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Monday Morning Update 1/16/17

January 15, 2017 News 5 Comments

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The US Supreme Court approves the request of Epic and other companies that asked the court to rule on the use of arbitration clauses in employment agreements to prevent employees from filing labor-related class action lawsuits.

Two federal appeals courts have ruled that the National Labor Relations Act protects the right of employees to engage in “concerted activities,” while a third court has rejected that argument in saying that the arbitration clause prohibits employees from suing their employer as a class.

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Epic wants to the court to set a standard by which such arbitration clauses will or won’t be consistently enforced.


Reader Comments

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From Pappadum: “Re: MD Anderson’s losses and layoffs. Encore ran the selection process and made $48 million, while third parties were paid hundreds of millions of dollars more. The larger story is how companies stand to benefit from an Epic selection (selling services afterward) and Epic’s inability to control the cost of their projects given their third party dependencies. You would think a system as notable and healthy as MDA would generate more discussion in the risk/reward of implementing Epic.” Unverified. I don’t have a lot to say about how consulting firms steer clients toward systems and then sell them more services, or that Epic projects are nearly always eye-poppingly expensive. However, MDA signed every agreement (apparently without a gun to its head) and is responsible for its own implementation no matter who it hired to help or at what price it elected to pay. It has a track record of underperforming EHR implementations, all the way through the homegrown ClinicStation system that Epic replaced, so perhaps the outcome was predictable. Certainly the entire industry could learn from MDA’s experience, but I don’t expect they are anxious to share. Also, to be fair, it’s early in their implementation when a lot of Epic projects look bleak before improving, not to mention that many if not most of MDA’s problems don’t have anything to do with Epic even though it’s an easy target.

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Perhaps this is a good time to refer folks to my report on Epic from almost a year ago, in which I obtained insight directly from Epic-using health systems (22 CEOs, 13 CFOs, 96 CIOs, 39 chief medical officers, and 32 chief nursing officers). All of those CFOs say they would choose Epic again, and even though project cost was Epic’s lowest score by far in my report, only 15 percent of CFOs said their projects ran over budget. The CFOs scored Epic at 7.4 on a 10-point scale on the all-important question of whether Epic’s benefits were worth its initial and ongoing costs.

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From Spiritus Frumenti: “Re: Zynx, Has essentially laid off their entire executive team.” It’s apparently a bit lonely at the top, as the company’s executive page lists only President Kevin Daly and SVP Jim Connolly. Having been expunged in the past six weeks are the other two executive team members, Bertina Yen and Victor Lee, both of them physician VPs who, according to LinkedIn, left in December 2016 (Yen does not list a current employer, while Lee is now VP of clinical informatics at Clinical Architecture). Going back a year ago finds eight executives listed, all of them now missing except for Jim Connolly. Daly was promoted to president from another Hearst company, MCG, in January 2016.

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From Cheesy Goodness: “Re: Epic’s Community Connect program, as at UIHC. It’s a stroke of genius since it takes Epic out of the picture for selling and servicing small community organizations (which Epic is not built for), it creates additional ties with the reselling large provider organization and thus increases barriers to their replacing Epic, and it hits hard at competitors such as Athenahealth and EClinicalWorks.”

From Porkpie Hat: “Re: Merge Healthcare. Lots of major reorgs going on under IBM Watson Health.” Unverified. 

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From Man About Town: “Re: WSJ article claiming Epic is hindering interoperability. This doesn’t bode well. The majority of Judy’s employees very publicly supported Democrat candidates, which served the company well when they were in power, but now could lead to repercussions.” The article was poorly done and full of inexpert opinions more suited for a crappy LinkedIn vanity piece than WSJ, but it did get exposure it didn’t deserve. I don’t think rather modest political donations will have much of an impact either way. I’m also certain Epic’s lobbying firm, Card & Associates (which had strong connections to the George W. Bush White House) is – like all other DC lobbying firms – working overtime to understand the new administration and start whispering to it the messages of its clients. I assume Epic also has a friend in House Speaker Paul Ryan (R-WI).


HIStalk Announcements and Requests

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HIStalkapalooza signups are winding down, both for this year and forever since it’s the last one. We’re at around 900 requests, so it’s about time to call it.

