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News 5/4/16

May 3, 2016 News 4 Comments

Top News

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Pharma services firm Quintiles – which acquired Encore Health Resources in 2014 – will merge with drug data and marketing firm IMS Health, creating a drug data behemoth with 50,000 employees and $7 billion in annual revenue.

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Quintiles founder Dennis Gillings, PhD was a biostatistics professor at University of North Carolina at Chapel Hill when he founded Quintiles in 1982, eventually making him a billionaire.  IMS Health is mostly known for selling drug prescribing and dispensing information to drug manufacturers to allow their salespeople to aggressively market their products to physicians.


Reader Comments

From Spiffy Duds: “Re: [vendor name omitted]. Glassdoor reviews say the place is imploding, running scared about Epic threat, losing customers and employees, late on software, new platform released with huge issues. The new president runs a fear-based shop and can’t stick to a strategic decision. The owner knows nothing about healthcare and is an incurable narcissist who believes the company is saving lives and doing things that no one else can do.” Unverified. I’ve omitted the company name since anyone can say anything on Glassdoor, plus Glassdoor now allows full viewing of comments only to those who write a review or submit a salary, of which I’ve done neither.  

From Publius: “Re: Coast Guard and Epic. It’s quite the coincidence that Leidos deleted the Coast Guard’s Epic SAN while working with Cerner on the DoD project.”


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mr. S from New Mexico, who asked for electronic circuitry to help Zack, a student in his high school class who has set his sights on obtaining a Harvard math and engineering PhD. Zack reports, “I thank you for empowering me to use electronic circuitry components to create Arduino circuits that I code and assemble. This is most exciting because I can use circuitry components that I previously was unable to access. Thank you for allowing me to do this.”

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Also checking in is Ms. W from Arizona, whose preschoolers are learning “sight words” in the 10 minutes per day she has set aside for using them. She reports, “These tools may be small to some, but to my students who do not have the opportunity to have these things, it is a great essential. I can’t wait to continue using these tools for the years to come in my classroom and see the great learning that happens.”


Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

May 11 (Wednesday) noon ET. “Measuring the Impact of ACA on Providers.” Sponsored by Athenahealth. Presenters: Dan Haley, general counsel, Athenahealth; Josh Gray, VP, AthenaResearch. Athenahealth will share the findings of real-time analysis of its provider network. The presenters will describe how patient financial obligations have changed, how physician reimbursement is trending, the patterns created by increased ACA coverage, and the effect of the latest ACA trends on physician practices.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Healthcare managed services vendor MedData acquires patient engagement software vendor Duet Health.

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Behavioral health telemedicine software vendor WeCounsel closes its $3.5 million Series A funding round. The company offers practices unlimited use of its platform for $15 per month.

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NIH awards ID Genomics a three-year, $3 million grant to continue development of its 30-minute test that identifies the bacteria causing an infection and matches it against a profile of antibiotic resistance to help doctors choose the right antibiotic.

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Cotivity, which sells payment accuracy solutions to payers in healthcare and retail, announces plans to launch an IPO.

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Investor Warren Buffett, asked a question about board member diversity at Berkshire Hathaway’s annual meeting, uses Theranos as an example of what not do do when choosing a board:

You know, one organization recently, the one that did the blood samples with small pricks, they’ve got some very big names on their board. Theranos. I mean, the names are great, but we’re not interested in people that want to be on the board because they want to make two or three hundred thousand dollars a year for 10 percent of their time. And we’re not interested in the ones for whom it’s a prestige item and who want to go and check boxes, or that sort of thing.

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Imprivata announces Q1 results: revenue up 23 percent, adjusted EPS –$0.21 vs. $-.24, beating analyst expectations for both. 


Announcements and Implementations

England’s West Suffolk NHS Foundation Trust goes live on Cerner.

CommonWell and NATE (the National Association for Trusted Exchange) will join each other’s organization as members.


Government and Politics

A study finds that citizens of states that spend more on social and public health services vs. healthcare services have better outcomes for several chronic and debilitating conditions.

The federal government will require the DoD’s Defense Health Agency to issue IT contracts through the General Services Administration.


Innovation and Research

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A study finds that the most profitable hospitals (based strictly on operating income) are for-profit, have higher markups, have regional prestige that allows them to dictate terms to insurers, and are located in states (interestingly enough) with price regulation. The most profitable hospitals in the 2013 data studied were 268-bed Gundersen Lutheran Medical Center (which made $300 million in profit from patient care), Sutter Medical Center, and Stanford Hospital. I checked Gundersen’s federal tax forms, which show 2014 profit of $95 million, down from $312 million in 2013. To its credit, the hospital paid its executives comparatively modestly, with the CEO earning $910K and the CIO $385K.

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Half of surveyed teens say they are addicted to their smartphones, with 78 percent of them checking their devices at least hourly and 72 percent believing they must respond immediately to texts and social networking messages. More parents than teens (56 percent) check their devices while driving, while a big chunk of both groups think the other ignores them and plays with their phones when they’re together. 


Technology

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Microsoft’s SQL Server 2016 will launch on June 1, with speed and security enhancements, support for the R analytics tool, the ability to query both structured and unstructured data, and the ability to query encrypted data without decrypting it first.

Google donates $250,000 toward Flint, MI’s water problems, of which $150,000 will fund a University of Michigan data project to identify homes with likely high levels of lead. UM will also develop a mobile app and website that will allow residents to visualize data and communicate with the city.


Other

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As reported here earlier in quoting Shriners CMIO Richard Paula, MD, the Joint Commission confirms in an emailed newsletter Monday that it has reversed its 2011 policy that prohibited sending orders via text message, effective immediately. Joint Commission says it changed its mind because messaging platforms have improved.

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The only rural hospital in Massachusetts — 19-bed, Partners-owned Nantucket Cottage Hospital – may cause all state hospitals to lose $160 million in Medicare funding in the next year after consultants make mistakes in calculating the hospital’s labor costs. The hospital’s high-cost location makes it the state’s most expensive and Medicare sets the labor payments to all other hospitals based on its costs. Some hospitals could lose 10 percent of their Medicare payments due to the mistake.

An interesting article describes Mid-Atlantic Permanente Medical Group’s hepatitis C screening protocol, which has these components:

  • An EHR alert recommends to providers that patients born between 1945 and 1965 undergo hepatitis C screening if they haven’t already had it.
  • Patients who test positive for the hepatitis C antibody are automatically ordered confirmatory testing.
  • An assigned hepatitis C coordinator manages the follow-up activities and educates the patient.
  • A liver damage assessment is automatically ordered.
  • Patients are connected to physicians to make sure ongoing care occurs.

A Kaiser Health News article concludes that hospitals are not good at coordinating post-discharge care with home health agencies and nursing homes, particularly when it comes to medications. The article notes that none of the $30 billion in HITECH EHR bribes went to nursing homes, rehab facilities, or home care providers. The article failed to note equally sobering problems in coordinating the care of patients with behavioral problems, which have a similar genesis.

The Chinese government will investigate search engine company Baidu following the death of a student who searched online for a treatment for his rare form of cancer. The student claimed that his search turned up a hospital that lied about a high rate of success with an experimental treatment he was given. Before he died, the student accused Baidu of promoting false medical information and called out the hospital for false advertising.

Two large employers who offered a healthcare price transparency tool found that only small percentage of employees used it and healthcare costs actually increased slightly.

A study finds that the price of oncology drugs is steadily and illogically increasing, as drugs whose initial high price was justified by expected narrow usage get more expensive even when new indications are discovered.


Sponsor Updates

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  • KLAS recognizes Sagacious Consultants (now part of Accenture) as a top-performing Epic consulting firm.
  • AdvancedMD releases a new ebook, “Advanced Practice Training: Changing the Game in Financial Reporting.”
  • Extension Healthcare releases a video showing how its Engage Mobile solution integrates with AirStrip One live waveforms.
  • AirWatch launches the Echo One Podcast.
  • Aprima will exhibit at the ACP Internal Medicine Meeting 2016 May 5-7 in Washington, DC.
  • KLAS recognizes Nordic’s Epic implementation support and staffing services, also ranking the company for the first time in the IT Advisory segment with a 92.6 score.
  • Besler Consulting releases a new podcast, “What Hospitals Should Do Regardless of Who is Elected President.”
  • DrFirst’s Rcopia e-prescribing platform wins the Surescripts White Coat of Quality Award for the fourth time.
  • CapsuleTech celebrates National Nurses Week May 6-12.
  • The Advisory Board Company features Carevive Systems in a presentation during its Oncology Roundtable series May 5-6 in Washington, DC.
  • CompuGroup Medical will exhibit at the Rural Health Care Conference May 10-13 in Minneapolis.
  • CoverMyMeds will exhibit at the 2016 New England Regional MGMA Conference May 5-6 in Bretton Woods, NH.
  • Wellcentive develops a free tool to calculate the cost of delaying the shift from payer volume to value-based care and reimbursement.
  • Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
  • ECG Management Consultants will present at the MGMA New England Regional Practice Management Conference May 5 in Bretton Woods, NH.
  • EClinicalWorks will exhibit at the IMGMA Spring Conference May 5-6 in Indianapolis.
  • Healthwise will exhibit at the EClinicalWorks 2016 Health Center Summit May 11-13 in Boston.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
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May 3, 2016 News 4 Comments

ResearchKit Unlocks the Power of Real-Time Clinical Research

May 2, 2016 News No Comments

New studies at Boston Children’s and RWJF highlight the evolving role of Apple’s mobile research technology.
By
@JennHIStalk

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It’s been just over a year since Apple introduced ResearchKit, an open source framework that enables researchers and developers to design apps for healthcare research. In that time, participation has soared. The platform now boasts 100,000 users who are submitting data to studies sponsored by hospitals and non-profits, including ones focused on asthma, breast cancer, diabetes, heart disease, hepatitis C, melanoma, Parkinson’s, post-partum depression, prostate cancer, and sleep apnea.

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Even the NFL Players Association has gotten in on the act, partnering with Harvard University researchers to use ResearchKit in a joint investigation into the long-term effects of football injuries on 3,000 former NFL players.

The platform has also made accommodations for personal genomics via integration with 23andMe’s module. Researchers can enable 23andMe customers to contribute their genetic data to a study or offer genotyping services from the company to study participants. It’s a timely move given the industry’s White House-driven focus on precision medicine and cancer moonshots.

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Apple, having realized the escalating potential of its own creation, decided earlier this year to start collecting ResearchKit data for its own internal purposes. Study participants who submit data to the Mole Mapper Study app and Parkinson’s mPower study app now have the option of also submitting that data directly to Apple. The company no doubt plans to use the data to further refine the platform and to impact future iterations of HealthKit and the new CareKit, corresponding apps that help power and further ResearchKit’s capabilities.

Real-World, Real-Time Research

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Studies leveraging ResearchKit continue to be introduced, evidence that the platform is well on its way to changing the face of medical research. “It’s the most evolved mobile platform to run studies,” says Paul Tarini, senior program officer at the Robert Wood Johnson Foundation, which has taken an interest in ResearchKit from the beginning. “We’ve been interested in what we call real-world, real-time data for a number of years now, especially what that data can tell us about our health, how it can be used for research, and how it can be used to improve care. ResearchKit was the first formal platform developed to conduct research by taking advantage of the IPhone’s native capabilities to collect real-world, real-time data.”

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Tarini and his team began talking about what kinds of apps might be useful within the ResearchKit library not long after its debut. “In discussions with Apple staff and industry experts, we ended up settling on mood and what helps influence mood,” Tarini explains. The result of that decision – RWJF’s Mood Challenge – launched earlier this month.

“We’re hoping the winning app could be used in part or in whole by another study that’s interested in including some aspect of mood or variable in its focus – something that other researchers can pick up, use, and plug in as they build their own apps,” Tarini adds. “We’re also interested in apps that use a mash-up of data, such as data from the phone and other sources, to shed light on mood. In this case, we’re particularly interested in data on social context. What are the graduation rates in your neighborhood? The income rates, family structures, crime rates, weather patterns? How do these influence health, if at all? We’re really focusing on building a culture of health in this country, and social context is certainly a reflection of culture.”

Uncovering the New Normal

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Researchers at Boston Children’s Hospital have also been ResearchKit fans from the beginning. “We are proud to be the first academic institution to launch our second ResearchKit app,” says Jared Hawkins, director of informatics and innovation and of the hospital’s digital health accelerator. The hospital launched its C-Tracker app last year to collect data on the effects of hepatitis C and debuted the Feverprints app last month.

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“One of the major lessons we learned from C-Tracker was how best to link anonymized data from ResearchKit to our servers at the hospital, securely and at scale,” Hawkins explains. “There are a number of commercial solutions for this, but none of them offered the flexibility that we needed. Fortunately, the C-Tracker team developed open-source software, C3-PRO, to accomplish this, which we have leveraged for Feverprints.”

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The Feverprints study and ResearchKit-powered app will help Boston Children’s researchers better understand what a “normal” temperature looks like, how fever patterns can be used effectively to diagnose disease, and how fever-reducing medications affect the course of an illness.

“The standard notion that a normal temperature is 98.6 and a fever is anything above 100.4 is based on questionable research from a few hundred years ago,” says Hawkins. “This study seeks to leverage modern technology, including smartphones and continuous temperature monitoring, to revisit this historical research and collect temperature from tens of thousands of participants to reassess what is normal.”

Form Factor Makes the Difference

The enthusiasm Hawkins has for Feverprints can be largely attributed to ResearchKit’s form factor. “It transforms how we can do clinical research by addressing some of the biggest hurdles we face as researchers – recruitment and long-term engagement,” he explains. “ResearchKit allows us to consent exponentially more users than would be possible traditionally, at minimal cost. These users have the power to enroll themselves, giving them a more direct role in the study and increasing engagement.

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“Overall user experience is improved because ResearchKit makes it easier to share health data,” Hawkins adds. “If the user allows it, data from any connected smart thermometer can automatically be loaded from HealthKit. Even if data is entered manually, the whole process takes less than a minute. We hope that the data collected will allow us to identify distinct ‘feverprints’ that may aid clinicians in patient diagnosis in the future. For this, continuous data from a wearable device may prove to be the richest, although temperature data captured at any granularity will be helpful.”

Hawkins add that Feverprints app developers plan to add additional engagement features in the near future that will, for example, allow users to see how their data has specifically helped researchers better understand normal and elevated temperatures, and how they compare to the population as a whole. “We don’t have to wait until the study is over to begin to feed our results back to the user,” he says, “which really drives home the power of participatory real-time research.”

Tarini and his colleagues at RWJF also see immense value in ResearchKit’s data delivery methods. “We like the creativity, the flexibility, and the democratization,” he notes. “More people can enroll in the studies. We also like the fact that the platform is able to turn more results around more frequently to participants.”

Changing the Research Game

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While there’s general consensus on ResearchKit’s ability to transform the way clinical studies are conducted, the verdict is still out on it being a bona fide “game changer.” It is, after all, available only to Apple users, which leaves the much larger Android user base without the means to participate. (an Android alternative called ResearchStack became available earlier this month.)

“I wouldn’t call ResearchKit a game-changer,” Tarini says, “because that means we’ve done it. I would say changing. ResearchKit is changing perspective on the importance of returning results to people. It’s producing greater engagement from the people who are participating.”

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“We’re also excited about CareKit and the opportunity for more seamless integration of research data with regular care,” he adds. “You can repurpose the data that was collected by the research study and inject it into the processes of care so that a provider can see the data that’s coming in from the study. Previously, that was really hard to do, if not impossible. ResearchKit is changing the relationship between research studies and their participants, and the relationship between the research enterprise and the care delivery enterprise.”

Hawkins is more optimistic about the role ResearchKit has thus far played in the evolution of clinical research. “It’s absolutely a game-changer for health research because it addresses some of the biggest hurdles we face as researchers – recruitment and long-term engagement. We are looking for other projects at the hospital that would benefit from ResearchKit as well as the newly announced CareKit. Apple has built some truly exceptional platforms to enable health research.”

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May 2, 2016 News No Comments

Monday Morning Update 5/2/16

May 1, 2016 News 5 Comments

Top News

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Meditech releases Q1 results: revenue up 4.3 percent, EPS $0.51 vs. $0.53. Product revenue rose 3.2 percent, with 78 percent of that coming from services. The company generated $23.1 million in total cash flow, all of which was paid to shareholders as dividends.

