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Monday Morning Update 10/6/14

October 3, 2014 News 42 Comments

Top News

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A Reuters report says Facebook is working on healthcare tools that include chronic disease support communities and health apps. It adds that the company has been meeting with healthcare experts and entrepreneurs and is setting up a health app R&D unit. Mark Zuckerberg’s wife is a doctor, so maybe it will do more than just the usual privacy invading and ad serving. Meanwhile, the company apologizes that it performed mood manipulation experiments on unwitting users by tweaking their news feeds to show extra-cheery or extra-depressing items to see how they reacted.


Reader Comments

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From David: “Re: CMS Open Payments. ProPublica has downloaded the database and made it searchable as Dollars for Docs. They’ve also done a great job with Treatment Tracker, which breaks out Medicare payments to doctors.” It’s pretty funny (or sad if you’re a taxpayer) that the non-profit newsroom quickly whipped up a perfectly fine consumer-friendly version of the mess that CMS and its army of highly paid contractors created.

From WhoopsInVA: “Re: Anthem BCBS in Virginia. Forgot that ICD-10 wasn’t actually going live this month and are rejecting all incoming claims because of diagnosis. Our athena rep just emailed us about this.”

From The PACS Designer: “Re: new iPad Air and Mini. Apple will be holding its next event on October 16 for the new versions of its iPad Air and Mini devices. It will interesting to see the changes they are making with the its iOS 8 system installed.” Maybe it’s just me, but I’m losing interest in Apple’s overly dramatic announcements of incremental product tweaks. The fanboys still achieve mandatory technical arousal and obediently line up outside the Apple Store as they’ve always done (ironically resembling the Big Brother-obeying monochromatic drones from Apple’s famous “1984” commercial), but Apple is a lot less interesting without Steve Jobs. I’m pretty sure I’ll do the same in eventually replacing my phone as I did with my iPad: buy a more innovative product for a less money even though it won’t come with the self-congratulatory hipster delusions in hanging around the Apple store pretending to be artsy and cool.  


HIStalk Announcements and Requests

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Most readers say it’s not OK for an EHR vendor to deny a hospital or practice access to its patient information in a billing dispute. New poll to your right or here: What’s your reaction to HIMSS announcing President George W. Bush as a keynote speaker for HIMSS15?

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Here’s my opinion on Bush as a HIMSS keynote: he wasn’t interesting as President, so I don’t really care what he has to say now that he’s cashing in on his pitiful legacy (unless he’s announcing that he finally turned up those pesky WMDs.) The HIMSS strategery is probably to scratch his back in return for his industry-enriching 2004 declaration that every US citizen would have an electronic medical record by 2014, so perhaps he will strut out in a flight suit and yet again prematurely declare “Mission Accomplished.”

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We’re putting together our MGMA guide featuring sponsors of HIStalk, HIStalk Practice, and HIStalk Connect that will he exhibiting or will be available to meet with interested attendees. Contact Jenn by Monday evening if your company sponsors and hasn’t already provided information.  

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

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Last Week’s Most Interesting News

  • The CMS Open Payments database goes live with inaccurate physician payments information and usability criticism.
  • CMS announces that it will miss its date to move Healthcare.gov’s hosting to HP, with its only option to leave it running on the previously problematic Verizon infrastructure through the open enrollment period.
  • UnitedHealth Group’s Optum division acquires MedSynergies, which offers physician practice billing and quality services.
  • Informatics pioneer Morris Collen, MD of Kaiser Permanente dies at 100 years old.
  • Experts warn health systems to test for the newly discovered Shellshock Unix vulnerability.
  • Epic CEO Judy Faulkner says in a rare interview that the company developed its own interoperability tools only when it became clear that the federal government wasn’t going to set clear standards.
  • Apple restores its HealthKit health data aggregation system and third-party apps that use it in an iOS 8 update.

People

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Spok names Hemant Goel (Siemens Health Services) as COO.

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Jim Dwyer (Santa Rosa Consulting) joins RCG Global Services as SVP and healthcare practice leader.


Government and Politics

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ONC loses another of its leadership team as Chief Nursing Officer Judy Murphy will resign to take the same position with IBM Healthcare Global Business Services. To quantify the turnover, I looked back at the ONC leaders who presented at HIMSS13: Farzad Mostashari (gone), Judy Murphy (gone), Doug Fridsma (gone), David Muntz (gone), Jacob Reider (still there), Jodi Daniel (still there), Lygeia Ricciardi (gone), Mat Kendall (gone), Joy Pritts (gone), and Kelly Cronin (still there).


