News 11/6/15

Top News

Allscripts announces Q3 results: revenue up 3 percent, adjusted EPS $0.13 vs. –$0.06, meeting revenue expectations and beating on earnings.

Reader Comments

From Worried: “Re: HHS and Department of Justice. Investigating [vendor name omitted] for fraud in EHR certification and safety issues.” Unverified, so I’ve left out the company’s name. Let me know if you have specific information.

From All Hat No Cattle: “Re: KLAS’s proposed interoperability measures. These are good and will really help highlight the issues, especially those that allow users to call out issues from within their own provider organizations. Issues like opt-in/opt-out are huge. I think it will also highlight the incredible job that Epic has done in allowing its clients to share information, which is becoming the gold standard.” The draft KLAS questionnaire for providers to assess their interoperability capability and use is indeed pretty good, targeting high-value connections rather than giving credit for connections that patients and clinicians don’t really care about. My only tiny quibble is that the document defines interoperability as “the ability” to exchange and use information, while the survey far more importantly assesses whether providers are actually doing it. The downside of the provider survey approach is that those who are unwilling to share information will point fingers at everyone else, skewing the results since it’s easier to blame generic “technical barriers” than to admit that you don’t want to provide information to your competitor and vice-versa. I guarantee that if health systems and doctors were paid a per-record fee for sharing their information, they would quickly overcome every alleged barrier and would pressure their technology vendors to figure it out (see: Meaningful Use bribes). The business case for helping patients being seen elsewhere is shaky.

From Poor Quality: “Re: University of Mississippi Medical Center. Gets an F in quality from Leapfrog, making it the worst in the state.” The hospital responds with the standard “our patients are sicker” excuse, saying other hospitals dump their problem patients on UMMC and that patients should not avoid the hospital just because it earned a failing grade. Sicker patients or not, UMMC scored horribly in all six surgical safety categories, such as leaving objects in the bodies of surgery patients. The chief medical officer says it’s not about whether the hospital earns an F or an A, it’s about improving outcomes for patients as a group, although not leaving sponges in patients might be a good start toward accomplishing both.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor LogicStream Health. The Minneapolis-based company, co-founded by a pharmacist and a physician, applies algorithms to hospital or clinic EHR data to develop clinically appropriate protocols, with one client reducing its post-surgical venous thromboembolism by 80 percent in improving outcomes and saving $1.1 million by applying individual risk assessments. The company’s platform quickly identifies clinical process problems to support data-driven adjustments that improve quality and provider satisfaction. It offers specific quality improvement modules for VTEs, catheter-associated UTIs, and central line-associated blood stream infections; cost containment solutions for high-cost labs and drugs; and the ability to measure the impact of order sets and nursing flowsheets. Co-founder Daniel Rubin, MD, MHI presented a webinar on reducing care variation that provides background. Thanks to LogicStream Health for supporting HIStalk.

Reader donations of $150, to which I applied available matching funds via DonorsChoose, provided math activity stations and wireless quiz technology for the fourth grade class of Ms. Williams in Lancaster, TX;  a CD player, lapboards, and clipboards for small-group math instruction for the class of Ms. Penagos in Carrollton,TX; and math supplies and games for Mrs. Johnson’s kindergarten class in Silvis, IL. Meanwhile, Mr. Moore sent an update from Minnesota with the photo above of his students using the STEM materials we provided.

A brilliant Twitter enhancement request comes from @Farzad_MD as he’s getting bombarded by conference attendees (some of them reporters paid by their conference presenter employer) live-tweeting banal observations and quotes that are useless out of context (and often within context). His idea: allow Twitter muting by hashtag. That would work great for squelching dull tweetchats as well, or to allow users to create Twitter “folders” that you could follow separately to bypass their sports cheerleading and instead focus only on their work-related tweets. I might add a second variant: allow muting a Twitter account for a user-defined time out, like shushing them until the conference they’re yapping about is over. The few people I follow on Twitter are mostly insightful 95 percent of the time but some of them are insufferable when they get unduly aroused by some meeting, sporting event, or personal accomplishment.

I still haven’t heard a word from anyone who has actually seen an EHR gag clause, so I’m calling BS on the reporter who stirred up that whole issue in the first place (along with the mindless parrots who squawked about that article despite its lack of evidence and obvious confusion as to what a “gag clause” even is). My assertion is unchanged: the pressure you feel to avoid speaking up about patient-endangering software problems is far more likely to come from the executive suite of your health system, not that of your software vendor.

