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March 10, 2015 News 11 Comments

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A GAO audit of the PPACA-mandated Patient-Centered Outcomes Research Institute (PCORI) predicts that its PCORnet research data network will struggle because EHRs have no common data model, which will require hiring resources to process the submitted information manually. GAO also questions whether the organization’s funding will be ongoing and sufficient, but notes that PCORI plans to sell data to drug companies. (Does any healthcare organization’s business model not involve selling data to drug companies?) PCORI also notes that it doesn’t always have or need claims data. It also acknowledges that its information will rarely be complete because of lack of a national patient identifier. PCORnet has spent $106 million so far of an expected total cost of $271 million through FY2019.


Reader Comments

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From Justin Graham: “Re: infectious disease informatics docs. There are a handful of us ID/IT types. Harris Stuttman at Memorial Long Beach, Gifford Leoung at Dignity, and David Classen in Utah and a few others immediately spring to mind. I’m sure there are more since the ID procedure of choice is the chart biopsy.” I shouldn’t have ignored that tiny warning in the back of my head as I was interviewing Ogechika Alozie and mentioned that he was probably the only informatics person I know with an ID background. I’ll hide behind my carefully placed “probably” in claiming good intentions while admitting poor off-the-cuff execution. Justin and I also talked about CMIO networking at the HIMSS conference and I volunteered to coordinate something for those CMIOs who are interested – let me know if that describes you (maybe Dr. Jayne will hang out with her peers).

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From Solilliquist: “Re: NantHealth rumor. They aren’t making Allscripts their sales organization. Just a few salespeople were let go and in fact new sales leadership is coming on board.” Unverified, but the source is sound.

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From Watcher of the Skies: “Re: eClinicalWorks. They have installed an inpatient system in 10+ hospitals in India. They are looking at hospitals in Europe and may someway bring the product to the US.” Unverified.

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From Nurse Tina: “Re: Antelope Valley Hospital EHR failure. The nurse union is asking the LA County Department of Public Health to investigate.” The California Nurses Association wants to know why the hospital didn’t have a backup plan for its unexplained system failure, which the nurses say caused a variety of clinical problems. The financially struggling hospital raised eyebrows a couple of years ago when it admitted marketing its OB services to pregnant women in China, who in return for paying their bills, earned their newborns instant US citizenship.


Cerner’s Implementation of OpenNotes

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I mentioned my interest in talking to an EHR vendor about their support of OpenNotes. Cerner connected me with Brian Carter, senior director and general manager of member engagement.

Brian says Cerner’s HealtheLife patient portal has given patients access to provider documents for at least five years, so it wasn’t challenging to expose yet another document in the form of provider notes. Cerner created a facility-wide configuration setting of whether the client wants to expose the notes. A second level of granularity is provided by allowing each client the option to allow their providers to designate a specific note as “private,” but interestingly only one client has chosen that option – none of the rest of its customers allow doctors to hide individual patient notes.

I asked Brian if clients are monitoring whether patients are reading their notes. He says clients use a lot of patient engagement reports, such as showing how long it takes each provider to respond to electronic patient inquiries, and seeing how patients are interacting with the notes about them will probably become a popular measure.

Brian says that no customer has complained that a patient saw something awkward or misleading. Any issues of that type lead to having a conversation with the patient that was probably important to have for other reasons. He mentioned an HIE-like example where a confused ED patient remembered that he had access to his records at another hospital via OpenNotes and he helped staff read up on his condition, avoiding an expensive battery of lab tests that was about to be ordered (I joked that it was like a patient-carried HIE, where the providers can’t access each other’s records except through individual patients, which isn’t a bad model).

I asked about planned support for OurNotes, where patients can annotate or add their own thoughts to the chart. Brian says patients could use that to correct their meds list or report a new allergy. I asked if that is wise since the hospital would be on the hook legally to actively monitor and react to those messages that could be coming in around the clock. Brian says the option will be offered only if the patient has a scheduled appointment within an upcoming window of time, which would then allow the provider to review all of their generated notes at once and reconcile their official EHR information during the visit.

I asked if Cerner plans to support patient-entered forms to make visits more efficient. The company is developing a custom form generator to create documents that patients can complete in advance, conserving their face-to-face provider time for more important interaction. Brian gave an example of a neurology practice that has a 90-question form that the patient can complete at home, which not only saves time, it also populates discrete Millennium data fields that can trigger alerts or document workflow.