Technology

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The FCC fines Marriott for blocking personal hot spots in its conference center to force attendees to buy its overpriced Wi-Fi services. Marriott issued a lame statement of protest, claiming that its actions were intended to protect guests from “rogue wireless hot spots” (at a larcenous price, of course) and blaming the FCC for “ongoing confusion.” The FCC took action after a Gaylord Opryland attendee claimed the hotel was “jamming mobile hot spots so that you can’t use them in the convention space.” Let’s see how this plays out at the HIMSS conference. Since my ATT wireless plan includes free tethering and 10GB of data transfer, I don’t even bother with airport Wi-Fi any more and I will quickly switch to my hotspot in a hotel if their Internet service is poor or expensive (or, as is often the case, both). Rumors abound that convention centers play games with cellular and Wi-Fi coverage in the exhibit hall to force exhibitors to buy their expensive network access.


Other

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This is bizarre. Texas Health Presbyterian Hospital (part of Texas Health Resources) initially said it discharged Ebola patient Thomas Duncan from its ED because of an EHR setup problem, explaining in considerable detail that the patient’s travel history was located only in the nursing workflow part of Epic where the physician didn’t see it. News media were all over that statement, leading THR to issue a a hurried retraction at 9 p.m. local time Friday evening saying it was correcting the previous day’s release and the EHR was fine after all. My speculation is that Epic complained vigorously about being thrown under the bus (but not by name) and threatened legal action, forcing THR to claim that its detailed, carefully explained statement was incorrect. My biggest concern – could the doctor have been so robotized by the EHR that he or she slipped on critical thinking? EHR or not, the patient sitting right there in front of you is telling you a story that you’d better listen to. What about the nurse, who had just been told by a patient with fever that he’d just come from Liberia? That information would seem to suggest a higher level of response than just dutifully entering the information in Epic and moving on. Computers sometimes fail, but not nearly as often as people. At least THR’s problem raised an industry red flag that had clinicians and programmers all over the country working this weekend to evaluate their processes and systems to make sure it doesn’t happen to them.

Update: a reader’s comment about the use of scribes sent me Googling and it turns out that Texas Health Presbyterian Hospital Dallas uses scribes in its ED. It would be interesting to know whether scribes were involved in this instance.

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Meanwhile, a poorly and smugly written piece in The Atlantic declares that, “The Ebola Patient Was Sent Home Because of Bad Software.” The author collected all of her inexpert healthcare IT opinions into one unfocused article, proclaiming the “atrociousness” of many EHRs and their “gaping loopholes,” complaining that the hospital was blaming “the robots,” opining that “a flawed EHR might have lead to the spread of an incurable virus,” and then veering off into a rant about interoperability, which has zero to do with anything. Author credentials are fair game if you’re going to editorialize, so let’s check hers: an intern until 2010, moved down from global editor to staff writer after 10 months in the higher position, wrote about home design and architecture, and listed her most recent accomplishment on LinkedIn as, “Talk about beards on the radio.” Nothing makes me angrier than people who’ve never spent a day working in either IT or healthcare blasting out their entirely unqualified opinions in passing themselves off as authoritative. The Atlantic should be ashamed for letting this dreck hit the airwaves just to get something reactionary up quickly. HIStalk Reader Tom called her piece “more than ridiculous,” observing that “highly configurable EMR software was used to ensure a medical mistake in clinician workflow never happens again.”

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Athenahealth’s Jonathan Bush, using his limelight-seeking power to ride the Ebola story in touting his company at Epic’s expense (while claiming he’s not) from his second home on the set of CNBC, trots out his stump speech to easily charmed reporters about “pre-Internet software” with no “network effect,” wrapping up with his company commercial in saying, “I hope soon that nobody will be on enterprise software and these things will be managed by people across thousands of hospitals.” He omitted the obvious rest of the sentence, “ … and instead will be running the sort-of cloud system and offshore-powered mailroom I sell that allows ATHN shares to trade at 1,220 times earnings.”

The government of India announces plans to make e-prescribing mandatory for all doctors to reduce corruption and inefficiency.

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Attorneys consider a plea deal for a third-year medical student who is accused of stealing a breast cancer patient’s iPad during a Code Blue in which the patient died at UCLA Medical Center. The patient’s family is most upset by the fact that the student allegedly wiped off the patient’s information before re-registering it to herself, depriving them of the chance to see the thoughts the patient had left for them.

