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News 6/6/14

June 5, 2014 News 12 Comments

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It’s been a busy week for ONC. After news of a reorganization, cheerleading for open data at Health Datapalooza, and receiving a letter from GOP leaders questioning its authority, the office publishes a 10-year vision statement on the future of interoperability. At 13 pages, it is “an invitation to health IT stakeholders … to join ONC in figuring out how we can collectively achieve interoperability across the health IT ecosystem.” Highlights include:

  • Nine guiding principles that stress customization, educating and empowering the public, simplicity and modularity, and leveraging the market.
  • Proposed development of an interoperability roadmap .
  • Three-, six- and 10-year goals that widen the healthcare ecosystem with each successive year to incorporate stakeholders from outside of the traditional healthcare IT industry, as well as placing more responsibility on the individual patient to provide digital data to caregivers.
  • Five building blocks upon which ONC will implement the aforementioned goals, focusing on core technical standards and functions, certification, privacy and security, HIE governance, and a supportive environment comprising all manner of stakeholders.

Several parts of the paper provide food for thought. How will the Meaningful Use deadlines line up with these goals? How will an organization like Epic react to ONC’s desire to “promote competition among network service providers in a way that avoids providers or individuals being ‘locked in’ to one mechanism to exchange health information?” The term “levers” is used throughout, prompting the question of whether ONC will continue to use carrots or sticks to promote interoperability.

It does mention that “ONC will help define the role of health IT in new payment models that will remove the current disincentives to information exchange,” so perhaps carrots will be the method of choice. All in all, the paper makes plain that ONC will be around for some time to come, both as a certification body and driver of regulatory health IT change.


Reader Comments

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From Valleyproud: “Re: Valley Health in Winchester, VA. Implements Epic in all six hospitals and all of its physician offices and clinics. The Epic project went live in 11 months, big bang style. This is a huge achievement and one of the first projects of its kind, incorporating a partnership with INOVA Healthcare to share a patient database and single instance of Epic with no ownership ties between the two systems.”

From Still Holding On: “Re: Allscripts. Surprised not to see anything about the Allscripts layoffs last week. Hit the Burlington office fairly hard. Rumors in my area are saying 50+ folks got their walking papers.” Unverified. This is the first I’ve heard.

From Kit Kaboodle: “Re: dictation. Does anyone have a recommendation for a basic, phone-based dictation system? A group of a dozen docs that have accents that do not work well with Nuance’s Dragon is looking. It’s almost like they want a simple, old type Dictaphone machine except it records via the telephone handset, then just ability to listen to it. No other bells and whistles — they made a point of that."


HIStalk Announcements and Requests

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This week on HIStalk Practice: Eric Shinseki resigns from the VA amidst calls for out-of-network care for veterans. ONC shuffles its leadership team, while GOP leaders take it to task. VITL Medical Director Kate McIntosh, MD discusses the role of patient feedback in HIE development. A new report highlights the ICD-10 coding and reimbursement challenges faced by pediatric practices. CMS refuses to look more thoroughly at the claims of Medicare upcoders despite spending $6.7 billion too much on reimbursements. Arkansas taps North Carolina for guidance in setting up patient-centered medical homes. Physician leadership is found to be key to ACO success. Thanks for reading.

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This week on HIStalk Connect:  Following Apple’s big entrance into health apps, Dr. Travis generates some heated debate with his post questioning Apple’s place as guardian of our health data. Kickstarter opens its crowdsourcing platform to just about everyone except health IT startups. At Health Datapalooza, StartUp Health introduces the newest class of startups accepted to its incubator program.


Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  Building a Data Warehouse and Analytics Strategy from the Ground Up. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This easy-to-understand discussion covers the key analytic principles of an adaptive data architecture including data aggregation, normalization, security, and governance. The presenters will discuss implementation tactics (team creation, roles, and reporting), creating a data-driven culture, and organizing permanent cross-functional teams that can create and measure long-term improvements.


Acquisitions, Funding, Business, and Stock

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Cerner leverages Red Hat Enterprise Linux to enhance the stability and performance of its CernerWorks application hosting services. Nearly 14,000 healthcare facilities host Cerner Millenium solutions remotely via the CernerWorks service.

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GE Healthcare unveils its Clinical Engineering Technology Management service to assist IT and clinical engineering with design, deployment, maintenance and management of mission-critical networks, wireless networks, distributed antenna systems, and devices that connect and provide critical patient data to healthcare providers and hospital IT systems. The company also announces that it is partnering with Real Time Medical to combine its Omnyx Integrated Digital Pathology solution with RTM’s DiaShare workflow management platform.


