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Monday Morning Update 8/31/15

August 29, 2015 News 17 Comments

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Former BIDMC CEO Paul Levy urges the attorney general of Massachusetts and her counterparts in other states to launch an anti-trust investigation into Epic, saying that agreements such as the one between Partners HealthCare and Epic “box out the competition” as the organizations act on their own mutual self interest. He gives this play-by-play:

  1. Partners spends $1.2 billion to implement Epic.
  2. Partners and Epic tell affiliated (not owned) medical practices that they have to replace their existing EHRs with Epic because they won’t be interoperable with the Partners (Epic) systems otherwise.
  3. Partners tells those practices that it won’t work with them if they don’t use Epic.
  4. Partners locks in its affiliated practices and dominates its market even further, while Epic forcefully displaces its EHR competitors, benefitting both organizations.

I hadn’t heard much about Levy since he parted ways with BIDMC (a Partners competitor) in January 2011 several months after admitting to an inappropriate relationship with a female employee (his MIT academic advisee hired as his chief of staff). Levy is working for a negotiating company, married his former chief of staff, and co-authored with her How to Negotiate Your First Job: 8 Steps That Will Create Value for You and Your New Employer.

Levy adds interesting commentary in response to a reader’s question: “Note above that BIDMC desire was to provide interoperability to the Atrius doctors. Brigham and Women’s Hospital, part of Partners Healthcare System, had had a referral relationship with Atrius for the previous 20 years. They had often promised to give Atrius that capability but stubbornly refused to provide it. There was nothing about what Halamka set up in roughly 60 days that BWH could not have at some point during the two decades. But providing interoperability was counter to the PHS strategic plan. This point was actually made by PHS at a financial briefing to bond investors in NYC–where they used the fact that interoperability was NOT available as a feature securing their finances–by making movement of patients out of their network more difficult. Folks on Wall Street found that an attractive strategy, too.”


Reader Comments

From Skeptical Shrink: “Re: blood test and app to predict suicide risk. Many promising genetic findings and biomarkers have been touted in the past, but failed to replicate. The app just incorporates known risk factors, so there’s nothing new there, although one unique thing is that it doesn’t rely on the patient’s self-report about suicidal ideas or plans. The bigger caveat is that the app won’t be helpful because it predicts suicide ideas in the next year, but in the ED, you need to know what’s going to happen soon to decide whether to hospitalize them. You’ll already know if they need a mental health referral, so the app doesn’t help you there. The study may or may not be a starting point in predicting suicidal behavior, but I don’t see the genetic test or app as ready or helpful for clinical use.” It does seem odd to think that suicidal behavior has a genetic basis that can be measured with high correlation. I like the behavioral apps that measure mood or that allow patients with known suicidal or depressive thoughts to “check in” each day with an assessment of their well being to allow outreach when indicated. 

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From I Want My Taxpayer Money Back: “Re: getting a clinical summary. I received a clinical summary after my specialist visit, hoping to use it to remind me about what we talked about and what I should be doing. It contained only the information I already knew from previous visits (meds, allergies, problems). I asked how I could get a copy containing his actual notes from this visit and they said I wasn’t the first person to ask. What good is CMS making sure EPs provide a clinical summary if the doctor’s notes aren’t included since they haven’t otherwise documented anything yet? Am I supposed to call or send a portal message days later to get the comments he made?” CMS’s Meaningful Use standards define a clinical summary as containing “relevant and actionable information and instructions” that mostly involve updated copies of the same basic information (meds, vitals, procedures, problems, and future visit instructions) along with “instructions based on clinical discussions that took place during the office visit.”  I don’t believe CMS requires sharing physician notes (that would be more the purview of the OpenNotes project, which I wholeheartedly support) although your doctor might be falling short of the documentation requirements if your summary didn’t include the instructions you were given verbally. Readers most likely can elaborate further, but from a technical and personal experience standpoint. I’ve been pretty happy with those I’ve received even though I don’t find much useful information in them, but I wouldn’t say they include every suggestion, observation, or aside that comes up in conversation. My suggestion would be to ask your specialist if it’s OK if you record your visit on your phone for later review, although some doctors will resist due to malpractice liability concerns. A good compromise would be to bring paper and a pen and take notes of what your doctor is saying – that creates shared ownership, and since most of us have kinesthetic and visual learning styles and therefore need more than just spoken words, you’ll remember almost everything even before you leave the office.

From The PACS Designer: “Re: Universal Data Link. You will be hearing about the Universal Data Link (.udl) application. Microsoft will be leading this effort since Windows Server 2003 reached end-of-life support last month with Windows XP next. Using the Microsoft Universal Data Link will simplify connecting to the numerous databases in existence today when doing database software upgrades of servers.”