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About a fourth of poll respondents either left for a better job or were promoted in the past year. Desperado expresses appreciation to the less-competent salespeople who allowed him to get promoted last week, while Paragon(e) and J3 lost their jobs to offshoring and acquisition, respectively. Frank’s advice for those who want a real promotion is to do your own thing, where you can focus on what’s important to you and be paid commensurate with your abilities, as hanging out your own shingle is “the last promotion you’ll ever need.”

New poll to your right or here: Has your employer cut expenses or reduced future expectations because of ACA uncertainty? I would be happy to get your poll vote and elated to read your comment explaining it.

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Welcome to new HIStalk Platinum Sponsor Parallon Technology Solutions. The Nashville-based company’s 400 professionals have implemented EHRs in 300 facilities and offer staffing and remote support services for all major acute care and ambulatory EHRs (Meditech, McKesson, Epic, Allscripts, etc.) and related applications. Its services include EHR implementation, help desk, application support, managed services, hosting, technical staffing, and strategic IT consulting services. It can help optimize Meditech investments, being certified to deliver READY Levels 1-3 and Pathway implementations for 6.x. Its Tier 1 Help Desk service alleviates challenges with hold times and first-call resolution rates, freeing up internal resources to work on priority projects and providing legacy system support. Technical services include data extraction and archive, reporting,  wireless network installation and support, voice communications, and integration. The company also outsources hard-to-find talent such as application developers, product analysts, DBAs, and network engineers. President and CEO Curtis Watkins is an industry long-timer with executive IT experience at HCA, St. David’s HealthCare, and Community Health Systems. Thanks to Parallon Technology Solutions for supporting HIStalk.

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We funded the DonorsChoose grant request of Ms. L on the west side of Chicago, who asked for math center materials for her kindergarten class. She is using the games during 25-minute math station rotation, putting out two or three of the games for students to learn from even as they’re having fun. She says they always rush to the Unlock It! game pictured above.


Last Week’s Most Interesting News

  • Two California HIE announce plans to merge.
  • President-elect Trump nominates David Shulkin, MD for the post of Secretary of Veterans Affairs.
  • Congress quickly begins dismantling the Affordable Care Act.
  • IBM Watson Health and the FDA announce plans to study the use of blockchain technology to exchange information between study participants and researchers.
  • President Obama and Vice-President Biden express frustration with lack of healthcare data exchange, with the President saying EHRs are his biggest disappointment of the Affordable Care Act.
  • A Wall Street Journal opinion piece calls Epic the “chief obfuscator” in being primarily responsible for the lack of EHR interoperability.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Sales

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Southern New Hampshire Medical Center (NH) chooses the Voalte Platform for smartphone-based secure communication and alert notification.


Decisions

  • Sycamore Medical Center (OH) with switch from BD to Omnicell automated dispensing cabinets in 2017.
  • Optim Medical Center (GA) will switch From Metro MedDispense to BD Pyxis MedStation automated dispensing cabinets in March 2017.
  • Baton Rouge General Medical Center – Bluebonnet (LA) will go live with Omnicell automated dispensing cabinets in 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


Government and Politics

In Scotland, 18 clinician organizations respond to the government’s call for input on its digital health strategy, urging the government to increase information-sharing capabilities among clinicians.

The New York Times speculates on the effect of proposed legislation that would dismantle the Affordable Care Act:

  • Eliminating insurance subsidies will cause 22.5 million people to drop their coverage, driving up prices for everyone as fewer healthy people sign up.
  • Eliminating the federal Medicaid expansion will leave 12.9 million people without coverage.
  • Consumer protections such as those involving pre-existing conditions, lifetime limits, and insuring adult children can’t be changed using the budget reconciliation process, so those will remain in place.
  • Eliminating the requirement that people carry insurance and that employers offer it will reduce the incentive of healthy people who can’t get employer-provided insurance to insure themselves.
  • Taxes on high incomes, prescription drugs, medical devices, and health insurance could be rolled back to pre-ACA numbers.
  • Value-based care models and other Medicare payment experiments will likely continue.

Privacy and Security

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In England, Barts Health NHS Trust shuts down some of its systems (but not Cerner Millennium) after an unspecified cyberattack that it says wasn’t ransomware.