Webinars

March 12 (Thursday) 1:00 ET.  “Turn Your Contact Center Into A Patient-Centered Access Center.” Sponsored by West Healthcare Practice. Presenter: Brian Cooper, SVP, West Interactive. A patient-centered access center can extend population health management efforts and scale up care coordination programs with the right approach, technology, and performance metrics. Implementing a patient-centered access center is a journey and this program will provide the roadmap.


Acquisitions, Funding, Business, and Stock

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Evidence-based imaging analysis vendor HealthMyne raises $4.5 million in a Series A funding round led by two Madison-area venture firms.

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Kareo acquires patient engagement and marketing technology vendor DoctorBase.

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Doctor house call vendor Pager raises $10.4 million from existing investors despite what would seem to be significant scaling barriers.

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In Scotland, Craneware announces six-month financial results: revenue up 2 2 percent, adjusted EPS $0.165 vs. $0.143.

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Epic CEO Judy Faulkner tells Modern Healthcare’s Joe Conn that she has created a private foundation that will receive all of her billions’ worth of Epic shares upon her death or any time at her discretion, guaranteeing that the company will never go public. She explains,

“One, I didn’t want the money, personally, or for my family. What would you want with all that money? It doesn’t seem right and I can’t tell you why. (We’re) putting it into a trust that can be used for the benefit of healthcare organizations, other exempt organizations and our communities. We can use it to (help) other charitable organizations that have contributed to our success. Because that’s where it came from.”


Sales

St. Peters Health Partners (NY) chooses Phytel for population health management.

Cornerstone Healthcare Group (TX) chooses MModal for documentation services and technology.

Greenville Health System (SC) will implement performance management tools from Practical Data Solutions as part of its Epic implementation.


People

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New York’s Healthix RHIO names Todd Rogow (HealthInfoNet) as SVP/CIO.


Announcements and Implementations

Northwestern Memorial Physicians Group (IL) goes live with Forward Health Group’s PopulationManager.

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For-profit consulting firm Ethisphere has been criticized in the past for charging companies to apply for its “World’s Most Ethical Company” award and charging winners again to use the resulting logo. If you’re still interested, the healthcare-related 2015 winners are Novation, Premier, Baptist Health South Florida, Cleveland Clinic, HCA, North Shore-LIJ, University Hospitals, and three Blue Cross companies. HCA also made the ethical list for the sixth year in a row despite having paid $2 billion in a 2002 settlement for Medicare fraud and another $20 million in 2005 for share dumping by several HCA executives right before the company announced poor earnings.

Zynx Health releases Consensus Builder, a web-based addition to its Knowledge Analyzer that allows clinicians to discuss and approve clinical content being developed.

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Cleveland Clinic will partner with lab testing high flyer Theranos to explore the possibility of reducing testing costs and turnaround time.

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Two academic medical centers in the Netherlands halt their implementation of the former Siemens Soarian, saying they are uncertain about the product’s direction under its new owner Cerner. A reader from there suggests that Cerner wasn’t showing much enthusiasm for the project at Erasmus University Medical Center Rotterdam and University Medical Center Groningen, adding that the small country has only eight academic medical centers and they are each going their own way instead of working together. Siemens announced the $55 million deal a year ago. 

Allscripts will embed Elsevier’s CPM Framework nurse treatment plans product in its Sunrise EHR, clearly hoping (given the fawning press release wording) to bolster its DoD EHR bid chances. The announcement is interesting since Sunrise developer Eclipsys (acquired by Allscripts in 2010) originally owned CPM Resource Center and sold it to Elsevier in 2007 for $25 million. Eclipsys originally bought the well-traveled CPMRC in 2004 for $5 million.

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Chesapeake Regional Medical Center (VA) will implement Epic using services from Bon Secours Health System subsidiary Good Health Connections, replacing McKesson Horizon.

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CoverMyMeds publishes the Electronic Prior Authorization (ePA) Scorecard. Facts from it:

  • ePA volume is increasing 20 percent per year.
  • 40 percent of prior authorizations are abandoned because of the workload involved.
  • 70 percent of patients with prescriptions requiring paper-based prior authorization don’t receive the meds originally prescribed.
  • 54 percent of EHR vendors have committed to supporting ePA, but only Allscripts, DrFirst, Epic, NextGen, NewCrop, and Practice Fusion have it available now.
  • 67 percent of payors and 70 percent of pharmacists have committed to supporting ePA and most of them are live.

Telehealth solutions vendor Ostar Healthcare technology announces its cell-enabled, vendor-neutral gateway that integrates payer and provider systems with remote monitoring devices such as scales and glucometers.