This week on HIStalk Practice: Healthcare.gov opens with no signs of IT trouble … yet. EClinicalWorks breaks into the UK market via a new partnership. The NC Medical Society Foundation works with Chess to transition rural practices to ACOs. Sanctus Healthcare implements CCM services from McKesson BPS. Wellero President Hanny Freiwat offers physicians advice on increasing patient payments before the end of the year. SHIN-NY targets physician practices after reaching RHIO milestone. The Toledo Clinic joins the Ohio Independent Collaborative. Culbert Healthcare Solutions Director Jaffer Traish offers best practices for streamlining the efforts of IT and operations.

This week on HIStalk Connect: Teladoc’s stock price falls 10 percent after reporting its Q3 results, which showed signs of impressive organic growth but still shows the company operating in the red after 13 years in business. Fitbit reports its Q3 results, posting better than expected earnings. The company was also named in a countersuit from rival Jawbone alleging that it has established a monopoly in the fitness tracker market. Monclarity raises $5 million to launch a "brain games" cognitive training app, despite widespread skepticism from neuroscientists over the effectiveness of such apps. Lumo raises $10 million to launch a B2B wearables platform that sets a company up with sensors, software, and an API to launch their own fitness tracking wearables powered with Lumo’s technology.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Consulting firm The Chartis Group acquires iVantage Health Analytics.

From the Cerner earnings call:

• EVP/CFO Marc Naughton said the company is disappointed about missing revenue expectations by $20 million, but delivered record bookings and has a strong pipeline that includes a $13.9 billion revenue backlog. The drive is that clients are tying payments to milestones and even to specific health system performance targets.
• The former Siemens Health Services brought in $250 million in revenue, 22 percent of Cerner’s total revenue, but was responsible for half of its $20 million revenue miss as some former Siemens clients dropped their maintenance agreements. Cerner says sales of the former Siemens products are “minimal … Siemens is negligibly impacting us” and that was the plan all along.
• President Zane Burke says the company differentiates itself from Epic by “the ability to deliver value along with predictable costs and timelines” as opposed to “their list of clients, where the significant costs of deploying and maintaining their systems have been cited as a key reason for financial challenges is starting to impact them in the marketplace.”
• The company says Epic-using Geisinger chose Cerner for population health management because “our capabilities could not be equaled by a competitor.”
• The company had two displacements of an unnamed ambulatory cloud competitor (presumably Athenahealth) due to “their lack of execution, failure to meet established objectives, rising costs after teaser rates, and a realization by the client that they ended up needing similar or more staff even though they thought they had outsourced the function to our competitor because they left much of the harder work and complex work to the client.”
• The company warns that revenue from its Department of Defense subcontracting will be slow, with the first Leidos task order representing less than 1 percent of Cerner’s quarterly bookings. That task order was valued at $98 million and 1 percent of Cerner’s quarterly bookings is $16 million, so at least for the quarter, Cerner’s cut of the DoD contract is less than 16 percent.

Cognizant reports Q3 results: revenue up 24 percent, adjusted EPS $0.76 vs. $0.66, beating revenue expectations but falling short on earnings. The company’s healthcare segment, which includes its $2.7 billion acquisition of TriZetto last year, contributed 30 percent of Cognizant’s revenue ($939 million) in a 43 percent jump.

Dell is rumored to be planning the sale of $10 billion worth of its non-core divisions to ease the $50 billion in debt it will take on to acquire EMC, with the former Perot Systems being one of the assets that could be placed on the block. Dell bought Perot for $3.9 billion in 2009.

Sales

For-profit, 16-hospital Iasis Healthcare (TN) chooses Cerner for EHR and revenue cycle systems.

San Joaquin General Hospital (CA) will implement Cerner.

Walgreens will implement Epic’s EpicCare in its 400 retail clinics beginning early next year, replacing its proprietary EHR. I think the drug chain’s 8,200 pharmacies use Greenway’s EHR, which I would expect to be at significant risk of eventual displacement since they obviously looked elsewhere for the clinics and they are bragging on the interoperability opportunities Epic will provide. Some of the sites and fast-on-the-draw tweeters missed the fact that this announcement pertains only to the in-store clinics, not all of Walgreens (yet).

ZappRX chooses the e-prescribing state law review data set and services from Point-of-Care Partners.

