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December 2, 2014 News 13 Comments

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An ONC blog post by Karen DeSalvo, MD called “Health Data Outside the Doctor’s Officer” references a new JASON report titled “Data for Individual Health” (JASON is a highly regarded independent science advisory group run by DoD contractor MITRE Corporation). The report addresses the steps needed to move to “a system focused on health of individuals rather than care of individuals” in creating a learning health system. Some of its recommendations:

  • HHS: take action on previously created reports and measure progress.
  • HHS: adopt interoperability standards and incentives.
  • HHS: support open API standards and pay providers more (the report suggests a 0.25 percent bonus in CMS’s Hospital Value-Based Purchasing Program) for using “ecosystem-friendly EHRs” that follow those standards.
  • HHS: encourage non-profits (such as disease-specific advocacy groups) to mark consumer apps with their stamp of approval to increase their adoption.
  • Joint Commission and professional schools: add informatics training requirements.
  • FDA: loosen control of product services that could be construed as practicing medicine, for example, allowing apps to report their information to both provider and consumer as a risk mitigation strategy.

With regard to interoperability, JASON says the market is moving in the right direction and specifically notes that Epic (which the report says is regarded as “among the most closed systems”) has announced that it will develop APIs to allow external programs to interact with its systems. However, it says that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs. The new report suggests that the government encourage “an incumbent vendor with significant market share” to propose an open API standard to encourage the market leaders to step forward rather than being forced to follow a competitor-proposed standard. It also says FHIR is a significant improvement over CDA document-based exchange.


Reader Comments

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From Enumerator of Legumes: “Re: Laurens Albada. You mentioned that he appears to have left as CFO of Greenway Health. He’s now managing director of financial services with the consulting group of Vista Equity Partners, Greenway’s owner.” Verified, according to his LinkedIn profile. That’s a nice move up.


HIStalk Announcements and Requests

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Reminder: I’m collecting questions for CommonWell. If you want more information about its interoperability technology or strategy, send me yours

“Utilize” has been at the top of my “most annoying words” list for a long time since it is just a needlessly complicated way to say “use.” However, its top position has been recently threatened by “leverage,” which in a remarkable coincidence is yet another pompously pointless way to say “use.” Give marketing people their way and system users will be renamed “leveragees.”

Listening: Green River, an obscure mid-1980s hard-rocking Seattle band that arguably created what would later be known as grunge. They’re angry and armed with loud guitars that require me to provide air drums accompaniment. Two of the members later formed the similarly intense Mudhoney. I’m also enjoying the amazing Dinosaur Jr., late 1980s indie rock that remains fresh (and loud).


Webinar

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Microsoft acquires 18-month-old, 20-employee Accompli — which developed a slick, free, Exchange-enabled smartphone email management app — for $200 million. I’ve tried it with my Gmail accounts and it has some nice features, such as smart messaging organization, easy calendar access, Dropbox enablement, and one-swipe conversion of an incoming email to a calendar event. I don’t know how Accompli planned to make money other than by being acquired, so maybe it cleverly noticed Microsoft’s mobile email weakness and figured MSFT would eventually wave money in its direction with hopes of renaming it Outlook Mobile. Accompli had raised only $7 million of VC money in its short history, so that’s quite a score.

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Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group. The paper says that Epic got involved with the acquisition at the last minute by insisting that Huron not hire any Epic employees within two years of their resignation from Epic, meaning Epic would be enforcing a requirement to which its employees hadn’t agreed. The article says local speculation is that Epic is beginning to fear being held liable for violating antitrust laws, especially after Silicon Valley software engineers filed a successful class action against big-name tech companies for conspiring to not poach each other’s employees. According to the paper, Epic has also warned consulting firms that they can’t put up Madison area billboards or advertise within 50 miles of its Verona no-fly zone, also extending its workforce control by giving hospital clients maintenance fee discounts for honoring Epic’s non-compete agreement. Epic’s only official response to the non-compete issue was, “This is being reverted to a one-year term. We’d rather not comment on the policy as a whole.”


Sales

Gila River Health Care (AZ) chooses NextGen’s ambulatory PM/EHR.

