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January 4, 2018 News 3 Comments

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A Mayo Clinic Jacksonville study finds that only around 20 percent of inpatients who had previously registered for its patient portal actually used it during their stay, concluding that inpatient portal use probably doesn’t improve outcomes.

Mayo’s portal provides a real-time view of lab results, admission notes, consultation reports, and operative notes. It does not, however, give patients access to progress notes or provide electronic messaging with care teams, which might help explain why they didn’t bother to log on (or the fact that they were busy being sick). There’s also the question of whether Mayo’s inpatients are representative of the populations of other health systems.

It may also be that staff communication there was good enough that patients didn’t have to chase down news about themselves on the portal.

What I would want in an inpatient portal, or more specifically, a custom app running on a tablet:

  • An integrated call system that allows me to indicate what I want or need and have my request prioritized and routed appropriately (just more ice at some point or a pain med now?)
  • A schedule of my meds due, a photo of each dose to double-check employees who might screw up, and a link to a standard medical reference so I remember what it’s for.
  • Two-way video would be nice for employees who otherwise have to make their way to my room for something that isn’t critical (maybe I want to ask a pharmacist a question, for example).
  • The ability to create tasks for staff (like fix my TV) and for staff to create tasks for me (like get out of bed and walk down the hall twice a day), with completion times noted and stored for accountability.
  • A Bluetooth-powered hospital badge that would flash the name and title of the person on the screen along with their photo and then record it so I could review it afterward.
  • A list of ordered but not yet performed tests or procedures, ideally with the dates and times they are scheduled.
  • Some idea of my care plan, success metrics, and expected outcomes.
  • A display of every line item being charged for my stay in as near real time as possible.
  • The usual hotel-like options for requests involving food, entertainment, and housekeeping.
  • The ability to record what a caregiver is telling me so I can review it afterward to avoid missing something important.
  • The Bluetooth badge-powered ability to display a giant, flashing red dollar sign when a hospital-sent caregiver enters my room who – despite my explicit instructions — isn’t in-network with my insurance.

Reader Comments

From Glory Basking: “Re: solutions, platforms, systems, applications. What’s the difference?” You would need to ask the marketing folks who love these terms and use them interchangeably. I remember an insistent email from a company’s marketing VP who was appalled that I had described its programmer utility (not the VP) as a “tool” instead of its preferred, overarching “platform.” That made me think of old-school techies would reference “a piece of software” — which was odd indeed since software is neither physical or divisible – or when an IBMer urged me in my short time as a vendor employee to always refer to our software as “solutions”or the even more grandiose “solution set” because it lulls the prospect into overlooking its many faults in picturing it as a reliable problem-solving appliance activated by writing a large check.

From Spinnaker: “Re: health IT podcasts. Which ones do you recommend?” I’ve never listened to any podcast – health IT or otherwise – but readers are welcome to make a recommendation. I would much rather skim the news visually for a minute or two (like on HIStalk) than sit through a real-time audio recording whose pacing I can’t control, but then again my attention span is so short that when I listen to the car radio (which isn’t often), I usually leave it on scan.

From Festivus: “Re: more EHR vendor lawsuits. See link.” Newly filed lawsuits are fun to write about, but I’ve mostly stopped because you’re just hearing one side of the story. Anybody can sue anyone for any reason in the good old United States of Litigious Peoples, so it’s journalistically lazy to write about a newly filed lawsuit as though it contains verified facts. Wait for the outcome – that’s the actual news.

From Thank You: “Re: HIStalk. It’s critical to my job and so valuable. I just wanted to drop a note and say thank you for all the hard work and effort you put into maintaining it and keeping the content fresh!” Thanks. I don’t have any time-suck hobbies other than starting with an empty screen and filling it up the best I can, so this is my golf or Facebooking.

