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July 29, 2014 News 14 Comments

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House and Senate leaders approve spending $17 billion to improve services at the Department of Veterans Affairs by leasing new facilities, hiring more clinicians, and paying for care delivered outside the VA for veterans who can’t get timely appointments. Most of the “cost of war” funding goes straight to the $18 trillion national debt. In related news, former Procter & Gamble CEO Robert McDonald is unanimously confirmed as VA secretary.


Reader Comments

From Legume Enumerator: “Re: Cerner earnings call. You missed the laughter toward the end of the call when EVP Zane Burke said that EMRs that don’t interoperate are borderline immoral. This supposedly ’open’ versus supposedly ‘closed’ systems debate that is beginning to surface in Congressional testimony and now on investor calls will become the battle cry for why the kids from Wisconsin should not be allowed to win the DoD (or any other, for that matter) contract.” “Open” has become a marketing term, jumping the shark when since-deposed Allscripts CEO Glen Tullman confidently and repeatedly declared that all of the company’s potpourri of acquired systems are open and interoperable because they all run on Microsoft SQL (showing little widespread openness, not counting Glen’s mouth). It is indeed worrisome when politicians start using the word as though they understand it and aim legislation accordingly. I challenge readers thusly: what core set of published standards or capabilities must a given EHR support to be considered open? We need to put some collective thought into this.

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From Gold Watch: “Re: Xerox Midas+. The managing director apologized to customers in June 2013 that the acquired product marketed as Midas+ Live failed to meet their needs. The company replaced him with the key person from the former company of the failed product, who reassigned most developers to the Juvo cloud-based product being developed using the failed product as its basis. The developers and an India-based contractor were supposed to finish the product by January 2015, but it exists only in demo form and numerous employees have left the company. Sales of the flagship product will be halted in August 2014, hoping to convince Midas+ customers to switch to Juvo, although employees have been forbidden using the word ‘sunset.’ The company’s stated mission is now to double its 2013 revenue by the end of 2016.” Unverified. A Xerox spokesperson provided this response:

We take all customer concerns seriously and address them directly to ensure our customers are delighted with our products and services. As a leader in our field, Midas+ is always working on developing new products that will enhance customer satisfaction and help improve the quality of care.

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From Headcount Reduced: “Re: Siemens. You missed the 7/25/14 layoff in Malvern. It wasn’t just contractors and consultants. Rumor is that 200 employees were impacted.” Unverified.

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From Stocky Lad: “Re: Health Evolution Partners. What was CalPERS thinking to put $700 million into Brailer’s first foray into private equity? It pisses me off as a California taxpayer. I assume HEP’s Summit will continue regardless since they were considering spinning it off even before this latest news. It’s a super event.” Enthusiastically endorsing the deal on behalf of CalPERS back in 2007 was its CEO, Federico Buenrostro, who was fired in 2008 and just pleaded guilty a couple of weeks ago to accepting bribes, defrauding workers and retirees, and obstructing SEC regulations. The next invitation-only HEP Summit is in April 2015. Some of its sponsors are Emdeon, McKesson, Optum, Walgreens, Healthagen, Oracle, and WellPoint. This year’s agenda featured a panel of past and present National Coordinators: Blumenthal, Brailer, DeSalvo, and Mostashari.

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From ThanksForPlaying: “Re: Norbert Fischl, CEO of CompuGroup Medical US. Has been removed from his position by Germany. His tenure, similar to that of his predecessors, was just over a year.” Verified. I interviewed him a couple of months ago. My surprise is minimal.


What a Cerner Acquisition of Siemens Health IT Would Look Like
By Chester of Malvern

  • Does the remote client operations (RCO) data center belong to the suitor?
  • Allegra, Invision, and Soarian customers would become service level agreement fodder – positive revenue – and customers of the first two would be targeted to replace their aging software.
  • Siemens US clients plus Cerner sites would push Cerner past Epic in size.
  • Soarian sites are happy with their financials, which are better than Cerner’s.
  • Siemens has a better and more stable international presence (see NHS Cerner replacement by CSC’s iSoft). Cerner has made some progress internationally, but regional capitation (most offer socialized care) and ease of implementation is Cerner’s burden.
  • Invision sites love their accounts receivable – tough to convince happy CFOs.
  • Soarian clinicals / financials could complement Cerner in the community hospital space where Cerner has historically been too expensive, specifically implementation support – complex integration.
  • Siemens MobileMD is a sound HIE platform, Cerner would be better at packaging and selling it. We like Cerner’s ACO and population management approach, so CareXcell would be gone, or at least have a bake-off with Cerner’s PM solution, and Cerner’s solution would win because they have an install base.
  • Siemens Intelligence could play a role as long as Soarian is not demolished.
  • Love the Soarian business process manager — the rules engine is quite impressive.
  • Siemens’ EDMS is better than Cerner’s and it is standalone.
  • Siemens RIS — legacy, so that is not a question. Doubt if a proprietary PACS would be needed Cerner has an acceptable image management solution, but neither company is popular in radiology or cardiology.
  • Siemens Lab is a legacy system that customers love. KLAS rating is high even though they do not really manage pathology very well (lab is standalone).
  • Siemens Pharmacy and MAK works with Soarian – different platform, but functional. A keeper if there is a willingness to port the technology to the same Soarian foundation (pharmacy not so standalone).
  • Cerner Millennium is difficult to install. Consultants who install Soarian do not have the same complaints.
  • Cerner services are about as effective as Siemens services – they both lose equally to consulting firms that are or have a lot of ex-Cerner / Siemens implementation and project management personnel.
  • Cerner could simply acquire Siemens for the client base and would, as most acquirers do, have a heavy hand in redundancy. However, Siemens has a surprising number of seasoned veterans if the transition is handled well and they don’t all run for the hills.
  • Soarian is not worth burning, but acquisitions for market share are rarely kind. Usually they are disruptive to a point of discontent.
  • Siemens need to prove a profitable community hospital IT model since Cerner hasn’t played well there. Over 3,000 hospitals have fewer than 200 beds and perhaps a Cerner Soarian campaign could help those most negatively affected by ACA.
  • Both Cerner and Siemens have had challenges in the ambulatory space. Cerner touts its progress in ambulatory care, but it’s mostly IDNs with ambulatory care centers that serve as feeding conduits to the hospital. Siemens hasn’t made the commitment to acquire or build a viable product.
  • The silver bullet for Epic is scalability. Even though Epic can control without collusion their pricing model, they cannot be the only choice for hospitals with fewer than 200 beds.

Acquisitions, Funding, Business, and Stock

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GetWellNetwork acquires patient rounding and satisfaction system vendor Marbella Technologies.

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Personal vital signs analytics software vendor Naperville, IL-based VGBio changes its name to PhysIQ and raises $4.6 million in Series A funding. The VA Center for Innovation is piloting the software in its VitaLink program, which warns caregivers of developing health issues by analyzing information from sensors worn by patients at home.

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Oncology data vendor Flatiron Health moves its headquarters to a newly leased 15,000 square foot office space at 96 Spring Street in New York City.

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The CEO of Roper Industries, speaking about its Sunquest division in Monday’s earnings call: “Sunquest had an all-time record quarter. There is Meaningful Use implementation and our ability to approve Sunquest’s ability to execute really paying huge dividends now, lot of upgrades in the hospitals. And we continue to invest very aggressively internally in Sunquest to capture more of the anatomic pathology and genomic testing opportunities that we see ahead. That’s lot of internal investment in there, but we’re also very active in the acquisition pipeline area around those areas … we’re going to expect double-digit growth for some time out of Sunquest that areas that we’re taking them into are very exciting areas. There is a lot of opportunity in the short run … It generates lot of cash.”


Sales

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Nebraska Methodist Health System (NE) selects Strata Decision’s StrataJazz for decision support, cost accounting, operating budgeting, management reporting, and productivity improvement.

Advocate Health Care (IL) will deploy vendor management technology from Connance.

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Comanche County Memorial Hospital (OK) selects Merge Healthcare iConnect Enterprise Archive and iConnect Access.

Eskenazi Health (IN) selects Streamline Health’s Looking Glass business analytics solutions.

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Cape Regional Medical Center (NJ) will implement Summit Provider Exchange to connect its multiple EHRs to the NJSHINE HIE.

War Memorial Hospital (MI) will deploy the JEMS Telehealth System.


People

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Quantros names Annie Callanan (Systech International) as president and CEO, replacing interim J.P. Fingado.

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Steven Davidson, MD, MBA (Maimonides Medical Center) joins PatientSafe Solutions as CMIO.

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Impact Advisors hires Tonya Edwards, MD (Bon Secours Medical Group) as physician advisor.

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Dave Cannell (Deloitte Consulting) joins Cumberland Consulting Group as managing director of the company’s life sciences practice.


Announcements and Implementations

Cerner names Rainbow Services, Inc. (KS) as the test site for its Community Behavioral Health mental health EHR.

SSI introduces its A/Rchitect suite, which includes analytics, denial management, and contract management. 

Maryland’s CRISP HIE issues an RFP for a pilot to add image exchange to its query service.


Government and Politics

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National Coordinator Karen DeSalvo writes a letter to the editor of the Boston Globe, saying that the paper’s story about EHR safety problems failed to mention positive EHR outcomes. She also pitches ONC’s proposed health IT safety center – the one Congress keeps saying ONC isn’t empowered to create.

A VA investigation finds that one of its pulmonologists copied and pasted old clinical information into its electronic patient records more than 1,200 times, possibly committing insurance fraud as a result if third-party payers were billed for his services. The unnamed doctor blames his “technical incompetence” and “stupidity.”


Innovation and Research

Baltimore startup Quantified Care, run by mostly Johns Hopkins graduate students and selling evidence-based mobile apps and hardware, starts a $15,000 Indiegogo fundraising (and PR-generating) campaign that offers an old-school but high-tech doctor’s black bag for a $300 contribution.


Other

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A new Institute of Medicine report says that while taxpayers are spending $15 billion per year to pay for medical residencies and fellowships — much more funding than any other profession receives and giving hospitals cheap and obedient medical labor — the government imposes little accountability and the system is not producing the kinds of doctors needed. The report also concludes that the program overemphasizes hospital training, reflecting its 1960s-era origins in falling short on healthcare IT, preventative care, and chronic disease management. The report recommends making changes to Medicare regulations over the next 10 years to create a more accountable and performance-based system, then deciding at that time whether taxpayers should be funding graduate medical education at all.

Schools of osteopathic medicine, which grant the DO rather than the MD degree but are otherwise nearly identical except for their emphasis on community medicine and preventive care, are producing a third of all new medical school graduates. Last year, 144,000 applicants competed for 6,400 DO school spots. Sixty percent of new DOs enter primary care vs. 30 percent of MDs.

A CBS News report says that medical identify theft is “the low-hanging fruit” for criminals and is increasing dramatically because the healthcare system doesn’t protect their information and those whose identities are stolen don’t find out unless their bills go to collections. The article points out that the impact isn’t just financial – a patient could be given the wrong meds or blood products or have their insurance terminated. The article leads off with the story of a woman who almost lost custody of her children because a drug user gave birth using her identity.

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It’s a Pyxis for pot: Medbox obtains patents for its biometric-powered marijuana dispensing technology. The company offers related services that include armored car cash transportation.

Weird News Andy notes “keeping cancer in the dark” as an animal study suggests that breast cancer becomes resistant to treatment with tamoxifen if the test subject is exposed to light at night, which suppresses melatonin production.


Sponsor Updates

  • Frost & Sullivan awards Validic its best practices award for value and customer focus in healthcare interoperability solutions,
  • Healthcare Data Solutions (HDS) releases a new white paper, “How EHRs Can Become More Than Just Vendors.”
  • DocuSign posts an article called “Don’t Risk Your Health (Data) with Paper.”
  • Beacon Partners posts a new blog entry titled “Four Questions the Proposed Meaningful Use Rule Doesn’t Answer.”
  • ZirMed announces partnerships with JASE Health, HAS-Software, AmeriCare, medQ, and Scorpion Healthcare.
  • University Hospitals (OH) expands its Premier relationship to include Premier Connect Enterprise as well as extending the supply chain services agreement for three years.
  • Health Catalyst adds keynote speakers and sessions and expands the attendee limit for its Healthcare Analytics Summit 2014 September 24-25 in Salt Lake City.
  • InstaMed announces that 70,000 healthcare providers have been paid through Member Payments since its launch one year ago.
  • Predixion Software CEO Simon Arkell is named a finalist in the “Outstanding CEO” category of the Orange County Technology Alliance.
  • Jen Reese shares how telemedicine technology is creating the need for doctors to have licenses in multiple states on pMD’s blog.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 29, 2014 News 14 Comments

Monday Morning Update 7/28/14

July 27, 2014 News 8 Comments

Top News

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A draft report from the Senate Appropriations Committee, responding to HHS’s FY2015 budget request, proposes to give ONC $61 million of the $75 million it requested. It adds that ONC should publicly report and then decertify EHRs that “proactively block the sharing of information.” It also wants the Health IT Policy Committee to create a report describing the challenges to interoperability and whether certification helps or hinders it. Reading down the long list of funded projects, it’s depressing to see how much taxpayer money is being dumped into government programs that claim to help one issue or another. All that aside, the interesting dynamic here is that ONC, like every government agency unwilling to reduce its budget or authority, keeps trying to expand its mission while Congress seems to think it is overstepping its authority and questions its effectiveness. I suppose $75 million is a rounding error in the federal budget, but as a taxpayer, I might question ONC’s value, along with what I’m getting for my $25 billion in HITECH handouts to providers who mostly regret having given up control in return for strings-attached government money.


Reader Comments

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From EarsToTheGround: “Re: Siemens. Well-placed sources say they’ve been told that their consultant and contractor positions are being terminated by the end of September as they phase out several EHR vendors. I don’t know if this is related to the possibility of a Cerner buyout.”

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From All Hat, No Cattle: “Re: pic from the Redwood Mednet conference in Santa Rosa, CA. I see the audience is a lot of older hippie types and open source geeks like Wes Rischel, Will Ross, John Mattison, David McCallie, etc. discussing HIEs with John Halamka.” There’s nothing like that "bald spot meets gray ponytail" look when it comes to self-identifying as an IT geek or that vaguely creepy “stuck in the 1970s” sound guy at the local music bar who doesn’t have the talent or nerve to be on stage but toils in the worshipful shadows of decades-younger musicians who do.

From Laredo Dave: “Re: Weird Al. Almost every buzzword you have ever heard, all in one video.” I’ve always detested Weird Al and his heavy-handed, sophomoric parodies of current events, but this one might make me a convert since even the music is good (very CSNY-like). It even includes one of my least-favorite, unnecessary pseudo-words: “administrate.”

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From Lupe: “Re: Childhood Cancer Awareness Month. It’s in September. I don’t have a million dollars to give for research, but I am the very lucky mother of a 16-year-old diagnosed a year ago. My goal, short of a cure, is to make the gold ribbon representing these horrific diseases as recognizable as a pink one for breast cancer.”

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From PP: “Re: Android tablet. Which inexpensive one did you buy that you liked quite a bit?” I got an Asus MeMO Pad HD 7 in December 2013 for $119 when it was on sale at Office Depot, frustrated that a newer version of my first-generation iPad was more expensive than a laptop. I still use the Asus tablet regularly and have no regrets. Android-powered tablets are just as good or better than the ones Apple sells for multiple their price, which may be why iPad sales are nosediving. I’m a casual user (checking email, looking up stuff on the Web,  watching Netflix, and reading Kindle books around the house, all over WiFi instead of cellular), so I don’t need a $499 iPad Air or even a $229 Google Nexus 7. The just-released latest model of the MeMO Pad is $134 on Amazon.


HIStalk Announcements and Requests

The intrepid Dim-Sum provided a detailed update about the Department of Defense’s EHR procurement, so I posted it separately.

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Athenahealth provided a response to the question from Watertown Boy about the effect of the company’s updated Meaningful Use calculations on those practices that have already attested. I posted their comment under the original question.

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Half of my poll respondents own stock or other equity of a healthcare IT company. I’m in the other half that doesn’t. New poll to your right: do EHR vendors have too much influence on related government policy?

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Welcome to new HIStalk Gold Sponsor DocuSign. Its solutions allow business to sign, send, and manage documents in the cloud, making them available and legally enforceable. Healthcare organizations such as Blue Cross Blue Shield, Cedars-Sinai, HCA, and New York-Presbyterian use DocuSign to streamline document-based processes. The result is HIPAA compliance, faster patient inboarding, shortened turnaround time for Medicare billing, and faster handling of paperwork involving credentialing, supplier contracting, and HR. I interviewed the company’s founder, Tom Gonser, a few months ago. I have received documents that required DocuSign signatures and it was infinitely easier than printing, signing, scanning, and emailing. Try it yourself with the company’s 14-day free trial. Thanks to DocuSign for supporting HIStalk.

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I’ve mentioned before the really cool (and free for personal use) remote control software I use: TeamViewer, from Tampa, FL. You can remote in to someone’s computer to fix something, remote into your own desktop from your phone, transfer files, and even hold online meetings or training sessions for up to 25 people. It is unbelievably simple, reliable, and satisfying to use. Just this week I’ve used it to remote into a colleague’s PC to diagnose a Windows problem and to remote into my home desktop from my phone.

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Listening: a new hard-rocking single, “Cool Kid,” from The Eeries, an unsigned Philadelphia band. Also: Young the Giant, great California indie rock. Here’s one more, this one with a healthcare IT angle: VEX (above), a locally popular early 1980s college punk band (Georgia College & State University) featuring a young Larry Stofko, now EVP of the Innovation Institute of St. Joseph Health System of Irvine, CA. VEX’s music is now on CollegeBand, which tracks down long-defunct cult college bands, digitizes their music, and sells it along with merchandise and music rights for movies and TV. That’s my kind of business.


Last Week’s Most Interesting News

  • Cerner turned in another solid quarter with record quarterly numbers. Epic may be winning most of the high-profile health system deals, but Cerner’s win rate is creeping back up, its Intermountain partnership looks promising, and the company has diversified itself into enough areas of healthcare that its future isn’t dependent on new Millennium sales. Both companies will benefit as Siemens shops its IT division and McKesson sends mixed signals about its health IT commitment.
  • The Boston Globe reviewed EHR safety in a wandering, anecdotal article that decried a lack of mandatory EHR problem reporting and the overall influence of vendors on government policy. It uncovered new information in revealing that a recent study of 5,700 malpractice claims found that EHR-related issues contributed to 46 patient deaths, although the study’s definition of EHR harm was loose: it included incidents involving missing information, incorrect user entries, and problems with providers trying to run EHRs and paper systems at the same time.
  • Two UK hospitals signed huge deals with tarnished vendors. North Bristol will replace Cerner Millennium with CSC’s Lorenzo, whose legendary vendor shortcomings (both product and implementation) killed the government’s $20 billion NPfIT, while the trusts overseeing Watford General Hospital signed a $44 million infrastructure contract with CGI, most widely known for its deep involvement with the failure of Healthcare.gov.
  • Leapfrog Group’s annual report found higher hospital CPOE use, but a third of those systems fail to detect major ordering problems.
  • NantHealth SVP Dave Dyell confirmed an HIStalk reader’s rumor report that he’s leaving the company, Patrick Soon-Shiong’s wildly ambitious conglomeration of a billion dollars’ worth of acquired companies. One of those was Dave’s former employer, medical device integration company iSirona.
  • Health Evolution Partners, a healthcare IT investment vehicle launched by former National Coordinator David Brailer when he left his government position in 2007, appears to be on its last legs. Its only investor, California Public Employees’ Retirement System, wants to cash out after the rookie private equity manager Brailer delivered years of near-zero investment returns despite promising 20 to 30 percent annually. HEP lists seven current portfolio positions, none of them related to healthcare IT.

