirm the facts, and redundancy would be eliminated. As team members jointly crafted a common set of observations and a single care plan, the note would evolve into a refined consensus. There would be a single daily narrative that told the patient story. The accountable attending (there must be someone named as the team captain for treatment) would sign the jointly authored Wikipedia entry, attesting that is accurate and applying a time/date stamp for it to be added to the legal record.

After that note is authored each day, there will be key events — lab results, variation in vital signs, new patient/family care preferences, decision support alerts/reminders, and changes in condition.

Those will appear on the Facebook wall for each patient each day, showing the salient issues that occurred after the jointly authored note was signed.

With such an approach, every member of the Texas care team would have known that the patient traveled to Dallas from West Africa. Every member of the care team would understand the alerts/reminders that appeared when CDC or hospital guidelines evolved. Everyone would know the protocols for isolation and adhere to them. Of course, the patient would be a part of the Wikipedia and Facebook process, adding their own entries in real time.

A study of ICU patient alarms finds that each occupied bed generates 187 audible alarms per day, many of them false alarms related to arrhythmia. It suggests that hospitals reduce alarm fatigue by reviewing their alarm settings and consider changing some alarms from audible to text messages.

A woman who tried to kill herself by gouging out her eyes with a pencil sues LA-USC Medical Center, saying that one of its nurses took a picture of her and shared it with a friend who then posted it on a shock website.

Weird News Andy fiddles around with this story, in which a concert violinist plays his instrument on the operating room table as neurosurgeons implant a “brain pacemaker” to correct his otherwise career-ending tremors. The surgery team monitored the patient’s movements via a three-axis accelerometer as he played and they inserted electrodes into his brain to make sure they hit the right spot. It worked: three weeks later, he was back on stage with the Minnesota Orchestra.  


Sponsor Updates

  • Yale New Haven Health System (CT) implements SSI Group’s Audit Management solution.
  • Predixion Software CEO Simon Arkell is named “Outstanding CEO” for a mid-sized company by the Orange County Technology Alliance.
  • PerfectServe President and CEO Terry Edwards writes a blog post called “Prioritizing Communications to Improve Care Coordination.”
  • AOD Software and Imprivata partner to provide a secure communication platform for the senior healthcare market.
  • Medical Economics names ADP AdvancedMD, Allscripts, Aprima, CompuGroup Medical, e-MDs, eClinicalWorks, GE Healthcare, Greenway, Kareo, McKesson Specialty Health, NextGen, Optum, Quest Diagnostics, and RazorInsights to its “Top 50 EHRs” list.
  • MedAptus will integrate Entrada’s dictation recording technology with its Pro Charge Capture solution.
  • Truven Health Analytics introduces Interactive Reporting, which helps health plans analyze account-specific cost, use, and quality.
  • Perceptive Software will introduce Medical Content Management at RSNA 2014.

EPtalk by Dr. Jayne

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I’m always excited to receive reader mail, although I’m terribly behind on answering it. I have a couple of blogger / author friends and am convinced HIStalk has the best readers out there. That was proven this week when several of you wrote offering advice for my friend’s oncology RFP conundrum. I appreciate the input and have forwarded your thoughts.

Weird News Andy weighed in on last week’s discussion of mood-altering wearables, sharing that it “depends on who is wearing them and what else they are wearing. Mrs. Weird has an effect on my mood no matter the other variables.” I hadn’t thought of wearables in that context when I was writing last week, but that’s an important point. Despite the mass integration of technology in all facets of our lives, I still don’t understand people who wear Bluetooth headsets constantly, let alone people wandering around with Google Glass in social situations. I wonder how much we miss of the world around us because of our devices.

