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May 31, 2016 News 7 Comments

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An ONC survey finds that 84 percent of US hospitals were using at least a Basic EHR at the end of 2015, a nine-fold increase since HITECH was adopted in 2009, although adoption by psychiatric and children’s hospitals lags. A Basic EHR must have the capability (even if the physician doesn’t actually use it) of accepting physician orders, recording meds and allergies, documenting encounters, recording problem lists, and viewing lab and imaging results.

Someone tweeted out what an inarguably great thing this is, but for the $31 billion in taxpayer bribes that were required to make providers use the same EHRs they were otherwise avoiding like the plague, maybe we should expect a bit more than just market penetration and instead look at outcomes, access, and data portability. I’m not so sure that I as a patient feel any safer, better cared for, or more appreciated as a customer just because I’ve seen some spotty,  half-hearted technology use amidst the still-mountainous piles of provider paper.


Reader Comments

From Burnt Steak: “Re: Epic’s mandatory employee arbitration clause. Whose side would you take?” I really dislike the idea of mandatory arbitration, especially when it’s buried (as it is with most retail contracts, like for credit cards and cell phone service) in small print. However, a lack of willingness to walk away means those employees or customers accept the terms offered. I have limited respect for employees who complain about their jobs, go on strike, or file employer lawsuits – they should prove their point by finding a better job elsewhere. The market will quickly tell them if they are underappreciated, and if it turns out nobody else is willing to give them more money or benefits, that should be a clue that they are sitting precisely at the intersection of supply and demand for their services and shouldn’t embarrass themselves further by complaining. You’re not going to make yourself look better by griping about the employer (or your spouse or the city that you live in, for that matter) that you freely chose.


HIStalk Announcements and Requests

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Mrs. McCullough says her Georgia kindergartners are using the six Kindle Fires we provided in funding her DonorsChoose grant request to engage with reading and math apps and to participate in a weekly learning center, where they listen to stories and play phonics games.

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It’s hard to accept rampant healthcare inefficiencies and indifference when people in many US cities can place an Amazon order by noon and receive it by bedtime that same day. Although maybe there’s hope from companies like Capsule, a just-launched New York startup that delivers prescriptions by bicycle at no extra charge and that uses technology for refill requests, medication instructions, and patient communication, although the founders wisely decline to label the company as the inevitable “Uber for drugs.”

I finally had my appointment with a new doctor (actually, her PA) last week for my annual physical, following the miscue from a few weeks back where I showed up for my appointment, filled out a mountain of paperwork, and waited for some time before being told that the doctor was out of the office for previously scheduled surgery (they said they tried to call me earlier, but had incorrectly entered my phone number). This time wasn’t perfect, either – all of the paperwork I had completed previously (medical history, insurance information, NPP, etc.) had been mysteriously lost, meaning I had to fill out the clipboard full of forms all over again. To add insult to injury, the PA either didn’t see or didn’t use the information, repeating questions about allergies, meds, smoking status, and other topics that I had already documented minutes before but that hadn’t yet been entered into their Practice Fusion free EHR. At least the EHR wasn’t intrusive during the visit (since she mostly documented on paper) and the e-prescribing worked OK.

My latest linguistic peeve: the use of “unpack” as a synonym for “explain,” which doesn’t save syllables or add nuance and is therefore pointless other than to make self-aware authors feel smugly clever.

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

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Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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


Acquisitions, Funding, Business, and Stock

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DrFirst acquires Meditech consulting firm The IN Group, saying the acquisition will allow DrFirst to help its customers make the most of their healthcare IT investments. 


Sales

MD Anderson selects Nuance’s Dragon Medical and PowerScribe 360 for physician documentation as part of its Epic rollout. MDA will also use services from Epic consulting firm Physician Technology Partners, which the announcement says is now owned by Nuance.