Webinars

August 12 (Tuesday) 1:00 p.m. ET. City of Hope Improves the Cancer Patient Experience With Salesforce.com. Sponsored by Salesforce.com. Presenters: Fred Stevens, director of call center operations, City of Hope National Medical Center; Todd Pierce, EVP of operations and mobility, Salesforce.com. Learn how City of Hope improved patient satisfaction and intake inquiries in 16 areas, gave 75 call center representatives the information they needed to deliver a personalized and seamless interaction, improved first-call resolution, and reduced average call transaction time by 42 percent (90 seconds) for over 1 million inbound calls per year. A live demo of Salesforce1 will follow.


Acquisitions, Funding, Business, and Stock

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From the Cerner earnings call:

  • Sales revenue was up 15 percent and the total backlog is at $9.69 billion.
  • The company says many population health vendors are not aggregating and standardizing data across multiple systems, which makes them of limited value. Cerner says it offers more of a CRM-type system that includes registry functions, data warehouse, analytics, and patient engagement.
  • The ambulatory user count increased to 65,000, double number from “just four years ago” as the company says it is displacing key competitors.
  • Cerner says it is commit to “having the most open EMR,” whatever that means when marketing-minded companies claim they have it while scoffing at open source alternatives.
  • The company says its services and hosting offerings differentiate it from competitors.
  • An analyst asked if Cerner would have a rich opportunity to earn business from clients of Epic given that Epic is “relatively uninterested or unmotivated in pursuing pop health based on some of the chatter in the marketplace.” Zane Burke declined to comment, saying only that the industry needs EHR-agnostic solutions and Cerner’s will work with any EHR.
  • Marc Naughton said that Cerner will have more specifics on their Intermountain project next quarter.

I missed this earlier announcement: Google launches Calico, a health and wellness company that has already hired four prominent physicians and named as its CEO the board chair of Apple (who is also board chair at drug maker Genentech.) It seems that Google is dipping toes all over the healthcare waters right after Google co-founder Sergey Brin complained that it’s a waste of his time because it’s too regulated. Maybe he was just being cranky over the FDA’s pressure on his wife’s consumer genetics business 23andMe, which still hasn’t complied with FDA’s requirement that as a medical device, it has to submit validated proof of its accuracy to earn the agency’s marketing approval.


People

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Surgical Information Systems names Jim Linder (Norwest Equity Partners) as acting CEO and executive chairman, replacing Ed Daihl.


Announcements and Implementations

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Healthgrades joins athenahealth’s More Disruption Please program, giving athenahealth’s practice customers the ability to post appointment availability online for patient self-scheduling. In the spirit of disruption, I would urge Healthgrades to stop sticking the superfluous “Dr.” in front of every provider’s name – we understand that MD is a doctorate without needing its conferees redundantly identified as “Dr. John Smith, MD.” Every time I see that, I think of chiropractors and podiatrists, whose DC and DPM credentials don’t provide adequate ego stroking since many people don’t know what they mean. “Dr.” in front of a name should be used only in social situations where you might otherwise use Mr. or other titles – it should never be used on a website, business card, sign, online article, or obituary unless you want to emphasize your smug pomposity.


Technology

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Qlik announces availability of a free desktop version of its data visualization and discovery tool.


Other

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The CFO of 71-bed Nevada Regional Medical Center (MO) blames its Cerner system for ongoing financial losses, saying that its incorrect billing requires the PFS department to analyze claims by hand. IT Director Chris Crist adds, “There’s a lot of problems from the Cerner perspective. Service requests, work orders, take a lot of time to stay on top of, and if you don’t respond to Cerner within a certain amount of time, they close the request.“ That’s a major black eye for Cerner given that its Healthy Nevada community health project is also in Nevada, MO and the hospital ended up with Millennium as part of that deal. The hospital’s CEO provided a predictably laudatory Cerner quote when Healthy Nevada was announced in July 2012, but she and the hospital’s board agreed that it was time for her to leave in February 2014.

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In South Africa, the government freezes the Siemens-related EHR and radiology system contracts of Gauteng Department of Health, worth $133 million, following allegations of bid-rigging. The winning bidder of the 2007 tender, Siemens reseller-controlled Baoki Consortium, provided a health department executive with free housing. Prosecutors added that the bid was issued even though the health department didn’t have the money, infrastructure, or trained users to operate the proposed systems for 37 hospitals and 300 clinics. The systems were never implemented. The contracts were terminated in 2009 when new a Member of the Executive Council was elected. Siemens has been named innumerable times over many decades as being involved, directly or otherwise, in bribery-related contract awards, although it was a subcontractor in this transaction and wasn’t accused of doing anything wrong.

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Self Regional Hospital (SC) goes public with the news that a laptop stolen in a Memorial Day weekend break-in contained information on at least 500 patients. The laptop was not encrypted. Police arrested two suspects, who said they panicked and threw the laptop into a lake. Perhaps the hospital’s apparently lack of technology sophistication in failing to encrypt PHI-containing devices extends to its website, which automatically starts playing the cheesiest, blandest royalty-free music imaginable as soon as its home page displays, with no option to shut the racket off.

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Bonny from Aventura did some self-study on the CMS “Two Midnights” rule and decide to memorialize her newfound knowledge as a cartoon.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 27, 2014 News 8 Comments

DoD EHR Update from Dim-Sum 7/28/14

July 26, 2014 News 4 Comments

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Use cases. My goodness, is there anything more exciting than creating “To Be” scenarios where major COTS vendors can look at the DHMSM scenarios and can say with a suspicious smile, “Is that all they want, is that all they need?” The features and functionality exist in today’s EHRs. However, the operational and technical architecture to pursue this capture are complex. Not impossible, but complex.

Will a single environment that shares clinical data be enough to support a global clinical data vault? How can any team perfect performance and balance that with improving the delivery of military health? How will synchronization improve and not attenuate data collaboration? Do EMPIs become active participants in providing a variety of global patient identification aliases? Commercial EHR solutions are being deployed each and every day across the United States that meet the DHMSM requirements outlined in acute as well as ambulatory environments. How can we translate those lessons learned in to the psyche of our service integrator / partner / prime?

Now for THEATER.  In my experience with beltway software vendors, I can say with a degree of confidence that they cannot design from scratch a theater-worthy solution. These folks seem to think COBOL is cutting edge and that FTP/SFTP transfers are the only conveyance vehicles for data. These are the same folks that design their user interfaces to look like Microsoft Access or a DOS-based Excel worksheet with enough data to push all the data available in the local database. This equates to a single chaotic and cluttered view.  

Workflow means something! It really does. It is not just a word on a marketing slick. Understanding how the clinician (I am including down range medics here), technologist, and nurses work. Teams have to take the time to talk to clinicians. Translate those conversations in to a cogent way to view data respective of the clinician’s specialty.  Establish when and where it is essential to provide drill-down views — a nurse does not need to have 14 alerts that sourced data pulls from a year ago on a bunion. Data view is about relevance and moving the patient and their care along an uncluttered path. With that lesson in mind, it is my assertion that it is a mistake to assume that a CMMI software development firm could actually provide a salient solution for theater. If you doubt this, take a look at the systems that are put together today.

The smart architects will solution along the lines of repurposing a backbone of an existing patient-centric portable EHR and emergency / occupational health solution(s). Heaven forbid we take a look at solutions that actually have a client base. Low communication and non-communications standalone systems exist – they can provide portable clinical applications that can bridge the combat medic with resuscitative care as well as make the wrinkle in patient timelines affected by airevacs merely a data entry point — a step in patient care. I understand that many believe it is as complex as ear hair removal for men hitting their middle ages, but it is easier to fix than that.

The ultimate theater solution will become an invaluable transfer tool rather than a manual harbinger of medication mis-management and shadow record keeping. Therefore, the theater challenge is keeping data succinct, aligning casualty care with best practices, and an enabler for medics to stabilize data transference in preparation for transport away from harm and to the safe harbors that military medicine can afford. A transfer is a transfer, not unlike moving a patient to a skilled nursing facility or stepping a patient from critical care to a more mundane and therapeutic homeostatic environment. Recovery, therapy, and rehabilitation are the natural progression. Why not assume that the element most needed to evacuate a patient should connect rather than be an island of information that cannot be assimilated and or aggregated after the clinical data is needed?

Clinical decision support requires algorithms and data entry at key intervals in care no matter the monitoring mechanism. Closed loop medication begins with initial care folks! The perfect test bed is to automate the airevac Patient Movement Record. This has to be done and is crucial for survivability and clinical collaboration at the next point of care. Telehealth has a role and cannot only be focused on monitoring, but on collaboration and en route data transference / collaboration. Tc3 needs to add a C for computerization to embed all elements of care allowing intra- and inter-theater transfer of patient-centric data to the folks that need it most. Blood means life, as does airway management, shock management, and the medic’s ability to simplify the medication, pain, and sedation med management.  

In a nutshell, it means that the service integrators cannot rely upon CMMI firms to take an innovative approach to the theater solution. These firms lack the fundamental qualifications necessary to understand patient care and the continuum that translates into lives saved. Teams have to marvel at the way military healthcare is provided today in spite of the shortcomings of poorly constructed and non-integrated clinical solutions that have been acquired to date. No finger-pointing, just an observation as a clinical HIT guy.

Perhaps the best place to start is by simplifying and modernizing the medical terms used across all data dictionaries and tables. Design “practical” pathways that can be assumed at the next duty station, base, and post. Data liquidity and actionable analytics can only be realized with a focus on the patient and the care he or she receives. I believe that today data (in the military theater) is deemed as a commodity that needs to be dissected for affect, rather than a kinetic, ever-changing, non-quantifying entity. We have to structure that which is unstructured and assume that sharing clinical data is not a burden, but a directive.

Patient identification is a challenge. We are aware of that. Someone has to lead and state that the axiom “right care, right time, right location” really starts by implementing a uniformed medical language. Patient identification reconciliation is the cornerstone of appropriate care and avoidance of medication errors. Interventions will occur with or without an EHR. Documenting it, though, has everything to do with adherence to standards so care can be provide in a seamless manner. Even if care started in some desolate stretch of land, the care initiation is key – ask any field medic.

What efforts are being made to ensure that we do not design the same menagerie of databases that cannot be deemed as up to date? Are data sources reliable when they were designed to spec to be isolated and un-retrievable? When you manufacture anything, you start with the end in mind. How could any reputable vendor equip any clinician an EHR contributor system without any thought of data integrity to share across the enterprise?

Believe it or not, the longitudinal care record is not a mythological creature. If it was, it would be  a unicorn with a bunion and the "As Is" would relegate care to a podiatrist instead of a vet that specializes in equine hoofcare. I fear that many of the beltway firms use archaic technologies and proprietary protocols that effectively eliminate the concept of one patient ,one record.

Understanding down range medical operations as well as the rules constructed to improve survivability means effective transfers of data. This is the only tenable path to measurable outcomes.

I do hope that myopic views will be avoided and that proprietary protocols will become a lessons learned and will translate into improving the way combat care is assimilated in to a viable path to healing.

In spite of ACA legislation, ARRA HITECH investments, and CMS incentives, the commercial EHR market is not expanding, but is instead becoming more and more consolidated. Vendors are trying to compete with strategic service organizations that leverage existing HIT solutions and endeavoring to focus on smarter ways to work, applying analytics to figure out improved ways of deploying service lines that make sense. DHMSM will receive solutions that can address the ever-changing landscape of healthcare and the manner in which clinicians deliver that care. The question is more along the lines of how will teams refine the way data is shared, how liquidity of clinical data can become actionable?

The “As Is” environment is daunting, not the challenge of feature and functionality requirements. Applying the same techniques used in the commercial market segments requires an understanding of how clinicians practice medicine. A great deal of time has been invested in understanding the military enrollment process the deployment systems and even where authoritative data is being sourced. This opportunity will be won — not lost by the way transition and education proliferation is managed, how parallel operations can be kept succinct and orderly.

The transient population of 1.4 million service members is relying on the teams that are pursuing an award, but the eventual winner has to be the troops we serve. This is not a DoD solution. It is an honor to know that the real customer is that lady and that man who wears the uniform of a US service. Sorry for the soliloquy, but this is my way to convey what is on the minds of men and women designing and solutioning every hour, if not on paper or in meetings, but in our minds.  Be innovative folks, and do not lose focus on what needs to be done.

I promise next time to throw salted pretzels at primes and vendors. After all, that is why I started my controlled rants.

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July 26, 2014 News 4 Comments

News 7/25/14

July 24, 2014 News 3 Comments

Top News

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Cerner reports Q2 results: revenue up 20 percent, adjusted EPS $0.40 vs. $0.34, meeting estimates of both. Orders for the quarter totaled $1.08 billion, the best Q2 in the company’s history.


Reader Comments

From Medium-Sized Data: “Re: data extraction. I challenge all of the companies promising world-changing analytics to extract all of your HIStalk posts to produce a list of hot topics by month and year, a cool infographic, or a detailed report.” That would be pretty cool. There’s a wealth of information in those old posts: tracking vendors that promised something that was never delivered, big announcements that were just hot air, and public perception items trended by vendor based on positive or negative HIStalk mentions. Companies are welcome to take a swing at it, and if they come up with something useful, I’ll toot their horn.

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From Watertown Boy: “Re: athenahealth. In a recent email to clients, they announced what appears to be their problem in over counting some of the MU items. What happens to practices that already submitted this year?” A July 21 email to customers says athenahealth “identified a need to improve our calculation logic” and will complete that work by July 25, adding its apology to customers whose performance numbers will suffer as a result. Athenahealth provided this response:

There is no impact on eligible providers who have already successfully attested for Meaningful Use (MU) this year. Athenahealth takes great pride in the integrity of our data and we proactively monitor guidance and interpretations issued by the Centers for Medicare and Medicaid Services (CMS) to ensure our system remains accurate and up to date.  Accordingly, when changes that affect our measure calculation logic are identified, athenahealth works to make the appropriate system changes and notifies clients of all recalculations, as we did this week.  In the event of system changes that impact MU measure calculations, athenahealth supports providers who have yet to attest by recalculating all associated data to determine the best time for those providers to attest with the most up to date data.

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From WellTraveledGal: “Re: Beacon Partners. Announced mass layoffs of sales and consultants. Paul Sinclair, formerly of Cerner and UnitedHealth / Ingenix, joins as sales VP.” President and CEO Ralph Fargnoli provided this response:

We have not had mass layoffs of sales and consultants. Beacon Partners continues to grow because of the excellent work our experienced team of healthcare professionals is providing to health systems throughout North America. Recently, we have realigned some of our business development and consulting personnel to better support the operational, clinical, and financial performance engagements of our clients, and to meet our goals for continued growth. As we execute our business objectives for the second half of the year, we are actively recruiting for both business development and professional services positions. 

From Boy Wonder: “Re: MU timeline for 2014. I wonder when your readers think CMS will announce a decision on the proposal to change the MU timeline for 2014? It better be quickly since many providers will be targeting Q4 as their one and only shot at MU2.”

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From The PACS Designer: “Re: genome discovery. Genome sequencing will cost as little as $1,000, according to the CEO of Illumina. The company has an improved MyGenome app.” It’s a pretty amazing advance, but the really amazing one would be to figure out how we’re going to pay for treating the new problems such testing reveals. We love snazzy new diagnostic techniques and decisive interventions, but aren’t so great at making them affordable. The most amazing development would be to figure out a way to get people to lose weight, exercise, and turn off their phones and interact with others in a genuine rather than electronic way to move the population health needle. Genomic discoveries are cool, but our health problems have little to do with a lack of technology.


HIStalk Announcements and Requests

This week on HIStalk Practice: MGMA begins the search for a new CEO. Kansas Health Information Network and ICA announce a record number of HIE connections. Harbin Clinic and Cigna team up for collaborative care. ONC alludes to a specific interoperability timeline by 2015. PCC Director of Pediatric Solutions Chip Hart discusses the sometimes challenging world of pediatric HIT. The HIStalk Practice Reader Survey is live. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the new interest in health data aggregation from Google, Samsung, and Apple. Researchers with Cedars-Sinai have successfully tested a biological pacemaker concept in pigs. TechCrunch reports that women’s health apps are leading in the mHealth segment in both funding and consumer engagement.

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My latest pet peeve: going to a company’s site and getting hit with one of those intrusive pop-up “your opinion is important” windows asking me if I want to take a survey. No, actually what I’d like to do is instantly leave any site that is clueless about annoying its web visitors with pop-ups. It’s nice to know your customer better, but nicer still to not drive them away with heavy-handed tactics whose only benefit is to make some marketing VP feel like they are contributing to business success. At least the HIMSS version doesn’t require answering before proceeding, so even though it’s annoying, I can live with it.

Listening: Phantom Planet, Southern California indie pop that’s been around for 20 years minus a hiatus or two.


Acquisitions, Funding, Business, and Stock

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Quality Systems, Inc. (the NextGen people) reports Q1 results: revenue up 8 percent, adjusted EPS $0.13 vs. $0.24, beating revenue estimates but falling short on earnings. The hospital unit continues to turn in poor performance with a loss of $3.5 million. Overall, bookings were down, earnings were down, and expenses were up.

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Streamline Health reports Q1 results: revenue up 7 percent, EPS –$0.16 vs. –$0.24.

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The parent company of Lumeris announces $71 million in new financing from new and existing investors, which it will use to boost its population health management capabilities and expand from eight to 20 markets for its value-based care solutions. The parent company’s other companies are Accountable Delivery System Institute (accountable care education),  Essence Healthcare (Medicare Advantage plan), and NaviNet (communication network).


Sales

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Aspirus (WI) chooses Strata Decision’s StrataJazz to help manage costs in its six hospitals. 

New Haven Community Medical Group (CT) chooses athenahealth’s PM, EHR, and patient portal.

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In England, North Bristol NHS Trust signs for CSC’s Lorenzo EHR, replacing Cerner Millennium. Lorenzo was the only choice offered with the now-defunct NPfIT, but previous owner iSoft and then CSC repeatedly botched implementations and missed deadlines, which was arguably the main reason that NPfIT went up in a $20 billion taxpayer-funded mushroom cloud in 2013. North Bristol admitted that its $37 million Millennium system was nothing but trouble right after its December 2011 go-live, much of that due to its own failings in not testing and training well, shortcutting data migration, and letting IT run the project. The go-live resulted in cancelled surgeries, incorrectly assigned appointments, and patients who were sent home because doctors couldn’t access their records. The trust also admitted it had underestimated Millennium’s cost, drawing the ire of government officials demanding to know why the average trust implementing Cerner was spending three times as much as those going live on System C’s Medway, which was later acquired by McKesson and then recently sold off to Symphony Technology Group as McKesson dumped its European IT business.


Announcements and Implementations

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NEA Baptist Clinic and Hospital (AR) will go live on Epic inpatient and outpatient in the next couple of months as the 100-bed hospital plans for its first EMR. They’re part of Baptist Memorial Health Care of Memphis, TN.


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Healthcare Growth Partners issues its always-insightful and downright eloquent healthcare IT mid-year review. This snippet is as brilliant as anything that’s been said about our healthcare challenges:

Inefficient markets typically result in a mispricing of goods and services. The cause is often due to monopolies, poor regulation, and a lack of market transparency. Each is a contributor to inefficiency in the US healthcare economy, but the primary shortcoming is the lack of market transparency, or information, needed to define the cost and quality of goods and services, otherwise known as value. In many markets, information is a tool for power and a proprietary competitive advantage. However, healthcare is not like most markets. Healthcare information is unique because it serves both a humane and a commercial purpose. At stake is the health of family, friends, neighbors, and ourselves, as well as the economy and corporate profits. Healthcare information exploited for the benefit of a few compromises the efficiency of the healthcare system as a whole. Nothing makes this clearer than the abysmal statistics of healthcare in the US. The power and profit potential for disruptive innovation in this nearly $3 trillion market is unfathomable. The advent of transparency will translate into a myriad of opportunities to drive down costs, improve outcomes, generate higher profits, and result in a stronger economy. 

