Recent Articles:

Morning Headlines 9/30/16

September 29, 2016 Headlines No Comments

My Vision for Universal, Quality, Affordable Health Care

Using NEJM as a podium, Hilary Clinton outlines her plans for improving healthcare, which includes improving ACA, working to “integrate our fragmented healthcare delivery systems,” and helping to increase research and innovation.

HITRUST Becomes First Healthcare Information Sharing Organization Connected to DHS Automated Indicator Sharing Program

Health Information Trust Alliance begins exchanging bi-directional cyber threat alerts with the Department of Homeland Security.

AARP, HHS Announce Winners of Challenge to Redesign the Medical Bill for Patients

HHS announces the winner of its “A Bill You Can Understand” design challenge. The challenge awarded two prizes, one for the bill that is easiest to understand, and another for the design that best improves the overall approach to the medical billing system.

View/Print Text Only View/Print Text Only
September 29, 2016 Headlines No Comments

EPtalk by Dr. Jayne 9/29/16

September 29, 2016 News No Comments

There has been a lot of chatter in the physician lounge recently about the “Pick your Pace” options for Medicare-related quality reporting next year. Of course, most of the chatter has been either from hospital administrators or from physician leaders of larger groups, since many smaller and independent physician groups may not even be aware of what is about to happen. I was part of a lively exchange this week around the fact that the program has to be budget neutral. To recap, the four options are: 1) Test the quality payment program (no penalty); 2) Report for part of the calendar year (small incentive); 3) Participate for the full year (modest incentive); and 4) Participate in an Advanced Alternative Payment Model (5-percent incentive). The devil may be in the details since it’s unclear how no penalty and small incentives can balance out to be budget neutral. Where is the incentive money going to come from?

It’s also not clear what the actual “test” process in option 1 is going to entail. Unless you’re just starting on your EHR journey, most organizations should be able to report for at least part of the year without significant difficulty. The data may not be of great quality, depending on how well you’re using your EHR, but you can still report it out. We’ll have to wait for the final rule, however, to see what the reporting requirements end up looking like. The partial-year option is going to be attractive to a great number of providers whose EHRs may not be ready for full-year reporting, so I expect to see the most questions on that option.

image

For providers that are in the thick of trying to comply with all the federal requirements, the 2015 Annual Quality Resource and Utilization Reports (QRURs) were released this week. The QRURs show what a provider’s payment adjustment will be for 2017 based on analysis of quality and cost domains. I attended the Medicare Learning Network call on the topic today. If I didn’t already know a considerable amount about the Value Modifier payment adjustment and the PQRS payment adjustment, I might be more confused after attending the call. The call began with a presenter essentially reading slides to the audience. There were constant references to the appendix, and fortunately the slides were available for download at the beginning of the call so that attendees could follow along.

I’m still mystified by the fact that it takes 21 months to analyze and release the data. We’re talking about using data from 2015 to determine how providers are paid in 2017. Although there was a Mid-Year QRUR that was released in the summer, it didn’t fully illustrate how payment adjustments might be applied. Regardless, the Mid-Year QRUR has little utility to encourage providers to modify their behavior in order to avoid adjustments, since it’s a look-back document. When trying to modify behavior, it’s most useful to provide real-time or at least fairly immediate feedback. Under the CMS construct, the feedback loop is delayed. Does it really take 21 months to aggregate and interpret the data? Or maybe the delay is intentional, as providers move deeper and deeper into a state of learned helplessness.

After about 15 minutes on the call, I felt my brain going numb as the presenter reviewed all the steps needed to access the QRUR. Providers or their designees have to go through the process of requesting an Enterprise Identity Management (EIDM) account which has multiple steps and sub-steps. The acronym soup became less savory as we learned about Provider Transaction Access Numbers (PTAN), which have to be obtained from the Medicare Administrative Contractor (MAC). Once you go through all the related steps and click your heels a couple of times, you can either view or download the presentation.

The presenter tagged-out to a second presenter who went through a table explaining the different sections of a “hypothetical” QRUR. Again, it was basically someone reading a slide to the audience – actually showing the various exhibits and sections while talking about them would have been useful. They did eventually go through some of the specifics, but I wonder how many attendees were following especially if this was the first time they were seeing this material. As the talk moved into discussion of the various quality and cost composite scores, and the need for a statistically significant deviation from the mean to be categorized as more (or less) than average, I wondered how many people attending the webinar understood those statistical terms.

Having spent my final two years at Big Medical Center working on a provider attribution project, I was eagerly awaiting the discussion of how Medicare beneficiaries were assigned to their respective Taxpayer Identification Numbers (TIN). This attribution drives the cost composite score found in the QRUR. Not only is CMS looking at spending per beneficiary, they are also looking at per capita costs for beneficiaries with various chronic conditions including diabetes, chronic obstructive pulmonary disease, coronary artery disease, and heart failure. They didn’t go into anywhere near the detail I expected for a provider to actually understand how the attribution was done. There are detailed elements involving whether a given TIN provided the majority of primary care services during the year, whether primary care services were received from subspecialists in the TIN, and more. None of that was covered.

Heading into the discussion of the “Informal Review Process” that providers can use to disagree with Value Modifier calculated for their TIN, the presenter became flustered due to a missing slide and rather than vamping her way through it, actually paused the presentation while they tried to sort it out. When she restarted, she actually re-read some scripted comments. I felt bad for her – we’ve all been on the downside of presentations that don’t go as planned. She then went into a discussion of various tables in the appendix, which again weren’t on the screen. Apparently, providers can download them in Excel and use them to analyze their own data, even de-identifying it by removing specific columns. It would have been good to see a screenshot of the data format to go along with the discussion.

Once she finally made it to the discussion of the review process, things were back on track. The review period began September 26 and is open for 60 days. The review has to be requested using the EIDM system and the process includes a Multi-Factor Authentication (MFA) step. Users have to remember to use the same MFA device type that they selected to use when they first created their accounts. Depending on how long ago one’s account was created, this may be a challenge. Users can then request the review, which leads to an additional three steps that weren’t shown in the webinar. Users can download a quick reference guide from the CMS website for more information on the reviews, although the link wasn’t shown in the webinar. As a side note, there were a couple of times at the beginning of the webinar where the speaker gave Web addresses verbally but with no link or text shown. Especially with a webinar platform, is there any reason why a link shouldn’t be shown on the screen and provided in the deck that was given to attendees? Another unusual statement (given by two different speakers) was that users should disable their popup blockers and should not connect wirelessly or via VPN but should connect via a wired connection. In this day of mobility and multi-platform device use, it felt like CMS is out of touch with how people use devices to receive information.

They opened the call to Questions and Answers and the first one seemed to challenge them, about whether the adjustment would be provided on a claim-by-claim basis or at the end of the year. Eventually they arrived at the per-claim answer. They answered the second question (about beneficiary attribution) by referring users to yet another website. I finally figured out why they wanted popup blockers disabled when a poll popped up asking how many people were viewing the session with me. There were also polling questions on whether I had difficulty accessing the webinar and whether I was satisfied with the webinar platform used. The questions continued, including one from a group who had discrepancies in the data from their QRUR. She was instructed to submit informal review for both QRUR and PQRS, and the latter has to be done through a different process that the group had difficulty explaining. They had to pause while they conferred, agreeing to look it up and provide it later.

That only served to underscore how complicated these programs are and how challenging it will be for provider groups of all sizes to try to keep up. Staying current with software and enforcing end-user behavior is hard enough, but this adds an entirely different layer of challenges for practice operations and management teams. I had to duck out for another call but am looking forward to seeing the rest of the Q&A in the transcript.

How is your organization coping with the QRUR? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 29, 2016 News No Comments

News 9/30/16

September 29, 2016 News No Comments

Top News

image

Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs, and will provide its own 50,000 employees Apple Watches free of charge.


HIStalk Practice Announcements and Requests

This week on HIStalk Practice: Dr. Gregg pontificates on the proper way for vendors to apologize for unexpected downtime. Enjoin VP James Fee, MD describes how physician engagement efforts can improve clinical documentation. Malvern Family Medical Clinic Owner Shawn Purifoy, MD offers insight into the benefits of joining an ACO and the struggle to remain independent. Medecision William Gillespie, MD lists three population health must-haves for primary care. Midwest Nephrology Associates Owner Gary Singer, MD digs into the benefits of Carequality’s Interoperability Framework.

This week on HIStalk Connect: Sirono Chief Revenue Officer Peter Longo discusses the problem with hospital billing and keys to successful patient payments.


Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Announcements and Implementations

image

Vidyo launches a clinical design service to help providers integrate telemedicine into their workflows.

PatientPing and Vermont Information Technology Leaders deem their care coordination technology collaboration a success at the six-month mark. Since going live, 400 provider locations in New England have been “pinged,” letting them know that their patients have been seen at local hospitals. PatientPing has recorded 62,000 notifications on 12,000 Vermont citizens.

image

UAB Medicine will replace its connectivity software with Orion Health’s Rhapsody Integration Engine – a project that will include rewriting 300 interfaces.

Cypress Creek ER (TX) selects Wellsoft’s EDIS for its third freestanding ER, set to open mid-October. Angleton ER (TX) will go live with Wellsoft technology when it opens in December.

NewCrop adds specialty medication prescribing software from AssistRx to its e-prescribing software.


Acquisitions, Funding, Business, and Stock

image

Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.

image

MedWand Digital Health secures a “major investment” from sensor technology-focused Maxim Ventures, which the Las Vegas-based startup will use to work towards anticipated 2017 FDA approval of its diagnostic device for virtual consults.