People

Rush Health (IL) hires Julie Bonello (Access Community Health Network) as CIO. I’m fascinated by her LinkedIn profile that shows she earned a BSN and then an MS in computer science, dropped out of the CIO role for several years to run the family’s chain of noodle shops as she cared for her aging parents, then jumped right back in as CIO of Cook County Health and Hospitals.

J. P. Fingado (Francisco Partners) joins healthcare talent manager software vendor HealthcareSource as president and CEO. Francisco Partners acquired the company in May.

Community Health Systems announces that SVP/CIO Gary Seay will retire at the end of the year.

Orion Health hires Robert Pepper (NeuroTrax) as VP of marketing for North America.

Announcements and Implementations

Influence Health announces a new version of its Connect clinical portal, which alerts physicians of frequent visitors who may be at risk for readmission and integration of DynaMed’s clinical information.

Medecision and Forward Health Group partner to provide population health management solutions to New York DSRIP participants.

Quest Diagnostics will sell de-identified patient lab results through analytics vendor Medivo to drug companies, which will then use the information to target their marketing to individual physicians. Medivo calls their business “delivering the promise of precision medicine by providing decision support on the use of targeted therapeutics,” which is probably not what pie-in-the-sky “precision medicine” dreamers have in mind when they picture using data to treat patients rather than to sell more drugs.

Healthgrades will expand its online appointment scheduling capabilities in partnership with MyHealthDirect.

Lincoln Surgical Hospital (NE) uses Summit Scripting Toolkit to import scanned documents from clinical modalities into Meditech, requiring just eight hours of analyst time to create and test the script and move it to production.

Durham, NC-based Touchcare, which offers a $99 per provider per month telemedicine app, adds a web-based provider dashboard and integrated billing capability.

Government and Politics

John Halamka, MD, recapping the November HIT Standards Committee meeting, repeats his call to dissolve the Meaningful Use program and move Stage 3 requirements into CMS’s upcoming Merit-Based Incentive Programs (MIPS).

Privacy and Security

An ED study finds that 71 percent of patients who use Facebook or Twitter don’t mind doctors looking at their accounts, although I can’t imagine any ED doctor who would find that any more useful that the uneventful stream of wearables data they rightfully ignore. Maybe that would be more useful for PCPs who could possibly wade through all the inevitable junk to piece together some sort of social history that the patient could have just told them directly. Or, perhaps there’s your startup idea: a private, Facebook-like app just for the intuitive entry of health status information that you share with whomever you want (doctor, family member, etc.) Maybe you post your weight or sleep schedule and your doctor gives it a “like” or adds a slightly scolding comment.

Technology

Amazon Web Services could bring in $16 billion in annual revenue by the end of 2017, making it the company’s most valuable business at up to $160 billion.

Researchers from Vanderbilt University School of Engineering make the hardware and software of their swallowable medical robots available via open source. The devices, also known as wireless capsule endoscopes, can be guided rather than just carried along by intestinal activity as are PillCams.

Precision medicine is here after all: CDX develops a chemical sensor that also uses big data and machine learning to analyze a sample of marijuana and apply the experience of that strain’s users to determine whether it will deliver the desired outcome (medical or otherwise) to the app user. The company will earn revenue from displaying paid advertising of dispensaries. The company plans to expend its “electronic nose technology” into other areas, such as air and water quality. This is a brilliant business model all around.

Other

In Pakistan, Hayatabad Medical Complex, alarmed by employees and physicians moonlighting in nearby medical facilities on company time, requires them to clock in using biometric ID. Board members also mandated that all procurement be moved online.

I’m amused that the AMA’s Thursday tweetchat on digital medicine innovation was led by its CMIO – who doesn’t even have a Twitter account.

I don’t understand this at all. A DC business paper profiles ListenPort, which it contrasts to Yelp and Twitter in providing a private place to complain directly to management. I thought we had that already in products called “email” and “texting.” They offer a free basic account, so maybe I’ll try it out.

A former purchasing assistant with England-based health IT firm Ascribe is sentenced to four and a half years in prison for stealing $900,000 from the company over five years. She used the money, obtained by paying phony invoices to herself, for vacations, cars, a house, and to pay off her son’s drug debts. Ascribe hired her even though she had previously been convicted for stealing from a previous employer. Ascribe sold itself to EMIS Group in 2013 for $88 million but says it could have gotten $5 million more had the theft not reduced its profitability.