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A 38-year-old Russian billionaire bank founder releases plans for “the world’s most pleasant hospital” that he will erect in the Dubai-inspired, purpose-built Tunisian Economic City. The hospital will sit on a man-made lake, look like a cruise ship, and require employees to dress (but not swear) like sailors.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Currently there are "42 comments" on this Article:

  1. Re: Texas Presby & Ebola patient:
    back in the old days when I was a hospital CFO /CIO ER docs were required to take a patient history (as well as nurses). Has that requirement been changed? If not how come the doc didn’t hear a unique accent (not American or Spanish) and ask about foreign travel? Can’t blame that on Epic…

  2. One common ED workflow is the use of scribes.The ED physician effectively only reviews the chart to sign the note. Thr scribe calls out abnormal labs, etc. minimizing the interaction of the physician with the record. This is a risky workflow. Few ED physicians will call out how little they use the record when scribes are in place but will tout how much time it saves having to interact with the record.

  3. Re: bizarre reporting from Texas Health Presbyterian. ‘My speculation is that Epic complained vigorously about being thrown under the bus (but not by name) and threatened legal action, forcing THR to claim that its detailed, carefully explained statement was incorrect.’ No doubt. Sitting on my 30+years in clinical informatics, hearing the initial reports that the nurse workflow didn’t update the MD’s workflow on all elements of the nursing assessment… likely TRUE. Hearing they quickly changed it… likely TRUE. Hearing speculation Epic went nuts and complained.. likely TRUE. Could have happened with any vendor as these discrete design decisions are the responsibility of the hospital IT/Informatics team. Unless, of course, the hospital staff is told the vendor already has vetted the design and there’s no need to customize’ (execs love to hear this phrase). Thinking this might be a reason to ensure the vendor has real clinicians and real experienced folks selling the design as vetted or the hospital has critical thinkers who can do the work as required.

  4. Re: ebolagate

    There is enough blame to go around, but this ain’t the first time that there was EHR facilitated communication failure.

    In the dinosaur days, the triage nurse would hang a piece of paper with vital signs and key findings and concerns highlighted, on the door or chart receptacle of the patient’s room. The doc would walk in to the patient with the paper armed with the key information.

    Now that is vital communication, which regrettably, no longer happens in those hospitals receiving Leapfrog awards for EHR and CPOE safety, and HIM$$ awards for being wired and paperless.

  5. HIStalk. Please do not go political. The latest poll is initiating reverse peristalsis by Words of Mass Destruction.

  6. Agree with Ann Marie on the use of scribes, Quick google search turns up…

    http://www.nytimes.com/2014/01/14/health/a-busy-doctors-right-hand-ever-ready-to-type.html?_r=0

    They may have given up scribes, or the ebola case may not have been covered by one of their scribes for a variety of reasons, but one reason scribes flourish is because user interfaces and workflow solutions are not up to the job (yes, I know there were scribes in place in some hospitals prior to EMR installs, but they are much more common now).

    Now one could argue that EMR’s being “up to the job” means supporting physicians trying to see too many patients because of our flawed reimbursement system, but if the doctor isn’t even interacting with the system to see the decision support prompts that are in place post go live of the monolithic system of choice, particularly if they moved off of a system that had all that and good physician acceptance without scribes, it’s hard to see the situation as progress eh?

    If this is truly the situation with the ebola patient, it makes a great illustration of why giving up the physician interaction with the EMR to scribes may have a few flaws. You still have to see the patient, take the history, and practice good medicine. But if this multimillion dollar tool is supposed to help out, and I’m not even seeing it until it’s time to do order entry, we haven’t gotten where we need to be.

  7. Mr. H your comments about J Bush are right on. If there was ever a question about why he’s a big blow hard, that answers it. It also shows his lack of knowledge about what really happens in a health care setting.

    A company that thinks it will win by unjustifiably denigrating the competition will only destroy itself. Hope I never see /hear him again at your HIMSS receptions.

  8. @keith #ebolagate

    It is insane and I am shocked that the system of care at Texas Health Resources was that dysfunctional despite its expensive EHR that the patient was sent home.

    Groopman and Hartzband described the “Where’s Waldo” syndrome of the EHR. Too much data, too much noise, and too little time to search the data and information silos of the nurses and ancillary services. FUBARD!

    Problem is that this genre of error is widespread internationally. As they said in the UK after a roll out of Cerner at the Milton Keynes, the EHR is not fit for purpose.

  9. Political Comments about President Bush-don’t start making this site about politics, specially about President Bush…are you kidding me?? If this continues my guess is this site will go down the toilet quickly. I don’t read this site to get your political opinion!