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Mark Neuenschwander has been around pharmacy-related IT for a long time, having brought out early comparative reports on automated dispensing machines and then on bedside barcoding. His new focus is on technology-assisted sterile compounding systems, those IT systems used in pharmacy IV rooms to make sure custom bags are correctly prepared (robotic systems, barcode scanning, imaging, volumetric and gravimetric analysis, etc.) His new report is available to hospitals for $349 and to everyone else for $499. I will say that when I was once asked to approve the purchase of one his reports for the IT department I was skeptical about the value, but once I saw it I (and used it) I declared it to be one of the most cost-effective information sources I had seen and I used it to plan our medication automation strategy. I’m mentioning it here since I know his work and some readers will be interested in it.


Government and Politics

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Oregon finally legislatively kills its Cover Oregon health insurance exchange, having not enrolled a single citizen for its $248 million cost and generating lawsuits between the state and its developer Oracle.

The cost of the Vermont Health Connect health insurance exchange could reach $200 million and the backlog of coverage change requests stands at more than 11,000.  

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FDA issues draft guidance (in the form of Q&A) for using electronic informed consent in clinical studies. It addresses such issues as how subject questions are handled, how to make sure subjects understand the information, and subjects are notified of changes during the study, and whether electronic signatures can be used.

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Bizarre: FDA recently developed a smart plan to stamp implantable medical devices with barcodes to allow tracking and recording them for clinical purposes. IT-inept CMS bureaucrats (the folks who brought you Healthcare.gov) are trying to kill the project, saying it’s too much trouble for them to add the ID number to claims forms, or as recently departed CMS Administrator Marilyn Tavenner explained in a February 23 complaint to two senators, “including UDIs on claims would entail significant technological challenges, costs, and risks” (to her agency, not to patients, just to be clear.) HHS Secretary Sylvia Burwell is on record as favoring including device IDs on claim forms.


Technology

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Apple announces its smartwatch and its long-awaited price — $350 to $17,000, depending on style (surely only rich fools would pay $17,000 for a first-generation electronic device that will be obsolete in a year). The ship date for the Apple Watch is April 24. As expected, it requires an iPhone for connectivity and does little that the phone can’t do perfectly well on its own, with the most obvious minor benefit being that people who stare at their phones all day instead of the world around them might appear slightly less self-fixated in staring instead at their wrists. Its most important feature is that fanboys will love it and toy with it conspicuously to make the rest of us feel that our lives are barren without it. The reviews have one point in common: nobody can figure out why it exists other than because Apple says it’s cool. The best reason to stick a new, expensive input device between you and your iPhone would have been the health tracking capabilities that Apple had to leave out.

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Apple also announces ResearchKit, an open source iOS software framework that allows people to connect with medical research studies via their iPhones. Developers can create testing apps that analyze voice patterns, handwriting, and gait that can then connect possible research subjects to programs and allow subjects to submit forms from their iPhones. Apps have already been developed for asthma (Mount Sinai), breast cancer symptoms (Dana-Farber), cardiovascular health (Stanford), blood glucose (Mass General), and Parkinson’s disease (University of Rochester). Sound good except that self-selected research participants don’t necessarily form a representative cohort, limiting the ability to draw inferences from their experience. There’s also the question of positively identifying candidates and their suitability based on something they type onto an iPhone screen.

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A fitness app developer says wearables (a term he deems “insufferable”) are making people less healthy as they focus entirely on hitting their easy 10,000 walking steps instead of doing actual strenuous activity. I’ve said that many times – an exercise program that doesn’t involve cardio and weights isn’t really an exercise program and instead is just plain old “activity,” which at least is better than sitting on the couch or at a desk.

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Personal ECG app vendor AliveCor earns FDA approval for providing a “normal ECG” message to users or to let them know their data is unreadable and to try again.

Influential 10-year-old technology blog Gigaom shuts down due to going broke.


Other

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A HIMSS Europe report that brashly declares that health IT reduces inpatient mortality, which it “proved” by simply matching up EMR Adoption Model scores vs. weighted mortality (note the not-very-many data points wandering around all over the place). It “confirms” its conclusion by asking IT people in hospitals that spend more money on IT if those systems improved outcomes, which of course resulted in a lot of “yes” answers. Skip all the verbiage to the end, where you’ll find, “Organizations with a higher EMRAM score tended to have a low mortality rate.” That’s an Evel Knievel-sized jump away from proving that if A correlates to B, then A must have caused B. Maybe higher-spending hospitals had more cash to invest in hiring better people, or were located in an area with a milder flu season, or were more enlightened about processes and outcomes which resulted in their buying technology rather than vice versa. We also don’t know how those hospitals performed before they implemented technology, which might be the most useful of the omitted information. HIMSS has a multitude of vested interests here: selling its EMRAM, pitching the wares sold by its Diamond members, and selling memberships and publications. They failed to prove anything decisively.


