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News 7/1/16

June 30, 2016 News 13 Comments

Top News

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Massachusetts General Hospital (MA) notifies 4,300 patients that their information was exposed in a February 2016 breach of dental practice systems vendor Patterson Dental Supply. Dental system security guy Justin Shafer notified the company in February that all instances of its Eaglesoft software are insecure because the database uses a default username of “dba” and a password  of “sql.”

The company expressed its thanks in May 2016  by filing a Computer Fraud and Abuse Act claim in which it notified the FBI that Shafer had illegally accessed its server, leading to a pre-dawn raid on his home by a dozen armed agents who hauled him away in handcuffs.

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SRS commented on the screenshots I ran showing hacker TheDarkOverlord (who I’ll refer to as “he” even though he or she hasn’t divulged gender) sitting on an SRS EHR log-in screen as he apparently used Remote Desktop Protocol (RDP) to steal their client’s patient data:

Protecting our clients’ patients’ information is a top priority at SRS. Upon receiving notification that patient data from one of our clients may have been compromised, we immediately launched an investigation. While our investigation has concluded that the SRS system itself was not compromised, we are working in partnership with our client to assist in any way we can. At this time, the matter has been turned over to the appropriate authorities.

The hacker published several SRS screen shots showing full patient information. SRS is right, though – accessing a system by breaching RDP isn’t taking advantage of a vulnerability of any system other than RDP. It’s just logging in using someone else’s credentials. The real question is how he obtained the log-in information. RDP can store system usernames and passwords that can be displayed with readily available utilities. It would be interesting to know whether the clinic had set up RDP for its own users or whether a software vendor had configured it for remote support use.

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Justin Shafer (see above) speculates that the SRS client is Athens Orthopedic Clinic (GA) based on partially readable information in the SRS screen shots. DataBreaches.net contacted the clinic and received this response from its CEO:

In the last 48 hours, we were made aware of a potential data breach relating to our online patient records. Today, we also received an email requesting that we comply with the hacker’s request (which has been published in various forms online.) We take the privacy of our patients very seriously, as well as the laws that guide patient privacy, and we are investigating what may have happened through the proper channels. When we have more information to share with you and your readers, we will be in touch. Kayo Elliott, CEO, Athens Orthopedic Center.

TheDarkOverlord also named the Midwest provider from whose system 98,000 records were stolen and then listed for sale: Midwest Orthopedic Pain & Spine in Farmington, MO.

The hacker says he contacted each provider and offered to destroy his copies of their records if they paid him, with the alternative being that he would offer their records for sale. All of the providers declined. Note that this is extortion rather than a ransomware attack since he didn’t lock the users out of their own databases – he just demanded money in return for not publishing the records. He also apparently accessed the systems using manual intrusion methods rather than automated malware.

I scoured the Web for how to secure RDP:

  • Use strong passwords.
  • Keep both client and server versions current since older versions have many vulnerabilities.
  • Enable network-level authentication.
  • Administrator-level users can run RDP by default, so either remote unneeded administrator access or remove the administrator account from RDP access and add a technical group instead.
  • Set a local security polity limiting the number of password attempts.
  • Change RDP’s listening port so it can’t be easily seen in hacker network scans.

Here’s a chillingly factual description of how to hack RDP to steal the sysadmin password. The hacker uses address resolution protocol scanning software to find device IP addresses; captures the data stream when an RDP client connects to the RDP server (such as when a vendor connects to provide technical support); and then looks for passwords in the sniffer file, visible as individual user keystrokes (or the hacker can use a brute force password cracker).

Vendors, you might want to give your customers some emergency security guidance about configuring RDP, TeamViewer, LogMeIn, or any other remote support tool your support agreement requires.


Reader Comments

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From Green Tomato: “Re: forcing consulting firm employees to sign Epic’s non-compete agreement. Here’s a copy of what my employer insists we sign. Interesting contents: (a) it completely restricts access to Epic code without ‘pursuant to a customer schedule’ language, so the company has already run into engagements that require review of Epic code; (b) it restricts access to the Chronicles database, again costing my company a couple of engagements because they needed to query Chronicles to support a customer; and (c) it includes the hugely overreaching and offensive clauses declaring that we can’t work for an Epic competitor for one year after leaving our current jobs. I’ve heard that other consulting companies have signed agreements without the non-compete clause. I am standing up to my employer in not signing the agreement and will likely lose my job in the next few weeks. Without getting a group together for class action lawsuit, I’m essentially screwed, and even with a group it would be an uphill battle.”I don’t have the expertise to evaluate the legality of a company requiring its employees to sign another company’s non-compete agreement, but firing someone for declining to sign would seem to sit in wrongful termination territory. The fact that your employer even put this in front of you is indicative of just how scared companies are of getting on Epic’s bad side. I invite legal opinion, although I think you are correct that, right or wrong, you would need a lot of time and money to mount a challenge, and by the time you prevail, you will have moved on. You also have the document in Word, so you could add “not” in a key place (such as, “This restriction will not apply to you”), print it, and sign it hoping that nobody notices your edit.

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From ThisChangeIsNotGood: “Re: McKesson and Emdeon. They fall short in integrating acquired products and their customer service lacks. Change Healthcare and Relay have KLAS scores that lag almost 10 points behind their competitors. Why will bringing two challenged organizations together be good for customers? The obvious answer is that it won’t – it’s just a very profitable transaction for Blackstone. They acquired Emdeon for $3 billion and used at least $1.5 billion in debt, so this deal gives them $1.75 billion in cash ($250 million in profit) plus they still own 30 percent of the resulting entity. The release mentions $150 million in cost reductions which has to be mostly employees – the companies are huge cash generators because their customer contracts are old and those customers are drastically overpaying. The question is how long hospital CFOs will tolerate out-of-market prices with mediocre solutions and customer satisfaction.” There’s also the question about the degree of alienation felt by McKesson Technology Solutions customers and whether they see that getting better or worse once they’ve been dealt off to NewCo since, most importantly to McKesson, they buy a lot of non-IT stuff that McKesson actually cares about.

From HIStalkFan: “Re: [vendor name omitted.] VP of operations is leaving after the international sales VP left in the past month as well. The company has fired 20 folks in the past few months and seems to be losing business fast.” I left out the name of the cardiovascular information systems vendor for now since the VP is still listed on the company’s executive page. 

From Luke: “Re: VistA. Says its 40-year-old code is hard to manage, unlike that of commercial products.” Maybe, but Epic has been around nearly that long and Cerner Millennium was built in the 1990s. All three products have been enhanced continuously since they were developed, so it’s not like running an un-updated copy of Windows 3.11. The problem with both the DoD and the VA is that they’re going to hand billions over to contractors no matter what product they use and will probably botch their implementations via poor planning and oversight.


HIStalk Announcements and Requests

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Mr. H says his Texas after-school STEM class is “beyond excited” about the STEM kits we provided in funding his DonorsChoose grant request. The students have built a robot arm and analyzed pond water, with one student proudly exclaiming while experimenting with a marble roller coaster, “We are engineers in the making!”

Listening: Gary Clark, Jr., accurately characterized by the reader who recommended him as “born two generations too late, Jimi Hendrix crossed with Stevie Ray Vaughn.”

This week on HIStalk Practice: ManagementPlus launches revenue cycle solutions for eye care practices. Jonathan Bush waxes lyrical about his political plans. Allergy Partners develops app to help its patients track meds, triggers, symptoms. VillageMD partners with New Hampshire-based practices to assist with value-based care transitions. HHS selects 200 physician practices to participate in its Medicare Oncology Care Model. "Dr. Trump" promises perfect healthcare for all.


Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

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


Acquisitions, Funding, Business, and Stock

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Marketing intelligence vendor Definitive Healthcare acquires competitor Billian’s HealthData.

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Teladoc will acquire telehealth consumer engagement platform vendor HealthiestYou for $155 million in cash and stock. Scottsdale, AZ-based HealthiestYou lost money on $10 million in FY2015 revenue, while Teladoc confirms that it will lose around $50 million in 2016. HealthiestYou offers price comparison and provider search. It seems like a ridiculous multiple for Teladoc to pay for an app that doesn’t seem all that interesting or related to its core telehealth business, but they must know what they’re doing.

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Google Capital takes a $46 million position in publicly traded marketplace Care.com, which matches families with caregivers.

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Allscripts sues its former chief marketing and strategy officer Dan Michelson – hired by competitor Strata Decision Technology as CEO in 2012 – as well as Strata, claiming that Michelson “has in his possession an external hard drive containing highly confidential and trade secret Allscripts documents and information.” Allscripts claims that Michelson has disclosed its information to Strata employees in violation of his Allscripts employment agreement. The lawsuit also notes that Strata hired several other Allscripts employees, several of whom worked in sales for EPSi, the Allscripts financial planning product that competes with Strata’s StrataJazz. Allscripts contends that it lost the #1 KLAS spot for Decision Support – Business in 2014 to StrataJazz because of the exposed information, causing EPSi to drop to fourth place in the 2015 report.


Sales

GoHealth Urgent Care chooses Orion Health’s Rhapsody integration engine to connect with its health system partners.


Government and Politics

Vice President Biden, questioned at a cancer summit about why medical institutions that receive government grants don’t always publish their research data, responds angrily, “I’m going to find out of it’s true. And if it’s true, I’m going to cut funding. That’s a promise.” NIH Director Francis Collins says the 2008 law requiring taxpayer-funded researchers to submit their clinical trials data to NIH-run ClinicalTrials.gov does not provide an enforcement mechanism, but he expects changes that will allow NIH to levy fines on those who don’t comply or the power to ban them from receiving further grants.

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The Wall Street Journal says health insurance deductibles should become the next health policy debate now that 91 percent of the US population has coverage. Since 2004, co-pays have dropped, worker wages have increased modestly, and deductibles have jumped 256 percent to become the #1 health cost concern of consumers as well as the preferred tool for employers trying to rein in annual premium increases.

Congress works on a financial bailout of Puerto Rico, where 9 percent of its population has moved to the US, causing its hospitals to struggle with unfilled beds and an exodus of clinicians that may cause a further downward spiral in employment and business investment. Puerto Rico’s governor observes that its residents pay the same Medicare tax as mainland residents, but it gets less federal funding than the states. Lenders have cut off further loans as debt soars, with one surgeon noting that the hospital’s electricity was turned off for non-payment in the middle of a surgery he was performing.


Other

AMIA announces the eligibility requirements to take the exam for its Advanced Health Informatics Certification, an alternative to the physician-only clinical informatics subspecialty. Until an unspecified time until which the majority of graduate informatics programs are accredited, the requirements are:

  • Employment in an operational health informatics role.
  • Attainment of a health professions graduate degree plus a master’s in health informatics (for which 36 months of informatics experience in the US or Canada can be substituted). Examples of acceptable degrees are MSN, MPH, NP, PA, DDS, DNP, PharmD, DO, and MD.
  • 18 months of informatics work experience.

AMIA’s next steps are to develop the exam’s core content, choose a certifying entity, and launch the accreditation of graduate health informatics programs.

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Commonwealth Fund President and former National Coordinator David Blumenthal, MD, MPP says that instead of trying to convince providers to share their patient information, a better way to eliminate information blocking is to put patients in control of their own records as a “consumer-mediated health information exchange.” Patients or their paid vendors would manage and distribute their own information to parties they specify, which could include researchers or public health authorities. Blumenthal says the next steps would be to certify and/or regulate the organizations that will help patients share their information and to give those organizations access to provider EHRs.

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Informaticist Harris Stutman, MD ended his “Jeopardy” run Wednesday, earning second place for the day but taking home three-day winnings of $63,500.

BMJ ponders whether it’s OK for conferences to ban live-tweeting of their educational sessions. Arguments for: (a) presentations may include unpublished results and preliminary conclusions; and (b) the presenters may have granted a copyright to journal that is publishing their work. The author suggests that conferences make their tweeting policy clear and that speakers indicate on their title slide whether they are OK with having attendees tweet out photos of their other slides and handouts.


Sponsor Updates

  • Audacious Inquiry announces that its Encounter Notification Service is delivering1 million ADT notifications per month.
  • Boston Software Systems launches an EHR migration and optimization podcast series.
  • Netsmart helps prepare health and human services providers for CARF and The Joint Commission accreditations.
  • Representatives from 30 healthcare organizations in Canada visited Toronto’s Humber River Hospital, which claims to be North America’s first full digital hospital, to learn about its Meditech 6.1 system.
  • CloudWave is named by Hewlett Packard Enterprise as Preferred Healthcare Network Partner.
  • Red Hat will host its annual summit will take place May 2-5, 2017 in Boston.
  • Sagacious Consultants releases the June 2016 edition of its Sagacious Pulse newsletter.
  • SK&A publishes its annual pharmacy compliance report.
  • Sunquest Information Systems hosts a Cancer Moonshot Summit in Tucson, AZ.

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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News 6/29/16

June 28, 2016 News 5 Comments

Top News

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McKesson will divest its Technology Solutions business into a new joint venture company that it will co-own with Change Healthcare (the former Emdeon), with plans to take the new company public sometime in 2017. McKesson will own 70 percent of the new company and Change Healthcare will own 30 percent.

McKesson will retain its RelayHealth Pharmacy business as well as its Enterprise Information Solutions division, but will “explore strategic alternatives” for the latter, which includes its remaining go-forward hospital information system Paragon along with less-attractive products like Star, HealthQuest, and OneContent. McKesson seems to have lost most of its Horizon customers to Epic or Cerner after they declined to move to Paragon under McKesson’s Better Health 2020 program, so this latest move will likely cause more defections.

The new company will take on up to $6.1 billion in debt to fund the transaction.

Blackstone Group bought publicly traded Emdeon, which operated under the WebMD name through 2005, for $3 billion in 2011 and took it private in a leveraged buyout. It renamed the company Change Healthcare in September 2015 after January 2015 plans for a $5 billion IPO never materialized.

McKesson struggled from the beginning with its $14.5 billion acquisition of HBOC in 1998, dogged by a massive accounting scandal, the resultant firing of several executives who were involved, aging product lines, and a lack of corporate focus. The company, like several before it, dabbled in health IT dispassionately but with the added baggage of having wildly overpaid for an immediately impaired asset. MCK share price dropped and didn’t recover for 12 years under John Hammergren, who was quickly promoted to co-CEO in the leadership void in 1999, eventually becoming the country’s highest-earning CEO.

