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Monday Morning Update 4/3/17

April 2, 2017 News 9 Comments

Top News

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HHS quietly hires Don Rucker, MD, MBA, MS as National Coordinator, as evidenced by his new entry on the HHS employee list.

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Rucker holds a Penn MD and Stanford master’s degrees in business and informatics. He is an adjunct professor in biomedical informatics at Ohio State, but is best known as being chief medical officer for Siemens Healthcare from 2000 to 2013.

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Apparently reporting to Rucker is former Rep. John Fleming, MD (R-LA), who said previously that he thought his newly created position of HHS deputy assistant secretary for health technology reform was equivalent to National Coordinator.

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Reader Comments

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From Lisa Buller:”Re: Skagit Regional Health’s Epic project. As the project director of this implementation, I can tell you the post regarding our EHR project is not only unverified – it is untrue. We are very happy with our selection of Epic and look forward to our on-time go live of October 1, 2017 and the improvement in quality, safety, and efficiency that it will bring to the care we provide our communities.” Lisa referenced the original Epic announcement that indicated a mid-2017 go-live date. Publicly available information suggests that the IT department added 53 positions with 20 more planned to implement Epic (although those employees are often rolled back to their previous jobs after go-live) and CIO John Dwight moved to EvergreenHealth in February. Both items were mentioned by the rumor reporter whose main point was that budget overruns of the $72 million project, if they exist, have not been publicly acknowledged. UPDATE: Lisa provides additional information: “Our project is on time for go live on October 1, 2017 across our organization, including two hospitals and 18 clinics. The project cost is $72 million. We moved our go live from July to October 1, 2017 to ensure adequate time for project build, test, and training. We currently have 23 consultant-employed FTEs – not 60 as was reported in the unverified post. The pay rate referenced in the post is also false.”

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From Steve: “Re: NTT Data’s divestiture of its healthcare software division. The acute EHR/RCM products are so far behind any of the competitors, have next to no market share, don’t show up in any industry reports, and NTT Data lost so many clients. I will be curious to see if they recover under the new company. It’s the same leadership that ran that division at NTT Data, so chances are probably pretty slim.” I’m thinking the prize there is the NetSolutions long term care software product line, which runs in 1,700 facilities.


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This infuriatingly common mistake bugs me. Is it really so hard to match a singular subject to a singular verb? As the headline writer might say, the grammatical sloppiness of Americans are driving me crazy.

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This Week in Health IT History

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One year ago:

  • The Department of Defense names its Cerner-centered EHR project MHS Genesis.
  • A study finds wide clinical variation in how patient visits are conducted by six virtual visit companies.
  • Southcoast Health lays off 95 employees after running over budget on its $100 million Epic implementation.
  • Massachusetts General Hospital and other Partners HealthCare sites go live on Epic.

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Five years ago:

  • CSC announces plans to launch iSoft in the US after poor performance in England’s NPfIT.
  • 3M acquires CodeRyte.
  • HHS awards $50,000 to the designers of THUMPr, a web-based heart health consumer profile tool.
  • HIMSS lists the HIT-related affects that would arise from a Supreme Court finding that some or all of the ACA is unconstitutional.
  • Seven-month-old hospice management software vendor Hospicelink predicts that it will hit $50 million in sales by the end of the year.
  • TriZetto announces plans to build a $40 million headquarters building in Denver.

Weekly Anonymous Reader Question

Last week I asked readers to describe their proudest moment in health IT, with these responses:

