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Morning Headlines 8/22/14

August 21, 2014 News No Comments

FBI warns healthcare firms they are targeted by hackers

The FBI issues an alert to the healthcare industry that hackers are targeting them following their breach of Community Health Systems.

Oracle Calls State’s Health Exchange Planning Akin To Building ‘A Skyscraper With No Architect’

Oracle blames Oregon officials for not hiring a systems integrator for developing its health insurance exchange.

AliveCor Receives First FDA Clearance to Detect a Serious Heart Condition in an ECG on a Mobile Device

The free app, which requires a $199 sensor, monitors ECG activity to detect atrial fibrillation.

HealthQuest Capital raises $110M for healthcare investments

The investment group plans to invest in medical devices, diagnostics, and healthcare IT.

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News 8/22/14

August 21, 2014 News 5 Comments

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The China-based hackers who stole the information of 4.5 million patients of Community Health Systems used the Heartbleed exploit for access, the first major cyberattack to do so since Heartbleed received major world attention in April 2014.  Community Health Systems provides employee VPN access using networking equipment from Juniper Networks, which along with other networking vendors was slow to update its products in response to Heartbleed. The hackers were able to log in as employees in the weeks after Heartbleed was announced and before vendors updated their software. There’s a lesson to be learned: watch for unusual behavior from user accounts and certainly for huge data files being sent outbound. Meanwhile, the FBI issues a flash alert to healthcare firms, warning that that they’re being targeted by hackers.


Reader Comments

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From Former SMSer: “Re: former Shared Medical Systems employees. A members-only Facebook group was started on August 15 and has 1,200 members. It is special to have so many warm personal connections 14 years after the Siemens acquisition.”

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From Eek How? “Re: Ekahau. Let its president go and the VP of marketing walked out. The company has gone from 119 employees to fewer than 45 in the past year. WiFi-based RTLS still disappoints hospitals.” Unverified, but former CEO Mark Norris has updated his LinkedIn profile to indicate his immediate availability.


HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi digs deep into data on the EHR replacement market. Industry representatives weigh in on Walmart’s foray into primary care. Newt Gingrich makes the case for integrating mobile health tools into care for veterans. Greenway Health and Apple are granted patents, though for decidedly different innovations. A physician in Alaska gets creative when attempting to opt out of Meaningful Use. Azalea Health CEO Baha Zeiden dishes on the simplifyMD acquisition and the role of telemedicine in rural communities like his. Thanks for reading.

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I talked today with the brilliant and articulate Dim-Sum,  who knows everything about the Department of Defense and its impending choice of EHR vendors for its $11 billion EHR project. He graciously agreed (probably while grimacing at the arm-twisting Lorre and I were applying) to host one or more webinars on the topic. Mark your calendar for September 18 at mid-day for the first one, in which Dim-Sum will describe the DoD’s healthcare reach, current systems, relationships with contractors and other government agencies, and selection process. The webinars will be fun, slightly cynical, and highly educational to those of us who don’t really understand military health, as well as crucial to those with a vested interest in what will be one of the largest and most expensive government IT projects in the world.

Also in September: the virtual launch of Ed Marx’s upcoming book, “Extraordinary Tales of a Rather Ordinary Life.”

I’m always interested in hearing from providers who would like to be interviewed, write guest articles, or otherwise participate in HIStalk. Let me know if you are willing. I get plenty of volunteerism from vendor people, but not much from those working on the provider side. 


Upcoming Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  


Acquisitions, Funding, Business, and Stock

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HealthPrize Technologies, which offers a medication adherence app, raises $3 million in its first institutional financing. Co-founder Tom Kottler’s first startup was MedAptus.  

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HealthQuest Capital raises a $110 million fund to invest in medical devices, diagnostics, and healthcare IT.

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Aging services technology vendor Healthsense, which offers a remote monitoring system for chronic diseases, adds a $10 million funding round.

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Vocera shares touched a 52-week low this week, closing Thursday at $8.48 and valuing the company at $216 million. Above is the one-year price of VCRA shares (blue) and the Dow (blue).


Sales

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Saint Agnes Hospital (MD) chooses clinical alerting and secure texting solutions from Spok, also upgrading its hospital call center suite.

Baylor Scott & White Health chooses the Allscripts dbMotion HIE platform.

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Baystate Health (MA) selects Premier’s PremierConnect Enterprise to support development of solutions within its Health Informatics & Technology Innovation Center, a co-working space and late-stage accelerator.

The Froedtert & Medical College of Wisconsin network chooses the analytics platform of Explorys.

Atlanta Gastroenterology Associates chooses Greenway PrimeSUITE EHR/PM.


People

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Surescripts names Tom Skelton (Foundation Radiology Group) CEO.


Announcements and Implementations

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PerfectServe opens an Atlanta office.

Forbes names Cerner to its list of the world’s most innovative large, publicly traded companies. Salesforce.com came in #1, and other familiar companies joining Cerner in the top 30 are Amazon, VMware, Red Hat, Stericycle, and Express Scripts. The ranking is derived from the somewhat questionable metric “Innovation Premium,” representing the degree that share price exceeds current business value.

SAS and 39-hospital Dignity Health (CA) will create a big data platform to reduce readmissions, create best practices for CHF and sepsis, and manage drug costs.

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Greenway Health receives a patent for the function of automatically aligning billing codes with payer- and location-specific fee schedules.

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AliveCor receives FDA clearance for its atrial fibrillation detection app that monitors ECG in real time and allows the user to email, print, and analyze their single-channel ECG records. The app is free, but the monitoring hardware costs $199.

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UltraLinq’s cloud-based image management solutions will be available through athenahealth’s No More Disruption Please program.


Government and Politics

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Oracle, in its lawsuit against the state of Oregon for not paying the company for its work on the state’s failed healthcare insurance exchange, says the state should have hired a systems integrator instead of trying to run the project itself. CMS made the mistake in trying to run the Healthcare.gov project without outside help.

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CMS Administrator Marilyn Tavenner didn’t just accidentally delete Healthcare.gov-related internal emails as she claimed, although this request pertains to a largely dull conversation about training telephone reps handling manual insurance sign-ups after Healthcare.gov failed. 

The FDA releases an API to allow programmers to access its MAUDE medical device problem database.


Other

Cerner CEO Neal Patterson not only dumps ice water over his head, he issues an Ice Bucket Challenge of his own to John Glaser, CEO of the Siemens health IT business that Cerner is acquiring. Glaser accepted the challenge.

As simultaneously cute and annoying as the virally spread ice bucket challenge videos are, this one is worth watching if you really want to understand the non-entertaining aspects of the disease as one of its sufferers takes the challenge and then explains how ALS affects him.

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Jamie Stockton of Wells Fargo Securities provides updated slicing and dicing of CMS hospital attestation data through June 30. The significant Stage 1 vendors are (in order) Meditech, Epic, Cerner, CPSI, McKesson, and Medhost. Of the 10 hospitals that have attested for Stage 2, Cerner has four, Meditech and CPSI have two each, and Medhost and Allscripts have one each. Top vendors of the EHRs used by the 977 physicians who have attested for Stage 2 are, in order, athenahealth, Epic, and Practice Fusion, who have 97 percent of the Stage 2 attestations among them.

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Economist Uwe Reinhardt writes a brilliant and remarkably compact criticism of the bizarre payment system of US healthcare. A tiny sample:

For starters, we allow our providers of health care – doctors, hospitals, pharmaceutical companies and other providers—to use classic price discrimination in the markets for their products and services. That tactic helps sellers to extract from buyers with different abilities or willingness to pay as much total revenue as can possibly be extracted from the buyers collectively … Altogether, the highly complicated cash flow resulting from this strange system of financing, flowing through so a myriad of capillaries, makes it almost impossible to hold any providers formally accountable for all of the moneys they receive. Somehow this rickety Rube Goldberg contraption of financing health care has worked in some fashion in this country, for over half a century. Many hospitals have thrived financially under it, while hospitals located in mainly low-income areas have struggled or gone under. And as a series of journalists—most recently Steve Brill in “The Bitter Pill”—have reported, this system also has put brutal financial stress on the budgets of many American households.

Aaron Carroll, MD, MS, a medical school professor and contributor to “The Incidental Economist,” explains why doctors have plenty of data problems without having to deal with patients sending them their fitness tracker information.

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The Columbus business paper profiles CoverMyMeds, which is doubling in size every year while remaining profitable as a bootstrapped company.


Apple CEO Tim Cook visited the VA hospital in Palo Alto, CA, tweeting a photo from the facility that is using iPads.

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Massachusetts eHealth Collaborative President and CEO Micky Tripathi examines the EHR replacement market in an HIStalk Practice post:

  • The number of EHRs used to attest has dropped considerably from MU Stage 1 to Stage 2.
  • Customers are switching from smaller vendors to the benefit of Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
  • Athenahealth and eClinicalWorks are losing customers to Epic.
  • Allscripts lost more customers than anyone, most likely because of its retirement of MyWay, which boosted Aprima’s customer base.
  • Epic, Greenway, and athenahealth are the EHR vendors most acceptable both to larger practices as well as hospitals given their maturity,support, and product stability.

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Burke Mamlin, MD of Regenstrief Institute pens a letter in response to the Indianapolis newspaper’s article on medical scribes, recommending caution since physicians don’t always review scribe EHR entries until after the fact, they don’t see clinical decision support recommendations, and they become dependent on the scribe. The letter describes Regenstrief’s vision:

Rather than using a scribe to reduce the computer’s role in the exam room, we envision the medical scribe’s role to increase the computer’s role. By using the scribe as a “Wizard of Oz” replacement for the keyboard and mouse, the computer can become an intelligent, anticipatory and active participant in the conversation between patient and physician. Physicians can become super-users as they learn from watching the scribe, there is less chance for errors when the physician is actively monitoring input, and benefits of real-time decision support will not be lost.

Weird News Andy finds this article interesting in that not only have an estimated 90 percent of hospitals and clinics lost patient data, the black market pays $50 per stolen medical record vs. just $1 for credit card information.


Sponsor Updates

  • Craneware will hold its first Revenue Integrity Summit October 14-16 in Las Vegas.
  • HCS participates in LeadingAge Center for Aging Services Technologies (CAST) EHR 2014 Selection Portfolio.
  • Ingenious Med employees complete their third annual 100-day team-centric Thrive Challenge.
  • Andrew Borland, Wellcentive’s director of architecture and research, is interviewed on Atlanta Business Radio.
  • The SSI Group adds contract management to its RCM offerings.
  • Aspen Advisors, Clinovations, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Encore Health Resources, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, Intelligent InSites, Nordic, Santa Rosa Consulting, and The Advisory Board Company are named on Modern Healthcare’s 2014 Best Places to Work in Healthcare list.
  • Besler Consulting, Clinovations, CompuGroup Technologies, Cornerstone Advisors, CoverMyMeds, CSI, Cumberland Consulting Group, Divurgent, eClinicalWorks, ESD, Etransmedia Technology, Forward Health Group, GetWellNetwork, Health Catalyst, Health Care Software, Healthcare Data Solutions, Impact Advisors, Imprivata, Informatica, Ingenious Med, Patientco, pMD, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, HCI Group, and Wellcentive are named on the Inc. 5000 Fast Growing-Growing Companies 2014 list.

EPtalk by Dr. Jayne

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One of my CMIO duties is to periodically review the patient care protocols in our EHR and recommend updates and additions. Evidence-based guidelines have been a part of our organization for almost two decades, but they’re constantly evolving. I like to do a comprehensive review every year, but there are always guidelines that change on the fly.

Occasionally, it seems like every day brings a new recommendation for screening or treatment. Some of the updates are relatively straightforward, but others can be quite controversial.

This year my review process took a twist. Our organization wants to start building financial information into our care protocols, including the cost and accessibility of various services according to the patient’s insurance coverage. Most payers are fairly transparent about what they do or don’t cover. Sometimes, however, the nuances between different plans offered by a given payer tends to make me a little crazy.

In addition, our state legislature has mandated coverage for certain services, but most of the laws were written to apply when patients enroll in a plan after the law goes into effect. For patients who are on older or existing plans, they may not be covered for the services until they change jobs or their employer changes plans or payers. We have some large regional employers who self-insure and somehow they seem to skirt some of the payment requirements as well.

Medicare has always been the steady player as far as knowing what will be covered and how. The payment guidelines are transparent and usually follow along with other federal guidelines. This year we have a bit of a wrinkle since the Medicare Evidence Development and Coverage Advisory Committee has decided not to cover CT screening for lung cancer, which is a “B” grade recommendation by the US Preventive Services Task Force. I read the commentary from their meeting and they cite the American Academy of Family Physicians, which feels the evidence is insufficient to recommend for or against the test.

This is where it gets really fun. In accordance with the Patient Protection and Affordable Care Act, marketplace insurance plans and many private plans are required to cover the screening with no out-of-pocket costs to the member. However, the law does not specifically state that Medicare is required to pay the full cost to Medicare beneficiaries. Instead of being able to do some relatively clean development around the USTSPF “A and B Recommendations” list,  we have to continue with the patchwork approach.

Quite a few guidelines have been revised for 2014 and more are under revision, so this project is definitely the gift that keeps on giving. I’ll be taking my recommendations to our clinical quality committee in the next week or so and then the development team can get to work. I’ll also be giving a report of my findings to our managed care negotiation team so we can try to leverage better coverage for the services we find most clinically appropriate.

Got guidelines? 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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August 21, 2014 News 5 Comments

Morning Headlines 8/21/14

August 20, 2014 News No Comments

US hospital hack ‘exploited Heartbleed flaw’

A cybersecurity firm claims that the theft of information on 4.5 million patients of Community Health Systems was performed using the Heartbleed exploit. The firm says CHS used network equipment from Juniper, which was slow to correct software vulnerabilities.

Cerner lands on Forbes’ most innovative companies list

Forbes names Cerner #22 on its list of large, publicly traded companies that invest in innovation.

SAS to build cloud-based big data analytics platform for Dignity Health

Analytics software vendor SAS will create a big data platform for Dignity Health to support care planning, value-based reimbursement, and outcomes and value performance analysis.

Wearable Intelligence is raising $8.4M for Google Glass for doctors

San Francisco-based Wearable Intelligence has raised $7.9 million of its goal of $8.4 million from investors that include Google Ventures and Andreessen Horowitz. Its Google Glass technology displays information from EHRs,clinical alerts, and real-time information from patient monitors.

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Morning Headlines 8/20/14

August 20, 2014 News 1 Comment

Community Health Systems data hack hits 4.5 million

Chinese hackers hit the for-profit operator of 206 hospitals for the identities of 4.5 million patients.

Apax seeks $3 billion sale of healthcare IT firm TriZetto : sources

The private equity firm is rumored to be seeking a buyer for revenue cycle vendor TriZetto in the $3 billion range after taking the company private for $1.4 billion in 2008.

White House won’t reveal documents related to ObamaCare website security

CMS and the White House refuse to turn over documents related to the security capabilities of Healthcare.gov, citing HIPAA concerns.

A Medicare scam that just kept rolling

Medicare paid $8.2 billion for power scooters, many of them for patients who had no medical need for them.

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August 20, 2014 News 1 Comment

News 8/20/14

August 19, 2014 News 1 Comment

Top News

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For-profit hospital operator Community Health Systems says it was the victim of a cyberattack in which the demographic information of 4.5 million patients of its 206 hospitals was stolen. The attack, which occurred in May and June, appeared to originate in China. The FBI is investigating. Community Health Systems is in the Fortune 500 with $7.2 billion in annual revenue and a pending $3.6 billion acquisition of Health Management Associates, which would make the company the largest for-profit hospital operator in the US.


Reader Comments

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From Changing Wind: “Re: Orion Health. With the upcoming IPO, employee bonuses are being changed from four times a year to once, holding cash at the expense of their employees.” According to a forwarded email from Orion Health CEO Ian McCrae, “As part of the Board and Management review of the company measures and targets, a decision has also been made to move the frequency of the Company Incentive payment to annual, which aligns with the personal component of the Short Term Incentive. This change now aligns us with what is common market practice and also takes into account the recognition that the achievement of the revenue target is heavily reliant on our performance in the second half of this financial year.”

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From Anonymous Tipster: “Re: Carl Dvorak’s testimony. To hear Mr. Dvorak complain about their customers bearing the cost of participating in data exchange governance mechanisms while spending many millions of dollars on Epic and then during verbal testimony claim that Epic is the underdog of the EHR industry made me laugh.“


Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  


Acquisitions, Funding, Business, and Stock

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Private equity firm Apax Partners LLP is looking for a buyer for payer and revenue cycle vendor TriZetto, according to rumors. Apax took TriZetto private in 2008 for $1.4 billion and hopes to sell it for up to $3 billion. TriZetto made $190 million in profit in the most recent fiscal year.

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Inc. profiles the British doctor who founded hospital workflow software vendor Medisas and the expensive, lengthy process involved in getting a visa to set up shop in this country.  

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Clinician rounding app vendor Listrunner raises $500,000 in seed funding from independent physician investors. A trial version of the app is free.

Physician services group Mednax will acquire revenue cycle management vendor MedData. I’m hoping new ownership doesn’t interrupt the delicious flow of fresh-baked scones that MedData provided in the exhibit at HIMSS14 since they were a high point of the conference.


Sales

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MultiCare Health System (WA) chooses Infor’s human capital management system.


People

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Surgical Information Systems promotes Jonathan Lujan to EVP of North American sales for SIS and AmkaiSolutions.

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Paul Sinclair (Allscripts) joins Beacon Partners as VP of business development.