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From We’ve Always Been At War With East Asia: “Re: Glens Falls de-installation of Epic. Judy Faulkner has been saying to large audiences that it doesn’t count as Epic’s losing a customer since they had only ambulatory. How does a company lose a customer while claiming its record is still unblemished?” I think Epic’s “we’ve never lost a customer” statement should be retired. It was already asterisked with “except in the case of acquisition” and now would require a second asterisk to say “and except for ambulatory-only sites.” Glens Falls will replace Epic ambulatory with Cerner, which it was already using on the inpatient side.


HIStalk Announcements and Requests

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Poll respondents say the ICD-10 switch in 4 1/2 weeks could go just about any way, with 29 percent saying CMS won’t be ready and payments will be delayed, the same percentage stating that providers won’t be ready, and 18 percent each predicting that just a few providers won’t be ready or that the conversion will occur with no major problems. Joe says the real problems will surface on October 15 as providers see reduced payments due to incorrect or non-specific ICD-10 coding, with the latter being acceptable to payers because non-specific codes pay less. New poll to your right or here: have you personally seen a health IT vendor software contract that contained a non-disparagement (“gag”) clause?

Dr. Jayne’s description of a practice scrambling to recover from a bad ICD-10 related update raised questions – email me with your experience:

  • Have you seen problems as Dr. Jayne described where an ICD-10 software  change will cause clinical (rather than billing) consequences?
  • For vendors, when was your final ICD-10 software update released?
  • For vendors, how many of your customers have installed the latest ICD-10 software update?
  • For customers, are you scrambling to get consulting help or your vendor’s attention as we wind down the last month of ICD-9’s existence?

I was thinking about the WDBJ shooting and the guy’s long record of work-related performance and anger issues, wondering if his previous employers disclosed his known problems when they were asked for a reference. My experience in hospitals is that you never say anything negative when asked for a reference (except perhaps acknowledging “not eligible for rehire”) for fear of being sued, even if the employee was caught stealing drugs, committing shocking medical errors, or threatening co-workers (it’s the HR version of software contract gag clauses). The best example is nurse Charles Cullen, whose several hospital employers strongly suspected he was killing their patients but let him quit with no blemishes on his record just to get rid of him quietly, allowing him to ply his trade by killing patients at new hospitals. He confessed to murdering 40 inpatients using common Pyxis-stored drugs (digoxin, potassium chloride, and insulin), but experts think he really killed hundreds.

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We’ve booked nearly all of the available sponsorship spots for HIStalkapalooza except the top one, the “Rock Star CEO” package that includes a bunch of invitations, an on-stage role, all-access passes, and a swanky private lounge in the House of Blues Las Vegas for entertaining prospects and guests. Contact Lorre.

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Ms. I sent photos of her Washington state kindergartners using the Microsoft Surface Pro 3, iPad Mini, and related accessories for math skills review that we bought via the DonorsChoose project (made possible by vendor donations – thanks!) She says the students use them every day. Companies can contact me to donate and have their money matched by an anonymous vendor executive who loves supporting STEM education in schools.

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

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Last Week’s Most Interesting News

  • CMS says its latest round of ICD-10 claims submission tests indicate that it’s ready for the October 1 switchover.
  • The VA awards Systems Made Simple and Epic a seven-year, $624 million contract to implement Epic’s Cadence patient scheduling system.
  • Banner Health confirms that it will convert its acquired University of Arizona Health Network from Epic to Cerner.
  • Health Catalyst shuffles its executive team in what appears to be preparation for an IPO.
  • CVS announces plans to extend its telehealth reach via pilot projects with American Well, Teladoc, and Doctor On Demand.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Announcements and Implementations

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Providence, RI-based Sproutel will introduce Jerry the Bear in September, a “smart teddy bear” that gives kids a medically validated curriculum for diabetes and other chronic conditions. They learn by feeding Jerry a healthy diet, matching insulin doses to carb intake, administering insulin, and listening to Jerry describe how he feels when his blood sugar is high or low.

Twenty-five bed Aspen Valley Hospital (CO) will implement Epic through Denver’s University of Colorado Health.


Technology

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A former Arizona State University rugby player who suffered an on-field concussion develops FITGuard, a smart mouthpiece that uses a player’s medical history and the measured force of hits to the head to light up concussion warnings. The connected app then automatically walks coaches or medical personally through a concussion assessment to make sure they get medical care if warranted.