People

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The HIMSS Privacy and Security Committee names Jeff Bell (CareTech Solutions) chairperson.

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CompuGroup Medical USA promotes Christopher Lohl to the position of vice president for research and development for its webPRACTICE and webEHR products and hires Michael Marini (Thomson Reuters) as RVP of sales for the ambulatory information systems division.


Announcements and Implementations

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A California grand jury report finds hospital leadership at fault in Ventura County Health Care Agency’s troubled Cerner rollout, claiming the organization failed to hire a project manager and create an implementation project plan. The jury’s findings are interesting given the recent C-suite fallout at Athens Regional Medical Center (GA) after its own troubled Cerner implementation. What seems to come through loud and clear in both cases is that technology implementations are only as successful as the leadership teams behind them.

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Kettering Health Network (OH) connects to the HealthBridge HIE summary record exchange service. The new service will enable KHN to share more complete patient information including tests, procedures, medications, and diagnoses. Earlier this year, KHN became the first health system in the state to meet Stage 2 Meaningful Use requirements for reporting of laboratory results when it sent results for eight facilities to the Ohio Department of Health via the HealthBridge network.


Government and Politics

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CMS releases its annual electronic clinical quality measures for eligible professionals, as well as corresponding specifications for electronic reporting. ECQM specifications are used for such programs as the Physician Quality Reporting System, to reduce the burden on providers to report quality measures, and to align with EHR incentive programs. While CMS encourages implementation and use of the updated eCQMs and specifications, it will accept all versions for the EHR incentive programs.

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While the fact that VA hospitals use MS-DOS is nothing new, revelation that it takes more than a dozen steps and multiple users to schedule an appointment takes on heightened relevance in light of the ongoing VA wait times scandal. In other VA bad news, a local paper sheds light on delays and rising costs associated with 41 construction projects for new VA outpatient facilities. Like its wait times, these construction delays are no surprise: the Government Accountability Office revealed earlier this year that only two of the 41 projects were on time, with average delays running to 3.3 years and costs increasing from $153.4 million to $172.2 million.


Research and Innovation

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A new report finds that CVS has the “dominating lead” when it comes to number of retail clinics, with more than double that of closest rival Walgreens. The report also finds that the CVS “MinuteClinic has earned a certain status among the healthcare establishment, forcing that establishment to recognize the retail clinic movement as a legitimate part of the healthcare ecosystem.”

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Google Glass continues to make inroads as a support tool in surgical settings. This article highlights the pros and cons several surgeons have experienced as a result of consistent Glass use during operations. Pierre Theodore, MD cites poor internal battery life and difficulty giving voice commands in noisy environments as drawbacks, though they haven’t precluded him from using Glass for more than 30 patients. He  is the first surgeon to receive clearance from a local institutional review board to use Glass as an “auxiliary surgical tool” in the OR.

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The HHS Idea Lab, ONC, and Total Communicator Solutions Inc. partner for a research project in workplace wellness as part of the SmartAmerica Challenge. Project Boundary is a mobile app that delivers personalized messages to help employees make healthier choices during the work day. Using Apple’s iBeacon technology, the app will send messages that offer health suggestions to workers near such places as stairways, elevators, vending machines, and water fountains. Employees will be incentivized with points to follow the automated suggestions. The idea to promote healthy choices at work is a good one, but the recent mania around consumer privacy and security will necessitate strong incentives to back up any “points” users may try to accrue.

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NHS Scotland announces that it will roll out telemedicine equipment, incorporating iPhones and iPads to 300,000 households over the next two years as part of an initiative aimed at elderly patients with chronic conditions. The scope of the project and the results achieved thus far seem unprecedented no matter what side of the pond you’re on. NHS hopes to replicate the 70 percent reduction in hospital admissions seen during trial testing.


Other

Cerner’s plans for expansion at its Three Trails Campus take a back seat to the challenges of enforcing its dress code during the summer. Julie Wilson, the company’s chief people officer, tells the local paper that, “It’s a challenge for all of us. And it’s becoming more challenging as the workplace has become more casual.” Wilson has her work cut out for her. Cerner, one of the fastest-hiring companies in Kansas City, plans to add 6,000 employees over the next 10 years.

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Vanguard Communications releases the Happy Patient Index, a ranking of 100 U.S. cities according to patient ratings of physicians, group medical practices, clinics, and hospitals found on Google+ and Yelp. The top three happiest cities are San Francisco/Oakland, Honolulu, and Madison, while the unhappiest are Laredo, Toledo, and Bakersfield. It would be interesting to compare the utilization of healthcare IT in the happiest cities with that of the unhappiest to see if any correlation exists.