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Ford Phillips, who has worked in healthcare IT for 38 years, has written a short story collection about growing up in a small town in southern Illinois called “East of the Sun and West of of the Moon.”


Announcements and Implementations

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KPMG will use Blue Cross Blue Shield claims information from Blue Health Intelligence, along with the CMS claims database, to enhance its service offerings.  

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A Baltimore technology site profiles Maven Medical, an eight-employee startup that offers a medical procedure price transparency app that helps doctors choose cost-effective tests based on average Medicare reimbursement rates.

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Self Health Network raises $5.6 million to further development its patient communications and private social network platform that supports patient-clinician communications, personal health records, home monitoring device data collection, and caregiver alerts.

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Accelerator Rock Health signs three new corporate sponsors: Abbott, Blue Shield of California, and Deloitte.

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Two Michigan senior living facilities implement the Visibility Resident Care call system, powered by Versus Technology’s RTLS.


Government and Politics

The White House denies a Freedom of Information Act request filed by the Associated Press that asked CMS to disclose records related to the security capabilities of Healthcare.gov. CMS refused to turn over the documents, claiming that doing so could violate HIPAA by making it easier for hackers to access consumer information. A legal expert comments, “Here you have an example of an agency resorting to a far-fetched privacy claim in an unprecedented attempt to bridge this legal gap and, in the process, making it even worse by going overboard in withholding such records in their entireties.”

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Premier, responding to a call from the Senate Committee on Finance for ideas that would make healthcare data more useful while maintaining privacy, says that ONC should mandate open APIs for data access as recommended in the recent JASON report. Other suggestions: open up access to government-related claims data, allow researchers access to EHR information, and provide incentives for interoperability that includes patient matching.

A Washington Post investigation finds that Medicare has paid $8.2 billion buying power wheelchairs and scooters for patients, many of whom didn’t need them. Companies, many of them set up by immigrants who became overnight millionaires, paid recruiters to get Medicare patients to participate in the scam. One patient found it odd that the medical equipment company that claimed he couldn’t walk had second-floor exam rooms with no elevators. Medicare put out fraud alerts, but kept paying, required by law to pay most claims within 30 days and reviewing only about 3 percent of them before paying. Medicare is a bit wiser, so criminals are moving on to selling drugstore shoe inserts as $500 orthotics and prosthetic arms and legs for patients in Puerto Rico who have no record of amputations.


Other

A Brookings blog post says HIEs are “Facebook for doctors,” with three factors that encourage doctors to use them: (a) receiving referrals; (b) being located where other communications channels are limited, such as in rural areas; and (c) peer influence.

In Australia, South Australian Health argues with Allscripts over lack of functionality in its Sunrise billing module, falling short so far over exchanging lawsuits.  


Sponsor Updates

  • Billian’s HealthDATA discusses five hospital hiring trends in the C-suite.
  • Kareo CMIO Tom Giannulli will speak at the UBM Medica’s Practice Rx conference September 19-20 about the role technology plays in improving patient care.
  • Medhost announces that Cottage Hospital (NH) has attested for Meaningful Use Stage 2.
  • CoverMyMeds doubles its employee count and is expanding into a larger office space.
  • Quantros will showcase its Pharmacy Safety Suite of Solutions at the NACDS Total Store Expo 2014.
  • Navicure launches Navicure Payments that enables clients to estimate and secure patient financial responsibility and collect balances before service and after adjudication.
  • South County Radiologists (MO) selects McKesson Business Performance Services for its 14-physician practice.
  • The Advisory Board Company explains how it became a “Best Place to Work.”
  • DocuSign publishes a blog entry, “Fuel the Digital Revolution in Life Sciences with SAFE-BioPharma.”

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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August 19, 2014 News 1 Comment

Morning Headlines 8/19/14

August 18, 2014 News No Comments

Community Health says data stolen in cyber attack from China

The for-profit chain of 206 hospitals says the information of 4.5 million patients was stolen, possibly by hackers with links to the Chinese government.

Microsoft cloud service Azure restored after partial outage

The hosting platform for cloud-based applications went down in multiple centers Monday evening, but the issue has since been resolved.

When Patients Read What Their Doctors Write

NPR covers the OpenNotes project with an opinion piece from an ED doctor and author.

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August 18, 2014 News No Comments

Morning Headlines 8/18/14

August 18, 2014 News 1 Comment

Health IT Policy Governance Subgroup

Epic President Carl Dvorak testifies on the company’s position and progress on interoperability.

M*Modal Announces New Board

MModal CEO Duncan James resigns and a new board is named two weeks after the company emerges from Chapter 11 bankruptcy

Pervasive Medicare Fraud Proves Hard to Stop

A New York Times article says HHS’s fraud prevention efforts are minimally effective because the agency doesn’t manage private contractors well and provider appeals have overwhelmed the system.

Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis

A study of 2011 California data finds that hospitals charged between $10 and $10,169 for the same lipid panel lab test. The same author previously found that the list price for an uncomplicated appendectomy prices ranged from $1,500 to $187,000.

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August 18, 2014 News 1 Comment

Monday Morning Update 8/18/14

August 16, 2014 News 9 Comments

Top News

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Epic President Carl Dvorak testifies at an ONC HIT Policy Committee interoperability governance subgroup hearing. Some of his points:

  • Epic’s Care Everywhere exchanges 4.6 million C-CDA documents each month with 26 non-Epic vendor systems, 21 HIEs, 29 HISPs, and 28 government agencies. Its connections to other organizations carry 20 billion transactions annually to 88 public health agencies, 18 research societies, 51 immunization registries, and 17 research registries. This, Dvorak says, portrays a broader definition of interoperability than just exchanging patient summary documents.
  • Dvorak said providers who receive Meaningful Use money should be required to participate in a national list of exchange-ready participants.
  • Epic recommends that Meaningful Use Stage 3 add eHealth Exchange standards for unplanned transitions of care.
  • Epic suggests allowing multiple trust verification services since DirectTrust is too expensive for some organizations.
  • Dvorak says data exchange should be simplified for data used only for patient treatment and not for the “payment and operations” part of HIPAA where information is often sold or redistributed to business associates.
  • Epic says ONC should give patients control of information sharing with a simple opt-in/opt-out option and let patients who want finer control to use their own personal health record instead.
  • Epic customers are reporting that state and local HIEs are demanding payments that exceed their connectivity value and that some are trying to pass laws requiring providers to pay their full fee just to access state immunization registries. Epic says immunization and public health reporting should be free to users and paid for by the states, and providers in states that refuse to do so should get an exemption from those Meaningful Use requirements.
  • Epic urges ONC to be wary of “political agendas and commercial competition” in assessing interoperability, adding that if ONC wants to get a true picture, they should encourage health care systems to voluntarily report their interoperability statistics directly to ONC. 

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Also testifying at the subgroup meeting, CORHIO Executive Director Morgan Honea said one practice was quoted $50,000 to connect to its network. He also said independent providers and small health systems should get Meaningful Use money for connecting to HIEs since they have little incentive otherwise.

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Tim Burdick, MD, CMIO of OCHIN, said that data are tethered to one EHR and one patient portal, giving an example of a cancer patient who has to log into the patient portals of six organizations to see her information, then send messages to the other five asking them to update their EHRs. He says that most of the 22 states in which OCHIN operates have their own technical standards and they are often outdated, vague, or impractical (example: data standards for immunization registries required 15 different interfaces.) He said that his organization struggles with connecting to specialized registries as MUS2 requires because not only is every state different, some registries are run by drug and device companies and require each participating doctor to pay a monthly fee or make them agree that the patient data they submit can be sold or used for any purpose. He says it’s hard to match Direct addresses to specific providers because some of them work for multiple organizations and it’s not clear whether each role has its own Direct address or what happens when that doctor stops working at that location. He finished by suggesting that ONC rate organizations that are using HIE best practices, which he calls “Yelp for HIE vendors.”


Reader Comments

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From HIErarchical: “Re: new insurance company-sponsored HIE in California. This has CalRHIO 3.0 written all over it. The program came from the president of UCLA, where former CalRHIO head Molly Coye, MD is chief innovation officer. She has surfaced to restart what was thrown out in 2010.” CalRHIO’s ambitious California-wide RHIO plans were thwarted in early 2010 when the state created a new entity that paired CalRHIO with a competitor with whom it had fought over HITECH money. CalRHIO, like former National Coordinator David Brailer’s Santa Barbara project, talked a lot but accomplished little – it brought one county’s EDs online. The chair of the newly created Cal Index HIE, which is funded with $80 million from Blue Shield of California and WellPoint’s Anthem Blue Cross, is the president of UCLA’s health system.  

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From Information Governor: “Re: information governance. I’m curious whether organizations have an information governance policy as described by a recent AHIMA white paper.” AHIMA recommends that hospitals define information as a critical business asset that is managed using published standards and the appropriate resources. Two-thirds of survey respondents said their organizations haven’t developed that kind of strategy. The most interesting part to me was the information life cycle management of electronic information, including accuracy, access, protection against loss, preservation for legal holds, managing data deletion, and plan for technology obsolescence. Actually, maybe even more interesting was the section on information controls: documentation requirements, downtime planning, data definitions, software testing, how information is corrected, and how data quality is measured. The survey went out only to AHIMA members, which may have skewed the results. Leave a comment if you’d like to describe your organization’s efforts.

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From Lodi: “Re: EMRs and quality improvements. You are a hospital IT person. Why do you always question study results proving that EMRs improve care?” Because the studies prove no such thing. It’s appalling to me that the people who conduct those studies, many of whom have a vested interested in being EMR cheerleaders, misstate their results as proving causation rather than correlation. Clueless reporters then add another layer of obfuscation by writing punchy but flat-out wrong headlines. I believe that hospitals using EMRs have better outcomes. I also believe that hospitals that have bigger profits, prettier buildings, cafeteria sushi bars, and showcase helicopters also have better outcomes. I’m throwing down a challenge to anyone who claims EMRs improve outcomes: show me your data.


HIStalk Announcements and Requests

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Cerner handily won the vote of which EHR vendor is best equipped to support population health management, although the IP addresses of respondents suggest that a huge percentage of the nearly 1,500 votes it received came from inside the company. Cerner contacted me to say they didn’t encourage ballot box stuffing, but non-Cerner voters nonetheless left scathing poll comments upon seeing the results, one of whom suggested giving the win to Epic by default (who also had some homers clicking away, with 62 of its 216 votes.) Let’s move on to a new poll to your right or here: is it a good deal for Cerner to buy the Siemens HIT business for $1.3 billion? Vote and then click the Comments link to expound further. Add some insightful comments and I bet some healthcare publications will use the results for further articles since information is otherwise scarce.

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I asked readers whether their employer requires them to share hotel rooms for group travel. The results: only 12 percent of respondents said yes, which is about the same percentage as reported in other national surveys. The numbers were the same for both vendor and provider employees. My thoughts:

  • Vendors theoretically save their customers money by forcing the rank and file to share rooms, but the frugality often ends when executives are involved as the lavish salaries and stock options dwarf the cost of a few hotel nights. Customer costs never go down, and it’s likely that customers of the room-sharing vendors pay just as much.
  • I would bet anything that company executives don’t share rooms. I’m not a fan of policies that only apply to people in the trenches.
  • A better option would be to book single rooms in cheaper hotels and provide group transportation to the event’s location.
  • The “two same-sex people should be comfortable and safe as roommates” idea is a dated concept that makes incorrect and stereotypical assumptions about sexuality and body image.
  • A shared employer isn’t enough reason for me to be comfortable with forced cohabitation with someone I barely know.
  • I’m a big fan of asking employees if they will share rooms instead of insisting they have to. That gives people who are uncomfortable with the idea for any reason a discrete way to opt out.
  • Lawyers would salivate at the chance to represent someone exposed to sexual harassment or violence because of employer-mandated room sharing.

Last Week’s Most Interesting News

  • Epic hires a lobbying firm, breaking from its long-held claim of having nobody assigned to sales, marketing, and government relations roles.
  • Free EMR vendor Practice Fusion raised the ire of practice customers and hopefully the awareness of other cloud-based system users in reminding those customers to insist on access to local copies of their data for downtime situations.
  • A survey of ACOs finds that most have only basic IT systems.
  • Massachusetts says it will spend more money to fix its struggling health insurance exchange website rather than move to Healthcare.gov.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.


Acquisitions, Funding, Business, and Stock

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Cerner shares (blue) are up nearly 12 percent since the company announced that it will acquire the healthcare IT business of Siemens on August 5, but they still lag the Nasdaq (red) over the past year.


People

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MModal announces that CEO Duncan James will resign from the company, which exited Chapter 11 bankruptcy two weeks ago. MModal has also brought in a new board.


Government and Politics

The New York Times reviews the government’s Medicare fraud efforts that cost $600 million per year, concluding that the 90 percent of fraud isn’t caught because HHS doesn’t manage the private recovery audit contractors it uses very well. The article says hospital pushbacks and extensive appeals have nearly completely shut down recovery efforts and cases can take up two years to get in front of a judge. It also notes that RAC bounties are so high that the companies paying fraudulent claims are sometimes the same companies paid to investigate them.


Other

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I missed this: Health Information Technology Exchange of Connecticut died a quiet death on July 1, 2014 when a new state budget bill repealed the creation of several quasi-public agencies, of which HITE-CT was one. Nobody seemed to notice or care, so that probably says it all.

In Canada, B.C. Emergency Health Services drops its $2.8 million ambulance electronic patient care record a year after it was supposed to go live, saying that, ”the vendor was unable to meet our business requirements.” The vendor was Interdev Technology.

A study of 2011 California data finds that hospitals charged between $10 and $10,169 for the same lipid panel lab test. The same author previously found that the list price for an uncomplicated appendectomy prices ranged from $1,500 to $187,000. Nobody pays list prices except the uninsured, who obviously wouldn’t be able to afford the ridiculous prices even if they wanted to pay. Healthcare prices are even more irrelevant than the inflated nightly rates listed on the back of hotel room doors.

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In a relevant story, a man who went to the ED of for-profit Bayonne Medical Center (NJ) to have them look at a finger he had cut days before is billed $9,000 for a tetanus shot and a bandage. The hospital’s CEO says it went out-of-network for the insurance company because of low payments and that it needs high ED charges to survive. The insurance company says the CarePoint Health-owned hospital is deliberately gouging consumers by dropping out of networks since New Jersey law requires the insurance company to pay for ED services anyway. The insurance company settled with the hospital for $6,640, and after the local TV station picked up the story, the hospital wrote off the balance owed by the patient. It’s ridiculous to put in-network verification responsibility in the hands (no pun intended) of a patient seeking emergency treatment, or to ask every employee who walks in the door whether they are in-network since hospitals always have private doctors and contractors running around who issue their own bills.

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The top 10 executives at the non-profit Blue Cross and Blue Shield of Alabama made more than $1 million each in 2013, doubling their 2011 pay. The president and CEO made nearly $5 million.


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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August 16, 2014 News 9 Comments

News 8/15/14

August 14, 2014 News 18 Comments

Top News

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A survey of 62 ACOs finds that many lack tools for risk management and patient engagement and haven’t made much IT progress in the last year. Every respondent said they have problems getting data from external organizations as they struggle with interoperability, workflow integration, and infrastructure maintenance. Few of them use secure messaging, referral management tools, self-scheduling, remote monitoring, smartphone apps, or telemedicine. Most do not coordinate care via an HIE.


Reader Comments

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From Bucolic Splendor: “Re: Practice Fusion. Was down most of the day Wednesday, a major catastrophe for practices all over the country. Nobody really believes their explanation.” Practice Fusion blames its multi-day downtime on unnamed third parties, their data center partner, and a “global Internet brown-out.” Strangely, some users could access the system on their phones only, others could get on with the Safari browser but not Chrome, while some users said they could get partial access by turning off Shockwave. Users ripped the company in Facebook messages for not answering the support line and failing to provide updates as their practices sent patients home without treatment. The bottom line: get SLAs from your cloud-based vendors (so the burden of reviewing their infrastructure is theirs, not yours) and make sure you have a local information retrieval option since even Internet connectivity itself isn’t guaranteed. The cloud is great except when it isn’t and then you’d give anything to have that under-the-desk server back. Some user comments:

  • “I just had a consultation with a patient I only see once monthly and I had no idea what we talked about last time.”
  • “Don’t care about your acquisition since I can’t see my patient charts!”
  • “Practice Fusion deleting comments & removing unfavorable forum threads is a BAD IDEA. One step away from charging for negative reviews. Spend more time on keeping the system up, and less time combing your social rep.”
  • “It is amazing how many people there are out there who is getting a superb free handout and then bite the hand that feeds them. And you are supposed to be professionals. Give me a break. Go out and actually pay for another premium service. Then you will have every right to bitch when things go wrong.”
  • “I see lots of photos of team-building games and fun … and bravo for that … but it appears there is less emphasis, as David Stewart suggested, on building infrastructure and contingency plans. Your suggestions to have a backup server and hub do us no good when the problem in on your end.”
  • “We may be looking for another EMR system. I’ve been relatively happy with the program when it functions, but the lack of adequate support has challenged our practice more than once.
  • “Although it is free to medical provider, some huge advertisers are paying big dollars and are the ones allowing it free for us. I hope they are aware of this inconvenience.”
  • “For everyone that is frustrated, how long have you been with PF? How many times has it gone down? I’ve been with them for 3 1/2 years and had a total of 4 hours of unplanned down time.”
  • “I am OK with a Day or 2 of outages, but this is a wake up call to how much we rely on you. Next time it might be a security issue and we are helpless to do anything about it. I would feel better knowing that if there is a catastrophe, I at least have a backup that I can use to go forward with. Maybe even a paid option – like $50 a month to be able to do a daily backup to my local computer.”