Advocate Community Providers (NY) chooses eClinicalWorks for population health management and interoperability to support its Delivery System Reform Incentive Payment program for 437,000 patients.

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Grand View Health (PA) chooses Cornerstone Advisors Group to upgrade its Meditech Client/Server 5.6 system to 6.1 and to support its early adoption of Meditech’s web-based ambulatory product.


People

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Anthelio Healthcare Solutions names Gary Trickett (Allscripts) as SVP of IT services.

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Anthony Caponi is named VP of healthcare IT at Direct Consulting Associates.

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Allana Cummings (Northeast Georgia Health System) joins Children’s Healthcare of Atlanta as CIO.

Payer software vendor Healthx names Sal Gentile (TriZetto) as CEO.


Announcements and Implementations

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MedAssets will use Procured Health’s data intelligence and workflow solution in its product value analysis services.

Jackson General Hospital (WV) goes live with CrossChx’s SafeChx biometric patient identification solution in its registration area.

NextGen connects its Share platform with Merge Healthcare’s iConnect Network to allow NextGen Share users to send orders to Merge systems and receive images back.

The American College of Radiology and Massachusetts General Hospital (MA) will use Nuance’s PowerShare Network to present clinical guidelines in radiologist workflow and to automate PQRS data collection.

Ricoh will offer Levi, Ray & Shoup’s VPSX software to its healthcare enterprise output management customers.

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Hosted infrastructure vendor SingleHop had me all impressed with their announcement that they would sign Business Associate Agreements with healthcare customers, at least until I hit the part of their press release that said HIPAA is “also known as the HITECH act.” Close enough for government work, I suppose, and it is kind of confusing.

EHR vendor CureMD chooses DrFirst’s EPCS Gold to add e-prescribing of controlled substances (EPCS) to its system. DrFirst reports that EPCS volumes jumped by 200 percent in the most recent three-month period, likely boosted by New York’s I-STOP mandatory e-prescribing requirement for all drugs beginning March 27, 2015.

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Lawrence Memorial Hospital (AR) goes live with electronic forms from Access.

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PeriGen is awarded a patent for its software that assesses fetal descent in helping OB-GYNs determine when it’s appropriate to perform a C-section delivery. I really like the company’s laser-sharp focus on fetal monitoring and the innovations it has introduced there. One of my favorite interviews was with CEO Matt Sappern a couple of years ago, when he succinctly explained the company’s products as, “Our ability to apply technology to what has been a subjective part of labor and delivery is important. Probably 80 percent of medical malpractice comes back to bad interpretation of the fetal monitoring strip. We’ve figured out a way to apply technology to help interpret that strip. ” 

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Boston-area Gillette Stadium, home of the New England Patriots, announces plans for an upscale, expensive, members-only end zone suite that will be called Optum Field Lounge, named for the healthcare IT division of UnitedHealth Group that’s sponsoring it.


Government and Politics

The Bipartisan Policy Center will live stream a six-hour meeting Wednesday titled “Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care” with participants that include Karen DeSalvo from HHS and McKesson’s John Hammergren. The former is not surprising; the latter, a bit so.


Technology

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Google Glass is a consumer bust that hasn’t even made it out of beta status, but it appears that Intel will get involved in selling it to enterprises, according to a Wall Street Journal report. A new Intel-powered version of Glass will be released next year and Intel will promote it to workplaces that include health systems. The new Glass is expected to have a longer battery life because of Intel’s power-conserving chips.

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Victoria’s Secret launches a sports bra that includes hidden heart rate monitor sensors.

Dropbox will launch its business API on Wednesday, which will allow third-party developers to create enterprise applications on top of the storage service using their own rules for security, compliance, and workload integration.

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An investigation by cybersecurity firm FireEye finds that an apparently US-based hacker group called FIN4 is using email phishing (without the usual obvious mistakes made by non-native speakers) to obtain insider information from 100 publicly traded companies, two-thirds of them in healthcare and pharma, that it then uses to play the stock market. Two of the identified targets are unnamed healthcare providers. The hackers embed VBA code in a copied document that mimics the Windows authentication prompt, leading the user to think they’ve lost their network connection and need to log on again. Those credentials are then used to probe the victim’s email for useful information and then to use that account to send compromised documents to colleagues at other firms. They even create Outlook rules to delete incoming emails containing words like “hacked” or “malware” that might have been sent as warnings from associates or IT departments. Recommended security actions include disabling Office VBA macros, blocking specific domains the group uses, and checking OWA logins from known Tor exit nodes since real users don’t use Tor (an anonymity network) to read email.