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The local paper covers the planned Cerner go-live at Chase County Community Hospital and Clinic (NE).


Sponsor Updates

  • Voicebrook releases VoiceOver SRE for pathologists, powered by Nuance’s Dragon Medical 360 technology.
  • BMH Physician Group launches MyHealthPortal powered by Medfusion.
  • Hudson Valley Bone & Joint Surgeons (NY) will implement the SRS EHR for its nine providers.
  • Victoria Romejko of Seamless Medical Systems discusses the ICD-10 drama and engaging patient in health on the company blog.
  • SpeechCheck will participate in the AHRA’s 42nd Annual Meeting and Expo August 10-13 in Washington, DC.
  • Validic adds Omron, Misfit Wearables, and Polar to its collaborators.
  • Zephyr-Tec signs a reseller agreement with nVoq to offer speech recognition to its current and future EMR clients for dictation and navigation.
  • Optum executives will participate in a workshop with HealthEdge at AHIP’s Institute 2014 June 11-12.
  • Good Samaritan Hospital (IN) launches myGoodSamHealth its online patient portal, powered by RelayHealth.
  • Clinical Architecture enhances Symedical, including 400+ terminologies and HL7 value sets to assist clients in meeting MU.
  • PatientPay CEO Tom Furr shares the vision and goals behind the company in an online blog.
  • Ingenious Med supports The Georgia Institute of Technology with a summer internship program.
  • GetWellNetwork introduces its patient and family engagement technology incubator GetWell Labs.
  • Halfpenny Technologies executives will participate in the AHIP Institute 2014 in Seattle, WA June 11-12.
  • Elliot Health System (NH) will implement Besler Consulting’s Transfer DRG Revenue Recovery Service to identify and manage underpayments.
  • NextGen’s Sharon Tompkins discusses HQM and P4P reporting and why it matters.
  • Aperek CFO Phil Sandy is named 2014 CFO of the Year by Triangle Business Journal.
  • Allscripts is hosting a population health management analyst summit at the CCM in Pittsburgh, PA with presentation replays on their website.
  • Vigilance Health (CA) partners with Sandlot Solutions to provide HIE services including Sandlot Connect, Sandlot Dimensions, Sandlot Metrix, and Sandlot Care Assist.

EPtalk by Dr. Jayne

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I was intrigued by this Smithsonian article that cites the pocket watch as the “world’s first wearable tech game changer.” It was interesting to learn how a simple thing like a watch impacted society. It goes on to discuss wristwatches and solutions like Pebble and Google Glass. I wonder what they’ll think about our technology in 100 years?

I’m still waiting to get my hands on technology from Ringly, which promises jewelry that will deliver phone notifications. I’m looking forward to a time where people can get their devices off the table and back in their pockets and purses where they belong. Despite rules about devices in meetings, I’ve seen a spike in people trying to multitask, which results in them completely missing the conversation in front of them.

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Continuing the wearables theme this week, Intel releases information on its “smart shirt” that tracks heart rate without a separate chest strap. Data will go via Bluetooth or WiFi to a phone or computer. It looks quite a bit like a cycling jersey, so I don’t know if the fashion conscious will bite. Maybe we can get Ed Marx to field test it on one of his future adventures.

In other consumer news, the Journal of the American Osteopathic Association publishes a piece reviewing Wikipedia contents for the 10 most costly medical conditions, including heart disease, cancer, hypertension, and diabetes. Although the authors discourage professionals from using Wikipedia as a medical reference, I’ve found it useful as a means to see what my patients are reading and to find quick links to citations for traditional publications.

CMS releases its annual update of Clinical Quality Measures for 2014. I always enjoy their press releases: “To help eligible professionals navigate the updated eCQMs, several resources are available… particularly the Measure Logic Guidance Document, which contains the technical release notes, additional guidance, and additional resources for implementers.” Do they actually expect eligible professionals to read this stuff? The Measure Logic Guidance Document is 259 pages long and I can’t imagine any frontline provider reading it.

The call for proposals for HIMSS15 is open through June 16. That’s nearly 10 months before the actual conference, decreasing your chances of seeing presentations that are fresh and timely.

HHS announces the winners of the Code-a-Palooza challenge. The winning entry, Smart Health Hero, is “designed to help patients and their families use Medicare claims data to make health care choices.” I had mentioned before that I’m not sure how claims data can help patients make decisions (especially given the concerns regarding the integrity of the data itself) and am looking forward to seeing it. If you have the scoop (or information on any of the other winning entries) email me.