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From Spam in a Can: “Re: EHRs. Epic’s ‘we make you more money’ claims are erroneous, if not disingenuous, according to this journal article.” I’m not sure it says that. A JAMA Ophthalmology article recaps a survey of ophthalmologists about EHR use. My takeaways:

  • The very long survey drew 348 respondents from a random sample of 2,000 AAO members invited, which isn’t a fantastic sample size or response rate (the US has about 18,000 practicing ophthalmologists). Only one respondent was selected within a given ZIP code and the survey was delivered via email. Of those respondents, only 265 reported using an EHR, so hopefully the authors discarded the 83 responses of those who don’t (but thus leaving the sample size even tinier).
  • Epic was the most-used EHR, although only a vendor ranking was provided rather than actual numbers.
  • 77 percent of EHR-using ophthalmologists say their practice is owned by physicians and only 6 percent by hospitals, which raises an interesting question – why the heck are so many of them using Epic instead of a specialty-specific EHR/PM? That seems suspicious.
  • The 72 percent of respondents who use EHRs say their net revenues and productivity have declined while their practice costs have increased.
  • Only 9 percent said net practice revenue increased with EHR use, while 35 percent said it stayed the same and 41 percent said it decreased. That seems odd since most of them also said coding levels and charge capture were unchanged or higher, leaving only reduced productivity as a possibility. Or that changes were associated with EHR implementation but not caused by it since time passed and situations changed either way.
  • 36 percent of ophthalmologists said they would go back to paper if given the chance.
  • A great majority of respondents said practice costs went up after implementing an EHR, but the study demographics also noted that most practices were running their first EHR. Obviously EHRs are more expensive than paper and the study didn’t ask respondents how much they thought costs rose, only whether they did, which again could have been due to unrelated factors over time.
  • Many respondents were pushed into using EHRs because of Meaningful Use incentives, which brought their own burdensome EHR documentation requirements.
  • It’s a perception study, which means that while practicing doctors rendered an opinion about cost, revenue, and profits, their participation was not vetted by role (so they aren’t necessarily involved in practice management) and their actual numbers weren’t reviewed.

HIStalk Announcements and Requests

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The frantic Post-New Year’s, pre-HIMSS housekeeping is underway. Sponsors who want to be featured in my HIMSS guide will be receiving a link to the data collection form (anxious ones can contact Lorre). It’s also time to open the HISsies nominations, recalling that it’s like a political primary – the candidates with the most votes will appear for voting on the final ballot, so don’t complain later if you don’t nominate now.

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Ms. M’s pre-K class in New York City received the science kits that HIStalk readers provided in funding her DonorsChoose teacher grant request. She reports, “We have been talking about volcanoes for the past few weeks. Many of the children didn’t even know what a volcano was. We are excited to start using these items within the next few weeks. You have made a tremendous impact on our class. Happy New Year.”

Listening: Garner, NC-based Sarah Shook & the Disarmers, a rare glimpse at what country music could be if devotees would stop throwing money at (a) throaty, big-city pretty boys inexplicably wearing cowboy hats indoors, and (b) privileged, bespangled warblers hiding their shiny pop ambitions behind a faux front of populism. This band is classic country meets sneering punk, unpolished and and full of hard-life experience, which is what country music used to be before big corporations took it over with harmless mannequins who would flee the studio in confusion if confronted with an actual pedal steel guitar or upright bass. I like that Sarah is an angry activist who chose as her band mates experienced (meaning: kind of old) musicians who really round out the sound.


Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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


Acquisitions, Funding, Business, and Stock

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VC-backed, four-state Medicare Advantage insurer Clover Health is not only losing money, failing to negotiate lower-cost provider contracts, and leaving patients on the hook for bills it won’t pay, it is also struggling with its highly-touted analytics technology. A bug in its algorithm that was supposed to rank members from sickest to healthiest for outreach calls had reversed the order with nobody noticing for several months, wasting the time of reps who called its healthiest customers first in chasing the high-hanging fruit.

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Enterprise telehealth platform vendor InTouch Health will acquire direct-to-home telehealth platform vendor TruClinic.

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AMA-backed Akiri, which offers a secure subscriber data transport network for healthcare, raises $10 million in a Series A funding round.


Sales

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The US Army expands its use of Vocera communications technology, adding a new hospital and expanding the rollout of two others.

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Capital Region Medical Center (MO) chooses CloudWave’s managed, cloud-based disaster recovery services for Meditech.

LA County Department of Health Services renews its revenue cycle management software and services contract with Harris Healthcare’s QuadraMed Affinity Corporation.