  10. I think it’s absolutely disgusting that THR felt it was okay to blame it on EMR workflows when clearly the problem is that they didn’t have proper Ebola protocols in place. How would you have liked to have been a patient that happened to use the same ER bathroom as this patient while he sat waiting for an MD even though the nurse should’ve identified him as a risk. And the worst part is they still don’t want to take responsibility. Admit your process and training stink and fix it. I think it’s completely unrelated to scribes as it never should have gotten that far. But, since we’re on the subject, THR indeed employs scribes in a method far more extreme than anywhere else I’ve seen, to the point where I wouldn’t want to be seen there. From what I understand, it’s not only documentation, they’re also queuing up the orders. There is so much blame to go around in this story. I hope at some point they stop deflecting and actually do something to fix it. People will still make mistakes, but this is just lack of preparation.

  11. Great to hear Athena remark on the subject – they run inpatient settings with hundreds or thousands of beds, all over the country, right? Easy to throw spears when your experience on the exact subject is entirely theoretical.

  12. Lost credibility slamming President Bush. History will show a man and administration that kept us safe.

    Feeling safer now?

  13. Mr HIStalk, don’t listen to haters. W is a poor choice of speaker, unless the convention’s focus is upon picture books.

  14. Agree with others who implore you not to get political. As for HIMSS I would urge the same as well. Suspect they are trying to balance the two Clinton keynotes of late. Why don’t you bring on some relevant healthcare leaders instead?

  15. I agree with @All4Him. Slamming Bush served no purpose but showing your liberal bias. He was a big-government Republican if not RINO and at the time of WMDs the world was on board with the decision. I don’t understand why you chose to slam him. Like @All4Him asks your esteemedness, are you feeling safer now?

  16. While paper may have advantages, you can’t argue that overall population health was well served by paper charts on the bed. Now remind me, Who was prez on 9/11?

  17. As my dear old dad used to say “Son, don’t ever bring up religion or politics.” The comments about former President Bush were not appropriate for this forum. You are better than that Mr. H.

  18. Based on you unnecessary comments regarding President Bush, I have lost my taste for your site. Now that I more clearly see your agenda, I am forced to no longer trust what is offered here.

  19. Mr H. – It appears you do have opinions about politics with your points about Geo B. So, are you backing Judy for President in 2016?

  20. re W.

    Im sure glad he’ll be the keynote at HIMSS. At least we won’t be lied to. Ebama is the prez that brought Ebola virus to a place near you, gave birth to ISIL in spite of warnings from military leaders, and a list of other failures.

    You wanna get political, lets. It’ll be the downfall of your blog.

  21. Who the H decided it’d be a good idea to put GW Bush on stage at HIMSS???!!!

    OMG!!! Not only a complete disaster to the country, to the world!

    I hope Code Pink shows up to throw a shoe at him….

  22. As far as the EMR being blamed by Texas Health Presbyterian, Epic is as integrated as they come, sounds like the physician did not review the history and what ever happened to the nurse simply turning to the physician to say “you should be aware, this patient was just in Liberia”, come on, take some responsibility!

    And excuse me ‘All4Him’ 9/11 happened on his watch.

  23. Kept us safe? Wasn’t 911 on his watch? Didn’t his “wife” Condoleeza ignore stark warnings about it?

    He also allowed Dick and Co to torture by US and international definition and history has shown his administration lied about the results – this fueled some of the turmoil today.

    Gained credibility here…

  24. Wow.

    Is the real Mr. Histalk on vacation and this week’s column is being ghost written by a bitter politico?

    Speaking of legacies, I’ll take the W legacy over the O legacy any day. O’s legacy, let’s see….Obamacare, Ebola in this country, the Arab Spring, the Rise of Isis, the VA scandal, the IRS scandal, search warrants on journalists, etc.

    At least our enemies feared us in the Bush years.

  25. A continuation of the prior comment:

    I see people saying things like “don’t make this political” – well HIMSS did just that. To pick such a polarizing political figure for speaker is astonishing. Plus, HISTalk is “Healthcare IT News and Opinion”. If you leave out the opinion, HISTalk would not be what it is, which is a great site for people to speak their minds.

  26. Texas Presby Ebola claim highlights an historic issue – How many MDs routinely read RN notes? How easy are they to cull information from?

    Few hospitals intermingle MD and care team notes. Most file separately, with MD requiring extra steps to access nursing documentation. RN assessments are a primary reason for hospitalization and early indicator of problems, often long before vitals change. Yet many MDs in EHR implementations request access to very limited nursing-collected data (not even data sets), e.g. ht/wt and vital signs for med admin dosing and decisions. MU Stage 1 criteria reflect this practice / priority (bad habit in my view).