Meditech Director Dan Valente, 85, has resigned as director and was replaced by CFO Barbara Manzolillo.


Reader Comments

From Dixie Chicken: “Re: Epic. Verona, WI will collect taxes based on an Epic campus value of $393 million, but Epic has spent billions on it. If that’s the basis of property taxes, is Verona celebrating when they should feel ripped off?” Verona will close the special tax district it created to get Epic to relocate there from Madison 14 years ago when the company had only 550 employees, cashing in the district’s financial surplus and making Epic’s campus taxable. The property’s value is established at the time the tax district is created, meaning Epic’s massive campus growth (from 550 employees to nearly 10,000) returns only a partial benefit as companies pay only lower, construction-related taxes when they expand.


HIStalk Announcements and Requests

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Forty percent of poll respondents think that EHR redesign offers the best hope for reducing the time physicians spend entering data into EHRs, while 25 percent say the capture of non-clinical information is the real problem that should be addressed. Tech MD wonders if those readers who chose EHR redesign or reduced data capture burdens believe the other choice is a lost cause, while Mobile Man says it’s futile to expect EHRs to be redesigned because they are intended to be big filing cabinets. Curious (along with a least one person per poll I run) expresses an unrequited lust for surveys that allow shades-of gray answers, which of course means that he or she must also prefer capturing EHR narrative rather than easily interpreted check-boxes for precisely the same reason  — I would rather force respondents to choose the “best answer” rather than leaving me to wade through 431 free-text comments and abstract their thoughts into a collective opinion.

New poll to your right or here: is the proposed replacement of Meaningful Use with MACRA positive or negative?

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Ms. Ahrstrom says the math books we provided to her South Bronx, NY third graders in funding her DonorsChoose grant request have eliminated the boredom using the limited selection of books available in the school’s library, as students can’t wait to finish each book and start the next one.

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Also checking in is Ms. B from Minnesota, whose students are still talking about the field trip we provided to the Wildlife Science Center even though it was weeks ago.

Listening: Nico Yaryan, of whom I know basically nothing except he’s a newcomer and I like his music. He sounds like he could make it big. Here’s another of his songs.


Last Week’s Most Interesting News

  • HHS issues a Notice of Proposed Rulemaking that spells out details of MACRA, the value-based payment model for providers who accept Medicare. MACRA will replace the Meaningful Use program with less-prescriptive measures called Advancing Care Information.
  • Joint Commission announces that it will permit clinicians to send orders via secure messaging, provided that the system they use supports specific message management and EHR integration standards.
  • Epic gives its side of the story on why the Coast Guard cancelled its EHR implementation plan.
  • NextGen confirms employee layoffs, immediate cessation of development on its NextGen Now cloud-based PM/EHR, and a strong focus on the HealthFusion PM/EHR it acquired for $165 million in January.
  • Apple releases the CareKit developer’s framework and announces availability of the first four apps that will use it.
  • The FDA rejects the “digital pill” drug application that would have used technology from Proteus Digital Health.
  • Nokia acquires consumer health device vendor Withings for $192 million to create Nokia Digital Health.
  • CMS releases the minimally redacted warning letter it sent to Theranos last month in which it accused the lab processing company with a lack of knowledge of CLIA standards and diluting finger-stick samples so they could be run on standard Siemens analyzers.
  • Verisk Analytics announces that it will sell its Verisk Health services business to Veritas Capital for $820 million.

Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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A small reference in Caradigm’s announcement of a new CEO last week says that Microsoft has sold its 50 percent interest in Caradigm the holder of the other 50 percent, GE Healthcare. The company didn’t explain why the change wasn’t otherwise announced.

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From the Athenahealth earnings call:

  • The company has partnered with Intacct to offer its hospital customers an ERP solution and says it will seek additional partnerships to expand its service capabilities.
  • Jonathan Bush said in answering a stock analyst’s question, “In the small-hospital market, there is a borderline collapse of the established technologies, so there is a huge demand … with the exception of Epic and Cerner, most of the HIT companies appear to be just not able to make a go of it.”
  • Bush added that Athenahealth won population health management system deals at Dignity and Providence because those health systems trialed products from their existing vendors and found them unacceptable (Dignity is a Cerner shop, while Providence uses Epic).
  • Bush said of the company’s efforts to move users of systems from the acquired RazorInsights to those of Athenahealth, “It’s very hard … in order to be that fast, the architecture was more client-centric than network-centric. Every single table — the drug list, the provider directory, the pharmacy supply, the medical supplies — every single one of them is a separate table that only works for each individual customer. That is not the point of Athenahealth … we are taking back those tables, taking back the administration of them and connecting them to great little Web services that connect to national tables that are always current, always correct because they’re maintained by us. That work involves moving the cheese of people that have worked very hard on their tables for years. So, it’s painful.”
  • Bush replied to an analyst’s question about an unnamed competitor moving to a cloud-based product, “You need to double-check on the idea that anybody that you’re thinking about is cloud-based. That somebody will host your data center and run backups does not make them cloud-based. I just described the agony we’re going through centralizing the remaining tables that are being maintained by clients. These are companies where 100 percent of tables are maintained by clients. This is just rental software and 99 percent of the code is running on the servers in the client side. So let’s be clear — those guys are not cloud-based.”
  • When asked about the credit-worthiness of hospital prospects, Bush said, “We used to joke in selling to doctors in the early days that we restrict our sales team to doctors that have a pulse. That was an interesting comment at the time because a lot of the doctors’ pulses that we originally signed were quite thready at best … not only are the HIT companies dying, but a lot of the hospitals are dying … . You have very, very low bed occupancy in this segment, a need to dramatically change strategy from kind of end provider of inpatient and acute care to front-end of the larger health system for the ill … if you took the imaging margins out of every hospital right now, more than half the hospitals in the country would close. Some of the best names in healthcare with the best institutions in healthcare have the majority of their profits coming just from an anomaly where the cost of the imaging equipment is going down because of digital equipment faster than Medicare can figure it out and chase them down.”
  • Bush explained the company’s More Disruption Please program as, “It’s too bad that Epic and Cerner and Meditech and all these guys can’t build open enough platforms, because we don’t really want to do Athena dietary management systems. But if it doesn’t come out of MDP and if Epic and Cerner and Meditech don’t open up their API so that they could be used by responsible developers, what can you do?“
  • Bush replied when asked about adding billing capabilities to the former RazorInsights product, “The front desk for the hospital is the front desk for AthenaNet. It’s the same front desk, same work flow, same insurance capture, same portal registration … one of the big arbitrage opportunities for AthenaOne for the inpatient is, we get all the doctors around the hospital. We don’t have to register them when they show up at the hospital. We already know what their deductible utilization is, we already know their eligibility, we know their medical records, et cetera, et cetera  … there has been a product we’ve been dying to release for years, for a decade, called AthenaController, which basically takes on the same approach to the cost cycle as we have to the revenue cycle. We are now pregnant with that baby. We have to do it.”

People

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Ryan Nellis (Optum) joins Stanson Health as SVP of sales and marketing.


Announcements and Implementations

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Clinical Architecture launches its SIFT Services product line, which uses natural language processing to extract coded data from free-text documents for specific data targets. The company offers a free trial of the first offering, SIFT for Meds. 

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Nordic hires its 600th consultant.


Government and Politics

Political differences aside, President Obama might offer Ronald Reagan a challenge for the title of funniest American president ever. Above is the video, “Couch Commander,” released by the White House and presented at the White House Correspondents’ Association Dinner. The Obamacare references at 1:33 are interesting.


Privacy and Security

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A science magazine analysis finds that the agreement between the UK’s NHS and Google’s artificial intelligence company DeepMind gives the company full electronic information on 1.6 million patients treated annually by three hospitals of Royal Free NHS Trust. Google says it needs complete information on all patients because NHS can’t provide a subset just for the kidney patients who will be monitored by Google’s Streams system. The agreement also calls for Google to develop a clinical decision support and surveillance system called Patient Rescue that will use real-time data streams from the hospitals. Critics are not only worried about Google keeping the patient information secure, but also that Google is the only company with access to the data.

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The American Dental Association notifies subscribers to its Dental Procedure Codes that some of its thumb drive updates contain malware. The ADA speculates that one of the duplicating machines used by ADA’s China-based manufacturer were infected with data from a previous customer, meaning that only the drives produced by that specific machine contain malware.


Other

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Here’s a nice quote from Farzad Mostashari, MD in responding to a tweet saying that non-profit Minnesota HIMOs (like most health systems everywhere) insist that what’s left when income exceeds expenses is a “surplus” rather than a “profit,.” although they seem to love the word “loss” when things aren’t so rosy. Perhaps Farzad can weigh in on “payment” vs. “reimbursement” and “invested” vs. “spent.”

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Dear Health Data Management, please spell company names correctly, not like the actual word is spelled. Thank you.  While I’m quibbling journalistically, I would to ask newspapers to stop saying that someone “checked himself in” to a hospital since that just doesn’t happen.

Here’s the next HIS Vendor Review from Vince and Susan, which this time looks at high-end vendors.


Sponsor Updates

  • T-System will exhibit at the CHIMA Annual Meeting May 5-6 in Denver.
  • The local news interviews TeleTracking President Michael Gallup about the company’s sponsorship of the Walk MS Pittsburgh 2016 event.
  • Fortune profiles Validic.
  • Vital Images will exhibit at the McKesson User Group May 2-4 in Atlantic City, NJ.
  • Huron Consulting Group will exhibit at the MAGI Clinical Research Conference 2016 East May 1-4 in Boston.
  • Wellsoft will exhibit at Emergency Medicine Update 2016 May 3-5 in Toronto.
  • ZeOmega offers the Jiva Consultant Certification Program.
  • PatientPay extends the $10,000 healthcare billing challenge.
  • Streamline Health will exhibit at the 2016 DCHIMA/MDHIMA Annual Meeting May 6 in Hanover, MD.

    Blog Posts

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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May 1, 2016 News 5 Comments

News 4/29/16

April 28, 2016 News 5 Comments

Top News

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HHS issues a Notice of Proposed Rulemaking for the long-awaited Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will replace the Meaningful Use program in moving clinicians to payment based on value starting in 2017. The Merit-Based Incentive Payment System (MIPS) sets Medicare payments based on quality, use of technology, clinical practice improvement, and cost. Physicians participating in alternate payment models such as CPC+ and the Next-Generation ACO will be eligible to receive bonuses without participating in MIPS.

A CMS blog entry from CMS Administrator Andy Slavitt and National Coordinator Karen DeSalvo says Meaningful Use boosted EHR usage, but adds, “We remain a long way from fully realizing the potential of these important tools to improve care and health.” HHS says incorporating Meaningful Use in the MIPS program in a program called Advancing Care Information will “make it more patient-centric, practice-driven, and focused on connectivity.”

Slavitt and DeSalvo’s article says Advancing Care Information will:

  • Simplify physician reporting by eliminated all-or-nothing measures.
  • Provide flexibility for doctors to choose the most applicable measures.
  • Emphasize interoperability and the right for patients to access their own information through APIs.
  • Reduce the number of measures from 18 to 11.
  • Exempt doctors from reporting if EHR technology isn’t applicable to their practice.

The article sheds light on the technology focus going forward:

These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients. Previously established requirements for APIs in the newly certified technology will open up the physician desktop to allow apps, analytic tools, and medical devices to plug and play. Through this new direction, we look forward to developers and entrepreneurs taking the opportunity to design around the everyday needs of users, rather than designing a one-size-fits-all approach. Already, developers that provide over 90 percent of electronic health records used by U.S. hospitals have made public commitments to make it easier for individuals to access their own data; not block information; and speak the same language. CMS and ONC will continue to use our authorities to eliminate barriers to interoperability.

The proposed HHS changes would affect only Medicare payments to practices. Nothing will change for hospitals and Medicaid program participants.

The full text of the 962-page proposed legislation is here. The Advisory Board Company posts a good summary.

Here’s a new three-minute HHS video for consumers that describes delivery system reform.


Reader Comments

From Richard Paula: “Re: texting of orders. The May 2016 Joint Commission Perspectives will contain a revised statement on texting orders, ending the ban enacted in 2011. It reinforces the fact that texting can be an expedient method of patient care. The secure texting platform must have:

  • A secure sign-on process
  • Encrypted messaging
  • Delivery and read receipts
  • Date and time stamp
  • Customized message retention time frames
  • Specified contact list for individuals authorized to receive and record orders

It requires text orders to be complete, dated. timed, confirmed, authenticated, and documented in the medical record.” Rich is CMIO of Shriners Hospitals for Children. This is a pretty big deal as companies whose messaging product can’t integrate with EHRs to complete the order loop now find themselves at a significant competitive disadvantage.

From Marshal: “Re: Meditech. Delta Regional in MS has signed to replace Cerner with Meditech. Salem Regional Medical Center in OH has signed with Meditech to replace their McKesson Horizon system. Cerner was the other finalist in that bid.” Unverified. 

From Graham: “Re: Coast Guard EHR. I saw that Politico just replayed your coverage from last October. The Coast Guard won’t say if a particular provider’s software caused the issues. What’s your take on where accountability resides? Sounds like mismanagement at a project level by USCG themselves, but Epic paying back $2.2 million on a $14 million award isn’t immaterial, either. It gets even fuzzier with the InterSystems component coming in later and then Leidos / Apprio / Lockheed.” The Coast Guard cited unstated problems with the implementation, seemingly blaming itself for a lack of consistent workflows and ongoing scope expansion, while outsiders speculate that it handled the product selection poorly and that Epic and Leidos may have bid too low to  meet the Coast Guard’s expectations.

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Meanwhile, Epic uncharacteristically posts its side of the Coast Guard story, saying its software was originally ready for go-live in 2011, but Coast Guard changes such as hardware procurement delays, vendor changes, data center changes, and a government accounting investigation of the Coast Guard’s method of payment threw the schedule off. The Coast Guard’s storage area network was also lost twice, once from corruption and once after someone from Leidos deleted it. Epic says the go-live was rescheduled for October 2015 and was on track until the Coast Guard cancelled it the month before for unstated reasons. Epic says it was paid in full and the Coast Guard did not ask for a refund.


HIStalk Announcements and Requests

I’m interested to learn what sort of EHR prototype the VA is creating in exploring the idea of replacing VistA with what sounds like another self-developed product. Let me know if you can provide information, on or off the record.

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The vast majority of 514 poll respondents (92 percent overall, including 90 percent of the females and 93 percent of the males) think it’s a bad idea for HIMSS to publish a separate website and newsletter for women in healthcare IT. Sandra says the goal is to be separate but equal rather than separate but separate, while NoHorseInThisRace says its a disservice for HIMSS to be “peddling its clickbait drivel” specifically at women. Lisa says she might take an occasional look but since the issues and concerns are the same for everyone, the choice of content the site will promote will be interesting. Long Disappointed by HIMSS adds that, “The comment made on HIStalk is appropriate – look no further than the board.” The women’s interest stories so far is lame – it’s anything related to Karen DeSalvo, third-party stories on gender pay gap, and mentions of people who have been promoted who happen to also be female.

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Ms. Anderson’s Arizona fourth graders, especially her special education students, have used the electricity and magnetism kits we provided in funding her DonorsChoose project to complete her standards-based assignments while having fun.

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Also checking in is Ms. Isaacs, whose Indiana second graders are using the 16 sets of headphones we provided to participate in an online literacy program, which she saves “gives our class the opportunity to focus on what we are learning rather than the other students around us.”

This week on HIStalk Practice: Thirty-six practices sign up for CancerLinq’s oncology analytics. Raleigh Orthopaedic Clinic settles with OCR to the tune of $750,000. AMA partners with IDEA Labs to support student entrepreneurship in healthcare IT. The American Telemedicine Association aims to broaden the Rural Health Care Connectivity Act. Reliance ACO COO Gene Farber highlights the role of CCM in coordinated care. UniVision gets into telemedicine. Vice President Joe Biden set to spice up Health Datapalooza. CDW’s Jonathan Karl offers advice on how to promote positive outcomes with communication and technology.


Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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A RBC Capital Markets analysis says Quality Systems / NextGen issued investor updates Wednesday indicating that it will focus on streamlining management, building up the business of the HealthFusion PM/EHR it acquired in January for $165 million, and cutting costs furthers. Analyst Dave Frances expresses skepticism on the downbeat business changes announcement given a shrinking market share in QSI’s core business, adding that, “We remain unconvinced that HealthFusion and Mirth are the answer.” Quality Systems says it will stop development on its NextGen Now product immediately, taking a $32 million charge and confirming that it will reduce headcount by 150 as I previously reported from reader rumor reports. The cloud-based NextGen Now PM/EHR was announced in November 2014 and was supposed to be launched in 2015.

A New York Times op-ed piece says Theranos wasn’t a product of Silicon Valley hype – the company pitched to top life sciences venture capital firms whose doctorate-heavy investment teams were put off by Theranos trying to appear cool while keeping the technical details intentionally vague. Those VCs also noted that Theranos hadn’t published in peer-reviewed journals and that the company’s board was made up of mostly old politicians with zero healthcare experience. The company’s investors were non-Silicon Valley types who were apparently less discerning.

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Leidos announces Q1 results: revenue up 5 percent, adjusted EPS $0.72 vs. $0.67. Chairman and CEO Roger Krone says in the earnings call it’s on track to bring the DoD’s MHS Genesis Cerner project live at two facilities in the Northwest by the end of the year, but Leidos will also continue making money supporting the old system for another 8-10 years until the Cerner rollout is finished.

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Athenahealth announces Q1 results: revenue up 24 percent, EPS $0.34 vs. $0.24, beating analyst expectations for both. ATHN shares are up 13.3 percent on the year.

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Spok reports Q1 results: revenue down 6 percent, EPS $0.17 vs. $0.18. The SPOK share price is down 12.9 percent compared to a year ago.

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Vocera announces Q1 results: revenue up 12 percent, EPS – $0.14 vs. –$0.17, beating analyst expectations for both. VCRA shares are up 7.8 percent in the past year.


Sales

MedStar Health (MD) chooses provider data management and scheduling software from Kyruus.

UK Healthcare selects Voalte for caregiver secure messaging.


People

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Medfusion hires John Juzaitis (ZirMed) as chief revenue officer and Michelle Murray (EDM Americas) as VP of marketing.

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Brigham and Women’s Health Care (MA) promotes Adam Landman, MD to CIO.

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Caradigm promotes Neal Singh to CEO. He replaces founder Michael Simpson, who has left the company.

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Anita Pramoda (Owned Outcomes and former Epic CFO) joins the board of Health Catalyst, replacing EVP/Co-Founder Steve Barlow, who remains on the executive team.


Announcements and Implementations

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The first four apps that use Apple’s CareKit developer’s framework are released to the Apple Store as the open source CareKit itself is also released to GitHub. The apps are Glow Nurture (fertility tracking), Glow Baby (maternity), One Drop (diabetes monitoring), and Start (depression medication tracking).


Other

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Here’s a cute “Take Our Daughters and Sons to Work Day” photo from Karen DeSalvo’s office from @Commanda4aCure.

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The FDA rejects the application for a drug-device combination, or so-called “digital pill,” to monitor drug adherence. FDA had already cleared the use of Proteus Digital Health’s technology in existing drugs, but wants to see more data before allowing Otsuka Pharmaceutical manufacture it as part of its Abilify antipsychotic medication. Proteus has raised $334 million in 10 rounds of funding, adding $50 million earlier this month.

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A man sues Snapchat and the 18-year-old driver who rear-ended his car at 107 miles per hour while taking a selfie, leaving him with brain damage. The teen admitted that she was speeding while posting to earn a Snapchat “speed filter” trophy icon for recording her speed with her photo. After the crash, the teen took a photo of her bloodied face and labeled it “lucky to be alive.” Snapchat says it gives users a warning not to use its speed filter option while driving.

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This TV screen grab will resonate with everyone annoyed by poorly timed Windows 10 update nagware messages.


Sponsor Updates

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  • Employees of Impact Advisors attending the company’s annual meeting in Orlando delivered 150 teddy bears to patients at Florida Hospital for Children.
  • Florida Hospital (FL) reports decreased mortality and a $72.5 million increase in appropriate reimbursement after rolling out Nuance’s Clinical Documentation Improvement embedded, with the next step being to embed Nuance Clintegrity CDI within Cerner Millennium.
  • Bernoulli will exhibit at the at the American Association of Critical-Care Nurses’ 2016 National Teaching Institute & Critical Care Exposition (NTI), May 16-19 in New Orleans.
  • Intelligent Medical Objects will exhibit at the IHealth 2016 Clinical Informatics Conference May 4-7 in Minneapolis.
  • MedData will exhibit at the Louisiana Chapter HFMA Annual Institute May 1-3 in Lafayette.
  • Orchestrate Healthcare will help Pertexa integrate its Radekal physician productivity tool for hospital use. The tablet-based product expedites the clinical encounter, reducing visit time by up to 30 percent.

Blog posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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April 28, 2016 News 5 Comments

How Providers Are Addressing Ransomware

April 27, 2016 News No Comments

Providers share their methods for staying one step ahead of healthcare’s latest foe.
By
@JennHIStalk

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While national headlines related to ransomware attacks on hospitals seem to have abated – for now – the healthcare industry’s interest in the latest cyberattack trend has only intensified. Research related to provider preparedness seems to come out weekly, highlighting what has by now become common knowledge: healthcare has a lot of work to do.

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A HIMSS study released in early April found that 75 percent of surveyed hospitals were or could have been hit with a ransomware attack in the last year, with a significant number or respondents saying they aren’t sure or have no way to tell. Statistics like these make IBM’s data on industry-wide breaches in 2015 that much more believable, where the global company’s Cyber Security Intelligence Index found that healthcare was the most-attacked industry in 2015 with over 100 million patient records compromised.

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The industry is working to handle what seems like a non-stop assault. HHS has created a Cyber Security Task Force to develop recommendations and best practices that could eventually impact legislation. Intermountain Healthcare (UT) has partnered with the University of Utah to establish a joint security center to help providers keep up with the latest cybersecurity threats, while providers in the trenches seem focused more than ever on assessing their cybersecurity vulnerabilities.

Taking a Proactive Approach

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Northwell Health, a New York-based IDN with 21 hospitals and 450 ambulatory sites, has taken a proactive approach to cybersecurity, according to Mark Jarrett, MD, senior vice president, chief quality officer, and associate CMO. (Jarrett also serves on the new HHS task force.) “Recent events have only supported our enterprise-wide efforts to secure our network,” he explains. “We are performing hazard vulnerability assessments on a regular basis. As news becomes public of new events, we adapt our defenses. Maintaining all current security patches on our multiple systems is also key. To prevent ransomware attacks, we are employing all standard intrusion techniques from technical, such as firewalls, to staff education and testing so that they understand social phishing and the risks of non-certified thumb drives. We remain concerned as the sophistication of intruders to introduce malware has been increasing.”

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Across the country, Texas Health Resources, a health system with 25 hospitals and 69 outpatient facilities serving the Dallas-Fort Worth area, has taken a similar approach. “In the last couple of years, we started to take aggressive action to defend against threats such as ransomware,” says Luis Saldana, MD, CMIO and medical director for clinical decision support. “This action included targeted reduction of direct user access to certain forms of unstructured data such as DICOM images and PDF files. We also have a robust anti-phishing program to reduce the possibilities of a user receiving or being lured into clicking on potentially malicious email links. We’ve also validated our backup and restoration strategies and have fine-tuned our incident response when we detect a ransomware attack.”

In terms of keeping up with emerging security threats, Saldana adds that Texas Health’s cybersecurity program is designed to continuously evolve and adapt. “We do this through a continuous risk-management philosophy that is linked to operations.”

Size Matters

Northwell and Texas Health are capable of taking such proactive approaches thanks to their internal resources – a luxury that smaller hospitals and physician practices are not typically afforded. “I believe small- to medium-sized health systems of stand-alone hospitals and practices that hadn’t had the opportunity to invest in a robust infrastructure to defend against this kind of threat, or that are unable to attract cybersecurity professional talent might be more vulnerable to the impact of such an attack,” says Saldana. “We are fortunate to have a fairly sophisticated cybersecurity program.”

Jarrett points out that with greater resources comes greater vulnerabilities. “Although our size allows us to have more resources than a small hospital or group of hospitals, it also means that there are many more potential sites for failure of our defenses,” he explains. “With 61,000 employees, the task of maintaining a high level of awareness around social phishing is monumental.”

Culture and Consultants Do, Too

Both Jarrett and Saldana are quick to point out that their organizations see cybersecurity threats like ransomware as more than just a problem for the IT department to solve. “Our organizational culture is really what makes this work,” says Saldana. “Our C-suite is very educated on the issues and very supportive, and the programs have been broad in scope – beyond just IT.”

“The C-suite recognizes this is not just an IT issue,” Jarrett adds. “They have supported IT in its efforts to ensure network security.”

For both organizations, support also comes in the form of outside expertise. Northwell engages third-party consultants to evaluate its cybersecurity and provide an outsider approach to vulnerabilities. Texas Health Resources has multiple partners that perform periodic testing of its internal and external defenses, as well as monitor its cyber defenses. “We have selected these vendors through proof-of-concept testing and self-defined cybersecurity capability needs,” Saldana explains.

Prevention Boils Down to Awareness

Saldana believes that cybersecurity prevention and preparation begins with awareness. “The first step is to acknowledge that you are constantly being targeted by threats,” he explains. “Then, backups, backups, backups. Know your recovery time requirements and build backup restoration capabilities to match those requirements. Ensure you have an effective and tested business continuity plan for scenarios when data might be unavailable.”

Saldana also suggested that providers keep their tools up to date and conduct frequent phishing training and testing to prepare employees. “Have an incident response plan in place and prepare your employees to have a heightened awareness,” he adds. “Carefully manage access and be prepared to respond and practice your plan. And don’t forget to keep up with industry intelligence. It’s important to see and learn from other organizations in many areas and to support other organizations who are targets for these types of threats.”

Learning from Hospital Peers

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The Intermountain / University of Utah shared Security Operations Center will play a big part in helping providers share industry intelligence around cybersecurity threats in real time. “It will be an opportunity for partner organizations to share learnings and intellectual property around security,” says Intermountain CIO Marc Probst. “There is also the opportunity to share some technical solutions and security intelligence. For example, the ability to immediately understand threats that other organizations are experiencing and to take action to prevent these at your own organization. To the extent organizations are members of the shared SOC, they could inherit these benefits.”

Probst adds that organizers hope to see the center up and running before the end of this year. “There are many details to work out.” he explains, “It’s possible that the participants could change and/or increase. There’s still a lot of work to do, but we are convinced that this is a good idea and we are actively pursuing it.”

Probst’s words reflect the learning curve the healthcare industry is still experiencing when it comes to cybersecurity and more targeted ransomware attacks. There is still – and will likely always be – a lot of work to do. Culture, collaboration, and vigilance will be key to ensuring that ransomware-related headlines soon become a thing of the past.

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April 27, 2016 News No Comments

News 4/27/16

April 26, 2016 News 5 Comments

Top News

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Nokia will acquire France-based consumer digital health device vendor Withings for $192 million to create Nokia Digital Health.

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Finland-based Nokia, which sold its mobile phone business to Microsoft in 2013, sells telecommunications infrastructure and licenses its brand name and patents.

Microsoft announced last year that it would write down $7.6 billion on its Nokia phone business (for which it paid only $7.2 billion) and would cut 7,800 related jobs as it refocused on the Windows Phone, sales of which were announced last week to be continuing their steady descent into market share rounding error territory.


Reader Comments

From Day1Date: “Re: NextGen. The ongoing restructuring continues with a layoff of around 5 percent focused on corporate, RCM, and ambulatory. This is to further the goal of focusing the company on being the best PM/EHR vendor in the market.” Several  readers report that NextGen has let 150 people go.

From Femdom: “Re: the HIMSS HIT rag. They’re creating a ‘room of one’s own’ with a separate section of their website and a newsletter for women only. I’m not sure that’s a good idea or even necessary.” That sounds like an awkward, paternalistic grab for feel-good advertising eyeballs to me. I doubt that whatever gender disparity exists in healthcare IT was caused by lack of vapid, gender-specific faux news; retweeted links to generic articles under the guise of “awareness” of which everyone is already amply aware; and running feel-good profiles of women whose accomplishments they devalue in spreading the recognition collectively over all women and not just the achiever. Creating what is in essence a special interest group for any demographic group seems like a step backwards to me no matter how well intentioned. Perhaps the publication could start by launching a hard-hitting investigative report as to why six of the seven executives of its parent organization HIMSS are white males.

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Disregarding my own cynicism for a moment, I will defer to HIStalk readers – take my poll as to whether a separate HIMSS-published site and newsletter for women is a good idea. Click the poll’s Comments link after voting to make your case.


HIStalk Announcements and Requests

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Mrs. Lee says her Arizona kindergarten students are using the math puzzles and magnetic wands we provided in funding her DonorsChoose grant to further their STEM knowledge.

Here’s a reminder to prevent the appearance of cluelessness: do not refer to times as “EST” since we’re on “EDT” until November 6. I’m surprised at how many seemingly otherwise competent people can’t keep this straight, and additionally surprised at how much it annoys me when they don’t. Under the premise that it’s better to mumble than shout when you aren’t sure, you can simply say “ET” and be correct all year.


Webinars

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Augmedix, which offers a Google Glass-powered remote scribe service, raises $17 million from five large health systems that include Sutter Health and Dignity Health, increasing its total to $40 million. Google’s development of an enterprise version of Glass – which never graduated from beta status and has largely disappeared even within Google’s hierarchy — has not been announced, leading Augmedix to suggest that it may explore other technologies. The company has a few hundred California doctors using its services.

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CMS releases the 45-page warning letter it sent to lab testing vendor Theranos last month, in which it individually addresses the company’s responses to dozens of problems at the California lab of Theranos with, “The laboratory’s allegation of compliance is not credible and evidence of correction is not acceptable.” The letter adds that the company’s responses “show a lack of understanding of the CLIA requirements.” CMS notes that Theranos diluted finger-stick samples so they could be processed on a standard Siemens lab machine, a practice that CEO Elizabeth Holmes had previously denied.

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Verisk Analytics will sell its Verisk Health services business to Veritas Capital for $820 million. I ran a rumor of the sale in early October 2015 and the company announced later that month that it was exploring strategic alternatives for the business. Veritas has no other healthcare holdings, but the private equity firm cashed in big in selling the Truven Health Analytics business it bought from Thomson Reuters for $1.25 billion in mid-2012 to IBM, which paid $2.6 billion to acquire the company in February 2016.

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Medical communications transaction platform vendor MEA-NEA-TWSG renames itself Vyne. Its newly created Vyne Medical business unit includes the former Medical Electronic Attachment (claims attachments) and The White Stone Group (healthcare communications management), while its National Electronic Attachment business unit offers electronic attachment management for dental practices.

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Blockchain technology vendor Gem launches Gem Health, which is partnering with Philips to build a healthcare blockchain ecosystem.

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Roper Technologies – whose healthcare IT holdings include Sunquest and Strata Decision – reports Q1 results: revenue up 4 percent, EPS $1.48 vs. $1.54, missing expectations for revenue and non-adjusted earnings but beating on adjusted earnings. CEO Brian Jellison said in the earnings call that Strata’s growth is “really exceptional” and that Roper will make more acquisitions.

Patient payments and check-in software vendor Inbox Health acquires the consumer health expense management technology of CakeHealth, which seems to have accomplished little beyond spending its tiny 2011 funding ($150K) despite aspirations of becoming “the Mint for healthcare.”

Apple reports Q2 results: revenue down 13 percent, EPS $1.90 vs. $2.33, missing expectations for both and guiding down as the company records its first revenue decline since 2003. It was also the first quarter in which iPhone sales dropped as Apple produced little innovation beyond offering bigger iPhone screens. AAPL shares dropped sharply in after-hours trading following the announcement. They’re down 20 percent in the past year.

Also turning in crappy quarterly numbers is Twitter, shares of which are tanking in after-hours trading Tuesday as the company misses revenue and earnings expectations wildly and reports slowing user growth despite its desperation-smelling rollout of Periscope and Moments.


Sales

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Baylor Scott & White Health (TX) will implement the Pieces surveillance and population health management system and will make an unspecified investment in the company. Pieces raised a $21.6 million Series A round last month.