Sponsor Updates

  • PatientSafe Solutions publishes “Unsecured Texting – The Monster Underneath the Bed.”
  • Direct Consulting Associates is profiled in a regional business publication after being named a NEO Success Award winner recognizing top-performing companies in Northeast Ohio.
  • Surgical Information Systems releases a quality extract for surgery-related eMeasures.
  • Novation will offer its members Versus RTLS workflow solutions.
  • First Databank posts “Sharing Lessons Learned in NDC Data Collection and Publishing with UDI Initiative Stakeholders.”
  • CoverMyMeds will exhibit at the sPCMA 2015 Business Forum March 16-17 in Orlando.
  • Clockwise.MD is named a semifinalist in the HIMSS HX360 Innovation Challenge.
  • CareTech will exhibit at the ACHE Congress on Healthcare Leadership March 17-19 in Troy, MI.
  • Bottomline Technologies will exhibit at Microsoft Convergence 2015 March 16-19 in Atlanta.
  • Clinical Architecture posts “The Road to Precision Medicine.”
  • CitiusTech offers “Making Clinical Data Actionable for Payers.”
  • Culbert Healthcare Solutions highlights “Issues to Consider When Sunsetting a Legacy Practice Management System.”
  • CareSync asks, “How Important is Sleep, Really?”
  • Bloomberg TV will feature Anthelio Healthcare Solutions on March 15 at 3 p.m. ET.
  • ADP AdvancedMD offers tips to create “The EHR-Switch Prep Plan.”
  • Impact Advisors is sponsoring the Women Working in Technology conference at Ball State University on March 20.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Currently there are "11 comments" on this Article:

  1. Cerner’s Implementation of OpenNotes – how about some real statistics? Cerner says, Brian says, He says, what do users say?

  2. RE: Netherlands academic medical centers halting Soarian implementation

    I don’t know the specifics, but it may be the right choice to stop spending more money on a product with a defined, limited lifespan. I wonder how many Soarian customers are already electing to move to Cerner Millennium? I know of at least one. How many other readers know of similar situations?

  3. RE: Wearables

    The link to the article doesn’t appear to be working, but I find that to be a pretty fantastic claim. Folks with the motivation to start an exercise routine don’t need wearables to motivate them, but they do provide some data for amusement more than anything. Wearables are positively impacting the other folks who’s default is couch time but now have a method for tracking their activity that provides instant visual gratification that they’ve accomplished something.

    Wearables are a gateway drug to exercise.

  4. re: Faulker private foundation. I’m skeptical on the legality of Judy’s plan to keep Epic private forever. I think the estate laws actually require the foundation to sell the stock. So the foundation has to sell the stock to generate the money it’s chartered to give to the charities if it is supposed to support. The foundation ends up selling off Epic piece by piece to give the proceeds of those sales to the charities. That leaves those Epic shares up for grabs, going to the highest bidder. Bring on the Black Friday free-for-all on Epic stock. When do we start lining up?

  5. This is completely and 100% untrue. Foundations can hold shares for as long as they see fit and, in fact, it would be in the foundations best interest to hold dividend paying shares to continue to fund on-going operations. If Judy wants to see her shares in private hands long after she is gone, she is more than welcome and allowed to do so.

    Many wealthy individuals donate shares to foundations. Warren Buffett being a great example. He would never allow shares to be forced on to a market at a specific time because it would greatly reduce the price of those shares.

    The only scare tactics that should be employed regarding EHRs are to those vendors that have zombie EHRs in near bankruptcy publicly traded companies. Be very wary of investing in a vendor that will quickly and without warning leave you in a lurch either in bankruptcy or by not living up to commitments.

  6. Re:Confused Consultant. I’ve no doubt that Judy has an army of highly paid lawyers who know estate law better than you.

  7. Re:Confused Consultant

    Think Hersey’s Trust Company but with a private company’s stock. The eventual bequest from the estate to the charitable organization would be pretty straight forward I think… The trust likely won’t be allowed to sell the shares (see what the Hershey board tried to do in 2002) no matter what, but will be able to pay forward the dividends to other groups.

  8. Seems to be a decidedly negative note to things today… At first I attributed that to the date (3/11), but then I remembered that I always get that wrong (the Ides of March is actually 3/15)…







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