This transaction, along with the eventual disposition of Enterprise Information Solutions, will once again remove McKesson from the software business.

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… but not the day after the transaction closes.

Your trivia questions for today:

  • Who was named as Hammergren’s co-CEO in the 1999 announcement that McKesson Chairman Charlie McCall and CEO Mark Pulido had been fired over HBOC’s accounting irregularities?
  • What was the name of McKesson’s short-lived online business that was launched in the heady dot-com days of 2000 and led by Hammergren’s former co-CEO, giving Hammergren full control?
  • What accounting company failed to detect widespread fraud as the auditor of both McKesson and Enron?

Reader Comments

From ProGoogler: “Re: Change Healthcare. Blackstone finally dumps Healtheon / WebMD / Emdeon / Change onto McKesson? Surprising that Change would dump all assets into a company they’ll only have a 30 percent stake in. HIStalk followers–what’s the take on this?”

From Silly Boy: “Re: McKesson and Change. Throwing their trash into a doomed-to-fail company, ridding themselves of all liability, and getting $1.5 billion each in cash out of it? Wow.” You forget to mention the advantageous tax accounting McKesson will use to walk away.

From Robert Higgins: “Re: dress while traveling. See this LinkedIn post, which says everybody should dress up while traveling on business because they represent the company and you should be extraordinary rather than ordinary.” I can’t imagine anything more mind-numbingly ordinary than a bunch of mid-level company hotshots wearing suits everywhere they go hoping to impress strangers who apparently value cloth over character. Real power players wear whatever they want (see: Mark Zuckerberg, Steve Jobs, etc.) while their un-creative, lemming-like underlings choke on ties. I’ve attended venture capital sessions at the HIMSS conference and my biggest takeaway was that the real money guys looked like they had just dropped by after a family cookout, while back at work my fellow IT management team members would illogically don their always-handy suck-up jackets for internal meetings or restroom trips.


HIStalk Announcements and Requests

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The Tennessee elementary school students of Mrs. Jones have shown “amazing growth” in benchmark assessments, she reports, after practicing reading and math on the the three Kindle Fires we provided in funding her DonorsChoose grant request.

I don’t really do anything with LinkedIn except look up people’s job histories, but you are welcome to join the 2,477 people who have connected with me there, of which 351 have written me really nice recommendations. There’s also the HIStalk Fan Club created by Dann many years ago, now up to 3,617 members, many of them CEOs, CIOs, CMIOs, etc. I might tell my mom about it just to see her puzzled double take since surely she views me fondly and accurately as her low-profile ne’er-do-well.


Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Ask Lorre about her “Summer Doldrums Special” sale.

This Tuesday’s webinar by West Healthcare Practice drew nearly 500 registrants and will no doubt generate many YouTube page views after the fact. I always give my first-pass critique of our webinars and rarely have any change suggestions for West. Lots of readers are apparently interested in what Henry Ford is doing with contact centers (including me).


Acquisitions, Funding, Business, and Stock

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Allscripts acquires RealCost.io — a decision support company founded by former EPSi executives Tim Rutledge, Ralph Keiser, and John Gragg – and will put the three men back on the Allscripts EPSi financial planning product line to serve as chief product architect, CEO, and COO of Allscripts EPSi, respectively. Eclipsys acquired EPSi in 2008 for $53 million in cash, followed by the acquisition of Eclipsys by Allscripts for $1.3 billion in 2010. All three left Allscripts from 2008 to 2011.

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VistA vendor Medsphere and ambulatory PM/EHR vendor ChartLogic will merge.

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EHR data sharing vendor Medal raises $3.8 million. Co-founder and CEO Lonnie Rae Kurlander is a 27-year-old medical student at Boston University.

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MedAssets-Precyse renames itself nThrive. Pamplona Capital Management bought MedAssets for $2.7 billion in November 2015 and combined its RCM business with Precyse, another of its recent acquisitions.


Sales

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Mercy Technology Services adds three clients: Riverview Health (IN) for Epic hosting, McLeod Health (SC) for data analytics, and Peninsula Regional Medical Center (MD) for Epic implementation support.


People

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Medical informaticist Harris Stutman, MD (MemorialCare Health System) returns as “Jeopardy” champion Tuesday night following his wins on the Friday and Monday programs that earned him $39,700.

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Premier promotes Leigh Anderson to SVP/CIO, replacing the departing Keith Figlioli.

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Microsoft promotes Simon Kos, MBBS to chief medical officer. It appears he went to work for industry (InterSystems, then Cerner) directly out of residency without actually practicing medicine.


Announcements and Implementations

Analysis by TransUnion Healthcare finds that patients experienced a 13 percent increase in their deductible and out-of-pocket maximum costs in 2015 at $1,278 and $3,470, respectively. “Patients are becoming the new payer,” the report concludes.

Vital IMages launches its application-neutral archive that connects proprietary data sets for interoperability and workflow.


Government and Politics

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In England, Health Secretary and “Remain” supporter Jeremy Hunt calls for additional Brexit referendum votes or other “democratic endorsement of the terms” by which the UK will extricate itself from the European Union. He is considering running for Conservative leadership as prime minister, urging full trading access but with immigration restrictions. Hunt said previously that NHS would face budget cuts and staff shortages should the UK exit from the European Union, a statement pro-Brexit supporters characterized as fear-mongering. Meanwhile, “Leave” campaigners appear to be backtracking on their assertion that withdrawing will free up $467 million each week, of which they had promised that a large portion would be sent directly to NHS to improve healthcare services.


Privacy and Security

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A hacker offers for sale the records of 655,000 patients from three unnamed US provider databases and reports that some of the information in them has already been sold. DeepDarkOverlord says he or she exploited an unstated vulnerability in RDP (remote desktop protocol) to take control of the provider computers and steal their patient data, after which he or she offered to return the data for a ransom that the providers elected not to pay. The prices range from $100,000 to $411,000 for each of the three databases:

  • An Access database of 48,000 patients from an unnamed healthcare organization in Farmington, MO.
  • A plain text database of 210,000 patient records stolen from a Midwestern provider
  • A plain text database of 397,000 patient records retrieved from an unnamed Georgia provider.

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Apparently one of the hacked providers uses the SRS EHR, based on the hacker’s screen shot of  him or her taking over a Windows 2008 server at the unnamed Georgia site.

The same hacker is also offering a 9.3 million patient record database from an unnamed insurance company, stolen using the same RDP exploit. Security researchers tested sample data and believe it’s an old database since many of the telephone numbers and email addresses it contains are no longer valid.


Technology

Comcast Business creates its largest Eastern US network in providing 100 Gbps Ethernet connectivity between the campus of Penn State Health Milton S. Hershey Medical Center (PA) and the university’s data center.


Other

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A survey finds that EHR-using physicians are less satisfied and more burned out, with physician satisfaction low for performing both EHR documentation duties and CPOE. Family medicine, ED, and orthopedic surgery are big trouble spots, while surgeons and ever-affable pediatricians are happier. Interestingly, the method of documentation didn’t affect the burnout rate much – it was about the same for dictation, voice recognition, handwriting or typing, and using scribes. Only 36 percent of respondents said the EHR has improved patient care and just 23 percent said it has increased their efficiency.

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Bob Wachter, MD cashes in on the success of his book “The Digital Doctor” in hiring himself out as a thought leader and video star to malpractice insurer The Doctors Company, a role he describes as, “My partnership with The Doctors Company will provide its 78,000 members and other physicians nationwide with the tools and information needed to thrive in today’s rapidly changing digital landscape.”


Sponsor Updates

  • FormFast publishes a new white paper, “Delivering ROI: The Case for Electronically Capturing Patient Signatures.”
  • FujiFilm will exhibit its Synapse product line at SIIM 2016 June 29-July 1 in Portland.
  • A study finds that hospitals that use Nuance’s clinical documentation improvement solutions score better in patient mortality ratings.
  • Meditech held its Nurse and Home Care Forum June 15-17 in Foxborough, MA.
  • Glendora Community Hospital (CA) goes live on electronic forms from Access and signature pads from Wacom in the ED and admission areas.
  • Bernoulli CIO John Zaleski will speak at the IEEE Chase 2016 Conference on Connected Health June 29 in Arlington, VA.
  • Besler Consulting wins a B2B Marketer Award for Best Contribution to Sales Account-Based Marketing.
  • Carevive Systems shares its latest poster presentation, “Implementation of Survivorship Care in a Network Hospital Setting.”
  • CTG and Catholic Health Systems will co-host a symposium, “Exploring the Impact of Security Threats: Is Your Organization Prepared,” June 29 at CTG headquarters in Buffalo, NY.

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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McKesson Spins Off Its Technology Solutions Business with Change Healthcare

June 28, 2016 News 8 Comments

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McKesson announced this morning that it will move its Technology Solutions business into a new company that it will co-own with Change Healthcare (the former Emdeon), with plans to take the new company public sometime in 2017.

McKesson Chairman and CEO John Hammergren said in statement, “This is a bold, innovative transaction that creates a company with an enhanced ability to help customers address their increasingly complex financial and clinical challenges. The new company will establish a more efficient suite of end-to-end payment and claims solutions, as well as clinical capabilities, while unlocking the value of our MTS businesses in a tax-efficient manner. We look forward to partnering with Change Healthcare’s management team and employees to create this new enterprise and to help customers reduce complexity, lower costs, and ultimately provide better care.”

McKesson will receive cash proceeds of $1.25 billion and will own 70 percent of the separate company. Change Healthcare, which is contributing all of its assets except for some minor pharmacy components to the new company, will get $1.75 billion in cash and a 30 percent ownership stake.

McKesson will retain its RelayHealth Pharmacy business. It will also keep its Enterprise Information Solutions division, but will “explore strategic alternatives” for that product line. That means that McKesson’s go-forward hospital information system, Paragon, is up for grabs.

McKesson’s John Hammergren will serve as chairman of the new company, while Change Healthcare President and CEO Neil de Crescenzo will become CEO.

The new company will take on $6.1 billion in debt to fund the transaction, of which $2.7 billion will be used to pay down existing Change Healthcare debt.

Monday Morning Update 6/27/16

June 26, 2016 News 7 Comments

Top News

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HHS considers running an ethical hacking program to identify cybersecurity vulnerabilities, encouraged by results from the Pentagon’s recent pilot program. The concerns of such a program are that, (a) hackers would by definition be encouraged to seek exposed confidential patient information, and (b) they are likely to find a lot of it, thus requiring someone to take action.

“Hack the Pentagon” was the first bug bounty program run by the US government. It drew 1,410 participants this past April and May and paid $71,200 in bounties, or an average of $588 for each verified vulnerability. Most of the reported vulnerabilities involved cross-site scripting, but one participant discovered a significant SQL injection bug.

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The DoD used the HackerOne bug bounty program that provides hacker invitations, a leaderboard, hacker messaging, payments, and workflow.


Reader Comments

From Venus de Milo: “Re: Epic’s new product name. Userweb shows a whole treat titled, ‘We are excited to announce Caboodle as the new name for Epic’s enterprise data warehouse.’” It’s a quirky name, but I like it. At least they don’t use eye-rollingly unoriginal names like Insight.

From Brownian Movement: “Re: Epic. The company forces the individual employees of consulting firms sign a non-compete directly with Epic. If you work for a consulting firm and have access to an Epic client’s system, you can’t work in software or sales for an Epic competitor for one year after leaving the consulting firm.” The non-compete agreement that Epic requires its own employees (and those of its customers) to sign is almost certainly not legally defensible, so it’s even more likely that such agreements signed by the employees of other companies couldn’t withstand a legal challenge. However, Epic’s industry clout and legendary legal firepower cause everybody to sign the paper anyway. Most of the griping happens only when someone wants to change jobs, but the sit-out period would be over before any expensive legal challenge could be completed. Think about Epic’s heavy-handed control – Epic’s new customers are required to let the company administer tests to their employees who want to work on their Epic project. Epic scores the tests secretly, providing only a hire/no hire recommendation. If you score well, you get to work on the Epic project team and thus get to retain your job. Score less well (by whatever standards Epic uses) and you’ll be banished to the legacy maintenance team with all the other rejects, thus assured of losing your job once Epic is live and your legacy system babysitting skills are no longer needed. It is reasonable to expect companies to stack the deck in favor of their own interests unless someone musters a challenge.

From Follow the Money: “Re: DOJ’s bust for a measly $900 million in Medicare fraudulent billing. Reminds me of a poem by James Roche.”

The Net Of Law

The net of law is spread so wide,
No sinner from its sweep may hide.
Its meshes are so fine and strong,
They take in every child of wrong.
O wondrous web of mystery!
Big fish alone escape from thee!

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From Stiffie: “Re: healthcare IT writers and reporters. I looked up their lightweight credentials and made you a table of who is out there dispensing analysis and advice.” I don’t necessarily agree since most publications simply rewrite press releases to resemble original reporting, so it would be a waste for them to hire someone with actual industry experience. If these folks can find and keep an executive-level audience, more power to them because it’s not easy.


HIStalk Announcements and Requests

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Two-thirds of poll respondents disagree with the AMA’s opinion that technology reduces the efficiency of care delivery. Some of those respondents correctly noted that “efficiency” is in the eye of the beholder, whose personal data capture efforts might – like paying income taxes — detract from their own performance in deference to the greater good. New poll to your right or here: how would you characterize McKesson’s contribution to health IT?

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Mrs. Riley’s Maryland second graders are using the 25 sets of headphones we provided in funding her DonorsChoose grant request to access Internet tools and educational games. They are less distracted by the noise of what other students are doing and she can differentiate the simultaneous activities being pursued by her special education subgroups.

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My WiFi range extender was performing erratically, so I replaced it with the $30 Netgear N300. You just plug it into a wall jack near the end of the wireless coverage range of your router, connect your smartphone or tablet to the newly created network (whose name, unless you change it, is your existing network’s name plus _EXT at the end), then enter the network password on the setup page.  I’m getting five bars and high speeds far from the router and it’s never hiccupped even once in several weeks. It’s a great solution for coverage problems (distant bedrooms, garage, workshop, or patio) or if you want to stream Netflix from a spot where coverage is too weak to support a high-quality picture. The little gadget even has an Ethernet port if you need to hardwire something.