  • Getting the result interfacing going from our lab to the local cancer treatment facility. It had been a months-long project with many fits and starts, but seeing it actually happen was amazing. They went from needing up to a week to get results to make changes to chemotherapy regimens to being able to make changes in a few hours. They can actually correlate some improved survival rates to being able to respond faster to changes in their patients’ health.
  • Being the first (and maybe only?) IT person to receive the Employee Recognition Award at the health care organization I worked for.
  • When I first started out in health IT, I was part of a SWAT team who would swoop into troubled sites. I was disheartened about six months into the job. I then went to my fifth or sixth site and sat with a doctor who was visibly frustrated. A few tweaks, 30 minutes of coaching and training, and customizing the program and all was better. I went back about three months later and the doctor gave me the biggest hug and looked at me with tears in his eyes and said "I’m no longer stuck in the dictation room until 7, 8, 9:00 at night. I leave the hospital at 6:00 at the latest every day since you came. I’ve made it to all of my son’s tee-ball games this season, my wife and I eat dinner together, I sleep better, and my nurses have all noticed a change in my patient care. Thank you so much. You have made me want to stay in medicine and keep doing what I was put on this Earth to do." Cue me totally getting all teary right ahead of a big executive meeting 🙂 But I remember that doc, and all the other docs on days where it’s kinda crappy. End of quarter, forecast calls, dealing with code issues, trying to keep customers… It’s all kinda crappy, but if I can do one thing each day where I help one person be able to go out there and do better at keeping people healthy and alive, that’s good enough for me.
  • Around 10 years ago, I was a sales executive working with small independent medical groups trying to help them move to our network-enabled rev cycle service. There was a wonderful physician I was working with who provided great family practice services to an undeserved population, but struggled to run her practice. I was fortunate enough to help her make the leap of faith to join our network. A year later, I called to check in. The physician started tearing up over the phone. (full disclosure: I went into panic mode once I heard her voice crack). I asked what was wrong and she said, "Wrong? Nothing’s wrong. Yesterday I was able to pay my daughter’s tuition in full for the first time and I owe that to your company.” Thinking about that moment still makes the hair on the back of my neck stand up.
  • When the first customer I helped acquire their eICU program verified the clinical, operating, and financial results we had promised. The icing on the cake is when one of the practicing intensivists also reported that for the first time in years he was sleeping through the night uninterrupted, and he felt more alive and happy than he had in years.
  • I designed and helped build a bedside critical care CIS that at one site operated nonstop for four-plus years without a server reboot. It was the only system in the data center that kept operating when all the others went down during a hurricane.
  • In a meeting, a frustrated physician, who felt burdened and attacked, retorted, "What’s the point? Nothing ever changes here anyway." After the meeting, I compiled a list of the changes that we had made in the past year. Some were IT, some were process, some were new initiatives. In all, I listed 24 accomplishments that we had completed in the previous 12 months. I leaned back in my chair, kicked my feet up on my desk, and raised my hands behind my head. In the silence, I swore I could hear a faint echo of applause.
  • In the late 1970s, I wrote a master’s thesis on clinical decision systems, which I defined (simplistically for research) as a physician, nurse, and patient. Key to the triad is the patient as an equal member of the decision team. IT wasn’t until a decade or so into the 21st century that the patient was recognized as a key decision-maker in his/her care. I was proud in retrospect that I had identified the key role a patient plays in their care, based on the different kinds of information which they hold and on which only they can act. Similarly with the differences among physicians and nurses and their unique and special knowledge and decision characteristics.
  • One thank you note from a former customer: “The richness of your experience and knowledge is a true asset to the HIT community and it’s always a pleasure to shine the spotlight on you. You never disappoint!”
  • Leading an EMR conversion and receiving Joint Commission accreditation 16 days post-EMR conversion with zero nursing citations at a hospital that had never passed Joint Commission without citations previously.
  • I was at the Magnet nursing conference doing a demo in our booth and a random attendee walked up and interrupted the demo and said, "I use your product every day and I love it" and then she just walked away.
  • Seeing a presentation about better care of patients by a customer using a tool I was integral in designing and testing. It’s pretty awesome to see someone talking about things that were were not possible prior to the existence of something I helped create.
  • Oddly, a proud time was spending New Year’s Eve 1999 on call and having almost nothing to do because the years of Y2K preparations were done right. Management invested appropriately and early enough to the work done, people worked hard to address all the issues, and the results were there. We were also prepared for what didn’t happen. I can’t recall another go-live that went as well.
  • Hearing a doctor exclaim, "Look, it’s right here!" as she pulled up a hospital discharge report in real time while the patient was in her office for a follow-up. No calls to the hospital chasing paperwork, no checking billing office inboxes or wire baskets — everything ready to go while the patient was in front of her.
  • Chair of an AMC department walking through exhibits at a conference, taking a few steps backward, turning to me at the booth and saying, "I may not have said this before, but your system has changed the way (our specialty) is practiced in America. Thank you."
  • Teaming with Kaiser Permanente in Southern California in a partnership to build and deploy an application integrated with Epic that used NLP to automatically calculate the E&M code at the point of care. This was an early (2005) commercial use of AI. The end result was an a operational success for Kaiser and a commercial success for our small company. The technology is now owned by Nuance.
  • Being the first hospital to activate the first commercially available EMR 19 years ago and it’s still running fine. And it only cost $16 million for an 800-bed hospital.
  • I don’t really have one other than doing a great job every day before the Big Vendor came along and there needed to be 8-10 of me.
  • My first invitation to Histalkapalooza.