People

image

Wendy Deibert (The VirtualEngine) joins Vidyo as VP of clinical services.

image

Teladoc adds the new role of COO to CFO Mark Hirschhorn’s responsibilities.

image

Greg Alexander (Evolent Health) joins Lumeris as national VP of market operations.

image

The Chartis Group promotes Michael Topchik to head of the new Chartis Center for Rural Health.

image

Michael Bain, MD (Qualified Emergency Specialists) will head Cincinnati-based TriHealth’s new clinical informatics department as CMIO.


Technology

image

Dr. Oz lends his gravitas to San Francisco-based wearables startup IBeat, becoming an investor, partner, and advisor to the company as it launches its heart-monitoring smartwatch via an Indiegogo campaign. For a mere $5,000, buyers can purchase the “Meet Dr. Oz Special,” which includes VIP access to this show, a two-night hotel stay in New York City, two watches and monitoring services, plus a signed book and scrubs. Oz was not involved in last month’s seed funding round of $1.5 million.


Government and Politics

image image

HHS and AARP announce the winners of their “A Bill You Can Understand” contest. Designs from Los Angeles-based RadNet, which won in the easiest-to-understand category, and San Francisco-based Sequence, which won in the overall approach category, will be tested or implemented in six healthcare facilities – including Cambia Health Solutions – across the country. (Jenn talked with CHS President and CEO Mark Ganz about the challenge as part of “The Hypocrisy of a Simpler Patient Bill.”)

image

Hillary Clinton takes to the New England Journal of Medicine to outline her vision for universal, quality, affordable healthcare. Her short op-ed hints at healthcare IT among her four goals: “I am also committed to expanding access to high-quality data on cost, care quality, and health delivery system performance to help patients and doctors make informed choices, and entrepreneurs build new products and services.” Donald Trump has thus far declined the same editorial opportunity.

ONC awards seven organizations $1.5 million to improve the flow of health data for patients and providers, particularly data related to medication management, laboratory data, and care coordination. The funding comes via the office’s High Impact Pilot and Standards Exploration Award programs.

HIMSS presents Acting Assistant Secretary for Health and former national coordinator Karen DeSalvo, MD with the Federal Health IT Leadership Award during its National Health IT Week festivities.


Privacy and Security

image

HITRUST connects and begins bi-directional sharing of cyber threat indicators with the Department of Homeland Security’s Automated Indicator Sharing Program. The information exchange corresponds with HITRUST’s new CyberAid program, which helps smaller organizations select security solutions and contribute to the exchange.

image

From DataBreaches.net:

  • The New Jersey Spine Center notifies patients of a July 27 ransomware attack that resulted in the provider paying an unspecified dollar amount to unlock all of its digital patient records. Files were reinstated on August 1.
  • Royal Cornwall Hospitals Trust in England suffers multiple ransomware attacks over the past year.
  • Australia Health Minister Sussan Ley apologizes to physicians for the accidental leaking of Medicare data, discovered after University of Melbourne researchers attempted to decrypt some of the data, thus inadvertently revealing sensitive information.

Research and Innovation

image

The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.

image

An American Telemedicine Association/Wego Health survey of 429 patients finds that just 22 percent have taken advantage of video visits in the last year, with the average patient engaging in between one and four virtual consults. Of that percentage, as many patients requested telemedicine services as their providers initially offered it. I’m not sure that “strong demand,” as tweeted above, is warranted with these results.


Other

image

Seems like #HIMSSanity has already begun.

image

British researchers have created a 3D-printed replica of the human body to help train surgeons, particularly when it comes to making that initial slice.


Sponsor Updates

  • Fortified Health Solutions will exhibit at the HIMSS Southern California Annual Privacy & Security Forum September 30 in Newport Beach.
  • Frost & Sullivan recognizes Orion Health with the 2016 European Frost & Sullivan Award for Product Leadership.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 29, 2016 News No Comments

Morning Headlines 9/29/16

September 28, 2016 Headlines No Comments

FDA Approves First ‘Artificial Pancreas’ for Diabetes

The FDA approves Medtronic’s artificial pancreas that automatically monitors a patient’s blood sugar levels and then administers the appropriate insulin dose.

Aetna to Transform Members’ Consumer Health Experience Using iPhone, iPad and Apple Watch

Aetna announces plans to offer an Apple Watch subsidy through large employers and select individual customers to ramp up its wellness and care management programs, and will provide its own 50,000 employees Apple Watches free of charge.

Fixing electronic health records is good. Adding scribes is even better

In a STAT editorial, an emergency medicine resident at the University of Virginia discusses the impact working with a scribe has on job satisfaction.

AMA Survey Finds Physicians Enthusiastic About Digital Health Innovation

An AMA survey of 1,300 physicians finds broad-based optimism for digital health innovations, but note that liability coverage, data privacy, workflow integration, and improved ease of use are all issues that need to be overcome before digital health tools will deliver at full capacity.

View/Print Text Only View/Print Text Only
September 28, 2016 Headlines No Comments

Safeguarding Smartphones in an Era of Escalating Vulnerabilities

September 28, 2016 News No Comments

HIPAA-related security concerns mount as smartphones become more ubiquitous across enterprise healthcare environments.
By @JennHIStalk

image

Ransomware headlines seem to reign supreme in healthcare news, and yet industry insiders know that the greater potential for cyberattack and financial loss resides in just about every person’s pocket (or pocketbook). Catholic Health Care Services of the Archdiocese of Philadelphia’s $650,000 settlement with OCR for HIPAA violations this summer is a prime example of the vulnerability of mobile smart devices. The settlement stemmed from the theft of a smartphone containing the PHI of 412 nursing home residents. Acting as a business associate, CHCS provided IT and management services to six SNFs, and was thus responsible for protecting resident PHI under HIPAA. OCR found that, in addition to a lack of encryption and password protection, CHCS also neglected to develop a risk analysis and accompanying plan for risk management.

While the organization’s lack of cyber safeguards and subsequent fine made headlines, it’s probably a safe bet to assume that other similar entities are operating without the appropriate security safety nets.

Getting on the MDM Hamster Wheel

image

Smartphone security “is a moving target,” says Alex Brown, director of strategy at healthcare communications company Voalte. “Today, there seems to be two layers of what people are looking into when it comes to smartphone security – applications on the device and the content of those applications. If your application has PHI sitting in it all the time, than you have a much higher risk than with an app that has PHI on it only when it’s connected to a server.

“Not every healthcare organization has the expertise to deploy security,” he adds, “which is why providers rely so much on vendors to make sure that they’re really keeping up to date with best practices around mobile device management.”

Brown finds that in today’s world of escalating cybersecurity concerns, constant dialogue with hospital customers about the importance of up-to-date MDM is a must. Hospitals are now faced with managing almost daily updates from Apple and Google, he explains, which, for many, has taken some getting used to.

“It’s an important piece that not a lot of sites think about,” Brown says. “It’s constantly moving. I like to refer to the smartphone space as a hamster wheel of updates. It can be a little daunting to get on it, and once you’re on it, you really have to keep up. If you don’t, that’s where you can introduce risk. The CHCS settlement was a gut check for other providers in the sense that they hopefully are now asking themselves, ‘Are we checking all the boxes constantly? Are there new boxes that we can now check?’”

Great Vendor Expectations

image

Parkview Medical Center (CO) CIO and Vice President of IT Steve Shirley has seen his fair share of cybersecurity practices, having spent 30 years in banking IT and nearly eight in healthcare. “In banking, we were mandated and audited on our vendor management programs. I routinely went onsite at vendor locations to audit their data centers, review their SaaS70 reports, and determine the overall security posture of the firm. We looked at their financials and did a significant amount of work to ensure the vendor was not only financially strong and stable, but secure, and that our data was safe.”

Shirley adds that security in the financial industry is at a higher level of maturation than in healthcare for obvious reasons. “They have to protect identities and money,” he explains. “Now that health data is under attack, we need to raise security to a higher standard. At Parkview, we’re heavy users of smartphones. The challenge is that in the BYOD world, other than our MDM strategy and provisioning, we don’t have a lot of control over what devices come in the door. And so we expect the highest level of security from our vendors. We include vendor management in our RFPs and require BA agreements for any vendor dialing into our system in any way. This is in addition to the standard requirement when the vendor has access to our data for things like analytical activity.

image

“When we implement new solutions,” he adds, “we collaborate with them to plan and design for security, whether at the mobile device level or system level. When we partnered with PatientSafe Solutions to roll out PatientTouch on the iPhone for services ranging from bedside medication verification to care team texting and communications, we brought in all of the vendors involved to develop a system that was not only reliable and functional, but also secure across all connections and access points. Six companies were involved: PatientSafe, their wireless vendor, our IT team and wireless vendor, Cisco, and Apple all participated in ensuring the system worked seamlessly and securely.”

Sticks Will Get the Cybersecurity Job Done

With regard to the CHCS breach, Shirley isn’t shy about sharing his opinion. “In the banking industry, I learned that we all mean to do good, but the movement of the day is so fast and furious that things tend to fall by the wayside,” he says. “And so the government stepped in with punitive measures for not meeting security or other standards. Y2K was a great example. The FDIC threatened to close banks if they didn’t have an appropriate Y2K strategy. I pray every day my hospital doesn’t get attacked and a breach occurs. As regretful and tough as the fine is, it’s a necessity because it creates an industry wakeup call for those who haven’t realized healthcare is under attack.