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From Reluctant Epic User: “Re: new Epic patent. I’m surprised the patent examiner thought that was novel for a Level of Service user interface.”

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From Details … Details: “Re: Habersham Medical Center. With Meditech’s industry-leading 800+ attestations, it would seem that there might be some missing information here.” I don’t doubt that a bit – it was the client that said it was a software problem. However, they also fired the IT director, so that plus Meditech’s lack of attestation problems elsewhere seems to put the blame on the hospital.

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From ShoezyQ: “Re: sharing hotel rooms. At the Allscripts user group meeting and annual sales meeting, the company requires employees to share hotel rooms. Maybe they should just send fewer people if they can’t afford the rooms. Can you ask your readers? I would never share a room with a colleague.” I’m with you. I bet Paul Black isn’t bunking up with Jim Hewitt at a Motel 6 and coordinating bathroom times, apologizing for snoring, and agreeing on the TV channel, so the policy is just for the “little people” who weren’t born with a suit on. It’s a pretty cheap company that requires employees to work a company event (which probably also means putting in a ton of excess unpaid hours away from home) and then forces them into steerage to save a few bucks. Maybe the peons could cook ramen noodles in their room’s microwave to save even more money. My strategy would be: (a) ask if you can apply your half-room cost to a single room and pay the difference for your privacy; (b) say you have sleep apnea and use a very loud CPAP machine that will keep your roomie up all night; or (c) find a new employer who values your dignity over their dollars. Meanwhile, I will ask readers as you requested: take the poll here and feel free to explain your employer’s policy via a comment.

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From John Britton: “Re: Cerner acquires Siemens. I am the CIO at a medical center that uses Cerner as our primary EMR as well as their Smart Room technology. We also use Siemens MedSeries4 for General Financials (AP, MM, GL). In 2010 we became one of the first Cerner ‘smart’ hospitals when we went live with this technology in 2010. Since then, I’ve had a front-row seat to the work Cerner has done to connect medical devices to the EHR through their CareAware ecosystem. Avoiding duplicative data entry and preventing errors are some of the biggest benefits of this approach. I think Cerner’s acquisition of Siemens will only accelerate their work to connect different data sources to the EHR. It might also help get closer to realizing more comprehensive interoperability and data sharing models between disparate information platforms using initiatives currently underway like the CommonWell Health Alliance.” John is CIO of Fisher-Titus Medical Center in Norwalk, OH.


HIStalk Announcements and Requests

This week on HIStalk Practice: HHS spends precious man hours (and taxpayer money) attempting to find emails related to the Healthcare.gov rollout. ONC launches a website to collect feedback on its interoperability roadmap. HIPAA worries cause OBs to remove baby pictures from their office walls. Dr. Gregg explains how HIT leads to HID. The Healthcare Administrative Technology Association opens for business. Investors outline their attraction to healthcare IT firms in Nashville. Square’s new appointment-booking feature poses potential HIPAA concerns for small practices. Thanks for reading.

This Week on HIStalk Connect: HealthMap, a Boston Children’s Hospital and Harvard Medical School collaboration, combines public health data, Twitter data, and Google news alerts to track the recent Ebola outbreak with greater accuracy than the World Health Organization. Apple is reportedly in discussions with Allscripts, Johns Hopkins, Cleveland Clinic, and Mount Sinai to generate support for its HealthKit rollout. Validic raises a $5 million Series A round that it will use to expand its digital health integration engine and grow its customer base.

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The first book written by ”CIO Unplugged” Ed Marx of Texas Health Resources will be released in late September. Watch for details of the upcoming virtual book launch for “Extraordinary Tales of a Rather Ordinary Life: How Applying Common, Everyday Principles Can Lead to Uncommon Results” on HIStalk.

Listening: new from The Gaslight Anthem, a hard-rocking New Jersey working class band that sounds like Springsteen backed by the Ramones. Also: new hard rock from the latest of several incarnations of Fuel from Henderson, TN – none of the 16 people who have played in the four-piece band’s 21-year history were in it continuously, but they always sounded good. 

I had a cool customer support experience today with one of our webinar tools. I had opened a ticket since the company basically rewrote the web-based software without instructions or updates to the knowledgebase. The support rep emailed me a screen capture movie showing how to do what I needed to do, even having a little one-way chat with me as he stepped through it. It would have taken him three times as long to write out the steps instead of just turning on Camtasia or whatever capture software he used to dash off a quick video.  That was both brilliant and personal, exactly what you want from a support tech.


BOSS Award Winner – Riton Khan

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Several people nominated Riton Khan for the HIStalk Beacon of Selfless Service (BOSS) Award. Riton is an HISP/iNexx deployment engineer with Medicity.

Adam Rossback of the Ohio Health Information Partnership said in his nomination, “Riton spent countless hours working with me to establish HISP integration with our organization to allow 30+ hospitals to attest for July MU2 attestation.” Donna Maxey of Healthcare Access San Antonio says Riton went above and beyond his job description by working through EMR integration issues with her clients, adding, “Whenever I felt my client was stuck, no matter what the issue was, I asked for a meeting and Riton would send me a screen shot of his calendar. He allowed me to pick any open day/time that the client’s vendor was available. I have yet to work with any vendor employee that is that transparent so that my clients could get the project done on time.” Several other of Riton’s customers added their accolades.

Congratulations to Riton for his excellent work, which makes him entirely deserving of both the thanks of his customers and the BOSS Award. 

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


Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.


Acquisitions, Funding, Business, and Stock

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MedAssets will acquire consulting firm Sg2 for $142 million in cash.

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Private equity firm GTCR will invest up to $200 million Cedar Gate Technologies, which it will form with former Medco CEO David Snow, who will add $20 million of his own money and serve as CEO. The company plans to “build a transformative company in the healthcare information technology industry by acquiring outstanding healthcare data and analytics businesses and accelerating their growth.” Snow is hardly an entrepreneur – he’s worked his whole career running giant insurance companies, although he’s on the board of a couple of startups.

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Geneva Healthcare, which offers a pacemaker data management platform that also integrates with other medical devices, raises $1.8 million in financing.


Sales

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Princeton HealthCare System (NJ) selects Premier’s integrated supply chain, performance, and technology services.

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In England, West Suffolk NHS Foundation Trust signs for Cerner Millennium. I think they went live a few years ago on iSoft’s Lorenzo (now owned by CSC) as part of the now-dead NPfIT. You may infer from the hospital photo that despite having the superior healthcare system, NHS doesn’t suffer from the Edifice Complex of aggressively billing Medicare and using the otherwise restricted profits to erect huge, artistically stunning buildings whose exteriors can’t be viewed by the sick people inside their walls but that stroke the egos of the proud community and the executives in charge.

Azalea Health signs up the physician groups of two Georgia hospitals for its EHR and RCM systems, Dorminy Medical Center and Irwin County Hospital.

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Wake Forest Baptist Medical Center (NC) chooses Tonic Health’s patient survey system.

National physician specialty services company Sheridan Healthcare chooses VitalWare’s iDocuMint ICD-10 code assignment and bill preparation tool for its 2,800 providers.

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Basset Healthcare (NY) chooses Strata Decision’s StrataJazz as its complete financial platform.

Urology Centers of Alabama adds Greenway’s PrimeRCM revenue cycle solution, joining its PrimeSUITE EHR/PM system.


People

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Louis Leibhaber (Fundamental Succcess LLC) joins WeiserMazars as director of the healthcare group.

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Asif Ahmad, CEO of Anthelio Healthcare Solutions, is appointed to the board of orthotics vendor Hanger, Inc.

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People Magazine profiles the family of MedAptus employee Jennifer Crowley, whose six-year-old son Padraig has been diagnosed with stage 4 neuroblastoma, the same rare childhood cancer that killed her infant son in 2006. Friends have started a fundraising page to help cover the family’s medical bills. Padraig was started immediately on chemotherapy and will have a long stay at Memorial Sloan Kettering.  

Larry Covington, former CEO of Unibased System Architecture, died earlier this week at 75. Services will be next Friday, August 22, in St. Louis. 


Announcements and Implementations

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Allscripts will integrate Clinical Architecture’s terminology management system, Symedical, with dbMotion.

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Two Texas hospitals are using Holon’s CollaborNet HIE platform in a state-developed pilot project to refer smokers to a free telephone-based smoking cessation program. Annual referrals jumped from seven to 1,254 after the single-click electronic system was put in place.

4medica announces the release of the first laboratory PHR licensed by MMRGlobal, which is curious in that paying off a patent troll is bragworthy.

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The non-profit Healthcare Administrative Technology Association launches to provide advocacy and member education to practice management system stakeholders.

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Impact Advisors joins the Epic-IBM team in pursuing the Department of Defense’s EHR bid.

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Allscripts and Netsmart will partner to co-develop solutions for their acute care and behavioral health EHRs, respectively.

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Nordic announces that it has worked with 100 Epic-using organizations, about a third of all Epic clients. That’s double the company’s 2012 total.


Government and Politics

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HIMSS EHR Association responds to a request from the Senate Finance Committee asking for comments about the availability of patient data vs. the need for patient privacy. The association says the biggest barrier to using existing data effectively is lack of a patient matching strategy, although it stopped just short of suggesting implementation of a national patient identifier.

CMS reactivates its Open Payments system for reporting drug and device company payments to doctors 11 days after taking it offline. Data problems had misattributed some of the physician payments.

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HHS says CMS Administrator Marilyn Tavenner inadvertently deleted emails related to the failed rollout of Healthcare.gov, explaining that she receives so many emails that she regularly hits her Outlook inbox limit and has to clear space. They added that she is supposed to forward or copy the emails for retention as the law requires before deleting emails, but she sometimes forgets. The National Archives and Record Administration says they can probably recover most of the internal emails since they would have been saved by their recipients, but those going to outside addresses may be gone for good. HHS has spent 23,000 staff hours so far trying to retrieve the emails in response subpoenas from Rep. Darrell Issa (R-CA), chair of the House Oversight Committee, so that’s a million-dollar plus delete key.


Innovation and Research

A HIMSS Analytics telemedicine study finds that … well, we don’t know what it finds since they provided a six-page teaser that only included the table of contents. That’s probably enough since the response rate was only 2.7 percent, so any generalization would be suspect.  

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Speaking of HIMSS Analytics, they should know better than to make this speculative leap even though clueless reporters do it constantly. They did the usual lazy test of mashing up some clinical quality data with their own EMR Adoption Medical scores and found that mortality was generally better in EMR-using hospitals. What the study couldn’t find – despite the headline stating otherwise – is that the EMR cause the improved outcomes. Why couldn’t they use the same detailed Healthgrades data and compare it to each hospital’s EMR go-live date from the HIMSS Analytics database and see if mortality improved afterward? It’s just absurd to try to claim that because EMR-using hospitals have better outcomes that the EMR should get all the credit. The same study found that sepsis mortality rates were higher in EMR-using hospitals, so if you feel an infection coming on and you believe this report, you should seek out any randomly chosen hospital that still uses paper charts.

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It was love at first sight between Gartner’s Hype Cycle and me years ago. Here’s a current version, which says mobile health monitoring is about to start moving up the Slope of Enlightenment. Big data and Internet of Things are still years away from matching their hype.

The Michael J. Fox Foundation and Intel announce their collaboration to objectively analyze data created from wearable devices to determine the progression of Parkinson’s Disease.


Technology

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Apple quietly adds another healthcare expert to its payroll: Divya Nag, founder of StartX Med, an accelerator to commercialize Stanford research. The beta version of iOS 8, released last week, includes support for spirometry data, an option to display medical ID on the lock screen, and health privacy options.


Other

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Epic officially breaks from its long-held “no marketing or government relations” position by engaging lobbying firm Card & Associates, run by the brother of the former White House chief of staff under President George W. Bush, as it seeks the DoD’s EHR bid.  

Beth Israel Deaconness CIO John Halamka says the hospital is almost ready for Meaningful Use Stage 2’s September 30 deadline, but is struggling with the 10 percent transitions of care threshold since few other providers, especially small physician practices, are capable of receiving the hospital’s information electronically. He adds, “On some days it feels that we have the only fax machine in town and thus it’s hard to fax.” That’s going to be everybody’s problem — so few providers are ready for Stage 2 that the go-getters don’t have anyone to exchange information with.

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Former Allscripts CEO Glen Tullman says patients don’t want more engagement with their chronic diseases – they want less engagement so they can get on with their lives. He says that pushing patient engagement is a patronizing approach that will kill off all the technology startups that haven’t made a dent in managing illness anyway. He adds that words such as “tracking,” “monitoring,” and “intervention” are disempowering because they suggest a loss of independence and that nobody’s going to analyze their own data or look up ways to be healthier. Not everything Glen said when he was at Allscripts made sense, but this does.

An article in The Atlantic says that big data from expectant women is being used for both good and bad: good for analyzing fetal DNA to uncover genetic problems, bad because marketers are using it to find purchasers of pregnancy tests and other products so they can launch aggressive marketing campaigns that hope to turn their offspring into long-term customers. Crafty data brokers use browser cookies, page view histories, Facebook posts, and online purchasing histories to build marketing profiles that are sold to any willing buyer. An example is the father who complained to Target that sending coupons for maternity clothing to his daughter encouraged teen pregnancy, only to find that Target knew something he didn’t: she was already pregnant.

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Torrance Memorial Physician Networks blames its EMR for allowing one of its doctors to code “homosexual behavior” in a male patient’s problem list. The patient, who is suing the doctor and practice for emotional distress and libel after seeing the entry in his chart after the hospital said they would remove it, says the doctor argued that the medical community is still not sure whether or not homosexuality is a disease. The man’s chart was coded with ICD-9 code 302.0, “ego-dystonic sexual orientation,” a code that was retired in 1987 to describe someone who’s unhappy with their sexuality. According to a spokesperson, “Due to the highly complex software used in creating an electronic medical record, the incorrect code continued to exist in an electronic table only. As a result, this incorrect diagnosis code was included on a paper copy of the record, which was provided only to the patient.”

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It’s surprising how much technology is being developed around the medical marijuana industry, but then again the financial alignment is clear. A radiologist and clinical owner develops CannaScan, a real-time, cloud-based validation system that allows Massachusetts police departments to verify that people found with marijuana have been issued a valid prescription. Massachusetts doctors were previously charging patients for ID cards, which the Department of Health found unethical, leading to CannaScan’s claim that it allows the “Good Guys to Weed Out the Bad.” The doctor says the software allows better care coordination and real-time patient management since it supports videoconferencing, scheduling, and notifications, or as he calls it, “A Clinic in the Clouds.”

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Weird News Andy utters one of my favorite Monty Python lines in titling this article “I’m not dead yet.” A hospital in Australia apologizes for faxing death notices for 200 still-breathing patients to their family doctors, saying someone accidentally changed the templates involved. At least it’s not just the US healthcare system that’s keeping long-abandoned technology such as pagers and fax machines alive.

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WNA also likes a story he calls “a knife on his mind.” A man in China taking a stroll feels pressure in his head, not realizing the cause until a shopkeeper points silently at the five-inch kitchen knife protruding from his skull. It had fallen from the balcony of a high-rise. He’s OK.


Sponsor Updates

  • NextGen describes the three tiers of the Patient Centered Medical Home.
  • The Meditech Solutions Group within Dell adds DataMotion Direct secure messaging to its portfolio of services.
  • CompuGroup Medical US and Teche Action Clinic (LA) team up to celebrate the 2014 National Health Center Week.
  • Levi Ray & Shoup announces the release of its Virtual Session Printer Agent.

EPtalk by Dr. Jayne

I attended a CME seminar this week which was actually pretty fun. It was good to get away from the grind of the IT world and remind myself why I became a physician in the first place.

Although most of us continue to have grumbles about payers, conflicting recommendations, and of course EHRs, we also have great stories about our patients and what it means to care for them. The course was on delivery of culturally competent care, which is pretty far away from what we usually deal with in the IT trenches.

Several of the physicians I met were interested in the fact that I gave up a busy solo practice to go into the world of IT. Many were from cities of a size that they may not have dedicated physician IT resources and were interested in how they could get more involved in the decisions that impact their practices and how they care for patients. Most were employed, although there were a few solo holdouts.

A couple are in direct-pay practice situations which I think is a very interesting solution to many healthcare issues. The patient sees the doctor, a fee is assigned, and the patient pays. If the patient wants to submit to insurance, they are given information about the visit so they can self-file. Although one uses EHR, the others don’t. All of them have opted out of Medicare and Medicaid. At least for now, all are happy.

It was strange to talk to physicians who aren’t dealing with MU attestation or the risk of audits. That’s become so much of our world lately. It was invigorating to see whether the grass is greener on the other side or not. I’m not interested in hanging up my IT hat, but I certainly would consider that model if I went back into a continuity-type primary care practice. It reminds me of the physician I saw when I was a kid.

Of course not being connected has its disadvantages. I don’t think I’d take it that far. I like the benefits of EHR too much to go back entirely.

Speaking of e-prescribing, I mentioned that I enrolled in the free Allscripts eRx product through the National ePrescribing Patient Safety initiative. Although the registration process was easy, I still am not set up to e-prescribe. Apparently they need to verify my NPI number. First they asked me to fax proof of my NPI, which I don’t have – I don’t have the original enumeration letter from way back when. I also don’t have a fax machine.