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Pontiac General Hospital (MI) chooses Medsphere’s OpenVistA EHR. The financial turnaround of the hospital, which has filed bankruptcy twice as Doctors Hospital of Michigan, is being led by 25-year-old Sanyam Sharma, whose computer scientist parents started eligibility software vendor Infrahealth and put him on the payroll when he was 14. He’s now EVP of the company and heads up Sant Partners, a company his parents created to buy Pontiac  following his father’s discovery as a consultant that the hospital had extensive revenue cycle problems. 

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Ohio State University Wexner Medical Center chooses Strata Decision’s StrataJazz for decision support, cost accounting, and contract analytics.


People

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Home monitoring technology vendor Sentrian hires Bryan Ness (Wellcentive) as chief revenue officer and Molly Cogan (Wireless Life Sciences Alliance) as VP of marketing and communications.


Announcements and Implementations

Liaison Technologies will launch its Alloy Health cloud-based integration service in Europe.

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Peer60 publishes “Hottest Trends in Medical Imaging IT (UK).”

UPMC (PA) signs its third agreement with organizations in China, collaborating with for-profit First Chengmei Medical Industry Group to offer clinician training and to advise the hospitals on hospital operations, including IT.

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Cincinnati Children’s Hospital Medical Center (OH) will use the Curelator Headache app to study the factors that precede migraine headaches in children and adolescents. The study’s 60 participants will use visual data entry tools to document emotional, dietary, physical, and environmental factors in 2-3minutes per day to show them their associated migraine triggers so they can make lifestyle changes. The app is commercially available in a limited-functionality free version and as a $50, six-month subscription that includes trigger tracking.


Government and Politics

A Congressional stalemate forces the CDC to cut emergency public health funding in many cities—including lab services, mosquito control, and disease surveillance — to free up money to address the Zika virus. It’s amazing given the amount of federal money that is wasted on low-quality, unneeded, and sometimes questionably billed hospital care that CDC has to choose which outbreak to fund with a fixed few million dollars.

China’s FDA reverses its push toward making non-prescription drugs available online, ordering e-commerce provider Alibaba to tell its vendors – include drug store chains — to immediately stop selling OTC drugs on its online marketplace.

In other Alibaba news, Hong Kong regulators say the company violated takeover rules in its 2014 investment in pharma data and barcode tracking company CITIC 21CN (now known as Alibaba Health Information Technology) because the deal included buying a medical technology company from a shareholder who was also the brother of the company’s vice chairman, giving the company an unfair advantage. The acquisition raised some eyebrows at the time because Citic 21CN’s small amount of revenue came from sales to the Chinese government and both companies have Communist Party and military leaders as investors. The acquisition and subsequent rise in Alibaba’s share price made Chen Xiaoying, wife of a former general, a billionaire. She bought a $68 million home two days before the deal was announced. 


Privacy and Security

The ED physician staffing service used by two Carondelet hospitals in Arizona notifies 1,000 patients that their information was disclosed when an ED logbook was stolen from the car of one of its doctors.


Technology

USA Today summarizes a report indicating that telehealth usage would increase if it was more affordable to hospitals and if medical studies prove that it works. I think it’s time to separate vendor-provided telehealth (online services that connect cash-paying patients with whatever doctor the vendor has available in the belief that patients think all doctors are equal) versus using the technology to interact with the patient’s trusted ongoing provider in a more convenient way. Some patients and conditions can be treated by a doctor in a speed-dating type of consultation where they don’t know anything about the patient except what they can learn by asking a few quick questions, but few would argue that an encounter of that type will be as successful as having a virtual visit with their regular provider who is armed with their medical records (although “successful” to most patients means, “I got the prescription I wanted.”)


Other

A man presenting to the ED with atrial fibrillation is successfully treated after the team notices his heart rate-recording Fitbit and determines that his AF was triggered by a seizure, therefore making him a candidate for electrical cardioversion. The case was described in a journal article that is mildly entertaining while not being all that medically useful since AF is treated all the time without consulting the patient’s wearable and instead asking them their history.