“It seems that while people understand that systems like servers, desktops, laptops, etc. are highly susceptible to attack if not properly protected, there’s a perception that smartphones are different,” he explains. “We, both industry and our consumers, need to get serious about understanding that a smartphone is a device that has access through the Internet and is thus vulnerable.”

image

Grace Hua, director of product management, clinical communications at PatientSafe, is of a like mind in her belief that hospitals should demand that vendors provide technology support and safeguards for clinician end users. “This should be a wakeup call not only for BAs, but for the industry as a whole,” she says in reference to the CHCS news. “BAs need to fully understand the importance of the data they are potentially putting at risk, and the implications of theft or security breach, as that data now has a dollar value tied to it. Hacking is now just as profitable in healthcare as other industries.”

Increasing Staff Awareness

When it comes to safeguarding smartphones and patient PHI, Shirley and his team are taking proactive measures to keep CHCS-type incidents at bay. Higher-level efforts include membership in security organizations like the SANS Institute and making sure that new technology deployments include a project milestone for evaluating and understanding potential security risks, and then developing a plan to mitigate them.

“This seems so intuitive,” he says, “but I think it is sometimes not the highest priority in the deployment of healthcare systems. Examples of this include installation of modalities for radiology that have communications facilities onboard, or even simple things like network printers.”

Shirley is especially excited about boots-on-the-ground efforts at Parkview. “We have a network security engineer who, in addition to his technical role, is responsible for security education. He regularly visits units during their daily huddles to give security tips like how to create strong passwords or how to validate that the person on the phone is authorized to receive information. Throughout the hospital, we use our digital wallboards to deliver security messages to everyone onsite. Our employee and physician newsletters have standing articles about safety. We’re also putting together a security video that will be required viewing for all employees. The effort has been huge in the last year to increase staff awareness.”

A Rising Tide Lifts All Cybersecurity Practices

Shirley is happy to report that his colleagues at neighboring institutions are paying just as much attention to securing mobile devices. “Two years ago, I would have said healthcare organizations are not paying enough attention to cybersecurity protection,” he says. “Now, I’m seeing new and extreme efforts every single day. Recently, a competitor healthcare system went to two-factor authentication for external access, and I think that’s awesome. At Parkview, we’ve implemented MDM for all of our devices. We don’t store data on laptops or mobile devices, and we don’t deploy any mobile hardware that hasn’t been encrypted. I think the industry understands healthcare is under threat and there are many points of potential vulnerability we need to address. It’s absolutely becoming more of a focus.”

View/Print Text Only View/Print Text Only
September 28, 2016 News No Comments

Morning Headlines 9/28/16

September 27, 2016 Headlines No Comments

InstaMed Announces $50 Million Investment From Carrick Capital Partners

InstaMed announces a $50 million investment from Carrick Capital Partners, which it says will be used to “drive the growth of the InstaMed Network, accelerate go-to-market strategy, and drive further innovation in healthcare payments technology.” The new round brings InstaMed’s total funding to $126 million since its 2004 formation.

Technology and Health Care: The View From HHS

HHS CTO Susannah Fox discusses the future of innovation in healthcare and HHS in a Wall Street Journal interview.

EHR Contracts Untangled

ONC publishes a guide on EHR contracting for providers.

Former Tuomey CEO to personally pay $1 million to settle False Claims Act case

Former Tuomey Healthcare (SC) CEO Ralph Cox will personally pay a $1 million fine to settle Stark Law allegations that he illegally compensated doctors in exchange for unnecessary patient referrals to the hospital.

View/Print Text Only View/Print Text Only
September 27, 2016 Headlines No Comments

News 9/28/16

September 27, 2016 News 2 Comments

Top News

image

InstaMed secures a $50 million investment from Carrick Capital Partners, bringing its total funding to nearly $126 million since launching in 2004. (CCP’s only other foray into healthcare IT seems to be a 2014 majority equity investment in post-acute software vendor Procura.) The Philadelphia-based company will use this latest round to further develop its healthcare payments technology and go-to-market strategy. CCP Managing Director Jim Madden will join InstaMed’s board, while colleague Chris Wenner will become a board observer.


Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock 

image

Waycross, GA-based Salus Telehealth and Chicago-based VideoMedicine merge under the Salus brand name to offer telemedicine hardware and software, including a direct-to-consumer app. Salus CEO Paula Guy will remain in that role over the newly combined company. VideoMedicine founder and CEO Charles Butler, MD seems enthusiastic about the merger, though his role moving forward remains unclear. Fun fact: He competed at the age of 18 in the 1998 Nagano Winter Olympic Games in the sport of ice dancing.

image

PeriGen confirms the acquisition of Hill-Rom’s WatchChild Fetal Monitoring System. The newly combined team will be led by PeriGen CEO Matthew Sappern, while the management team will include executives from both companies. WatchChild General Manager Brian Bishop will join PeriGen as chief product officer. PeriGen also closed a corresponding investment round led by Ambina Partners, giving AP founder Greg Share a spot on PeriGen’s board.


People

image

Sentry Data Systems promotes Tom Tran to CFO and COO.

image

Cerner President Zane Burke joins the board of Truman Medical Centers (MO), which signed on to a 10-year EHR deal with Cerner last fall.

image

Shelby Solomon (Connecture) joins Medecision as SVP, corporate development and strategy.


Announcements and Implementations

image

Sunnybrook Health Sciences Centre will implement patient registration technology from Harris QuadraMed across its three facilities in Toronto.

Cigna adds virtual consults from American Well to its telemedicine offerings for 2017 employer-sponsored and individual health plans. The payer rolled out a similar service from MDLive in 2013.

Standards development organization NCPDP works with Experian Health to develop a vendor-neutral universal patient ID management tool.

image

Several hospitals, including Boston Children’s Hospital and Mercy Health System (WI), and a Pennsylvania-based care program for the elderly, roll out Circulation’s medical transportation technology, which takes advantage of Uber’s API to help providers and patients schedule rides that cater to specific needs and preferences. 

Indiana-based HMO MDWise – a joint venture between Eskenazi Health and Indiana University Health – taps Valence Health to process its medical claims beginning January 1.

image

San Mateo County Health System (CA) implements NextGate’s EMPI patient-matching technology across its 10 divisions and six EHRs.


Privacy and Security

image

The GAO releases a “scathing” report on cybersecurity preparedness in health information technology, recommending that HHS “update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.”

A former Alberta Hospital Edmonton employee inappropriately accesses the records of 1,300 patients over the course of 11 years, most likely out of “personal curiosity,” making it the Canadian province’s largest deliberate breach of health data.


Technology

image

SnapMD adds provider-to-provider consult capabilities to its telemedicine technology.

image

Varian Medical Systems develops new cancer care coordination software that aggregates EHR, IS, and portal data from the patient, PCP, radiation, medical and surgical oncology, and social services.

image

Memorial Healthcare System partners with American Well to offer a telemedicine app for members of its managed care or consumer health plans.

Casenet rolls out the latest release of its TruCare care administration and management software.


Government and Politics

image

President Obama gives his stamp of approval to National Health IT Week, reminding citizens of the “billions of dollars” spent to encourage the adoption of EHRs at 97 percent of the country’s hospitals, and his efforts to launch the Precision Medicine Initiative.

image

Coinciding with nationwide health IT marketing push, ONC releases its Health IT Playbook, a Web-based manual that updates the Patient Engagement Playbook for Providers, offering guidance on a wide variety of health IT products and topics. The playbook includes a guide to EHR selection and contracts.


Research and Innovation

image

Despite past “snake oil” commentary, an AMA survey of 1,300 physicians finds that a majority are optimistic about the potential of digital health tools to improve patient care. Enthusiasm seems to outweigh adoption: Physicians cite liability coverage, EHR workflow integration, and data privacy as must-haves for successful and consistent adoption.


Sponsor Updates

  • Forward Health Group Founder and CEO Michael Barbouche speaks at the Wisconsin BioHealth Summit September 27 in Madison.
  • Impact Advisors releases a new white paper, “Realizing Clinical Benefits from EHR Investments.”
  • Liaison Technologies and Meditech celebrate National Health IT Week.
  • Meditech releases a new white paper, “The Benefits of an Integrated Approach to Critical Care.”
  • Verscend Technologies kicks off its eighth annual conference, taking place in Palm Desert, CA through September 30.
  • Glytec receives three patent notices of allowance for its EGlycemic Management System.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 27, 2016 News 2 Comments

Morning Headlines 9/27/16

September 26, 2016 Headlines 1 Comment

GAO slams HHS in health IT cybersecurity report

The GAO releases a “scathing” report on cybersecurity preparedness in health information technology, recommending that HHS “update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.”

Medical Record Mix-Ups a Common Problem, Study Finds

The Wall Street Journal reports on an ECRI Institute study on wrong-patient medical errors, of which 7,613 cases were identified between January 2013 and July 2015. The report calls for an increased use of barcode scanners and patient pictures embedded within the EHR, but stops short of calling for a national patient identifier.

A New Tool to Help Health Care Providers Get the Most Out of their Health IT

ONC releases its Health IT Playbook, a web-based manual that updates the Patient Engagement Playbook for Providers, offering guidance on a wide variety of health IT products and topics.

ACO Spillover Effects: An Opportunity Not to Be Missed

A NEJM study investigates what impact ACOs might be having on non-ACO patients being treated by the network.