Other

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Cleveland Clinic tries to distance itself from the somewhat anti-vaccine comments made by its wellness center medical director, although it draws Twitter wrath for: (a) promoting other “bogus treatments;” (b) not pulling the original article down; (c) downplaying “a series of bad decisions flying in the face of evidence” in calling it “confusion;” and (d) running a wellness center in the first place. There must be tension given that CC is a medical and research powerhouse on the one hand, while on the other the wellness center’s online store offers trendy detox kits, meditation DVDs, and bags of quinoa. Surely patients must be confused as the clinic outsources to them the responsibility to reconcile the separate-but-equal parts of the organization that may or may not offer evidence-based care.

A study in Israel finds that rude patients get their doctors worked up to the point they deviate from practice standards. Teams of NICU doctors and nurses who were scolded by an actress playing an angry mother fell short for the rest of the day in all 11 performance measures reviewed in the study. The researchers then tried two possible solutions. Having the clinicians write about their experience afterward made the situation worse, but assigning them a behavioral modification game raised their rudeness thresholds to the point that their performance was identical to that of the control group, in effect providing them with rudeness resistance. The bad news for patients is that even if you don’t get  nasty yourself, you are equally disadvantaged when following another patient who did (and we all know there’s plenty of them out there).


Sponsor Updates

  • Santa Rosa Consulting migrates Memorial Health System (OH) to Meditech 6.15 Ambulatory.
  • ZeOmega publishes a new case study explaining how its clinical and technology assessment team helped MDwise improve operational efficiencies and increase ROI.
  • The Red Hot Healthcare podcast features Conduent (formerly Xerox Healthcare) VP of Health Strategy Rohan Kulkarni.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Currently there are "5 comments" on this Article:

  1. RE: MDA — Here are the initial contract awards…from 2013:
    -$60M to Epic (software)
    -$48M to Encore (services)
    -$4.8M to Cognizant (ICD-10 planning)
    I’m sure these numbers grew overtime as they all seem low across the board for a system the size of MDA, especially the software number. Not to mention that Santa Rosa would have made a pretty penny for go-live support. http://www.prweb.com/releases/2015/10/prweb13012061.htm

  2. Re: Speaker Paul Ryan and Epic. I don’t think you should assume a relationship there just because he is from Wisconsin. Janesville is very different than Madison. Epic’s biggest ally in Congress is Sen. Tammy Baldwin. I hope Speaker Ryan grants Epic an audience and listens to their side of the interoperability story, but I wouldn’t assume he will. Cerner is much more Republican friendly. Just compare Neal Patterson and Judy’s campaign contributions (http://www.fec.gov/finance/disclosure/norindsea.shtml). Judy has made one $2600 donation to Ryan’s campaign, but it’s not much in comparison to the ~$350,000 she’s donated to Democrats and Democratic PAC’s. I asked Judy in 2010 what she thought of Rep. Ryan, his ideas for Medicare and Medicaid, and if they would negatively impact Epic’s business. She didn’t give me a straight answer, but she also didn’t seem to be a fan of Ryan’s.

    I’m curious if you have information about Speaker Ryan and Epic that would imply they have his ear. Epic isn’t perfect, but they’re the best EMR in the world and they take interoperability seriously. Could they do better? Of course, but they’re not running a church.

  3. There was probably some mismanagement on MDA’s part (you don’t just end up laying off 1,000 employees), but don’t forget that the health system brought in an experienced Epic CIO in Chris Belmont (Ochsner) to oversee the implementation. Seems like they at least tried to Epic-proof themselves…

    • It’s “their” not “there”. You’re part of the reason third-party companies provide recommendations–accuracy matters.







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Reader Comments

  • HIT Girl: Amazingly, he's the CEO of a patient-payment company. You'd think he'd have bothered to pop the hood on the whole billi...
  • Johnny B: ACP paper - I don't know that providers will ever be able to come to a consensus on how they want to document. Some want...
  • FLPoggio: What this piece totally ignores is that you and the provider (roofer) dealt directly with each other. Now what if you ha...
  • AC: That's not an apt comparison. Imagine instead if while the roofer was doing his thing, another random roofer dropped by ...
  • HIT Girl: I've worked in EHR design & support for the last 14 years or so, and when I was hospitalized in I think 2007 I got m...

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