Reader Foie Gras wrote about this year’s Clinical Informatics board certification exam: “Thanks for your description of last year’s experience. I took the exam this past week and I want a do-over! I feel like I studied very very hard, reviewed the AMIA course, took lots of notes, and am experienced in the field, but there were definitely questions on the test with terms I did NOT know and even on some of the topics I’d studied up on. I felt they asked a very nuanced question that I just couldn’t feel comfortable with. A bit frustrating after quite the marathon and sprint of studying. Here comes the two-month wait. I really don’t want to have to study for that thing again (although yes, I learned a ton studying for it and it was really enjoyable at times.)”

I heard similar feedback from other colleagues who sat for the exam this year. Preparing for board certification can be arduous, but being able to find some enjoyment in it says something about the personality traits of those who stay in medicine. I share the frustration about some of the terminology (particularly eponyms) used on board exams. If it walks like a duck and quacks like a duck, and actually is a duck, is the fact that it’s a Baikal Teal vs. a Carolina American Wood Duck really relevant if the question is asking how many feet it has?

I enjoy leisure reading much more than I enjoy reading CMS regulations or (heaven forbid) the Federal Register, so I was excited when a colleague left a copy of “Doctored: The Disillusionment of an American Physician” on my desk. Sandeep Jauhar is a New York cardiologist. I was familiar with his first book, “Intern.” The sequel was a pretty quick read and explores several healthcare dynamics from the last two decades: the fall of fee-for-service reimbursement, providers who order diagnostic testing for their own enrichment, and fragmentation of patient care.

Although I haven’t had to deal with some of the scenarios he encountered after leaving fellowship, I’ve experienced enough of them to share some of his feelings of disillusionment. In addition to being about the “mid-life crisis” facing medicine since the creation of Medicare in the 1960s, it also covers his own mid-life crisis, which makes some sections a little difficult to read. Still, I appreciate his candor and his willingness to stick his neck out as he shares his story.

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I’m used to getting a variety of mailers and postcards from vendors and recruiters, particularly around HIMSS and other conferences. I was surprised this week to get a recruiting postcard from Uncle Sam. I’m sure the mailing was set up weeks ago, but the statement “because of the wide scope of the Army’s activities, you may have the chance to see and study diseases that are not usually encountered in civilian practice” to be very timely. Some of my best friends are currently or have been military physicians. I am grateful for their service and for the sacrifice of everyone serving in all branches of the military. Veterans Day is approaching, so make plans to thank your colleagues, neighbors, and family members who have served.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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October 23, 2014 News 11 Comments

Morning Headlines 10/24/14

October 23, 2014 Headlines 1 Comment

HHS reshuffles amid Ebola crisis

Karen DeSalvo, MD leaves her post leading the ONC to take over as HHS’s acting assistant secretary for health. Interim national coordinator Jacob Reider, MD also announces he will leave ONC in the coming weeks, leaving ONC COO Lisa Lewis to take over as the new acting national coordinator.

HHS Secretary announces $840 million initiative to improve patient care and lower costs

HHS announces $840 million in new grant money that will be used to help provider organizations implement the tools needed to create more coordinated, integrated health systems.

Wikipedia and Facebook for Clinical Documentation

John Halamka MD, CIO of Beth Israel Deaconess Medical Center, calls for clinical documentation, which was designed to support billing needs, to be redesigned as an interdisciplinary communication tool.

Cerner Reports Third Quarter 2014 Results

Cerner reports Q3 results: revenue is up 15 percent to $840 million, adjusted EPS $0.42 vs. 0.35.

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October 23, 2014 Headlines 1 Comment

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Reader Comments

  • Jay Alicea: A great and timely read....
  • Stephanie Marlowe: I'm interested in the future that Google is promising. It is interesting that they over all have the biggest say in tech...
  • : Judy is not happy that there is a negative perception about Epic’s technology that is creating market pressure for the...
  • C Harris: Re: ONC. A "steady ship" can also be one that is lying at the bottom of the ocean. ONC reportedly has over 150(!!) emp...
  • Kathy L.: Very wise words - as always. Wish that more execs understood this way of thinking. ;)...

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