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The report says that companies that sell out for high multiples have these characteristics:

  • SaaS delivery that generates recurring revenue
  • Pricing alignment so that the company makes money when the customer realizes value
  • Scalable distribution that lowers the cost of acquiring a new customer
  • Providing value that will carry into the post-ACA environment instead of just exploiting current system flaws
  • Rights to the data created by their customers
  • Market leadership, strong management, and growth

Government and Politics

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Women & Infants Hospital of Rhode Island will pay $150,000 to settle data breach charges resulting from a 2012 incident in which 19 unencrypted backup tapes containing the information of 12,000 prenatal diagnostic center patients disappeared. That’s not a federal HIPAA fine – $110,000 of the payment is a state civil penalty, $25,000 is for attorney fees, and $15,000 will fund an attorney general data security education campaign.

The GAO will release a report next week that outlines Healthcare.gov’s go-live problems, the cost to fix them, and the work remaining.

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FTC Commissioner Julie Brill, concerned about a May report that showed 12 mobile health and fitness apps were sharing user information with 76 companies, says that third-party data use is where “the rubber hits the road when it comes to patient harm.” Despite urging that consumers be given more control on the use of their information, Brill says that no new regulations are planned.

A California appellate court dismisses a class action lawsuit that sought $1,000 for each Sutter Health patient whose information was stored on a stolen computer, a suit that had exposed Sutter to a potential $4 billion payout. The court found that the state’s Confidentiality of Medical Information Act requires proof of unauthorized access to patient information, not just possession of the physical form of the data (a hard drive, in this case) by an unauthorized individual. One of the attorneys for the patients originally said that an unencrypted computer storing the information of 4 million patients should have been stored in a windowless room under lock and key instead the office that was broken into.

The Wall Street Journal profiles William LaCorte, MD, a Louisiana internist who has pocketed $38 million as his share of 12 Medicare fraud lawsuits he filed, mostly against drug companies. He even named his newly purchased 34-foot boat Pepcid. The article also mentions a former pharmacy that found whistleblower lawsuits to be a more lucrative business, having netted it $425 million so far.

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Former Procter & Gamble CEO Robert McDonald, in his confirmation hearings for Secretary of Veterans Affairs, says the agency needs to “continue to expand the use of digital technology to free human resources” and “create, with the Department of Defense, an integrated records system.”


Innovation and Research

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UnitedHealthcare makes its Health4Me app available to all consumers, not just its customers. It providers doctor search and medical price review.


Technology

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Allscripts receives an Intel Innovation Award for its Windows-powered Wand mobile EHR navigation system. 

Google’s Google X research group will analyze genetic and molecular information from 175 volunteers to define a healthy human, hoping that the Baseline Study’s new diagnostic tools will allow Google’s computers to find patterns that allow earlier detection of disease. That project may or may not be related to the company’s recently announced glucose-measuring contact lens.


Other

The administrator of Bradley Healthcare and Rehabilitation Center (TN) says employees really like its new PointClickCare EHR, but adds that the system caused Medicare payment delays in its first two months. The system was configured to use the facility’s five-digit ZIP code instead of the required nine-digit code and nobody knew how to open warnings from its intermediary about incorrectly formatted claims. The facility admits that it should have trained users better before going live.

An NPR report says HIPAA was created to protect patients, but healthcare organizations are intentionally or unintentionally using it to protect their own interests, such as hospitals that refuse to give patients their own medical records claiming it’s a HIPAA violation, when in fact the law intended the opposite. It also mentions that VA management used HIPAA threats to squelch potential whistleblowers.

A patient who starting shooting in the psychiatric unit of Mercy Fitzgerald Hospital (PA) is shot by the psychiatrist he wounded, who returned fired using his personal firearm despite the hospital’s policy barring on-campus weapons except by on-duty police.


Sponsor Updates

  • Elsevier Clinical Solutions will use the clinical evidence platform of Doctor Evidence LLC in its Evidence-Based Medicine Center.
  • Perceptive Software’s Acuo Vendor VNA earns DIACAP certification as part of its 2012 DoD contract to manage clinical content for US Army and Navy hospitals around the world.
  • Etransmedia Technology shares the process of taking a state-of-the-art urology practice with on-site PT through their EHR implementation and decreasing the cost of clinical documentation by 75 percent.
  • Allscripts EHR solutions connect to the State of Arkansas HIE.
  • Ingenious Med CEO Hart Williford shares four core beliefs that have enabled him to transition companies from startup to explosive growth and maintain company morale.
  • Truven Health Analytics links clinical data to claims, enhancing oncology-focused outcomes research studies.
  • Shareable Ink’s CTO Stephen Hau discusses its expansion to an iPad version and the risks and successes involved.
  • e-MDs ranks fifth overall in the Medscape EHR Report 2014.
  • ACO Buena Vida y Salud (TX) partners with Sandlot Solutions to connect with the Rio Grande Valley HIE (TX) using Sandlot Connect.
  • The Association of Community Mental Health Center of Kansas will implement Netsmart’s CareManager while the Kansas Health Information Network will implement Netsmart’s CareConnect solution.

EPtalk by Dr. Jayne

Jenn tweeted about this recent Washington Post piece on Maintenance of Certification (MOC). Since I now have to maintain certification in both clinical informatics and my primary specialty, it hit close to home. Although board certification is technically “voluntary,” in my market it’s a necessity – no payers will credential you if you’re not certified.

I agree with the author that merely having certification doesn’t add a lot to my actual practice of medicine. I don’t treat chronic disease or deliver babies any more, other than in an absolute emergency. I do, however, perform a mean laceration repair and reduce dislocations like a boss. None of that is on my board exam, however.

You may be asking what this has to do with healthcare IT. It’s this: nearly everything for MOC is online and some of it is a true pain. Plus, there’s not a lot of content for some of us who are largely administrative or don’t have true continuity practices.

Case in point: my Board offers a handwashing module for MOC. If you’re in traditional practice, you’re supposed to survey your patients then key in the results and analyze them. If you’re not in continuity practice, they give you mock data that you still have to key in and analyze. How hard would it have been for them to preload the data? I’m sure the argument is I need to have the experience keying in data since the others do, but that’s ridiculous.

We’re claiming that primary care physicians should be quarterbacking healthcare delivery teams and working at the top of their licensure, yet we have them manually keying in data for recertification. Physicians at my institution are burning out at an alarming rate. This is just one more thing we ask them to do. Manually keying data isn’t a good use of our time.

On the flip side, some organizations have tried to partner with EHR vendors to extract data for quality studies. My vendor used to do this for two specialties but ended up stopping it, supposedly because the burden of keeping up the code was too great and the functionality wasn’t adopted widely by customers.

I have to admit I’ve been somewhat of a slacker with regards to MOC for my newly-minted clinical informatics subspecialty. I’m in the middle of an online cultural competency module for my primary specialty that I keep having technical difficulties, with so the idea of digging into other content doesn’t excite me.

I do obtain regular Continuing Medical Education credits, typically double what is required by my Board, which is four times what is required by my state licensing board. That’s the most valuable to me as far as keeping up because I can choose CME that’s relevant to what I actually see in practice. Cramming for a test once every 10 years (even when I can listen to all the lectures on my handy-dandy iPod) doesn’t say much about my skills listening to patients or being a clinician who can actually speak with patients in a way that they understand and makes them confident in the treatment plan.

Readers may ask, if we don’t have ongoing board certification, how will patients tell if we’re quality physicians?

It’s my great hope that eventually when we are truly meaningful users of EHR technology (not the government-speak kind of MU, but the real kind) we’ll be able to show what kind of physicians we are. How many of Dr. Jayne’s patients had failure of their laceration repairs? How many had unexpected scarring? Was her documentation readable and did she provide a patient plan in a way that the average person with a fifth-grade reading level could understand? Did she communicate back with the patient’s primary physician and arrange a follow up?

A friend of mine does minimally invasive knee replacements. He puts all of his data on his website for the world to see. He’s published multiple studies on his outcomes. All he does is knees. To me, seeing his data (including infection and complication rates) is a much better marker of his skill and competency than knowing he passed a board exam that covered the rest of the realm of orthopedic practice.

Before EHRs, trying to mine paper charts for that kind of data was nearly impossible. Most of my colleagues who were doing outcomes research used separate databases and registries and there was a lot of manual entry. Now we have the ability to study our populations at a moment’s notice. As a CMIO, I provide my physicians a sheaf of reports each month that let them know how they’re doing with respect to national standards and also to their peers. That kind of data will drive behavior change far more than reading a board review book might.

I’m hopeful for the future, but meanwhile I’m stuck with the expense and tedium of MOC.

What does your CMIO think of MOC? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 24, 2014 News 3 Comments

Morning Headlines 7/23/14

July 23, 2014 News 2 Comments

Hazards tied to medical records rush

The Boston Globe reports on the sometimes tragic results of the nation’s hasty implementation of EHRs, and the anti-regulatory message being broadcast by vendors.

Swiss Walgreens? $4 Billion Tax Cut Considered At Corner Of Happy, Healthy & Tax-Free

Walgreens considers moving its headquarters to Switzerland through the acquisition of Swiss-based Alliance Boots, a move that would save the company $800 million in taxes annually.

Characteristics Associated With Post-discharge Medication Errors

A small study examining post-discharge medication errors finds that 54 percent of cardiac patients reviewed had at least one error on their discharge medication list.

Hospital trust makes ‘biggest investment in IT for more than a generation’

In England, West Hertfordshire Hospitals NHS Trust signs a $44 million contract with CGI to update the IT infrastructure of its 600-bed hospital, Watford General, which came under scrutiny last year when its EHR was blamed for a scheduling issue that resulted in the death of two cancer patients.

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July 23, 2014 News 2 Comments

News 7/23/14

July 22, 2014 News 7 Comments

Top News

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A Boston Globe article says that HITECH has pushed EHRs into clinical settings, but “staunch resistance to any regulation by the politically influential health records industry” has sidestepped the reporting and tracking of medical errors they cause. It cites a malpractice study that found that the most common adverse event to which EHRs contributed – of which 46 caused patient death – was often due to providers that straddle both paper and electronic records. The study also cited problems of incorrect data entry, inappropriate use of EHR copy and paste instead of entering fresh daily notes, and computer downtime.


Reader Comments

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From Anonymous Tipster: “Re: Siemens acquisition. I heard from a highly placed Cerner executive that the deal will be done for $1.2 billion. It will probably shake up Cerner’s stock price, but leave it with better financial capabilities and a bigger customer base.” Unverified, but the rumor that Cerner will acquire the Siemens healthcare IT business seems to have legs and the non-anonymous folks who are telling me have well-placed sources.

From Recognize This: “Re: Nuance. I heard a rumor about major layoffs and closed job requisitions.” Unverified.

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From Desai Arnaz: “Re: HITPC. I looked at the HITPC schedule and every MU Committee meeting is cancelled the rest of the year. They have met faithfully every two weeks for the past several years. What is going on?” I think the old Meaningful Use Workgroup has been replaced by Advanced Health Models and Meaningful Use under Paul Tang, and since that group was just formed, they probably haven’t put their meetings on the calendar yet. But my already-slim interest in ONC’s doings is lessening by the day, so maybe someone more attuned to HITPC’s workings can jump in with an explanation.


HIStalk Announcements and Requests



The LinkedIn Police Department has decided that my Carl Spackler photo and my use of “Mr.” as a first name makes them unhappy, so I need suggestions for alternatives. I’m at least impressed that someone at LinkedIn recognized the Cinderella boy’s photo on my profile even though it means I have to replace it.


Acquisitions, Funding, Business, and Stock

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HealthEquity, which offers an online health savings account management system, announces plans for a $100 million IPO. I’m intrigued by co-founder Steve Neeleman, MD, who played Division 1 college football, ran the airport services division of an airline, wrote a book on HSAs, and still practices as a surgeon. I’m not impressed by wealth or self-importance, but I like people who are interesting in multiple ways.

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PM/EHR vendor Azalea Health will merge with competitor simplifyMD, although “merge” sounds like an acquisition by Azalea Health given that the new entity keeps its name and executive team. Azalea Health got its start with a $1,000 business plan prize from the local chamber of commerce. Its founders all graduated from Valdosta State University (GA). The company will now have 70 employees with main offices in Alpharetta and Valdosta, GA.

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“Smart clothing” vendor Sensoria (formerly Heapsylon), whose tagline is “The Garment is the Computer, gets a $5 million first-round investment. The Redmond, WA company was founded by former Microsoft executives, as you might suspect given its location.

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England-based HealthUnlocked, which calls itself “LinkedIn for Health” in connecting people with a given condition to each other and to providers, announces plans to expand globally and its release of a new mobile app. 

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Canada-based Privacy Analytics, which offers data de-identification and masking products for healthcare organizations using data for secondary purposes, gets $3.5 million in seed funding.

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Epion Health, which offers a patient check-in app, receives a $4.5 million first funding round. It announced last week its participation in athenahealth’s More Disruption Please program.

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Forty big US companies, some of them drug manufacturers, have recently bought small foreign firms and declare their new headquarters to be at that company’s overseas location, a loophole (“tax inversion”) that allows companies to avoid paying US taxes on their foreign profits. The latest rumored possibility: Walgreens, which has an option to buy the remaining 55 percent part of a European drug wholesaler that it doesn’t already own.

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GE Chairman and CEO Jeff Immelt says GE Healthcare is facing US market challenges as hospital admissions decline and the Affordable Care Act makes hospitals wary of buying new medical equipment.


Sales

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Parkview Medical Center (CO) selects the Emma clinical communication system from PatientSafe Solutions.

Community Hospital Corporation (TX) chooses the HCS Interactant EHR for its long-term care hospitals.

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Fauquier Health (VA) chooses TigerText secure messaging.

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In England, the trust running Watford General Hospital signs a $44 million contract with CGI to update its IT infrastructure and services. The hospital blamed its outdated IT system earlier this year after an internal review found that at least two cancer patients died when the hospital failed to send them appointment letters. CGI had a software-related problem of its own – Healthcare.gov.


People

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Population health management vendor Aegis Health names Chuck Steinmetz (Emdeon) as CIO.

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Systems Made Simple elects its CMIO, Viet Nguyen, MD, to its board.


Announcements and Implementations

Coastal Healthcare Consulting announces a Meaningful Use mock audit service.

New York eHealth Collaborative announces the first seven healthcare startups selected to participate in the 2014 New York Digital Health Accelerator. They are AllazoHealth (predicting medication non-adherence; Clinigence (care gap identification); Covertix (protection of confidential information); iQuartic (analytics); Noom (weight loss app); Quality Reviews (hospital patient feedback and online ratings); and Sense Health (connecting with Medicaid patients).

Lifepoint Informatics introduces a patient portal for lab results and diagnostic imaging reports.

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MemorialCare Health System’s Orange Coast Memorial Medical Center (CA) goes live on the Aventura Roaming Aware Desktop.

East Jordan Family Health Centers (MI) goes live on Forward Health Group’s PopulationManager.

Vocera releases Alarm Management and Alarm Analytics, patient safety solutions that address alarm fatigue. The company also releases the latest version of Vocera Care Experience, with enhancements to its Care Rounds, Care Calls, and Business Intelligence modules.

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Ping Identity announces PingID, a smartphone-based user authentication system for what it calls the “post-password era.” Any application or person requesting authentication sends a push message to the phone of the user, who then simply swipes the message to verify their identity.


Government and Politics

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NPR covers Mini-Sentinel, a $116 million FDA project that will churn through medical claims data provided by 18 insurers and health plans to look for adverse drug events.

Mary R. Grealy, president of the Healthcare Leadership Council, tells a House subcommittee that for-profit companies should be given access to federal health databases to help work on disease and population health problems.


Innovation and Research

A small study finds that half of post-discharge hospital cardiac patients were taking at least one medication not listed on the discharge medication list or vice versa, a problem more commonly found with patients with low health literacy.


Technology

An Illinois-based ambulance company is testing Google Glass units from Pristine, Inc. to allow paramedics to transmit live video to the ED for real-time consultation, saying the $1,500 units are a low-cost entry to telemedicine. The test will determine whether the consumer-grade technology and available bandwidth are reliable enough for treating critical patients.

Amazon announces a limited preview of Zocalo, a fully managed cloud-based storage and synchronization service for enterprises that will compete with Dropbox, Box, Microsoft OneDrive, and many others. Zocalo costs $5 per user per month for 200GB, offers administrative and signup tools, and integrates with Active Directory. It runs on and is managed from Amazon Web Services. That’s bad news for the hugely money-losing Box, which focuses on the non-consumer market and has targeted healthcare as a key vertical.

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The New York Times profiles NovaSom, which just released a wireless, at-home sleep apnea test that costs $300 (a tenth of what hospitals charge) and eliminates the patient inconvenience of being wired up and put to bed under the watchful eyes of camera-monitoring sleep technicians.

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A Minnesota TV station covers Ambient Clinical Analytics, which is commercializing Mayo-developed ICU dashboard technology.


Other

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Eight-hospital UNC Health Care (NC) says it expects to bounce back this year after financial losses it attributes largely to the cost of its Epic implementation. The system delayed its approval of its new budget until the Epic rollout was further along.

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The Johns Hopkins Hospital (MD) will pay $190 million to settle a class action lawsuit brought by 8,000 patients stemming from the actions of a former employed gynecologist who used a secret camera worn around his neck to record his examinations. The doctor committed suicide in early 2013 days after he was fired.

A Texas doctor says her EHR is “only a little better than a fax machine” because nobody requires that EHRs communicate with each other even though the government rewards their use. The chair of the Texas Medical Association Practice Management Council says the government has failed to set standards and wants medical societies to get involved. “Had we when this all started said we need open databases … that any EMR can understand, then the EMR vendors would have to compete on workflow and features. If we could somehow organize to say this is the way databases need to work, so that we can have this data exchangeability, then we’ll have competition on the presentation layer and the workflow.”

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The CEO of Henry Ford Health System (MI) says she’s disappointed that Moody’s downgraded the health system’s bonds because of poor operating results and its $356 million Epic system, admitting that it had “two or three tough years for us with increasing uncompensated care, Medicare cuts, and the Epic impact to us that caused productivity issues.” However, she adds that the use of Epic is producing $50 million per year in savings.

Patent troll Uniloc USA files lawsuits against Cerner, CPSI, e-MDs, Epic, GE Healthcare, Greenway, Medhost, and other vendors for violating its patent, which involves displaying clinical data in a spreadsheet-type format. One of the company’s idiotic lawsuits was against Rackspace, which it said violated its patent because Linux rounds a number before performing a calculation. The judge told Uniloc to hit the road before its case even came to trial.

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New York-Presbyterian Hospital (NY) is renting space at the Blueprint Health accelerator, installing its own computers and servers at the accelerator’s SoHo offices to create an “innovation space.” It will work on projects that include a system that allows inpatients (presumably pediatric ones) to play games and message each other and another involving tablet-based bedside communications. The hospital says it is also open to commercializing technologies developed by Blueprint’s startups.

The American Osteopathic Association passes a resolution urging patients not to use symptom-checker apps and websites as an alternative to an office visit, saying that such self-diagnosis tools don’t take their medical history into account and often miss drug interactions.

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The husband of a pregnant woman who started early contractions three hours from the nearest hospitals uses the First Opinion app to text a doctor, who walked the couple through delivering their healthy baby. The 24-hour-per-day service offers one free consultation each month or $12 for additional ones and guarantees a doctor’s response within nine minutes. The company announced $1.4 million in new funding in May 2014, raising its total to $2.6 million. The founder and CEO intended developed the app for pregnant women, but saw an opportunity in the 85 percent of family doctor visits that he says involve five-minute conversations that end with the doctor saying, “Come back if it gets worse.”