View/Print Text Only View/Print Text Only
September 26, 2016 Headlines 1 Comment

Curbside Consult with Dr. Jayne 9/26/16

September 26, 2016 News No Comments

image

National Health IT Week is underway. According to the press release, “This annual celebration is a time for all of us to reflect on the progress we have made and recommit ourselves to advancing the promise of health information technology.” The newest National Coordinator for Health IT, Vindell Washington, MD will host a Twitter chat on Tuesday starting at 11am ET using the hashtag #AskVindell. Topics include the current and future state of health IT as well as questions and answers. There are all kinds of National Health IT Week activities taking place across the country. I’m out with clients this week so I won’t make it to any of the festivities. Still, I wanted to take a chance to reflect on my own time in the Health IT trenches.

I was fortunate to attend a medical school that rotated its students through hospitals that embraced technology. Looking back, some of it was pretty primitive, but back in the day we thought we were cutting edge as we navigated through the lab system with light pens tethered to green-screen terminals. One hospital had started its own EMR. Even in the early days, it had most of the data needed to round on patients – laboratory data, vital signs, medication lists, and more. It was a luxury to prepare for rounds at a single workstation rather than having to round up paper charts and dig through them.

Surprisingly, the more advanced hospital was a community hospital rather than the primary academic hospital. Looking back, it may have been easier to pilot informatics platforms on the community side since the roster of admitting physicians was fairly stable. Although residents and students participated in patient care, it wasn’t at the same volume as the academic hospital. The community hospital was progressive in other ways, building the first hospitalist program in the city and serving as a pioneer in laparoscopic surgery.

My medical school class was the first one to have email accounts issued to everyone with the expectation that we’d actually use it, as opposed to it being optional. Granted, it was Lotus Notes, but it was high tech at the time. We still did our histology coursework looking at carousel after carousel of 35mm slides, however. We had a transcription service where someone took notes at every class and distributed them; without laptops, we took old-fashioned paper notes then typed them up later, printed them, and photocopied them. No one seemed to put two and two together that we could have been emailing them around. Today, my school augments its gross anatomy program with virtual anatomy – 3D computer simulations based on CT scans taken of live individuals. Very different than the cadaver cross sections that we worked with.

Health IT really started to boom while I was in my residency training, with increased nursing documentation being done electronically, although paper copies were still printed and added to the chart. There was a lot of fighting over PCs because the hospital hadn’t really thought through the computerization piece or what it would look like from a workflow standpoint. The residents thought we were cool because we could dictate our History and Physical documents and Admission notes using Dragon. It not only helped avoid the lengthy, handwritten note process but made sure the documents were on the chart quickly compared to the turn-around time required for “regular” transcription. No one at the time thought of outsourcing transcription services to 24×7 resources in another country, and certainly no one thought much about natural language processing.

I purchased my first handheld device as a Chief Resident. While others seemed to be leaning towards the Palm Pilot platform, I went with the Pocket PC. Although I legitimized my purchase by using it to take attendance at Grand Rounds and to use Excel to track various program requirements, I secretly thought the coolest feature was the fact that you could put music on it. The ultimate mix tape was now in your pocket at all times (or at least as long as the battery lasted). I found that Pocket PC in a drawer a few weeks ago and it fired right up. The data files were gone but the music was all still there, providing a much-appreciated blast from the past.

When I opened my solo practice, I was supposed to be on an EHR from day one, but there were implementation issues, forcing me to spend a year on paper charts in an office that wasn’t built to house paper charts. When we finally got our system, we learned a lot about vendor bait-and-switch, starting when the trainer first arrived and tried to train us on a system that was different than what we actually had installed. It went downhill from there and ultimately resulted in a de-installation. That experience, however, set the groundwork for my career in health IT, as hospital leadership realized I had been through the wringer but learned quite a bit, and could be an asset to their future EHR plans. I slowly crossed over into the technology side of things and never looked back.

People occasionally ask whether I think it was a waste of time to go to medical school. They often assume I don’t see patients anymore. Being a physician first was critical to me winding up in the wild and crazy world I work in today, and I wouldn’t trade it even with the hideous student loans and the long, torturous work hours. I learned health IT on the side and on the fly, while building a practice and settling in as a young physician. We’ve gone a long way past many of the things I used to struggle with early in my career – trying to access charts in the middle of the night, dealing with pharmacies that weren’t comfortable with electronic prescriptions, and bringing faxes directly into the EHR. Now we’re moving into an age where pharmacogenomics is a reality and we have the world’s library at the tips of our fingers at all times.

I remember doing an interview for the hospital newsletter early in my career. The CMO called to blast me for saying that having computers in the office allowed me to look things up during the patient visit. He felt that my statement implied that I was inexperienced and that patients would avoid me. Quite the opposite: Patients appreciated having a physician who was willing to look things up and show them the actual literature so that we could make decisions together. Having technology in the room transformed how I practiced in a positive way, and I know it made a particular difference for many of my patients. Sometimes, as we reflect on how we work with technology today, we tend to demonize it without putting into perspective what our daily lives would look like without it.

Even though it sometimes drives me crazy, I’m grateful for healthcare IT and what it has done for me personally. I’m hopeful for what the future holds, even despite the mandates and regulations. I can’t wait to look back in another five or 10 years and see where we’ve gone.

How has health IT impacted you, personally or professionally? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 26, 2016 News No Comments

Morning Headlines 9/26/16

September 25, 2016 Headlines No Comments

GE Healthcare Aims to Fund up to $50M for Global Health Startups

GE launches a healthcare-focused accelerator with $50 million in funding.

Our Decision to Exit the ACA Marketplace

BCBS of Nebraska announces that it will exit the state’s health insurance exchange, citing the $140 million in marketplace-related losses it has suffered thus far.

Remote Alaska port clinic goes modern with telemedicine

Providence Alaska Medical Center (AK) begins offering telehealth critical care consults to a clinic in Unalaska, the remote town that is home to Dutch Harbor, one of Alaska’s busiest fishing ports.

HIPAA settlement illustrates the importance of reviewing and updating, as necessary, business associate agreements

Care New England Health System pays $400,000 to settle HIPAA violations after OCR discovered, while investigating a lost backup tape, that it had hadn’t updated its business associate agreement with Woman & Infants Hospital (RI) since 2005.

View/Print Text Only View/Print Text Only
September 25, 2016 Headlines No Comments

Monday Morning Update 9/26/16

September 25, 2016 News 4 Comments

Top News

image

GE Healthcare launches Five.Eight, an accelerator (not to be confused with the Athens, GA rock band) for global healthcare startups aimed at improving outcomes for the estimated 5.8 billion people in the world who don’t have access to quality, affordable care. The accelerator hopes to enroll 10 companies in its first program, each of which will work with GE on developing scalable products for potential distribution or integration into GE’s portfolio. Seed funding of up to $5 million per startup may also be available.

image

India-based Tricog is the first member of the new accelerator. The startup has developed technology to help ED physicians diagnose heart attack patients within minutes, decreasing time between symptoms and treatment and increasing survival rates.


HIStalk Announcements and Requests

image

It’s Hillary Clinton in a landslide with heavy HIStalk reader turnout. Maybe I’ll run it again after the debates. New poll to your right or here: continuing last week’s poll, which health IT salesperson LinkedIn credential would most impress you?

image

Welcome to new HIStalk Platinum Sponsor Ivenix. The Amesbury, MA-based company has transformed IV infusion delivery from the decades-old technology of competitors to the connected world to improve patient safety, eliminate workflow inefficiencies, and protect the hospital’s bottom line by reducing adverse events. The Ivenix Infusion Management System measures and adjusts IV flow rate in real time and supports mobile viewing of infusion status and alarms, integrating with the EHR to auto-program and auto-document. Adaptive technology eliminates the need for ongoing calibration, while software and security updates along with drug library updates are delivered without removing devices from the floors. Ivenix addresses the challenges of increasingly complex dosing regimens, the demand for EHR integration, and infusion technology-related patient safety issues. Thanks to Ivenix for supporting HIStalk.

I found this video that describes the benefits of the Ivenix Infusion Management System, including eliminating nurse time spent manually documenting IV pump information in the EHR.


Last Week’s Most Interesting News

  • Epic announces a number of new offerings and initiatives at its annual user group meeting, which attracted 18,000 attendees.
  • The Chan Zuckerberg Initiative donates $3 billion to “cure, prevent, or manage all diseases by the end of the century.”
  • Private GPs in England offer third-party video visits as an alternative to long appointment wait times, with NHS footing the bill.
  • The entire board of Cairns Hospital in Australia resigns following an unpopular and over budget Cerner rollout.
  • Appalachian Regional Healthcare (KY and WV) brings the computer systems of its several hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by a malware attack.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

Blue Cross Blue Shield of Nebraska pulls out of the federal health insurance exchange, leaving Nebraskans with extremely limited purchasing options when open enrollment starts November 1.

TierPoint will spend $20 million to build the first phase of a 90,000 square-foot data center in Dallas.


Announcements and Implementations

image

Canopy Health, an accountable care network formed out of an affiliation between California-based UCSF Health and John Muir Health, selects financial risk management and population health services from Conifer Health.

image

Sydney-based Macquarie University’s MQ Health campus partners with Emory Healthcare (GA) to launch the country’s first remote intensive care unit monitoring program using technology from Philips.