I asked if I could email it. They said yes, but again I need to provide proof. They helpfully directed me to a website where I could look myself up and find my NPI number, which I already knew and submitted to them. I’m not sure why they couldn’t go to that website and verify that the number I provided matches my name, but instead sent me 12 emails and called the office multiple times to tell me to go take a screenshot of a public website and email it to them.

I was finally able to find time to do that and sent it off, so hopefully they’ll get me set up soon. In the meantime, the system isn’t that useful since we don’t have a demographic interface to it and everything has to be manually keyed. Looks like I’ll be going back out to look for other vendors regardless of the outcome with the NPI.

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From The Grey Goose: “Re: Allscripts user group meeting in Chicago. My kind of town! Check out this view from my hotel room.” I wasn’t sure initially if this picture was real or from a postcard, but I can only hope I have such a great view when I’m in town for HIMSS. This will be an interesting HIMSS for me since we’re in the middle of consolidating our systems. By the time it rolls around, we’re likely to be under contract with a new vendor. That will put a whole new spin on things.

The Allscripts user group meeting is in full swing and purports to have a Thursday night client event with bands Styx and The Gin Blossoms performing. Sounds like a great time and I hope some of the attendees share pictures. I’m off to the airport now. It will be good to sleep in my own bed before handling the torrent of emails that flooded in while I was away.

What’s your favorite vendor user group client event? 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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August 14, 2014 News 18 Comments

News 8/13/14

August 12, 2014 News 3 Comments

Top News

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The White House creates the US Digital Service, a new program that will recruit the “country’s brightest digital talent” to provide strategic guidance on major IT projects like Healthcare.gov and iEHR. Mikey Dickerson, an ex-Google engineer credited with saving Healthcare.gov, has been tapped to run the service. As a deputy federal CIO, he will work with similarly titled Lisa Schlosser in her role of policy, agency oversight, and accountability. The new service will ultimately consist of 25 experts brought in on two- to four-year term appointments to help agencies plan, improve, and fix IT programs. It will be financed with existing funds in 2014, and scale in 2015 as outlined in the President’s FY 2015 budget.


Acquisitions, Funding, Business, and Stock

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Cerner jumps to the top spot of the Kansas City Business Journal‘s Top Private-Sector Employers List due in large part to the addition of 1,550 local employees in the past year. That’s not counting the 16,000 it will need to hire to fill its planned $4.5 billion Three Trails Campus, or the unknown number it may create in the coming years as a result of the Siemens acquisition.

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National staffing company Jackson Healthcare acquires Sullivan Healthcare Consulting, which focuses on improving the performance of the hospital perioperative suite through surgery benchmarking, scheduling, staffing, sterile processing, and surgery IT implementation. SHC will serve as a complementary service line to Jackson Healthcare operating companies Premier Anesthesia and Jackson Surgical Assistants.

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Hospital administrators at Emerson Hospital (MA) attribute the facility’s operation-margin gains and service-line upticks to an increase in outpatient services. Though IT upgrades in the mammography department have led to the need for fewer patient visits, referrals from other places for Emerson’s new, higher-quality mammographies have made up for the decline.

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Healthcare IT firm Priority Consult acquires business intelligence and analytics software developer Balanced Insights to form Cordata Healthcare Innovations. The new company will use Balanced Insight’s technology as a starting point for a new generation of patient navigation and tracking applications. Priority Consult president and CEO Gary Winzenread will serve as Cordata’s president and CEO, while Balanced Insight founder and CEO Tom Hammergren will serve as CTO.

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Population health and workflow technology company Acupera secures $4 million in financing from Lightspeed Venture Partners. It will use the Series A funding to scale its product development team and add to its customer implementation group.


People

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Travis Crenshaw (United Surgical Partners International) joins Foundation Healthcare Inc. (OK) as CIO.


Announcements and Implementations

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University of Colorado Health selects Zix Email Encryption to provide consolidated, secure email to 18,000 users across its system, which includes University of Colorado Hospital, Memorial Health System, and Poudre Valley Health System.

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Allegheny Valley Hospital (PA) becomes the first in the state to equip its paramedic team with iPads. The pilot project has so far enabled AVH ER physicians to observe 12 patients on their way to the hospital. The hospital paramedic team will present the results of the project to the Pennsylvania Department of Health, which is considering rolling out similar programs across the state.

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Providence Medical Center (KS) selects the GroupOne Health Source One Rate platform of medical billing and EHR implementation services for 40 of its providers. PMC will use the OneRate platform to facilitate integration of physician practices into its multi-specialty network across the greater Kansas City area.

UnityPoint-Allen Hospital and Black Hawk-Grundy Mental Health Center in Iowa announce they will begin electronically sharing patient records early next year.

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St. Joseph Mercy Health System launches a telemedicine service from MDLive that provides real-time physician appointments 24 hours a day, seven days a week via video, phone, or app. Patients are connected with a SJMHS or MDLive physician who can offer treatment evaluation and advice, and e-prescriptions.

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Halifax Regional (NC) launches the HalifaxHealthLink patient portal, which follows the successful rollout of the FollowMyHealth portal for patients of Roanoke Clinic, Roanoke Valley Internal Medicine, and Halifax Regional Cardiology.

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The Willis-Knighton Physician Network (LA) selects InteliChart’s Enterprise Patient Portal to serve as a single portal solution for its system of network clinics. Physician Network Administrator Greg Gavin noted that “[a] vendor-neutral patient portal that provides a single source solution for our patients as well as a consistent brand across the entire Willis-Knighton System were top priorities in selecting a solution” to improve communication, coordinate care, and facilitate patient healthcare goals.


Government and Politics

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ONC launches a website designed to collect feedback on its proposed interoperability roadmap. Stakeholders have until September 12 to provide their thoughts and comments, after which ONC will present aggregated feedback to the Federal Advisory Committee for its input and recommendations. An updated version of the roadmap will be posted for public comment early next year.


Research and Innovation

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Creative England announces a £1m fund for small and medium enterprises in the North, Midlands, and Southwest regions designed to stimulate creative and digital innovation in UK healthcare. Four new programs will open as part of the fund. The first is the West Midlands Interactive Healthcare Fund, which will offer five £50,000 investments to support projects that focus on improving quality of care, caring for people with dementia, supporting people with long-term conditions, and data visualization. Applications will be assessed on a rolling basis and the fund will close on Oct. 31, 2014.

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A new report finds that using a touchscreen EHR to support and monitor a national antiretroviral therapy program in Malawi faced challenges similar to that of EHR adoption in the U.S.:

  • Implementing a point-of-care EHR has been more challenging than initially anticipated.
  • The success of a POC system ultimately depends as much on a commitment from system users as on the technologies employed.
  • Poor adherence to system use will result in incomplete data.
  • Health workers will not adopt a system if they do not find sufficient value in it. Consequently, the primary challenge is to identify and address the value proposition for the user. This is an iterative process that requires a commitment to regular and ongoing dialog with the users if this paradigm shift to POC system use is to be sustainable.

Technology

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Reports surface that Apple is in HealthKit development talks with providers at Mount Sinai, Johns Hopkins, and the Cleveland Clinic, as well as with Allscripts. Cleveland Clinic CIO William Morris says the clinical solutions team is experimenting with HealthKit’s beta and is providing feedback to Apple. Representatives from the other three organizations have not yet chimed in.

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Simple Medical Software Inc. releases the SimpleRounds app to help providers better communicate and collaborate on patient care. Developed by SMS founder Rubén Zamorano and Manuel Martinez, MD the app features secure text messaging, billing manager, physician directory, rounds manager, patient census, and sign-out manager.


Other

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The local paper highlights the new $1.3 billion Parkland Memorial Hospital, one of the first “digital hospitals” in the U.S. The hospital, set to open in May 2015, will feature $80 million worth of digital technology including touch-screen way finding kiosks, smart beds, baby tracking devices, and hand-held communication devices for nurses, as well as an integrated digital system controlling nearly every aspect of its operations. CIO Fernando Martinez points out the hospital will be similar to a smart home: “All the digital devices in a smart home can talk to each other because they’re connected to a common hub. That’s not unlike what we do, only we’re much bigger.”

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Irish health service officials find that the number of patients waiting more than a year for hospital treatment surged 600 percent between December 2013 and May 2014. They have not formally addressed the spike, but have noted they are addressing the issue “in the face of significant financial challenges.”

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Jersey City Medical Center (NJ) reveals that a computer disk containing 2011 Medicaid patient information was lost in June when a package sent via UPS failed to arrive. The unencrypted disk contained an undisclosed number of patients’ names, and many of their Social Security numbers and birth dates.

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This article highlights the success of the Maryland Chesapeake Regional Information System for our Patients (CRISP) HIE, which has seen patient searches by providers jump from under 10,000 in late 2012 to nearly 55,000 as of last month.


Sponsor Updates
  • Capsule discusses why timing is everything with vital signs.
  • Rochester Regional Health Information Organization (NY) and HealtheConnections RHIO of Central New York are live on eHealth Technologies’ Image-Enabled Results Delivery.
  • The Advisory Board Company offers its ready-to-present slides on the surgical services market trends for 2014.
  • OhioHealth upgrades its Infor Cloverleaf solution to V6.0.
  • Aventura client Hunterdon Healthcare System’s Greg Melitski will explain how they met their ED workflow challenges at the Optum Client Forum in Chicago, August 18-21.
  • Streamline Health is participating in the Allscripts ACE 2014 Conference, which kicks off today.
  • Wolters Kluwer ProVation offers a white paper entitled “ICD-10: The Gift of Time.”
  • Black Book names Allscripts “Best of the Best” Ambulatory EHR vendor for interoperability.

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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August 12, 2014 News 3 Comments

Monday Morning Update 8/11/14

August 9, 2014 News 5 Comments

Top News

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Massachusetts will upgrade Massachusetts Health Connector instead of piggybacking on Healthcare.gov, officials decide. The state will replace fired contractor CGI, to which it has paid $52 million, and replace it with Optum. The struggling site has cost $108 million so far.


Reader Comments

From Chris: “Re: jaded by the industry. We vendors are jaded too because it is a very difficult industry to serve. Fat cat EMR vendors have stolen from hospitals for years for very little value or improved outcomes. Then ACA just dumps millions into the hands of the same vendors, starving those innovating and trying to change a culture from the ‘80s. We have to deal with absurdities like IE7 (and IE8, 9, 10, and 11) while we push boundaries with iPad. There is so much apathy and very little standardization and consistency from one hospital to the next. You have to laugh at the amount of money that’s being spent to convert to electronic medical records and protect privacy. Paper wasn’t so bad after all and it was certainly cheaper. Until human behavior changes and the FDA starts protecting our food supply, we’re just fooling ourselves about improving healthcare.”

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From Sticky Clicky: “Re: Habersham Medical Center. Which EHR forced them to return their Meaningful Use payments due to lack of capability?” They’ve been running Meditech forever, I believe. The hospital spent $3 million on software upgrades and attested for Stage 1, but later found that “a statement we made to CMS that it would work was in error” so they returned the $1.5 million in incentive money.

From Equitable: “Re: a recent vendor raising debt funding. I’m guessing it’s because they failed to raise equity after hiring Blair to try. Investors were concerned about the viability of an e-prescribing vendor at this point in the market.”

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From Certified: “Re: LabCorp. Nationwide systems down as of noon Friday. Radio silence from corporate. Why aren’t they at Starbucks informing customers by Gmail? They can afford elite collection agencies, but their IT systems are primitive.” Even LabCorp.com is down as I write this Saturday evening and their portal log-in page returns an internal server error. That’s some major downtime.


HIStalk Announcements and Requests

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Two-thirds of poll respondents think the federal government should develop EHR interoperability standards and make them mandatory. New poll to your right (or here):  which EHR vendor is best positioned to support population health management?

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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Last Week’s Most Interesting News

  • Cerner announces that it will acquire the healthcare IT business of Siemens for $1.3 billion in cash as Siemens finally unloads the business it bought in 2000 for $2 billion, making Cerner the biggest vendor in the industry in terms of revenue. Cerner’s interest is buying a captive audience for conversion to Millennium, incorporating patient data from the legacy systems of Siemens into a population health management system, and using R&D to blur the line between diagnostic and therapeutic equipment and IT systems in a post-EMR world.
  • Six Wisconsin health systems announced their affiliation to manage populations and earn business, including sharing patient information from the Epic system used by all six to deliver care and manage patients across institutions.
  • The annual EHR report by the Robert Wood Johnson Foundation finds that HITECH-incented hospitals and practices have rapidly implemented basic EHRs, but few are using them comprehensively and only a tiny percentage of users are ready for Meaningful Use Stage 2.
  • HHS OIG released a report that said ONC’s certification program doesn’t focus enough security issues ,such as enforcing password complexity and managing user privileges.
  • The State of Vermont ends its $83 million health insurance exchange contract with CGI, saying the site still isn’t fully functional.
  • Allscripts announces Q2 results that meet analyst expectations.

Acquisitions, Funding, Business, and Stock

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Voalte will open Voalte Labs, an independent research center, in its home town of Sarasota, FL. It will be run by Don Fletcher, PhD, the company’s chief scientist.

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From the Allscripts earnings call:

  • President and CEO Paul Black says the company will benefit “as clients look for solutions that are both interoperable and fully integrated, something Allscripts’ open platform is uniquely positioned to provide.”
  • The company’s one Sunrise hospital sale in the quarter was to a 78-bed hospital.
  • Black says the company’s new “fusion” technology will integrate parts of dbMotion, Sunrise, TouchWorks, and Pro.
  • The company blames reduced revenue vs. 2013 on “a continued shift toward subscription software arrangements.”
  • Maintenance revenue dropped as customers moved off MyWay.
  • The company blames flat transaction revenue on Medfusion, which cancelled its agreement with Allscripts claiming it wasn’t getting paid and that Allscripts was urging its portal users to switch to Allscripts acquisition Jardogs, now called FollowMyHealth.
  • The company is targeting Siemens customers now that its business will be acquired by Cerner.
  • Allscript expects international business to double as a percentage of total revenue, from 5 percent to 10 percent.

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The CEO of Siemens Healthcare, quoted in the announcement that it will sell its health IT business to Cerner, said:

We have continuously invested in our HS-portfolio and achieved significant progress on the technology side. At the same time, we realized that business success of our hospital information systems could not always keep pace with our competition. Additionally an increasing number of country-specific requirements, such as resulting from US healthcare reform, make it increasingly challenging to achieve sufficient scale effects. Going forward we will focus on the development of information systems that support our businesses in laboratory diagnostics as well as imaging and therapy.


People

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Patient data monitoring app vendor Conversa Health appoints Peter Levin, PhD (US Department of Veterans Affairs) to its board.


Announcements and Implementations

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Google announces availability of preview version of its Google Fit software development kit. It allows programmers to access a user’s fitness history as recorded on Android-powered apps and sensors. Google Fit is scheduled for a fall release.


Government and Politics 

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Oracle sues the state of Oregon, claiming that the Cover Oregon health insurance exchange owes it $23 million for using its software. This follows the state’s announced intentions to sue Oracle for the $134 million it paid it to develop the site, which never went live because of problems. According to a state spokesperson, “The state fully expected to end up in litigation over Oracle’s failure to deliver." Oracle says the state failed to define system requirements, focused on the site’s appearance instead of its functionality, and failed to hire a systems integrator. Oracle adds that state officials went on a 60-day day retreat to define specifications but “returned empty-handed.” Legal experts say the state probably won’t win its lawsuit against Oracle because of the state’s weak contracting practices and the fact that its actual contract is with Dell, which paid Oracle time and materials as a subcontractor. Meanwhile, the state is planning to dump Cover Oregon and use Healthcare.gov after spending $250 million in federal taxpayer money on the failed website.


Innovation and Research

Here’s how surgeons use TedCas’s Microsoft Kinect-powered user interface in the OR.


Texas Health Resources / CVS MinuteClinic Affiliation

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CVS Caremark and Texas Health Resources announced an affiliation three weeks ago to provide convenient primary care services such as medication counseling, chronic disease monitoring, and wellness programs at CVS/pharmacy stores and MinuteClinic locations. The organizations hope to keep people healthier and out of the hospital and ED. I spoke to Barbara Adams, VP of Innovative Technology Services for Texas Health Physicians Group / Texas Health Resources about the relationship.

She says the driver for THR was to increase its access points. She said, “We have 250 clinics in DFW. We wanted to be able to refer after-hours patients so they don’t have to go to the emergency room. Many of the THR ED patients don’t have primary care doctors.”

Minute Clinic is staffed by nurse practitioners. Texas law requires physician supervision in the form of a review of 10 percent of charts. CVS will pay THR’s physicians for providing that supervision. THR also may gain referrals if patients choose them from the list MinuteClinic provides.

CVS is using a homegrown EMR but is moving to Epic, which THPG already uses. For now, the organizations will exchange information using Surescripts. The NP can push a message into THPG’s Epic system and the organizations can exchange CCDs over the HISP. Once CVS goes live on Epic next year, message exchange will be directional using Epic’s Care Everywhere.


Other

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TechCrunch profiles five-employee PicnicHealth, which offers a $39 per month personal health record that is populated from information the company obtains by performing manual records requests for a person’s encounters. The fee also includes ongoing digitization of new records, synching with patient portals, and unlimited records delivery to doctors. The company’s official address is a San Francisco apartment.