Other

USC cardiologist Leslie Saxon, MD provides some fascinating quotes in discussing her rather startling recommendation that patient biometric data should be placed on Facebook for doctors to review and share.

Oftentimes, you’ll see a patient and they have a vague symptom. You see them for 0.00001 percent of their life and you have to contextualize, use your experience, do some guesswork and diagnostics to understand what’s going on. Your car has over 100 sensors. They’re wireless, it’s continuously monitoring itself and telling you when it’s going to get sick, providing you with this A.I. so people’s cars don’t break down as often any more. One of the things that’s really interesting about digital health and sensors is that we haven’t seen a lot of the data that’s being captured before, so we’re not sure how to contextualize it. I’ve been doing cardio electrophysiology for over 25 years. Now that I’m monitoring some of my patients all the time, I don’t know what some of this stuff means. We’re going to have to build these data sets, track clinical events, then go back and contextualize it—say, oh, okay that was a sign of that.

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In England, the CIO of Meditech client Liverpool Women’s NHS Foundation Trust says EHRs from CSC, Cerner, and Meditech can’t handle hospital specialty areas such as neonatology and OB-GYN and he’s putting efforts instead into implementing the open source Alfresco electronic document management system. He says, “As long as you’re seeing all the information pertaining to a patient, why should I put it in a single box and sacrifice the good things on the specialist systems so it’s all in one place? I think I could do a lot more good for patients with the money it would cost.” Once Alfresco is live, Microsoft Sharepoint will get the boot because he says it’s too expensive. Alfresco is available as a free online trial or download.

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In Australia, Royal Children’s Hospital, which will go live on a $41 million Epic implementation in 2016, is looking for a medical device integration vendor.

The Russian economy continues to tank (no pun intended) beyond mass doctor layoffs and hospital closures as sagging oil prices and Western sanctions apply a double chokehold, with Apple raising prices up to 25 percent to offset the devalued ruble, which dropped 6 percent against the dollar on Monday alone and 42 percent in the past year. That puts the ruble as the world’s worst-performing currency behind only the subject of its aggression, Ukraine. Food prices are skyrocketing and banks have restricted the swap of rubles for other currencies. Up to 10,000 healthcare reform protesters took to the Moscow streets Sunday morning, carrying signs saying “Save money on war, not doctors” and demanding that the city official in charge be fired.

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Highland-Cashiers Hospital (NC) mails letters to 25,000 patients explaining that its HIM contractor TruBridge made a configuration mistake that opened up some of their information to the Internet.

A literature review finds that while HIE usage probably has reduced ED visits and cost in some cases, no studies have been conducted that prove any particular benefit even though the government has subsidized their operation with $600 million in taxpayer money.

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Several children’s hospitals will offer their patients televisits with Santa in the eighth year of the Cisco Santa Connection program that uses the company’s Telepresence system.

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Bizarre: a corporate guy buys a USB-chargeable e-cigarette from an eBay user in China. He plugs it in and the cigarette phones home and plants malware.


Sponsor Updates

  • TeraRecon offers an upgrade program for its enterprise imaging customers.
  • Perceptive Software is demonstrating new features of its Acuo Vendor Neutral Archive and the newly announced Clinical Archive this week at RSNA. 
  • University of Arkansas for Medical Sciences reports significant nurse time savings from using Capsule’s SmartLinx to send medical device data to Epic.
  • PerfectServe posts a blog entry titled “Evolving Healthcare: Six New Realities for the C-Suite.”
  • Extension Healthcare CEO Todd Plesko will present a session on alarm management at the mHealth Summit in National Harbor, MD December 7-11.