Weird News Andy titles this story as “Getting Screwed.” A former California hospital owner admits to bribing surgeons to implant counterfeit spinal surgery hardware, some of it made by local machine shops, into patients. The bribes included cash and flights staffed by accommodating prostitutes.


Sponsor Updates

  • Besler Consulting offers a free version of its Readmission Analytics tool for hospitals to manage their 2015 QualityNet Hospital-Specific Reports, covering number of days to readmission, a summary of discharge destinations, the presence of clinical contributors, and a breakdown of facilities to which patients are being readmitted.
  • Gartner positions Perceptive Software in the Leaders Quadrant for enterprise search solutions.
  • Black Book names Nuance the #1 vendor for end-to-end clinical documentation improvement.
  • Extension Healthcare will exhibit its next generation clinical alarm management and care team collaboration solution, Extension Engage, at the Siemens Innovations ’14 conference August 10-12.
  • TeraMedica announces that seven of the top 17 hospitals on the “US News & World Report Best Hospitals” list use its image archive and management system.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 22, 2014 News 7 Comments

Monday Morning Update 7/21/14

July 19, 2014 News 13 Comments

Top News

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The Leapfrog Group’s just-released 2013 survey finds that 43 percent of the 1,400 responding hospitals entered at least 75 percent of medication orders in a CPOE system with clinical decision support. However, a third of the CPOE systems tested by 931 hospitals failed to failed to warn physicians of serious ordering problems.


Reader Comments

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From Veteran SQ Vendor: “Re: Sunquest. I just returned from SUG and Matt Hawkins was a brilliant choice by Roper. The culture change is discernible and Hawkins is approachable, involved, listening, and leading – which have been missing for a long time. I hope it’s not too late.” Sunquest previously violated one of my key predictors of success – its top executive refused to move to its headquarters city (Tucson). The company also had some defective Misys DNA in its gene pool, put quite a few inexperienced aptitude hires in jobs they’ve failed at, runs a questionably integrated office in India (was that redundant?), and in typical lab analytical fashion thinks everything important can be measured and managed from a spreadsheet. Sunquest’s overall problem is that it’s a market leader in a saturated niche in which Epic and other vendors are nibbling away at some of the decreasingly sexy core LIS business and its lab customer has to take one for the (integrated) team, which makes it an expiration-dated cash cow unless it can figure out how to innovate again. Also, hungrier companies are going after the genomics and personalized medicine business where the company should be strong. All of that is fine as long as Roper doesn’t expect a lot of future growth for its $1.4 billion investment — you can only squeeze the existing base of cash-strapped customers so much. Matt needs to take a firm hand in re-establishing the connection between his office and the troops, try to compensate for all the private equity BS the remaining employees have had to deal with, clear out the management deadwood, articulate a position of where the company is going beyond the comfortable box in which it works, and put together a team that can handle an acquisition or two in the not-too-distant future. That’s the unsolicited advice I would give most new CEOs, and at least Sunquest doesn’t need to make reactive changes quickly since Roper seems patient.

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From NP: “Re: NantHealth. SVP and former iSirona CEO Dave Dyell is the latest in the ranks of departing execs. He was working to integrate Patrick Soon-Shiong’s myriad acquisitions and deliver on the good doctor’s immense (but confused) vision for healthcare, but fell victim to Nant’s micromanagement and acquisition indigestion.” Dave verifies that he has left NantHealth, which will probably be concerning to iSirona users who don’t care about PSS’s grand plans as long as their medical device connectivity keeps working.

From Sugar Sister: “Re: vendor demos. I viewed several lately. Epic may not have a marketing department, but they must have a showmanship department given their slick show with Wisconsin jokes. Their software is also slick – it reminds me of Apple in its attention to detail. You only get a product to that level if someone in authority demands it. Athenahealth is not a cloud-based solution. ‘Cloud’ means your data can be stored anywhere and your instance could be running anywhere. Athena knows exactly which specific database server has a particular customer’s data and which server it will fail over to. That works, but investors are right to question the cloud marketing spin. Athena has so many customers that have attested to MU2 compared to other vendors because those other users haven’t upgraded their systems yet. Epic has way below 50 percent of customers running the latest production version. Athenahealth is like a Greyhound bus – if you don’t want to worry about anything but seeing patients, leave the driving to them. Epic is a Cadillac limo – a beautiful ride if you hire a driver who knows the roads.”


HIStalk Announcements and Requests

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Poll respondents said their success comes from hard work and building relationships rather than education, luck, and planning. New poll to your right: do you own stock or other equity in a healthcare IT-related company?

I hit an internal buzzword-and-hype limit the other day after reading too many overwrought press releases. I was thinking that if a hospital report writer wrote a cool list of diabetic patients who hadn’t been seen in six months, a vendor’s marketing team would be announce it as, “Cloud-based business intelligence and population health management analytics, powered by a comprehensive, scalable patient engagement and clinician workflow platform whose real-time alerts and actionable insights support the Triple Aim of improving patient experience, advancing health, and reducing costs.”

Listening: new Finnish operatic metal from Amberian Dawn, with new singer Capri and without (thankfully) the background grunting often found in so-called “Beauty and the Beast” female-led Northern European metal. I explain the genre thusly: ABBA backed by Black Sabbath.


BOSS Award Winner – Amy Thomas

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Our first Beacon of Selfless Service award winner is Amy Thomas, interface architect at Edward Elmhurst Healthcare, Naperville, IL. VP/CIO Bobbie Byrne commends Amy for leading a conversion of 120 physicians from NextGen to Epic, using NextGen CCDs from three separate database instances as summary documents and writing extracts to copy patient demographics, future appointments (which Bobbie says “sounds easy but is really hard”), lab and rad results, progress notes, immunization histories, and vital signs. Amy did this while supporting live hospital interfaces and working on ICD-10 and population health management projects. Congratulations to Amy.

You are welcome to nominate a non-management individual for BOSS Award recognition.


Acquisitions, Funding, Business, and Stock 

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From the athenahealth earnings call:

  • Athenanet added 2,500 providers in the quarter, raising the total to 55,000.
  • Half of the company’s transaction volume is still paper-based.
  • The Epocrates acquisition has created new leads, but its revenue is dropping and the premium version is struggling because it’s too hard for subscribers to renew online. According to Jonathan Bush, “We’re hammered pretty hard by Epocrates which had a very big miss … Epocrates is about half what we thought we would get by now.”
  • The company has high hopes for the upcoming Epocrates secure messaging functionality
  • Bush says that hospitals have 40 percent unused capacity that could be used to offset their cost of fixed assets. The company has partnered with Accenture to help hospitals open up that capacity with the goal of selling athenaCoordinator Enterprise, which now has three customers.
  • Bush says it failed last year in its goal of having its account managers bring in 1,000 new leads, saying, “We knocked out a good, solid 78 leads during 2013, so we had to retrain and reorient our account management teams.”
  • Asked about promises to inpatient prospects about athenaCoordinator, Bush said, “Nobody wants to be the first guy on athena’s inpatient thing and nobody wants to be the last guy to drop a quarter billion dollars on Epic, so they’re sitting and trying to figure out which wolf to feed when they come out of their tepee. I pity them. It’s a hard decision.”
  • Asked about the company’s More Disruption Please program, Bush described it as, “The leading edge, the exciting new bubbling up from the primordial venture capital ooze is of generation of companies that are performing on the cloud across many clients in a single instance, activities that used to sit in a hospital information system. So suddenly entrepreneurs are saying, ‘These giant enterprise software companies, these single-instance software companies, actually won’t make it and they are old and there’s going to be an opportunity to sell into the nurses and the pharmacists and the inventory management people at the hospital.’ So you’re seeing a collection of cloud-based athena architecture, but more like a Salesforce business model, a monthly user rent type business model community of apps that represent in total kind of 80 percent of the surface area of a complete hospital information system in API connected independent little cool apps.’”
  • On fitness tracking and related personal health apps, Bush said that 91 percent of people aren’t patients until some event happens, calling it “100 million conscientious objectors” who care about their weight, body, love life, and people they’re are caring for. He adds that athena looks forward to connecting to Apple’s Health “despite Apple’s decline” and “the quickly rising Samsung stuff.” 
  • Bush says that people are recognizing that Obamacare  is “a huge rise in deductibles” and the company will focus on helping its users get the “love and money in equal measure” from their customers.

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Above is the one-year performance of athenahealth (blue) vs. the Nasdaq (red), which it trails after a nearly 50 percent ATHN haircut in a two-month period starting in March 2014.

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Your money would also have been better off invested in an Nasdaq index fund (red) a year ago than in Allscripts (blue), but at least MDRX shares are moving back up over the past month.

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GE Healthcare’s Q2 results: revenue down 0.7 percent, net profit $730 million vs. $726 million.


Sales

New York City Health & Hospitals Corporation chooses Constellation Software’s QuadraMed Affinity QCPR. I assume this is just a renewal since they’ve been running Affinity and then QCPR since the early 1990s. Toronto-based Constellation Software, which sells all kinds of unusual vertical market software, acquired QuadraMed from Francisco Partners in June 2013. It put QuadraMed under its Harris Operating Group, which sells public utility and public safety software. Its other healthcare IT company is ERP software vendor MediSolution.


Other


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I missed this from a couple of weeks ago: the private equity fund of former National Coordinator David Brailer, MD, PhD has flopped and its biggest investor, California Public Employees’ Retirement System, reportedly wants to cash out its investment. CalPERS pledged to invest $700 million in Brailer’s Health Evolution Partners seven years ago after he promised returns of 20-30 percent despite his zero experience in private equity and the marginal success of the one company he formed and sold, CareScience. Instead, their money is dead with a 2.6 percent annual return and the only company HEP has sold was for a loss. CalPERS also put $200 million in a money-losing HEP “fund of funds” focused on healthcare. Some of CalPERS’ board members questioned in 2012 the decision to put hundreds of millions of dollars into no-experience company that didn’t actually invest their money until 18 months later. CalPERS also paid $5 million for a 15 percent equity interest in HEP and paid it $52 million in fees in its first five years. Despite Brailer’s stated investment focus in healthcare IT, HEP shows no active investments in healthcare IT companies among its seven portfolio positions. Calpers was initially  HEP’s only investor and the company has declined to say if it has obtained others.

A Stanford biophysicist develops an easily shipped microscope made of folding paper that’s as powerful as a desktop instrument yet can be produced for $1. The Gates Foundation-supported FoldScope project hopes to get the devices to third-world countries for faster diagnosis of infectious disease. It’s one of few TED talks in which the audience breaks out into applause at several points and gives a standing ovation at the end.

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Weird News Andy notes that 20-bed Three Rivers Hospital, a Critical Access Hospital in Brewster, WA, has been evacuated due to the 169,000-acre Carlton Complex wildfire that has destroyed 100 homes and shut down power to most of the Methow Valley.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 19, 2014 News 13 Comments

News 7/18/14

July 17, 2014 News 8 Comments

Top News

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CVS Caremark signs a clinical affiliation agreement with four healthcare providers (ProHealth Physicians, Texas Health Resources, Palmetto Health, and The Baton Rouge Clinic) whose patients will gain access to clinical support, chronic disease monitoring, and wellness programs at CVS drugstores and MinuteClinic retail clinics. MinuteClinic will send electronic medical histories and visit summaries to each patient’s PCP and CVS will share messages and alerts. CVS announced in February 2014 that its MinuteClinic division would move from its homegrown EHR to Epic’s EpicCare, saying it needed a platform that would allow it to share information with other providers more quickly and give it patient portal and analytics capabilities.


Reader Comments

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From Pop Counter: “Re: EHR vendors counting patients. Epic touts 50 or 60 percent coverage of the US population. How do they arrive at that number and how does it align with market share?” It’s an arguably flawed SWAG that doesn’t have a lot to do with market share, but it is a great marketing point from a company that claims to employ no marketing people, where huge marketing billboards magically appear on its HIMSS booth walls without human intervention. The “percentage of the US population” claim is also being used to impress the Department of Defense in its EHR selection. I’ve heard that Epic simply asks its customers (even the non-live ones) to estimate the number of patients they serve, applies some mysteriously derived percentage of potential overlap with other Epic sites, and then just adds it up. But let’s look at it from the point of view of an EHR company engineer being asked by the marketing department to arrive at such a number. Being objective and pedantically pragmatic as engineers often are, you would point out these challenges:

  • We don’t host every client system, so we can’t just run some super-query of unique medical record numbers. We have to ask the hospitals to report the number back to us.
  • Even though an individual health system may have successfully applied the one-patient, one-record rule, there’s no easy way to de-dupe overlapping patients across multiple clients without some kind of master person index algorithm. As a vendor with multiple health system clients in the same geographic area, we can’t easily account for patients who have information in all of them.
  • We would be counting imported CCD record from someone else’s system. Should we really count that as a complete patient record in our system when it wasn’t even created there?
  • We have a massive number of old patient demographics that we imported from our legacy system during conversion and we haven’t seen some of those people for 10 or more years.
  • Some patients in our database have died, quite likely elsewhere so that we don’t have a record of it.
  • Since we have an ambulatory system, we get an easy “credit” for a patient who merely drops by for a one-time ophthalmology consultation or lab test with no plans to return. The “record” in our system is minimal, containing (if we’re lucky) allergies, chronic conditions, and medication reconciliation. Almost everything of value is stored by other providers.
  • We as a vendor who sells primarily to large academic medical centers can boast of more patients because of higher churn from referrals, specialty clinics, and large ambulatory practices, all of which see patients who are also in the EHR databases of many other providers. Ambulatory visit patients greatly outnumber hospital inpatients, so the numbers are artificially skewed to favor vendors with many active sites in both, and in fact a large ambulatory EHR vendor may have more unique patients than any hospital vendor.
  • It’s not a zero-sum game. The market-leading system might claim 50 percent of US patients, the runner-up could have 45 percent, the third-place vendor might count 40 percent, and so on. That doesn’t mean we’ve sold more systems, have more users, process more active patients, or house complete data on more patients than anyone else.
  • As an engineer, I think we need to be careful about implying that having a high percentage of the population covered reflects attributes of our system or our company that are important to prospects. It’s more accurately a reflection on the size and patient diversity of our existing customers.

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From The PACS Designer: “Re: BlackBerry. It’s not seen much in the healthcare setting, but that could change if it becomes a takeover candidate. With its shares selling below $10, BlackBerry might soon become a division of Apple since consolidation in the mobile space is starting to happen. The real question is would that be practical for Apple to pursue.” BlackBerry’s market capitalization is down to around $5 billion after a big drop following the Apple-IBM enterprise announcement, which threatens BlackBerry’s one bright spot of mobile device management revenue. However, the company has $3 billion in cash, an enterprise user base that has no instantly appealing alternative, and a bunch of patents, so someone should be interested.

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From Point Taken: “Re: GE Healthcare. Any idea of substantive outcomes from the bold 2012 aspiration from GE, saying that it will invest $3 billion in R&D in the Healthymagination program to foster at least 100 innovations to lower healthcare costs by 2015?” I will leave it to GE to respond if they like. I know they’ve done a lot specifically to develop lower-cost medical technology (not IT) in India, but I haven’t heard otherwise. The few press releases on the Healthymagination site are old, the most recent annual report posted is from 2012, and the newest video on their YouTube channel is from 2012.

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From Sext Machine: “Re: doctor sexting during surgery. Thanks for the post – we got a kick out of that at our company. Do you know of other physicians who have gotten in trouble for using SMS messaging to share patient data?” I will defer to readers since the “trouble” involved is likely to be more related to internal discipline rather than being formally charged with violating HIPAA. I will say that I talked to a CIO today who implemented a secure messaging system to avoid users sending PHI via text messaging, but then found additional benefit in using the system to coordinate care among physicians.

From CEO: “Re: social media. We’ve been writing a weekly company blog but haven’t gotten Twitter and LinkedIn followers. How can we get better social media visibility?” I should mention that this was an actual (paraphrased) question I received today from the CEO of an HIStalk sponsor. Here was my excerpted answer, which I figured I might as well share in case anyone else is interested:

Company blogs rarely say anything fresh or insightful, often being cranked out by a marketing person or ghostwriter. They also try to appeal to every kind of reader, from newbie to old pro, programmer to CEO, with content that nobody hates but that nobody loves either. As a result, they aren’t going to get a lot of social media attention because they don’t say anything new. I don’t think your tweets will be all that compelling to Twitter users since they are infrequent, mostly link back to company material on your website, and don’t have much personality. People with big Twitter followings tend to be passionate about a subject other than their employer and that enthusiasm shines through. However, the question is whether that even matters. Companies tend to get wrapped up in the number of followers or retweets without having any idea whether that translates into more business.


HIStalk Announcements and Requests

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Reminder: you can nominate a non-management employee, co-worker, or vendor person for the HIStalk BOSS (Beacon Of Selfless Service) award. It’s for people who went above and beyond during a specific incident, such as downtime, an IT crisis, bug fix all-nighter, or anything else in which your nominee sacrificed their own self-interest to fix a problem.

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We like Niko Skievaski, the former Epic guy who produced “Struck by Orca,” an entertaining book about ICD-10 (he dropped off autographed copies at our HIMSS14 booth). He’s working on a new book, MU2i (MU2 Illustrated), which will ship in September. Artistic types who are willing to contribute a picture can contact Niko.

This week on HIStalk Practice: Mostashari’s Aledade venture works to set up an ACO in Arkansas. Healthcare IT sees its first billion-dollar acquisition quarter. CVS announces new clinical affiliations and a $1.5 million community health center grant program in partnership with IBM. A new independent practice study finds EHR workarounds are used for three main problems. Takeaways from the recent eHI webinar on ONC’s 10-year vision for interoperability. Providers and consultants are welcome to share an “Idea of the Day” with the HIStalk Practice audience. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers the growth of ZocDoc, benchmarking its success against his early predictions for the company. Google announces that it will commercialize its glucose monitoring contact lenses through a partnership with medical device manufacturer Novartis, which hopes to have the non-invasive glucose reading lenses on shelves within five years. Apple teams up with IBM to target the enterprise mobile markets. 

Listening: new from the 60-something metal gods Judas Priest, who sound great even with the album’s horrible production. Also: new Linkin Park.


Acquisitions, Funding, Business, and Stock

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Athenahealth announces Q2 results: revenue up 27 percent, adjusted EPS $0.32 vs. –$0.08, beating expectations for both.

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Microsoft announces that it will cut 18,000 jobs in the next year – 14 percent of its workforce – with the former Nokia unit taking most of the hit. Like all companies desperately ditching headcount to keep Wall Street happy, the Bill-less and Balmer-less Microsoft says it will simplify processes, increase accountability, reduce management layers, and make itself faster and more agile. I don’t recall hearing the announcements when it made processes more complicated, reduced accountability, added management layers, and let itself get slower and fatter. Microsoft paid $7.2 billion for Nokia in September 2013, which was probably the polite thing to do given that Nokia’s demise was hastened by hitching its teetering wagon to Windows Phone.

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Behavioral EHR vendor Valant Medical Solutions receives an $11 million private equity investment.

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Medical image exchange platform vendor DICOM Grid gets $6 million in funding from Mayo Clinic and Canaan Partners.

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Online doctor search vendor BetterDoctor closes $10 million in Series A funding.


Sales

Texas Health Resources (TX) chooses LogicStream Health’s Intelligence Platform to manage and optimize its clinical decision support. I’ve pored over the company’s site for several minutes and I still can’t figure out how its product works given the maddeningly high-level non-detail it provides in abundance.