Technology

MSN Healthcare Solutions incorporates SyTrue’s NLP OS operating system and AdvancedBI’s business intelligence tools into its new NLP-based analytics offering for radiologists.

image

VitreosHealth adds predictive risk models for identifying gaps in care, mental health conditions, and patient motivation to its population health management analytics engine. Models for palliative care will be rolled out towards the end of the year.


Research and Innovation

AHRQ looks for peer-reviewed, patient-centered outcomes research findings related to geriatric care shown to have improved patient outcomes for potential investment in broader dissemination and implementation. 

image

I missed this a few weeks ago: The National Science Foundation awards Rice University mechanical engineer Marcia O’Malley a $1 million, three-year grant to develop a tool that will track the movement of a surgeon’s operating tool and emit a vibration if his or her technique is deemed too rough. (No details are given as to how “rough” will be determined.) O’Malley says the tool will combine virtual reality with real-time touch feedback that will hopefully make the process of learning how to perform delicate surgeries easier.


Privacy and Security

Care New England Health System pays a $400,000 HIPAA fine for neglecting to update its BA agreement with Woman & Infants Hospital (RI), for which it provides IT system technical support and information security. The lack of updated documents came to light when WIH reported the loss of unencrypted backup tapes containing the PHI-filled ultrasound studies of 14,000 patients. WIH ended up paying a $150,000 fine for its role in the breach.


Other

image

Iliuliuk Family and Health Services, the only clinic serving Alaska’s extremely remote Unalaska Island (which also happens to be one of the country’s busiest commercial fishing ports), launches virtual consults via satellite technology with Anchorage-based providers at Providence Alaska Medical Center. The local news reports that the service will connect mainland ED physicians with clinic staffers to treat injuries “among the Bering Sea crabbing fleet made famous by the Discovery Channel show ‘Deadliest Catch.’”


Sponsor Updates

  • Experian Health will host its Financial Performance Summit October 5-7 in Nashville, TN.
  • Patientco releases its annual State of the Industry Report.
  • PatientMatters will exhibit at the Arkansas Hospital Association Annual Meeting & Tradeshow October 5-7 in Little Rock.
  • PerfectServe will exhibit at ANCC 2016 October 5-7 in Orlando.
  • Lexmark Healthcare submits a formal pledge of commitment to interoperability.
  • Sagacious Consultants makes a charitable donation to Tri 4 Schools to help extend its Exercise to Achievement after-school program.
  • The SSI Group will exhibit at the AAHAM ANI 2016 conference October 5-7 in Las Vegas.
  • Summit Healthcare and ZeOmega will exhibit at InSight 2016 September 27-30 in San Antonio.
  • Sutherland Healthcare Solutions will exhibit at the HFMA NJ National Institute October 5 in Atlantic City.
  • Navicure receives number-one rankings in client satisfaction and client loyalty across three Black Book RCM survey categories.
  • Valence Health will exhibit at the Georgia Society for Managed Care Conference October 5-7 in Young Harris, GA.
  • ZeOmega releases a video, “SignalHealth Deploys Advanced Care Directives Repository Through Jiva HIE.
  • ZirMed ranks first for end-to-end RCM in the 2016 Black Book Report for the fifth consecutive year.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 25, 2016 News 4 Comments

Morning Headlines 9/23/16

September 22, 2016 Headlines No Comments

Epic Systems’ ‘wonderland’ includes humanitarian pursuits

A local paper covers Epic’s annual user group meeting, which drew a crowd of 18,000 attendees.

Digital Hospital resulted in “significant adverse impacts” upon patient safety in Cairns

In Australia, the entire board of Cairns Hospital resigns following an unpopular and over budget Cerner rollout. A staff survey included complaints that the system was “convoluted and time consuming, with significant adverse impacts on patient safety and care.”

Mamba Ransomware Encrypts Computer Hard Drives, Rather Than Data

A new ransomware called Mamba now encrypts the entire infected hard drive, rather than just specific files.

New board headed by McNeil

In England, the newly formed Digital Delivery Board will be overseen by NHS England’s new chief clinical information officer Keith McNeil.

View/Print Text Only View/Print Text Only
September 22, 2016 Headlines No Comments

News 9/23/16

September 22, 2016 News 3 Comments

Top News

image

Facebook founder Mark Zuckerberg and his wife Priscilla Chan, MD will donate $3 billion to “cure, prevent, or manage all diseases by the end of the century.” Zuckerberg noted that we spend 50 times more on disease treatment than prevention and says the couple’s donation will bring scientists and engineers together to build research tools and technologies.

image

The first project funded by the donation will be the $600 million Chan Zuckerberg Biohub, which will bring together scientists and engineers from Stanford, UCSF, and Berkeley. Its first two efforts involve infectious disease (developing a universal diagnostic test,  using gene editing tools to create new drugs and monoclonal antibodies, using machine learning to mine clinical trials data for vaccine development, and deploying a rapid response team during disease outbreaks) and mapping all human cells to create the Cell Atlas for research.

It’s an impressive donation, but still only one-tenth of what the NIH spends on research in a single year. It’s trendy for tech companies (IBM, Google, Microsoft, etc.) to arrogantly think they can “solve” disease. I’m a bigger fan of Michael Bloomberg’s donations that involve public health or those efforts that involve personal responsibility or uncontrolled healthcare costs rather than chasing elusive magic bullets. At least these first projects commendably blend technology with developing a baseline of intelligence than can be built upon over the years.


Reader Comments

image

From Considering Further Education: “Re: your observation that salespeople typically don’t have advanced degrees. As a salesperson, how much more credible would I be with an MBA or other advanced degree? I’m young and motivated, but wondering if it would pay off.” My observation was that salespeople (and thus CEOs promoted from sales roles, as is often the case) often have no degree at all or unrelated bachelor’s degrees from universities not on anyone’s top lists, with my assumption being that they were so confident in their career path that they didn’t expect to be competing for jobs on the basis of educational credentials. I would place zero value on a salesperson having an advanced degree, but I’ll ask experienced readers to weigh in, especially as it pertains to moving from sales to executive positions.

I should mention that every time I talk about advanced degrees, I get a bunch of emails from indignant folks who don’t have them describing their personal success in a world of less-competent, less-motivated degree holders in thusly assuming they hold no value for anyone. I suspect that everyone’s ideal credentials are their own, with any more education being worthless paper-hanging and any less education failing to clear the slippery educational slope (if you don’t need a master’s, do you need a bachelor’s? What about a high school diploma?) Degrees don’t matter if you work for yourself, start Facebook, or land a CEO position, but for most people, they will elicit some reaction and affect employment opportunities at least indirectly.

image

From Ascetic Acid: “Re: integration report. What do you make of this gaffe?” Looks like bad strategery.


HIStalk Announcements and Requests

image

Welcome to new HIStalk Platinum Sponsor Sutherland Healthcare Solutions. The Clifton, NJ-based company is a leading provider of consulting, BPO, ITO, and analytics services to providers, payers, government, and ACOs, with 5,000 employees working from 15 sites around the world. It offers claims administration and adjudication, coding, technology services, end-to-end RCM, analytics, patient experience consulting, and population and payment solutions. Health IT services include product development, maintenance, and support; testing as a service; implementation; integration; clinical help desk; and training. Among the company’s 100+ clients are six of the top 25 US hospitals and three of the five largest US health plans. CEO Graham Hughes, MD  is an industry long-timer, having spent time at IDX and GE Healthcare. Thanks to Sutherland Healthcare Solutions for supporting HIStalk.

This week on HIStalk Practice: Doctor on Demand CEO Hill Ferguson discusses the intersection of fintech and health IT. Health Systems Informatics launches population health management consulting services. FDA, USDA announce app development competition, telemed funding as part of Prescription Opioid and Heroin Epidemic Awareness Week. Coordinated Care Oklahoma adds DrFirst tech. Kansas City Care Clinic goes with care coordination tools from BluePrint Healthcare IT. Community Health Center selects Safety Net Connect IT as part of school-based effort in New Mexico. AAFP elects new president. Physician morale takes a nosedive.


Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

image

HIPAA-compliant hosting and EHR integration technology vendor Catalyze raises $6.5 million in a Series B funding round, increasing its total to $12.5 million.

image

Hill-Rom will sell its WatchChild fetal monitoring system business to advanced fetal monitoring and clinical decision support vendor PeriGen to focus on its core growth areas of falls prevention, patient satisfaction improvement, and infection prevention. The 18 CWS employees assigned to WatchChild will be offered positions with PeriGen. I described the company’s history in responding to a June 2012 reader rumor report that Hill-Rom was shopping WatchChild even then as:

The WatchChild OB monitoring system is owned by Hill-Rom, mostly known for selling expensive hospital beds and a few other marginally related product lines. WatchChild was supposed to be a natural extension of the company’s NaviCare nurse call system. HRC shares haven’t exactly shone lately, dropping from $48 in July 2011 to $30 now [note: they’ve rebounded to $61 since], so Hill-Rom may simply see the frenzy of M&A activity in healthcare IT as a good opportunity to sell some or all of its IT holdings to focus on core business. All of this is speculation since they’ve made no announcement that I’ve seen. Hill-Rom used to be known as Hillenbrand Industries, whose humorously complementary business was Batesville Casket Company. I’ve always wondered if they might put some of their nurse call technology in those caskets as an upgrade for those who fear being buried alive.

TransUnion acquires RTech, which offers post-service eligibility solutions to maximize hospital reimbursement, for $62 million.