Other

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The Madison, WI paper predicts Carmageddon-level traffic this week as Epic’s user group meeting brings in 9,000 visitors and local schools begin classes on Tuesday. It’s going to be warm in Verona, with highs near 90 each day and high humidity.

Yelp, which will now feature more information about hospitals, admits that it’s hard for the company to manage Internet shaming that poses as reviews, such as those reviling the dental practice of lion-shooting dentist Walter Palmer by non-patients (removal of which triggered a free speech protest despite their irrelevance to his dental capabilities) and a “review war” of Democrats vs. Republicans on the Yelp page of a pizza restaurant whose owner was photographed hugging the President. The insightful article predicts the creation of a “shame economy,” where consumers threaten business with negative reviews and businesses hire reputation management firms to fight them. Yelp claims it, too is a victim since it’s at the mercy of user-generated content, but it didn’t complain about making money for doing little more than creating a platform for free contributions.

Bankrupt Hutcheson Medical Center (TN), which re-opened its closed OB unit this past December with fancy hardwood floors, Wi-Fi, HDTV, and iPads, shuts the unit back down again after the upgrades failed to attract enough business.


Sponsor Updates

  • The SSI Group and TeleTracking will exhibit at the California Association of Healthcare Admissions Management event through September 2 in Sonoma.
  • Surgical Information Systems recognizes clients and partners including Abington Health (PA), Robert Wood Johnson Health Network (NJ), Susquehanna Health System (PA) and CapsuleTech with its Perioperative Leadership Awards.
  • T-System will exhibit at the 2015 GHIMA Annual Meeting September 2-4 in Jekyll Island, GA.
  • Recondo Technology integrates its BenefitPlus patient estimation tool with Epic’s Benefit Collector, increasing point-of-service collections by an average of 12 percent in a multi-state health system.
  • The Children’s Home Society of Missouri honors TriZetto with its Visionary for Children Award.
  • Valence Health releases results from its annual US Attitudes Towards Health Insurance and Healthcare Reform survey.
  • Forbes ranks Verisk Analytics the 18th most innovative company in the world.
  • Vital Images will exhibit at HIMSS AsiaPac15 September 6-10 in Singapore.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Currently there are "17 comments" on this Article:

  1. The real problem with the Epic/Parnters saga is Partners. They are, by themselves, a monopoly in Massachusetts and they act that way.

  2. Paul Levy’s personal life betrays his true character.

    He was fired for good reasons – poor judgement and not understanding the world as it is.

    His silly attacks on Epic and Partners and on them each separately through the years are unfounded and come from that same lack of character and poor judgement that haunted him throughout his life.

    If his vision of making the world a better place is to attack those who contribute to that mission every day, then he’s seriously misguided.

    Time to let obscurity welcome him with open arms.

  3. I agree with not being to know about Mr. Levy’s personal life unless it is germane to the story. I think more highly of HisTalk’s journalistic quality.

  4. The Partners/Epic issue with affiliates is well known here in the inner circles of independent medical practices. Together, these two are trying to strong arm affiliates into adopting Epic – though admittedly, Epic is taking more of a back seat to this, than what they have done elsewhere, and letting Partners lead the charge. And yes, it is a fact that Partners is telling practices that you either switch to Epic, or you are out of our network and our contracts with payers.
    I’ve advised a number of specialty practices that have relationships with numerous healthcare systems (Boston Childrens, a Cerner shop, BIDMC, a RYO shop, several Meditech community Hosp in area) to hold their ground. Eventually, Partners will see the light and back down. Of course Levy’s request to the AG is only making matters worse for Partners in the local press.

  5. Its posts like this one that make me want to stop my 10 year readership of histalk. This reads as a personal attack and does not add context to his comments. I’m OK reading this blog knowing it has a slant towards Epic, but this is another example of bias that erodes confidence in the reader. I understand that this blog is crafted through countless hours of personal time, but this isn’t journalism and shouldn’t be construed as such. I don’t know when, but histalk has become the Fox News of healthcare IT.

  6. I suppose if Phil Spector writes a dynamite new song, you all want the news articles to just gloss over all his “personal problems.” A journalist writes a four paragraph article about the man, and spends two sentences discussing his past, and you all think it’s a hatchet-job? Overreact much?

  7. Paul Levy’s background is important for those in the industry who don’t know him — likely b/c he’s not done anything in healthcare for years. He can’t just be labeled as a “former CEO” without updating what’s happened since if his Epic comments are to have context. Nothing in this post is news about him – he admitted what he did and it’s in his Wikipedia entry. He created a high paying job for his former student and made employees uncomfortable with the relationship, which is the real story (not the personal parts of it that weren’t stated here). The book plug was nice and she was his co-author. HISTalk didn’t mention his Athenahealth (anti-Epic) shilling and that he helped BIDMC earn a $7 million settlement for gender bias toward his chief of anesthesia.