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HIPAA worries are causing obstetricians to remove “baby boards” that feature photos of babies they’ve delivered from their office walls. An OCR representative confirms that the practice is illegal even if the family sends the picture for that purpose since “implied consent” doesn’t count.

A new regulation in India requires doctors to write prescription in all capital letters to avoid sloppy cursive handwriting that was causing medication errors.

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A California pathologist is charged with embezzling $500,000 from the pathology company that promoted her to CFO, with one of her first accomplishments being to give herself a raise from $226,000 to $739,000.

Weird News Andy says this story involves a million-dollar typo. A family who purchased  health insurance through Nevada’s health insurance exchange finds themselves on the hook for $1.2 million in medical bills related to premature birth of their daughter because of an incorrectly entered date of birth. The state has already fired Nevada Health Link’s contractor Xerox, who says the only way to add a newborn is to cancel the family’s policy and start over.


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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August 9, 2014 News 5 Comments

News 8/8/14

August 7, 2014 News 16 Comments

Top News

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Six Wisconsin health systems that cover 90 percent of the state create a network to share resources, manage populations, and attract the business of employers, insurance companies, and individual insurance holders. All of the 44 hospitals owned by the unnamed network’s members use Epic and will share their Epic EHR information to manage populations and deliver care across facilities. The systems are Aspirus, Aurora, Bellin Health, Gundersen, ThedaCare, and UW Health. The board chair of the network says the members chose a virtual affiliation because working out the financial and administrative details of a merger would have taken too long.


Reader Comments

From Pink Slip: “Re: hospital IT department layoffs. Do  you agree that the number seems to be increasing, or am I just noticing the announcements more?” That’s a good question to pose to readers, who are welcome to provide their thoughts. I asked the Advisory Panel about layoffs recently and few reported any, so I’m skewing toward it being perception more than reality.

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From Frazzled CIO: “Re: Cerner. Our hospital announced the same day of the Cerner-Siemens announcement that we’re in discussions to acquire another hospital. We’re Cerner and they are Siemens. The announcement may have sent me over the edge if I hadn’t already been alerted through HIStalk of the potential deal and pondered the potential impacts ahead of time. Awesome work and thank you.” I will pass those thanks along to the readers who alerted me months before it happened and then provided thoughtful analysis Tuesday when it was announced. The “analysis” run by other sites was generally lame and dull, showing a remarkable lack of insight in gravely pontificating that Cerner should keep Millennium as its showcase platform (were they seriously thinking that Cerner would be tempted to lead with Soarian?) or that Cerner paid too much (they bought the Siemens IT business at the fire sale price of one year’s revenue, most of it probably recurring since Siemens isn’t selling much, and those customers can’t bolt short term.) The financial risk to Cerner is low as long as they don’t let the Siemens mess distract them.

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The Siemens business needed to be bought because they had trashed it in the 10 years they owned it, as is often the case when a big company jumps into healthcare IT because it seems like easy money and because it makes their executives fell Silicon Valley-ish. I will repeat my mantra: only three companies (Epic, Cerner, and Meditech, although CPSI might logically be included) are serious competitors in the hospital core systems market and all three (a) built most or all of their products on a single platform; (b) sell and support one core system; (c) rarely acquire companies; and (d) haven’t themselves been acquired. Cerner breaks what would have been my fifth rule since they aren’t privately held, and now that they are buying the Siemens business, they will violate my third rule as well and we’ll see how that goes. Siemens was waiting to fall – events of similar importance that may happen one of these days that would put the industry into a similar frenzy are (a) Judy Faulkner retires and hands off Epic to her successors; (b) the retirement-age owners of Meditech decide to sell it given lagging market performance and the chance to cash out at the top; (c) Allscripts throws in the Sunrise towel because of infrequent sales, poor ambulatory integration, and a missed DoD contract if that happens; and (d) DoD’s selection makes Cerner, Epic, or Allscripts a household word but threatens to suck the energy out of them with endless government bureaucracy and implementation challenges.  

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From Brian Yeaman, MD: “Re: Cerner acquires Siemens. In my longstanding history with Cerner as a major client in interoperability and around HIE an population health for nearly a decade, we’ve seen Cerner commit and engage deeply around interoperability. We’ve had great success with Cerner native solutions as well as acquired solutions and their ability to support all platforms while integrating the best of both worlds regarding the front and and back end for HIE, Long Term Care, reporting, Direct and other EHR integration have empowered tremendous success in our efforts in Oklahoma. I’m very confident that this will be a big win for existing and new Cerner clients via Siemens alike. Cerner’s efforts to enhance interoperability and the entire care continuum and care regions like Coordinated Care Oklahoma just took a quantum leap, in my opinion, to the good.” Brian is chief administrative officer of Coordinated Care Oklahoma. I think it’s a good deal all around. Siemens was not that great of a vendor, hoarding its legacy system recurring revenue and pretending the world hadn’t changed since the swinging SMS 1980s. Its customers would have been faced with abandoning the company’s antiquated core systems at some point anyway since Siemens did little beyond half-heartedly dangling the unattractive Soarian bait in front of them with no bites. Cerner will force Siemens customers to finally make a long-term choice, hopefully soothing the pain of the ripped-off Band-Aid with attractive Millennium pricing and conversion assistance.

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From Holly Mathews: “Re: Epic. Putting the health back in healthcare—that’s been a big initiative of mine at Epic for the past three years. It finally seems like preventative care is coming to the forefront of EMR attention or at least it’s slowly being pieced together. There is absolutely more emphasis on what folks are to doing to maintain a healthy lifestyle. To a new Epic customer today I responded, ‘Yes, we do integrate with Fitbit.’ There is a genuine desire to promote and manage not just the patients who are sick. I work at Epic as a project manager, but I also race bikes on a professional cycling team. Last week I won a stage at the Prairie State Cycling Series in Chicago. I thought it was pretty cool. :) Epic will ultimately help drive the shift of medical practice paradigms to focus on and manage active lifestyle choices.” My favorite part of Epic is the youthful, idealistic enthusiasm of its mostly 20-something very smart employees with no pre-Epic healthcare experience who jump in with both feet, have fun, and work hard. My stock in trade is jaded, world-weary cynicism formed by many years of being ground down by clueless executives, dysfunctional vendors, and healthcare decisions made by everybody except patients and clinicians, so it’s fun to see new optimistic new blood who think they can change the world and who in fact just might, no matter who they work for.

From OGMD: “Re: Practice Fusion. Don’t even mention their name on HIStalk – cover them on HIStalk Practice. The only docs I know that use it are one-doc practices too cheap to purchase a best-of-breed EMR. They still use paper charts because Practice Fusion comes with no training and is not robust enough to go entirely paperless.”  

From LFI Masuka: “Re: patient portals. The government mandates them, but patients will go online when it’s convenient or necessary. Kaiser’s success didn’t come from government mandate – they have things set up where it’s a bigger hassle to not use the portal than to use it. Most healthcare organizations don’t have such comprehensive control of the patient experience. My PCP is on Centricity, my specialist in the same clinic is on paper, and the local hospital is on an old version of Meditech. There’s a rudimentary RHIO trying to aggregate everything. As a patient, what compelling reason do I have to use a portal on any of these systems? I might trend some vitals or use it more if I had emergent health issues, but that won’t push the mandated numbers. We are throwing millions of dollars at technology in search of a problem.”

From Curious and Curiouser: “Re: patient portal opt-in. People are building the field to plug into the CCD format, but not actually placing the question anywhere it can be answered, essentially making every patient opt-in. What is your readers’ experience with opting in/out of portals? Are they asking the question or just opting everybody in to meet their numbers? It bothers me that the patients’ wishes aren’t being taken into consideration.”

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From The PACS Designer: “Re: Apple. Reports suggest that the iPhone 6 could be announced on September 9.” 


HIStalk Announcements and Requests

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This week on HIStalk Practice: Dr. Andy rants about the review of systems and checklist solutions. Telemedicine’s future in small practices comes into question. Big-box retailers continue to encroach on the business of primary care. Patients go the Priceline route for non-emergency care. Over 100 medical groups call for delay of the Open Payments system. Physician and EP Stage 2 MU attestations continue to underwhelm. Mark Gettleman, MD leaves brick and mortar for mobile and online at Goofy Gettwell Pediatrics.

This week on HIStalk Connect: Dr. Travis discusses the overlooked direct primary care segment of digital health and why he’s excited to see what new technologies it spawns. The FDA publishes draft guidance reducing its regulatory oversight on a large segment of Class I and II medical devices. Doctors On Demand raises a $21 million Series A to expand its national telehealth platform. Researchers at the Medical College of Wisconsin link text message-based reminders with improved preoperative instruction adherence. 

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I almost never look at HIStalk readership stats, but May always starts the summer slowdown that runs through September. Surprisingly, the numbers jumped sharply up this past May despite mostly routine news and the rise has continued through June and July to record levels. Tuesday’s Cerner-Siemens announcement drove record single-day traffic with 10,600 visits from 7,800 unique people – I run HIStalk on a high-powered dedicated, rack-mounted server (geek alert: Xeon E3 four-core CPU, dual 7,200 RPM primary disks, 120GB SSD for MySQL databases, 16GB DDR3 memory, CentOS 64-bit Linux) and the page still took forever to load on Tuesday afternoon when the site was slammed. Visits in the past 30 days exceeded 150,000 and the number of unique people reading is 38,000, more than double the July 2013 total. I get an amazing amount of support from readers, sponsors, and contributors and I’m glad to see the numbers reflect that.

Listening: new from Mary Lambert, an eloquent and empowering 25-year-old Seattle singer-songwriter with a heartbreaking history of sexual abuse, body image problems, and bipolar disorder whose dark and emotional live performances often elicit tears from her audience. Lyrics: “Girls like us are hardly ever wanted, you know. We’re used up and we’re sad and drunk and perpetually waiting by the phone for someone to pick up and tell us that we did good. Well, you did good. I know I am because I said I am. My body is home.” If that’s not your thing, the new Godsmack rocks – my hand is tired but happy from desk-drumming.


Acquisitions, Funding, Business, and Stock

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Allscripts announces Q2 results: revenue up 2 percent, adjusted EPS $0.09 vs. $0.05, meeting analyst expectations for both.

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Practice Fusion acquires Ringadoc, which it calls a “telemedicine platform” and “next generation patient-doctor communication tools” vs. Ringadoc’s self-description as “medical answering service software.” The appeal to Practice Fusion — other than the fact that its CEO is an investor and mentor to the now-acquired company — is that Ringadoc is testing a doctor consultation service for consumers, although it seems to be phone-based rather than online.

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The private equity firm that has owned healthcare product research vendor MD Buyline since 2011 sells the company to contract management solutions vendor TractManager.

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Valence Health says its first-half revenues are up 51 percent year over year and it has added 10 clients so far in 2014. Headcount has risen 150 percent in three years to 470 and the company just leased 125,000 square feet of new office space in Chicago.

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Walgreens announces that it will spend $15 billion to complete its acquisition of a European pharmacy and beauty company, but will surprisingly decline the resulting opportunity to declare its headquarters offshore to save a fortune in US taxes because of expected protracted IRS challenges and consumer backlash. The stock market’s reaction: shares dropped 14 percent. Meanwhile, the CIO of Walgreens hopes to leverage IT to meet the company’s goal of cutting operating expenses by $1 billion annually as it expects annual revenue to jump to $130 billion in the next two years.

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Doctor on Demand, which offers $40 video visits, raises $21 million in a Series A round, with Sir Richard Branson as one of its investors. The company is recruiting doctors to staff its service, touting flexible shifts, $200K income for full-time work, no overhead, malpractice coverage, the ability to work from anywhere with Internet access, and easy-to-use paperless technology that is “more like applications they use personally than traditional medical software.” Sounds like the job-frustrated Dr. Jayne should work some shifts and report back.

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Optum-owned QSSI, which was called in to save Healthcare.gov, will be the lead office tenant at a new Columbia, MD downtown office project scheduled for completion in July 2016.

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CoverMyMeds will lease 64,000 square feet of office space in Columbus, OH to handle its expected growth from 70 to 180 employees in the next few years.

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DrFirst secures $10 million in debt financing, which it will use to expand its development resources and prepare for international expansion.


People

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Peter Csapo (VHA Inc. and McKesson before that) joins Accretive Health as SVP/CFO as the struggling company prepares to restate its financials.

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CompuGroup Medical US promotes Werner Rodorff as CEO/SVP, replacing Norbert Fischl.


Announcements and Implementations

MModal joins athenahealth’s More Disruption Please program, adding its Fluency Direct and Fluency Flex mobile solutions to the MDP Marketplace.

Medicity and athenahealth will improve interoperability between their systems.

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T-System donates T Sheets to QuestCare Clinic, a Dallas-area non-profit urgent care clinic. It is operated in partnership with Watermark Community Church and sees patients without requiring ID, insurance, or appointment, asking only for a $10 donation.

Children’s National Health System (DC) goes live on MedAptus’ dual-code ICD-10 solution for 600 physicians and 400 nurses.


Government and Politics

A VA hospital social worker and union president who claimed in May that her hospital was keeping secret patient waiting lists says the hospital harassed her after she met with a White House representative in July by taking her desktop PC away for a week to encrypt it.

A review of 2013 AHA hospital survey data finds that only six percent of hospitals met Meaningful Use Stage 2 criteria. The actual number is probably even lower because the authors looked only at EHR capabilities, not actual usage in tricky areas such as sending summaries of care and allowing patients to access their own information. The study also did not take into account where hospitals stood with regard to 2014 Edition criteria.


Other

A former Epic employee posts details of the company’s “cryptic raise/bonus black box,” explaining that the normalized results from ranking each employee against co-workers in the same role are sent to the compensation team that assigns raises. This person was hired right out of college at $60K and earned bonuses of $16K and year-end raises of 18 percent and 10 percent. The annual salary of the employee, who was probably 24 when he or she left Epic two years later, was $84K. 

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Can Sanjay Gupta, MD please get back to his medical practice and ask CNN to return to its regularly scheduled programming of cute cat videos and celebrity gossip?

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An internist writes in a NEJM article what it’s like coordinating the ambulatory care of a newly diagnosed cancer patient. In the 80 days from the time the internist told the patient about a liver mass until the day it was removed, the patient saw 11 other clinicians, had 11 office visits other than with the internist, and underwent five procedures. The internist communicated with those other clinicians via 32 emails and eight telephone calls, adding another 12 calls with the patient or the patient’s wife. He concludes that such coordination is essential for patient safety, but is difficult since it involves distributed teams of people who don’t know each other and the healthcare system was not designed to support collaboration. The internist was modest enough to not point out that neither he nor his employer (Weill Cornell Medical Center) were paid a penny for all of his efforts.

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The annual Robert Wood Johnson Foundation report on EHRs finds that:

  • Two-thirds of hospitals have received HITECH money, but few of them can meet Meaningful Use Stage 2 criteria.
  • 59 percent of hospitals are using at least a basic EHR, quadruple the percentage of just four years ago, but only 26 percent have a comprehensive EHR and that number has increased only 3.6 percent since 2010.
  • Of the physician practices that received a Medicare EHR incentive check in 2011, 12 percent didn’t get one in 2012.
  • Of the physician practices earned a Medicaid EHR incentive payment in 2011, 61 percent did not in 2012.
  • The only hospitals that fell on the wrong side of the “digital divide” are critical access and small rural hospitals.
  • Health information exchange is still in its infancy, with barriers being privacy and security, competition concerns, and lack of physician demand.
  • Most hospitals use their EHR to create organizational performance dashboards, but only about half use them to identify care gaps and allow doctors to query their data directly. The key barrier is lack of EHR dashboard and query functionality.

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Weird News Andy speculates that patent trolls are getting bolder given this newly issued patent for this innovative process: (a) a patient calls a doctor’s office; (b) the receptionist records their information and asks the doctor if they want to talk to the patient; (c) if so, the receptionist calls the patient back, transfers the call to the doctor, and adds the recording of the call to the patient’s file. The article points out the infamous MMRGlobal/MyMedicalRecords, which sent threatening letters to practices who dared speak to their patients by telephone without paying it a license fee.


Sponsor Updates

  • Aperek posts highlights of its attendance at the AHRMM conference.
  • Blanchard Valley Health System extends its Wellcentive PHM initiative by instituting a Nurse Care Navigation program that nets significant ROI.
  • Boston Software Systems publishes a white paper on avoiding five myths of EHR migration and eliminating the chaos.
  • MEA|NEA uses the importance of a good website as an example of the importance of technology to growing a business in a recent blog post.
  • PerfectServe posts an article titled “The Changing Role of the Physician.”
  • Aprima kicks off its user conference in Dallas.
  • ADP AdvancedMD spotlights three smaller private practices using its cloud solution to stay clinically and fiscally efficient.
  • Kareo suggests six steps to take in hiring the right staff for a medical practice.
  • NextGen Healthcare announces a new name for its November user group meeting, NextGen One.
  • Premier Health (OH) discusses how it solved the challenges and complexities of payer pre-certification by deploying Passport Health’s OrderRite.
  • SRSsoft will participate in the American Society for Surgery of the Hand conference September 18-20 in Boston.
  • Allscripts shares what “Open” means for healthcare and why it’s so important.
  • IHT2 offers an infographic, “Analytics: The Nervous System of IT-Enabled Healthcare.”
  • Susan Niemeier questions whether the new cool thing is always the smart choice when it comes to technology on Capsule’s blog.