People

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Switzerland-based healthcare wireless and security technology vendor Ascom names Holger Cordes (Cerner) as CEO.

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John Driscoll (Care Centrix) and John Glaser (Cerner) join the board of Press Ganey.


Announcements and Implementations

InterSystems will interface its TrakCare information system to the blood ordering and inventory management system of the Australian National Blood Authority to allow its users to automate blood ordering and distribution.

CareOne LTAC Hospitals (NJ) completes its implementation of NTT Data’s Optimum Clinicals.


Government and Politics

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India passes a law requiring cell phone manufacturers to add a panic button and satellite-based locating technology to their smartphones, hoping to improve the country’s widely publicized rape problem. India doesn’t have a 911-type emergency number but hopes to introduce one soon. Companies sell several personal safety apps (such as My Safetipin, above) to India-based customers, most of which notify an emergency contact and share the user’s location.

In Australia, the state of Victoria will spend $23 million to develop a real-time database to help doctors and pharmacies identify patients who overuse prescription drugs. Victoria recorded 330 deaths from prescription drug overdoses last year, more than the number of people killed in car accidents or from overdoses of illegal drugs.

Parents of children with muscular dystrophy testify to the FDA about the benefits their children receive from taking a drug with questionable proven effectiveness. Afterward, the FDA declared that the drug company’s poorly designed, 12-patient study was not sufficient to prove the drug’s value, but three of the 10 panel members abstained from voting after being moved by the comments of the parents. Following the “no” vote, some of the audience members shouted at the advisory panel. The FDA says it will “take the views of the community into account.” I can’t decide if that’s an admirable move toward patient empowerment that shows the value of “little data” or an uncomfortable vaccine-like abandonment of science in allowing laypeople to argue with emotion rather than documented facts.

The FDA warns drug companies that it won’t accept clinical studies that use data prepared by India-based Semler Research Center after an FDA inspection turns up evidence of intentional data tampering.

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New York Mayor Bill de Blasio will propose big changes and $2 billion in subsidies to bail out money-hemorrhaging NYC Health + Hospitals that include reducing ED visits, turning inpatient space into ambulatory facilities, and developing vacant property, all while closing no facilities or laying off any employees to avoid $6 billion in losses over the next five years. The consultant’s report is here.


Innovation and Research

A study of the 46,000 Maryland residents who had a least five ED visits in 2014 finds that 70 percent of them used more than one hospital, meaning that most hospitals won’t be able to identify those high ED users or coordinate their care using their own data alone.


Other

An op-ed article in a British newspaper says idealistic young Americans should work on domestic problems instead of trying to save the world in addressing overly simplified issues in exotic locations. It explains the “reductive seduction of other people’s problems” as being no different than if an idealistic, naive student in Uganda traveled to America for the first time, confidently expecting to win fame and maybe an award for fixing our gun violence problem. In a related item, a new book questions whether healthcare volunteers who trek off to developing countries for short stints help or hurt those communities, with the author concluding after analyzing the available data that the net effect is probably slightly positive if the volunteer has the right attitude. The problems with medical volunteers include that they may be tempted to perform tasks that exceed their skill level, they may try to impose unrealistic US standards,  and that they could hurt local doctors by undermining confidence or offering free services that put them out of business.

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Western Australia’s health department, which hasn’t had a permanent CIO since 2010, gives up after finding no suitable candidates and instead creates a support services organization led by a procurement specialist who will oversee IT. WA Health’s troubled IT implementation delayed the opening of newly built 783-bed Fiona Stanley Hospital in 2013.


Sponsor Updates

  • AirStrip announces that 4 million US births have been monitored using its system over the past 10 years.
  • Interactive patient TV vendor PDi will provide patient education videos from Elsevier.
  • Aprima will exhibit at the American College of Physicians Internal Medicine Meeting May 5-7 in Washington, DC.
  • Audacious Inquiry’s Team Ai took first and second place at the Port to Fort 6k.
  • Team EcoBase from First Databank and Zynx Health wins second place at the FHIR Connectathon in Indianapolis.
  • Besler Consulting releases a new podcast, “Comprehensive Care for Joint Replacement (CJR) Target Pricing & Episode Spending Calculations.”
  • CenterX will exhibit at the NCPDP May Work Group Meetings May 1-2 in Scottsdale, AZ.
  • Obix posts a video covering the use of its perinatal data system at Norman Regional Hospital (OK).
  • CitiusTech will exhibit at the LHC Executive Briefing with Milton Johnson, chairman and CEO, HCA, May 4 in Nashville.
  • Crossings Healthcare Solutions releases its Spring 2016 e-letter.
  • Direct Consulting Associates will exhibit at iHealth 2016 May 5-6 in Minneapolis.
  • EClinicalWorks will exhibit at the American College of Physicians Internal Medicine Meeting May 5-7 in Washington, DC.
  • Extension Healthcare will exhibit at the IONL Mid-Year Conference April 29 in Bloomington-Normal, IL.
  • HCS will exhibit at the NALTH 2016 Spring Clinical Education & Annual Meeting April 28-29 in Memphis, TN.
  • Healthwise will exhibit at the ZeOmega Client Conference May 2-4 in Plano, TX.

Blog posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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April 26, 2016 News 5 Comments

Curbside Consult with Dr. Jayne 4/25/16

April 25, 2016 Dr. Jayne, News 1 Comment

I wrote last week about my experience with a client who had been swindled by a practice administrator who had promised far more than he could deliver. A reader commented: “I would have loved to hear a few more specifics on what a practice might do to avoid hiring such an administrator or office manager. It has also been my experience that too many independent practices don’t seem to know what to really look for and consequently suffer down the road.”

I’ve certainly done more than my share of hiring and firing over the last decade. On my own, I’ve employed medical assistants, office managers, and partners. I also had to terminate at least one of each. As part of the corporate world, I’ve had to deal with vetting a host of positions including clinical staff, IT staff, managers, and operations execs. As a consultant, I’ve been asked to deal with errant members of the C-suite and upper management and also to assist in finding their replacements.

The best tip I can offer anyone in a hiring position is an old adage: trust your gut. Nearly every time I’ve gone against my gut, there’s been a poor outcome. Sometimes you can’t avoid it, especially if you’re in an employed capacity or part of a larger corporate entity.

For example, I once had to hire an analyst to run some lab interface work. The health system’s HR department (which usually left something to be desired) was only able to find two candidates who were remotely qualified. Although their resumes were decent, both of them interviewed somewhat poorly. I felt the first one didn’t understand the job we were offering, despite our attempts to explain it and talk about the work she would be doing. She kept going back to what she had done in the past and how good she was at it, even though we were trying to assess whether she’d be a good fit going forward.

The second one was too folksy right off the bat. Don’t get me wrong, I’m a folksy girl myself, but there’s a time and place for familiarity and it’s not in a job interview. I don’t want to hear about your children and your weekend plans – not because I don’t care, but because it’s too easy to get close to discussion topics that are normally a bad idea during the interview process. She seemed to be much more eager than the other candidate, but I didn’t really feel that she would be able to get the job done.

I wanted to go back to HR and ask them to look for other candidates, but was under pressure to fill the open posting immediately to ensure we could get someone in the position before a series of budget cuts that might force us to pull the opening off the board.

Although her interface skills were decent, it turned out that her overly casual demeanor was reflective of casual regard which she paid to all her work. When asked for status reports, it always felt like she was on the cusp of getting to the tasks that needed to be done, rather than actually doing them. She also liked to spend a lot of time chatting with other team members, which impacted not only her productivity, but that of others. It felt like she spent a lot of time doing nothing and then sprinted towards the deadline, which was a poor fit for our company culture.

Although I was involved in the hiring, I wasn’t her direct manager. He didn’t seem to have the wherewithal to deal with her because she interpreted every element of constructive criticism as “being mean.” Needless to say, she didn’t last very long. My failure to fight for my gut feeling in that situation bothered me for a long time.

Besides following your instinct, it’s important to watch out for people that seem too good to be true. Maybe they have a seemingly stellar record of accomplishments, but are willing to work for a salary that is lower than they appear to be worth. Sometimes you can get a bargain, but usually there’s a good story to go along with it. For example, a highly-skilled administrator who moves to a small town to care for aging parents or someone who needs a more low-key role to provide greater work-life balance. Usually these candidates realize that they may seem oddly matched for a position and will take the lead on explaining their desire to move down the ladder.

Other times, though, they might not have a good explanation for why they left their last position, or the references they provide don’t seem to make sense. I admit that it’s getting harder and harder to get a decent reference, particularly from past employers. Often organizations will simple verify the dates that the individual was employed. If you’re lucky, they might tell you if the person is eligible for rehire. Getting a true reference that you feel you can trust is like gold.

Other things that I sometimes don’t see smaller practices do: the consumer background check. They may do a criminal check, but not a consumer one. In this day and age, it’s important to know whether the people you are hiring have had any financial difficulties, particularly if they are going to be a position to handle funds within the office. Of course, that won’t tell you if the employee will make bad decisions, like the front desk staffer that I fired after finding $1,200 in co-pays in the sample closet. Why, you might ask, was the money in the sample closet? Because she didn’t have time to go to the bank and do the deposit each night, so she wanted to keep it somewhere “safe.”

Organizations should also make sure that candidates have valid experience for the position they’re trying to fill. Candidates might not have held the exact same job or title, but should be able to clearly explain how their previous experience will translate to the new position. Especially for higher-level roles, most organizations don’t have time to deal with someone who cannot hit the ground running. I do occasionally see it though, with groups that feel like they can mold someone into something that they may not be able to become.

Administrators should be able to talk about their achievements in previous roles and cite metrics for practices they’ve led. How have their days in accounts receivable been? Even if they weren’t stellar, did they show a positive trend? What initiatives did the candidate lead to try to move things in the right direction?

Potential employers need to have a list of solid questions to ask that relate to the needs of the organization. If you’re planning to become a Patient-Centered Medical Home, ask about that experience. If the candidate doesn’t have experience, ask him/her what he/she would do to get up to speed should they be hired. Anyone worth their salt should be able to articulate a plan to learn about a new discipline or new initiative, especially since the healthcare system we may be operating in over the next few years doesn’t exist yet. If they can’t come up with a reasonable strategy, they might not be a good fit.

Once an administrator or practice manager is hired, the practice should keep close tabs on their performance, not only in the initial hiring period, but in a regular ongoing fashion. Practice leadership (owners, partners, managers, etc.) should be having monthly meetings to review financials and potential problem areas in the practice. If the administrator says everything is rosy all the time, something is wrong. Even in the strongest practices there is always opportunity for improvement or some sort of personnel issue to make management aware of.

Owners or top leadership should also watch out for staffers that continuously spread blame around to vendors, payers, or other staff without showing even the smallest level of introspection about whether they could have done something differently.

Another good question to help assess a potential hire is this: “Given what you know about our organization, if you are hired into this position, what do you see the first six months looking like?” In my experience, candidates who plan to do a good amount of listening and observing before making too many changes are often the best. They’re willing to take their time to figure out what they have to work with, assess the team’s strengths and weaknesses, and make a careful plan rather than coming in with guns blazing.

What’s your worst hiring or firing nightmare? Email me.

Email Dr. Jayne.

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April 25, 2016 Dr. Jayne, News 1 Comment

Best Practices Coming Soon to a Virtual Visit Near You

April 25, 2016 News No Comments

Top telemedicine vendors weigh in on a recently published study calling for them to share best practices.
B
y @JennHIStalk

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A recent JAMA-published study comparing quality of care among six telemedicine vendors highlights the growing pains that this evolving method of healthcare delivery seems to be going through. The clinical variation found in the virtual visits – ranging from asking the proper questions and performing the correct examination steps to ordering medically indicated tests – prompted researchers to recommend that telemedicine vendors share best practices.

It’s a novel idea, one that suggests telemedicine is ready to move from its awkward “tween” phase to becoming a more mature and collaborative force. Would sharing best practices reduce clinical variation? Do telemedicine vendors or other stakeholders foresee improved patient care (or the chance to market themselves better) if they were to follow standards and share best practices? Would such collaboration even be feasible?

These are the questions that will drive telemedicine stakeholders — including payers and organizations like the American Telemedicine Association (ATA) — to the next phase of market maturity.

Aren’t We There Yet?

Some may argue that telemedicine already has standards in place. They would be half right. Most if not all vendors have their own internal set of guidelines and clinical best practices, in addition to those published by the Federation of State Medical Boards and the American Medical Association (AMA).

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Doctor on Demand, for example, implemented protocols from Day One that include a double-blinded peer review, daily visit feedback, and an antibiotic stewardship program.

“We employ our doctors, which I think is a big differentiator,” says Doctor on Demand Chief Medical Officer Ian Tong, MD. “For instance, we couldn’t do our peer review program with a group of independent contractors who are just getting on our platform periodically to make some extra money and moonlight. That’s much more difficult to do.”

“The way that we leverage technology allows us to monitor a number of things,” he adds, “including duration of the visit, idle time for the doctor, and patient satisfaction scores. We can aggregate that information and give our physicians feedback, letting them see patient comments at the end of every day.”

“Am I ready to say that everything I just listed is the best practice?” Tong asks. “Not yet, but I doubt anyone’s doing more. I can tell you that brick-and-mortar practices don’t do half the things I just listed. Eventually those may lead to the development of best practices, but you have to go through a certain amount of market maturity.”

Getting Past the Growing Pains

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Most telemedicine vendor executives agree that market maturity is a work in progress and that shared best practices won’t become the norm until the average consumer, employer, and even payer sees the benefit in virtual care.

“We wholeheartedly believe that absolute transparency in best practices and lessons learned from mistakes are key to allowing this industry to move forward responsibly,” says American Well President and CEO Roy Schoenberg, MD, MPH. “The biggest hurdle to telemedicine is the still prevailing misconception of what it can do and the operating know-how of how to make it a safe extension of traditional care delivery.”

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Scaling telemedicine’s potential in terms of user acceptance and technical capability is top of mind for the entire market right now. “The industry is in its infancy based on the market potential,” explains Teladoc Chief Medical Officer Henry DePhillips, MD, who adds that the market potential for telemedicine visits is about 550 million interactions annually. “We’re predicting that we’ll do 900,000 visits this year,” he says, “and so we’re just barely scratching the surface of the market’s potential, which has a lot to do with why, up until now, best practices have not yet been established.

“A misstep by any of the vendors in the space will potentially have a negative impact on the entire industry, not just that particular vendor,” DePhillips adds. “I think it’s incumbent on all of us to have really high standards for clinical quality of care, patient safety, reporting, record keeping, and patient experience because the industry needs to keep moving forward.”

Third Parties Attempt to Take the Lead

It’s not for lack of trying that a nationally recognized set of telemedicine best practices has not been created and adopted among stakeholders. Organizations like the ATA, Health Information Trust Alliance (HITRUST), National Committee for Quality Assurance, and URAC (formerly known as the Utilization Review Accreditation Commission) have attempted to drive the best practices conversation via certification programs.

Tong sees immense value in attaining third-party accreditations, and points out that Doctor on Demand has certifications from ATA, NCQA, and HITRUST, “which is really important, but not as sexy. That involves the security of your health records and platform. I think that’s actually a pretty high bar, to be honest. A lot of hospitals don’t have all three of those certifications.”

Teladoc has pursued similar recognition and was the first telemedicine vendor to achieve NCQA recognition. “There are a number of players in the industry that want to be seen as the stamp of approval for the telemedicine industry,” DePhillips says. “I think they’re all heading in the right direction in raising the bar on patient safety and care quality, but I don’t think any of them have really figured out how to dominate that part of the industry yet.”

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He does see potential in some kind of Energy Star-like stamp of approval for telemedicine. “I think the concept of having trusted third-party validation is correct,” he explains. “End users will eventually look for that. We actually display the NCQA logo on our website. I think that it will help business. It’s just a matter of which third party you want to hang your hat on at the moment. I think the players, from the stamp-of-approval standpoint, are probably going to shift over time.”

Schoenberg is in accord with his competitors, adding that telemedicine’s eventual stamp of approval will need to have two parts – “approval for the quality and safety of the platform used and a recognition of the quality of the clinical service, which will be implied by the already familiar brands offering it, e.g. Blue Cross Blue Shield, UnitedHealth, Cleveland Clinic, etc.”