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The question this week: What is your favorite moment from any past HIMSS conferences?


Last Week’s Most Interesting News

  • An IBM report finds that the number of healthcare records exposed via breach dropped 88 percent for 2016 vs. 2015, with just 29 percent of incidents involving outsiders.
  • The FBI warns healthcare organizations that hackers are targeting FTP servers configured to allow anonymous access.
  • The White House appoints Roger Severino as director of HHS’s Office for Civil Rights.
  • A review of UCSF’s virtual glucose management service finds significant improvement in glucose control.

Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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NTT Data sells its hospital and long term care software suites to newly created and PE-backed Cantata Health. Those products involve Optimum (hospital clinical and RCM) and NetSolutions (for skilled nursing, assisted living, and independent living). The PE backer is GPB Capital Holdings. NTT Data acquired the software with its acquisition of Keane in October 2010 at a rumored $1.2 billion. Cantata Health will be led by former NTT Data healthcare technologies division executives Mike Jones (CEO) and Rich Zegel (CTO).

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NantHealth reports Q4 results: revenue up 18 percent, EPS –$0.19 vs. -$0.10, beating earnings estimates but falling short on revenue, sending shares down 3 percent Friday. The company lost $184 million in the fiscal year, doubling its 2015 losses.


Decisions

  • Community Health Systems (TN) chooses Infor for enterprise financial management and will begin rollout this year.
  • University of California Irvine Health System (CA) will go live with Oracle PeopleSoft ERP in 2018.
  • Charlton Memorial Hospital (MA) will go live with Oracle PeopleSoft HR this year.

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


Other

Public radio profiles Kaiser Permanente’s opioid prescribing program, implemented in 2009 after clinical leaders noted that OxyContin was among its most-prescribed drugs, patients were on the medication for long periods with ever-increasing doses, some of the prescriptions were for 1,000 or more pills, and doctors were specifying brand name drugs that weren’t covered by insurance but that command a higher street value. KP studied its opioid use from its Epic data, sent reps to counter pharma sales pushes to use more, programmed Epic to help guide physician decisions, and implemented “The Difficult Pain Conversation” to encourage patients to stop demanding opioid prescriptions.

The VA complains about employee-friendly laws that force it to keep paying workers it’s trying to fire, with the latest example being an employee who was caught watching pornography while with a patient who the VA has to keep paying for at least 30 days while the bureaucracy-laden termination process is followed.

A heart surgeon who sued former employer Memorial Hermann (TX) for using peer review and quality data to discredit him after he complained about quality problems wins $6.4 million in a jury award.

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Epic’s April Fool’s web page makeover included these stories:

  • Introduction of TinDR, an Epic app that allows doctors and patients to choose each other via a right or left swipe, quoting a doctor user as saying, “I didn’t do great in med school, but I hit the gym six days a week, and that’s finally paying off.”
  • The meeting of AI systems IBM Watson and Epic Bruce, in which Bruce sent Watson a 2 a.m. messaging questioning, “You up?”
  • The release of Chirp, a clinical notification app for the Apple iRing that displays college insignia or birthstones in the absence of pending notifications.

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A hacker defeats the facial recognition security of the just-released Samsung Galaxy S8 smartphone by copying the registered user’s Facebook photo and then just sticking it in front of the phone’s camera.

A med student’s interesting article says that the broken medical residency electronic match program is leaving half of new graduates without a residency slot. The author says the electronic application process encourages blasting out applications en masse, overwhelming the ability of the residency programs to evaluate their candidates wisely. He concludes that pen and paper applications might force applicants to be more selective in expressing their true interests, adding that the number of electronic applications per student could also be limited but that’s not likely because the AAMC-owned system makes a lot of money per application.

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California-based surgery collaboration app vendor Casetabs (which describes itself pointlessly as “the Uber of surgeries”) runs a Craigslist ad (where apparently all the health IT experts look for work) for a sales development rep with some fun requirements:

  • “Sales sniper with a proven track record of crushing sales quotas.”
  • “Extreme comfort in cold-calling (70-100 calls/day).”
  • “Water Garden office complex in Santa Monica (sofas, fire pit, B-ball, football, corn hole, Foosball, etc.)”
  • “High performance, high pay environment (eat what you kill).”

Here’s Part 2 of the top 10 HIS vendors report from Vince and Elise.