Listening: Eye Empire, an apparently defunct band that offered the compelling combination of alt metal chops with understandable vocals rather than screaming and grunting, not that there’s anything wrong with that. For an even harder edge with a biker bar vibe (since they love featuring strippers in their videos), there’s always Southern hard rockers Texas Hippie Coalition, which sounds and looks like Charlie Daniels fronting Pantera.


Last Week’s Most Interesting News

  • The newly installed president of the American Medical Association says his practice doesn’t use an EHR, preferring to pay the penalty rather than participate in Meaningful Use.
  • An HHS OIG analysis finds that one-third of Medicare recipients were prescribed potentially addictive opioids last year at a cost of $4.1 billion.
  • HHS credits analytics for helping it identify the 301 people it arrested for Medicare fraud.
  • The VA continued its hints about eventually de-emphasizing or replacing of VistA in favor of a commercial product.
  • McKesson is reportedly trying to sell its health IT business to Change Healthcare (the former Emdeon).
  • A federal report recommends national quality reporting, real-time data sharing, use of best practices, and civilian-military cooperation in reducing 30,000 unnecessary trauma patient deaths each year.

Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Ask Lorre about her “Summer Doldrums Special” sale.


Acquisitions, Funding, Business, and Stock

How health IT stocks performed in Friday’s Brexit-triggered selloff, which I expect to be reversed Monday as investors realize that several mechanisms exist to reverse the UK’s decision and that the timeline is long in any case:

Dow: down 3.4 percent
Nasdaq: down 4.1 percent
S&P 500: down 3.6 percent
Allscripts: down 2.7 percent
Athenahealth: down 0.8 percent
Cerner: down 3.1 percent
McKesson: down 3.8 percent
Quality Systems: down 3.1 percent


People

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Paula McCann, VP/CIO of East Texas Medical Center Regional Healthcare System, is appointed to the Texas Health Services Authority board.

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Rosanna Morris, RN, MBA, chief nursing officer and Epic EHR implementation co-leader of Nebraska Medicine, is named CEO of Beaumont Hospital (MI).


Announcements and Implementations

IDC Health releases yet another worthless health IT vendor revenue ranking with methodology unspecified. Assuming its information is correct – which I don’t when privately held companies are involved – I don’t know exactly what anyone would do with that information other than, (a) the PR people in companies named to the list who brag on the bestowment of questionable awards; and (b) the uncritical health IT rags that milked this anemic “news” for several paragraphs of slightly reworded press release text. As a customer, I wouldn’t necessarily be delighted that my vendor has more revenue than its competitors, especially if the portion I contributed wasn’t worth what I received in return. Bigger is definitely not associated with better. Perhaps it is appropriate that IDC in text messaging parlance stands for “I don’t care.”

Austin-based revenue cycle technology vendor DaVincian Healthcare, which has raised $50 million in funding, wins a contest for using Amazon’s Alexa to solve financial payments problems. The winning system allows patients to receive prescription refill reminders, ask questions about their prescriptions, and send messages to their providers. I think a lot of people are like me, though – I bought Alexa but never use it since the benefit is unclear if you’re already near a phone and I don’t really know what all it does since Amazon is cool like Apple in not providing a manual. It seems to be best suited for ordering even more stuff from Amazon. The video features a robotic phony doctor decked out in the obligatory scrubs, white coat, and the doctor ego elevation tool (a stethoscope) sitting in what looks like a spare bedroom in front of a desk full of books puzzlingly turned around backwards (they probably didn’t have any actual medical books handy). In fact, the windows in the doctor’s office look exactly like the ones in the patient’s living room and in his daughter’s house, so perhaps they all live together in Alexa-powered health IT communal bliss. Fun aside, it’s a nicely done video and the product is interesting if someone can validate the extent to which Alexa customers have integrated it into their daily lives.


Government and Politics

HHS names Aaron Miri, CIO and VP of government relations of Imprivata, as the privacy and security representative of the HIT Policy Committee. Appointed to the HIT Standards Committee are new members:

  • Rajesh Dash, MD (Duke University School of Medicine)
  • Kay Eron (Intel)
  • Peter Johnson (retired)
  • Kyle Meadors (Drummond Group)
  • Terrence O’Malley, MD (Massachusetts General Hospital)
  • Andrey Ostrovsky, MD (Care at Hand)
  • Wanmei Ou (Oracle)
  • Larry Wolf (Strategic Health Network)

In Australia, the CIO of Queensland Health and CEO of eHealth Queensland resigns after just seven months on the job to take a private sector position. He was placed under investigation three weeks after taking the job following a nepotism complaint. He was hired by his wife, a Queensland Health executive.

China uses the death of a student from treatments he found from Internet searches to tighten the government’s control over the Internet, requiring search providers to censor “rumors, obscenities, pornography, violence, murder, terrorism, and other illegal information” along with limiting the display of paid ads. That won’t affect Google, at least for the moment, since the Great Firewall has blocked it almost continuously in the years after the company declined to censor search results.

A Vermont citizen advocate wants to know, “What does Vermont have to show for its $50 million investment in VITL?” in referring to Vermont Information Technology Leaders. He questions why patients don’t own their data and claims that VITL’s contract with its technology vendor Medicity requires it to transfer all of its intellectual property and patient information to the company.


Privacy and Security

A newly signed Illinois law requires covered entities that report a data breach to OCR to also notify the state’s attorney general even if the incident doesn’t meet the state’s definition of a breach.


Technology

Here’s your “Jeopardy” question for the week. The answer is, “A study surprisingly finds that you really can go blind from playing with this in the dark.” The correct question: “What is a smartphone?”


Other

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A Peer60 medical image sharing report finds that McKesson is leading in installations and recommendation scores, with LifeImage leading the pack by a wide margin among vendors being considered by first-time adopters. The least-desirable image sharing technology is, thankfully, CDs, while cloud networks toped the list and site-to-site sharing came in #2. The highest-risk vendors for replacement are Sectra and Philips, with their  biggest threat being customers who are pursuing a single-vendor strategy and superior technology.

PBS covers the ordeal of a heart bypass patient who verified that the hospital and surgeon accept his insurance, only to get stuck with a $2,200 bill from an ICU doctor who doesn’t. The patient asks reasonable questions of an unreasonable healthcare non-system: “Out of nowhere, somebody who you never heard of, I don’t remember meeting, sends a bill. Why is he not accepting the insurance?  Why is he out of network?” The answer isn’t so simple, of course – hospitals take hundreds of insurances whose coverage varies widely, with the real problem being that hospital bills aren’t all-inclusive even though you might logically wonder why not. The article profiles another patient who was left on the hook for a $5,000 out-of-network plastic surgeon’s bill after rushing to the ED with deep ankle cuts. The hospital answered the reporter’s inquiry with a dry, concise response: “The current system is not optimal.”


Sponsor Updates

  • Sunquest will host the Tucson Cancer Regional Moonshot Summit on July 29.
  • Craneware will exhibit at the HFMA ANI conference in Las Vegas this week and will co-present a session about pharmacy revenue integrity.
  • Optimum Healthcare IT joins CHIME as a foundation partner.
  • T-System celebrates 20 years of advancing care delivery and financial outcomes for EDs, freestanding emergency centers, and urgent care.
  • ZDoggMD will make an appearance at TeleTracking’s annual conference, October 9-12 in Naples, FL.
  • TierPoint is recognized in Gartner’s June 2016 “Magic Quadrant for Disaster Recovery as a Service” report.
  • TransUnion, VitalWare, Huron Consulting Group, and Zynx Health will exhibit at the HFMA ANI Conference June 26-29 in Las Vegas.
  • Valence Health Chief Strategy Officer Phil Kamp will speak at the HFMA ANI Conference June 26-29 in Las Vegas.
  • Visage Imaging and Vital Images will exhibit at SIIM 2016 June 29-July 1 in Portland.
  • Wellsoft EDIS publishes a new case study on its work with Kingston General and Hotel Dieu Hospitals.
  • ZirMed client Baptist Health will share how it leveraged the company’s revenue cycle solutions at the HFMA ANI Conference June 26-29 in Las Vegas.

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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News 6/24/16

June 23, 2016 News 1 Comment

Top News

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The Justice Department charges 301 people (including 61 doctors, nurses, and other licensed professionals) with $900 million worth of Medicare fraud, with many of the cases involving prescription fraud and compounding pharmacies. HHS OIG credits its use of real-time billing data and analytics to identify outliers to investigate.


Reader Comments

From Caboodler: “Re: Epic. Just announced that their data warehouse product will be renamed from Star to Caboodle. This has got to be a new low in their ‘cute and clever’ naming convention.” Unverified, but I’ll be on the lookout for an accompanying product named Kit.


HIStalk Announcements and Requests

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Mrs. Hendrickson says her Ohio middle school students are using the voice recorders we provided in funding her DonorsChoose grant request during “read to self” improvement time. She’s also sending the recordings home for the parents to review. She adds, “My students who struggled most seem to have made the most growth with the recorders.”

This week on HIStalk Practice: HHS announces $100 million in funding to help small practices with MACRA. Doctors Care becomes the first urgent care chain in South Carolina to offer telemedicine. American Well expands, welcomes new executive. PediaQ raises $4.5 million. FQHCs in West Virginia partner with Aledade to form a first-of-its-kind ACO. Eye Care Leaders Group gets into consulting. The Maryland Health Care Commission awards telemedicine grants to independent practices. Yard work inspires Dr. Gregg to coin the phrase “EHR litter.”

This week on HIStalk Connect: Samsung unveils its vision for Human-Centered IoT. Digital health insurance startup League raises $25 million. MassChallenge announces the $25.8 million Massachusetts Innovation Catalyst Fund. Online therapy provider Talkspace raises $15 million. Burner unveils a witty break-up app.


Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Ask Lorre about her “Summer Doldrums Special” sale.


Acquisitions, Funding, Business, and Stock

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Reflexion Health, which offers Microsoft Kinect-powered tele-rehabilitation software, raises $18 million in a Series B funding round, increasing its total to $30 million. It seems pretty cool, although basing a company on a consumer electronics gadget is risky, as those startups that built their business around Google Glass can attest.

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Shares in Quality Systems (NextGen) hit their five-year low this week. Above is the one-year share price chart for QSII (blue, down 73 percent) vs. the Nasdaq (red, up 73 percent), with the company’s market cap at $726 million.


Sales

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Eos Healthcare chooses the iTraycer medical device inventory management system from Jacksonville, FL-based Medical Tracking Solutions.


People

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American Well promotes Jon Freshman to CTO.


Announcements and Implementations

Vital Images launches Version 7 of its Vitrea advanced visualization software that includes scalable deployment options, personalization, and standardized user interface across all modalities. Vitrea can also turn patient scans into 3D printing-ready files.

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Visage Imaging releases new versions of its mobile apps for its enterprise imaging platform with enhancements that include barcode scanning, Touch ID fingerprint authentication, and multitasking views.

Six Sutter Health and Alameda Health hospitals in Northern California implement PreManage ED from Collective Medical Technologies to flag ED frequent flyer patients across their facilities. The Salt Lake City-based company’s real-time EDIE (Emergency Department Information Exchange) system has also been used in Oregon and Washington to reduce unnecessary ED visits.

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Cedars-Sinai will offer discharged patients a ride home via HomeHero, a startup in the Cedars technology accelerator that claims to be “the #1 rated healthcare startup in the country.” HomeHero offers non-medical transportation and home assessments for $22 per hour, offering a customer app that allows choosing a provider and booking services in Los Angeles, San Francisco, and San Diego. The CEO’s failed previous venture was Flowtab, an app that connected bar patrons with the bartender for ordering and paying for drinks.

Experian Health announces new products that include Denials Workflow Manager, Compliance Manager, and Patient Financial Clearance.


Government and Politics

Medicare spent $4.1 billion last year to provide 12 million of its beneficiaries (one-third of Medicare recipients) with opioids such as OxyContin and fentanyl, with those patients averaging five such prescriptions filled. The AMA’s righteous indignation toward “digital snake oil” should perhaps be refocused on the free-wheeling prescribing of its members that is addicting and killing a lot more people than lame consumer apps.

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Department of Veterans Affairs Under Secretary for Health David Shulkin MD says Wednesday in testimony to the Senate Committee on Veterans Affairs that the VA’s proposed digital health platform “is not dependent on any particular EHR” and that its VistA Evolution funding will deliver value “regardless of whether our path forward is to continue with VistA, a shift to a commercial EHR platform as DoD is doing, or some combination of both.” He adds that the Joint Legacy Viewer is a read-only connection between the VA and DoD systems, but eHMP (Enterprise Health Management Platform) will replace the 20-year-old CPRS as a provider point-of-care tool in 2017.


Other

An study finds that state-run prescription drug monitoring programs reduce opioid-related overdose deaths by 1.12 per 100,000 population. The authors note that West Virginia is the nation’s major outlier – despite implementing such a program in 2002, its overdose death rate is nearly twice as high as the next-highest state.

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An interesting article by Mike Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health, observes the correlation between the decline in health of US citizens with their stagnant incomes in which the top 1 percent of earners have increased their annual wages 138 percent since 1979 while the bottom 90 percent had only a 15 percent increase in those 37 years, which is associated with an alarming disparity in survival. As is the case with most health measures, the US lags pitifully behind other high-income countries, coming in #43 in deaths of children under 5.

The European Union considers a law that would require companies to pay “electronic persons” social security taxes for robots they use. Governments are worried that such automation will raise unemployment, increase wealth inequality, and undermine employment-based social security programs.

The new president of the AMA says his orthopedic hand surgery practice doesn’t use an EHR, explaining that “I just take the [Meaningful Use] penalties.” I don’t see a website for his practice, either. As an orthopod, he’s probably not amused by the hilarious video above, although I shouldn’t generalize since the orthopedic surgeons I’ve known are among the most prolific jokesters about their profession. 