A London newspaper profiles a hepatitis C patient whose only hope for survival is the new drug Harvoni, which has a 95 percent cure rate at an astonishingly high price. The man finds a doctor in Australia who imports a cheaper version of the drug from India and China, where drug company Gilead Sciences was forced to license the manufacture of local versions since those governments say Harvoni is almost identical to older, cheaper drugs and therefore won’t pay for it. The doctor tests the imported drug’s purity and mails it to patients who pay his consultation fee. Some NHS doctors will work with such “buyer’s club” patients since NHS can’t afford to provide the drug to everyone who needs it and buying prescription drugs from other countries isn’t illegal in England. However, the British pharma trade group says patients who buy drugs offshore are stifling innovation and taking away treatments intended for poor countries. US insurers and governments are struggling to pay for Harvoni, which costs $1,125 per pill and $95,000 per treatment. The same pill in India costs $10.

Here’s a pretty funny “EHR in the exam room” video from Athenahealth that I ran across while looking for something else. 

The Wall Street Journal profiles the use by Northwell Health (NY) of an evidence-based calculator that assesses the likelihood of strep throat, respiratory infection, and deep-vein thrombosis based on physician answers to questions popped up in the EHR and then guides appropriate ordering of medications and tests. A medical school professor overseeing testing of the software in Wisconsin primary care clinics says physician participation in the optional program  is low, however, because “there is a big backlash against clinical decision support.” 

The speaker at a Memorial Day ceremony in Anthem, AZ is Bill Krissoff, MD, a since-retired orthopedic surgeon who shuttered his practice following the 2006 death of his Marine son in Iraq. He joined a Marine Corps medical battalion at age 60, deploying to Iraq and Afghanistan “to finish Nathan’s unfinished tasks” in serving on the resuscitative surgical team as primary or assisting surgeon for 225 serious casualties.

Weird News Andy finds it ironic that “smart” tampons double as a blood collection tool that allows women to track their reproductive health via an iPad (WNA snickers right about there). I can’t decide if this is a great use of technology or the moment where we collectively jumped the quantified-self shark.


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Currently there are "7 comments" on this Article:

  1. RE: I finally had my appointment with a new doctor (actually, her PA) last week for my annual physical, following the miscue from a few weeks back where I showed up for my appointment, filled out a mountain of paperwork, and waited for some time before being told that the doctor was out of the office for previously scheduled surgery (they said they tried to call me earlier, but had incorrectly entered my phone number). This time wasn’t perfect, either – all of the paperwork I had completed previously (medical history, insurance information, NPP, etc.) had been mysteriously lost, meaning I had to fill out the clipboard full of forms all over again. To add insult to injury, the PA either didn’t see or didn’t use the information, repeating questions about allergies, meds, smoking status, and other topics that I had already documented minutes before but that hadn’t yet been entered into their Practice Fusion free EHR. At least the EHR wasn’t intrusive during the visit (since she mostly documented on paper) and the e-prescribing worked OK.

    I entered my H&P into a Word document and print it before each visit. When handed the standard and oft ignored for to complete, I attach my H&P instead. I have had grumbling from clerical staff, but compliments from the nursing and medical personnel. They re-enter it in part or in full into Epic. Until we rebel (and I do loudly, though respectfully) against repeatedly filling out the same form, nothing will happen.

  2. RE: My latest linguistic peeve: OK, here’s mine (since you brought it up!). The phrase “walk back” as in “he had to walk back his comments on blah blah blah and, admittedly, I’ve heard this more in reference to Donald Trump than anyone else I can think of. No matter, it’s all annoying (and I won’t be walking back that comment!)

  3. #onc

    You have finally seen the light of day when you state: “I’m not so sure that I as a patient feel any safer, better cared for, or more appreciated as a customer just because I’ve seen some spotty, half-hearted technology use amidst the still-mountainous piles of provider paper.” Ask the doctors in Vancouver about EHR safety, while you are at it.