Hospital Sisters Health System (IL) chooses Health Catalyst’s Data Operating System analytics system for its ACO and PCIN.


People

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Mike Ruotolo (Inovalon) joins PatientSafe Solutions as regional sales VP.


Announcements and Implementations

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A new KLAS report on population health management identifies six functionality areas (data aggregation, data analysis, care management, administrative and financial reporting, patient engagement, and clinician engagement) and finds that HealthEC and Forward Health Group lead the pack, with feedback coming mostly from ACOs. Health Catalyst, Arcadia, and Philips Wellcentive topped satisfaction for IDNs/CINs. Narrowly-focused PHM solutions offered by EHR vendors scored surprisingly poorly in clinician engagement compared to leaders Forward Health Group and Enli. 


Government and Politics

HIMSS adds VA Secretary David Shulkin to a Friday morning session at HIMSS18 called “It Takes a Community – Delivering 21st Century Coordinated Care for Those In and Out of Uniform” that also features Defense Health Agency Director Vice-Admiral Raquel Bono. I assume the VA will have signed its Cerner contract by then, but you never know. I noticed that HIMSS will also need to change the title of fellow keynoter Eric Schmidt, whose credential as executive chairman of Google parent Alphabet will end at company’s board meeting this month when he assumes the less-keynoterly title of “technical advisor.”


Other

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A fascinating article by oncologist and author Siddhartha Mukherjee, DPhil, MD describes “the dying algorithm,” a 2016 Stanford project that mined EHR data retrospectively to create a deep neural network that could accurately predict whether a given patient would die within the next year. Interestingly, the algorithm works well but remains a black box because it’s not easy to figure out what it learned or how it applies its information to individual cases. It’s also interesting that despite sounding coldly high tech, the algorithm was developed with a nobler, more humane purpose – to identify terminally ill patients within the 3-12 month survival “sweet spot” in which palliative care is most effective in not wasting resources too early, but allowing patients enough time to settle their affairs.

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New versions of the cell-enabled Apple Watch are randomly rebooting in hospitals, apparently affected – as its documentation acknowledges is possible – by pacemakers, defibrillators, and other medical equipment. Users report that switching the watch to airplane mode while in the ICU prevents rebooting.

I enjoyed this video from Brad Nieder, MD, a practicing doctor and comedian whose “The Health Humorist” website invites folks to, “Put on a paper dress. Grab a magazine from 1987. This won’t hurt a bit!”


Sponsor Updates

  • Healthfinch is mentioned in KLAS’s emerging companies report.
  • AssessURhealth joins Greenway Health’s online marketplace.
  • Formativ Health renovates new space with sustainability in mind.
  • Ingenious Med staff volunteer with Open Hand Atlanta to deliver meals to the homebound.
  • KLAS highlights Health Catalyst as a high performer in a new population health management report.
  • Kyruus will exhibit at the JP Morgan Healthcare Conference January 8-11 in San Francisco.
  • ZeOmega adds identification and stratification tools to its Jiva population health management solution.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Reader Comments

  • DrM: Found the person who knows nothing about user change management. (Did I do it right, is this how we play the game?) S...
  • Seargant Forbin: @ What's with the Fairview guy? I don't think this Apple comparison is helping your case any. I bet if you spoke with de...
  • Bobby: Great point Bob. Cerner and Epic are both organic companies that value a “one big honking system” approach to thin...
  • AynRandWasDumb: "The most recent Epic trick I heard is that, now that Epic is requiring every customer to move to quarterly updates inst...
  • Bob: Even though Apple could take IP directly from the Apple ecosystem developers, their usual model is to just buy the compa...
  • You might say I'm a dreamer...: Will this Cerner dust up with the DoD now give us a real granular discussion on a national level as to what Interoperabi...
  • Eddie T. Head: To claim that Apple is a hardware company and not a software company is quite odd. Without their software, Apple's hardw...
  • DrM: Epic's model does assert the ability to use any IP in App Orchard without compensation or limitation, it's why the few v...
  • Matt: VA CIO: Expect another 10 years of VistA in facilities during new EHR rollout This is clear indication of how the VA ...
  • Satan warming up the fiddle?: Coming in to an election season where healthcare will most certainly be part of the debate are we starting to see the fi...

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