Sponsor Updates

  • Ingenious Med, Leidos Health, and Navicure will exhibit at the HFMA ANI Conference June 26-29 in Las Vegas.
  • PDR’s Jeffrey Wiltrout is recognized as a PM360 Elite Disrupter.
  • LifeImage and National Decision Support Company will exhibit at SIIM 2016 June 29-July 1 in Portland.
  • MedData is named a 2016 Top Workplaces, Workplace Achiever by The Cleveland Plain Dealer.
  • T-System celebrates its 20-year anniversary as a leading provider of health IT solutions for episodic and emergency care this week.
  • Meditech will exhibit at the Michigan Health & Hospital Association Annual Meeting June 29-July 1 on Mackinac Island, MI.
  • Netsmart shares takeaways from its first annual Public Health Summit.
  • Recondo Technology, Experian Health, Patientco, PatientMatters, Relay Health, and The SSI Group will exhibit at the HFMA ANI Conference June 26-29 in Las Vegas.
  • Point-of-Care Partners expands its e-prescribing state law review resource to include new state mandates.
  • Summit Healthcare supports Boys & Girls Clubs of Central Florida, this year’s recipient of the Heart of MUSE charity.

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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The Hypocrisy of a Simpler Patient Bill

June 22, 2016 News 4 Comments

HIStalk gauges industry reaction to the HHS patient bill design challenge, which aims to highlight the need for easier-to-understand statements and more patient-centered engagement.
By
@JennHIStalk

Medical bills, especially traditional paper statements, are not known for being easy reads. More often than not, they are a mixture of codes, abbreviations, dates, and — if a patient is lucky — breakdowns of services and supplies rendered.

The eyes of most patients stray immediately to the balance due, the derivation of which is typically shrouded in mystery. What makes perfect sense to a provider’s or payer’s accounting department causes sticker shock in patients, who feel helpless because they don’t understand what they’re being charged for. The bill inevitably sits unpaid for several weeks while patients wait for some sort of “deux ex machina” that never comes.

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It is this frustrating fiscal conundrum that HHS is looking to address with its “A Bill You Can Understand” design and innovation challenge. Announced in early May, the challenge –which “seeks to draw attention to the complexity of medical billing and how patients are impacted” — has two components. One prize will be given to a participant that designs the easiest-to-understand bill. Another will be given for creating the best transformational, patient-centered approach to improving the medical billing system. Earning either prize will be no small feat.

Stop the Insanity

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HIStalk readers have wasted no time in sharing their withering opinions of the challenge. Frank Poggio, founder and CEO of The Kelzon Group, got straight to the heart of the matter:

This is the height of hypocrisy. Does CMS think providers on their own created the insane billing requirements and processes? It started with Medicare Part A, then B, then D. Co-payments, deductibles, out of network, referral approvals, contractual allowances, UC charges, and on and on. Next, billing systems will have to deal with VBP, P4P, bundled payments, MACRs, and more. Providers never asked or suggested any of these — they just have to figure out how to carve up charges/costs and services and put it all on a one-page bill. A 1995 analysis found that the Federal Register contains 11,000 pages dealing with an IRS 1040 submission, but hospital billing required 55,000 pages to describe. If CMS really wants to simplify the patient bill, they need to go to a single-payer system. Until they do that (not likely), the patient bill will continue to be the mess it has been for the last 50 years. Who do I call to collect my $5k?

Poggio has a point, of course, but that doesn’t mean attempts shouldn’t be made to streamline the patient billing process, especially when recent studies have found that the most significant patient payment challenges include a patient’s inability to pay or pay on time and the need to educate them about their financial responsibility.

While the challenge hopes to address the education piece, it also opens a Pandora’s Box of questions related to price transparency and consumer empowerment. How can patients become savvy healthcare shoppers if the cost of services they ultimately select aren’t properly explained to them, not to mention agreed upon by all parties involved ahead of time?

A Step in the Right Direction

Ten healthcare organizations, including Cambia Health Solutions, have signed on to test and implement solutions submitted to the challenge. It’s an apt fit for Cambia given its history of focusing on improving transparency within its regional health plans and direct health companies, plus its emphasis on incubating transparency innovation within its collaborative Cambia Grove space.

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“At Cambia, we are relentlessly focused on creating a healthcare system that removes confusion, mystery, and pain that it creates for consumers – a system built to engage with and flawlessly serve individuals and their families with respect at every turn and in every encounter,” says CHS President and CEO Mark Ganz. “Producing a medical bill that is simple, straightforward, transparent – and therefore truly accountable to patients – is a huge step in the right direction.”

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HFMA Director Sandy Wolfskill echoes Ganz’s comments, adding that, “This new HHS challenge is focused on the medical bill for the patient, so receiving a standardized, understandable bill from all healthcare providers should help patients immediately understand what they owe and why they owe it. There is a very realistic chance that bills will be resolved more quickly.”

Wolfskill also believes that a truly understandable bill will ultimately help patients feel more in control of their care. “As patients, especially those with high-deductible health plans, begin to exercise their options to shop for more affordable, quality care,” she explains, “they will begin to expect that providers are transparent around price and quality, and can explain prices in a way that allows patients to compare providers.”

Ignorance Isn’t Bliss

When it comes to challenge detractors, Wolfskill advises HIStalk readers to remember that “HHS is challenging providers to produce an understandable bill for what the patient owes for the service – and assembling that information is totally in the hands of the providers. Yes, there are multiple stakeholders, but at the end of the day, the provider has all of the information needed, including the impact of the provider’s financial assistance policies, to communicate effectively with the patient about the financial responsibility involved.”

“Rather than ignore this challenge from HHS,” she adds, “providers should realize that this medical billing challenge is simply another step in the transparency journey. HFMA has publicized industry guidance and best practices around price transparency and patient financial communications, and sees this HHS initiative as another component in developing a high-quality, comprehensive financial care approach for patients to compliment the high-quality clinical care already being provided.”

Billing’s Bottom Line

While steps in the right direction and forward momentum on the transparency journey are positives for patients, the challenge and its results may be more of a marketing exercise than a truly game-changing attempt to create an industry standard.

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“I think the challenge is a great exercise, but there are ultimately too many competing interests,” explains Patientco founder and CEO Bird Blitch, adding that there will be technological challenges for those providers who use different inpatient and outpatient billing systems. “I think everyone is passionate. People have to think objectively about the payment piece and not just about sending the bill. Payment is what we need to be thinking about, not billing. If we focus on that, then we’ll be answering the right question of how to bill better.”

Blitch brings up a good point. While many providers are beginning to think about patient bill design from a marketing and patient satisfaction perspective, the bottom line of patient billing is still payments received. Patient satisfaction scores could improve in tandem with bill design, but the success of any design standards adopted as a result of the challenge will ultimately be measured in lower provider billing costs related to more timely patient payments.

Better Bills Start with Consumer Friendliness

“If you’re building it to increase patient satisfaction, great,” Blitch says. “Then, you’ve got to understand patient dissatisfaction. I think the biggest thing I might look at from a billing perspective is that it’s written from the standpoint of an accountant. If you look at a lot of these bills, they’re columns, debits, and credits. Most consumers don’t have accounting majors, and so when we look at designing the bill, we look at how consumers are understanding and consuming Web content. We look at not only color psychology, but iconography, even the actual user experience. How do their eyes track? Eye motion up, down, and around the bill happens within split seconds of opening the letter, and that matters. I don’t think providers are looking at it that way yet. They’re still looking at it from the accountant’s viewpoint. The challenge’s stance is that you’ve got to tear your current design down and start over.”

“We all need to be thinking about this from the consumer’s standpoint, but I think we also need to ask, ‘Why are we doing this?’ This is not a bunch of snake oil,” he emphasizes. “We’ve all had terrible billing experiences. Change will happen when it is driven by consumers, or when it is driven from the bottom up. No one thought that the banking industry could be disrupted, but online bill pay did. No one thought that Walmart could be disrupted, but Amazon has done it. No one thought that Blockbuster could be disrupted, but Netflix did it. When you empower the consumer, when industry gets out of the way and lets them choose and gives them freedom to understand, they will respond accordingly.”

(Dis)Satisfaction will Lead to Savvy Shopping

As Blitch mentioned, healthcare’s many stakeholders are passionate about this topic. Whether it’s patient satisfaction or payments received (and it’s becoming increasingly difficult to separate the two), the medical bill of the future will be a key component of a patient’s healthcare journey – perhaps even the deciding factor when the question of follow-up care arises.

The HHS design challenge has at the very least placed a spotlight on the need for more patient-friendly billing, and that’s no small thing given that 47 percent of consumers are paying more attention to their healthcare bills than they did a year ago. That figure will likely increase as premiums and deductibles continue to soar, hopefully making savvier healthcare shoppers of us all.

Morning Headlines 6/22/16

June 22, 2016 News 2 Comments

McKesson considers IT unit merger with Change Healthcare

Reuters reports that McKesson is considering merging its health IT business unit with Change Healthcare, the former Emdeon.

Healthcare RCM: Trends in Alternative Payment Model Adoption

A Peer60 report explores adoption of alternative payment models, finding that hospitals under 500 beds are far less likely to transition to new payment models than larger organizations.

VA Won’t Use Law That Allows Expedited Firing of Executives

The VA will no longer use its authority to expedite the firing senior executives after the Justice Department ruled the provision unconstitutional because it denies employees the right to appeal their firing.

CancerLinQ—ASCO’s Rapid Learning System to Improve Quality and Personalize Insights

Robert Miller, MD director of the American Society of Clinical Oncology’s CancerLinQ big data project, describes how the platform works and the value it offers front line oncologists.

News 6/22/16

June 21, 2016 News 4 Comments

Top News

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Reuters reports that McKesson is discussing a merger of its Technology Solutions IT business with Change Healthcare (the former Emdeon) as MCK sheds its non-pharmaceutical business lines in trying to prop up its share price, which has dropped 24 percent in the past year.

It’s not likely MCK will get anywhere near the $14.5 billion it massively overpaid for book-cooking HBOC in 1998 since most of HBOC’s original product lines are dead or dying, customers were alienated by the poorly devised and executed Better Health 2020 program in 2011, and there’s not much new to crow about other than RelayHealth. But getting out of the IT business should at least temporarily buy time of the “unlock shareholder value” type.

The industry will once again relearn the oft-told lesson that health IT toe-dippers who earn most of their money in unrelated sectors will always bail out for greener pastures while shafting the customers who believed the lofty predictions and promises made by executives who have long since left for greener pastures themselves. I’ll wait patiently while you ponder your answer to, “Name something amazing McKesson has done in its 18 years in health IT.”


Reader Comments

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From Lou: “Re: LinkedIn recommendation. I left this for you." That made my day – thanks.

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From Able Bodied: “Re: Presence Health (the merger of Resurrection Health and Provena Health). Has decided to go all Epic. Provena uses Meditech. Interesting considering the cost of Epic and that Presence Health bonds have been downgraded by Moody’s to nearly junk status because of poor financial performance and a questionable outlook for the next 18 months. Can you say a merger with a larger system? Word on the street is that they are talking to Ascension.” Unverified. New management at Presence has taken a lot of write-downs, laid off hundreds of people, and had to borrow more than $500 million at the end of May after losing $186 million last year. Resurrection moved from McKesson Horizon to Epic in 2011.


HIStalk Announcements and Requests

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I spent quite a bit of time Monday resolving a hack on my AT&T cell phone account. I called the company immediately after receiving $2,300 in emailed payment updates. A hacker had somehow added himself as an authorized user of my account, bought two iPhones on contract, then paid the contracts off in a Washington Apple store.  AT&T telephone support backed out the charges, but I had to go to the AT&T store to have the SIM card replaced. I also changed my password to a stronger one (I admit that my years-old one was weak) and added a second-level security challenge of a four-digit PIN. It’s interesting that my credit card wasn’t compromised since nobody – including AT&T employees – can see the actual credit card number, only the last four digits, but once you’re in the account you can make purchases using it. I was thankful yet again that I use the magnificent LastPass to manage all my passwords for a princely $12 per year, meaning I log on seamlessly to all sites despite having created strong passwords like my new AT&T one.

My overused word of the week: “seasoned,” a meaningless adjective peppered (pun intended) throughout LinkedIn by executives who describe themselves as such instead of allowing the reader to simply peruse their past experience and decide for themselves. I’m also occasionally annoyed by LinkedIn profiles written in the third person or that don’t contain complete sentences and thus give the appearance of being written by a Godcam-like observer instead of the profile holder, such as, “Proven track record of consistently increasing business performance.” If you want to stand out on LinkedIn, be yourself instead of spitting out inflated, boring bullet lists extolling personal greatness. Also, invest in a professional headshot instead of cropping the grainy image of your head from a family photo (or inexcusably not including a photo at all, suggesting body image issues).

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I received an email link to the HIMSS member survey today and, as happens every year, bailed out after wading through three dense pages of questions with no end in sight. They just can’t seem to understand that (a) the time requirement should be reduced and clearly stated in the email; (b) the survey should show a progress meter; and (c) making every answer required instead of just assuming the don’t know/not applicable choice as the default is annoying. It looks like a survey designed by a committee of people who don’t know much about surveys.

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Mr. Weber (who is a Teach for America teacher) reports that his Hawaii middle schoolers are using the two Chromebooks and assorted supplies we provided in funding his DonorsChoose grant request to dig deeper into math and to perform college readiness work during his advisory time. He adds, “My students were thankful for everything. They wondered who could donate so much to our school without even knowing them. They sincerely appreciated the generosity of strangers, and I think it made them think about ways that they could contribute to society in the future.”


Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Lorre’s getting bored because of the industry slowdown that kicks in every year right about now, so ask her nicely for her “Summer Doldrums Special” that we always run through Labor Day and you’ll get a great deal.


Acquisitions, Funding, Business, and Stock

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Pharmacy restocking software vendor Kit Check raises $15 million in a Series C round, increasing its total to $37 million.

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The New York Times profiles the struggling Oscar Health, a self-proclaimed insurance disruptor that uses technology to offer consumer-friendly policies. The company, which has raised $728 million and is starting a New York health center to deliver care itself, is losing money because:

  • It sells policies only on insurance exchanges, which have enrolled fewer people than expected.
  • It’s getting stuck with sicker patients with expensive pre-existing conditions whose coverage is guaranteed by ACA.
  • All insurers are realizing that they priced their exchange policies too low to break even, although Oscar’s competitors have the advantage of being able to make up their losses elsewhere.

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Philips acquires Northern Ireland-based digital pathology software vendor PathXL.