Desert Imaging (TX) chooses IDS AbbaDox RAD to manage its radiology workflow.

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Children’s Hospital Los Angeles (CA) and Wisconsin Statewide Health Information Network sign four-year contracts for Orion Health’s Rhapsody integration engine.

The FHP Health Center (Guam) selects the eClinicalWorks EHR.

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University of Kansas Hospital selects Health Catalyst’s data warehouse.


People

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Susannah Fox (Pew Research Center) is named as an entrepreneur in residence at the Robert Wood Johnson Foundation.

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Informaticist and former ONC Deputy National Coordinator Charles Friedman, PhD is promoted to chair of the Department of Learning Health Sciences at the University of Michigan Medical School. 

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Paient satisfaction and physician reputation vendor SayAh names Warren Dodge (Creekside Healthcare Consultants, Altos Solutions) as CEO.


Announcements and Implementations

TeraMedica completes the implementation of its Evercore VNA for the public health system of New South Wales, Australia, saying it’s one of the world’s largest VNAs in covering 7 million patients, 110 facilities, and nine PACS that process 3 million imaging procedures each year.

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The Central Texas division of Baylor Scott & White Health goes live on API Healthcare’s ShiftSelect.


Government and Politics

Two subcommittees of the House Energy & Commerce Committee held a joint meeting Thursday to discuss the use of technology to advance medicine. Above is Rep. Phil Gingrey, MD (R-GA) calling out Epic for selling a “closed platform” whose users have received more than half of the $24 billion in HITECH payouts, asking if taxpayers should be subsidizing the purchase of products that are supposed to be interoperable but aren’t. Gingrey says it may be time for the committee to look at the practices of EHR vendors, saying “fraud may be perpetrated on the American taxpayer.”

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Three Arkansas Medicaid patients sue the state for refusing to pay for a cystic fibrosis drug that costs $300,000 per year. The patients meet FDA’s treatment criteria, but the state says the patients must first prove that older and cheaper drugs don’t work for them. According to the executive director of the National Association of Medicaid Directors, “We have this public health mentality that all people have to be cured no matter what the cost, and also let the innovators charge whatever they want. Those are fine theories independently, but when you combine them together in a finite budget environment, it’s not sustainable.”


Innovation and Research

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In Canada, Telus Health opens an innovation center in Toronto.


Technology

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A physician reviews a $3.99 iPhone app that claims to measure blood pressure using only the iPhone, with the developer suggesting it’s a Johns Hopkins product. The physician reviewer  talked to the CEO (who graduated from Hopkins but is otherwise unaffiliated) who says the app is “for entertainment purposes only” and shouldn’t actually be used to measure blood pressure. He says he’ll consider adding that disclaimer, which should not exactly boost sales.


Other

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Medscape surveys 18,000 self-selected physicians about their EHRs. My observations:

  • The survey asked, “Are you using an EHR?” which is a horrible question given that (a) it doesn’t distinguish between a practice EHR and a hospital EHR and most physicians practice in both settings, and (b) it doesn’t define “using.” All but 7 percent of respondents said they’re using an EHR or planning to do so within two years.
  • The most widely used EHRs (again subject to the limitations of failing to distinguish between practice vs. hospital) are Epic (23 percent), followed by Cerner, Allscripts, eClinicalWorks, and NextGen. Three percent or fewer reported using well-known systems such as Practice Fusion, the VA’s VistA, athenahealth, Greenway, and McKesson.
  • The top-rated system was the VA’s VistA, which also had the highest reported user satisfaction. However, the VA’s physician users are all employed and use only that EHR, so they’re probably going to be happier than a community-based doctor who has an EHR in the office plus different EHRs at each hospital in which he or she sees patients.
  • VistA and Epic were top rated for connectivity.
  • Only 42 percent of respondents said they are satisfied with their EHR vendor, and 16 percent say they’ll be replacing their system (it’s not clear how the hospital-based doctors could have answered this since it’s not their call).
  • Overall, the survey’s results are questionable in its failure to distinguish among the multiple settings in which the average physician uses EHRs and its lack of definition of “using” (Entering orders? Having a clerk create a bill? Looking at a hospital rounds list on an iPhone?) For that reason, I would characterize its conclusions as entertaining but hardly authoritative. However, I doubt that will stop vendors and lazy writers from crafting clickbait headlines and swaggeringly wordsmithed stories about the results.

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In the UK, Homerton University Hospital NHS Foundation Trust goes live with RFID technology that will track the movement and location of paper charts within the facility. The hospital says it won’t even bother to file patient notes alphabetically since they can just be shelved and located later by RFID. Paper records were tracked previously using Cerner Millennium.

An article in Health and Human Rights Journal profiles New York City’s jail system, which tweaked its eClinicalWorks EHR to help protect the rights of high-risk inmates (the article fails to note the difference between jails and prisons, the former being local facilities housing both those awaiting trial as well as those serving short sentences, so calling their occupants “prisoners” isn’t correct). EHR templates were created to identify injury patterns in vulnerable populations (LGBT, mental illness, injured, held in solitary confinement) consistent with inmate wrongdoing, officer misconduct, sexual assault, and self-harm.

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Weird News Andy simply titles this story as “Smile.” Police arrest an upstate New York man for flying a $1,300 video-recording drone in front of the windows of a medical facility’s exam rooms. “Front Row Dave” says he made a mistake but won’t stop “droning.” His Facebook page has a picture of his drone, which appears to be a DJI Phantom 2 Vision+ Quadcopter with FPV HD Video Camera and 3-Axis Gimbal. The video above was made by a guy on a cruise using that same drone, which must be a voyeur’s delight. I’m thinking about flying one over HIMSS conference airspace in Chicago, or perhaps in the exhibit hall.


Sponsor Updates

  • Orchestrate Healthcare posts a blog entry, “Healthcare Business Intelligence: Harness the Power.
  • PerfectServe’s VP/Chief Clinical Officer Leigh Ann Myers, RN writes a blog post, “Changing the Culture for SBAR Communications.”
  • Kareo opens an operations center in Las Vegas, NV.
  • Regenstrief Institute joins ConvergeHEALTH by Deloitte’s real-world evidence and analytics consortium.
  • AirWatch by VMware opens registration and lineup of analyst speakers for the Airwatch Connect Global Tour 2014 in Atlanta, London, and Sydney.
  • McKesson launches Benchmark Analytics, which provides reports and consulting services to optimize performance.
  • GetWellNetwork’s CEO Michael O’Neil discusses the CDC Morbidity and Mortality report on the cost of cancer survivorship with a local journal.
  • Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.

EPtalk by Dr. Jayne

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HIMSS15 is looking for proposals for preconference symposia. We’re returning to Chicago this year, so dig out your winter boots and scarves. I’m not convinced that moving to April is going to allow the meeting to escape winter’s wrath. I seem to be cursed any time my travel remotely involves Chicago, so I’m not sure I’m looking forward to it.

Continuing the Open Payments saga from earlier this week, I was finally confirmed as a real, live physician so that I could access my data. I don’t have any data listed for the 2013 program year and that’s probably accurate, plus or minus a martini. I know I provided my NPI to one device manufacturer when we had drinks, but the reporting threshold is $10 and I’m not sure I topped that even though the cocktail in question was good.

Speaking of money, AMDIS released its annual report on CMIO salaries. There were 120 respondents and average compensation was up, according to the report. Based on the compensation of CMIOs I know well, the range isn’t terribly reflective of our reality in the trenches. The report also noted that although salaries have increased, job satisfaction is on the decline. I would agree that job satisfaction is an issue. It could be that my role has matured or perhaps it’s all the government regulations, but the job isn’t as much fun as it used to be. I’m the kind of CMIO that enjoys rolling up my sleeves and digging into cool projects, so every time I have to sit on another committee or address another regulation, it sucks a little bit of my life away.

I was surprised to see that more than 70 percent of respondents maintain a clinical practice. It’s getting harder and harder to do so. I’m one of the CMIOs whose own organization doesn’t support administrators who want to continue seeing patients. My clinical opportunities are cobbled together at a variety of facilities, which makes scheduling a bit of a challenge.

It’s hard to interpret the data with the relatively small sample size, however. I’m not sure how many CMIOs there are in the US, but there are many more people doing CMIO-type roles without the title and often without the compensation. Of respondents, 25 percent are certified in the subspecialty with another 25 percent considering it. Unfortunately many of my strongest colleagues are unable to sit for the exam since they didn’t maintain a primary board certification. I’m somewhat ambivalent about that personally and hope that those physicians who are certified but don’t see patients any more aren’t required to keep up a primary certification for no reason.

On the other hand, I had an email this week from a recruiter looking for a board certified physician to fill a locum tenens job in the US Virgin Islands, so maybe that primary certification is a good thing after all. They actually said “soaking in the sun with beverage in hand” in the opening paragraph, so they get full credit for that one. Doubtful that the actual experience would live up to the hype, like so much in healthcare these days.

I love some of the headlines I see: recently “MU drives patient savings” has been my favorite. Based on the duration of the program and what was actually involved in Stage 1, coupled with the relatively small numbers of providers attesting for Stage 2, I’m not sure we can arrive at this conclusion. Did they factor in the time cost of visits running late because providers were playing catch-up with the ever-increasing and burdensome requirements? Interestingly, the study in question had data provided by HIMSS.

Another great one cited Stage 2 EHRs as not being ready for data sharing. I don’t disagree with this one, although I think they focused too much on the technical problems of CCDA exchange and not enough on the philosophical problems. Some of the documents I see coming into our system are technically correct, but really don’t tell the clinician what he or she needs to know. For example, a patient who was seen in the emergency department for a laceration. I’d rather have the physician’s pen-and-ink sketch of the wound than any syntactically correct description, but there’s no room for that in the game of data exchange.

It’s probably a good thing that I can’t keep up with all the news that hits my inbox because it would just aggravate me. If I’m going to be aggravated, I’d rather be annoyed by the challenges of my latest pastry therapy project. For those playing along at home, this week’s specimen is the Blueberry-Lemon Bundt Cake from my good friend Martha Stewart. And thanks to YouTube for videos on how to zest a lemon without going insane. The picture doesn’t do it justice, but I loved the cake pan.

Got a favorite Bundt cake pan or recipe? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 17, 2014 News 8 Comments

News 7/16/14

July 15, 2014 News 9 Comments

Top News

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IBM and Apple announce a partnership to develop business applications for iPhones and iPads. IBM will also sell Apple products and provide on-site services to business clients, while Apple gains business credibility and a tie-in to IBM’s big data capabilities that will make its devices decision-making tools. The deal also gives Apple’s iOS more enterprise credibility against the more widely used Android operating system. The companies say more than 100 business apps will be available by fall.


Reader Comments

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From Baron Schkinn: “Re: Siemens. The rumor is surfacing again that Cerner will buy the health IT division of Siemens and close the deal by the end of the summer, coming from an inside source who I trust. That would give Cerner a replacement for its failed ProFit, a backup center in another earthquake zone, a shot at selling to the significant number of Invision and MedSeries4 clients, and would make Cerner the #1 vendor over McKesson in revenue. They would still be left with two poor ambulatory solutions that would make them non-competitive with Epic.” Unverified, other than the seemingly solid rumor that Siemens is shopping the business it describes on its website in a predictably confusing fashion as “the Siemens Healthcare Information Technology business of Health Services, Siemens Healthcare” (which offers several humorous acronym-powered punning opportunities.) Cerner might be willing to pay the rumored $1.4 billion just to get the Siemens customer base and a few worthwhile niche-filling nuggets (MobileMD, although nothing else comes to mind given Soarian’s minimal-and-dropping competitiveness) but it would seem to be a better fit for private equity. Cerner doesn’t do a lot of acquisitions and one that size might spook Wall Street, which Cerner doesn’t like doing, but anything can happen when it comes to acquisitions.

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From BadBuy: “Re: Sunquest. Significantly behind full-year sales target, with the top two reps at just over 50 percent. Vista/Huntsman Gay made out like bandits.” Unverified. Roper Industries acquired Sunquest in July 2012 for $1.42 billion after what I’ve heard was shockingly minimal due diligence. I would assume that former owners Huntsman Gay Global Capital and Vista Equity Partners did indeed do quite well for themselves given that the former paid only $208 million to acquire 51 percent of Sunquest in December 2010, with Vista holding on to 49 percent. That means Roper paid more than three times that valuation just 19 months later. Roper executives talked up Sunquest’s revenue growth and implementation improvements in the company’s most recent earnings call, adding that Sunquest will have “quite an exceptional year in 2014.” Roper’s diversified growth is steady – share price has more than tripled in the past five years. The longer you work in this or any other industry, the more you realize it’s the generic money guys, not the deep subject matter experts or passionate advocates, who do really well. “Owning” has more potential reward (and risk) than “doing.”

From Binge and Purge: “Re: Johnathan Samples. You’ve probably already heard, but he has left Greenway after 13 years and started a new company.” Samples, who was Greenway’s chief innovation officer through last month, threw in with former Greenway Chief Product Strategist Jason Colquitt at Across Healthcare, which offers what appears to be an unfocused array of consulting and software development services.

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From Yalie: “Re: Yale-New Haven. Anything in writing about their hard Epic downtime system-wide for two days last week?” The local paper says a network switch went down Friday for a handful of hours, requiring the hospital to cancel elective surgeries. Epic information was still available from cached copies.


HIStalk Announcements and Requests

I’ve confirmed that Epic’s FDA 510k submission was for a bedside matching system, not a blood bank system.

We hear a lot about the suits in the healthcare corner offices, but not enough about the cube-dwellers who perform the actual work that pays for them. I am offering the HIStalk BOSS (Beacon of Selfless Service) Award to recognize those trench warriors (provider or vendor) who toil without bonuses, reserved parking spaces, or the ever-present validation of company-paid butt kissers. The BOSS Award isn’t a trophy or cash, but rather recognition in HIStalk of a non-management employee who went above and beyond during a specific event (downtime, sales demo, screaming surgeon demanding a new laptop, etc.) to save the day. Anyone who observed the individual’s laudable effort firsthand can nominate someone – a supervisor, peer, or customer. Submit your candidate here.

We like to keep in touch with HIStalk’s sponsors and we just sent an e-mail to all the contacts on our list. Let Lorre know if we missed you.


Acquisitions, Funding, Business, and Stock

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The US Bankruptcy Court approves MModal’s reorganization plan, allowing the company to emerge from bankruptcy in August as it had originally announced.

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The Teamsters Union urges McKesson’s shareholders to approve its proxy proposal to eliminate the company’s change-of-control terms that will give its top executives $283 million if new owners fire them, including $140.5 million for John Hammergren alone.

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Craneware announces $70 million in sales in the first half of 2014, up 80 percent year over year.


Sales

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Saint Mary’s Hospital (CT) selects Wellsoft’s EDIS.

Wheeling Hospital (WV) adds Sunrise Financial Manager to its Allscripts systems.

Carrus Hospitals (TX) will deploy Medhost’s clinical and financial solutions via the company’s hosted Medhost Direct platform.


People

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Rob Lipowski (Cleveland Clinic) joins Perceptive Software as director of healthcare solutions.

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Perry Lewis (McKesson) is named VP of industry relations of CoverMyMeds.

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“Inc.” profiles Beyond Lucid Technologies Founder and CEO Jonathon Feit, who has Tourette Syndrome. It points out the difficulty he has in performing company pitches and recorded videos without the characteristic twitching. His company sells an electronic patient record system for first responders.


Announcements and Implementations

Summit Healthcare announces that 26 facilities are live on its Summit Care Exchange technology, which allows providers to send CCDs to a Health Information Service Provider via Direct to meet Meaningful Use requirements.  

EHNAC and WEDI launch an accreditation program for practice management systems, announcing GE Healthcare, Medinformatix, and NextGen as pilot participants.

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Elsevier Clinical Solutions announces its Clinical Documentation Improvement Reference App, which provides clinical term look-up and medical necessity information with an emphasis on ICD-10.

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New Orleans-based startup Clinicate launches its clinical file-sharing solution for providers and patients. It also contains some unrelated tools such as drug lookup. It’s free for patients and a single provider can use the system free for up to 100MB of storage.

Healthcare Data Solutions announces availability of the HealthcareData360 EHR market intelligence database, which allows looking up EHR decision-makers both within and across connected provider organizations.


Government and Politics

NIST and OCR will co-host “Safeguarding Health Information: Building Assurance through HIPAA Security” on September 23-24, 2014 at the Grand Hyatt in Washington, DC. Onsite attendance runs $345, while Webcast attendees will pay $200.

The FCC’s 17-year-old system crashes under the weight of 800,000 comments filed regarding net neutrality, forcing it to extend the comments deadline until midnight Friday. Comments can be filed (and read, in the case of the most recent 10,000 comments) here.

Eighty-nine House lawmakers sign a letter requesting that CMS remove penalties for clinical laboratories that perform tests for Medicare patients, explaining, “Pathologists have limited direct contact with patients and do not operate in EHRs. Instead, pathologists use sophisticated computerized laboratory information systems (LISs) to support the work of analyzing patient specimens and generating test results.” CMS granted pathologists a hardship exception for 2015, but the College of American Pathologists wants the requirement to be eliminated permanently.


Innovation and Research

Three computer scientists who developed the first program that passed the Turing test — convincing a human that they are interacting with another human rather than a computer — have joined startup Wholesale Change, which will develop online tools to help consumers choose Medicare insurance plans.

@Cascadia tweeted about Israel-based Tyto Care, which offers a handheld device and cloud platform that allows patients to do their own physical examination while being guided remotely by their doctor.

Chicago-area researchers query the EHRs of 23 primary care practices to identify patients likely to have undiagnosed hypertension based on their historical pattern of in-office blood pressure readings, inviting those patients to follow up with a more comprehensive series of readings. The practices not only alerted patients, but also turned their work into a quality improvement project by continuing to remind both patients and physicians of the need for follow-up until an ICD-9 code was entered indicating that hypertension had been either confirmed or ruled out.


Technology

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The Alcon division of Novartis AG licenses Google’s smart contact lens technology that will measure and report blood glucose levels. Meanwhile, the former Google X director who led the development of the contact lens as well as Google Glass announces his departure from Google and his excitement at going to work for Amazon. He made headlines last week by saying that Glass is “not necessarily the definitive answer” for wearable technology.

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Welch Allyn adds customizable patient scoring to its Connex vital signs monitor, allowing hospitals to use their own Early Warning Score to identify deteriorating patients. The company’s clinical surveillance system can send the results wirelessly to the hospital’s EMR and can also monitor for falls, pressure ulcers, and respiratory distress.


Other 

A new HIMSS Analytics report says “germ-related hospital applications” have high growth potential. That oddly phrased category (clinicians never say “germs” unless talking slowly to laypeople who possess limited medical comprehension) includes systems for infection surveillance, patient acuity, and laboratory outreach.

HIMSS14 is named the fourth-largest medical meeting of 2013 with its 36,5325 attendees, following the FIME (Florida International Medical Expo) trade show in Miami, the Greater New York Dental Meeting, and RSNA.

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Two surgeons from UNC Hospitals (NC) open a burn center in Malawi, which has 14 million people and only 20 surgeons. One of the UNC surgeons added that UNC’s new Epic electronic medical record and potentially the addition of telemedicine services will help it treat patients in their local areas of North Carolina rather than transporting them to Chapel Hill.

Let’s hope Massachusetts isn’t the national healthcare model everybody brags on: healthcare will eat up almost a third of the new state budget vs. the 20 percent it consumed in 2001.

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An article describes how 25-bed Cottage Hospital (NH) became one of the first hospitals to attest for Meaningful Use Stage 2. It’s a Medhost facility and hired an informatics nurse to keep things moving along.