AMIA will induct 13 new Fellows in the American College of Medical Informatics on November 15.

An Atlantic article says programmers should stop calling themselves “engineers” since they aren’t regulated, certified, or required to take continuing education. It says the tech industry has cheapened the term “engineer” by applying it to everybody who isn’t in sales, marketing, or design.

I haven’t watched TV for years, but this week’s episode of “CSI: Cyber” titled “Hack E.R.” (although “Hack E.D.” would have been better) apparently spins a tale of a hospital whose network was penetrated by ransom-seeking hackers through a smart TV (what the heck hospital has those?), causing the death of a patient when they disable her heart monitor. The hospital couldn’t take the network down because it would disable all their ventilators (huh?) Then a patient died when the malware-affected EHR didn’t give his doctor an allergy warning as he entered an order. The entire episode, which seems absurdly hammy and unrealistic (being TV, after all), streams here with a ton of commercials and gratuitous on-screen graphics as annoying as those “pop up” shows from years ago. I couldn’t hack (no pun intended) more than a few seconds’ worth, but I notice the series stars Ted Danson (who looks like Sam Malone’s grandfather even with his wig on) and the episode was directed by Eriq La Salle, who played Dr. Peter Benton on “ER.”

Sponsor Updates

• A hospital group in Indonesia reports success in deploying InterSystems TrakCare.
• A Rand Corporation study finds that Health First (FL) improved patient throughput significantly using systems from study sponsor TeleTracking Technologies to identify bottlenecks and improve processes.
• InterSystems publishes a new white paper, “Creating Sustainable 21st Century Health Systems: EHealth and Health Information Technology.”
• Navicure will exhibit at MGMA Mississippi November 6 in Pearl.
• Strata Decision Technology announces highlights from its Decision Summit.
• PeriGen will demonstrate its new PeriCALM CheckList at the Synova Associates Perinatal Leadership Forum November 11-14 in Dallas.
• Obix will exhibit at 2015 Perinatal Leadership Forum November 11-14 in Dallas.
• Medecision and its customer Baystate Health will present a session on population health management at the HIMSS 2015 Big Data & Healthcare Analytics Forum this week.
• Experian Health will exhibit at the HMA CFO Forum November 11-14 in Utah.
• Jefferson College of Public Health recognizes PatientSafe Solutions VP of PatientTouch Coordinated Care Amber Thompson as a 2015 Health Education Hero.
• PDS CEO Asif Naseem is profiled in the local paper.
• Validic announces client growth and enhancements that allow mobile app developers to connect to clinical devices and to Apple Health.
• PerfectServe will exhibit at the American Association for Physician Leadership Fall Institute November 13-17 in Scottsdale, AZ.
• Sandlot Solutions will exhibit at the HIMSS Connected Health Conference November 8-11 in National Harbor, MD.
• The SSI Group will host a user group meeting in Nashville on November 10.
• Streamline Health will exhibit at the HFMA Big Data Analytics Conference November 10-12 in Denver.

Blog Posts

• Medical Data Everywhere: Danger in the Cloud (ID Experts)
• Legacy Data Management: Strategic Considerations for Successful Clinical Data Abstraction (Impact Advisors)
• A Day in the Life of FHG Account Management, or How It’s All About the People (Forward Health Group)
• Patient Engagement for the Entire Family (Influence Health)
• The Sharing Economy Behind the Sharing Economy: Cloud Platforms (Liaison Technologies)
• Revolutions in Healthcare Analytics, Part 2 of 6 – New Data Sources (Optimum Healthcare IT)
• And though we use it here … I can’t use it over there …” (MedAptus)
• Four ways to prepare for next year’s price transparency dialogue with patients (Recondo Technology)
• Billing Office Horror Stories Hit the Box Office (Patientco)
• Care Coordination: A Challenge mHealth vendors are choosing to ignore? (Practice Unite)
• This STEM bears fruit for two million students (Lexmark)
• Accurate Provider Data Plays an Important Role in Meeting Meaningful Use Objectives (Phynd Technologies)
• Messaging Must-Haves: What Features are Essential for a Great Messaging Product? (PMD)
• It pays to do your homework on hospital safety rankings! (Qpid Health)
• Meaningful Use Stage 3: A Brief History and What Lies Ahead for Healthcare IT (Sagacious Consultants)
• Readiness: The Precursor to Health IT Adoption in the Long-Term Care Setting (Surescripts)

Contacts

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

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