  4. Mr. H, I am a loyal reader who respects the work you do and your opinions. On this particular opinion, if all things were equal, I would find myself agreeing with your point much more. All things not being equal (spoiler: I don’t see all things as equal in this case) I would respectfully challenge you on your last sentence regarding “griping about the employer you freely chose”.

    There is such a thing as a decision made under duress. In extremis this would mean that if you agree to something unconscionable with a loaded gun to your head, it cannot be looked upon as a binding agreement. Epic is not actually holding a gun to anybody’s head. However, I’d also say telling an existing employee they must sign an agreement which abnegates their rights under Federal Law to seek redress of grievances in a court or to lose your job is clearly not a free choice, as your statement would presuppose. And it isn’t exactly a free market in today’s job market, is it? In the EMR market, it’s rapidly becoming a “choice” of working for Epic or Cerner (this isn’t exactly a great proposition for those of us who are consumers in this industry, either, but that’s a whole other subject).

    Consider the choices available to employees this agreement was being imposed on, frequently years after they’ve signed an employment agreement: Do you move, potentially with kids, to a different city? Is there another option that pays a comparable wage freely available? Are you truly “free” to go elsewhere, or has your employer encumbered your options in other ways (i.e. via a non-compete agreement that prevents you from working for clients, not just actual competitors)? Do the executives of the company who are imposing these agreements have similar restrictions on their own options in these matters?

    I’m not arguing that your comments on supply and demand don’t have a degree of bearing on some of the considerations I just mentioned. That being said, there’s a spectrum the law has to consider and I’d argue that Epic’s employees are a microcosm of problems in the labor market more generally that favor increasingly monopolistic employers to the extent that these are decisions being forced on workers under duress. Meanwhile, billionaires are getting richer.

    There are a small minority of people that will agree to go elsewhere on the principle alone, but the National Labor Relations Act is there precisely to protect the rights of workers more generally from the predations of employers whose hand has grown too strong. Epic’s hand is very strong today, and its behavior is becoming more predatory. It’s resembling an angry bull in a china shop more than the respectable underdog it once was.

  5. RE: Filling out the mountain of paperwork…Have you heard about WEDI + MGMA + HIMSS + Sullivan Institute’s Virtual Clipboard Initiative? http://www.wedi.org/knowledge-center/virtual-clipboard This initiative’s goal is to address this exact situation you described with best practices around a mobile application experience. There have already been a few vendors who have piloted this type of solution and recently presented on their findings and next steps at the WEDI Conference the other week.

    The project seeks to leverage smart technologies to dramatically enhance the patient experience while improving patient safety. The Institute and its partners are working to create a solution blueprint for a smart mobile solution that will ease the patient check-in process by automating demographic, insurance and critical clinical information (e.g. allergies, medications and lab results) elements.

  6. Re your arbitration comment response, I think that is an understanding of free markets that is true in a theoretical, frictionless, perfect economy, but that is misleading to the point of being dangerous in a real market. While an employee staying with a job might seem to indicate that the job is priced at least adequately, in reality, various forms of friction and other factors can cause people to accept and especially keep jobs that have unfair terms and conditions (and especially ones that are forced onto them after they have worked there, become established, have families, etc). Labor laws exist exactly to prevent the distortions of a real market (and sometimes the implications of a free market) from allowing employers to take advantage of employees, and forced arbitration contracts such as these are designed entirely to circumvent such labor laws and prevent employees from organizing. Limited respect for employees who don’t immediately choose to pack up and leave their job at the first sign of such contracts is a very unfair viewpoint.

  7. Touché to “Regarding Epic’s Burnt Steak” & “Armchair Economist”. You are getting some very objective and relevant pushback on your arbitration comment.

    Too many people have this Ayn Rand’ian notion of the capitalist economy. Worse, that notion supposedly applies only to employees and not to employers. If the playing field were truly equal, there wouldn’t be unreasonable non-compete agreements, would not have limits to what an employee could do with the intellectual capital gained during their service (aka, restrictive patents) and so on and so forth. But I am only repeating the points that those other two commentators made so effectively.







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