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:
- Partners spends $1.2 billion to implement Epic.
- 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.
- Partners tells those practices that it won’t work with them if they don’t use Epic.
- 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.”
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.
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.”
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
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.
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.
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.
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.
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.
Announcements and Implementations
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.
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.
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.
- 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.
- “Almost one-third of Physicians Would Switch EHRs for Electronic Prior Authorization” (Surescripts)
- “Insurance Insights: Moving Beyond the Regulatory Stick” (VisionWare)
- “It’s All About the Journey” (Voalte)