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 "13 comments" on this Article:

  1. re: Epic non-compete

    It’s ironic that one of the tools used to “persuade” hospitals to honor their non-compete is the good maintenance discount. Meanwhile, hundreds, if not thousands of experienced ex-Epic employees are forced to leave healthcare for a year. Most do not come back. It’s sad that most of the banks and insurance companies around Madison have more accumulated Epic experience on their payroll than many of the Epic-approved consulting companies that these same hospitals are hiring. How much has this cost the industry and individual hospitals in increased training expenses and missed opportunities???

  2. Looks like Cerner already has a 2 year non compete…

    http://www.bullhornreach.com/job/1390037_cerner-clinical-automation-specialist-jacksonville-fl

    *Please note that former Cerner associates within their 2 year non-compete are not eligible and should not be working at Cerner client sites within these 2 years.

    Easy to bash employers but they aren’t like college. You don’t pay them to get trained. They pay you to get trained and it’s fair to ask for you not to take advantage of that. Clearly forever isn’t fair, but a year not benefitting from their investment in you in relationship to their customer relationships isn’t all that uncommon.

    This goes back a long way in history and actually works in everyone’s best interest – even the whiney kids who thought they were entitled to train on Cerner’s or Epic’s dime and walk out and make their fortunes immediately while hurting the companies customers by failing to follow through on projects they signed on to do.

  3. RE: Agree to Disagree

    The economics behind an employee who will want to become an Epic consultant working for Epic are that the employee takes a lower salary than they otherwise would have while they are working for Epic and Epic subsidizes their training on the software (same as any large brand name software vendor).

    Epic’s only goal in enforcing its non-compete is its own financial benefit not “fairness” to anyone.

  4. To earlier points: It is fair for companies to expect a certain amount of payback for their investment in training. Judy always expressed intentions of making sure no Epic or customer employees were able to use the fact that they got hired to get their initial training and then jump ship.

    I was an employee at Epic in the mid-90s and our agreements at that time seemed more oriented to that principle. You had to agree not to work for a customer or consulting company for 6 months only if you left before 3 years of service at Epic. If you worked at Epic for 3 years, there was an understanding that you had paid back their investment in you.

    So while it didn’t affect me personally when Epic began making it a standard part of customer contracts that the customer wouldn’t hire Epic employees for a year after leaving Epic, a number of people I worked with that left after I did were very upset that Epic reserved the right to enforce terms on them that they didn’t agree to.

    My own feelings are that this is unreasonable. It gives Epic too much of a free pass to write this off as a reason that they are so successful “because they are so protective of their intellectual property”. This is really no different than other practices that benefit monopolies. Monopolies can do all kinds of unreasonable things that benefit them. So how could it not be succesful? The question is really whether they are competing fairly to expand their turf, or unfairly to protect their turf. This feels unfair, and it’s sad because it used to be reasonable.

  5. I hear the sound of violins playing, for all the poor ex-Epic folks who do something different for a year and then jump into consulting. Really one of the world’s great tragedies.

  6. Given the economy over the past 6 years or so of recession, it’s not trivial to be unable to find work in your field for a year. I’m not saying you should feel especially sorry for folks who often *chose* to put themselves into that situation, I’m merely suggesting that you might want to temper your scorn for it, particularly if you think that a two-year non-compete sounds fair.

  7. For some laughs, check out the linked article for some of the examples they listed as things the ex-Epic people did for their “year off” – fixing bicycles! Hanging out in coffee shops! *eyeroll*

  8. I don’t understand the logic behind seeing the 1 year non-compete as paying Epic back for their investment in you. Their investment in me was rewarded by me working my tail off to bring one of their customers live. They made hundreds of millions of dollars on the install, and my billable rate along made it a worthwhile investment on their part (Needless to say, Epic employees receive a paltry % of their billable rate).

    As someone mentioned above, the faux-altruism that Judy is constantly spewing is nonsense. Customers hire consultants because they NEED outside help. Restricting access to this pool of capable employees only puts customers in a bind. I know that Epic recommends that customers staff the project internally, but anyone who has done an Epic install knows that it requires a knowledge base that takes time and experience to create, and isn’t replicated by sending non-experienced folks to Verona for a week or two. If they really only cared about the end goal of making the customer successful, there wouldn’t be all of the antagonism that exists between Epic and Epic-consulting firms.