EPtalk by Dr. Jayne

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Of course the big news around the IT corridors today was the announcement of Cerner’s purchase of the Siemens Healthcare IT business. We are using solutions from both parties in at least some fashion. I’m not going to say exactly which ones (or respond to a reader comment asking specifically what systems I use) because I’d like to keep my day job. Let’s just say we have multiple hospitals that we’ve acquired over time and thus have a variety of systems in play.

We’re consolidating, which made the announcement more interesting although it’s not clear at this point how the marriage will impact us. If we decide to chuck everything and move to a different vendor entirely (always possible, but I’m not sure we can scrape up that much cash) it might be a moot point. Unfortunately, so many of our users have grown accustomed leveraging multiple systems to get the work done that the idea of a single vendor isn’t as sexy as it once was.

There was exactly zero discussion of the merger in the physician lounge, which didn’t surprise me. Unless they have stock in a given vendor or were involved in a selection process, some of our providers are oblivious to what system they’re actually using. We’re one of those cutesy organizations that gives every system an acronym used in a branding campaign to assist with user buy-in. I once had a user tell an auditor that our vendor was “SMILE” because we had used that acronym for a go-live.

Coupled with the fact that some of our systems are from vendors that acquired other products that we already owned and morphed them into a suite of quasi-connected pieces under a single name, it’s a wonder we can keep track of everything that’s in place.

For those users who do care that we use multiple systems, one benefit of consolidating our vendors would be a more consistent user experience. We already do a fairly good job of interfacing the data from system to system so that users don’t have to duplicate data entry, but it would be nice to have a more uniform look and feel. I’ve been through several product demos as part of the consolidation effort and have to say that even among vendors purporting to be single system, the look and feel can vary dramatically depending on whether they purchased components or built the system from scratch.

In the same set of comments, Brian Too asked how physicians want technology to reconcile the “tactical” needs of point of care IT support with the “strategic” needs of population health and statistical capabilities. “How do you make the physician interactions with an EMR low-friction while still gathering enough information, of sufficient quality, to support the strategic imperatives?” The answer is a difficult one. The key is in finding an easy way to enter discrete data that physicians don’t perceive as “clicky” or overwhelming.

I’m personally holding out hope for voice-to-data in which narrative can be parsed to identify discrete elements. Physician notes could appear like the dictations they’re accustomed to, but the data could sit underneath, ready for the picking. Technologies are getting closer and closer, but we’re still not to the point where we can pull it off in the way physicians expect.

Even with the slickest user interface, most of our providers still perceive data entry as being something they shouldn’t have to do (even though they did it in the paper world, only with a pen). I think it’s a factor of the volume of data they have to enter now compared to the pre-MU, pre-ACO era.

He also asks: “How much of current physician griping is more about having lost a certain amount of workplace control versus serious mismatches between software capabilities and real workflow needs?” Particularly among ambulatory physicians (and especially among those whose practices have been acquired by a hospital or health system) loss of autonomy may be the majority of the problem. Many organizations do not do a great job with the change management piece of the EHR transition. I see them doing a similarly bad job in transitioning purchased practices from independent to employed models, especially when the organization desires to standardize workflows or centralize certain practice functions.

When we hire new physicians coming out of training, I don’t hear anywhere near the level of complaining that we do when we acquire practices. Most new physicians have used EHRs during training and they’re used to the limitations, so whether they’re using one system or another it doesn’t seem to be as much of a big deal. You’d think we get more complaining from our most tenured physicians, but we actually don’t. The most vocal and unhappy of our providers are in the 45- to 55-year-old range. They’re generally proficient users, but they also have the highest expectations for what the system should be able to do and don’t like it when it doesn’t deliver.

At this point my perspective is so warped, I’m not sure what an ideal EHR would look like. For more and more physicians, the ideal EHR looks like a scribe.

What is in your ideal EHR? 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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August 7, 2014 News 16 Comments

News 8/6/14

August 5, 2014 News 13 Comments

Top News

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Cerner announces its intention to acquire the assets of Siemens’ health information technology business, Siemens Health Services, for $1.3 billion in cash. Cerner Chairman and CEO Neal Patterson told HIStalk that “the broad driver is the post-Meaningful Use era” and the large R&D budgets of both companies. The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion in annual revenue. Cerner expects the transaction to close in Q1 2015.

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Lorre took notes during the announcement call:

  • The Siemens customer attrition rate has been improving. Cerner will give them a clear path to a stable future and help get them there. Some percentage of those customers would have ended up with Cerner anyway.
  • When asked why the Siemens business is worth acquiring now when it was shopped previously with no takers, Cerner EVP/CFO Marc Naughton implied that Siemens cut the price and was waiting for a strategic buyer that wouldn’t leave its customers hanging.
  • Two Cerner executives will join the leadership team of Siemens. Only the client experience and administrative functions will be combined in the short term.
  • Siemens has had flat revenue for a couple of years and Cerner will boost that. Siemens has invested a lot of overhead in an unnamed project that didn’t accomplish anything – it will be cut immediately.
  • Neal Patterson, asked why this acquisition will work when so many other large ones haven’t, said Siemens knows what it’s doing and can expand, especially in population health management, specifically with regard to interoperability and openness.
  • International support will be evaluated country by country.
  • Asked why he was suddenly open to an acquisition, Neal said that IT is now ubiquitous and government incentive money is running out. IT will be pressured to meet mandates and provide measures. Cerner will evolve to population health and become a bigger part of the new middle. Cerner is building the most integrated EHR with integrated revenue cycle. Neal said he didn’t have a lot of enthusiasm about the transaction initially, but he went back to the two questions (would it slow Cerner down and can Cerner win over Siemens customers).
  • Neal said much of the industry’s healthcare IT talent comes from Cerner, so they have resources to draw from.
  • Neal said Siemens is a good asset with great talent at a fair price. They are passionate about innovation.

Reader Comments

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From Anon: “Re: Siemens. I read that the company is the largest application hosting vendor in healthcare. Any truth to that? It might add credence to Cerner’s bid.” I wouldn’t be surprised since they’ve been running remote hosting (or is that “offering cloud-based SaaS solutions?”) since the timesharing 1970s. That would provide a guaranteed revenue stream, at least until clients move off those legacy platforms, the pace of which might well be accelerated by the change of ownership.

From Black-Scholes Supermodel: “Re: Cerner acquiring Siemens. If that happens, I will take you to the biggest steak dinner ever at Gibson’s at HIMSS, wear a pink tutu, and dance on the table until I get thrown out.” That’s from a July 23 email to me from a very good equities analyst joking about my running the improbable Cerner-Siemens rumor yet again on HIStalk (going back into May). Now that I have both dinner and entertainment to look forward to at HIMSS, I’ll share the analyst’s logic: (a) Cerner says they don’t need to buy market share because their products are good enough on their own; (b) Cerner  integrates everything except a few ancillary plug-ins and doesn’t want more product lines; (c) Cerner already has ample opportunity in the rip-and-replace market, which it estimates at 2,000 customers, so it doesn’t need a fast track into the Siemens legacy business. The analyst concludes that Cerner buying the old SMS means that Cerner’s growth is stagnating and it needed to ignore its long-held principles to feed the beast.

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From HIS Junkie: “Re: Cerner acquiring Siemens. Looks like the John G magic could not work. He gave it a good try, but this was a sinking ship for over a decade. Let’s see, Siemens bought it for about $2 billion, gets 1.3 back … that’s only about $100 million per year loss! ..and it’s a great opportunity for Epic. Adds another 500 or so prospective clients to the mix.” Siemens destroyed quite a bit of corporate value, not to mention it paid way too much for SMS in the first place back in 2000, a 73 percent premium over SMS’s share price at the time. The division’s annual revenue today is the same as it was in 2000 and Siemens was anxious to unload the company for just 1x revenue.

From HealthITPundit: “Re: Cerner acquiring Siemens. So Judy Faulkner got Neal to bite! It was her plan all along that if Cerner bit more thank it could handle, Epic would be the last vendor standing. This will be an interesting corporate integration as any in this space. If Cerner is successful, they bought their market share. If they crash and burn, Judy is a genius. All the other verboseness about the win-win-win is a diversion from the truth. It’s all about stopping Siemens clients jumping to Epic. Gosh, I wish I thought of it!” That’s a solid observation. Cerner gains inside access to a large contingent of prospects who are sitting on primitive platforms. Cerner will be whispering “Millennium” in a soft and sexy voice while Epic bangs on the outside door. They won’t all go Cerner and some of the existing recurring revenue they contribute is already built into the $1.3 billion acquisition price, but they should be less-expensive customers to get onto Millennium and some of them are outside the traditional big-hospital demographic of both Cerner and Epic, plus both Cerner and Siemens offer hosting and operational support that is Epic’s weak point. 

From Dave Lancaster: “Re: Cerner acquiring Siemens. What impact might this have on smaller systems where both companies have competing products, such as their integration engines (Cerner OPENEngine vs. Siemens OPENLink)? Soarian and Siemens Rx et al. have some form of OPENLink embedded in them as their messaging services applications.”

From Kermit: “Re: Cerner acquiring Siemens. Nice HIStalk shout-out on this story.” That was nice – a few sites get their ideas from HIStalk and virtually none of them admit it, so thanks to Forbes.

From Old Malvernian: “Re: Cerner acquiring Siemens. Who do you think will be laid off beyond those from last month? John Glaser will probably get a big payday, as did Marv when he closed the Siemens deal in 2000. The other top execs will get an easy letdown, as most contracts have a nice acquisition clause. The Germans will be repatriated and employed. Those left hold the flaming bag of poo will be the H1B staff, offshore contractors, and worldwide rank and file. Siemens is the third largest employer in Chester County, PA. I wonder what the revised ranking will be?” Corporate support departments are sure to take a quick and painful hit: HR, marketing, and finance. The technologists and support people should be OK until product decisions are made. Those working in the hosting group should be in great shape. Sales could go either way – the company doesn’t seem to be selling much, so it’s tough to make an argument to spare sales from a shakeup. Every acquiring company says “business as usual” while drawing up long lists of those to be executed.

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From Himster: “Re: MModal COO Ronald Scarboro. Word on the street is that he has resigned effective immediately. No official statement from the company.” MModal verifies that Ron has left the company.

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From SQSUX: “Re: Sunquest. I’ve heard that more tenured folks are out the door. VP of HR is out and global client relationship manager has resigned.” Verified.


Vince Ciotti told me in late April that he was hearing rumblings about Cerner acquiring the health IT business of Siemens. He apologized for being wrong when it didn’t happen the following week, then emailed later to say he was hearing it again. I thought he might be right, so I saved this piece he sent me a couple of weeks ago so he could get the appropriate recognition when it happened.

Cermens? Siener??
By Vince Ciotti

Now that Siemens has officially announced that their HIT division is up for sale, the rumor about Cerner being a potential buyer becomes more interesting. The potential deal represents a huge shake-up in the HIS industry. Below are a few implications of what this deal could mean to the many parties involved.

Cerner

  • ProFit. After the $106M settlement with Trinity Medical Center in North Dakota at the end of last year, Cerner might have started looking for a replacement for its ProFit patient accounting system. When Siemens put its HIT division on the market, Soarian’s revenue cycle system must have seemed like a dream come true. Soarian’s clinicals still face several challenges (e.g. in the EDIS and ambulatory EHR arenas), but the revenue cycle module is relatively complete and working reasonably well, so for Cerner, the billion euro ($1.4B) price tag Siemens is asking might be reasonable in light of potential future litigation.
  • Data center. To its credit, Cerner has built two large data centers in Kansas City, many miles apart, which gives them reasonable protection against Midwest tornados. However, students of history might remember the New Madrid earthquake of 1812 that literally shook the whole state of Missouri. There was no Richter scale then, but scientists estimate it was between 7-8 points, and a re-occurrence today would cause unimaginable damage throughout the region. Acquiring Siemens’ super-modern data center in a different seismic zone would give Cerner the best backup protection of any US remote hosting vendor.
  • Sales team. Between them, Cerner and Siemens have the two best sales and marketing organizations in the industry. Both firms have grown to over a billion dollars in annual revenue thanks not only to their powerful new sales teams, but equally potent “account executives” who manage clients after the sale and sell new modules and systems, implementation assistance, consulting (totally objective, of course…), outsourcing, etc. These two combined teams would be able to sell screen doors on submarines, let alone HIS systems and services.
  • #1 vendor in revenue. We have been tracing the top HIS vendors’ annual revenue for many years for several leading HIS journals, and by our calculations, adding Cerner’s $2.9B in 2013 revenue to Siemens’ ≈$1.4B (what they’re asking for their IT division is probably about equal to its annual revenue) would create a $4.2B giant, a billion dollars larger than current industry leader McKesson. The merger would put Epic in third place, at “only” $1.7B

Siemens Clients

  • Soarian clients. One could imagine an interesting face-off between Millennium HNA and Soarian Clinicals at new prospects, but HIS-tory tells us that Cerner will probably stick to its Millennium HNA core system for future hospital sales, building an “integrated” interface to Soarian Revenue Cycle. What the deal means for Soarian clinical clients is an interesting question – Cerner would eventually try to convert them to Millennium, probably as individual contracts (from 10-12 years in duration) come up for renewal.
  • Invision and Medseries4 clients. Siemens recently assured the hundreds of clients on these aging HIS systems that Malvern would be supporting them for many more years, but will Kansas City? Again, the contract duration would probably determine how long they offer to support these individual hospitals: long-term contracts with many years to run would be supported the longest, while shorter-term agreement might get pressured to convert off of them earlier, lowering Cerner’s costs to support these legacy systems and increasing Millennium sales.

Competition

  • Epic. Should stand to gain enormously in future competitive situations as Siemens’ clients go to market, as Epic’s tidal wave of victories over the past five years continues. This is especially true at IDNs with large physician practices, where Epic still rules with its extremely functional and totally integrated ambulatory EHR and PM systems. Siemens had promised to add an integrated ambulatory EHR and PM system to Soarian, but the slow delivery of this costly R&D project could be one of the main reasons the parent company is selling its HIT division.
  • McKesson. The sunset of their large-hospital Horizon system has left them out of most large hospital sales for years and they are only beginning to make headway with Paragon in the mid-sized hospital market of 300-500 beds. The real question is how long it will take them to upscale Paragon to compete with Cerner and Soarian in the high-end market of 500+ beds. I should be fully retired (and maybe even deceased!) before that occurs, so I’ll leave that prediction to other pundits.
  • Allscripts. Would now rank in fourth place in terms of annual revenue at ≈$1.4B. Their solid ambulatory EHR and PM systems should sell well under Paul Black’s ex-Cerner leadership. However, the lack of true integration with the Eclipsys-based hospital EHR will be a weakness that the Cerner/Siemens sales reps will hammer upon.
  • GE. Oddly, their recent victory over Siemens in the bidding war for the French-based Alstom may have been a contributing factor in Siemens’ decision to sell its US HIT division to deepen its capital reserves. GE’s ambulatory solutions continue to perform well, but they have not made a hospital sale with their ex-IDX Centricity Enterprise system in recent memory, but rather have lost clients to Epic repeatedly. Now if Alstom has an EHR system…

Historical Precedents

Ironically, the only vendor acquisition of this size was when Siemens itself acquired SMS in 2000 for ≈$2B, not a bad profit for Jim and Harvey, who started SMS in 1969 with a $5M loan from savvy Wall Street investors. Prior to that, it was McKesson’s acquisition of HBOC in 1998 for a $14B stock swap that had topped the charts, although the subsequent financial scandal caused that stock value to drop precipitously. Aside from these two mega-deals, other large acquisitions that put the Siemens bid in perspective include include:

  • Allscripts buying Eclipsys for $1.35B
  • NTT Data acquiring Keane for $1.2B
  • GE gobbling up IDX for $1.2B

However, these other deals didn’t involve one HIS vendor buying another, each with a competing array of HIS products and services. That’s what makes the potential of Cerner acquiring Siemens’ HIT division an unprecedented industry shake-up, in that it will impact over 1,000 hospitals with these two vendors’ complex array of systems installed. Should make some interesting reading on HIStalk for many years to come!


Acquisitions, Funding, Business, and Stock

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Premier, Inc. will acquire clinical surveillance software vendor TheraDoc from Hospira for $117 million in cash. TheraDoc has 1,000 facility customers. The price reflects around 10 times the company’s operating earnings, according to the announcement. Hospital acquired TheraDoc in 2009 for $63 million. Premier’s SafetyAdvisor is similar in analyzing data for hospital-acquired infection and for antimicrobial stewardship programs.

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MModal exits Chapter 11 bankruptcy following financial restructuring and debt reduction of 55 percent.

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Imprivata announces Q2 results: revenue up 34 percent, adjusted EPS –$0.81 vs. $0.01, falling short on earnings expectations.

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The slide continues for the wildly hyped Castlight Health, with shares closing down another 4 percent Monday to $11.70 vs. March’s IPO day close of around $40. That’s a stunning 70 percent drop in less than five months. Above, it’s (obviously) CSLT in blue and the Dow Jones Industrial Average in red. Even at the fire sale price, the company is frothily valued at $1 billion, or 36 times revenue. The company announced last week that two of its directors have quit and the COO is leaving at the end of September, coinciding with its Q2 report that listed a $22 million quarterly loss.

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McKesson shares closed Monday at an all-time high. You would have made 10 times your investment had you bought shares in the post-HBOC disaster days of 2000.


Sales

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Providence Health & Services (WA) and Greenville Health System (SC – above) choose Infor Healthcare, which includes supply chain management and execution.

The Navy Medicine Operational Training Center (FL) selects AtHoc for mass notification and command-wide communications.