Sales

The Koble-MN HIE, health data intermediary, and health information organization chooses Orion Health’s Amadeus precision medicine platform.


People

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Release-of-information systems vendor Verisma names Marty McKenna (Allscripts Analytics) as president and CEO.

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Paul Boemer (FIS Healthcare Solutions) joins PatientPay as EVP.


Announcements and Implementations

Denver Health (CO) goes live on Bernoulli’s Nuvon VEGA medical device integration.

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A new Peer60 revenue cycle report finds that about two-thirds of hospitals don’t plan to participate in value-based payment programs, with those under 500 beds being more hesitant to change. They worry about getting stuck with non-compliant patients as competitors cherry-pick the patients that show higher levels of value and thus generate more revenue. Interestingly, the second-most reported expected impact of value-based payment is eliminating IT vendors who can’t demonstrate solid return on investment, with hospitals apparently happy to give them a pass until money gets tight.

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The US Patient and Trademark Office issues Aventura its eighth patent, this one covering how the company’s Sympatica situational awareness platform updates virtual resources and applications based on user location in managing roaming computing sessions.

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Quintiles opens a healthcare technology and apps accelerator in Research Triangle Park, NC, staffing it with simulation analysts, wearables experts, and user interface designers.

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C.L. Brumback Primary Care Clinics (FL) goes live with Forward Health Group’s PopulationManager and The Guideline Advantage.

Scottsdale Institute publishes a report describing the IT challenges involved in creating clinically integrated networks.


Government and Politics

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California auditors find that CalVet, the state’s VA operation, has wasted $28 million since 2007 on a since-cancelled EHR contract for veterans homes. The auditors blame CalVet for poor project oversight. CalVet had decided to replace Meditech because veteran histories could not be viewed across facilities, choosing SolutionsWest Consulting (later Brekken Technology) as a replacement even though it was not Meaningful Use certified.

Medicare finally realizes that its fraud-incenting “pay and chase” practice of paying providers first then asking questions later doesn’t make sense as it tests a program in five fraud-famous states (IL, FL, MI, MA, and TX) in which home care providers will have their claims reviewed in advance before CMS pays for those services. CMS previously found that 60 percent of the home care claims it paid were “improper.”

The VA won’t fast-track executive firings now that the Justice Department has ruled that VA employees have the right to appeal their termination to the Merit Systems Protection Board. Rep. Jeff Miller (R-FL), chair of the House veterans panel, said of the VA’s decision not to use the authority given it by Congress in response to the wait times scandal, “Everyone knows VA isn’t very good at disciplining employees, but this decision calls into question whether department leaders are even interested in doing so."


Other

Oncologist and informaticist Robert Miller, MD, medical director of the American Society of Clinical Oncology’s CancerLinQ cancer big data project, describes how the “learning system for oncology” works. CancerLinQ, built on SAP’s HANA platform, extracts data from oncologist EHRs via several methods and standardizes the information with a terminology rules engine and natural language processing. Doctors can query the identifiable information of their own practice’s patients, while de-identified analytics reports are provided by the CancerLinQ team. CancerLinQ provides real-time practice performance analysis against standard quality measures and gives oncologists observational data to support clinical decisions. The article concludes with an excerpt from a journal editorial:

However, how is an individual clinician to proceed when faced with a patient in the exam room with a rare tumor for which evidence-based clinical practice guidelines do not exist, and the patient is not a candidate for a trial? Or a patient with a common malignancy like breast cancer coexisting with a myelodysplastic syndrome with del[5q]? Or the much more common scenario of a patient with compromised renal function faced with the decision as to the advisability of potentially nephrotoxic, but curative adjuvant chemotherapy? The availability of a powerful tool like, CancerLinQ, that can provide insights into the real world outcomes of similar patients, when combined with existing trial-generated evidence and full patient consent, may be transformative to the practice of the art of medicine in these difficult situations.

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UCSD Health CIO Chris Longhurst, MD, MS tweeted out this photo from the CHIME/AMDIS CMIO Boot Camp, held this past Sunday through Tuesday in Ojai, CA.

A study finds that doctors who accept inexpensive drug company-paid lunches prescribe more of the brand-name drugs the company sells to their Medicare patients. Perhaps the AMA could look into this instead of chasing imaginary “digital snake oil” or maybe CMS should just buy every doctor a fast food lunch to get on their good side about MACRA. My experience with doctors is this: while maybe a fourth of them apply quid pro quo in intentionally returning the drug company favor by altering their prescribing habits, most of them instead simply overestimate their own objectivity and intelligence in being able to distinguish drug company propaganda from rigorous scientific review. In other words, they actually think they were educated rather than sold to. Drug reps love playing to a doctor’s inflated ego in getting them to do their bidding.

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CNBC profiles a former Microsoft designer who was paralyzed by a medical mistake at Overlake Hospital Medical Center (WA). He received a $20 million settlement and a seat at the table as Overlake reviews what went wrong in his case and how systems design work might prevent other errors.

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The 66-year-old bass player of Foghat (“Slow Ride”) is left unable to play music due to the side effects of lung cancer chemotherapy. A 2012 CT scan revealed a lung mass and the suggestion “to exclude the possibility of a primary lung neoplasm,” but he wasn’t notified of the finding and nobody followed up. The tiny growth has since spread, is inoperable, and carries just a 4 percent survival likelihood. He’s suing.


Sponsor Updates

  • AirStrip is featured in an Ultera Digital podcast on health IT marketing.
  • GetWellNetwork Founder and CEO Michael O’Neil is named EY Entrepreneur of the Year for 2016 in the health category in the Mid-Atlantic region.
  • Besler Consulting releases a new podcast, “Healthcare Retrospect Part 1: All Americans Were Uninsured.”
  • Strata Decision Technology receives “Peer Reviewed by HFMA” designation for the second time.
  • Boston Software Systems releases a new podcast, “Migrating Legacy Systems to Epic.”
  • Optimum Healthcare IT hires Larry Kaiser as director of marketing.
  • Impact Advisors publishes a white paper, “Cutover Plan: The Missing Link to a Successful Go-Live.” 
  • Divurgent will exhibit at HFMA’s ANI Conference June 26-29 in Las Vegas.
  • E-MDs will host its annual User Conference & Symposium June 23-25 in Austin, TX.
  • HealthGrid will deliver patient education content from Healthwise via its patient engagement solution.
  • EClinicalWorks will exhibit at 2016 Optometry’s Meeting June 30-July 2 in Boston.
  • Glytec’s Glucommander and EGlycemic Management System are featured in five studies presented at the American Diabetes Association scientific sessions.
  • Greencastle Associate Consulting’s Jim Blanchet earns PMP certification from The Product Management Institute.
  • HCS will exhibit at the Texas Hospital Association Behavioral Health Conference June 23-24 in Austin, 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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Monday Morning Update 6/20/16

June 19, 2016 News 2 Comments

Top News

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A government report estimates that 30,000 US patients die unnecessarily from trauma each year since trauma center death rates vary widely such that “where you are injured my determine whether you survive.” It urges creation of a national trauma system driven by best practices that includes both military and civilian systems and pre-hospital providers such as ambulance services.

The leading cause of death among people under 46 years old is trauma (motor vehicle accidents, gunshots, and falls).

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The report from the National Academies of Sciences, Engineering, and Medicine recommends that trauma centers create real-time access to patient-level data that would also be used in a national quality improvement program.


Reader Comments

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From Former Westminster, CO Employee: “Re: McKesson. I worked on Horizon for 15 years. Upper management refused to listen to QA, support, implementation, and development and would demand that change requests be closed with known software bugs shipped to clients to meet project deadlines. Hospitals would then report the bug, which would be re-opened as a Hot Fix Solution as the cycle repeated. Management was more concerned about running a tight ship and laid off many critical people. Paragon will suffer the same because the management culture has not changed.” Unverified.


HIStalk Announcements and Requests

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Most poll respondents would struggle to pay an unexpected medical bill of $5,000 to $25,000, which is a lot better than the 47 percent of Americans that a federal study found would struggle to pay a $400 emergency bill. New poll to your right or here: do digital tools reduce the efficiency of care delivery as the AMA contends?

Here’s a fun enhancement idea for the new iPhone patient data EHR query: let the app automatically file an HHS data-blocking complaint for unsuccessful requests.

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Mr. Martinez is using the document camera we provided in funding his DonorsChoose grant request to record his live presentations so that students in his California high school classroom can review portions they missed or to keep up when they’re absent. He’s recording additional examples and placing them on his website so that students can follow along on their own time.

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Also checking in is Mrs. Evans from Florida, who says many of her elementary school’s students had never used a tablet until we provided six of them for her gifted class.

Listening: new from Radiohead, slower and more melodic (some might say “wimpier”) than previous masterworks like “OK Computer,” but sometimes you have to let good bands evolve and give their new stuff a multiple-play chance to grow on you.


Last Week’s Most Interesting News

  • Apple adds C-CDA records import capability to iOS 10, giving iPhone-using consumers the theoretical ability to request and capture their basic medical information from provider EHRs.
  • AMA passes a resolution supporting creation of an ONC-administered health IT safety center.
  • Doctors in Australia demand that patient update access to their own medical records be revoked, saying they can’t trust the information.
  • The AMA’s EVP/CEO lashes out at “digital snake oil,” broadly panning the health-related software that is available to doctors and consumers.

Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Lorre’s getting bored because of the industry slowdown that kicks in every year right about now, so ask her nicely for her “Summer Doldrums Special” that we always run through Labor Day and you’ll get a great deal.


Acquisitions, Funding, Business, and Stock

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TransUnion acquires Auditz, which offers point-of-service patient revenue products.

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Cerner shares continue their recent slide, closing at prices not seen since July 2014. Above is the one-year price chart of CERN (blue, down 22 percent) vs. the Nasdaq (red, down 6 percent).


Announcements and Implementations

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LeadingAge Center for Aging Services Technologies creates an EHR adoption model for long-term and post-acute care providers.


Government and Politics

The government of South Australia continues its years-long legal pleading to software vendor Work Systems, whose 1990s-era, DOS-based patient records system is still being used by 64 of South Australia’s health sites. The vendor demands that state government stop using its software since its license for a retired version has expired, but the government argues that forcing it to stop using the system would endanger patients. South Australia is in a bind because its Allscripts-powered EPAS project is behind schedule and over budget with only three sites live amidst widespread doctor protests that the system endangers patients.

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Karen DeSalvo, MD, MPH and her HHS team wore blue to support Men’s Health Week last week.

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An independent analysis finds Healthcare.gov to be the second-most secure consumer website.

The VA engages Underwriters Laboratories to help improve the cybersecurity of its medical devices.


Other

It’s been said that “a true test of a man’s character is what he does when no one is watching,” which is an apt summary of a new study that finds increased rates of hospital hand-washing when clinicians know they are being observed. Easy-to-spot infection prevention nurses saw a 57 percent rate of hand-washing compliance, while less-recognized volunteers saw staff washing their hands when they should only 22 percent of the time.

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An excellent analysis by Arcadia Healthcare Solutions that I hadn’t previously noticed until NPR ran a story on it finds that the cost of care provided to dying patients in their final 30 days varies widely by where they die. Patients who expire in a hospital consume $32,000 worth of services, while those who pass away in nursing homes, hospices, and at home cost $21,000, $18,000, and $5,000 respectively. Saddest of all is that 40 percent of patients died in a hospital, something that few people want. The company offers several interesting dataset visualizations on its site.

I also missed this New York Times op-ed piece from a few weeks back in which a University of Oslo professor pans the idea of a “cancer moonshot,” saying the Catch-22 of cancer is that it can’t be cured and thus keeping people alive longer means they’re more likely to get cancer again. He recalls that President Nixon called for a cancer moonshot of his own in 1971 and the National Cancer Institute has spent $90 billion since then even as cancer rates increased. He concludes that the effort wasn’t wasted, however: “We’re a lot better at fighting cancer. We just can’t cure it,” but warns of “the rhetorical spin that drives the cancer enterprise.” He urges that doctors save lives via the “boring stuff” of getting patients to stop smoking, use sunscreen, eat better, and exercise, saying that will do more good than “promising the moon.”


Sponsor Updates

  • Vital Images will exhibit at SCCT 2016 June 23-26 in Orlando.
  • Zynx Health will exhibit at AMDIS 2016 June 21-24 in Ojai, CA, as will LogicStream.
  • Integris and The Chartis Group will present “Centralized Scheduling for a Physician Enteprise” at the HFMA National Institute June 26-29 in Las Vegas.

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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Morning Headlines 6/17/16

June 16, 2016 News No Comments

Hands-on: Apple brings HL7 CCD health records to HealthKit in iOS 10

iOS 10 includes an enhancement that will let iPhone users to download and store their health records from providers capable of transmitting a CCD.

Navicure Partners with Bain Capital Private Equity to Continue Growth and Expand Healthcare Technology Platform

Navicure receives a strategic investment from Bain Capital Private Equity. Financial terms were not disclosed.

AMA Throws Support Behind Development of a National Health IT Safety Center

AMA house delegates approve a proposal formally supporting the creation of a National Health IT Safety Center.

Doctors want patient control over e-health records revoked

The Australian Medical Association argues that patients should not be able to control what is entered into their personal health records. AMA president Michael Gannon, MD explains, “If patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.”

News 6/17/16

June 16, 2016 News 1 Comment

Top News

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Apple’s iOS 10 will allow users to request copies of their medical records from their smartphones, provided their provider’s EHR can export a Continuity of Care Document. Users can also import records from Safari and Mail. The translated medical summary can be stored directly in Health.


Reader Comments

From Meltoots: “Re: CMS and EHR vendor snake oil. MU was an unmitigated disaster for safety, security, usability, efficiency, and physician burden, yet it continues with a new name. Everyone wants to move away from fee-for-service, yet we have no idea how to attribute quality care from multiple doctors to a single patient. This is a not-so-secret CMS push to put providers into large practices so they can crank down on payments. Providers have had enough.” The other concept at work is that hospitals, which have performed so pitifully and indifferently in coordinating patient care and managing populations, are figuring out how to reap the lion’s share of the money that will be spent to improve it. It’s also interest that just as it’s hard to detect Medicare fraud because providers work under the NPI of other providers in group settings, it’s equally hard to determine using billing data which of them is individually responsible for wise or unwise care decisions.