Sales

image

CHI Franciscan Health (WA) chooses Glytec’s EGlycemic Management System for real-time insulin dosing in its eight hospitals, integrated with Epic.

image

Adventist Health chooses Oracle Applications Cloud for ERP, human capital management, analytics, and enterprise performance management.

image

Johns Hopkins Aramco Healthcare will deploy Epic and Hyland OnBase in its facilities in Saudi Arabia.


People

image

Clinical trials software vendor Cure Forward hires Frank Ingari (NaviNet) as CEO.

image

In England, NHS England chooses its just-appointed chief clinical officer Keith McNeil, MB to also head up its new Digital Delivery Board. McNeil resigned as CEO of Addenbrooke’s Hospital last year just before Cambridge University Hospitals NHS Foundation Trust (which includes Addenbrooke’s and The Rosie Hospital) was placed on “special measures” for a number of patient care problems; he was also CEO when the Regulator Monitor investigated the trust’s financial challenges following its $300 million Epic rollout.


Announcements and Implementations

image

Bakersfield Memorial Hospital (CA) rolls out a camera-equipped security robot that patrols the ED parking lot and offers visitors a button to call a security guard.

image

LiveProcess announces new mobile apps for patient care and transitions, discharge, staffing, transplant, and hospital operations.

image

St. Luke’s University Health Network (PA) goes live with Caradigm Care Management to support its Bundled Payments for Care Improvement program.

image

UPMC launches Curavi Health, which will offer telemedicine equipment and software to nursing homes and provide after-hours consults from University of Pittsburgh Physicians.

image

Engage, the IT services division of non-profit Inland Northwest Health Services (WA), offers a NetApp-powered cloud backup and recovery solution to the 40 hospitals whose Meditech systems it hosts.


Government and Politics

image

An HHS OIG audit finds that the state of Washington overpaid $9.2 million to 19 of the 20 hospitals that received Medicaid EHR incentive payments in 2011-2015.


Privacy and Security

From DataBreaches.net:

image

  • Keck Medical Center of USC notifies patients that it experienced a ransomware attack on August 1, adding that it recovered its systems without paying.
  • Codman Square Health Center (MA) notifies nearly 4,000 patients that an unnamed number of its employees looked up patient information on the New England Healthcare Exchange Network without authorization, with those employees since either suspended or fired. The employees viewed information of non-Codman patients whose information was stored on NEHEN, which is an interesting twist on the usual “viewed without authorization” situation.
  • The forever-bungling Yahoo warns users that it has become the victim of what is apparently the biggest breach in history, with the information of 500 million accounts exposed in 2014 by “a state-sponsored actor” with the announcement coming right before the company closes the sale of its pathetic dregs to Verizon for next to nothing. An interesting reader comment to that item says it’s suspicious that breached companies always scapegoat unverified “state actors” instead of “some 16-year-old kid.” At least the overused “sophisticated attack” excuse is now rare. Expect the average consumer to become even more wary of signing up for health-related apps and portals.
  • The information of thousands of patients whose information was stored by a now-closed physical therapy EHR vendor is exposed in a “leaky bucket” of its incorrectly configured Amazon Web Services S3 (Simple Storage Service) account.

image

In light of the AWS breach, DataBreaches.net suggests reviewing business associate agreements using the checklist above.

Hackers take ransomware up another notch with Mamba, which instead of encrypting files, encrypts the entire hard drive and offers to sell the password required to boot up the PC. At least some Luddite hospital might have its first laptop encrypted, although not in a good way.

A survey finds that half of IT professionals don’t understand that emptying a PC’s Recycle Bin doesn’t permanently erase the files it contains.


Other

Google parent Alphabet kicks off its carefully controlled DeepMind Health public outreach meeting with an apology that the event was held at Google’s opulent London offices, suggesting that more accessible community spaces might be more appropriate going forward. The company, which has been criticized for its lack of transparency for rolling out clinical products without the required government approval, says it has been clear since it acquired DeepMind for $500 million that intends to build a business model from its use of patient data it gets for free with use of its hospital software, but suggests that it would like to get paid for clinical outcomes rather than the traditional software vendor activity. A prototype of a patient portal app was shown, although development has not started.

image

In Australia, the entire board of Cairns Hospital resigns following massive budget misses following its implementation of a Digital Hospital program in which it installed Cerner Millennium. Employee surveys following the go-live earlier this year – results of which the hospital has declined to release but they leaked out anyway — found that the system was not intuitive and user friendly, endangered patients with its specimen order and collection workflow, and was brought live without adequate testing and support coverage.

The local paper says McDonough District Hospital (IL) has been live on a new EHR, Cerner Safari, for three months. I’m not sure where they got that name.

image

A Madison TV station runs a UGM-inspired video profile of Epic’s 90-employee culinary team led by Chef Eric Rupert (not to be confused with Chef Eric Ripert), where everything — right down to the hot dog buns and ice cream — is made from scratch. 

The Madison paper runs some highlights from Epic UGM:

  • The company is working to provide Syrian refugees with their health information on flash drives.
  • Epic will offer free licenses and maintenance to federally qualified health centers.
  • MyChart will be enhanced to allow patients to get an estimate of their care costs and to apply online for charity care.
  • Epic will integrating with state doctor-shopper databases and using predictive modeling to help manage opioid use in individual patients.
  • Video visit capability will be built into Epic.
  • The company says its Cosmos Research Network of big health systems will support better understanding and treatment of diseases.

SNAGHTML24dc388b

Naveen Rao observes the hostile user response caused by United HealthCare’s recent app update, noting that the company even recycled an apparently rare positive user comment from an old press release touting a previous upgrade in the absence of any other positive user reaction. He questions how a company of UHG’s size with a technology and innovation budget of $3 billion could release an app that apparently won’t work for many people, why users should be expected to re-enter information from elsewhere, and why UHG seems indifferent to the feedback of its customers. My conclusion is that it’s not only tough to create a consumer app that’s easy to use, is thoroughly tested under an infinite number of scenarios, and gives immediate gratification, but it’s also true that app developers aren’t used to scaling their support services to meet the understandably high expectations of patient-customers who just want a human to respond to both their technical and medical needs.

image

Perhaps UHG should have read this fascinating article (thanks to Eric Topol, MD for tweeting it out) called “The Scientists Who Make Apps Addictive” that describes how the digital interface can be used to shape user decisions and how companies use complex psychology in their apps to get people to do their bidding. Expert B.J. Fogg gives Uber as an example of why companies should design for habits, where the experience is so positive that users won’t even consider alternatives. He also advocates that apps “make people feel successful,” as in Instagram’s photo options that make people feel like artists. The article notes Facebook’s use of psychology in playing to each user’s yearning for social approval via likes and invitations to connect, concluding that “whoever controls the menu controls the choices” in a digital world designed by a few 20-something men working for a handful of mega-app companies in San Francisco. The article compares apps to casinos, where slot machines are “Skinner boxes for people” and algorithms predict when a given player’s losses might encourage them to walk away, at which time the casino dispatches a “luck ambassador” to give them a free show ticket or a steak dinner to keep them losing money. The article brilliantly summarizes with insight that should interest app developers:

The casinos aim to maximize what they call “time-on-device.” The environment in which the machines sit is designed to keep people playing. Gamblers can order drinks and food from the screen. Lighting, decor, noise levels, even the way the machines smell – everything is meticulously calibrated … But it is the variation in rewards that is the key to time-on-device. The machines are programmed to create near misses: winning symbols appear just above or below the “payline” far more often than chance alone would dictate. The player’s losses are thus reframed as potential wins, motivating her to try again. Mathematicians design payout schedules to ensure that people keep playing while they steadily lose money. Las Vegas is a microcosm. “The world is turning into this giant Skinner box for the self,” Schüll told me. “The experience that is being designed for in banking or healthcare is the same as in Candy Crush. It’s about looping people into these flows of incentive and reward. Your coffee at Starbucks, your education software, your credit card, the meds you need for your diabetes. Every consumer interface is becoming like a slot machine.” These days, of course, we all carry slot machines in our pockets.


Sponsor Updates

image

  • Volunteers from Impact Advisors worked with an Illinois environmental education group to recycle crayons for children’s hospitals last week.
  • Iatric Systems, Meditech, and Santa Rosa Consulting will exhibit at InSight 2016 September 27-30 in San Antonio.
  • MedData will exhibit at the HFMA Fall Revenue Cycle September 28 in Bellaire, MI.
  • Black Book names Navicure #1 in end-to-end RCM technology solutions for hospitals under 100 beds.
  • Definitive Healthcare releases a new version of its app that provides access to its provider data from Salesforce.com.
  • NTT Data will sponsor Blue Cross Blue Shield’s Information Management Symposium September 25-28 in Detroit.
  • Obix Perinatal Data System will exhibit at the Nursing Perspectives Conference September 28-30 in Buford, GA.
  • NCQA awards PCMH 2014 pre-validation status to the analytics platform of Arcadia Health Solutions.

Blog Posts


Contacts

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

125x125_2nd_Circle

View/Print Text Only View/Print Text Only
September 22, 2016 News 3 Comments

EPtalk by Dr. Jayne 9/22/16

September 22, 2016 Dr. Jayne No Comments

clip_image002 

The Epic UGM was held this week and I was pleased to receive an invitation to LogicStream Health’s “Taste & Toast” event. Hosted at the Frank Lloyd Wright-designed Monona Terrace and lead by a certified sommelier, it sounded like a great event. I wasn’t able to make it to UGM this year due to conflicting priorities, but wanted to give them a particular mention for offering free Uber services upon request. The risk of driving under the influence is definitely reduced when you don’t drive yourself.