People

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PatientSafe Solutions names Peter Longo (Health Gorilla) SVP/chief revenue officer.

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Jason Jobes, associate director of revenue cycle solutions at The Advisory Board Company, is named to the Board of Examiners for the 2014 Malcolm Baldrige National Quality Award, which is managed by NIST.  

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Genome informatics vendor DNAnexus names David Shaywitz, MD, PhD (Theravance) as chief medical officer.

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David Levin, MD (Cleveland Clinic) joins Nordic as chief medical officer.


Announcements and Implementations

DataMotion launches Direct Community Web Portal, which allows hospitals to meet Meaningful Use Stage 2 transition of care objectives by securely transferring PHI from one care setting to another. Affiliated providers aren’t required to use Direct or to run a certified EHR – the portal include a CCD viewer.

American Heart Association launches an Open Innovation Challenge for Midwestern startups with ideas about how to help people prevent or manage cardiovascular disease or stroke. The 10 best ideas move on to a crowdfunding competition and the top three then pitch to judges and investors in Chicago in November. The winner gets a $20,000 grant and whatever crowdfunding money they raise. Applications are due on September 12.

EHNAC releases new criteria for its HIE Accreditation Program that include the Texas program. EHNAC is a non-profit organization that accredits HIEs on their use of standards to achieve quality and trust.

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California Integrated Data Exchange, funded by $80 million from Blue Shield of California and Anthem Blue Cross, announces plans to develop the Cal Index statewide HIE. Cal Index says it will go live in late 2014 with 9 million records online. The initial funding covers the first three years of operating expenses, after which the HIE plans to sell subscriptions. Note the business model: insurance companies are paying, which makes sense since they get access to data and their costs should go down with better care coordination. Finally there’s a business case for running an HIE.

IMedicor launches a cloud-based dental EHR.

Mississippi Medicaid launches a clinical data repository, provider portal, and MPI using technology from MedeAnalytics.


Government and Politics

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Vermont ends its relationship with CGI and gives Optum a no-bid contract to take over Vermont Health Connect, saying CGI repeatedly missed deadlines and the site still isn’t fully functional. The state says the cost of the insurance exchange will probably exceed the $83 million CGI was to be paid, of which Vermont has already written checks for $57 million (97 percent of which comes from federal taxpayers). The state’s chief of health reform said in response to questions about hiring Optum without bidding out the work, “The state RFP process takes forever … we are undoubtedly going to get hammered. I don’t care.”

The Affordable Care Act is boosting the bottom lines of both for-profit and non-profit hospitals as newly insured patients use more orthopedic, oncology, and maternity services. Insurance companies are spending more than they expected, with Cigna’s CEO saying that health insurance exchanges aren’t sustainable unless more people, especially healthier ones, sign up through them.

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CMS temporarily suspends use of its Open Payments system that shows payments made to doctors by drug and medical device companies. CMS found that a batch of payment records from an unnamed company had assigned payments to the wrong doctor by including an incorrect state medical license number. The system isn’t live yet, although doctors are able to verify their information.

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An HHS OIG review finds that ONC’s former temporary certification program (ATCBs) didn’t ensure that certified EHRs were retested, didn’t include a training program to ensure that  testers were qualified, and didn’t look hard enough at security-related issues such as password complexity and user privilege changes. ONC replied that ATCBs are extinct and full certification now features improved security and privacy features, to which OIG commented, “We do not agree that the 2014 Edition EHR Certification Criteria sufficiently address our security concerns regarding the Temporary Program.”

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Habersham Medical Center (GA) is struggling financially after voting in September 2013 to pay back $1.5 million in HITECH EHR incentive money it found it hadn’t qualified for and for borrowing $37 million for expansion and facility improvements. The CEO found that the 53-bed hospital had attested for the first incentive payment without having the necessary software despite having spent $3 million upgrades, leading to his dismissal of the IT director and sending CMS its money back.


Innovation and Research

Accenture and Philips develop proof-of-concept software that allows people with ALS and other nerve diseases to control Philips products using their brainwaves, along with existing capabilities to use voice and eye commands.

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More promise of using technology in cancer treatment: a startup that develops oncology drugs by artificial intelligence and big data gets its first drug into human trials.


Other

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The AMA tweeted the above graphic that references a magazine’s survey. The survey’s methodology wasn’t stated, which would have been nice since some of the percentages involve subsets of other questions and the devil is in the details. It also wasn’t stated if the survey involved self-selected online respondents, the validity of which is nearly zero.

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In England, The Royal Free Hospital uses OpenText’s content management product to import paper-based progress notes and link them to Cerner Millennium.  

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A crematorium in England installs a Digital Autopsy center run by software company iGene London. It uses a multi-slice CT scanner to create a 3D image that a pathologist can examine on a tablet.

A Russia-based crime ring is found to have stolen 1.2 billion Internet username/password combinations and 500 million email addresses using botnets.

Local governments in China say GE Healthcare’s telemedicine projects are floundering because their equipment is too expensive at over $300,000 per installation, adding that GEHC tried to sell less-expensive equipment to take market share away from Siemens but ended up competing with its own distributors.

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Weird News Andy performs a literature review of robot nurses. Around 150 “welfare facilities for the elderly” in Japan are using Palro robots that remember names, faces, and previous conversations. Gizmodo profiles the RIBA-II robot nurse. Pittsburgh-based robotics firm RE2 releases a new line of robots that can mimic human movement to perform repetitive processes and lift heavy objects. The upcoming Disney movie “Big Hero 6” features an engineer who transforms a robotic nurse into a fighting machine with pop-out wings and a projectile fist (which could be useful for robotic nurses assigned to urban EDs.)


Sponsor Updates

  • Beacon Partners will exhibit at the Siemens Innovation Conference August 10-13 in Tampa, FL.
  • A blog post by Brad Levin of Visage Imaging addresses how radiology can improve productivity and quality.
  • Health Catalyst CMO Bryan Oshiro shares his wake-up call that solid data can save lives.
  • Greenway extends special pricing for Engage14 in Dallas September 4-7.
  • Greenway suggests how to select the clinical quality measures for a primary care practice.
  • ICSA Labs certified HIStalk sponsors Medfusion and Wellsoft in July.
  • HealthTronics posts its event schedule through the end of the year.
  • InstaMed launches its bi-coastal billion transaction infrastructure.
  • Premier Medical PC (AL) selects McKesson Business Performance Services.
  • Craneware and Shriners Hospitals for Children are co-presenting this week at AHRMM14 on automation of supply and pharmacy management processes.
  • Allscripts announces speaker information and agenda for ACE 2014 in Chicago August 12-15.
  • Valence Health is moving into larger office space in Chicago with plans to hire an additional 500 employees by 2019.

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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August 5, 2014 News 13 Comments

Cerner To Acquire Siemens Health Services for $1.3 Billion

August 5, 2014 News 6 Comments

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Cerner announced this afternoon that it will acquire the assets of Siemens’ health information technology business, Siemens Health Services, for $1.3 billion in cash.

According to a statement from Cerner Chairman and CEO Neal Patterson, “We believe this is an all-win situation for the clients of both organizations and all of our associates and shareholders. Through more than $4 billion of cumulative investments in R&D, Cerner has established a strong market standing and is positioned for continued growth. Siemens’ health care IT assets provide additional scale, R&D, an impressive client base, and knowledgeable and experienced associates who will help Cerner achieve our plans for the next decade. In addition, the alliance we’re creating will drive the next generation of innovations that embed information from the EMR inside advanced diagnostic and therapeutic technologies, benefitting our shared clients.”

I spoke to Patterson ahead of the announcement. He said, “Siemens could not keep up with the need to innovate across the continuum,” adding that Cerner looked carefully at how its business would fit into Cerner’s. “If it slowed us down, we weren’t going to touch it. If we didn’t think it would have a huge value proposition, we weren’t going to touch it.”

Patterson added, “The broad driver is the post-Meaningful Use era” and pointed to the $650 million combined annual research and development spend between the two companies. The companies will also jointly fund a $100 million alliance to perform development activity around diagnostic and therapeutic medicine. “IT systems are important to Siemens’ healthcare modalities,” he told me. “We will go much deeper than the workflow level.”

Patterson summarized, “This is a win-win-win across the board. Siemens clients will get a lot of value. We will partner on their core healthcare business. Lots of our clients use both systems in different capacities.”

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Cerner says it will continue to support Siemens’ platforms and will support Soarian “for at least the next decade.”

John Glaser, PhD, CEO of the Siemens unit, said in a statement, “We are excited to join with one of the most competitive companies in health IT today, and a recognized leader in innovation. Siemens cares deeply about its clients and believes Cerner is the best organization to fully support their health IT needs going forward. The knowledge and strength of our combined resources opens up great possibilities for future collaboration and development, which is exciting for all of us. And our clients will benefit from our alignment with a company that has such a strong historical and future commitment to rapid innovation.”

The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion of annual revenue. The transaction is expected to close in the first quarter of 2015.

HIStalk has featured rumors of the acquisition going back to early May, when Vince Ciotti was the first to tip me off to the rumors.

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August 5, 2014 News 6 Comments

Monday Morning Update 8/4/14

August 2, 2014 News 5 Comments

Top News

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Johns Hopkins Medicine (MD) and Kaiser Permanente announce a collaboration in which they will share EHR best practices, develop technology to deliver personalized medicine, and create better and cheaper care models.


Reader Comments

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From HIS Geek: “Re: Siemens. To understand Siemens’ lack of smooth integration, you need to go back to the SMS roots. In the 1980s and 1990s, SMS technical groups were organized internally based on hardware loyalties — DEC, IBM, PCs, networks –not customer or market needs. Silos of technology, support, and sales added more problems. Siemens failed to fix the SMS legacy. It added its own agendas on top of it all and ignored the EHR market trends.” Big vendors trying to juggle legacy products always have that problem – segregation of their expertise by product line and destructive internal infighting for executive attention. Both McKesson and Siemens bet their credibility on new showcase products that failed – Horizon and Soarian – although I respect Siemens for at least trying to build something new even though their stodgy German leadership and SMS’s mainframe mentality made it unlikely to succeed. The best full-spectrum vendors – Epic, Cerner, and Meditech – are healthcare-only and focus on a single product line that they built themselves, and even with Cerner and Meditech their weakest products are ones they acquired. Big corporations dabbling in multiple vertical industries usually populate the bottom rungs of healthcare IT user satisfaction and innovation; prospects they convince otherwise are likely doomed to repeat history.

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From DenverDermPA: “Re: Greenway. We had a PrimeSUITE upgrade to 17.0 two weeks ago. The system has slowed to a crawl – it takes 2-5 minutes just to change patients. Greenway support advised that it’s a known issue documented in the 30-page release notes. The impact has been an extra 1-2 hours charting after hours every day, extra time to respond to critical lab results, and an extra day to respond to refill requests. Should I consult with legal counsel? Are other users having this issue? Can I report EHR issues to the government?” Two weeks is a long time to live with a crippled system, but Greenway is your only hope of fixing the problem. Assuming you’ve escalated to a high level and are continuing a dialog that suggests they’re working on it, I wouldn’t call a lawyer or complain to the federal government – you might feel good about lashing out, but that’s going to create a barrier between you and the only people who can improve your day-to-day existence. I’ve forwarded a high-level Greenway-provided contact who promises to look personally into your issue. If the problem is yours alone, a few hours of tech time should figure out a solution, but if it’s not (which I agree would then indicate poor QA on Greenway’s part, and I’d be interested in hearing from anyone else having the same problem), the developers need time to develop an all-client fix that doesn’t break something else. You also mentioned that you don’t have a test environment and didn’t read the release notes, which I understand as a very small practice, but that’s a lesson learned – you and your vendor bear equal responsibility for making sure new releases work in your particular environment and that you are ready to go live with the changes — including training, required configuration, and testing every critical function regardless of whether or not the vendor says they changed them (the functions programmers didn’t mean to change are usually the ones that elude QA). SVP of Product Management Mark Janiszewski provided this response to my inquiry:

Many of our Greenway PrimeSUITE customers recently upgraded to our Meaningful Use-certified release in order to attest for Meaningful Use. This release contains a number of new and changed workflows made necessary by MU 2014 requirements and also includes improvements to our lab orders module. We’re working with our customers every day to answer their questions regarding the many new capabilities of 17.0. Also, we’ve identified several areas where the workflows and tools can be enhanced to improve efficiency, and have our development team focused on getting those to our customers as quickly as possible – currently every few weeks.


HIStalk Announcements and Requests

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Respondents were split 50-50 on whether EHR vendors influence government policy too much. New poll to your right: should the federal government define and mandate EHR interoperability requirements? Click the “Comments” link on the poll box after voting to elucidate further.

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Welcome to new HIStalk Platinum sponsor WeiserMazars. The New York-based accounting, tax, and advisory company, founded in 1921 (!), offers providers and health plans IT consulting (planning, review, governance, network planning, system selection, contracting, project management, and facilities management), financial advisory services, revenue cycle services (assessment and transformation, revenue integrity, point-of-service collections, charge master, charge capture, and collections improvement), and full service options for managed care related services. A recent client survey found that 98 percent would recommend the company to others. Ken Fischer, who ran his own firm Smart Solutions for Health Care and worked for KPMG’s healthcare practice before that, is in charge of the healthcare group. I noticed that the company announced Friday its acquisition of pmpm Consulting Group, a California firm that offers managed care services. Thanks to WeiserMazars for supporting HIStalk.

It’s interesting that the significant percentage of Americans who are fat, don’t exercise, and ignore the instructions of their doctors can’t fixate enough about the media-hyped transfer of two Ebola patients to the US, accompanied by the embedded TV talking head doctor Sanjay Gupta.

Listening: the stunning Scotland-based heavy metal progressive (Rush meets Spock’s Beard) band Pallas, which has been around intermittently since the early 1980s.


Last Week’s Most Interesting News

  • CMS issued a rule setting October 1, 2015 as the enforcement date for ICD-10.
  • McKesson turned in great quarterly numbers, but its earnings were hurt by an accounting change involving the sale of its European healthcare IT business. Revenue from the Horizon product line that’s being phased out dropped as expected.
  • A GAO report found that Healthcare.gov will end up costing taxpayers nearly a billion dollars, much of that due to CMS mismanagement of the project.
  • Congress moved quickly to approve giving the VA $16 billion to hire more staff, open new clinics, and pay for the outside care of veterans who can’t get prompt VA appointments.
  • The Senate Appropriations Committee directed ONC to identify and decertify EHR vendors that “proactively block the sharing of information.” Meanwhile, big vendors continue to proclaim themselves as “open” and criticize their competitors – namely Epic – as “closed.”
  • The companies that acquired Sunquest and Encore Health Resources say they are contributing strongly to their bottom lines and are growing.
  • National Coordinator Karen DeSalvo wrote a letter to the Boston Globe expressing disappointment at its article that criticized EHR-related oversight and patient safety, adding her pitch for ONC’s proposed health IT safety center.

Acquisitions, Funding, Business, and Stock

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Outpatient surgery software vendor SourceMedical acquires Encircle Healthcare, which offers a surgical eligibility and registration patient portal.

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From CPSI’s earnings call Friday:

  • The company implemented its new ED system in three hospitals and has two more scheduled next quarter.
  • The new Medical Practice EHR is live in 10 practices.
  • Ten hospitals completed Meaningful Use Stage 2 attestation and another 13 are ready. The patient engagement requirement is the big stumbling block.
  • The Meaningful Use delay hasn’t impacted sales since it was really only a three-month delay – deferring to 2015 requires a full-year attestation starting October 1, 2014 instead of attesting for a 90-day period.
  • Scheduling the user conference in Q2 rather than Q3 moved a $500,000 expense up one quarter.
  • Chairman and CFO David Dye said that rural hospitals are struggling, but added, “I can hardly think of any time in the 25 years that I’ve been here that I wouldn’t have said the exact same thing.”
  • President and CEO J. Boyd Douglas said in response to an analyst’s question about Cerner reporting small-hospital gains with CommunityWorks that CPSI isn’t seeing Cerner in any significant way after a slight uptick a year ago.
  • Dye said that while CPSI might consider acquiring a population health management systems vendor, they’ve never done an acquisition and have written all products themselves.

People

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Tomas Gregorio (HealthEC) is named senior executive director of healthcare systems innovation of New Jersey Innovation Institute. He was VP/CIO of Newark Beth Israel Medical Center from 2006 to 2010.

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PM/EHR vendor MedEvolve names Michael Schiller (Streamline Health) CEO.


Announcements and Implementations

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Carolinas HealthCare (NC) releases The Amazings, a free game app for kids 7-12 who have asthma. It helps them avoid triggers such as pollen and cigarette smoke. That’s a pretty cool project for a health system to take on.

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Wisconsin-based Anthem Blue Cross and Blue Shield provides subscribers access to LiveHealth Online, which provides mobile-based, two way video telemedicine sessions with US-based doctors to residents of most states. Visits average 10 minutes and cost $49 by credit card without insurance. Doctors can generate prescriptions from the visit in many states. Users can choose a doctor by viewing their profile and their online ratings. LiveHealth Online is WellPoint’s rebranded version of American Well.


Government and Politics

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Massachusetts gubernatorial candidate and former Institute for Healthcare Improvement President and CEO Don Berwick, MD says that “healthcare costs are eating the state alive” at 42 percent of the state’s entire budget, or $15 billion per year. Berwick says administrative overhead makes Massachusetts “the most expensive state for healthcare in the most expensive country in the world” and proposes a single-payer system that would create transparency and public accountability. The Democratic primary is September 9.