Competitive Collaboration is Key for Now

While stakeholders wait for the gold standard of telemedicine certification to emerge, vendors like those reviewed in the JAMA article have focused on collaborating with each other to ensure best practices are shared in the interests of all.

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“Although we compete for customers, we collaborate in many ways,” says DePhillips, noting that Teladoc is a member of the ATA and Alliance for Connected Care, a DC-based think tank that includes other broadly defined telemedicine companies. “When it comes to regulatory, care quality, and/or patient safety issues, there’s actually a lot of collaboration among at least the top-tier telemedicine companies,” he adds. “I actually have a professional relationship with my counterpart at our primary competitors. We’ll get together occasionally and talk about how we can work together to solve regulatory issues, most of which are in the past. In some cases, some of the companies will pool funds to help with a regulatory issue. We will not pool resources, but we’ll have a pretty good, detailed conversation around the best approach to patient safety, what standards are out there from the various specialty societies, and what we should be following as an industry. Like I said, a rising tide truly raises all ships. That’s the industry we’re in, especially at this level of maturity.”

Vetting Vendors in the Meantime

For now, potential users will have to use their best judgment in selecting telemedicine services for their members, employees, or themselves. In addition to the certifications mentioned, Schoenberg, Tong, and DePhillips have their own must-haves and red flags for vetting vendors.

“Video visits are a must,” says Tong. “It’s also important to look at the quality of the physicians. What are the hiring practices and training regimens? What are the quality assurance programs that practice has in place? They may not all want to give you their secret sauce, but I think it’s very reasonable to ask, ‘How do you do that?’”

DePhillips believes that, in addition to quality and patient safety assurances, potential customers should look at three key things. “When I look at the younger, smaller players in the industry, I find that they tend to cut corners in two areas. Number one is the way in which they put their provider network together. There’s no other company besides Teladoc that has licensed providers that are physically present in all 50 states. A lot of this cross-state licensing discussion is a non-issue for us. It’s heavy lifting and it’s expensive, but we chose to do that because we think it’s the best route to take. Vendors should also have the infrastructure to support future adoption and to scale.”

Schoenberg’s advice takes a more high-level approach: “First, map out all that you want to do with telemedicine — urgent care, follow-up care, provider-to-provider consults, etc. — and ask the vendor to show you how they can support it. Then, map out all of the systems you will need those services to integrate or exchange data with, and ask the vendor to show you how they can do that. Then, think of what it will take to roll out to all involved – patients, providers, payment stakeholders, marketing, actuaries – and ask the vendor to show their depth of understanding of what needs to be done to be successful in each. Finally, look for leadership you can trust to keep you ahead of the curve as the world of delivering healthcare via technology explodes forward.”

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April 25, 2016 News No Comments

Monday Morning Update 4/25/16

April 24, 2016 News 9 Comments

Top News

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Lockheed Martin lays off 200 IT employees in preparing for the $5 billion merger of its IT business with Leidos.

It’s called a merger rather than an acquisition because the companies are using a tricky Reverse Morris Trust so Lockheed can exit the IT business without paying taxes on its gain. A company creates a subsidiary, the subsidiary merges with another company to form a new company, and the new company then issues at least 50 percent of shares back to the original company’s shareholders.


Reader Comments

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From Madison: “Re: Nordic. No more word of what happened with the Drew Madden sexual harassment and retaliation charges, but it looks like Nordic wanted a change. First they brought in a new CEO, moving Drew to president. Now he seems to be gone — he is no longer referenced on their page.” The LinkedIn profile of former Nordic President Drew Madden shows he left the company this month, with a tagline he added saying, “Honored and blessed to have worked for THE BEST company in the business!” A former marketing VP filed a complaint in 2014 against Nordic with Madison, Wisconsin’s Equal Opportunity Division, claiming she was fired for complaining about suggestive texts sent her by Madden, while Nordic says the VP willingly participated in such attention, their banter was lighthearted and not unusual for co-workers, and she was fired for poor performance. You can read what he said and she said.

From Finally: “Re: Epic. Heard they’re on a hiring freeze for roles they have been continually hiring for (implementation, development, etc.) for years. Seems like they overstaffed with optimistic thoughts of government deals.” Unverified. 

From Ben: “Re: Vail Valley Medical Center. Therapist steals medical records.” The Colorado hospital will inform 3,100 patients that a former physical therapist copied their medical records onto a thumb drive before leaving to join a new employer. The hospital says it has since added restrictions on how employees can copy patient files and adds that police are investigating.


HIStalk Announcements and Requests

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It was nearly an even split between poll respondents who would be concerned about their privacy if they were being treated for depression by an EHR-using provider. Some respondents commented that the real problem is the perception of mental health issues as a personal weakness. Tami summarizes well in saying, “Depression and mental needs to be treated more along the lines of cancer. If you can get help before it progresses too far, treatment can be easier and perhaps quicker. If you wait too long, it can be a death sentence. There are risks with every piece of data that leaves you.”

New poll to your right or here: what is the best answer for reducing the time doctors spend entering data into EHRs?

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We fulfilled the DonorsChoose grant request of Ms. Hamilton, whose Arizona special education middle school class asked for timers, books, and math games. She reports that the students are now competitively playing multiplication bingo and challenge themselves to beat the clock in completing their assignments.

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Also checking in is Mrs. Bierhals, whose Pennsylvania second grade class received programmable robot kits and an iPad Mini. She says, “The children have been using the items from the minute we received them. We have managed to build all the robots and programmed them to run on different frequencies. Since the weather is starting to break, we are planning on having Robot Races outside for the end of the year. Now we have to work on their driving skills.”

I think we’re entering the summer health IT doldrums, at least as evidenced by the paucity of significant, interesting news items.

I wasn’t much of a Prince fan, but like a lot of people who are jarred into paying attention only after someone famous dies, I’m learning what I’ve missed in appreciating 2004 video of an ultra-cool Prince leading a supergroup with his scorching guitar solo on “While My Guitar Gently Weeps.”

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Comcast, the “Most-Hated Company in America” that provides around half of the residential broadband connections in the US (under the Xfinity name) where many of its customers don’t have an alternative, finds a loophole around net neutrality to try to protect its cable and content businesses against cord-cutters who decide they only need a Roku box running Netflix or Hulu. The company is rolling out Internet usage caps that work like cell phone data plans in charging customers extra if they run over Comcast’s limit. Use of Comcast’s own Stream TV service doesn’t count since technically it uses Comcast’s wire but not the Internet, putting Netflix at a huge disadvantage. Comcast says the change is about fairness since customers who use less data pay less, but that’s not exactly true – nobody pays less and the best you can hope is to not get dinged extra for the same service. Complaints suggest that people are avoiding buying houses in areas where Comcast is the only source of Internet connectivity. Please, Google, put fiber everywhere.


Last Week’s Most Interesting News

  • Maine becomes the second state to mandate electronic prescribing of narcotics.
  • Patient privacy finally trumps the demand for medical reality TV as New York-Presbyterian pays $2.2 million to settle HIPAA charges that it provided patient information to TV crews.
  • Parrish Medical Center (FL) says its IT payments spat with McKesson is endangering patients as the company stops providing drug database updates and threatens to pull its entire product line from the hospital.
  • The federal government launches a criminal probe of Theranos.
  • Court filings of MetroChicago HIE’s lawsuit against the defunct HIE vendor Sandlot Solutions show the HIE desperately trying to restore its Sandlot-housed data before the company closed its doors for good.
  • Canada’s Alberta Health Services says it will RFP a new system, expecting to spend at least $316 million to replace 1,300 mostly non-interoperable systems whose purchase it subsidized.
  • A Wisconsin jury awards Epic $940 million in its trade secrets lawsuit against India-based Tata Group.
  • VA CIO LaVerne Council hints that the VA plans to built a VistA replacement instead of buying a commercial product, telling Congress that a working prototype of a product she likens to Facebook and Google will be ready within a few months. She also confirms that she has placed the VA’s $624 million patient scheduling system contract with Leidos and Epic on hold while they test a homegrown product that will cost only one-tenth as much.

Webinars

April 26 (Tuesday) 1:00 ET. “Provider-Led Care Management: Trends and Opportunities in a Growing Market. ”Sponsored by HIStalk. Presenter: Matthew Guldin, analyst, Chilmark Research. This webinar will provide a brief overview and direction of the provider-led care management market. It will identify the types of vendors in this market, their current and longer-term challenges, product capabilities, partnership activity, and market dynamics that influence adoption. It will conclude with an overview of key factors for vendors and solutions moving forward.

May 5 (Thursday) 2:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Technology

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Several CNET editors who bought Apple Watches but then stopped wearing them say it doesn’t really do anything useful, its apps are lame, it’s easier to just pull out a phone, and it’s too complicated. Even Apple co-founder Steve Wozniak isn’t impressed:

I worry a little bit about — I mean I love my Apple Watch, but it’s taken us into a jewelry market where you’re going to buy a watch between $500 or $1,100 based on how important you think you are as a person. The only difference is the band in all those watches. Twenty watches from $500 to $1,100. The band’s the only difference? Well this isn’t the company that Apple was originally, or the company that really changed the world a lot.


Other

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A JAMIA article says hospitals should not prohibit testing in their EHR’s production environment because test environments can’t perfectly mimic the live system’s interfaces and realistic patient data. I ran a poll in February at the suggestion of Dean Sittig, one of the authors, and 15 percent of respondents said they never allow creating test patients in production. The article offers these tips:

  • Test software changes in the test environment first, then enable the change in production for a small group of testers if possible.
  • Use distinctive names for test patients in the production environment, using a consistent prefix such as” ZZZtestingBWH345, OneTest” rather than cute names like “Santa Claus” or names like “Test” that actually exist as real patient names.
  • Create specific user accounts for testers and lock them out of making changes to non-test patients if possible, auditing their transactions to make sure they are performing only approved work.
  • Train downstream personnel on how to respond when they see the results of test patient transactions and notify them before testing starts.
  • Filter test patients from reports and data extracts.

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The death of Prince at 57 caused folks to look back on a year-old research paper that analyzed the deaths of US pop musicians, finding that they die nearly 20 years younger than the rest of us, with the most common age at death being 56. The author even looked at deaths by musical genre, finding that gospel singers had a better quality of life while rappers are nine times more likely to die by homicide than the average person. Metal and punk performers were much more likely die by accident or to commit suicide.

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The Rochester, MN paper notes that Mayo Clinic has nicknamed its Epic project Plummer to honor internist and endocrinologist Henry Plummer, MD, who created Mayo’s practice model in 1910. He also developed the clinic’s “one patient, one record” paper records system and the pneumatic tube delivery system to deliver them (it was the interoperability API of its time). Apparently he was well compensated (or well inherited) since he built Plummer House, his 300-foot-long, five-story family Tudor estate on 65 acres that features 49 rooms, 10 bathrooms, and nine bedrooms. His mark as an innovator carried over into the design of Plummer House, which when completed in 1924 had a central vacuum system, underground sprinklers, a security system, garage door openers, a heated pool, and the city’s first gas furnace.

Here’s the first of three “2016 HIS Vendor Review” summaries from Vince Ciotti and Susan Pouzar of HIS Professionals.

Imprivata creates a pretty funny video urging hospitals to “ditch your page boy.” I noticed immediately that for both patients pictured, their vital signs monitors are working great despite not being attached to them (perhaps there’s a wireless innovation there as well) and that the guy’s IV drip is not actually dripping into him. I noticed a few other mistakes at re-creating a hospital room – do you?


Sponsor Updates

  • T-System will exhibit at ILHIMA Annual Meeting April 28-30 in Tinley Park, IL.
  • Verisk Health’s Sam Stearns and Molly Grimes contribute an article to Employee Benefit News on optimizing the value of maternity care.
  • Huron Consulting Group will exhibit at the Association of Information and Image Management Conference April 26-28 in New Orleans.
  • ZeOmega will host its Connections 16 client conference May 2-4 in Dallas.
  • Xerox will host a Google+ Hangout on population heath management May 5 at 1pm ET.
  • YourCareUniverse publishes a new white paper, “Addressing the Rise of Healthcare Consumerism & The New Marketing Reality.”
  • ZirMed will exhibit at the Radiology Business Management Association Summit April 24-26 in Colorado Springs, CO.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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April 24, 2016 News 9 Comments

News 4/22/16

April 21, 2016 News No Comments

Top News

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Maine will require prescriptions for narcotic drugs be transmitted to pharmacies electronically beginning January 1, 2018. Prescribers of narcotics and benzodiazepines will also be required to check the state’s prescription monitoring database before issuing a new prescription and every 90 days as the prescription is renewed.


Reader Comments

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From Meditech-Using CIO: “Re: Meditech. This comment from their 10-K is one of many reasons the company in its current state won’t be the company they seem to think it will be. Essentially all of its 2015 income was given back to shareholders as dividends rather than increasing R&D or hiring more talent. The whole corporate structure seems to be based on shareholder enrichment. Also, take a look at product revenue, which has dropped by nearly half in two years. Perhaps the problem is that everybody on the leadership team started with the company right out of school – not one executive knows anything other than Meditech, which I cannot imagine under any scenario being a good thing unless you’re all about dividend income.” Meditech’s executives average 36 years of employment with the company, starting their careers there at an average age of 25. The least-tenured of the executive team joined Meditech in 1990. I’m anxiously awaiting the company’s Q1 numbers, which rumors suggest will be highly interesting.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Ms. W, who asked for three tablets for her California second graders. She has installed reading and math practice apps and says, “The tablets have been especially useful for my most struggling readers. They often have a hard time working independently during reading rotations. They all try really hard, but get stuck on some of the work. The tablets have given them an opportunity to work on fluency and sight words with a little more support even when a teacher is not available to help them out.”

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Also checking in is Ms. Read from Texas, whose middle school class received a bunch of electrical components for working on “squishy circuits.”

This week on HIStalk Practice: AMA launches the Healthier Nation Innovation Challenge. Urgent Team goes with DocuTap’s EHR, PM, and billing software. Physician’s Computer Company works with ThinkMD to bring its MEDSINC technology to the US market. The Massachusetts League of Community Health Centers selects HIE connectivity consulting services from EMedApps. Everseat offers users rides to their doctor appointments via Lyft. SingleCare partners with AmericanWell to offer Pittsburgh members virtual consults. Robin Zon, MD of Michiana Hematology Oncology shares her experience with patient-friendly clinical trial technology.

We’re down another music legend on the year as Prince dies at 57.

Listening: new frantic, ragged dairy punk from Appleton, WI’s Tenement, a necessary antidote to over-produced, soulless musicians who never seem to sweat or express any emotion other than self-admiration.


Webinars

April 26 (Tuesday) 1:00 ET. “Provider-Led Care Management: Trends and Opportunities in a Growing Market. ”Sponsored by HIStalk. Presenter: Matthew Guldin, analyst, Chilmark Research. This webinar will provide a brief overview and direction of the provider-led care management market. It will identify the types of vendors in this market, their current and longer-term challenges, product capabilities, partnership activity, and market dynamics that influence adoption. It will conclude with an overview of key factors for vendors and solutions moving forward.

May 5 (Thursday) 1:00 ET. “Reducing CAUTI and Improving Early Sepsis Detection Through Clinical Process Measurement.” Sponsored by LogicStream. Presenters: Jen Biltoft, director of quality improvement, SCL Health; Marla Bare, EHR architect, SCL Health. This webinar will describe how SCL Health reduced catheter-associated urinary tract infections by 30 percent in just three months through clinical process measurement. The SCL Health presenters will also share their plans for applying a similar process to the early detection of sepsis.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

Non-profit insurer EmblemHealth lays off 250 IT and operations employees and contracts their work out to Cognizant. EmblemHealth says using systems offered by Cognizant subsidiary TriZetto will save hundreds of millions of dollars in development costs and won’t require company maintenance resources. Displaced employees are complaining that they have been asked to train their offshore replacements. The attorney who was helping EmblemHealth’s IT employees unionize posts a video in which EmblemHealth CEO Karen Ignagni announces the layoffs. She has been CEO for just seven months following  long career as lobbyist-CEO of the American Association of Health Plans, but before that, she ironically worked for the AFL-CIO as director of employee benefits.

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Microsoft reports Q3 results: revenue up 2 percent, EPS $0.62 vs. $0.61, missing earnings expectations.