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Dr. Weird News Andy would like to order a vodka drip, stat. Veterinarians save a cat that poisoned herself by licking spilled brake fluid off her fur by administering IV vodka to counter the effects of ethylene glycol. Princess the cat is recovering at home, which by WNA’s calculation leaves her with eight remaining lives.  


Sponsor Updates

  • Clinical Computer Systems, Inc., developer of the Obix Perinatal Data System, celebrates its 20 years in healthcare.
  • ZeOmega will exhibit at NAACOS Spring 2017 Conference April 5-7 in Baltimore.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Currently there are "9 comments" on this Article:

  1. RE: Southcoast Health lays off 95 employees after running over budget on its $100 million Epic implementation.

    My first thought when I read this is to ask “I wonder how the folks who made the decision to buy Epic at Southcoast and apparently underestimated the true project cost feel about having 95 employees lose their jobs because of that decision?” Is that a fair question?

    • What would you expect the response to be? That they’re happy? There are consequences to running out off money and they can heartwrenching. I’m sure the chosen software vendor has little to do with their feelings.

      • Dear Value,
        I think you missed my point. Your answer had a snarky ring to it so let me try again. I was asking for clarification (not pontification) as the the way the comment was written suggested (to me) that IF the project came in on/under budget, those 95 positions would be intact. I am well aware that sometimes IT projects automate processes that require the need to reduce staffing. Again, asking the ‘author’ for clarification of the report.

  2. Maybe the truth is that Epic automation helps you eliminate manual steps and the staff needed for them.

    It can be sad, but after you do enterprise automation, you can get more done with lots less staff in the organization.

    And, in almost all cases, it isn’t 95 “people who lose a job” it is “positions” being eliminated, most of which are done by natural attrition and not filling those positions for the future.

    The truth is in the numbers. Epic sites thrive after they get through their projects.

  3. I always get a chuckle when executives and project leaders say that they are “happy with their decision.” If you were a key player in the decision to move forward with the project you aren’t going to cut your own legs off and announce to the world the biggest decision you ever made was the wrong one. As for subordinates openly criticizing the leadership that made the decision isn’t a great career move. For at least 5 years after the go live any accounting of the project of course will be biased because of the core instinct of self preservation. I believe the only way we will get a true reckoning as to whether or not these huge Epic installs were worth it will only come when new leadership is installed and an unbiased accounting takes place. It’s probably already happening but releasing that information would probably be seen as an embarrassment to the organization regardless of who made the decision.

  4. Re: NTT DATA – Netsolutions may be the prize, but I am interested to see if the remaining clients will jump ship similar to the other transactions. I think our contract has out if the company is sold.

  5. “Is it really so hard to match a singular subject to a singular verb?”

    Prediction: 300 years from now, the conjugation of verbs in English will be based on the closest preceding noun, not the subject. There will be a click-bait-y article on the future version of the internet about how what sounds natural to us now used to be considered erroneous hundreds of years ago, with this quotation cited.

    This will be the lasting legacy of HISTalk: A repository of grammar crankery to remind future generations that everyone has always thought their own contemporaries were uniquely terrible at using their own language.

  6. The decision to purchase Epic at Skagit Regional Health was purely one based on ego by the then and current executive leadership and by the provider community. The majority of the major health systems in the greater Puget Sound area use Epic, Confluence Health, UW Medicine, Providence Health & Services, MultiCare and Peace Health. Skagit has IDN envy. Related to Lisa Buller, she was not on board when the decision was made, she is a hired gun who goes around the country and runs Epic installs. Her investment is that she is making some serious coin on the project. While the initial contract was for $72 million for an enterprise agreement it did not include all the install costs and none of the hosting costs, which are in separate agreements with Epic and significant.

    While I agree that roughly 20% – 25% of the staff now in IT could be reallocated to other roles once the system goes live, current budgets estimates do not indicate that will happen. Also they organization has outsourced the legacy support to CTG Health Solutions for Meditech, NextGen and interfaces. Recently with the arrival of a new COO they have started to disengage some of the 60 or so consultants who have been working on the project. Not sure how much will be saved by this move, but its a token gesture. The real issue here is how can a leadership team in good conscious even consider a project of this scale that could fiscally strangle this rural hospital and cause its possible demise or the necessity of it to align with a larger provider. Many in the community who understand the issues believe this was the end goal of leadership to force the governing board to be forced to align with a larger player. The current CEO plans to retire in roughly 2 – 3 years, aligning with a big player would be a nice end point to his career.

  7. Confluence is in the middle of their own Epic disaster so probably not the best reference. Just another example of egregious spend for an over time over budget project.







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