“US News & World Report” lists its “Best Hospitals 2014-15”: (1) Mayo Clinic; (2) Mass General; (3) Johns Hopkins; (4) Cleveland Clinic; (5) UCLA Medical Center; (6) New York-Presbyterian; (7) HUP; (8) UCSF; (9) Brigham and Women’s; (10) Northwestern Memorial; (11) University of Washington; (12) Cedars-Sinai, tied with UPMC; (14) Duke; (15) NYU Langone; (16) Mount Sinai; and (17) Barnes-Jewish. 

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“The Wall Street Journal” reports that the ambitious $54 million biotech facility created from the converted Brooklyn Army Terminal stands nearly empty, reportedly because of squabbles between its two developers, SUNY Downstate Medical Center and the city’s Economic Development Corp. The project’s former executive director, who left last year, said public agencies are lousy at running speculative developments because they have too much bureaucracy behind them and lack the mindset to get it done. The project is limping along by renting space to non-biotech companies at a discount despite its mission of boosting the city’s biotech presence.

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Madison, WI’s weekly hippie newspaper covers Epic’s purchase of wacky artwork at the summer art fair run by the Madison Museum of Contemporary Art, saying that Judy Faulkner brings an employee team armed with a “generous budget” (some of it in cash) to find big, bold, and whimsical pieces.

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A father whose six-week-old daughter died of a liver tumor after spending her entire life in the hospital posts a request on Reddit asking for help to Photoshop the only photos he had of her, all of them showing her with tubes in place since she had never been without them. His post generated 2,700 comments of support and many photographs and drawings. He called attention to “Now I Lay Me Down to Sleep,” whose volunteer photographers take portraits of families with their dying or deceased child.


Sponsor Updates

  • The Sunquest User Group conference is being held this week at the JW Marriott Desert Ridge Resort in Scottsdale, AZ.
  • HealthMEDX sponsored the “Prescription for Change” technology discussion for long-term and post-acute care providers, with CEO Pam Pure and Medical Director Charles Rogers, MD participating.
  • Laura Argauer of CTG co-presented “Using Transformational Data Analytics to Improve Care Valuation, Management and Outcomes of Chronic Kidney Disease Patients” at the Healthcare Analytics Symposium & Expo 2014 this week.
  • Health Catalyst shares a case study on Crystal Run Healthcare (NY), explaining why they bought rather than built a data warehouse.
  • Predixion CEO Simon Arkell will discuss the explosion of connected devices and predictive analytics challenges in healthcare during the Microsoft Worldwide Partnership Conference in Washington, DC this week.
  • Kari Bunting, RN of MedStar Franklin Square Medical Center (MD) will present her research on reducing excessive uterine contractions aided by PeriGen’s PeriCALM Patterns EFM at the Summer Institute in Nursing Informatics in Baltimore, MD this week.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 15, 2014 News 9 Comments

Monday Morning Update 7/14/14

July 12, 2014 News 6 Comments

Top News

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Former health system CEO Joe Swedish, now CEO of WellPoint, says he’ll focus the company on technologies such as telemedicine, kiosks, and smartphone-based instruments (he didn’t mention the company’s partnership with IBM to develop Watson-powered applications). Swedish is also driving use of WellPoint’s databases that are populated from processing 581 million medical claims each year. It’s good to work for an insurance company – Swedish’s shares are worth $15 million and he’s paid $7.5 million per year. I remember him way back when he was CEO of Winter Park Hospital (FL).


Reader Comments

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From A Concerned Customer: “Re: NantHealth. We as a customer are hearing of extensive layoffs of the iSirona people. Almost all of the account executives were let go.” Unverified.

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From LISPro: “Re: Epic. I’ve heard the company has submitted to the FDA for 510k certification of their new blood bank module.” Unverified.

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From Not From Me: “Re: Intermountain. The short-term choice (three or so years) would have been Epic, but we went with Cerner because of Epic’s dated technology, Cerner’s openness, and the feeling that we would be more of a partner than a customer with Cerner. The partnership is more than words. We’re working closely with Cerner and their horde of sharp, dedicated people on the implementation. We have some pieces they don’t and those are being built into the Cerner system, while some of our own development efforts have been redirected since Cerner already has that functionality. The first rollout is scheduled for December and I think it will go well due to the way the teams are working together.” Unverified.


HIStalk Announcements and Requests

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Two-thirds of poll respondents have used their PCP’s patient portal in the past six months. New poll to your right: what contributed most to your present success? Young people will be interested to learn what worked for their more experienced healthcare IT peers. Click the “comments” link in the poll to elaborate further.

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

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Acquisitions, Funding, Business, and Stock 

Epic says that it has 7,400 employees, 600 more than it reported in February, probably boosted by the college graduation of its latest round of hires.

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QPID Health will move its offices to Federal Street in Boston to accommodate expected growth.


People

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Brad Holcomb, RN (St. John’s Health System, First Consulting Group, BHL Consulting Group) died on May 14 at 47. His wife Lucretia said it would be OK for me to mention the donations page a family friend has set up for their children.


Announcements and Implementations

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Valence Health announces its Further 2014 conference, September 10-12 in Chicago. It’s open to anyone and the cost is amazingly low: $500 includes registration, meals, entertainment by Second City, and two nights’ accommodations at the Drake Hotel ($400 per night on the hotel’s site for those dates.) If you’re local to Chicago, you can go for $199 without hotel. Some of the agenda is specific to customers, but a lot of it isn’t, covering value-based care, clinically integrated networks, patient engagement, and predictive risk. I would attend myself if I didn’t have a conflict , and may yet in fact, since it looks worth juggling other stuff around.


Technology

A hospital in Spain is using the Oculus Rift virtual reality gaming headset in the OR for nervous surgical patients. The immersive device provides calming scenic movies with music that minimize the patient’s perception of the OR’s noises and bright lights. Facebook must have been impressed since it bought the company for $2 billion in March even though the headset won’t be available to consumers until next year. The founder of Oculus is a 21-year-old California college dropout.

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An article profiles the use by Duke Medicine (NC) of a geographic information system tied to its homegrown clinical database query tool, allowing researchers to study medical issues by neighborhood, socioeconomic indicators, and even proximity to fast food restaurants, all in real time.


Other

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In England,the Health & Social Care Information Centre reports that Summary Care Records have been created for 41 million patients, with only 1.4 percent of them opting out of the program. The SCR program was intended to give off-hours providers fast access to a patient’s medications and allergies using information from practice-based EHRs. Around 5,500 practices have created SCRs for patients. SCR was until recently a floundering part of the now-defunct National Programme for IT. A British Medical Association IT committee chair called for its shutdown in early 2013, saying that while 23 million SCR records had been created, only 100 hospitals and after-hours providers were using them.

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An article by former FDA Deputy Commissioner Scott Gottlieb, MD says existing policies don’t encourage researchers to develop high-priced cures for diseases that would reduce overall lifetime patient cost for chronic conditions. He suggests a system in which payers can finance their longer-term benefit through government-backed guarantees and accounting rule changes.

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I found a cool heart rate app that  works sort of like a pulse oximeter – you put your finger on the phone’s rear-facing camera, the app turns on its flash so it shines through your finger, and then it measures and displays your heartbeat as a real-time graph. It seems to be quite accurate, making it useful for people who exercise or who have atrial fibrillation. The developer claims 25 million users and offers others for cardio exercise, sleep cycle analysis, biofeedback stress reduction, and blood glucose logging.

Weird News Andy sniffed out this story: a woman who received experimental treatment for paralysis eight years ago in which cells from her nose were injected into her spine grows another nose from the injection site. WNA also suggested taking the stairs in hospitals after a study finds that elevator buttons have more germs than restrooms.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 12, 2014 News 6 Comments

News 7/11/14

July 10, 2014 News 5 Comments

Top News

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National Coordinator Karen DeSalvo reorganizes the HIT Policy Committee. Also announced by ONC: only 972 EPs and 10 hospitals have attested to Meaningful Use Stage 2. Athenahealth users lead the EP Stage 2 attestation by far. Clearly ONC’s budget and influence are shrinking as disenchantment with the Meaningful Use program grows and providers focus on more strategic goals than lapping at Uncle’s Sam’s ever-distancing carrot.


Reader Comments

From McLayoffs: “Re: McKesson. Decimated their ranks last week, so I wouldn’t be surprised if they sold off that business. It’s not one that John Hammergren ever wanted to be in, but inherited when he took over. All non-essential implementation teams were dissolved and upgrades are rumored to be handled by national support. A lot of good people were lost last week. I’m not surprised that Siemens is calling it quits as well, with Epic dominating the market. I’m even seeing Cerner to Epic conversions now.” Unverified.

From Punch Bowl: “Re: Nuance. Acquiring Notable Solutions, Inc.” Unverified. NSI offers solutions for document capture and forms processing to a variety of industries.

From Kites Away: “Re: research question for your audience. Is strategic planning a useful exercise? Why or why not?” I will let readers weigh in. My opinion is that it’s a good exercise even though the assumptions and predictions often turn out to be wildly off. It makes people focus on the current state and to consider the array of possible future states.


HIStalk Announcements and Requests

This week on HIStalk Practice: Key takeaways from the 2015 proposed physician fee schedule. The ONC Health IT Policy Committee presents the latest round of Meaningful Use attestation numbers (and notes the vendors leading the pack). Cigna creates 100 collaborative care arrangements with large physician groups. The Accountable Care Coalition of Greater New York uses new grant money to launch a medication adherence program, while Milwaukee Health Services uses new funds to upgrade its EHR. Online consumer service providers and the DMV pilot a patient identity management program. Thanks for reading.

This week on HIStalk Connect: Dr. Travis breaks down Rock Health’s recent “Mid-Year Digital Health Funding Report.” In Europe, the $2 billion Human Brain Project is under threat of boycott from the scientific community over its hard line stance on funding out-of-scope projects. Syria is getting international support through an ICU telehealth program that is helping resolve the country’s physician shortage. AdhereTech raises a $1.25 million Series A for its connected pill bottle. 

I received two items from readers that I’m going to decline to run because I don’t think it’s fair to the companies involved, but I want to explain why. First was a healthcare IT vendor CEO who was arrested for battery, which I don’t think is fair game because it’s personal and being arrested isn’t the same as being found guilty. Second is a lawsuit brought against a company that alleges it broke its contract with an offshore development shop, which has the same problem in being just an allegation so far. I like good rumors and gossip as much (probably more) than the average person, but both of these documents name people who shouldn’t be tried on the pages of HIStalk. I’ll report the final legal decisions once they are out.


Acquisitions, Funding, Business, and Stock

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Revenue cycle vendor RevSpring acquires Talksoft, which offers an automated appointment reminder service.

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Allscripts acquires UK-based Oasis Medical Solutions and will implement its Oasis Patient Administration System as a single-source solution for the UK market.

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USA Mobility, along with its previously acquired Amcom Software, changes its name and Nasdaq ticker symbol to Spok (pronounced “spoke”).

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Oncology data analysis vendor Syapse raises $10 million in a Series B funding round. Its product integrates genomic information with the EMR to display data for decision-making, suggest treatment plans, and track outcomes.


Sales

Centegra Health System (IL) adds revenue performance improvement solutions to its existing MedAssets agreement.

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Carrus Hospitals (TX) will deploy Medhost’s clinical and financial solutions via the company’s hosted Medhost Direct platform.

Memorial Sloan Kettering Cancer Center will implement Allscripts dbMotion and continue its use of Sunrise EHR.


People

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Health Data Specialists promotes Chad Jones to Cerner practice director.

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Harold Paz, MD (Penn State Milton S. Hershey Medical Center) is named EVP/CMO of Aetna.

George Murillo (Leidos Health) is named western area VP of Orchestrate Healthcare.


Announcements and Implementations

Awarepoint announces the availability of awareAssets V3.0 for RTLS-based asset tracking and workflow optimization.

Lexmark’s Perceptive Software launches Perceptive Cloud Share, a cloud-based content management system for video, images, and other rich media.

DSS adds real-time abnormal lab results alerts to the VA’s VistA CPRS Version 31.

Elsevier launches PolicyNavigator, a knowledge management tool for healthcare policies and procedures.

Healthcare Engagement Solutions launches the Uniphy clinician communications platform.

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MediSafe releases its medication adherence app for Google’s Android Wear smartwatch technology.


Government and Politics

The HIMSS EHR Association weighs in on HHS’s proposed Meaningful Use changes, saying pretty much the same thing as other groups before it: (a) turn the proposed rule into a final rule quickly and without changes since providers are otherwise forced to make decisions blindly; (b) define the types of delays that are acceptable for not implementing 2014-certified EHRS – vendor delays, lack of provider resources, lack of local interoperability options, etc.; (c) simplify the combinations stages, objectives, and EHR certification year; (d) simplify the proposed CQMs; (e) delay MU Stage 3 to avoid the same rush and confusion that accompanied the rollout of Stage 2.

A tiny observational study published in Annals of Internal Medicine finds that the government failed in its attempt to make Healthcare.gov as easy for millennials to use as popular websites. Its recommendations: (a) allow clicking on health insurance terminology to bring up a definition; (b) make it clearer that preventive care is included in all plans offered; (c) make the dental insurance option clearer; (d) improve sorting and filtering of available plans; (e) explain the available tax credit and cost-sharing options that reduce cost; and (f) call “catastrophic” plans something else, such as “minimal” or “value.”

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CMS designates non-profit Health Care Cost Institute as the first national Qualified Entity, meaning it can merge Medicare claims data with commercial payer data to provide price and quality transparency.

CMS gives Tennessee 10 days to fix its $35 million Medicaid eligibility system, saying it is preventing people from signing up for insurance on Healthcare.gov. CMS says state workers ignored requests to assign more people to the project and failed to help new users navigate its system. The state blames Northrop Grumman for missed deadlines and has paid the company only $5 million so far.

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A GAO report says the VA-DoD integrated EHR (iEHR) plan met only one of six required conditions in FY2013. The VA and DoD abandoned their two-year-old plan to develop a single EHR in February 2013 due to cost and timelines, leading Congress to threaten to cut off 75 percent of the iEHR budget unless six conditions were met (define a budget, set a timeline, break out annual and total spending, define how costs would be shared, establish data standardization, and comply with government acquisition policies.) The only fully satisfied condition was creation of a cost-sharing schedule. The joint oversight group says the plan has changed to the point that the original goals no longer measure the program’s success, leading GAO to recommend holding the VA and DoD responsible for publishing accurate budgets, maintaining a deployment schedule, developing data standardization rules, and proving that they are indeed compliant with federal purchasing policies.


Other

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Cerner increases the estimated cost of its new 16,000-employee campus to $4.45 billion and wants Kansas City’s tax commission to chip in an additional $110 million in tax breaks, boosting the total taxpayer support to $1.745 billion.

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Quick — who’s the CEO of Microsoft? No, it’s Satya Nadella, and he plans to rejuvenate the company by moving from “devices and services” to “platforms and productivity,” emphasizing mobile-first and cloud-first.

Partners HealthCare seeks a $145 million loan to help it pay for a new building, raising its total debt to $4 billion. Part of that money was targeted for its $1.2 billion Epic implementation.

A Florida lawsuit questions whether release of information companies can charge lawyers more than patients for copies of their hospital medical records. An attorney became upset at being charged $1.00 per page by HealthPort for a client’s medical records when state law specifies $0.25 per page, but HealthPort says the lower rate only applies to patients even though it recently lost a case using that argument.

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A new bond issue for Providence Health & Services (WA) gets high, stable rating, with its ratings agency noting that, “PHS has nearly completed its system-wide implementation of the Epic electronic medical record (EMR) system. Implementation has spanned many years, and has occupied a significant portion of the system’s capital budget. Outsized operating expenses related to Epic have suppressed margins but are now expected to reach a steady state going forward.”

Weird News Andy likes the idea of “virtual gastric banding” described in this article, where hypnotists convince patients they’ve had weight loss surgery, sometimes even causing them to lose weight afterward from the power of suggestion alone. Of course WNA questions the $1,500 cost in  wondering, “Can the patient then hypnotize the hypnotist to induce memories of payment?” WNA also likes a rare case in which a man suffers a blood clot in his brain after head-banging at a Motorhead concert, leading WNA to suggest renaming the band “Subdural Hematoma.”

Bizarre: city police charge a 17-year-old boy with child pornography for sending explicit photos of himself to his 15-year-old girlfriend and then ask a judge’s permission to inject him with arousal drugs in a local hospital so they can snap new pictures to compare to those he allegedly sent. I immediately thought of the “sketch artist” principal’s office scene in “Porky’s,” not safe for work or for those with a non-warped sense of humor but possibly the funniest four minutes (shot straight through with no edits) in movie history.


Sponsor Updates

  • PatientSafe Solutions’ Cheryl Parker shares how informatics nurses contribute to products roadmaps through analysis, compliance, consultation, coordination, facilitation. and integration.
  • Lucca Consulting Group offers post-implement feedback and testimonials.
  • MedData will participate in the Annual MI Emergency Medicine Assembly July 27-30 in Mackinac Island, MI.
  • A report by Imprivata and the Ponemon Institute says pager inefficiency and the inability to use text messaging costs the average hospital approximately $1.75 million per year.

EPtalk by Dr. Jayne

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One of the things I enjoy least about my work in the CMIO trenches is keeping up with the ever-present stream of new rules, proposed rules, and all the supporting documents that go with them. It shouldn’t be a surprise that only a very small percentage of Eligible Providers have attested to Stage 2 Meaningful Use. As of May 1, only 50 Eligible Providers were on the books. Although the individual measures are not that difficult, keeping up with the voluminous documentation on all of them is a chore, as is preparing the documentation needed for attestation and potential audits.

CMS hasn’t disappointed in releasing its proposed rule to update the Medicare Physician Fee Schedule in 2014. I didn’t have time to read the 600-plus page rule myself, but luckily one of my vendors digests the information for its customers and sends out the highlight reel. As we always suspected, parts of MU are becoming mandatory independent of the actual MU program. Physicians billing for chronic care management would be required to use an EHR certified under 2014 criteria.

I was excited to see that Medicare is considering coverage for telemedicine services, including psychotherapy and wellness visits. I question, however, exactly how the digital prostate exam (and I don’t mean high-tech digital) or other sensitive exam maneuvers can be done via telemedicine, although I agree that a lot of the preventive counseling aspects of an annual visit don’t require a face-to-face visit if you already have a good relationship with your patient. Although those services aren’t specifically part of the Medicare “Annual Wellness Visit” paradigm, they are recommended services.

Are we setting ourselves up to have different kinds of wellness visits for patients, such as the Medicare Annual by phone, the Medicare Annual in person, the “G-Code Special” for those physical exams that have to be performed in person, and more? Patients can barely keep track of the services they need at present without having to worry how they’re delivered. And you can bet that if we try to bundle any of them into other in-person services, we won’t get paid. The Medicare Annual Wellness visit does recommend biometric assessment. I’m not sure I trust my patients to report what the scale actually says and we’re not yet in the Star Trek world of the medical tricorder. Although coverage for telemedicine sounds great in person, it just goes to show that the devil is in the details.

One of the other things I enjoy least about my work is dealing with difficult physicians. Although I’m not responsible for physician discipline per se, I do have to provide input when physicians are creating issues during implementation and training. I had mentioned a few weeks ago that we would start deploying new practices after Independence Day. This week has not disappointed for sheer magnitude of “stuff you just can’t make up.”

One of our surgeons decided to book two elective cases at the same time as his prearranged EHR training, then demanded that we train him later that evening. What do you even say to that? They weren’t emergencies. Although our trainers are happy to accommodate evening sessions when requested in advance, they can’t do it on short notice due to family and other obligations. I really think that he hopes to stall his go-live by staying untrained.