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From Gray Sky: “Re: Medhost. Has had outages for the past two weeks for all hosted applications. Inside information points to a storage information where customer data has been erased. The company continues to investigate options to restore the data to a reasonable point in time.” I ran this rumor Tuesday with the vendor name omitted pending the company’s response, which Medhost has provided:

Medhost supports software applications in over 1,100 facilities across the United States, Canada, and Puerto Rico. Over the past several weeks we have experienced system outages impacting a total of three hosted facilities. In one instance, the outage was extended for several days. Medhost utilized both system vendors and consultants as well as its internal resources to determine the cause of these outages and to act to prevent any future outages. The extended outage was due to failure of the operating system. Medhost applications were not a contributing factor to this system outage and no customer data was lost. All customer systems have been restored and are working as designed. While we view any outage as unacceptable, we will use this as an opportunity to improve availability and resiliency of the Medhost systems. Medhost Direct historical uptime availability exceeds 99.99 percent, and no hosted facility has experienced an outage of more than 14 hours in over two years.

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From  Credenza Cowboy: “Re: Martha Jefferson’s errant EHR click that mistakenly labeled the patient as deceased. They aren’t live on Epic yet.” I didn’t realize that, although I attended a years-ago Cerner user meeting at which their IT director was present, so maybe they are on Cerner. Either way, it’s an interesting tip-of-the-iceberg type user error that fortunately, in this case anyway, had no clinical impact. Sentara bought the Charlottesville, VA hospital in 2010.

From Pensive Moment: “Re: digital snake oil. Do  you agree with the AMA?” Mostly no. The AMA’s solution to all problems is to put doctors in charge of everything despite their poor track record of following evidence-based guidelines, delivering whole-person health, and serving as patient advocates without bias toward their personal incomes. They have also demonstrated their own snake-oil gullibility in letting drug and medical device companies dictate their clinical behavior via shady but effective sales tactics that sometimes result in sub-optimal or even dangerous medical decisions. You will notice minimal reference to care teams in the AMA’s impassioned stand that, as usual, assumes the “Doctor as God” position in excluding all other clinicians and in pushing AMA’s commercial interests. The AMA is right that many apps (especially the consumer-facing ones) are of questionable value and that doctors have been shafted in being expected to document everything for the benefit of bureaucrats. They’re also correct that much of what doctors don’t like was handed down to them from insurance companies and the government (whose checks they don’t mind cashing, however, as evidenced by their continued participation). The AMA’s bloviating is what you get when each clinical profession has its own membership organization looking out for the interests of its dues payers while claiming to represent patients who are – along with the 80 percent or so of US doctors who aren’t AMA members, including a bunch who quit after AMA endorsed passage of the Affordable Care Act — invariably absent from its proceedings. All of the solutions offered by the AMA for “digital dystophia” involve AMA-led products and services, so from now on, let’s blame them.

From Limelight Seeker: “Re: our event. Please promote the upcoming tweetchat, webinar, or video I’m involved with.” I will say only this: quite a few overexposed pontificators — especially social media self-gratifiers and cheap-seats observers — are short on credentials to be educating the rest of us. My accomplishment-driven twit filter is powered by LinkedIn.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Catalyst Healthcare Advisors. The eight-year-old company offers consulting services in strategy, finance, operations, and technology (IT strategy, system selection, contract negotiation, and system implementation, optimization, and integration). The company led Yale-New Haven’s expense reduction project in helping the health system save $350 million annually. Among its other 200 clients are Baylor, Indiana University Health, Community Health Network, and Good Samaritan Hospital. You may know founder and CEO Steve Furry, who has been in healthcare consulting for 35 years, and senior advisor Parker Hinshaw, who founded maxIT. The company just announced the hiring of two new sales executives covering the West and Midwest. Thanks to Catalyst Healthcare Advisors for supporting HIStalk.

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Ms. Marlowe says her North Carolina kindergarten class is benefitting greatly from the Chromebook we provided in funding her DonorsChoose grant request, with the students specifically enjoying listening to stories online.

Listening: reader-recommended Richmond-based singer-songwriter Lucy Dacus, an up-and-comer who sings thoughtful and warm indie folk music that reminders the reader of the magnificent Cowboy Junkies and me of Kristin Hersh of Throwing Muses

This week on HIStalk Practice: CMS announces $10 million in grants to help practices transition to new payment models. Midwest Orthopaedic Consultants goes with care coordination tech from PinpointCare. AMA adopts long-awaited ethical guidelines for telemedicine practice. CureMD adds Izenda business intelligence tool to its PM software. Emergency Care Specialists launches joint venture with Answer Health Telemedicine. Facebook develops suicide prevention tools and protocols. Culbert Healthcare Solutions VP Randy Jones equates revenue cycle KPIs to “the ritual of the snipe hunt.”


Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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


Acquisitions, Funding, Business, and Stock

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As I mentioned in an update to Monday night’s post following a response to my inquiry to Navicure, Bain Capital Private Equity makes an unstated strategic investment (presumably taking a majority interest that meets the definition of an acquisition) in the company. Among the sellers is JMI Equity, which took a minority position in Navicure in 2009. JMI bears the initials of John Moores Inc., whose other accomplishments (beyond being an IBM programmer) include founding BMC Software, serving as lead financier of Peregrine Systems and ServiceNow, and formerly owning of the San Diego Padres.


Sales

The soon-to-open Sacred Oak Medical Center (TX) chooses Medsphere’s OpenVista EHR.

In Scotland, NHS Fife chooses InterSystems TrakCare, the twelfth Scottish Health Board to do so. 


People

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Clinical rules modeling vendor Applied Pathways hires Steve Lefar (Sg2) as CEO. Founder and CEO John Feldman will continue as board chair.

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Madhu Sasidhar, MD (Cleveland Clinic) joins consumer engagement platform vendor Envera Health as CMIO.


Announcements and Implementations

Congratulations to the HIStalk sponsors who took 40 spots in the 2016 HCI 100:

The local paper notes that FHN Memorial Hospital (IL) is testing Meditech 6.1 in its $8 million OurFHN project, expecting an October go-live.


Government and Politics

The American Medical Association approves a policy supporting the creating of an ONC-administered National Health IT Safety Center. The policy proposal was submitted by Matt Murray, MD, chair of the Texas Medical Association’s IT committee, driven in part by work done by Texas-based health IT researchers Dean Sittig, PhD and Hardeep Singh, MD, MPH.

The US Supreme Court rules that the VA must always give exclusive preference to veteran-owned small businesses when issuing contracts, overriding the VA’s argument that it is only required to meet specific annual contracting goals. The court says the VA must show preference to veteran-owned bidders as long as the competition meets the Rule of Two (at least two bidders are expected to submit offers and the amount of those bids is expected to be reasonable).

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New York’s attorney general forces legal website Law360 to stop requiring employees to sign non-compete agreements unless the employee has insider knowledge of trade secrets. Law360’s terms required all employees, even those fresh out of college, to sit out a year before taking another job in the same industry. The attorney general of Illinois is also upset that the non-compete clause in the employment agreement of sandwich chain Jimmy John’s prohibits employees from taking a job with another sub sandwich company for two years after quitting.


Privacy and Security

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A former IT employee sues Aspen Valley Hospital (CO) and its privacy officer, claiming that the hospital’s HR director/privacy officer disclosed the employee’s HIV status over cocktails with the hospital’s HR recruiter at a conference after noting a large medical claim for his antiviral medications. The employee filed a complaint with the hospital and then HHS as a HIPAA violation, after which he says he was disciplined, demoted, and then fired after 11 years at the hospital.


Other

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The Australian Medical Association calls for the capability of patients to manage their own medical records to be removed, saying that doctors don’t participate in the national My Health Record data-sharing program because they can’t rely on patient-provided information. The AMA wants patients locked out of making changes to core set of database elements that includes the meds list, allergies, discharge summaries, pathology and imaging results, weight, height, blood pressure, and advance directives. They also want eventual restriction of patient changes to ECG results, blood type, vaccination history, infectious disease status, surgery history, and even the patient’s chosen emergency contact. The AMA says the changes will increase trust and therefore physician usage of the system, which is nearly non-existent.

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A Nielsen survey finds that 89 percent of PCPs claim they often remind patients about preventive screenings, but only 14 percent of patients say they receive them. Only 5 percent of the two-thirds of Americans who are overweight say their doctors suggested a weight loss program. Half of patients aren’t seeing doctors who can view their history via an EHR. Only one in four patients can contact their doctor by email or patient portal question submission, with older people more likely to avoid use of available technology.

This has a small amount of health IT relevance: the mold-breaking YouTube teen vlog series “lonelygirl15” is being re-launched after 10 years by its creators, which include Miles Beckett, MD, CEO of electronic credentialing vendor Silversheet. I interviewed him in April 2016.

Theranos CEO Elizabeth Holmes will present at the American Association for Clinical Chemistry’s annual conference in August, with her submitted abstract suggesting that her talk will be long on defensive self-promotion and short on offering the definitive clinical validation data that scientists long to see. I’m not clear about why a college dropout should be presenting at a clinical conference or why the education committee would accept a presentation titled “Theranos Science & Technology: the miniaturization of lab testing,” but it will probably be an overflow session. I will be disappointed if the attendees don’t boo her off the stage.

In China, a hospital janitor is arrested hiring friends to direct out-of-towners looking for the hospital to a specific room he had rented inside it, where he delivered ineffective but expensive treatments. The health department has closed the hospital as a result. That type of scam is common in China, where hospitals routinely rent out rooms to anyone willing to pay.


Sponsor Updates

  • InstaMed releases its annual report on trends in healthcare payments.
  • InterSystems, Intelligent Medical Objects, and Meditech will exhibit at AMDIS 2016 June 21-24 in Ojai, CA.
  • Liaison Technologies wins a Stevie Award for Favorite New Product from the American Business Awards.
  • Visage Imaging validates the interoperability capabilities of its Visage 7 Enterprise Imaging Platform at the IHE Connectathon 2016 held in Bochum, Germany.
  • MedData will host a job fair June 22 in Grand Rapids, MI.
  • The HIMSS SIIM Enterprise Imagine Workgroup publishes its second white paper.
  • Validic and Omnicom Health Group will partner to counsel healthcare companies on connected health.
  • Netsmart will exhibit at the Washington Behavioral Health Conference June 22 in Yakima, WA.
  • Nordic receives RightSourcing’s Gold Supplier Award.
  • Qpid Health and Streamline Health will exhibit at AMDIS 2016 June 21-24 in Ojai, CA.
  • The latest KLAS report ranks Sagacious Consultants as the highest-rated firm for revenue-cycle optimization.

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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News 6/15/16

June 14, 2016 News 5 Comments

Top News

American Medical Association EVP/CEO James Madara, MD, speaking at the organization’s annual meeting, lashes out at “digital snake oil” of clinically unproven software and technology products that “impede care, confuse patients, and waste our time,” adding that “interoperability remains a dream.” He says doctors – who mistakenly failed to participate in early digital health projects – need to separate the lame digital tools from the potentially magnificent ones, explaining the present state of “digital dystopia” as:

Direct-to-consumer digital health devices—which only in the fine print say ‘for entertainment purposes only’—to our clunky electronic records, to ICUs that sound like primitive swamps abuzz with a cacophony of  bells, alarms, and whistles.

However, many of the solutions that Madara offers involve products from which AMA benefits – an incubator, an innovation studio, and lobbying efforts.

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Meanwhile, John Halamka takes the counterpoint to the “digital snake oil” label, saying that more study rather than politician-like hyperbole is needed to understand that “we’ve achieved exactly the results we designed” in striving to simply replace paper charts with their electronic counterparts and to meet various government mandates. He provides examples in interoperability (e-prescribing, public health reporting, and lab reporting); population health (EHR patient panel queries); and consumer engagement (patient portals), all of which laid the foundation for the next generation of tools that will support team-based workflow, lifetime encounter records, care management workflow support, and family engagement tools. Halamka repeats the same advice he offered for Meaningful Use: focus on a small number of achievable outcomes.


Reader Comments

From Pomp and Circumstance: “Re: vendor press releases. Healthcare institutions are increasingly forbidding them to distribute press releases announcing new sales or contracts. This may distort the perception of success of companies that are compliant with the wishes of their customers.” It’s tough for a vendor to tout their successes when the client asks them not to, going beyond just not naming the client specifically, but prohibiting the sale from being mentioned at all. That practice prevents some much-need visibility into who’s buying what, but I agree that there’s no value to the new customer unless the sale can be crafted into a more self-serving announcement.

From Sticky Wicket: “Re: innovation award winners. You didn’t list those from the attached announcement.” I don’t consider press releases of these types worth mentioning since the average health system CIO would have minimal interest in companies whose enterprise readiness is years away at best even if they manage to avoid being among the 95 percent that will never be successful. Thus I’ve stopped running announcements of the following types, preferring to wait for actual customer success:

  • Company funding under $1 million.
  • New accelerators forming or companies joining an accelerator.
  • Tiny companies winning an app contest or submitting an innovative idea.
  • Startups offering a new consumer-facing health app whose outcomes have not been studied.

From Duluth: “Re: Navicure. Sold to Bain.” Unverified. I’ve reached out to the company for a response but haven’t heard back. UPDATE: Navicure confirms that it will receive an undisclosed strategic investment from Bain Capital Private Equity. Founder and CEO Jim Denny and the executive team will remain with the company.

From Gray Sky: “Re: [vendor name omitted]. Has had outages for the past two weeks for all hosted applications. Inside information points to a storage information where customer data has been erased. The company continues to investigate options to restore the data to a reasonable point in time.” Unverified. A company spokesperson responded quickly after hours and is trying to reach one of its executives for a response, so I offered to withhold the company’s name until my next post, which will also include any response the company provides.

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From DOSsier: “Re: US Department of State. Issued an RFI for an off-the-shelf EHR for diplomatic missions.” The RFI is here, but note that it covers EHR implementation project management services only – it’s not a RFI for an actual EHR. The original plan was for the Department of State to share the Coast Guard’s Epic system, but the Coast Guard has backed away from that project. Before that, the DoS was planning to roll out the DoD’s AHLTA, so perhaps this RFI involves the DoD’s Cerner rollout. I don’t know the source of the DoS’s existing eMED system. The RFI was posted June 3 with a two-week response date.