    Levy led a shocking BIDMC turnaround, but it’s not all lollipops and rainbows. See here:

    http://www.bostonmagazine.com/2010/11/the-getaway/

    Otherwise, who cares? His blog comments were important to be the lead HISTalk story.

  8. Speaking for ambulatory clients I must confess some extreme frustration at Judy’s comments, assuming that report is accurate. 

    Compared with Epic years ago, almost everything about our experience has declined and it just doesn’t register with them. Code quality has become more of a concern as they have grown, the quality of their installs on new products has been down, and the ongoing support relationship on their more established products lacks the initiative to keep up. Frontline support staff tell us we have to wait one or two versions for almost every fix, even for things that are comparatively simple. And the timelines for these new versions only get longer. It doesn’t even feel like we have anyone we can complain to anymore. Carl might hand us off to someone, if he responds at all, and the people we get handed off to are more and more abrasive.  They’re not seeing what we’re seeing, which is that they are slowly becoming the lumbering Goliath to whom they always claimed to be David. 

    My only slight relief at Judy’s comments lies in that she actually said in words what Epic has been saying in deeds for some time. It would be actual relief, however, if it was an acknowledgement and not an excuse. Epic is trying to rationalize a loss by claiming the customer didn’t count, but it’s the fact that customers increasingly don’t count which is the whole problem.  

    There’s a direct line between that attitude and the story in today’s update about Partners. Epic made its name by being the better choice. I’m sad to see it acting more and more like it’s the only choice.

  9. Two pieces of context

    1. Partners has a similar portal from atrius to its instance of epic- the same not levy references halamka built. It’s true halamka built it first. But I am pretty sure it’s not true that a similar tool doesn’t exist at partners

    2. It’s my understanding that many (although not all) practices in partners contracts use their home grown emr. With the move to a commercial product, they are retiring that emr. so that explains some of the move to epic

  10. “What good is CMS making sure EPs provide a clinical summary if the doctor’s notes aren’t included since they haven’t otherwise documented anything yet?”

    Sometimes I wonder who writes these questions. Anyone with any real desire to know what’s required by CMS for clinical summaries could do what those who trudge the road of MU have done and look it up: Alas, physicians notes are not required in clinical summaries.

    Further more, anything more than a sample rate of 1 in a survey of outpatient docs will provide opinions across the entire continuum: from those on board with the idea to those entirely against, in my experience.

    Transparency is the new normal, however, and at least one of the big three EHR vendors is including the option as a feature. As mentioned, the whole idea of including progress notes in such a document is divisive, and my guess is a sea change will need to occur before it becomes a requirement.

  11. Epic’s still the better choice by a long shot.

    Someday maybe somebody may challenge, but Epic has withstood the salesmen of SMS and Siemens, the ambitions of AllScripts and Eclipsys and the craftiness of Cerner and their Vision center.

    Epic just executes. Not for the stock market. Not for private equity. They just execute for the customers and their patients.

    Let it be.

  12. Antitrust laws apply to break up monopolies. When an organization (like Partners) makes a very specific branding, clinical, and financial decision, the sherman anti-trust act likely won’t apply. I’m sure epic’s competitors wish the government would “break” them up, but no one is going to break up Epic and damage patient care in the US. The health care system is complex and with its own set of issues, but messing up the only fully integrated and functional EHR isn’t one of them.

  13. Re: Talking BS and Ambulatory Lives. You’re both right.

    Talking BS, I suspect that you work for Epic and are rooting for the home team. And you are correct. There are other, though fewer, vendors in the marketplace right now. Epic is still a better choice than any of them.

    However, because I suspect you work for Epic, you especially should not be blinded to the points being made by another customer. The points about declining service and speed resonate very much with our organization, too. It’s not a hysterical comment that Epic has become completely incompetent, and that the sky has fallen. It is a comment that they are not as good as they once were. Things do take much longer these days, and require more energy on our part in terms of getting Epic to act. I’ve generally never had a problem with Judy or Carl getting back to me, but it does take longer these days and I, too, find myself getting delegated to people that I don’t think are particularly good at finding a path to help us.

    Many of us have worked with Epic for many years. I’m glad for the success they’ve had, and proud of the part that we played with them in helping them become so established. It’s still a fair point to make that if you want to become a monopoly, you need to earn it every day. You need to be better than you’ve ever been, and competing just like you were still the underdog. We’re not living our best days with Epic right now.







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