His power play failed, however, and he only ended up short-changing himself since his partner showed up and training was delivered. He’s just going to have to play catch-up because we have 22 go-lives teed up behind this cohort and there’s no room for game playing. His partner was an absolute joy to work with and decided to move his own go-live forward. I’m betting the practice dynamic is going to be pretty interesting in the coming weeks. Hopefully positive peer pressure will win the day.

One of the things I enjoy most about my work is the people I have gotten to know over the years. Although it seems like there’s a lot of movement around the industry, especially among the sales force, there’s still a sense that we’re all in this together and a willingness to help out whether you work directly together or not. I was able to meet up with a friend who used to work for one of my vendors and learn about his adventures in a different part of the industry. Another consultant I worked with early in my career turned up on a project I’m peripherally attached to. It’s definitely a small world and I’m glad to have people with whom I can commiserate. Maybe if I’m lucky though one will read the 600 pages of federal regulations and give me the Cliffs Notes version.

Will trade wine for summaries – email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 10, 2014 News 5 Comments

News 7/9/14

July 8, 2014 News 1 Comment

Top News

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Siemens AG is reportedly considering the sale of its healthcare IT unit (potentially worth over $1.4 billion) to focus on its industrial and energy businesses. The company considered selling its microbiology unit earlier this year, and is already spinning off its hearing-aids unit in an effort to give its healthcare businesses “operational independence.” A HIStalk reader familiar with these types of M&A scenarios notes that this rumbling is “sort of like rumors of McKesson selling off its IT division. They both keep losing customers, so who would want to jump on that mess? But, Siemens probably feels it’s best to sell now before it is worth less.”


Acquisitions, Funding, Business, and Stock

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CliniWorks announces a strategic alliance with Pfizer in which the companies will work to develop a population health management platform that will enable large medical groups and IDNs to improve patient engagement, and deliver more efficient and effective quality healthcare in nearly real time.

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Blackberry announces plans to open a healthcare services platform in India that will enable the integration of medical devices to aid in the early detection of illness. Blackberry India has several trial projects underway at local hospitals, all of which include integration with health information systems and medical equipment. A presence in India will likely serve Blackberry well, as providers there are expected to spend $1.08 billion on IT products and services in 2014. It seems likely the company will introduce those providers to the clinical operating platform from NantHealth, which it acquired a minority stake in earlier this year.

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Blackberry’s interest in niche markets may just help it stand out from larger players like Samsung, which expects to post second-quarter earnings that fall $1.4 billion short of analyst expectations. The company attributes its loss to low demand in a saturated global market, and cannibalization of tablet sales by “phablet” phones. No word yet on whether a heist in Brazil affected Samsung’s earning predictions. Thieves held hundreds of factory employees hostage while they stole $36 million worth of Samsung tablets, mobile phones, and laptops.

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N.C.-based Validic acquires Infometers Inc., a California-based technology company that connects remote healthcare monitoring devices to healthcare organizations. As a result, Validic has opened a Silicon Valley office and seems well on its way to achieving its goal of 300 clinical and wellness device and application integrations this year.

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Following a disappointing second quarter, Royal Philips announces it will implement a new management structure within its healthcare sector, with all healthcare business groups reporting directly to Philips CEO Frans van Houten. Philips Healthcare CEO Deborah DiSanzo has decided to leave the company.

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Capsule Tech announces it will open a Singapore subsidiary to support its growth in the region. Capsule Singapore will provide medical device integration implementation, technical and commercial support, pre-and post-sales assistance, and customer service.


Sales

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Southern Illinois Health System expands its use of Ascend Software, selecting the company’s SmartTouch HR Imaging technology to create a paperless environment in its HR department. The 20-facility health system already uses Ascend solutions in its accounting department.

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Holy Name Medical Center (NJ) selects Wolters Kluwer Health Language Workflow-Enhancing Search solutions. HNMC will use the solution to support encoding its problem lists in SNOMED-CT for Stage 2 Meaningful Use and the transition to ICD-10.

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Cumberland Medical Center (TN) implements DataMotion’s Direct Secure Messaging with its Meditech EHR, resulting in successful attestation for Stage 2 Meaningful Use. The 189-bed hospital is a member of the East Tennessee Health Information Network, for which DataMotion provides Direct addresses.


People

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T-System names Roger Davis (Accenture) president and CEO.

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IPC The Hospitalist Company appoints Jeffrey Winter (Correctional Medical Services/Corizon Health) senior vice president of sales and marketing.

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ESD names Richard Armstrong (Leidos Health) Cerner practice director.

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HealthTrust appoints Kent Petty (Wellmont Health System) as CIO.


Government and Politics

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FDA officials are likely starting to sift through the 158 submitted comments addressing the FDA Safety and Innovation Act draft report. Several health IT industry groups seem to have reached a consensus, citing the need for limited regulation of clinical decision support software, and a desire for the FDA to dig deeper when it comes to specifics. The EHR Association noted in its comments that “the limited number of examples of applications in each category provided in the report is not sufficient to determine the risk categories for the many existing and new applications being developed, and we urge their expansion as this proposal is finalized.” Concerns around the proposed Health IT Safety Center were also raised, though recent media coverage suggests that the ONC’s policy advisory committee has endorsed workgroup recommendations for the center.

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The Health Care Cost Institute announces that CMS has certified it as a “Qualified Entity,” making it the first organization to have full access to national Medicare claims data for reporting on the costs and quality of healthcare services. The Qualified Entity program, created as part of the ACA, permits certain organizations to combine Medicare Parts A, B, and D claims data with other payer data to evaluate the performance of healthcare providers, services, and suppliers. HCCI plans to pursue a research agenda using the combined dataset containing information on over 100 million individuals.


Research and Innovation

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A study finds no evidence to suggest that hospitals are systematically using EHRs to increase reimbursement. Hospitals that adopted EHRs increased billing to Medicare at a rate comparable to that of non-EHR adopters. Detractors of the study, which only looked at inpatient records, think the real billing problem is more likely to be found in EDs and outpatient clinics, which are increasingly run by hospitals.

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Results from a new international study highlight four myths about the future of healthcare IT, particularly as it pertains to helping global healthcare organizations transition to all-digital environments:

  • People don’t want to use digital services for healthcare – 75 percent of patient respondents expect to use digital services in the future.
  • Only young people want to use digital services – Digital-service use is expected to increase across all age groups.
  • Mobile health is the game changer – Awareness and process execution are in fact core drivers of digital-service adoption for patients.
  • A comprehensive platform of service offerings is a prerequisite for creating value – The services that Singaporean patients request most show it’s not always necessary to start big (good news, no doubt, for Capsule Tech).

Other

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Sensationalist headlines aside, The Bill & Melinda Gates Foundation is in fact backing development of wireless, implantable birth control that could be effective for up to 16 years. Massachussetts-based MicroCHIPS is working on the implant, which can be turned on and off via remote control. The device will begin pre-clinical testing in the U.S. next year, during which the company will no doubt work with the FDA to overcome hacking concerns.

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The New York Times profiles Kevin Tracey, MD president and CEO of the Feinstein Institute for Medical Research for the North Shore-LIJ Health System (NY). Tracey shares his view on great leadership in the operating room: “It’s about clearly stating the purpose and asking people how they’re doing and really listening if someone needs something different that day. If the operating team can accommodate the needs of that person without deviating from the plan, that person will be a better member of the team.”

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The New York Attorney General files suit against Beth Israel and St. Luke’s-Roosevelt hospitals, and Continuum Health Partners, accusing them of accepting over $1 million in Medicaid payments they were not entitled to, and had in fact received as a result of a known computer error in 2009 and 2010. (Continuum owned both hospitals prior to a recent merger with Mt. Sinai.) A Mt. Sinai representative has firmly stated it intends to argue the case “vigorously” in court.


Sponsor Updates

  • HealthTronics signs a distribution agreement with HS Medical to provide HS Amica microwave ablation apparatus to providers.
  • Arcadia Healthcare Solutions client Carlos Olivares, CEO of Yakima Valley Farm Workers Clinic, is named CEO Visionary of the Year.
  • A.D.A.M.’s SmartCare V1.2 receives MU certification with eClinicalWorks V10.0.
  • The Advisory Board Company profiles the new Medicare patient in a recent research brief, offering five ways they’re different and how to engage them.
  • LifeImage’s Hamid Tabatabaie discusses transparency and OpenTable for medical imaging in a recent blog post.
  • Hennepin County Medical Center (MN) details how it was able to save almost $11 million after working with Leidos Health on a revenue cycle optimization plan.
  • LDM Group provides an overview of what population health management’s purpose and goals within healthcare actually are (and what they are not).
  • GetWellNetwork is profiled for starting GetWell Labs to assistant fledgling health technology companies develop their software.
  • Divurgent shares how pharmacists and pharmaceutical companies assist in remaining relevant as an ACO and CIN in a new white paper.
  • AirWatch by VMware launches Partner University and updates its Academy Certification Program.
  • BCBS of North Carolina integrates with CoverMyMeds to streamline the prior authorization process.
  • Leeds Teaching Hospitals NHS Trust uses InterSystems HealthShare for its regional master patient index.
  • Hayes Management Consulting explains the details of decision support extracts.
  • Emdat explains the benefits of dictating documentation within the EHR in a fun, informative video.
  • CareTech Solutions achieves ONC HIT 2014 Edition Modular EHR Certification from ICSA Labs for its iDoc solution.
  • Western Medical Associates (WY) is live on its eClinicalWorks patient portal.
  • Wolters Kluwer Health partners with Logical Images to offer VisualDX to its Lexicomp clients.
  • Quintiles completes the acquisition of Encore Health Resources, which will now be known as Encore, a Quintiles Company.
  • DrFirst announces in a new briefing that there are now over 28,000 pharmacies nationwide that accept electronic prescriptions for controlled substances.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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July 8, 2014 News 1 Comment

Monday Morning Update 7/7/14

July 5, 2014 News 6 Comments

Top News

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Google co-founders Sergey Brin and Larry Page (net worth: $31 billion each) don’t seem too excited about moving Google into healthcare (again) despite recent developments with Google Fit. Brin, responding to a question about the company’s experimental glucose-reading contact lenses, says, “Generally, health is just so heavily regulated. It’s just a painful business to be in. It’s just not necessarily how I want to spend my time. Even though we do have some health projects, and we’ll be doing that to a certain extent. But I think the regulatory burden in the US is so high that think it would dissuade a lot of entrepreneurs.” He’s probably talking specifically about FDA-approved medical devices, but that’s not clear. Page repeats his claim that data mining would save lives, although in this iteration he puts the number at 10,000 saved lives in the first year rather than the 100,000 he gave several times previously. You know healthcare is a mess when the guys who can take pictures of every street in the US and make self-driving cars can’t figure out how to crack the bureaucracy and special interests. On the other hand, their own efforts with Google Health and Google Flu Trends were pathetic, so maybe that just gives credence to the argument that it’s easy to criticize healthcare when you don’t know much about it.


Reader Comments

From Fort Apache: “Re: Dim-Sum’s comments about DoD claims processing and Epic. Kaiser is implementing Epic’s Tapestry Claims Payment System (AP Claims) throughout the country for all of their business. Epic won’t need to find a third-party partner for the DoD bid.” Verified.

From SQSUX: “Re: Riverside, IL. I spoke to the lab director — they are moving to Epic and Beaker.” Unverified. I will note the apparent trend, however, that hospitals previously wary of Beaker’s readiness seem more inclined to replace incumbent their incumbent LISs, even best-of-breed ones, with Beaker given that it carries no additional license fee, it has a theoretical integration advantage (whether that’s real depends on who you ask), and gives the hospital a single vendor to contact for support. I doubt that implementing Beaker is ever the favorite option of the lab director, but he or she is often pressured by hospital administration to justify why Beaker isn’t “good enough” given the perceived advantages outside the lab. I’d be interested in hearing from a lab director who’s made the switch and what was gained and lost from the lab’s perspective since I know the issue is coming up a lot.

From The PACS Designer: “Re: Windows 9. ‘Threshold’ is the code name for the upcoming release of Windows 9 next year. Microsoft will be bringing back a new version of the their popular Start Menu that many currently miss in their present Windows version.” The hard drive of my main computer, an Asus desktop, failed last week. I found a suitable replacement desktop PC on clearance at Office Depot for around $400 that met my minimal specs (8GB memory, 1TB hard drive, USB 3.0). It had Windows 8.1 pre-loaded with a change that bypasses the Metro tile display as its default. My suggestion is to not obsess with the Windows 8.1 changes and don’t do something silly like wipe the drive and reinstall Windows 7 just to avoid learning something slightly new when most people only barely interact with the OS anyway. Everybody knows that every other version of Windows is crap and that’s been the case since the late 1990s, but at least this latest Windows 8 kludge upgrade fixes Microsoft’s colossal blunder in trying to force a tile-based mobile interface on the vast majority of computer users who don’t have (and don’t want) a touch screen for desktop use. My only hesitation was whether to buy a laptop or a desktop and I went with the latter – even though they are a dying breed, I like having lots of USB ports without needing a hub, easy dual-monitor support, and having all the wires under the desk instead of on top of it.


HIStalk Announcements and Requests

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More than half of respondents to my poll would recommend the Epic-IBM EHR package to the Department of Defense. The skeptic in me wonders if the large number of participants suggests vendor vote-urging. New poll to your right (or here): does your PCP offer a patient portal and have you used it in the past six months?

Listening: new post-grunge from South Africa-based Seether, which has been rocking a Nirvana-ish sound since 2002.

A few readers reported seeing pop-up ads (some with audio) when visiting HIStalk-related sites, to which I always suggested running an antivirus/spyware scan since it wasn’t happening for me. I tracked it down – the company that provided the hit counter that displayed at the lower right of the page (the “8 million visits since June 20, 2003” text) had slipped in some sneaky ad software in Javascript that could hijack the page, so I replaced it. The page loads faster and the hijacking problem is fixed, with the only downside being that the new stats package I installed can’t display the cumulative total on the page.

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Welcome to new HIStalk and HIStalk Practice Platinum Sponsor GE Healthcare. The company offers healthcare IT products in enterprise imaging (Centricity RIS, PACS, Clinical Archive, and Centricity 360 collaboration), care delivery management (Centricity EMR and PM, Perioperative Manager, Perioperative Anesthesia, Perinatal), population health management solutions, revenue cycle management, financial risk management, EDI and claims processing, contract modeling and management, activity-based costing, and utilization management. Thanks to GE Healthcare for supporting HIStalk and HIStalk Practice.

Here’s an overview video of GE Healthcare IT that I found on YouTube. I think it’s the same one mentioned in their sponsor ad.


Acquisitions, Funding, Business, and Stock

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Orion Health is considering going public with an IPO on the New Zealand Stock Exchange, with an unnamed source suggesting a value of around $440 million US.  


Sales

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CaroMont Health (NC) contracts with Mercy Technology Services to implement its Epic system. MTS is the IT services division of Mercy, the 33-hospital Catholic system that is accredited as the first Epic Connect provider. The health system provides implementation, hosting, application management, consulting, and analytics. MTS also provides its model of Epic that includes its own customizations, or as it says, “Unlike Epic’s out-of-the-box base model, Mercy’s system contains years of enhancements driven by the physicians and nurses who use it.”


People 

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Amy Abernethy, MD, PhD (Duke Medicine) is named CMO/SVP Oncology of oncology data technology vendor Flatiron Health, which recently raised $130 million from Google Ventures. She is also on athenahealth’s board of directors and will retain a part-time oncology role at Duke. Amy is a regular HIStalk reader and we’ve decided that an interview might be fun.  

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Urgent care EMR vendor DocuTAP hires Bryan Koch (Greenway Health) as EVP of revenue cycle management.


Government and Politics

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NIH awards a four-year, $43 million grant to form the NIH Undiagnosed Diseases Network, which will use genetic and clinical screening to focus on diseases that affect as few as 50 people in the entire world.

The VA signs a three-year, $162 million contract with  Accenture’s ASM Research to support VistA and develop web-based access to Vista’s CPRS patient record system.

A Washington Post analysis finds that 90 percent of the emails intercepted by the National Security Agency came from ordinary US citizens rather than suspected terrorists, some of them including medical records emailed between family members. The agency’s tools can sniff data from all voice and data networks and can extract email information from Yahoo, Microsoft, Facebook, and Google, all without requiring a probable cause warrant.


Technology

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An Inc. article says that Facebook’s declining usage makes it a target for startup competitors that won’t sell the personal data of their users. According to one startup CEO, Facebook has three big problems: “The first one is privacy–you want to be able to communicate without having your communication monitored and monetized. The second is monopoly. You don’t have open competition; you have somebody who controls who wins and who loses and how much they charge for the service. There is no way a social network should be a monopoly–everybody suffers, from the vendors to the consumers. And that’s the third problem: It really stifles innovation." The article predicts replacement apps that allow users to control (and sell, if they want) their own information, declaring, “If this is the information age, then information has value. And if it has value, how come everybody has it but us?”  The parallels to healthcare data are significant.


Other

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A New York Times article points out that insurance company UnitedHealth plays both sides of Medicare hospital payments as it pays hospitals less than they’d like via its Medicare Advantage plans but also charges hospitals via its Executive Health Resources subsidiary (acquired in 2010) to help them justify higher payments from Medicare.

Milwaukee Health Services (WI) receives a $190,000 city loan to upgrade its GE Healthcare EHR to earn Meaningful Use incentives. The community health center spent $3.1 million on its previous Pearl EHR from Atlanta-based Business Computer Applications, Inc., which it sued in a dispute over being locked out of its system over unpaid invoices. BCA, which did a lot of government work with CDC and NIH and sold EHR systems to prisons, was acquired in February 2014 by government contractor Acentia.

The Raleigh, NC newspaper covers local implementation of Epic at all three major systems:  UNC Healthcare, Duke University Health System, and WakeMed. It also mentions Epic-related billing problems at Cone Health and Wake Forest Baptist Medical Center, but WakeMed says its clean bill rates jumped from 80 percent to 96 percent after moving practices to Epic. Like most things in life, it’s not what you have but how you use it.

ICU telemedicine services are saving lives in war-torn Syria, where the both the government and rebel forces are accused of bombing hospitals that they claim are harboring opposing forces. The US-based Syrian American Medical Society (SAMS) started a telemedicine program last year to alleviate a shortage of doctors to care for ICU patients, most of them civilians injured by randomly dropped barrel bombs. Doctors from Canada, England, the US, and Saudi Arabia use Skype and webcams to oversee ICU patients and offer suggestions during surgeries. Syria previously had one of the Middle East’s best healthcare systems but has lost half of its doctors. Another 460 healthcare professionals have been killed in 156 hospital attacks, 90 percent of them carried out by government forces.

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The Federation of State Medical Boards issues a telemedicine-focused model state policy that would make it easier for doctors to obtain licenses in multiple states. Expedited licensure would be available for certified specialists with no history of disciplinary problems. The patient’s location at the time of the encounter would determine which state’s medical regulations would apply. FSMB subject matter Alexis Gilroy, JD mentioned this change when I interviewed her in May. This is a great and potentially quickly implemented alternative to national licensure, allowing doctors to practice in multiple states (telemedicine, referrals from other locations) without having to apply for licensure state by state.

Weird News Andy calls out the sad story of a veteran who died waiting for an ambulance while he was inside a VA hospital. The man collapsed in the cafeteria of the Albuquerque VA hospital, but hospital policy required him to be transported by ambulance to its ED, just 500 yards from where he went down. Employees called 911 and performed CPR in the cafeteria during the 15-20 minute wait for the ambulance. The hospital is reviewing its policy, but despite the negative press, it’s pretty much standard in every hospital I’ve worked in. You can’t have ED people leaving the building (and their patients) to sprint down the sidewalk with a gurney. The article didn’t say whether those performing CPR were clinicians with code cart support, and if so, the outcome was probably predetermined regardless of location.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 5, 2014 News 6 Comments

Morning Headlines 7/2/14

July 2, 2014 News No Comments

 Billionaire With Achy Knees Cashing In on Health Data

Bloomberg profiles InterSystems and its owner Terry Ragon, whose net worth has soared to $3.1 billion since starting the company.