From Pickle Entry: “Re: ACA insurance. UnitedHealth Group is pulling out of the exchange in my state. I’ve had to change insurance companies every year since Obamacare was rolled out, paying multiples of the premium prices I paid before the ACA.” The administration touts decreasing levels of uninsured citizens. That’s good, but those newly insured people are spending a lot of insurance company money catching up on their deferred health needs while young, healthy citizens are going without insurance because they are unlikely to get a payback. You can’t blame insurance companies who are stuck with a money-losing risk pool of self-selected patients when they stem their financial bleeding by exercising the only option the government gives them – shutting down their exchange plans. You are fine if you have employer-provided insurance, have a low enough income to qualify for endless government insurance subsidies, are old enough for Medicare, have few assets and therefore little financial exposure to expensive uninsured services, or are rich enough to not care. Otherwise, you’re paying more to keep the insurance-funded profits flowing to providers, drug companies, and the endless bureaucracy of middlemen who make up most of the US healthcare non-system and who are happy that ACA gave them newly insured patients to bill without touching the real problems of unjustified prices, fraud, and the financial incentive to create overutilization.

From Dan Blocker: “Re: data blocking. John Halamka says he’s never seen it. I say he needs to look harder.” Lots of people (including ONC) claim  that providers and EHR vendors intentionally block the flow of patient information, but nobody is serving up real-life examples instead of poorly sourced anecdotes. Such proof can only come from patient complaints and those are rare because: (a) patients don’t know that their interoperability expectations should be higher; (b) the moment of need is when they are unwell; and (c) they don’t have the information or incentive to figure out who to complain to. I bet that if you asked 100 people who were in the process of being seen as inpatients or outpatients to ask those providers to retrieve their history from other providers, nearly all of them would be unsuccessful, but turning that into a data blocking complaint against either of the providers or their respective EHR vendors would require a lot of investigatory legwork. Most of what’s wrong with healthcare is due to indifference or ineptitude, not carefully planned evildoing.


HIStalk Announcements and Requests

Listening: reader-recommended Fantastic Negrito, raw Delta blues from the Oakland,CA solo artist who describes his music as “uncut realness and zero concern for pop anything” and whose background is uplifting. Mark my words: all things (especially musical ones) must pass and eventually audiences will tire of shimmery musical junk food crafted by false-prophet celebrity musicians who possess no life experience and whose primary musical instrument is Auto-Tune. 

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Ms. Westover says students in her inaugural high school microbiology course in Georgia are making good use of the lab supplies we provided in funding her DonorsChoose grant request, examining bacteria and analyzing water samples in discovering “a whole new microscopic world.” 


Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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


Acquisitions, Funding, Business, and Stock

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Hearst acquires a majority stake in MedHOK, which offers health plan software including case management, utilization management, and medication management. MedHOK will be incorporated into Hearst Health, which includes First Databank, Zynx Health, MCG, and Homecare Homebase.

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A federal court dismisses the patent infringement lawsuit brought by telehealth provider American Well against competitor Teladoc, with the court finding that American Well’s patent is too abstract to be enforceable. Teladoc asked the patent office to invalidate American Well’s patients in 2015, after which American Well sued Teladoc just before Teladoc’s IPO. American Well will of course appeal. TDOC shares have dropped 33 percent in the year since its IPO.

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Hospital medical device spend management software vendor Procured Health raises $10 million in new funding. The Chicago-based company had raised $5.1 million, with its most recent round being completed in March 2014 with little news since. 

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Sunquest acquires patient flow technology from The Royal Liverpool and Broadgreen University Hospitals NHS Trust, which it will market to customers of its Integrated Clinical Environment. 

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Patient access and RCM services vendor MedData will acquire RCM services vendor Cardon Outreach for $400 million.

Microsoft inexplicably pays $26.2 billion to buy LinkedIn in its biggest acquisition ever. Microsoft always seems desperate to grab onto whatever is trendy at the moment, wildly overpaying to acquire companies with higher growth potential that it then runs into the ground in repeated and easily predicted examples of failed synergy. MSFT is paying a 50 percent premium to the share price of LinkedIn, whose luster has faded as its revenue stalled and the platform keeps finding new ways to annoy its users in between their rare bursts of job-seeking and self-promotional activities.


Sales

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Manati Medical Center (PR) and Mayaguez Medical Center (PR) choose Meditech 6.1, raising the company’s Puerto Rico hospital count to 21. 

Tampa General Hospital (FL) selects records aggregation and referrals management tools from EHealth Technologies.

Mainstreet Health will implement the HealthMedx Vision EHR for its transitional care facilities.


People

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Justin Barnes (Justin Barnes Advisors) is named partner and chief growth officer of IHealth.

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Extension Healthcare hires Ben Kanter, MD (Sotera Wireless) as CMIO.

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Eric Kretzer (Strata Decision Technology) joins SA Ignite as SVP of products.


Announcements and Implementations

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Boone Hospital Center (MO) lays off 26 transcriptionists following the decision by parent company BJC HealthCare to outsource transcription services to Madison, WI-based Amphion Medical Solutions, which was acquired by Atlanta-based IMedX in January 2016. 

The American Medical Association adopts ethical standards for telehealth and telemedicine at its annual meeting, noting that technology doesn’t change the ethical requirements for physicians to place the patient’s interests first. The guidelines also urges physicians to be cautious in making treatment decisions based on the limited information available in a telemedicine session and suggests that care coordination is essential.


Government and Politics

The SEIU healthcare employee union tries again to convince California to cap total hospital CEO compensation at $450,000, the same salary earned by the President.


Technology

Microsoft’s new XBox console eliminates the dedicated port for its Kinect motion-based controller, leading to speculation that Kinect is being phased out. Kinect is used by several innovative healthcare applications for pain assessment, physical rehabilitation, and patient-provider communication. My speculation would be that Kinect turned out to be less interesting (and less profitable) for consumer use but it will continue with a non-gamer focus.


Other

The former chief nursing officer of Sonoma West Medical Center (CA) sues the hospital and one of its board members, claiming she was fired after raising concerns about problems with the hospital’s new clinical software that was developed by the board member’s company. She says the hospital allowed the board member to use its patients as his EHR guinea pigs because he has donated $9 million to keep the previously closed hospital afloat, with the resulting buggy product mixing up patient records, providing incorrect medication information, and failing to display the code status of patients. The software in question appears to be from E-Health Records International, which claims that its tablet-based HarmoniMD hospital EHR can be brought live in single day. Its only users appear to be Sonoma West and a single hospital in Africa.

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A Commonwealth Fund-sponsored study finds that only 30 percent of behavioral health providers use EHRs, recommending that SNOMED and LOINC terminology be enhanced to address behavioral needs, incorporating IT costs in setting bundled payment policies, adding behavioral-specific clinical decision support and interoperability capabilities to existing EHRs, and requiring EHR vendors to beef up their security capabilities.

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A Peer60 report on payers finds that BCBS and Medicare are the ambulatory provider favorites by far, with UnitedHealthcare trailing the pack. Providers like payers that get them paid more quickly with minimal staff involvement, while their least-favorite attributes are time-wasting practices, denials, and poor customer service.

CMS Acting Administrator Andy Slavitt commits at the AMA conference that CMS will simplify its processes, involve physicians in decisions that affect them, focus on patients, support small physician practices, and make “healthcare technology a tool, not an industry.” Some snippets:

Off-the-shelf tools like Certified EHRs and clinical data registries can provide complete capabilities [for quality reporting], but other options exist as well, including most types of reporting that a physician is doing today. If CMS can get data automatically or through another source, we will do so … [CMS will focus on] putting more pressure on technology vendors and less burden on physicians, so physicians can do simple things like track referrals when a patient sees another specialist or visits a hospital … It’s also time to ask a lot more of the technology and technology vendors. This is particularly true in the area of what many call interoperability … the burden needs to be on the technology, not the user. EHR vendors and hospitals that use them will now be required to open their APIs so data can move in and out of an application safely and securely. This will also serve to help eliminate the ‘desktop lock’ that occurred based on early EHR decisions by allowing technology to more easily plug and play. Today’s data silos are more a function of business practices than technology capability and we cannot tolerate it any longer.

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Here’s a textbook example of how to write a bad press release. The boring headline contains glaring spelling and capitalization errors, oddly uses the past tense, and reeks of company self-importance in providing a “news item” that would interest no one except the unfortunate author who was charged with getting some company buzz out there despite a lack of buzzworthy events. It randomly capitalizes job titles and other words that are not proper nouns (“EHR Systems”) and uses awkward phrasing that suggests it was crafted by someone whose mother tongue is not English. My mom’s advice remains valid: if you don’t have anything good to say, don’t say anything.

A Virginia hospital blames a misplaced EHR click for sending a sympathy card to the family of a patient who was in fact still alive. Sentara Martha Jefferson Hospital says someone clicked “deceased” instead of “discharged to home” in Epic, triggering the obviously automated condolences. At least the errant checkbox entry didn’t create a medical error that actually killed the patient.

Athenahealth’s Jonathan Bush provides an impassioned video reaction to news that TV host John Oliver formed a fake debt collection company, bought $15 million in overdue medical accounts receivable for $60,000 cash, and then told those patients that he was forgiving their debt. I assume that buying debt at less than a penny on the dollar means it was uncollectible anyway, so it wasn’t really much of a gift.

The Minneapolis newspaper covers the problem in which patient advance directives are not easily located in EHRs. It cites a study in which less than one-third of ED doctors were confident that they could find patient preferences for resuscitation, feeding tubes, or ventilators.

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Eastern Maine Healthcare System (ME) offers voluntary early retirement to 43 of the 300 employees in its IT department, which is running $3 million over budget.

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The American Diabetes Association is embarrassed when it allows a drug company to present new, sensitive research data to thousands of doctors attending one of its conferences, warning them to hold the information for one hour until the public announcement and the inevitable stock market reaction. The itchy Twitter finger doctors were already blasting out photos of the presentation’s title slide even before the presentation began, after which they tweeted out the presentation’s data slides and charts despite pleas from the ADA to remove them. Novo Nordisk shares dropped 5.6 percent on the modestly positive news.

Here’s the final physician practice vendor overview from Vince and Elise, which includes tips for product selection.

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Weird News Andy loves good customer support even if it comes from sophisticated ransomware hackers who now provide live-chat operators to walk victims through the payment process in an effort to differentiate themselves professionally by improving usability. WNA suggests the hacker’s customer support agent be prepared to answer questions such as:

  • How do I buy bitcoins?
  • How do I know you will actually unlock all our data?
  • Do you provide training on how not to click suspicious links?
  • How’s the weather in Romania?

Sponsor Updates

  • Impact Advisors is named as  one of the 500 largest technology integrators in North America.
  • AirWatch announces updates to AirWatch 8.4.
  • Bernoulli CNO Jeanne Venella is featured on RN FM Radio.
  • Carevive Systems will host a tweet chat on the oncology care model on June 21.
  • Cumberland Consulting Group will exhibit at AHIP June 15-17 in Las Vegas.
  • Fast Company features CTG Technical Recruiter Kate Orngard in an article on recruiters.
  • Extension Healthcare will exhibit at the ONL Annual Conference June 16-17 in Newport, RI.
  • FormFast publishes an infographic on the real cost of paper-based informed consent processes.
  • Healthfinch will exhibit at the AMDIS Annual Physician Symposium June 21 in Ojai, 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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Curbside Consult with Dr. Jayne 6/13/16

June 13, 2016 News 4 Comments

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I spent 38 of the last 72 hours seeing patients. Even the full-time physicians in my practice don’t usually work that much in a short stretch, so I’m not surprised that I found it exhausting. Normally, I find our EHR tolerable, but there were times in the last several days where it was unbearable. I experienced instability like I haven’t experienced since being a beta client for another vendor several years ago. I seemed to find more errors in the physician workflow than my co-workers found in the support staff workflows, and I could feel my attention drifting because I was becoming increasingly annoyed.

At one point, I was managing multiple high-acuity patients when I encountered a string of error messages. The one above nearly put me over the edge. End users should never see error messages like the one above. It’s insulting to the users and, although I’m sure it might mean something to a developer, it doesn’t mean anything to a customer who is trying to care for patients. It’s enough to make one want to wish for even more federal regulations – but only if they require vendors to provide mechanisms for graceful error handling.

As an EHR user, I sometimes feel like I’m a research subject in an experiment that hasn’t been approved by any kind of institutional review board. Everyone thinks that Certified EHR Technology is going to make our world a better place but the jury is still out on whether it’s going to truly be effective. And while we as physicians are having to cope with arduous workflows as a result of the regulations, there are advancements that would really benefit us that remain unaddressed.

Over the last decade, I’ve accumulated a wish list of product “enhancements” that would benefit the people in the trenches. Years later, though, they’re mostly unaddressed:

  • The NCPDP standard for electronic prescribing limits the “SIG” or prescription instructions field to 140 characters. I’ve been told for years that this will be addressed in a future version of the SCRIPT standard, but it remains unaddressed in any production system I’ve ever used. Physicians who have tried to prescribe triptans or other medications that require unstructured SIGs know exactly what I’m talking about. I bet 140 characters made sense at some point, but it’s time for a change. If we can regulate the picklist selections available for marital status, certainly we can regulate this.
  • Standardized lab ordering mechanisms are lacking. One major national reference lab supports electronic directory of services (eDOS) formatting but another doesn’t. This leads to a hodge-podge of strategies for EHR vendors who are trying to manage multiple lab compendia. Some use third parties to try to keep it straight, and others push the work onto the clients. This can result in thousands of physician offices trying to stay in sync with their reference labs, often with a lot of manual work. If we can regulate the use of CPT for lab charges, certainly we can regulate this. (I have to admit that I got a kick out of this reference on eDOS that mentioned that “MU3 proposed rules are anticipated to be published in January 2014 with final rule anticipated to be published in summer 2014.)
  • Requirements for lab vendors and the way they deliver results is lacking. Although physicians are required to use LOINC codes for results to meet various quality measures requirements, there is no requirement that lab vendors send LOINC codes with their results. I’m working with a handful of clients right now who are having to do manual recoding to attach LOINC codes to their results, so that they don’t get dinged on their quality reports. If we can regulate the use of SNOMED, certainly we can regulate this.
  • Interoperability remains elusive. Even when systems communicate, the mechanisms used to reconcile data from disparate systems can be clunky at best and downright unsafe in certain situations. Although some vendors have robust algorithms to identify potential matches and bring data seamlessly into the patient chart, others deliver a greater cognitive load than I experienced in my third semester calculus class. If we can regulative giving lip service to usability through user-centered design, certainly we can make it a reality.