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Venture capitalist Bill Gurley says the the Silicon Valley “unicorn” bubble burst when the Wall Street Journal started its investigation of Theranos. He makes these points about those privately held companies with paper valuations of more than $1 billion:

  • Theranos is an example of a company that raised money from a handful of investors with a high paper valuation, but that doesn’t mean the company is doing well or that shares are worth the valuation imputed by what those investors paid.
  • Unicorns have rarely gone public, leaving insiders no way to cash out.
  • High-profile startups are failing and laying off employees in attempt to slow their record-setting burn rates.
  • Mutual funds are writing down some of their overly optimistic unicorn investments.
  • Nervous investors are asking questions about profit, not just the previous goal of growth at any cost.
  • CEOs desperately want to avoid new funding rounds at lower valuation, investors don’t want to write down investments that previously looked successful, and founders may cash in ahead of their investors in a rush to the exits.
  • Opportunistic “shark” investors are offering funding with ugly terms buried in the details that underlie their seemingly high valuation, allowing entrepreneurs to prop up a high valuation with a ticking time bomb of unfavorable terms that can only be dodged with a successful IPO.
  • Entrepreneurs accustomed to readily available capital will find it hard to accept new funding rounds at lower valuations, the pressure to quickly become profitable, or to reverse “stay private longer” thinking and prepare for an IPO.
  • Gurley concludes, “Founders have come to believe that more money is better, and the fluidity of the recent funding environment has led many to believe that heroic fundraising is a competitive advantage. Ironically, the exact opposite is true. The very best entrepreneurs are relatively advantaged in times of scarce capital. They can raise money in any environment. Loose capital allows the less qualified to participate in each market. This less qualified player brings more reckless execution which drags even the best entrepreneur onto an especially sloppy playing field. This threatens returns for all involved.”

Sales

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Centra (VA) chooses Cerner Millennium and HealtheIntent for its five hospitals and 50 non-hospital locations. 


People

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HealthLoop names Bevey Minor (MarketPoint) as chief marketing and development officer and Harry Kirschner (The Advisory Board Company) as chief revenue officer.


Announcements and Implementations

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Mount Sinai Health System (NY) joins the OpenNotes movement.

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Northwell Health (the former North Shore-LIJ) announces that its 3D bioprinting body replacement parts project will receive $100,000 in additional funding after it received the most public votes among three of its innovation projects. Northwell will spin the project off as a separate company, which expects to have the technology ready for human use in five to 10 years.


Government and Politics

Politico reports that the Coast Guard has terminated its Leidos/Epic EHR project without any sites going live after spending $60 million, which is hardly news since I reported it here (and confirmed it with Epic) on October 7, 2015.

The State of Utah declares pornography to be a public health hazard that creates psychological and physiological addiction, although the non-binding resolution carries no funding to do anything about it.

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England’s Health and Social Care Information Centre renames itself to NHS Digital, with Noel Gordon named chair.


Privacy and Security

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New York-Presbyterian Hospital (NY) pays $2.2 million to settle HIPAA charges of disclosing PHI to the ABC crews filming the TV series “NY Med.”

Crouse Hospital (NY) fires one of its medical residents after he was caught hiding two spy pen cameras in one of the hospital’s ICU bathrooms. The doctor’s lawyer says his client – who also has three years’ experience as an investigative reporter — was trying to find the person who stole his Adderall prescription and GoPro camera, noting that the spy cameras weren’t pointed at the toilet and did not record anyone identifiable on the video.

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The information of 3,200 patients of Wyoming Medical Center (WY) is exposed when two employees click links in phishing emails. The hospital says its email system contained PHI, such as medical record numbers, dates of service, and some medical information. One of the affected patients is the hospital’s CEO.


Other

Another healthcare payment quirk: a woman’s doctor-ordered genetic test isn’t covered by her insurance company because they say it’s experimental, but instead of being billed at the testing company’s $349 uninsured patient rate, they insist that she pay $1,494, the amount the company charges insurance companies. In other words, having insurance cost her an extra $1,145.

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Arizona State University’s business school names McKesson Chairman, President, and CEO John Hammergren as its 2016 Executive of the Year, in which it recognizes “top executives who serve as exceptional models for future business leaders.”

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An Orlando TV station says patients are being endangered at Parrish Medical Center (FL), which is suing McKesson for what it says is a botched software implementation. The hospital claims McKesson shut off its access to drug database updates and has threatened to remove all of its products the hospital uses if the hospital doesn’t pay the bills it is disputing. Parrish signed up for Horizon Clinicals, Horizon Enterprise Revenue Management, business intelligence, cardiovascular information system, ambulatory PM/EMR, and RelayHealth in February 2011.

I ran across a study concluding that only about half of psychiatrists (as surveyed in 2009) accept medical insurance, the lowest insurance acceptance rate of all specialties. That means those already-alarming studies showing that most behavioral information isn’t visible in EHRs actually understate the problem – they assumed that the denominator was the number of visits found in claims databases, but those visits insurance didn’t cover wouldn’t be recorded anywhere except in the private records of the mental health professionals.

A federal appeals court rules that Reading Hospital (PA) isn’t liable for the injuries sustained by an AMN Healthcare contractor who sued the hospital after falling down a flight of stairs while supporting the hospital’s Epic go-live. The court ruled that AMN’s contractor was actually a hospital employee because the hospital directed his work, leaving him unable to sue the hospital for personal injury because he was already covered as a “borrowed servant” by workers compensation.

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Fox consumer affairs TV reporter John Stossel, writing from his New York-Presbyterian Hospital bed, says the hospital’s care is good but its customer service isn’t:

Doctors keep me waiting for hours, and no one bothers to call or email to say, "I’m running late." Few doctors give out their email address. Patients can’t communicate using modern technology … I fill out long medical history forms by hand and, in the next office, do it again. Same wording: name, address, insurance, etc. … In the intensive care unit, night after night, machines beep, but often no one responds … Patients will have a better experience only when more of us spend our own money for care. That’s what makes markets work.


Sponsor Updates

  • Iatric Systems will exhibit at ANIA 2016 April 21-23 in San Francisco.
  • Influence Health will host its annual Client Congress April 24-27 in Phoenix.
  • Ingenious Med is recognized as a Pacesetter by the Atlanta Business Chronicle for the fourth year in a row.
  • Cumberland Consulting Group will offer legacy system data management services in conjunction with Trinisys.
  • Leidos donates $32,000 to the Special Operations Warrior Foundation through a Defend the Rim campaign with the Washington Wizards.
  • Life Science Nexus features LogicStream Health in a new blog.
  • Agency Spotter Founder Brian Regienczuk interviews Medecision CMO Ellen Donahue-Dalton about healthcare marketing trends.
  • Netsmart will exhibit at the CIBHS National Behavioral Health Information Management Conference & Expo April 27 in Garden Grove, CA.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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April 21, 2016 News No Comments

Morning Headlines 4/21/16

April 20, 2016 News 1 Comment

Report to Congress April 2016

In a MACRA-mandated report to Congress, ONC evaluates the feasibility of establishing an EHR comparison tool to support providers evaluating health IT products.

2016 Cyber Security Intelligence Index

IBM publishes its 2016 Cyber Security Intelligence report cites healthcare as the most targeted industry for cyber attacks in 2015.

US to Delay Release of New Hospital Ratings

CMS announces that it will hold off on publishing quality ratings for hospitals until July amid questions from health providers and Congress over the methodology behind the ratings, “We are concerned that the star rating system may be misleading to consumers due to flaws in the measures that underpin the ratings,” states an April 11 letter signed by 60 senators.

Here’s Why This Genetics Biotech’s Stock Plunged Today

Gene sequencer manufacturer Illumina’s shares dropped 23 percent Tuesday after reporting preliminary Q1 revenue of $572 million, missing its forecasted $596 million, and lowering its projected 2016 growth from 16 percent to 12 percent.

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April 20, 2016 News 1 Comment

News 4/20/16

April 19, 2016 News 7 Comments

Top News

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Federal prosecutors launch a criminal investigation of Theranos, seeking to determine whether the lab company misled regulators and investors about its technology. Founder Elizabeth Holmes said during her squirmy and somewhat creepy “Today” show appearance on Monday (sans her trademark black turtleneck, but sporting her equally common deer-in-the-headlights look) that she was “devastated” to learn of extensive company failings of which she was previously unaware.

Holmes confidently told “Today” that the company will survive because the world needs it, although I wouldn’t be so sure. She says Theranos will “rebuild this entire laboratory from scratch.” Maybe the show’s label of Holmes as “billionaire” (on paper, anyway) was correct before the hydrogen-filled Theranos zeppelin went down in flames, but I doubt anyone would buy the entire, permanently tarnished Theranos for anywhere close to $1 billion at this point.

The mistake Holmes made in starting Theranos as a rich, Stanford dropout (at 19) was proclaiming it to be a high-valuation, disruptive Silicon Valley tech startup rather than a tiny entrant into the boring back office lab system business that is dominated by Quest and LabCorp, failing to put reasonable clinical oversight in place and competing with them mainly on price (although the sustainability of even that business model has yet to be proven). It’s  OK and maybe even desirable to be quirky, obsessively focused, publicity-shy, and inexperienced when you’re starting a faddish website for easily amused 20-somethings, but less so when you’re running a federally regulated medical business with lives on the line.


Reader Comments

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From CarrolltonObserver: “Re: Greenway Health. Tee Green is stepping away and another 100 employees were let go last week. My guess is that Tee is slowly stepping away to get into politics.” See  my mention in the People section below. The company says Tee “will remain in an active, full-time role as executive chairman, focusing on innovation and growth initiatives,” which sounds like work more appropriate to the position he left than the one he’s taking. 

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From Blue Horseshoe MD: “Re: cholera in Haiti. This article that describes the US implications is mind-blowing, but it also demonstrates the power of data visualization in epidemiology and thus in medicine.” Haiti’s cholera epidemic, which has killed nearly 10,000 people and infected 775,000 others, was apparently caused by UN peacekeepers from Nepal who brought the disease with them and from whom it spread due to negligent sanitation practices. The article says the CDC and the US administration are trying to hide the outbreak’s source by using questionable public health tracking measures. No cases of cholera had ever been reported in Haiti until the peacekeepers arrived and geo-mapping of reported cases points directly to the UN facility, with a CDC official going on record in unscientifically characterizing its response as, “We’re going to be really cautious about the Nepal thing because it’s a politically sensitive issue for our partners in Haiti.”

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Speaking of the value of data visualization, the Johns Hopkins Bloomberg School of Public Health launches a fully online, part-time masters in spatial analysis for public health.

From How EMRya?: “Re: the EMR replacement market. All the vendors thought the high EMR dissatisfaction rate would keep the market going with replacements. I don’t think it evolved that way. Physicians burned themselves out with their selection process within the past five years and don’t want to go through it again with vendors that seem about the same. Companies like NextGen and Greenway are retooling their business to an EBIDA strategy of just holding onto the base in running a profitable company in a saturated market.” I agree that it’s not likely that large numbers of physicians will want to go through choosing and implementing a new EHR no matter how unhappy they are with their current one. Even if they do eventually switch, it would be tough to build a stable business based on what they might do and when they might do it. I predicted early in the HITECH days that vendors would scale up to meet temporary demand, but then find it hard to shrink back down once they had blown through their share of the taxpayer billions. Maybe that’s why everybody from Allscripts to EClinicalWorks is trying to pivot into something fresh that’s outside their historic core competency, which usually ends up being population health management for lack of alternatives.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor PokitDok. The San Mateo, CA-based company (its name is pronounced “pocket doc”) offers a healthcare API ecosystem that meets consumer-driven healthcare market demands. APIs include clearinghouse (enrollment, eligibility, authorizations, claims, claims status, referral – all of those X12 APIs are free); patient scheduling (across all major PM/EHR systems); identity management (EMPI queries); payment optimization (medical financing qualification tools); and a Private Label Marketplace for provider search (scheduling, eligibility, payments).  Customers use these APIs to connect doctors to patients, to help payers and providers develop new business functions, and to connect EHRs and other digital health services. PokitDok’s APIs allow startups to scale immediately with lower cost, encouraging innovation and connectivity. Thanks to PokitDok for supporting HIStalk.

Here’s an overview video of PokitDok that I found on YouTube.

My latest pet peeve: people who say “pop health,” apparently challenged to find time in their day to enunciate the three additional syllables. They probably mean “population health management technology” anyway, so maybe their 10-syllable avoidance is worth it. 

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Mrs. Ulhaque from Texas is happy that we funded her DonorsChoose grant request for a single classroom iPad that is shared by her 24 students. She says they love playing educational games and she is rewarding students who show academic improvement with extra time on it.

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Also checking in is Ms. Munoz, who teaches Grade 5-6 math and science for special education students (intellectual disabilities, Down syndrome, brain injury, autism, etc.) We provided four tablets and cases, which she says have helped the students complete lessons they couldn’t previously tackle before because of their disabilities and motor skills problems.  The students who can’t write or speak are using a communications app that allows them to interact with their teachers and fellow students. Just to give you an idea of how little it costs to fund such a significant classroom project, HIStalk readers paid for half of the $363 total and Google matched that amount.


Webinars

April 26 (Tuesday) 1:00 ET. “Provider-Led Care Management: Trends and Opportunities in a Growing Market. ”Sponsored by HIStalk. Presenter: Matthew Guldin, analyst, Chilmark Research. This webinar will provide a brief overview and direction of the provider-led care management market. It will identify the types of vendors in this market, their current and longer-term challenges, product capabilities, partnership activity, and market dynamics that influence adoption. It will conclude with an overview of key factors for vendors and solutions moving forward.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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A reader provided details on the lawsuit brought by the MetroChicago HIE against Sandlot Solutions. The HIE says Sandlot took away its data access one day after warning it that it would be shutting down but then provided a database copy. The HIE said that was unacceptable since any technical snags in restoring the information could cause the HIE itself to shut down. The lawsuit says Sandlot was insolvent and was closing following a failed merger attempt. Santa Rosa Consulting, listed in the lawsuit as Sandlot’s owner (which I’m not sure is exactly true – the parent of both is Santa Rosa Holdings), was a co-defendant in the lawsuit. Sandlot announced its only funding round ($23 million) about 18 months before it shut down (it’s always a red flag when a company fails to raise new money unless it’s doing so obviously well that it doesn’t need it). Interestingly, the HIE says Sandlot’s actions violated HIPAA since the company is a business associate of the HIE. Also interestingly, the lawsuit claims that Sandlot refused to provide the HIE with its data because the database would contain previously deleted data from other Sandlot customers.

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UnitedHealth Group makes good on its earlier threat to stop offering policies on Affordable Care Act marketplaces as it loses $1 billion on those policies over the past two years. The company will offer exchange policies in only a handful of states in 2017, saying that the market isn’t growing and it’s being stuck with sicker patients as younger, healthier ones don’t see the value in buying health insurance. UHG’s policies are rarely the least expensive and it holds only a 6 percent market share.


People

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Scott Zimmerman (TeleVox / West Interactive) joins Greenway Health as CEO, according to his LinkedIn profile. He apparently replaces Tee Green, who is now listed on the company’s site as executive chairman.

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Voalte hires Adam McMullin (SFW Capital Partners) as chairman and CEO.


Government and Politics

A study finds that nearly 3 percent of physicians who provide Medicare Part B services billed CMS for work that would require more than 100 hours per week, with optometrists, dermatologists, and ophthalmologists leading the pack. Those same providers also submitted more high-intensity billing codes than average. The authors suggest using Medicare’s utilization and payments data to flag potential fraud, although they probably underestimate the complexity of how providers use their National Provider Identifier to bill Medicare for services they don’t necessarily provide personally.

Florida becomes the second state to prohibit hospitals from balance-billing patients treated in their network for services rendered by the hospital’s out-of-network practitioners — such as surgeons, ED doctors, and anesthesiologists — for which the patient can’t seek an in-network alternative. The patient will pay the in-network rate, leaving the insurance company and provider to negotiate any additional payments.


Privacy and Security

The computer systems of Newark, NJ’s police department are taken offline for four days following a ransomware attack.


Other

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The board of Massena Memorial Hospital (NY) approves $1 million to upgrade its “ancient” Meditech system (or “metatech,” as the local paper spells it) in contracting with CloudWave for cloud-based hosting. The CEO warned the board that their current implementation runs on Windows Server 2003, which he describes as “a big garage door somebody could hack their way through and steal everything.”