Contacts

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

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12 Responses to “News 6/6/14”

  1. 1
    Powered by ... Says:

    Kettering Health is Powered by Epic. Seemed to go unstated, but probably relevant.

    Epic has quickly become the most interoperable company in healthcare IT.

    Good challenge would be to find another EHR that is more interoperable with the outside world than Epic.

  2. 2
    Fred Savage Says:

    To Kit Kaboodle 3M HIS has solutions that can help Call 800-367-2447 or check out the http://www.3mhis.com web site They have a hosted solution that the doctor can dictate on

  3. 3
    marc Says:

    Re: Dictation –

    Kit Kaboodle – Check out the M*Modal solutions at http://www.mmodal.com specifically the M*Modal Fluency Voice Manager solution may fit the bill. Does really well with accented speakers. The demo is at: http://www.mmodal.com/fluencyvoicemanager

  4. 4
    Lazlo Hollyfeld Says:

    Epic is more interoperable than any other EHR? Says who? No research to begin to substantiate that and other application vendors especially HIE vendors like Orion Health or Medicity among others would refute that strongly.

  5. 5
    GenesRFree Says:

    How is Epic when it comes to unstructured Data? Exactly, it can’t do anything with it! It can work great with it’s own structured data, but unfortunately in healthcare, unstructured data is what is growing at an enormous rate. NO EHR can manage that growing conundrum.

  6. 6
    Fourth Hansen Brother Says:

    Hey GenesRFree- what kinds of unstructured data? Examples? There are a few things Epic can do. There are some EHRs that are all about the unstructured data if I know what you’re talking about, I think, but not real MU friendly.

  7. 7
    NoteReader to the rescue Says:

    Epic runs Nuance or MModal Natural Language Processing to read unstructured text of any sort and convert it to actionable clinical data which can update the formal discrete and coded data fields in the EMR.

    And, has delivered this in 2 versions already. Everyone deals with unstructured data these days.

    On interop, Orion and Medicity are not EHRs, their just hubs or at best a CDR with a viewer?

    Looking at the install base of EHRs getting docs to meaningful use, does any one of those vendors have anything approaching Epic’s Care Everywhere network performing at the level Epic is performing at today?

  8. 8
    insidehr Says:

    @NoteReader to the Rescue there aren’t any other EMR vendors doing anything like Epic is doing. When you factor in the cost to the providers to work with an HIE vs. what they can achieve with CareEverywhere, the gap is even more dramatic.

    There was a case study done in Minnesota in 2010. At that time they estimated they could share the medical records for over 75% of the entire state’s population on the CareEverywhere platform alone. There are quite a few states (i.e. Illinois, Ohio, Texas, North Carolina, Missouri, California, etc….) that would fit a similar profile.

    Just a guess, but I would imagine this capability will be the ultimate tipping point for the VA decision. Most of their facilities are in more metropolitan areas, a demographic that Epic dominates. The patient cross over between the large Academic Medical Centers and the VA facilities is significant, and its going to be tough to pass up that established network at no additional cost above and beyond the overall installation.

  9. 9
    GenesRFree Says:

    4th Hansen-CT, MRI, EEG Video, Fetal Monitoring strips, etc., you know, the rest of the patient record. Epic cannot deal with this data, nor can HIE that are out there flourishing. In order for clinicians/hospitals etc. to have a view of the entire patient record they need to add to Epic. Unstructured data is a key component of the patient record that continues to be left behind. And by the way, that same unstructured data is growing at a much faster rate than structured and will be needed as an organization moves forward with there data analytics strategy.

  10. 10
    Imagine Images Says:

    But wait GenesRFree – you don’t need to transport those objects in the first place. Remember a 64 slice scan is humongous!!!

    What you do, which is what Care Everywhere is doing, is you send an object id from the source system which when matched up with the source locations image sharing URL allows users to access the object from one 1 true home.

    Also, look at what LifeImage is doing live and demoing with Epic. That works for both patient self managed images as well as health system images.

    Plenty of options for a system that is sincerely want to share. Don’t forget though that you need a system that would rather get access to the free MRI you just did rather than do an new MRI and have to charge all that money (or wait, gather all that revenue) for redoing that same MRI.

  11. 11
    Fourth Hanson Brother Says:

    GenesRFree, yes Epic has ways of dealing with that kind of material quite well as others have noted. There are worse things out there to deal with….

  12. 12
    GenesRFree Says:

    II and 4th Hanson- but you are still using the source system PACS. And I am also talking about all unstructured data, including emails, jpeg, wav, pdf etc. I don’t think Epic has built in capabilities to handle that at all. I’m familiar with Life Image and all I see they deal with is Dicom files.

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