    RN notes went from novellas on paper to endless pages of normative statements and check boxes – in both cases hard to determine patient status and subtle changes. In a legal chart review of ~1000s of pages of nursing notes it was nearly impossible to track the patients’ deteriorating state.

    If risk of overload can be mitigated, apt warnings in the EHR have value – but clinicians evaluate hundreds of clinical scenarios every day. With or without an EHR, one expects an informed ED RN to inform the ED doc of high risk situations, and establish proactive patient protocols. The MD also could have pieced this together on an H&P. Why they didn’t would be the key issue to address. Do clinicians rely too heavily on computer to put it all together, and communicate with each other?

  27. HIMSS and Politicians – regardless of your party, who values anything a politician has to pontificate on during HIMSS? Bill and Hilary certainly didn’t enlighten anyone in attendance. HIMSS should save the money and reduce the price of admission for provider organizations. And save us from Topol and his toys – and Soon-Shiang with his next ego centric project. How about a keynote speaker who has made a difference in healthcare delivery? Someone with a real heart for the sick…and weary?

  28. Yes – lets keep the political opinions and commentary out of HISTalk… Simply asking the question as to whether anyone would like to see Bush as the
    Keynote speaker at HIMSS is enough. Your opinion on whether he would make a good keynote speaker doesn’t have to revolve around your opinion of
    him as a president. Does he know enough about the industry to be a worthwhile keynote speaker at HIMSS?

  29. You have a direct connect with Ed Marx and he is always willing to share information, especially here, oh he has a blog here. He is the LEADER of THR. Where is he now? OWN IT.

  30. Everybody loves rumors, opinion and snark until they get butthurt over something they themselves are biased about, then they raise holy hell that nobody should express those things. The lack of eloquence in the fussing is knee-jerk reaction without real thought. The commentary here has been equally cutting toward Obama, the Clintons, and now Bush.

  31. Lab Rat-wasn’t it HIMSS that invited Hillary Clinton already, you don’t think she has a political agenda? And no one disputes this is a site for opinion, but for the healthcare IT world, not politics in the US. If it gets political this page will go on forever!
    Angel-I’ll only say this, the major difference between Obama and Bush is one loves this country and kept it safe, the other is purposefully trying to tear it down and make it an also ran. Open your eyes and see what’s going on. And let’s keep politics out of HISTalk or this site will fail.

  32. The reason TPD continues to submit posts to Mr. H. is the high quality that his website brings to healthcare in general! TPD has political opinions too but won’t submit them since that’s Mr. H’s option and he always keeps things interesting so that’s why he has so many fans, and I submit other interesting stuff instead. To cut back on the opinion part will make HIStalk less inviting to readers!

  33. Yo dude…in response to your opining on our former President George Bush and the upcoming HIMSS Conference I am not interested in nor do I turn to this site for opinions and insight into United States national security issues and foreign policy with respect to your comments on WMD and the President’s speech aboard the USS Lincoln in 2003.

    Based on your comments pertaining to WMD and the speech aboard the USS Lincoln it is obvious that you do not bring forward an informed perspective on either of the matters – if you feel the need to express yourself there are other forums for which to do so.

    Look, you do a great job with the site and the information around healthcare information technology is informative, valuable and timely…but stick with what you know and what is relevant to the site topic(s) –> Healthcare Information Technology.

  34. @genesrfree (or is that genesrmissing?) – I wouldn’t go that far to call Mr. Bush “purposefully trying to tear it (the USA) down” – it is possible he wasn’t purposefully lying about the WMDs in Iraq, which resulted in the loss 4,486 U.S. service members. And I am glad you appreciate Mr. Obama leading the US out of the worst economic recession without raising taxes on the middle class, and still managing to reduce the budget deficit, because, like all of us, he “loves his country”.

  35. Thanks for bashing the Bush family. I would hope that in a few years when HIMSS decides to have Obama as the speaker, you bash him equally. You didn’t when they had Bill or Hillary.
    You have lost some of my respect…

  36. RE: What’s your reaction to HIMSS announcing President George W. Bush as a keynote speaker for HIMSS15?

    Why don’t we cut-to-the-chase and conduct a poll on political party affiliations. Select one party pursuant to our current Congressional seats:

    Democrat

    Republican

    Independent

    Poll Outcome: At least the reader will understand the mentality of opinions expressed on HIStalk. I would be happy with HIT-Neutral and regarding Interoperability, just “get ‘er done”.

  37. A surprising number of people are offended that a site which explicitly says it offers “News & Opinion” has posted an opinion. Especially since the opinion part is what sets it apart from joining any of the endless HIT email lists which will gladly email you HIT news.







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