NextGen Healthcare and Mirth Launch Enterprise Interoperability Platform

Quality Systems Inc., parent company to both NextGen and Mirth, announces a new interoperability offering that allows NextGen customers to leverage Mirth’s interoperability platform to meet Stage 2 MU data exchange requirements.

Tale of two health care websites: Minnesota presses on; Maryland moves on

Minnesota health leaders say they will stand by its problematic health insurance exchange website despite calls for its replacement and reports that only 26 of 73 site functions are working. Deloitte has been contracted to repair the troubled site.

Medical Cost Trend: Behind the Numbers 2015

PwC forecasts a 0.3 percent increase in healthcare spending for 2015, citing EHR investments and the overall economic recovery as drivers. The report goes on to say that value-based reimbursement models and integrated care delivery networks appear to be helping contain the cost inflation.

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July 2, 2014 News No Comments

News 7/2/14

July 1, 2014 News 10 Comments

Top News

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Bloomberg profiles InterSystems founder and owner Terry Ragon, net worth $3.1 billion, and the connections he has with other early healthcare IT companies such as eScription and IDX.


Reader Comments

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From Illinois Blago: “Re: Riverside in IL. Moving from McKesson to Epic.” Unverified.

From GhostofEclipsys: “Re: Allscripts. In an effort to reduce costs as sales continue to wane, the company is considering outsourcing its client education and training group this fall. This has not worked well for other HIT companies and is an often quoted reason for not selecting a vendor during RFP. Clients want training by experts from inside the four walls who have critical relationships with engineering, not the B-team outsourcer. The Allscripts education team has won several awards for client education nationally.” Unverified.

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From Block and Tackle: “Re: Self Regional Healthcare. Has had three days of Allscripts Enterprise downtime due to a known issue involving a patch. I’m curious if readers have had similar experiences with Allscripts Enterprise.” Unverified.

From Nasty Parts: “Phytel laid off a large number of people today. Rumor has it that the primary VC wants their $40M investment back and that Premier backed out of a deal to buy Phytel. I hear Phytel wants $225M and Premier wants to only pay $165M. So, today’s layoffs are to help the company get to a more profitable number that can justify the larger purchase price.” Unverified.

From Furydelabongo: “Re: athenahealth. The Belfast, ME office is bringing in a local primary care practice, Searsport Family Medicine,  to serve as the clinic practice for their employees as well as be a test site for new functionality.” Unverified.


DoD EHR Update from Dim-Sum

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DHMSM status and latest rumors in the halls of bedlam, located “just to the right” of K Street. Sorry about he delay, I have been rather busy.

  • June marked the date where the DHMSM vendors will finally peruse a more comprehensive assessment of what each and every vendor will have to endeavor.
  • Great job Captain W and your respective team – The REAL RFP will be dropped September 2014.
  • One can only hope that your DHMSM team’s work will allay the fears and will fuel the excitement of those that are crazy brave and yet confident to move forward with this unique EHR experience
  • Rumors are ringing about the Womack ousting. In all sincerity, I believe that all three impact solution teams could improve safety across the DoD HIT environment, be it Cerner, Siemens/athena, or Epic (have yet to decide if Allscripts can compete with their sub-mundane acute solution). Good news, DoD, all of these solutions will improve workflows, enable true integration and interoperability, and will be focused on clinician adoption. In the immortal words of the DoD, “There is no such thing as too much training?” COTS love to train the trainer (for a nominal fee) and perhaps that mentality will be a bright spot in a bleak environment.
  • Six site visits by DoD to Epic sites, one gratis for McKesson, Meditech, and Cerner. I guess Siemens/athena and Allscripts missed the boat?
  • Can anyone explain how with two media submissions (one article, one announcement) the DHMSM solution price went from $5.5B to $11B? Perhaps it is the Watson effect?
  • In that same way of thinking, I believe that the first decade in a half of amateur DoD HIT design cost tax payers a trillion dollars give or take a half a billion!
  • Claims rumors abound. Wondering how much of the claims processing debacle including collections will be handled by one of the big three. This is an essential component, and since ABACUS is having FISMA issues, I figured that maybe Mr. Miller will see value in pushing claims in the DHMSM deal – more than revenue cycle, so sorry, Epic, you will have to actually find a third-party system (feel the fear!)
  • Industry Day – interesting, not as interesting as the RFP team read. Telehealth, asset tracking, real enterprise scheduling, military styled healthcare logistics (COTS, this is more of a challenge than most realize – hope there are some real discussions to understand what it means to be a functional ERP+ system).
  • Cerner, you are not ranked in the top five to install your own system. Good thing you have Accenture to pick up the slack – Leidos “as is” is your key to victory – Theme “transition, transition, transition”
  • Siemens, be happy athena is a very competitive ambulatory care solution. Teamed with your SOA your co-hosting maturity in acute and ambulatory settings make a lot of sense. I believe it might be appropriate for Tibco to lend a hand in the technology story that is truly a differentiation for the Lockheed team.
  • BTW, Lockheed, I could have sworn you had more than a part-time employee working your public relations program – is it difficult to state your intentions? CSC passed you as though you were riding a moped on the autobahn.
  • Allscripts, CSC, and HP — what a combination. You only need a population health solution and have to press the fact that Eclipsys is not archaic – good luck with that. Great announcement, short, succinct, and made people scratch their head.
  • McKesson is rumored to be in deep negotiations with themselves – so far no progress.
  • Cerner is the closest COTS to try to emulate what Epic has done, stating proudly that they are a monolithic solution, built on a myriad of frameworks they are competitive and can hold their own (however, I do not like the ambulatory solution, but the RFP will not have a weighted value assessment on features and functions, merely a check box that allows a team to state “YES we CAN"). Cerner should also utilize the Oracle story as they did in Utah for a win.
  • Accenture “good on you” for the Henry Schein relationship. If my teeth were falling out of my mouth, the first and most exciting dental EHR solution I would want managing my episode of care would be Dentrix!
  • GE Healthcare is missing in action. Perhaps an upcoming announcement will be made about their acquisition by SAIC? OK, maybe that is pure rumor :-)
  • VistA – we all know your solution is awesome, everyone loves it, adoption in a monopoly environment is 110 percent. However, do you really think after the debacle that is VA, informatics should try to be proliferated across the DoD? Methinks NO.
  • NOTE: After several “as is” and “to be” meetings, the EHR vendors real fears have more to do with two things: (a) Legacy solutions that were so poorly designed and the manner in which they were integrated requires duct tape and glue – can any vendor that programmed the old solutions actually stand behind their solution?  Did anyone within 50 miles of the beltway ever read anything about HIT standards? (b)How does a real EHR maintain parallel operations with a variety of poorly designed systems? These two thoughts are constantly on the minds of the EHR vendors – it haunts their dreams!
  • There is a sobering thought I had with a colleague over a cigar — that Leidos (SAIC in general) and Grumman should not be allowed to bid as a member of any team, but instead be enlisted as enablers to access the “stuff” they created. Perhaps they should be relegated to provide 100 percent support for all transitions, migrations, parallel synchronization, and conversions for the new EHR solution team. This time using real standards, ones that people can understand, would be refreshing. In essence they should act as Switzerland so they can actually do something that emits value over the next 5-7 years associated with rollout. Think of it as penance.

Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


Sales

Arkansas Methodist Medical Center (AR) chooses T-System’s ED documentation and coding solutions.

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Children’s of Alabama extends its contract for Allscripts Sunrise and adds dbMotion, Sunrise Ambulatory Care, and Sunrise Emergency Care.


People

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Voalte promotes Trey Lauderdale to CEO and appoints a new board of directors: Tom Johnson (Global Imaging Systems), Nico Arcino (Kaiser Permanente), William Gish (Cerner Corporation), Isobel Harris (PeopleFluent), Jeffrey Lozon (Revera), Michael Marvin (MapInfo). 

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SRS names Scott Ciccarelli (GE Healthcare) as CEO. He replaces Evan Steele, who will become senior advisor.

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AirStrip promotes Matt Patterson, MD to president and hires Nancy Pratt, RN, MSN (St. Joseph Health) as COO.

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Robin Raiford, RN-BC (The Advisory Board Company) died on June 26 at 62. The visitation and service will be held Wednesday, July 2 in Springfield, VA. Details and guest book are here.


Announcements and Implementations

PatientKeeper adds a rules engine to its charge capture solution that allows billers and coders to manage code edits.

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QSI subsidiaries NextGen and Mirth announce NextGen Share, a Health Information Service Provider (HISP) that will connect NextGen and non-NextGen EHR users via Direct.

Albany Area Primary Health Care (GA) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.


Innovation and Research

Researchers develop the capability to create blood vessels using a 3D printer and then growing cells around them, leading to the possibility of “printing” a full organ.


Other

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An Ars Technica article written by an early Google Glass Explorer  says Android Wear smart watches make Google Glass obsolete. Reasons: (a) Google is developing more technology for Android Wear than for Glass; (b) Glass will always look weird and raise suspicions that the wearer is secretly recording them; (c) Google disabled live video streaming on Glass because it didn’t work well; (d) Glass doesn’t fold, so it takes up a lot of room wherever you place it other than on your face; (e) it’s easier to look at a watch than upward to Glass; (f) Android Wear watches cost $200 vs. Glass at $1,500 and do more; (g) Android Wear is being run by Google’s powerful Android team while Glass is a skunkworks project that hasn’t even exited beta; (h) Android Wear is faster and less buggy; and (i) Google has no plans to add augmented reality or facial recognition to Glass to make it something more than just a computer built into a pair of glasses.

Weird News Andy wonders “retail or wholesale” when an ED patient is charged with walking out with $300 worth of medical supplies that included bed sheets, 47 latex gloves, a bloody syringe, oxygen tubing, washcloths, alcohol wipes, lubricant, and pulse oximeters. WNA concludes, “The list price on a pulse oximeter on Amazon is $199. A single aspirin might be a hospital charge of $25. Seems like the perp might have gotten off cheap.”


Sponsor Updates

  • Aventura releases the latest in its “This is Aventura” video series, seasonally appropriate in being set to the “1812 Overture.”
  • EDCO Health Information Solutions publishes an article, “Solve Patient Indexing Errors Once and for All.”
  • Liaison Healthcare will offer its EMR-Link laboratory and radiology integration solution to members of GNYHA Services.
  • Beacon Partners offers an article, “Four Key Components for Building a Sustainable mHealth Strategy” and publishes a blog post “Are You Ready for Change? Four Questions to Ask Before Launching a Healthcare IT Project.”
  • Truven Health Analytics reports that 300 hospitals have integrated Micromedex patient education and clinical decision support with their EMRs so far in 2014.
  • QPID CEO Mike Doyle will participate in the “Big Data and Decision Making” panel at the Connected Health Symposium 2014 October 23-24 in Boston.
  • ADP AdvancedMD introduces integrated fax with a short video clip.
  • ICSA Labs certified products from First Databank, Iatric Systems, Juniper Networks, Orion Health, Quest Diagnostics and The Advisory Board Company in June.
  • Health Catalyst explains the anatomy of healthcare delivery model in a recently published white paper.
  • Maury Regional Medical Center (TN) selects Nuance services for its medical transcription needs.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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July 1, 2014 News 10 Comments

Monday Morning Update 6/30/14

June 28, 2014 News 22 Comments

Top News

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White House Deputy Chief of Staff Rob Nabors delivered his review of the VA to President Obama Friday. The report’s high points:

  • The VA is the country’s largest health system with 1,700 sites and $150 billion per year in funding.
  • The 14-day patient scheduling standard was unrealistic and encouraged inappropriate behavior.
  • The Veterans Health Administration needs to be restructured because it has little accountability, isn’t responsive, and can’t communicate effectively.
  • One-fourth of all federal government whistleblower complaints involve the VA.
  • Individual VA facilities often ignore VHA’s directives and sometimes express their disagreement via the press.
  • Employees know that the federal government rarely fires anyone, so they don’t try to solve problems.
  • The VA’s VistA system is “cumbersome and outdated,” but is state of the art when it comes to capturing patient documentation to form an integrated health record. The real problem with scheduling patients is a lack of clinicians, support personnel, and space, not deficiencies in IT systems.
  • The VA hasn’t planned well and hasn’t tied its budget requests to specific outcomes.

Reader Comments

From Mcklayoffs: “Re: McKesson layoffs. There were huge ones in April. I heard it happen again on Thursday. I heard even some of the Paragon folks were let go from services. You have to wonder if that’s their go-forward solution.” Unverified.

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From Lt. Dan: “Re: cyberwarfare visualization. This real-time map of hacker attacks shows that the US is getting bombarded by pretty much everyone.” The extremely cool display from cybersecurity firm Norse, which looks like one of those 1960s US-Soviet World War III doomsday scenario illustrations, shows who’s being attacked and from where. Some of the information is surprising: at this moment, attacks are being launched from the domain of drug maker Merck in New Jersey as well as the University of Michigan and Cal Berkeley, quite a few attacks are originating from military domains, and the US is by far the most popular intended target with 10 times as many attacks as #2 Hong Kong.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Ivenix. The Amesbury, MA-based company offers the Ivenix Infusion Management System, a smart IV pump that combines information technology with new smart pump design to reduce errors and improve patient safety. It measures and adjusts IV flow rate in real time and manages patient-specific infusion information via a secure, wireless, Web-based architecture that lets clinicians make decisions by viewing remote dashboards that display infusion information, alerts, alarms, and cross-pump drug alerts. Its analytics capability supports organization-wide quality and cost projects. IV orders are sent to the pump with nurse verification via open, pluggable EMR integration and drug library and software updates are delivered transparently. Thanks to Ivenix for supporting HIStalk.

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Six percent of poll respondents said they participated in a video-based visit as a patient in the past year. New poll to your right: which EHR package should the DoD choose – Allscripts, Epic, or Cerner? Click the Comments link on the poll widget after voting to defend your decision –  you never know, maybe the DoD is looking for your insight.

Listening: Austin-based Ume, who I saw live awhile back. Singer/guitarist Lauren Larson shreds it on stage with monstrous distorted guitar licks, passionate vocals, and a head-pounding mane of blonde hair, but I met her after the show and she’s a tiny, sweet Texas cheerleader type who decided to take a break from working on her PhD to focus on music along with her bass-wielding husband Eric. Ume is on tour with Circa Survive, which will play in Riot Fest in Chicago in September with some of my favorite bands: Jane’s Addiction, The Cure, Weezer, Metric, Failure, Superchunk, Dandy Warhols, and Mastodon.


Webinars

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.


People

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ONC’s Director of the Office of Consumer eHealth Lygeia Ricciardi announces on Twitter that she has resigned effective July 25.


Announcements and Implementations

ZirMed announces enhancements to its Analytics solution that include a customizable dashboard and drill-down interactive KPIs for key business metrics.

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Cerner, not surprisingly, joins Epic and Allscripts in throwing its hat into the DoD’s EHR replacement ring. Cerner will bid along with partners Accenture and Leidos. Someone asked me on Twitter how I saw it playing out and I gave the odds at 80 percent Epic, 20 percent Cerner, and zero percent Allscripts. Epic has a big advantage in covering a huge chunk of the US population, having the only comparably sized implementation in Kaiser Permanente, winning just about every large-system bid, having implemented its system with the Coast Guard, having IBM as a partner, and having powerful members of Congress like Paul Ryan who have previously demonstrated willingness to use their clout to push Epic. Cerner’s advantages are the comfort level of being a large, publicly traded company with increasing healthcare reach outside of IT, strong government-savvy partners in Accenture and Leidos, good hosting experience, and a potential willingness to beat Epic on price in what will be the biggest deal in healthcare IT history. I don’t see Allscripts having a chance since large hospitals aren’t buying Sunrise, its biggest client North Shore-LIJ is keeping whatever enthusiasm it has quiet, its offerings are narrow compared to Epic and Cerner, and memories of its corporate stumbling  haven’t faded yet, but it does have the strongest set of partners in CSC and HP, the latter being important since the much-touted $11 billion bid value is a 10-year cost including maintenance and infrastructure where HP shines.


Technology

3M announces ePrivacy Filter, $50 software that uses webcam-powered facial recognition to limit screen viewing to the authorized user, warn them if someone is looking over their shoulder, and blur their screen when they step away.


Other

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Implementation of the C-CDA (Consolidated Clinical Document Architecture) semantic interoperability standard needs work, according to a JAMIA-published study by a group that found many errors in documents submitted from 21 systems. Meaningful Use Stage 2 requires using C-CDA, but the samples provided to the authors often included missing or incorrect information. The authors made four recommendations: (a) create a site with public C-CDA samples and scenarios since vendors say they don’t always know how to represent their data; (b) require EHR certification testing to include validating terminology such as SNOMED and RxNorm; (c) add a certification requirement that EHR vendors provide all of the data elements they capture instead of making many of them optional; and (d) electronically monitor the quality of real-world C-CDA documents being produced and report results. The authors conclude that further effort will determine whether C-CDA documents “can mature into efficient workhorses of interoperability.”

A study finds that patients discharged from hospitals that use an advanced EHR cost $731 less than those from non-EHR using hospitals. The methodology isn’t convincing: (a) the data is from 2009 and simply matched up a discharge database to what the article says is the HIMSS annual survey (which really means the HIMSS Analytics database);  (b) the “cost” figures were the nearly worthless cost-to-charge ratios that everybody uses because hospitals don’t track individual unit costs well; (c) the analysis seems to have looked only at overall cost rather than for comparable diagnoses or treatments, but I’m not clear on that from the methodology provided; (d) correlation isn’t causation, so any jumping to conclusions that plugging in an advanced EHR will reduce hospital costs is ridiculous.

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Here’s how disintermediated San Francisco cab drivers are competing with ride-sharing service Uber (valued at $18 billion): they’re using an app that lets people pay them for the public parking spots they intentionally occupy for that purpose. The city has ordered the app’s Italy-based developers to cease operations, saying its excuse of selling convenience rather than parking spots is “like a prostitute saying she’s not selling sex — she’s only selling information about her willingness to have sex with you.” The developer of a competing app is paying people $13 per hour to tie up high-demand evening spots in the Mission District and then resell them, give the company working inventory to promote its app.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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June 28, 2014 News 22 Comments

Morning Headlines 6/27/14

June 26, 2014 News No Comments

Philips and Salesforce.com announce a strategic alliance to deliver cloud-based healthcare information technology

Philips will partner with Salesforce to create a CRM-like population health platform they are calling a ‘patient relationship management’ system.

CareCloud Raises $25.5 Million in Venture Debt from Hercules Technology Growth Capital

CareCloud raises $25 million in a debt-backed financing from Hercules Technologies Growth Capital. The cloud-based EHR vendor will use the funding to further develop its system and grow its market presence.

Boston gets second tech IPO of the year via Imprivata

Imprivata raises $66 million in its IPO Wednesday, with shares closing eight percent higher than their $15 initial price.

CCHIT Announces Launch of New Guide Services

CCHIT announces that it will begin offering consulting services to guide EHR developers through the ONC certification process.

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June 26, 2014 News No Comments

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Reader Comments

  • Lindy: @Chester of Malvern. Just save your energy and buy into the "flawless" world of Epic. Though you might want to stop b...
  • Not Tired of Suzy, RN: @Karen_DeSalvo I am not aware of any evidence that EHRs have improved outcomes or reduced costs. And that does not inclu...
  • AC: "I challenge readers thusly: what core set of published standards or capabilities must a given EHR support to be conside...
  • HIS Junkie: Re: Openness... What about this question - Who or what organization should demand that all vendor systems be open (defi...
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