A recent study published in Annals of Internal Medicine looks at whether hospital employment of physicians improves the quality of hospital care. The study looked at readmission rates, mortality, length of stay, and patient satisfaction at hospitals between 2003 and 2012. There were 800 hospitals that had moved to a more employed physician model vs. 2,000 that had not. The authors noted no association between the presence of employed physicians and most of the scores, although there was a slight change in pneumonia readmissions. The study looked only at Medicare beneficiaries aged 65 and older, so it’s not clear how the data would apply to other populations. It also didn’t look at government-run facilities.

Another study that caught my eye this week looked at “The Effect of Wearable Technology Combined With Lifestyle Intervention on Long-term Weight Loss.” The authors compared a “technology-enhanced weight loss intervention” to standard behavioral modification techniques, looking at nearly 500 participants between 2010 and 2012. Everyone was treated with initial diet and counseling. At the six-month point, participants were split into a group who self-monitored and a group that used a wearable device. Weight was tracked every six months for a total of two years. Researchers also looked at fitness, physical activity, dietary intake, and body composition.

Nearly 75 percent of participants completed the study. Although both groups improved in fitness, activity, diet, and body composition, young adults with a body mass index (BMI) between 25 and 40 lost less weight if they were in the wearable group. Based on technology-related fitness behaviors I observe in the workplace, there’s a chance participants focused more on the technology than on their actions or personal responsibility. There’s also the chance that as they saw the activities racking up, they felt it was OK to eat a bit more since they were being active. The bottom line is that we still have a lot to learn about the effectiveness of technology interventions in solving complex health problems such as obesity.

If anyone questions the challenges facing healthcare, they only have to look as far as the recent FDA decision approving the drug eteplirsen. The FDA’s own advisory panel voted against recommending approval for the drug, based on a clinical trial that only involved 12 patients and didn’t have adequate placebo control. Critics accuse the FDA of setting a dangerous precedent for approving drugs based on patient and pharmaceutical company lobbying rather than on science. The FDA will require the manufacturer to conduct trials to confirm the clinical benefit, and depending on the outcomes may opt to withdraw approval of the drug.

clip_image004

In preparation for the October 1 update for ICD-10 codes, CMS is alerting providers to resources such as the 2017 ICD-10-CM and ICD-10-PCS code sets. I know a lot of providers that fail to understand that these need to be updated each year or are content to let their office staff or EHR vendor figure it out. Not having the correct codes installed after the cutoff can result in denied claims and a ton of extra work, so it’s worth a minute to make sure your practice has a plan.

clip_image006

AMIA is seeking submissions for the iHealth 2017 meeting. The event is focused a bit more towards the application of clinical informatics as opposed to research, and participants are encouraged to submit programs, pilots, and innovations in health informatics. Submissions are open through October 18 and this year’s conference topics are grouped under:

  • Analytics and the Learning Health System
  • Clinical Informatics
  • Interoperability and Informatics Infrastructure
  • Health Policy and Payment Reform

AMIA also announced that they’ll be offering licensed childcare during the AMIA 2016 Annual Symposium to be held November 12-16 in Chicago. The Women in AMIA task force led the efforts to make this a reality. Cerner and Epic were listed as sponsors on the email announcement.

I see several physicians at the local academic medical center. All of them are of the “once a year” variety, so I don’t expect a lot of communication from them. I had no recent appointments and nothing scheduled, so I was surprised to start receiving communications about my upcoming surgical appointment along with patient questionnaires and more. I called the help desk to figure out what was going on and they said they could see no appointments for me in the system, yet the messages kept on coming. Apparently I’m having a consultation for spinal surgery for my ongoing pain management problems, or at least that’s what the system thinks is going on.

I fully understand glitchy computer systems that do seemingly unexplainable things, but I’ve run into some attitude from help desk staffers that act like they don’t believe I’m actually seeing what I’m seeing. I’ve offered to forward the emails back to them along with screenshots of the portal, but they don’t seem keen on using that to troubleshoot. In this era of medical identify theft and big data, patients have the absolute right to have their documentation be correct and telling them to “just ignore the information if it doesn’t apply” is not the right answer.

Have you had success in correcting erroneous online records? Email me.

Email Dr. Jayne.

View/Print Text Only View/Print Text Only
September 22, 2016 Dr. Jayne No Comments

Morning Headlines 9/22/16

September 21, 2016 Headlines 8 Comments

Mixed reactions to CMS tool predicting impact of MACRA on providers’ bottom line

During an HHS Advisory Panel on Outreach and Education, CMS agreed to developing an online tool that will help providers estimate the impact choosing either the MIPS or APM track of MACRA will have on revenue.

Mark Zuckerberg and Priscilla Chan Pledge $3 Billion to Fighting Disease

Facebook CEO Mark Zuckerberg and his wife Priscilla Chan announce that they will invest $3 billion over the next decade on projects that align with an overall goal of preventing, curing, or managing all diseases by the end of the century.

athenahealth Works with CDC and other Specialty Societies to Combat Opioid Abuse

Athenahealth launches a data visualization dashboard trending data related to the nation’s opioid epidemic.

Anthem, Cigna Have Accused Each Other of Merger Breach

A legal filing by the Justice Department reveals that both Anthem and Cigna are accusing one another of violating the terms of their merger agreement. The Justice Department is suing to block the merger on anti-trust grounds.

View/Print Text Only View/Print Text Only
September 21, 2016 Headlines 8 Comments

CIO Unplugged 9/21/16

September 21, 2016 Ed Marx 8 Comments

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

Gotta Serve Somebody!

Contrary to some readers’ comments last blog, I remain committed to the concept that “you’re gonna have to serve somebody, yes indeed.” Bob Dylan made this slang popular with his song of the same name. (Gotta Serve Somebody).

The negative reaction to the concepts of servant or act of service in the workplace is not surprising. Disheartening, but not surprising. If you break it down simply, there are two kinds of people. Those who choose to serve and those who desire to be served. I choose the former. I choose to serve with the former as well.

I view life as service and the workplace no different. I serve my family. I serve my church. I serve my community. I serve my God. I serve my patients. I serve my boss. I serve my employer. I serve those who report to me. I serve my employees. Everything is service. Life is service. I often miss the mark and selfishness creeps in, but service is my default orientation and what I aim for.

I am not sure how a life of service mindset begins. Are we born with it? Is it developed? Is it discovered? I often reflect on it because I believe it is foundational for who we are as people and who we are as leaders. I practice a few things to keep my service orientation keen and my heart soft, and to encourage those who serve with me to do the same.

Simple things:

  • Service vocabulary. We spend most of our lives “working,” so I purposefully substitute service for work in my daily speech. It reframes the way I view things. I don’t loathe to go to work. No! I look forward to serving!
  • Voice of the customer. I programmatically create opportunities for my teams to serve. Clinician shadowing and listening sessions are just a couple of techniques.
  • Healthcare volunteering. I encourage everyone to give back through volunteering. It does not have to be a hospital setting, though healthcare volunteering does directly reinforce the concept of workplace serving. For five years, my oldest son and I volunteered weekly at a children’s hospital. For many years you would find my family spending Christmas dressed as elves accompanying Santa on his rounds.
  • Direct reports. Ask each of them how you can serve them. How you can help them reach their goals? How you may wash their feet? The greatest leaders wash feet, clean toilets and are present in all life transitions.
  • Testimonials. I try to have customers or patients give talks at every team meeting. A 10-minute talk from a patient or clinician is more effective than 500 minutes of speeches from you or me. Recently our CMO spoke to our team. Quiet in demeanor and voice, you could have heard a pin drop as she eloquently wove her personal and professional story together, culminating in reinforcing the critical nature of our team’s service. Wow!
  • Patient encounters. Engage patients whenever possible. Learn their stories. Ask them for feedback. Round with your peers!

Life is difficult and all have been hurt, bruised, offended, or abused. I will never claim to relate to it all, but I can relate to some. I believe we are born with soft hearts, but life happens. Over time, our hearts can become callous and hardened. It is tragic. It is invisible.

External appearances often mask the real world inside. Left unchecked, our attitudes and world view become jaded. I do not pretend to understand the depth of another person’s pain. I am also not going to hide my head in the sand and pretend personal pain does not impact the workplace or how we view things such as service.

While I have been fortunate to witness the softening of hearts in the workplace, I offer no magic formulas or cure-all. Transformations come from counseling, medications, prayer, and other tools I am less familiar with. I am not pushing one transformation method over another, but if you are a leader, I implore you reconsider your viewpoint if you do not believe your role should include servant leader. As a leader, one key to success is to model service, both to those you report to as well as to those who report to you. By embracing this mindset, I guarantee you and your team will transform.

I share this idea in order to break hearts. To reach a broken heart, you must first break the heart. When I see dying kids become excited from winning Bingo, my heart breaks. When I see an elderly couple hold hands one last time in the ICU, my heart breaks. When I see clinicians wrestle with the loss of life, my heart breaks. When I witness a marriage of a couple in our hospital because one of partner is too sick to go home, my heart breaks. When I hear loved ones grieve in our waiting rooms, my heart breaks.

My heart has a propensity to harden, so I constantly try to experience first-hand the impact of my team’s service. Having served this way for many years, I can attest to the fact that when entire teams are mobilized, culture changes and transformation occurs. The best thing? Not only does the organization change and become exceptional at serving patients and clinicians, the individual team members transform as well. Performance and outcomes improve.