Other

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Stanford Medicine (CA) launches the first ACGME-accredited clinical informatics fellowship, directed by Stanford Children’s Health CMIO Christopher Longhurst, MD, MS.

A federal claims court overturns the VA’s ICU systems award to Picis, finding that the VA relaxed its standards in choosing its products over those of CliniComp, which filed suit.

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Richard Cope, president of specialty EHR vendor Boston Advanced Analytics (formerly Coping Systems), is fined $1,000  by the city of Quincy, MA for renting his home on Airbnb. The city’s inspector confided to reporters, “We believe there are others.”

A Tucson, AZ urology practice notifies 3,000 patients of a data breach after finding that employees don’t always remove stick-on labels from urine sample cups before throwing them away. The labels contained patient name, date of birth, chart number, physician name, and date of service.

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The management team of Riverside Hospital (TX) asks a US district judge to allow its former administrator — who is charged with leading a $158 million Medicare fraud ring at the same hospital and is banned from working in healthcare — to return as an unpaid consultant to save the hospital from financial peril. The state had previously stopped sending patients to the hospital because of widespread fraud, but the former administrator contacted Congresswoman Sheila Jackson Lee, who successfully demanded that the state give the hospital another $3 million. The hospital paid “recruiters” $300 for each Medicare patient they brought off the street to one of the hospital’s six psychiatric clinics, where the senior citizens hung around all day as the hospital billed Medicare $116 million for therapy sessions.


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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August 2, 2014 News 5 Comments

News 8/1/14

July 31, 2014 News 7 Comments

Top News

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A new CMS rule officially confirms October 1, 2015 as the new ICD-10 deadline. The announcement adds a bit of unintentional humor in saying the revised date “allows health care industry ample time to prepare for change.”  


Reader Comments

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From The PACS Designer: “Re: Apple iTime. TPD’s sleuthing of US Patent Office new approvals has uncovered the iWatch patent. Apple iTime is the name given to patent # US 8,787,006 B2 for the wrist-worn device. Apple’s stock price has been rising since the patent was issued, probably some employees adding stock to their portfolios before any announcement from Apple.” It’s actually a three-year-old patent that was just approved, and like any good patent, is maddeningly vague to ensure covering as much intellectual property as possible. It mentions a GPS, heart rate monitor, accelerometer, and touch screen as options that are contained in the strap.


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Siemens Products
By Quiet One

In response to Chester of Malvern’s post on “What a Cerner Acquisition of Siemens Health IT Would Look Like.”

As much as I criticize Cerner, at least they have an integrated system. Siemens Health Services’ systems might as well all be from different vendors.  It seems like they deliberately made them difficult to integrate so they could sell more services. Or maybe that was the result of them laying off people in Malvern and outsourcing work to India.  

I can’t imagine why someone would want to buy this set of assets other than for the customers and the data center. I doubt that Cerner would maintain the products, which is unfortunate since having lots of choices is good for all and Invision and MedSeries4 are good systems that got neglected due to the Soarian fiasco.

  • "Soarian sites are happy with their financials, which are better than Cerner’s." I would seriously question this. Hardly anyone implemented Soarian Financials and they put even less effort into this product than they did Soarian Clinicals. It would probably be true to say Invision customers are happy with their financials, although that incidentally is the oldest part of Invision, based on IBM’s SHAS, and is batch oriented with sort of a CICS-based overlay so it’s not the most ideal product in my opinion.
  • “Love the Soarian business process manager — the rules engine is quite impressive." If you’re impressed with their rules engine, which is a separate product on a separate box with its own implementation fees, you’ve obviously never worked with Epic, or for that matter, Cerner.
  • "Siemens RIS…" Actually, this is one of their better products and is relatively stable. It has a pretty well designed Unix/DMQ/Sybase backend. Siemens is big in radiology because of their medical equipment business. The RIS product was moved out from under Siemens Health Services, so I wonder if it would be part of the sale.
  • "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)." This astonishes me more than anything and makes me question KLAS’s methods (Siemens does actively encourage customers to submit KLAS questionnaires). To say that it does not manage pathology very well is a big understatement. It does not have any pathology functionality at all, nor does it have blood bank functionality, or even instrument interfaces. It does offer a single outgoing and incoming instrument interface to connect to a broker like Data Innovations that you get to buy separately. It’s built on top of the Siemens RIS platform, but it seems like they gave up midway. So what does it do? Not much. In fact, for the administrative/setup functions, they use forms on a Microsoft Access MDE file linked to the Sybase back end.
  • "Siemens Pharmacy and MAK works with Soarian – different platform, but functional." This is a DSM/Cache-based product built on top of their discontinued Unity system and has a lot of baggage from that. It actually is standalone and is often used by Invision and Soarian sites due to integration hurdles that Siemens imposes to prevent them from going with competing products. That said, integration between Siemens Pharmacy/MAK and Soarian is surprisingly difficult. You’ll also need to purchase the rules engine separately (again a separate box and separate implementation costs) and will probably need to purchase a third-party label printing system.

HIStalk Announcements and Requests

This week on HIStalk Practice: UNC-Chapel Hill researchers develop the FutureDocs physician shortage forecasting tool. Colden & Seymour ENT and Allergy, and Children’s Healthcare Massachusetts go live on the Wellport HIE. The American Academy of Family Physicians rebrands its Center for Health IT. The Children’s Health Alliance implements the Wellcentive Advance population health management platform. The Global Partnership for Telehealth conducts successful telemedicine consultations in Honduras. 23andMe secures new funding from the NIH. Take the HIStalk Practice reader survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers Benedict Evans’ most recent podcast, connecting the proliferation of smartphones with the inevitable scaling of mHealth use cases. Proteus Digital Health extends its Series G funding round to make room for more investors, closing the round at $172 million. Google announces a new health-focused X Labs project that aims to capture as much data as possible on human health, down to the genome and molecular level.


Acquisitions, Funding, Business, and Stock

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MedAssets reports Q2 results: revenue up 2.7 percent, adjusted EPS $0.30 vs. $0.30, meeting revenue expectations and beating consensus earnings expectations of $0.29.

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McKesson reports Q1 results: revenue up 37 percent, adjusted EPS $2.49 vs. $2.11, beating expectations on both. Meanwhile, an employee McKesson fired four months after the company’s last annual meeting in which the man asked CEO John Hammergren to improve employee wages and benefits was back at this this year’s meeting, hoping to persuade shareholders that Hammergren’s $292 million change-of-control golden parachute is unreasonable. The former employee and the union he works for were unsuccessful – shareholders vote down a proposal to reduce the amount, which McKesson’s board explain as “an important tool for motivating our executives in the face of a potential change in control transaction.”

From the McKesson earnings call:

  • The company’s sale of its McKesson International Technology was reclassified from discontinued operations in 2014 to continuing operations in 2015, causing a charge of $34 million ($0.11 per share) to GAAP earnings.
  • McKesson won’t rebid its UK workforce solutions business when it expires late next year.
  • Technology Solutions revenue dropped 8 percent because of already-expected poor Horizon Clinical revenue, the divested foreign business, and “planned elimination of a product line.”
  • John Hammergren is pleased with RelayHealth’s growth.
  • He talked up CommonWell, which he says will be expanded and commercialized after the pilots are completed. He didn’t say what “commercialized” means.

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From Merge Healthcare’s Q2 earnings call:

  • The company says it, along with other enterprise imaging system vendors, is being hurt by indecision, mergers, and a preoccupation with ICD-10 and Meaningful Use Stage 2 among providers.
  • Merge says it signed seven new iConnect customers in the quarter, iConnect Cloud Archive is growing rapidly, and Merge eClinical OS increased user count by 27 percent.
  • The company expects hospital mergers to trigger new VNA and universal viewer sales.
  • Merge is offering per-transaction contracts with no minimums.

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In the Quintiles Q2 earnings call, CFO Kevin Gordon says he expects the acquired Encore Health Resources to contribute services revenue of $40 million. CEO Thomas Pike adds of the acquisition with regard to its pharma customers, “With our new acquisition of Encore, we also see this real flow of interest into the electronic health records and how our customers can really understand the practice of medicine taking place out in hospitals and in clinics associated with their drugs. I think the capabilities we’re assembling just give us unique insights for those customers.” Quintiles is a big pharma services vendor headquartered in Durham, NC with 29,000 employees and a $7 billion market cap.

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CPSI announces Q2 results: revenue flat, EPS $0.81 vs. $0.77.

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The Advisory Board Company reports Q1 results: revenue up 15 percent, adjusted EPS $0.30 vs. $0.31.

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Vocera reports Q2 results: revenue down 9 percent, adjusted EPS –$0.16 vs. $0.01.


Sales

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Healthcare Data Solutions will provide its US healthcare databases and business intelligence services to aPureBase, a Denmark-based life sciences data supplier.

Michigan Health Information Network selects DataMotion to provide Direct Secure Messaging services.

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Capital Women’s Care (MD) enters into a 10-year agreement with NextGen Healthcare to provide RCM services for its 45 locations.

Bon Secours Health System (MD) will deploy Premier’s PremierConnect Enterprise data warehouse and business intelligence platform.


People

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Vocera names Justin Spencer (Symmetricom, Inc.) as EVP/CFO.

Avery Cloud, CIO at New Hanover Regional Medical Center (NC), will leave the organization this week to take a position with an unnamed Houston employer.  


Announcements and Implementations

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Several Novant Health (NC) hospitals will go live on its $600 million Epic project this weekend. Novant says it hopes to avoid the Epic-related problems experienced by its Triad competitors Wake Forest Baptist Medical Center and Cone Health.

Navicure added 272 new accounts in Q2, a 76 percent jump over a year ago.

Geneia launches its Theon analytics platform.

Medical animation vendor Nucleus Medical Media joins the Greenway Marketplace.

Levi Ray & Shoup launches PageCenterX/Satellite to provide downtime reporting capabilities for system outages.

PMD launches its Observation Result interface to streamline cardiology test interpretations and charge capture.

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Microsoft names Allscripts its “US Health Provider Partner of the Year.”

In Germany, the government will create an eHealth council to promote the exchange of digital healthcare information.

CHIME launches a new membership organization, the Association for Executives in Healthcare Information Security (AEHIS), as a professional organization for healthcare chief security officers. CSOs who are accepted by December 31, 2014 will be recognized as founding members and will receive a year of membership free.

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Providence Health & Services partners with Patrick Soon-Shiong’s molecular medicine institute to buy a $10 million population-scale genomic sequencing system best known for breaking the under-$1,000 test barrier. Providence will use the genetic information to tailor cancer treatments to individual patients, processing the information on Soon-Shiong’s supercomputer array run by the NantOmics division of NantHealth.


Government and Politics

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A GAO report concludes that Healthcare.gov has cost taxpayers $840 million so far and warns that continued CMS mismanagement, including sloppy contracting practices and poor oversight, will cause problems in the upcoming November open enrollment period. Accenture’s initial contract for $91 million to replace the fired CGI has already swelled to $175 million through June due to design revisions. CMS agreed with the report’s recommendations that they get their act together, which would have been nice a few hundred million dollars ago. Surely nobody other than the federal government could roll out a billion-dollar website. Maybe we taxpayers should develop our own Meaningful Use performance standards (with GAO’s help) and cut HHS’s budget for failing to meet them.

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The Cover Oregon health insurance signs a $70,000 contract its former CIO Aaron Karjala, who resigned in March after the $134 million system’s failure. The state hopes he will help them build a case in their lawsuit against Oracle.

The CIA admits that its officers hacked into the computer network of the Senate Intelligence Committee, which oversees the agency.


Technology

George Takei gets a smartphone physical in Boston, although he seems more amused than impressed. 


Other

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Dan Nigrin, MD, MS, SVP/CIO of Boston Children’s Hospital (MA), publishes an article in the just-released issue of The New England Journal of Medicine called “When ‘Hactivists’ Target Your Hospital.” It describes the orchestrated distributed denial of service (DDoS) attacks launched against the hospital by the hacker group Anonymous, which was upset about a child custody case. Data traffic jumped 40 times normal, although the hospital blunted nearly all of its impact by working with a DDoS defense vendor, which rerouted traffic to is filtering center and sent only legitimate web page requests through to the hospital. The group also tried direct network attacks and blasting phishing email hoping an ill-advised employee click would give it access. Dan urges hospitals to inventory their Internet-dependent systems and develop contingency plans if connectivity is lost, such as in their case where prescriptions could be created but not sent electronically to pharmacies. The hospital also temporarily shut down its email systems to figure out how to handle the phishing challenge and found quite a few undocumented internal processes that require email.

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I’m trying not to swear at a writer’s incorrect summary of a predictably pro-EHR study from HIMSS Analytics (and published in two HIMSS-owned publications). It found that hospitals that are higher up the EMRAM ladder had better patient outcomes in some areas. For the zillionth time, correlation doesn’t equal causation. I have no doubt that hospitals that can run and afford Stage 6/7 EHR implementations can deliver better outcomes for specific diagnoses and procedures. However, that doesn’t mean the EHR contributed to the result just because it’s there. I bet there’s a similar correlation between patient outcomes and hospitals whose cafeteria features a sushi bar, but that doesn’t mean that adding sushi bar will improve heart attack survival rates. I would be more impressed with a vertical study that compares a single hospital’s results before and after EHR implementation. Don’t blame HIMSS Analytics since they were careful to use the word “association” – it’s writers who have never worked a day in healthcare or healthcare IT who are declaring authoritatively but inaccurately as they try to explain topics way over their heads.

A woman sues her plastic surgeon after finding before-and-after pictures of her face on his website with the label “cocaine nose.”

Weird News Andy calls this story a triple threat. A Michigan man dies when a medical problem causes him to crash his car into an abandoned house, which turned out to be full of swarming bees that kept rescuers from reaching him.


Sponsor Updates

  • Six hundred Aprima users have signed up for the company’s user conference, which will be held August 8-10 in Dallas. ONC Deputy National Coordinator Jacob Reider, MD will deliver the keynote address.
  • PerfectServe publishes a blog post called “TeamSTEPPS – Building a Support System for Safety.”
  • CitiusTech is profiled in Forbes.
  • Azam Husain discusses the importance of identity management for protecting patient health information on Caradigm’s blog.
  • IHT2 shares a graph displaying the top 10 challenges faced by EHR users.
  • Sagacious Consultants donates $10,000 to Wounded Warrior Project, Camp American Legion, the Legacy Fund, and the Aaron Grider Foundation in support of veterans.
  • HIMSS Analytics Data reports that Imprivata OneSign is used by 51 percent of hospitals using McKesson’s Paragon or Horizon EMRs.
  • Encore Health Resources CEO Dana Sellers discusses the company’s acquisition by a Fortune 500 company.

EPtalk by Dr. Jayne

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I’m always on the lookout for any product or service that can make patients’ lives a little easier when they have to navigate the crazy healthcare world in which we live. I was excited to learn about CoPatient, which offers free audits of medical billing documents. The patient provides the bills and insurance information and they review and provide a no-charge report with a list of itemized costs and potential errors. From that point, patients can try to resolve the problem themselves, or CoPatient will handle the appeal for a fee.

They offer a “Negotiator” level, which is a flat 30 percent of the savings obtained. The “Guardian” level offers historical review or processing of regular medical bills through a monthly individual or family subscription. The Guardian level also includes use of their mobile bill pay app, but it’s full so you’ll have to go on a waiting list. I just finished fighting with my insurance company over an erroneous biopsy charge (I think I’d know if I had one). Based on my hourly salary and the time it took to resolve the issue, it would have been worth letting them handle it.

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I had fun this morning doing a project for the urgent care where I moonlight. Although we use paper charts, many of the physicians work at other facilities where EHRs are in use. The lack of a way to electronically check medication prescriptions for patient safety and drug interactions has been a concern for several of them. I brought it up when I joined and offered to help find a system when they were ready.

We had a situation Monday night where I needed to urgently sign a Family and Medical Leave Act form that a patient brought by the office at the last minute. I’m on a belated birthday trip this week and had no access to a printer, let alone a fax machine. I signed it electronically using DocuSign (incidentally a new HIStalk Gold Sponsor) and emailed it back. Our managing partner was impressed that I knew to do that and emailed a few hours later asking me to look into eRx systems.

I knew of a couple of standalone systems but visited the Surescripts website to compare features. I was surprised by the sheer number of prescribing systems out there, whether freestanding or part of an EHR. I narrowed it down to a handful and started gathering information.

I’m planning to do a trial of the National ePrescribing Patient Safety Initiative product from Allscripts. The fact that it’s free is certainly a draw. It looked easy enough to register for the system and I’ll hopefully have time to do that in the next couple of days. I’m not scheduled to work at the urgent care until next week so we’ll have to see what I know by then.

Have you used a stand-along eRx system? Any advice? 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 31, 2014 News 7 Comments

News 7/30/14

July 29, 2014 News 16 Comments

Top News

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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 16 Comments

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Reader Comments

  • Keith McItkin, PhD.: @pm_from_haities Shame on you for your diatribe v doctors. I would not object if you blamed hospitals, but doctors? C...
  • PM_from_Haities: Let's face it the reason health care in the US is messed up is because it's so far way from being capitalism. The easies...
  • Eddie T. Head: The US Healthcare system has very little to do with capitalism. I believe that is what is meant by "Altogether, the high...
  • richie: "Oligopolies are capitalism". It's easy to say, but awfully meaningless....
  • El Jefe: Uwe and his criticism. Yo bro, it's called capitalism. If you don't like it please move to Canada....

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