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A brilliant article in London’s “The Guardian” says unlearned movie stars should stick to pretending to be someone else on screen rather than taking positions on medical science, referencing “Vaxxed,” the new movie about Andrew Wakefield, the widely discredited anti-vaccine doctor who eventually lost his medical license. Robert DeNiro included the film in his film festival with a vague rationale that the documentary “is something people should see,” only to pull it when scientists complained. The Guardian notes:

If “Vaccinating With the Stars” looks a little inappropriate where public health is concerned, so too is the prospect of children falling ill because an actor clearly hasn’t read Wakefield’s Wikipedia entry. Unless, worse still, he has.

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An LA Times article quotes University of Michigan’s Karandeep Singh, MD, MMSc, who says unregulated and sometimes poorly design healthcare-related apps can be “like having a really bad doctor.” It points out a recent study of Instant Blood Pressure, a $4.99 app marketed without FDA approval that correctly diagnosed hypertension only 25 percent of the time, with the company hiding behind the excuse that it isn’t intended for diagnosis and treatment, thus rendering its raison d’être questionable.

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A New York jury awards $50 million to a woman who says she has become incontinent after her obstetrician performed an unnecessary episiotomy during the birth of her healthy child in 2008. The woman says she was forced to quit her job, has to wear panty liners, and can’t have sex with her husband. The doctor, who insists he did nothing wrong and that the woman never complained about any issues, says, “Someone can just make up a story, cry to the jury, and they will ignore all the records and give her a big award.”

Sparrow Health System (MI), bowing to pressure from the National Labor Relations Board and the state nurse’s union, rescinds its policies that prohibited employees from talking about health system policies on social media and to the press. NLRB says the health system’s policies related to social media, cell phone use, the wearing of unapproved buttons, and gossiping are overly broad and are discriminatory.

Minnesota hospitals report that their emergency departments are becoming “holding pens” for sometimes violent mental health patients, forcing other patients to wait for hours or to be sent elsewhere as up to half of their gurneys are occupied by patients who require levels of oversight and security that few hospitals can provide. One hospital psychiatrist reports, “This is supposed to be a place of peace and security. Instead, we have acute psychiatric patients banging on windows, throwing feces, and assaulting people. It’s deeply unsettling to other patients in the ER.”

In Canada, Alberta Health Services will spend $316 million over the next five years to replace 1,300 mostly non-interoperable clinical systems with a single system that can maintain a single medical record. It will issue an RFP shortly. The College of Physicians and Surgeons termed existing systems “woefully inadequate” in late 2014, with a government official adding that after spending nearly $300 million, Alberta “really got nothing more than electronic isolated file systems. Do we realize we need to have data exchange standards before we start adding systems? We need systems to talk. It blows my mind.”

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A study of those Dyson Airblade hand dryers with which business replace paper towels (while claiming unconvincingly that their motivation is your health rather than reducing their restroom expenses) finds that they blast germs onto anyone within 10 feet of the bathroom wall, so you’d better hope the person using it washed their hands well first. Dyson disputes the study, claiming the paper towel cartel is behind it.


Sponsor Updates

  • Aprima will exhibit at the Boulder Valley Individual Practice Association meeting April 26 in Lafayette, CO.
  • Catalyze CEO Travis Good, MD will speak at the HITRUST Annual Summit April 25-28 in Grapevine, TX.
  • Besler Consulting releases a podcast on “IME Shadow Billing.”
  • Crossings Healthcare Solutions will exhibit at the Cerner RUG April 20-22 in Charlotte.
  • Cumberland Consulting Group Managing Director Tom Evegan guest blogs for Revitas.
  • EClinicalWorks will exhibit at the California MGMA 2016 Annual Conference April 22-23 in Sonoma.
  • Isthmus Magazine features Healthfinch and its data partnership with Beekeeper.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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April 19, 2016 News 7 Comments

Monday Morning Update 4/18/16

April 17, 2016 News 10 Comments

Top News

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Epic’s trade secrets lawsuit against India-based Tata Group concludes with the Wisconsin jury awarding Epic $940 million in damages. The verdict calls for Tata to pay Epic $240 million for the benefits received by its subsidiary (Tata Consultancy Services) from stealing Epic’s trade secrets plus another $700 million in punitive damages. The lawsuit said employees of Tata posed as Kaiser Permanente employees to gain access to client-only Epic documentation that Tata planned to use to develop a competing product.

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Tata says it will appeal, claiming it did not use Epic’s information in the development of its Med Mantra system. The company says its developers never saw Epic’s materials.

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The $940 million judgment will certainly be reduced by the presiding judge, who chided Epic’s damage claims before the hometown jury’s verdict was announced. He observed:

  • Epic didn’t provide the court with the method it used to calculate its damage claims until after the trial began, which could cause those claimed damages to be excluded.
  • Epic hasn’t proved that it was damaged to the extent claimed or that Tata benefited to that degree, explaining, “The complete lack of evidence tying the costs of Epic’s research and development efforts to any commensurate benefit to TCS dooms its methodology.”
  • Epic claims that the biggest benefit to Tata wasn’t stealing development secrets or source code, but rather then value of “what not to do” that is “spread throughout the enterprise.”
  • The only evidence provided of how Tata used Epic’s information was a side-by-side marketing graphic comparing Epic’s products and Tata’s Med Mantra, with the claimed damages “based on Epic’s speculation that the confidential information is sitting on a shelf somewhere to be used immediately after this trial ends.”
  • The judge says such “future use” assumptions are more appropriately addressed via injunction to prevent such use  rather than a speculative damage award. He also noted that Tata has mostly failed in its attempts to penetrate the US market and that an injunction would reduce its chances even further.

Reader Comments

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From Verisimilitude: “Re: HealthTap access on Facebook Messenger. I’m not sure how much privacy protection people are given. I’m no HIPAA expert, but my guess is there’s a big fat release and arbitration clause buried in a EULA someplace.” Video visit vendor HealthTap offers a free chatbot Q&A service using Facebook Messenger rather than real-time access to actual human doctors. HealthTap’s terms of service are indeed voluminous and include an arbitration clause. I tried the Facebook service and it was worthless – all I received within several hours of asking a simple question was a list of previously answered similar questions (that weren’t similar at all) and a link to HealthTap’s site.

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From Nasty Parts: “Re: NextGen. A major re-org was announced as Rusty Frantz continues the Pyxis-ization. It has dissolved its silos into ‘One NextGen,’ and as a result, multiple senior execs are transitioning out.” Unverified. Nasty Parts named several VPs who are leaving and says there’s “much more change to come.” I’m not sure that’s a bad thing. Frantz has been CEO at Quality Systems for almost a year, so he’s had time to think through what needs to be done.

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From Maury Garner: “Re: Sandlot Solutions. You reported their closing. I ran across this lawsuit filed by one of their customers to prevent Sandlot from destroyer their data immediately after copying it for them. The article describes Sandlot Solutions as insolvent and closing.” I don’t have a Law360 subscription to see the details, but your description of their article seems accurate.

From Rebuttal: “Re: IT departments. In the last 5-6 years, I’ve noticed that organizations I’ve interviewed with seem to care more about what I can bring rather than having a balanced interest in our mutual needs. It seems that complex vendor systems have turned IT departments into sweatshops.” It may well be that the high cost of vendor systems has raised provider expectations that new hires will immediately pay off in task-specific, product-specific ways with implementation and optimization. It’s also probably true that for-profit companies in particular aren’t as interested in investing in mutually satisfying long-term relationships with new hires who might bolt once they’ve built their resumes. Lastly, I would speculate that the rise of the 1099 economy has redefined the work environment on both sides to a “what have you done for me lately” mindset. I’ll invite readers to weigh in.

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From Vince Ciotti: “Re: Bill Childs. Just to make sure readers appreciate how progressive Bill and the pioneering team at Lockheed were, they also came up with:

  • CRTs (cathode ray tubes). They called them VMTs (Video Matrix Terminals) in an era when most systems relied on keypunch cards and green bar paper reports for input and output.
  • Light pens. The precursor (punny?) to today’s mice, an idea Jobs and Wozniak copied from Xerox PARC. Clinicians using MIS only had to click on the VMT screen instead of trying to learn touch typing.
  • Screen building. Lockheed (later TDS) called it matrix coding, but teams of clinicians designed their own order screens rather than implementing a model designed by programmers who never saw a patient.

Feeling nostalgic? You can read more in Vince’s HIS-tory series that ran on HIStalk for several years. I immersed myself back into them over the weekend as a guilty pleasure.

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From Rocket J. Squirrel: “Re: Erlanger. A rocky start to the Epic project. The consultant evaluation ignored the lowest-cost option and the CTO who made the decision is gone after eight months. Totally behind on project staffing and already six months delayed.” Unverified.

From Alpha Surfer Dude: “Re: Dr. Brink’s article on radiology benefits managers. See what’s going on in Hawaii if you want to learn why this is so topical.” A Readers Write article by James A. Brink, MD, vice chair of the American College of Radiology and Mass General radiologist in chief, criticized plans to require pre-authorization of advanced imaging. He says electronic guidelines can help ensure the appropriateness of such orders in real time. Insurer Hawaii Medical Service Association (HMSA) made outpatient imaging pre-authorization mandatory in December 2015, leading doctors to complain that care is delayed and that tests are often denied. Newly proposed legislation would hold insurance companies rather than providers liable for any civil damages resulting from pre-authorization delays. HMSA requires doctors to contact Arizona-based radiology benefits management company National Imaging Associates (a subsidiary of publicly traded Magellan Health), leading one Hawaii doctor to complain, “Do you want those decisions to be made by offshore non-experts?” Taking the counterpoint, it was widespread ordering of medically questionable imaging studies – sometimes by doctors with a financial interest in the machines used to perform them — that created the need for such restrictions in the first place. As they say, one person’s excess cost is another’s livelihood.


HIStalk Announcements and Requests

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Only 12 percent of poll respondents have had a virtual visit in the past year, although 81 percent of those who did were satisfied. New poll to your right or here: would you be worried about your privacy if you were being treated for depression by an EHR-using provider? Please explain after voting.

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Mrs. May, a first-year teacher from Florida, says her special education classes are using the STEM and engineering kits we provided in funding her DonorsChoose grant request not only to learn about science, but also “how important communication is to get to the finish line.”

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Also checking in is Mrs. Johnson from Oklahoma, who says her elementary school students “are loving the hands-on materials that you have provided for us. I no longer hear any complaints when I ask them to go to their math stations because they are not only enjoying them, but they are practicing their skills.”


Last Week’s Most Interesting News

  • CMS threatens to ban Theranos CEO Elizabeth Holmes from the blood testing business for failing to correct problems that CMS had previously called to the company’s attention.
  • Kaiser Permanente launches a database of data contributed by its members that researchers will use to study how genetic and environmental factors affect health.
  • CMS announces a five-year pilot of CPC+, a medical home model that requires the use of a certified EHR, and for one of the two tracks, a signed agreement from the practice’s EHR vendor that it will support the capabilities needed.
  • Kaiser Permanente releases a summary of what it has learned from having a large number of its patients use a portal, disclosing that one-third of its PCP encounters are now conducted by secure email with expectations that the percentage will increase significantly.

Webinars

April 26 (Tuesday) 1:00 ET. “Provider-Led Care Management: Trends and Opportunities in a Growing Market. ”Sponsored by HIStalk. Presenter: Matthew Guldin, analyst, Chilmark Research. This webinar will provide a brief overview and direction of the provider-led care management market. It will identify the types of vendors in this market, their current and longer-term challenges, product capabilities, partnership activity, and market dynamics that influence adoption. It will conclude with an overview of key factors for vendors and solutions moving forward.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Cardinal Health-owned NaviHealth, which offers post-acute care utilization management services, will acquire care transition software vendor Curaspan Health Group.

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Behavioral health software vendor Quartet Health raises $40 million in a Series B funding round led by GV (the former Google Ventures), increasing its total to $47 million.


People

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Mark Cesa, whose long healthcare IT sales career included stints with Baxter Healthcare, GTE Health Systems, Eclipsys, Tamtron, QuadraMed, Allscripts, and Napier Healthcare, died of cancer April 1. He was 61.


Announcements and Implementations

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Voalte announces that it signed 125 hospitals in its fiscal year ending March 2016, increasing its customer base by 83 percent.

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Imaging IT expert Herman Oosterwijk posts the Digital Imaging Adoption Model that was announced a few weeks ago by the European Society of Radiology and HIMSS Analytics.


Government and Politics

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VA CIO LaVerne Council says in Congressional testimony that the VA needs “a new digital health platform” and seems to suggest it will pursue a custom-developed system rather than buy a commercially available product or upgrade VistA. Council says a working prototype will be available in a few months that “is aligned with the world-class technology everyone’s seen today and using in things like Facebook and Google and other capabilities. But it also is agile and it leverages what is called FHIR capability, which means we can bring things in, we can use them, we can change them, we can respond.” Lawmakers are justifiably concerned that the history of the VA specifically and government agencies in general suggests a high likelihood of expensive failure and lack of interoperability with the DoD, but Council says the cost-benefit analysis is solid. She also reiterated previous statements that the VA is putting its $624 million Epic patient scheduling system rollout on hold while it tests its own self-developed system that will cost just $6.4 million. The VA and Congress, anxious to deflect bad publicity about the VA’s wait time scandal, quickly threw IT money at the patient scheduling problem last year despite scant evidence implicating technology as the problem.

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CMS Administrator Andy reiterates that EHR certification will require vendors to provide open APIs for interoperability.


Privacy and Security

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The Department of Homeland Security’s US-CERT urges Windows PC users who have Apple’s QuickTime installed to de-install it immediately after a security firm finds major vulnerabilities and Apple quickly drops QuickTime for Windows support. It’s fine on Apple devices.

A federal appeals court rules that a healthcare company’s general liability insurer must defend it against security breach claims even when the policy doesn’t specifically include cyberbreach wording. .


Other

Jenn covered for me Thursday and mentioned the JAMIA-published study that found missing information about patients with diagnoses of depression or bipolar disorder, about which I will opine further. The authors try to make the case that primary care EHRs suffer from “data missingness” that indicates that “federal policies to date have tilted too far in accommodating EHR vendors’ desire for flexible, voluntary standards” that “can lock providers in to proprietary systems that cannot easily share data.” Underneath that big (and preachy) conclusion is a little study with a lot of problems:

  • It analyzed data from 2009 only, eons ago in HITECH years (in fact, that was the same year that HITECH was passed, well before it had significant EHR impact).
  • It covered patients from a single insurance plan’s patients, treated by a single medical practice, using a single EHR (Epic).
  • The “data missingness” it claims involves only two behavioral health diagnoses that were likely treated by specialty providers (LCSW, PhD, psychiatrists) who weren’t HITECH-bribed to adopt EHRs and who often don’t use them because of privacy concerns and lack of benefit.
  • The study matched EHR information to claims data in finding that 90 percent of acute psychiatric services were not captured in the EHR. The authors should have noted that many patients seeking behavioral health services pay cash to avoid creating a claims history, seek help from public services, or travel out of their own area for them to maintain privacy, all of which could impact their conclusions.
  • It’s likely that some or even most of the patients with missing information would have opted out of automatic sharing of their behavioral health information given the chance.
  • The authors blame EHR vendors for the lack of interoperability, but give the organization they studied a free ride in assuming that it freely exchanges information with any other provider who expresses interest.
  • The study seems to state an expectation that every primary care provider’s EHR have a complete patient record from all sources of care, which is a nice dream, but as they correctly conclude is not today’s reality for many reasons, most of them unrelated to EHR vendors. That doesn’t necessarily mean the information isn’t available (via an HIE, records request, patient history, etc.) but only that it isn’t updated in real time across EHRs everywhere.
  • Lack of information doesn’t necessarily change the treatment plan or outcome. Doctors have never had that information, electronic or otherwise, so it’s not like EHRs caused a new problem.
  • The best conclusion is this: if you want the most nearly complete patient information available, use both EHR information and individual patient claims data across all commercial and governmental payers and present it from within the patient’s EHR record. That’s not how the system works for most PCPs, however.