You have to serve someone. You might as well choose what and whom.

Footnote. The best resource I have found on servant leadership is Greenleaf.

Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on LinkedIn and Facebook and follow him on Twitter.

View/Print Text Only View/Print Text Only
September 21, 2016 Ed Marx 8 Comments

HIStalk Interviews Eric Widen, CEO, HBI Solutions

September 21, 2016 Interviews 2 Comments

Eric Widen is co-founder and CEO of HBI Solutions of Palo Alto, CA.

image

Tell me about yourself and the company.

I’ve worked in healthcare my entire career. I’ve had an eclectic mix of experience working for consultancies, electronic health record vendors, for myself for a period of time, and for providers. All with a focus on implementing technology to drive improvement, from a health system standpoint and now more so from a population standpoint.

The theme has always been around using data that’s inherent in these systems to help drive performance improvement. We founded the company on that concept of helping health systems and organizations take advantage of data to improve their performance, Specifically to improve population health approaches by leveraging data that’s mostly residing in electronic health records, which have become more ubiquitous over the last 10 or 15 years.

How do you position the company among the many that offer analytics and population health management technology?

Population health, analytics, and even predictive modeling are broad-based terms and topics. Many vendors are saying similar things.

Where we differentiate is that we’re not a platform company. We’re very much a focused solution that we term a precision health solution or precision medicine solution that’s leveraging real-time predictive models that are proprietary intellectual property that we’ve developed. These are our own real-time predictive models that we provide that drive our precision health solution. That’s a niche focus.

We’re technology platform agnostic. We see this as an important piece to identify people at risk for untoward events before those events happen. In real time, meaning leveraging electronic health record data to do that in order to keep people healthy and from creeping up the disease and cost curve over time. That engine that we built can be installed in many different types of platforms. We think it’s an important piece of the puzzle.

Population health includes analytics, care management to take care of the patients, and the interventions that are going to be applied to patients. Our focus is in real time identifying people at risk for poor outcomes before they happen and then identifying the interventions to apply to those patients in order to mitigate the risk from ever happening.

That engine is what we provide. It can be deployed on many different types of platforms, including interoperability system platforms or EMR platforms. Those two examples of interoperability solution vendors and electronic health record vendors also pitch that they do population health. They provide the platform to do that. Very few organizations are providing the specific engine that we provide.

Are providers becoming willing and able to intervene when their patients are flagged as high risk?

What happens on the provider side today is that they’re balancing multiple incentive structures. They’ve dipped their toe in the water. What we’re seeing is 10, maybe 20 percent of the health system’s population is under a new payment mechanism, meaning at risk and/or upside gain for populations. But they’re still balancing the fee-for-service methodology at the same time. These are schizophrenic conversations. Everyone agrees that future is coming and that taking care of patients and keeping them healthy is going to be the new care model going forward, but they’re not there yet.

Organizations are confused about the speed of when that’s going to happen and it freezes decision making a little bit. Organizations are being successful with the experiments in taking care of patients proactively to keep them healthy in order to make financial gain under these new payment mechanisms. Where they can carve out those patient populations and apply these methods, they’ll restructure their care management processes to do that.

They’re really struggling with that decision when and how to do that. We see them doing it well where the incentives are aligned and there is a service component to that to help them rewire their care management processes to think differently about taking care of patients pre-disease or taking them from an at-risk standpoint as opposed to post-disease, which has been the old care model.

Is it an ethical struggle for providers who are beginning to see the value of providing population health management but realize that it could cannibalize their incomes if they do it or everyone, including those for whom they’re being paid fee-for-service?

I don’t think it’s an ethical struggle. It’s a clear problem to solve. It gets back to the acceleration of when are these going to come in full force.

We have clients that have done exactly that. They’ve done such a good job at using our solution to target patients at risk, keep them out of the emergency room, keep them out of the inpatient setting, keep them on the right care programs to mitigate disease progression, whereby they have reduced admissions and volume to their hospital. They’ve had a struggle with that.

What they’ve said is that this is the right thing to do for the patients at the end of the day, to keep them healthy and out of the acute care settings. What they’re looking to do is figure out how to accelerate taking on more incentive-based contracts and risk-based contracts in order to keep this going.

I don’t think it’s unethical. They had upfront conversations about it and they’re trying to figure out strategically how to continue to navigate this process. All of the organizations we’ve talked realize it’s coming and they’re willing to prepare for it. It’s just a matter of speed.

Providers can’t just unilaterally reach out to a high-risk patient and tell them what to do. Is it a marketing challenge as well as a clinical challenge to get patients engaged in this process that’s new to them?

Disengagement from a patient standpoint is a continuous problem for care managers. The ability to engage the non-engageable is a never-ending problem for the care management folks.

What we’re seeing and what we think is important is that the applying the same interventions to the whole population is inefficient. Applying risk stratification information to your patient population allows you to target both resources and the right interventions to the right patients in order to focus. It’s a much more efficient deployment of resources in order to be successful in this game so you’re not wasting time on patients who are otherwise low risk.

The non-engaged patient population, there’s always a sub-cohort of those patients that are always there. It just requires different skills to engage them from a care management standpoint. It’s very much an approach and a methodology that these organizations need to think about to solve that problem.

We will probably look back years from now and see the readmission focus as tactical, with an uncertain impact on outcomes and maybe even on overall cost. Will this push to identify high-risk patients extend further than just keeping them out of the ED and inpatient beds?

I think that’s right. CMS has been thoughtful about their approach for aligning incentives. They’ve gotten better over time for doing this. You see the commercial insurers following CMS’s lead.

The one metric of focusing on readmissions post-discharge, you do have to apply advanced proactive and thoughtful discharge planning to mitigate a patient from coming back, which includes understanding the local and outpatient ambulatory resources that are available in order to mitigate the acute readmission from happening. Even though it was focused on an inpatient metric, the ability to affect that measure required them to think pretty broadly about systems that are potentially external to their four walls to put these programs into place.

I thought it was a good exercise to being able to mitigate that measure or outcome on patient population against a broader portfolio of measures that they’re going to put into place, which is going to inevitably head to capitation 2.0, payment to keep patients otherwise healthy and not using unnecessary resources to stay healthy.

Couldn’t hospitals dig through their EHR data themselves without additional technology? Also, is it enough to use that inpatient data snapshot alone vs. what might have happened to that patient in the 30-day readmission window?

The philosophy is to use any and all available data on the patient in order to understand what’s going to happen in the future. EHR has provided a great, rich resource for that data set. They are real time and they’re clinically based. But you can augment that with claims data, billing data, and things like natural language processing, which is extracting information from the notes and also connecting that to publicly available data from things like the CDC or census information to understand average income levels or average education levels per ZIP code. All the information that is becoming more and more available on patients is very helpful in predicting the future that’s going to happen.

You want as much information as you can possibly get on a patient to predict the future. That includes not just the inpatient data, but the full gamut of inpatient, outpatient. You’ve got public HIEs, which can provide a rich resource if they’re structured correctly in capturing data centrally to have a longitudinal health record across the geographic area. But what you’re seeing health systems do more and more now is deploying more private HIE infrastructure to tap into that ambulatory information that’s extending beyond their four walls and at least setting up agreements with ambulatory providers to capture as much information to provide a comprehensive view on the patient.

Where solutions like what we provide come into play is allowing the machine to do as much as work as possible to help augment clinical cognitive thinking on the patient population. Computers and computer machine learning and so forth can automate a lot of information that a physician and or care manager wouldn’t otherwise be able to do. It can help them augment their clinical education and background in order to take care of patients by providing more information that they otherwise wouldn’t have.

Another component is the ability to integrate into the workflow. Risk information is helpful in providing the content to understand which interventions to apply to mitigate the risk. Automating that into the clinical workflow so that it becomes part and parcel of what a clinician and or care manager is doing on a day-to-day basis is a necessary component in order to not have bifurcated systems and make the workflow as efficient as possible.

What this gets down to is identifying proactively patients at risk with the interventions that apply to that and automating suggested care plans and orders on the patient that a physician or care manager can quickly think through in order to provide the right intervention to the patient.

Where do you see the concept of predictively identifying patients at risk playing out over the next five years?

When we first started this, there weren’t too many players in the game. What we saw mostly in the market were legacy, claims-based risk vendors who were focused on the insurance market or health plan market. What we’re seeing now are more companies like us using clinical information to provide real-time risk stratification information.

Over time, these will become more of a commodity and part and parcel of doing work because it’s necessary for organizations to think this way proactively about their patients and patient population and keep them healthy at home. All the right incentives are aligning to make this a necessary core component of taking care of patients while they’re healthy, while they’re in a pre-disease state, forever escalating up the risk curve.

View/Print Text Only View/Print Text Only
September 21, 2016 Interviews 2 Comments

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

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

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • PM_From_Haities: Re: The Alchemist Does your post on deleting patient data have anything to do with this scandal? http://www.cbsnews....
  • rxpete: Seems like the President of one of your big vendors (Cerner) being a board member might be a bit of a conflict of intere...
  • Honest question: Are you curmudgeon about Health 2.0 (thus no mention) or are there just too many conferences for you to have an opinion ...
  • TheAlchemist: I apologize to HIStalk. Did not realize that the HIT community was such a left-wing advocate group, i.e., 57.52 %. Tha...
  • Whitney: I would love to see an updated version of this!...

Sponsor Quick Links