    Instead, they try to undermine the credibility of established firms with a track record of success. All so they can send out their >200/hr ‘experienced’ implementers instead of letting the customer hire people with much more experience for half the price. The funny thing is, anyone who has been on both sides of the equation knows exactly how most customers view Epic and their practices. I can’t tell you how many meetings have ended, and after Epic drops off the customer looks at me and says ‘Okay, now tell me what’s really going on.’ It doesn’t exactly leave a good taste in their mouth when they can do a quick LinkedIn search and realize they are paying more for their 5 month tenured AC than someone who worked at Epic for 4 years.

  9. It would be nice if Epic enforced their policy fairly. Certain consulting firms can do as they please with ex-Epic consultants while others are called on the carpet by Judy. Can’t wait for the Epic implementation business to dry up!

  10. Mr. Drummond,

    Agree. With HITECH moving through its money, we’ll see consulting opportunities dry up dramatically.

    Won’t be a good time to be a consultant. Big firms will start to give the low level bench away cheap to gain favor at the senior strategic level.

    All those Epic kids who jumped ship will be looking to climb back aboard somewhere. Most of them are pretty bright, so I assume we’ll see an infusion of low cost, normal labor rate, good experience people moving into jobs in delivery systems.

    Should be an interesting and innovative time.

  11. Those who’ve never opened and ran a business – don’t sound like business people.

    I’d suggest staying consistent – and focus on companies that are out-of-business.

  12. Regarding Mr. Pink’s comments: If your point is that the non-compete problems of a middle class, college-educated employee seem indulgent compared to the concerns of the truly destitute in poor countries, then I think most people would concede that point. We’re talking about a Developed World dimension of a problem. That doesn’t mean that there isn’t still a problem.

    You were simply quoting a Tarantino movie with the sound of violins, but it is a useful analogy, so allow me to retort. Maybe the concerns of an ex-Epic employee sound like violins. I doubt, though, that most people can hear those violins over the Stratocaster turned all the way to eleven (with great distortion) by Billionaires.

    It’s not helpful to mock a semi-privileged class when an uber-privileged class is behaving unreasonably towards them. I can’t say that I feel true pity for someone who chooses to wait out a 1 year non-compete, but it is a fair point that even the 1 year restriction is very out of touch with the workforce and what had always been Judy’s stated aims – to prevent poaching.

    Most people reading this board are likely college-educated and middle class, and leaving aside some of the stories about coffee shops and fixing bikes during the year after Epic, most of these people are just like us at that stage. There are college loans, car payments, rent, and everyday things. They hustle. They work.

    I’m sympathetic to these folks because I was one at one time. So were most readers. And I doubt most people think it’s reasonable to demand 2 years, when 1 year was already over the line. Or to demand any timeout after a certain period of service to Epic. Or to write clauses into customer contracts which effectively extend prohibitions on future employment beyond what you agreed to in employment contracts with all your earlier employees. That last one doesn’t just sound unreasonable. It sounds like a potential cause for action by a class.

    As someone who is oriented to Epic’s customers’ point of view these days, it also needs to be said that the employees aren’t the only ones getting hurt here. The length of these restrictions drives up the cost of consultants. The higher cost of consultants increases the incentives for people to leave Epic. Customers pay a cost in that process.

    I don’t like calling Epic out too specifically here. They’re ultimately doing what a lot of other companies are doing. But they are what started this conversation and a number of us who have had fond experiences with them don’t want to believe what we’re seeing in Judy stepping this far beyond the rationale she’s always had in these policies. 1-2 year prohibitions on working in the broader Epic community aren’t about preventing poaching anymore. They’re about hurting competition in areas you’re looking to move in on, and spiteful against good employees that for whatever reason decided to leave.

    The Judy I wish to remember didn’t want to appear as the bull in a China shop, and I believed in her as really showing a way to compete and win in a noble way. The best noncompete strategy Epic’s had is to make itself the place people prefer to stay. It would be very noble of her to do one of her counterintuitive flourishes in this moment and return to Epic’s original employment terms. Contradict the “wisdom” of these noncompetitive practices that were the darker side of the Steve Jobs Legacy, and treat your employees as the professionals they are. After all, they helped make you a huge success.







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