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Kansas City tax authorities approve reimbursing Cerner for $1.75 billion of the $4.45 billion construction cost of the company’s new The Trails campus. Cerner says the new space will allow it to add 16,000 jobs within 10 years and  the increased post-construction assessment should generate $2.6 million of additional property taxes per year.

In Canada, Nova Scotia has spent $30 million on incentives for practices to use EHRs, but faxing is still the most common way for practices to communicate with each other because the government-approved systems aren’t interoperable.

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Lee Memorial Health System (FL) comes up with creative excuses for earning a one-star quality rating from CMS: (a) the hospital converted to Epic just three years ago; (b) incomplete EHR coding caused the health system to be compared unfairly; (c) CMS doesn’t take into account tourist-driven seasonality; and (d) CMS doesn’t take socioeconomic factors into account and therefore penalizes hospitals that treat poor patients who are sicker (a minor variant of the “our patients are sicker” explanation). The hospital didn’t suggest that it will actually treat patients any differently even though its largest customer gave it the lowest possible quality score.

Weird News Andy notes that “even junkies are logical” as evidenced by this story, in which drug abusers are injecting themselves in the bathrooms and parking garages of Massachusetts General Hospital so they can get medical help quickly if they overdose. MGH says people are even tying themselves to the emergency pull cords in its bathrooms so the alarm will go off if they keel over in a narcotic stupor.


Sponsor Updates

  • A Spok case study describes the 50 percent of University of Utah Health Care’s incoming residents and medical students who choose to communicate using Spok Mobile for secure text messaging.
  • Medecision President and CEO Deborah M. Gage is named as one of the most powerful women in healthcare IT.
  • T-System will exhibit at the UCAOA National Urgent Care Convention April 17-20 in Orlando.
  • Huron Consulting Group is named by Forbes as one of America’s Best Employers for the second consecutive year.
  • Wellsoft will exhibit at TCEP Connect 2016 April 21-24 in Galveston, TX.
  • ZirMed will exhibit at the California MGMA Conference April 21-23 in Sonoma.
  • Zynx Health will exhibit at the ANIA 2016 Conference April 21-23 in San Francisco.
  • PatientPay shows commitment to rid paper from healthcare billing in support of The Nature Conservancy.
  • QPID Health CMO Mike Zalis will speak at the North Carolina Association for Healthcare Quality Annual Conference April 21-22 in Durham.
  • Huffington Post interviews Red Hat CEO Jim Whitehurst.
  • The SSI Group will exhibit at the Healthcare Finance Institute April 17-19 in Tysons Corner, VA.
  • Streamline Health will exhibit at the 2016 California MGMA Annual Conference April 21-23 in Sonoma.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
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April 17, 2016 News 10 Comments

EPtalk by Dr. Jayne 4/15/16

April 15, 2016 News No Comments

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In follow up to my recent discussion of faxing as a primary mechanism of data sharing, a reader sent this piece with data from a January provider survey. Traditional communication methods (letter, fax, phone) are still in use by the majority of providers. The graphic only tells part of the story, however. In order to have a better understanding of the situation, we’d need to see data from the same providers that shows what percentage of communications falls into each of the buckets. For example, 89 percent of providers are receiving using paper-based methods. Is that one letter or a hundred? The same goes for electronic exchange. Maybe only 40 percent of providers are doing it, but they’re doing it 90 percent of the time. I wanted to dig deeper into the data, but it was behind one of those “enter your email address to access this resource” pages. Those drive me crazy – it seems like it’s always a multi-step process to get the download. I’d look much more favorably on an organization that presented its content up front and asked you to sign up if you wanted to learn more, compared to organizations that require your address and then clutter your inbox.

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Midmark’s announcement that it is acquiring RTLS vendor Versus Technology caught my attention. I’ve always been a fan of Midmark –  its sales team impresses me with their relatively-subdued, knowledge-driven approach as compared to the bluster of some of their competitors. They’ve been innovative in providing solutions that just work, which is always appreciated when you have hundreds of devices to bring online. Midmark is also interesting as a company. Starting more than 100 years ago as an industrial equipment company, they entered healthcare in the 1960s and diversified to veterinary and technology segments. It seems to be a company that works at its own pace and ignores the industry hype. We’ll have to see whether the acquisition changes that.

From Direct Doc: “Thanks for the Curbside Consult on the state of primary care training programs. What do you think about the fact that Harvard doesn’t even bother to train students in family practice?” He didn’t mention that the article he cited clarifies that it’s not just Harvard. There are actually 10 medical schools (many of which are regarded as the nation’s top schools) that don’t have a department of family medicine. Some of them do offer optional family medicine courses, but I can say from first-hand experience that it’s not the same as taking a course in a school with a full-fledged department. I was barraged with comments during my training that I was “too smart for primary care” and our administrators were saddened that my class had more students match into family med than into general surgery. They also allowed some financial aid shenanigans that actually put primary care grads at a disadvantage. Needless to say, I’m not on the alumni donation list.

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Wearable tech vendor Ringly announced the bracelet version of its customizable notification jewelry. Their ring offering was a bit too chunky for my taste but I really like the bracelet concept. I’m not a fan of gold accessories, but I’ve been watching their products for a long time. They have a non-gold option for ring designs, and once they offer one in a bracelet, I will be sold. The idea of being able to receive notifications when messages arrive from a specific sender is an attractive one. I don’t routinely use audio notifications on my phone and turn off the notifications on Outlook and other apps, but I’d like to know if a high-priority client is trying to reach me outside of my normal email-checking periods.

Mr. H mentioned the CMS announcement regarding the Comprehensive Primary Care Plus (CPC+) initiative. It’s designed as a new medical home model that allows practices to choose one of two tracks for value-based reimbursements. One track will provide a smaller, monthly per-patient payment plus bonuses. The second provides a larger payment but has more requirements. It’s slated to run for five years and they want to include 5,000 practices. The launch is scheduled for January 2017, which doesn’t give practices much time to get their acts together unless they’re already doing a medical home model or have started the extensive change management and process work that is needed to make it viable. I have worked with a couple of practices that participated in the original Comprehensive Primary Care (CPC) program that started in 2012 and runs through the end of this year. The ones I worked with were already recognized by NCQA for their Patient Centered Medical Home efforts, and were looking for assistance with reporting and other EHR needs to meet the CPC requirements.

The key Comprehensive Primary Care Functions involved include: access and continuity; care management; comprehensiveness and coordination; patient and caregiver engagement; and planned care and population health. The higher-paying track definitely has more extensive healthcare IT requirements including the ability to manage the payments on the revenue cycle side. Although track 1 maintains regular fee-for-service payments, track 2 delivers hybrid payments with reduction in E&M payments for a percentage of claims. Bonus payments are also tiered, at $2.50 per patient per month on track 1 and $4 on track 2. Interestingly, incentives are prepaid at the beginning of a performance year, but must be refunded if the practice doesn’t meet quality and utilization performance thresholds.

Track 2 partners must submit a letter from their EHR vendor that outlines the vendor’ commitment to “supporting practices with advanced health IT capabilities.” I found it interesting that this wasn’t required for Track 1, because I’m not sure what difference it really makes. Of course vendors are going to say that they’re supportive. What else are they going to do? The devil will be in the details though, and I’d be surprised if this doesn’t lead to a host of de facto requirements that vendors may struggle to meet.

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From The Ghillie: “I know that working with clients during their EHR transitions can be frustrating. You seem like an outdoorsy person, so I’d like to suggest an additional benefit to the paperless office transition.” I have to say, I’m smitten, especially since I’m a big fan of reduce/reuse/recycle. Most of my cast-off file cabinets were only two drawers, but I’m going to keep an eye out for a four-drawer on the yard sale circuit.

Do you have a novel use for cast-off equipment? Email me.

Email Dr. Jayne.

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April 15, 2016 News No Comments

News 4/15/16

April 14, 2016 News 3 Comments

Top News

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Yet another scathing letter from CMS to Theranos comes to light. Federal regulators propose banning company founder and CEO Elizabeth Holmes from the blood-testing business for two years after her company failed to correct serious problems discovered at its California lab. The news surfaces a week after Theranos bolstered its Scientific and Medical Advisory Board (perhaps in a last-ditch attempt to rescue what’s left of its reputation) with representatives from CDC, American Association For Clinical Chemistry, and several academic medical centers and hospitals across the country.


HIStalk Announcements and Requests

This week on HIStalk Practice: Western New York’s HealtheLink welcomes new physician practices. GA-HITEC reaches MU goals with Georgia-based physicians. HealthTap offers free consults via Facebook’s Messenger app. Spotify highlights the favorite tunes of healthcare IT legislators. ("The Ties That Bind" never seemed more apropos.) ONC highlights the successes of the REC program – in 124 pages. Buffalo Cardiology & Pulmonary Associates closes its doors after 40 years, citing a "new era of health care." Bill Moreau, MD details the impact healthcare technology will have on Team USA during the 2016 Summer Games in Rio.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

Athenahealth acquires physician scheduling startup and More Disruption Please accelerator program graduate Arsenal Health (fka Smart Scheduling) for an undisclosed sum.

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OSF Healthcare (IL) formally launches OSF Ventures, a $75 million venture fund that will invest in four to six businesses a year focused on reducing healthcare costs or improving patient experiences and outcomes. OSF clinicians will serve as willing guinea pigs for the fund’s companies, which already include Health Catalyst and Pieces Technologies.

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GSI Healthcare relocates its headquarters to the BNY Mellon Center in Philadelphia’s City Center. The company, which offers care coordination technologies for ACOs and Medicaid Health Home programs, plans on growing its employee base by 60 percent this year, largely in technical positions like software engineering.


Sales

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Orion Health signs contracts with two hospitals in London for its EHR and patient engagement software, and one with NHS Fife in Scotland for an integrated health and social care record for adult services.

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MultiCare Health System (WA) expands its relationship with Health Catalyst, signing an enterprise-wide technology subscription agreement and professional services agreement. Health Catalyst will tie a portion of the professional services contract to achieving MultiCare’s annual $25 million improvement goal. The health system participated in the company’s $70 million Series E round of financing in February.


People

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Specialists On Call names Sean Banerjee (Evolent Health) CTO and Ann Kessinger (The Advisory Board) executive vice president of sales and marketing.

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California-based Stanford Health Care’s Board of Directors appoints David Entwistle (University of Utah Hospitals & Clinics) president and CEO.


Announcements and Implementations

Ensocare offers Dell Services customers access to its discharge management and care transition technology.

CVS MinuteClinic partners with American Well to offer its Ohio-based patients access to Cleveland Clinic physicians via a new Express Care Online program.

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Mobile podiatry provider KG Health Partners teams with VAR ClinicAnywhere to implement HealthFusion’s MediTouch EHR and PM software for long-term care.


Technology

Navicure develops Navicure Perform, an analytics solution that helps providers identify and rectify cash-flow bottlenecks from within the company’s claims management software.

Panacea Healthcare Solutions incorporates a Web-based charge management solution from Holliday & Associates into its CDMauditing coding and compliance technology.


Government and Politics

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California announces a $179 million settlement with Xerox stemming from a failed computer modernization of its Med-Cal claims processing system.

Louisiana’s Administration for Community Living awards nonprofit population health management company EQ Health Solutions a three-year grant to help Medicare beneficiaries recognize and prevent healthcare fraud.

Reports surface that the VA is looking to implement its own scheduling software rather than spend the $624 million promised to Lockheed Martin and Epic as part of last year’s highly sought after, seven-year-contract win. The agency is reportedly testing a homegrown solution at 10 pilot sites.


Privacy and Security

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Intermountain Healthcare VP/CIO Marc Probst announces during a World Health Care Congress presentation that the health system will partner with the University of Utah and several other organizations to create a joint security center focused on thwarting cybersecurity attacks. Probst noted in a HIStalk interview earlier this year that security would be top of mind for him while strolling the show floor at HIMSS. You can read the interview here.


Innovation and Research

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A study published in Nature describes a neuroprosthetic breakthrough called electronic “neural bypass” that has restored a quadriplegic man’s ability to move his hand.

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A JAMIA study comparing patient data recorded in a typical EHR with corresponding data from insurance claims finds the EHR data to be fragmented and incomplete a majority of the time. Researchers looked specifically at mental healthcare and found outpatient care records for patients with bipolar disorder and depression missing an average of 57 percent of the time, and record of acute psychiatric services missing 89 percent of the time. The findings prompted researchers to suggest that “priorities for further investment in health IT will need thoughtful consideration.”

A survey of 82 health system executives shows that healthcare IT is still a top area for capital spend, and the need for interoperability is greater than ever. Nearly 70 percent of respondents feel their organizations successfully access ambulatory data from employed physician networks, while just 38 percent feel as successful with affiliated or non-affiliated networks.


Other

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NY Jets wide receiver Brandon Marshall visits Silicon Valley to test the tech waters for the mental healthcare nonprofit he co-founded with his wife, Michi. Project 375 has partnered with Chicago Public Schools to offer behavioral health services to students, and has committed to investing $1 million to McLean Hospital, where Marshall received treatment for borderline personality disorder. He sees great potential in artificial intelligence like X2AI’s Tess bot and the impact it could have on psychotherapy.


Sponsor Updates

  • The Black Book 2016 Research Report recognizes Medicity as the top vendor in public/government and agency HIE systems.
  • The local paper highlights the success UK Healthcare (KY) has had with GetWellNetwork’s patient engagement technology.
  • Health Catalyst receives the 2016 Gallup Great Workplace Award.
  • Iatric Systems will exhibit at the HCCA 2016 Compliance Institute April 17-20 in Las Vegas.
  • Influence Health will host its Influence Client Congress April 24-27 in Phoenix.
  • InterSystems will exhibit at the Healthcare Payers Transformation Assembly April 19-21 in Houston.
  • Intelligent Medical Objects and Navicure will exhibit at the EClinicalWorks 2016 Enterprise Summit April 19-21 in Boston.
  • PDR will exhibit at Direct to Consumer National April 19-21 in Boston.
  • LifePoint Informatics releases a white paper, “Why Access to Lab & Diagnostic Data is Important to Providers, Payers and Patients.”
  • LiveProcess will exhibit at the 2016 Preparedness Summit April 19-22 in Dallas.
  • Netsmart will exhibit at the New York State Public Health Association annual conference April 21 in Cooperstown.
  • Nordic posts a new video, “Large EHR Implementations: Two critical success factors.”
  • Obix Perinatal Data System will exhibit at the AWHONN Virginia Conference April 23 in Virginia Beach.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

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April 14, 2016 News 3 Comments

Morning Headlines 4/14/16

April 13, 2016 News No Comments

Intermountain, U. Utah to open cybersecurity center with 3 others

Intermountain Healthcare will partner with the University of Utah and several other organizations to create a joint security center focused on thwarting cybersecurity attacks.

Regulators Propose Banning Theranos Founder Elizabeth Holmes for at Least Two Years

Federal regulators have proposed banning Elizabeth Holmes from the blood-testing business for two years after her company failed to correct serious problems discovered at its California lab.

Restoring cortical control of functional movement in a human with quadriplegia

A study published in Nature describes a neuroprosthetic breakthrough called electronic “neural bypass” that has restored a quadriplegic man’s ability to move his hand.

State Junks $179 Million Medi-Cal IT System, Will Start From Scratch

California announces a $179 million settlement with Xerox stemming from a failed computer modernization of its Med-Cal claims processing system.

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April 13, 2016 News No Comments

Morning Headlines 4/13/16

April 12, 2016 News No Comments

Vermont first to coordinate health care delivery with disruptive information sharing technology

Vermont will implement PatientPing state-wide, a care coordination service that alerts providers when their patient is being treated at any other facility in the state.

Kaiser Permanente launches ‘research bank’

Kaiser Permanente has launched a new research tool that will allow its 675,000 members to submit their genetic, environmental, and general health data to a database that will be used by researchers to study how genetic and environmental factors affect health.

Lawsuit: TGH nurses told woman’s family that she is HIV positive

A woman is suing Tampa General Hospital (FL) after a nurse inadvertently disclosed her HIV status in front of family members. The nurse was coordinating with transplant team personnel over a Vocera speakerphone.

GE Ventures and Mayo Clinic Launch Company to Scale and Digitize Cell and Gene Therapies

GE Ventures and Mayo Clinic launch Vitruvian Networks, a company that will market software and manufacturing services to cell and gene therapy producers.

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April 12, 2016 News No Comments

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