Unfortunately, my list is growing longer rather than getting shorter. We’re forced to gather loads of information that could be put to good use but isn’t. For example, we collect information on race, ethnicity, religious preference, language preference, sexual orientation, and more. In many cases, it’s not used to further clinical care. It would have been great to have a prompt to ask about religious fasting the other night when I was treating a patient with profound dehydration. Although it occurred to me to ask, it didn’t occur to my patient care technician or to the resident I was supervising.

My state doesn’t have a usable database for identifying potential abuse of controlled substances. That’s not a vendor problem but a failure by our legislators to ensure that what they legislated was actually delivered as promised. It’s sad, because I could benefit from that kind of technology every single day. Other states have had it for years but here I am, calling around to try to confirm my suspicions when I’m concerned about a patient.

I know the industry is going through growing pains. There is a tremendous amount of external pressure and we’re trying to use technology to solve the broader healthcare problem rather than addressing the root causes. We can’t expect that to be easy, and I’m hoping we’ll look back on these times someday and chuckle at our relative naivety. Of course, there’s always the chance we’ll look back on these times fondly, because things will have gotten worse. Let’s hope that doesn’t come to pass.

For now, I’d settle for some friendlier error messages. I’d take “I’m sorry Doctor, I’m afraid I can’t do that” rather than hearing about unhandled exceptions or missing widgets. What’s your most annoying error message? Email me.

Email Dr. Jayne

Monday Morning Update 6/13/16

June 12, 2016 News No Comments

Top News

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In light of voided test results and potential CMS sanctions, Walgreens ends its relationship with Theranos, closing all 40 of its Theranos Wellness Centers in Arizona. Walgreens will redirect lab testing to third-party companies or to the certified Theranos lab in Phoenix.


Webinar

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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


Last Week’s Most Interesting News

  • McKesson may sell its health IT business unit to focus efforts on its core drug distribution business.
  • Vice President Biden announces formation of the Genomic Data Commons, an open-access cancer database that will help researchers collaborate and share information, as part of the administration’s Cancer Moonshot.
  • Theranos says that less than one percent of its blood test results have been voided or corrected, a clarification on earlier reports that it would need to cancel or amend tens of thousands of results.
  • Practice Fusion settles FTC charges that it misled consumers by soliciting reviews for their doctors without disclosing that the information would be publicly posted on the Internet, leading to patients unknowingly publishing their own sensitive patient information.
  • The House passes the Helping Hospitals Improve Patient Care Act, exempting ambulatory surgical centers from MU and MIPS penalties.

Privacy and Security

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UC San Diego (CA) halts plans to post physician reviews and star ratings on its website after realizing the surveys it sent to patients didn’t disclose that their comments could go public, potentially revealing their identities. The two-hospital system has postponed launching the reviews to redistribute surveys with appropriate disclosure language. While one healthcare executive believes the decision is based on physician pushback in the face of potentially damaging reviews, Practice Fusion’s recent settlement with the FTC over a similar situation lends UCSD’s decision some merit.

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Twitter locks accounts and issues password resets after reports surface that 32 million passwords were leaked on the dark web. The company denies that its servers were hacked, instead attributing the leak to “combining information from other recent breaches, malware on victim machines that are stealing passwords for all sites, or a combination of both.”


People

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The University of Iowa Health Alliance promotes Jennifer Vermeer to CEO.


Innovation and Research

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A survey of 750 insured consumers reveals that they aren’t shopping around for healthcare services as much as industry insiders seem to hope they will. Just 30 percent of health plan members comparison shop, and only 30 percent of plans offer comparison-shopping tools. While 42 percent of those surveyed ranked such tools as “very important,” it’s hard to believe that importance would translate to more savvy shopping when a similar percentage believe the "cost is covered by my health plan, so it doesn’t matter."

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NewYork-Presbyterian Hospital concludes its 10-week long InnovateNYP Pediatric App Challenge, awarding $40,000 to three finalists:

  • FhirStarters pediatric medication administration app, developed by Riley McKenna and Anees Merzi.
  • Teen Screen mental health screening and resource app, developed by Vikas Mandadi.
  • NYP Care Companion patient engagement app, developed by Ekaterina Chernetsova, Roman Makhnenko, Andrew Gluschenko, Dan Piekarz, Alexander Demura, Margarita Olshanskaya, Egor Kobelev, and Allan Wellenstein.

Government and Politics

Illinois-based Boyd Memorial Hospital, HSHS Holy Family Hospital, and Hillsboro Area Hospital will share a $155,000 USDA Learning and Telemedicine grant to expand stroke treatment, neonatal, and pediatric telemedicine programs.


Other

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Stan Larkin lives for 17 months without a heart by wearing a SynCardia Freedom Portable Driver. Powered by compressed air and worn in a backpack, the artificial heart allowed the 25 year-old – the first patient in Michigan to use the device – to live until he received a successful heart transplant in May.

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South Australia Health hopes to hire a spin doctor for a six-month stint to convince the public that its highly criticized Enterprise Patient Administration System is worthwhile. The electronic records system is years behind schedule and over budget by over $200 million. Hospital physicians have formally complained that the system cut clinical activity by 50 percent, and have written a letter listing 37 major flaws and pleading for it to be shut down. SA Health named Allscripts as vendor of choice for the 80-hospital, $225 million project in November 2010 and signed the contract a year later.

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The local paper looks at the hard time physicians often having locating end-of-life directives within EHRs, attributing the problem to a lack of training and/or intuitive field within the EHR. It holds up Gundersen Lutheran Medical Center (WI) as a forward-thinking organization when it comes to advance care planning documents. The hospital made digitizing such documents a priority when it implemented Epic in 2008.


Sponsor Updates

  • Valence Health makes the top 20 of Fastest Growing Companies in 2016 by Crain’s Chicago Business.
  • Verisk Health and ZeOmega will exhibit at AHIP June 15-17 in Las Vegas.
  • Huron Consulting Group will exhibit at Vital 2016 June 15-17 in Boston.
  • Zynx Health will exhibit at the Nurse and Home Care Forum June 15-17 in Foxborough, MA.
  • Black Book names E-MDs the top ambulatory EHR for thoracic and vascular surgery specialties.
  • The Chartis Group Director Jody Cervenak co-authors a chapter in the new second edition of the Oxford Textbook of Critical Care.
  • PokitDok attains Microsoft certification and is inducted into the Microsoft Azure Marketplace.

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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News 6/10/16

June 9, 2016 News No Comments

Top News

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Practice Fusion settles with the FTC over charges that it misled consumers by asking for reviews of their physicians without adequately disclosing that those reviews would be posted publicly online. The reviews were published in 2012 as part of the company’s efforts to develop a public-facing healthcare provider directory. “Practice Fusion’s actions led consumers to share incredibly sensitive health information without realizing it would be made public,” says FTC Bureau of Consumer Protection Director Jessica Rich. “Companies that collect personal health information must be clear about how they will use it – especially before posting such information publicly on the Internet.” The settlement, which seems to carry no fine, prompted the FTC to publish six privacy pointers, with perhaps the most relevant being, “Disclosures should reach out and grab consumers,” and “Don’t bury key facts in a hard-to-understand privacy policy.”


Reader Comments

From EMR Expert: “Re: Financial trouble in the Middle East. Like many other vendors in various sectors, Cerner, Epic and InterSystems are having tough times collecting their money from existing clients. One of the executives of those companies stated that their Accounts Receivables of the value of more than $15 million is overdue by more than six months. Support contracts are not being renewed and payments for implementation are not honored. It is a catch 22 situation when all their clients were oil rich and now cash strapped governments/government entities.”


HIStalk Announcements and Requests

This week on HIStalk Practice: AMN Healthcare acquires Peak Health Solutions. CancerLinq announces new collaboration and practice sign-up milestones. North Carolina Medicaid reform will include the development of a statewide HIE. South Carolina lawmakers pass telemedicine-friendly legislation. SingleCare partners with American Well. Closed-door meetings in Texas could lead to more telemedicine-friendly legislation. Medfx and Falcon Physician develop software for nephrology practices. FastMed Urgent Care rolls out TouchCare telemedicine services at 57 clinics. Tandigm Health Medical Director Leslie Saltzman, DO shares the hurdles physician groups face when implementing telemedicine tech.


Webinars

June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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


Acquisitions, Funding, Business, and Stock

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Xerox launches Virtual Health Solutions, a new service line that will offer providers telemedicine consulting, interface design and development, and virtual clinic services.

Connecture, a technology company that builds online health insurance marketplaces, acquires ConnectedHealth, a benefits technology platform that helps employers chose health plans. Financial terms were not disclosed.

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Southcoast Health (MA) reports that its $100 million Epic implementation boosted the local economy by $3 million, mainly through hotel room costs, car rentals, gas, and dining. Nearly a third of the health system’s budget for the project went to costs associated with expenses for Epic staff and consultants.

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Martin Shkreli jeeringly pleads not guilty to an updated indictment – one that adds a new conspiracy charge to original December allegations that he illegally took stock from a biotechnology firm he launched in 2011 and was fired from three years later. Not surprisingly, the “habitually unavoidable-for-comment Shkreli unloaded as he spoke to customers at a Manhattan Dunkin’ Donuts outlet while live-streaming on Periscope.” In related (and absurd) news, Shkreli blocks presumably reputable reporters from his Twitter stream, and lauds an upcoming satirical musical about his purchase of a $2 million single-copy Wu-Tang Clan album. It will no doubt give Hamilton a run for its money.


Announcements and Implementations

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Radiology Associates of Macon (GA) extends its RCM agreement with Zotec Partners.

Meditech develops a sepsis management toolkit for select EHR customers.

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St. Vincent’s Medical Center (CT) rolls out telemedicine services from Zipnosis.

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The Guam Dept. of Public Health and Social Services partners with Good Samaritan Hospital in Los Angeles to roll out a specialty care telemedicine program for island residents.


Sales

Houston Methodist (TX), Meadows Regional Medical Center (GA), and Shore Medical Center (NJ) sign on for Unified Provider Management software from Phynd Technologies.


People

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North Mississippi Medical Center promotes Shannon Fryery to director of telehealth for North Mississippi Health Services.

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Callie Shaver (Greenville Regional Hospital) joins Jersey Community Hospital as HIM director.

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Ed Mercado joins Crux Quality Solutions as CEO.


Government and Politics

The VA fires three more administrators within the Phoenix VA Health Care System. Lance Robinson, assistant director at the Carl Hayden VA Medical Center; Brad Curry, chief of health administration service; and Darren Deering, DO the hospital’s chief of staff; were all terminated for “negligent performance of duties and failure to provide effective oversight.” The terminations come more than two years after the exposure of the cover up of a huge backlog in medical appointments that severely impacted veteran care.

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The House passes the Helping Hospitals Improve Patient Care Act, excluding ambulatory surgical centers from Meaningful Use and MIPS penalties.


Innovation and Research

Cerner launches a one-year pilot study that will help determine whether patient’s genetic data can play a motivating role in promoting behavior change.

A Health Affairs study correlates the use of prescription drug monitoring programs with a 30 percent reduction in the rate of prescribing Schedule II opioids, a change that continued in the second and third years following the launch of the program.

A small Health Catalyst survey of hospital executives finds that 62 percent have between zero and 10 percent of their care tied to the value-based contracts CMS hopes to have hospitals converted to by 2018. Just 3 percent meet the CMS goal of 50 percent value-based reimbursement today, and only 23 percent expect to meet it by 2019.


Technology

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Avizia adds the patient-facing MyCare app to its AviziaOne telemedicine and secure messaging solution.

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Experian Health’s Coverage Discovery uncompensated-care alert tool can now integrate with Epic’s EHR.

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Influence Health develops new digital presence management technologies that include directory listings, reputation, and online provider review ratings tools.


Other

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Jennifer Lawrence signs on to play Theranos founder Elizabeth Holmes in an Adam McKay-directed drama about the now-infamous blood-testing startup.

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A mother in Australia uses Siri to call emergency services when she discovers that her sleeping baby had stopped breathing. While the digital assistant may have contributed to saving the girl’s life, it likely had more to do with the mom’s administration of CPR, given that the ambulance took 20 minutes to arrive.


Sponsor Updates

  • Impact Advisors achieves top overall performance score in the KLAS Healthcare IT Advisory Report.
  • InterSystems and PDR will exhibit at AHIP June 15-17 in Las Vegas.
  • LiveProcess will exhibit at the SC Hospital Association Hospital Preparedness Summit June 8 in Columbia, SC.
  • MedData will exhibit at the Southern Coastal Emergency Medicine Conference June 10-11 in Kiawah Island, SC.
  • Medecision signs on as a founding member of the Accountable Care Learning Collaborative.
  • Navicure will exhibit at the Arizona NextGen UGM June 10 in Phoenix.
  • Nordic and Stella Technology will exhibit at the HIMSS New York State meeting June 16 in the Bronx.
  • Millward Brown names NTT Data to its 2016 Brandz Top 100 Most Valuable Global Brands.
  • Obix Perinatal Data System will exhibit at the 2016 AWHONN National Convention June 11-15 in Grapevine, TX.
  • Experian Health will exhibit at the Georgia Society for Managed Care meeting June 12-14 in Jekyll Island.
  • PatientMatters will exhibit at the Ohio Hospital Association Annual Meeting June 13-15 in Columbus.
  • The SSI Group will exhibit at the Gulf States ASC Conference June 15-16 in New Orleans.
  • Catalyze achieves a second HITRUST CSF Certification.

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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EPtalk by Dr. Jayne 6/9/16

June 9, 2016 News No Comments

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Thanks to everyone who sent well-wishes about my recent hand injury. I’m happy to report that I’m recovering and have traded out the giant dressing for something more sleek – today I sported a Mickey Mouse themed bandage. I’m seeing patients tomorrow and am a bit nervous about hand hygiene, but our infection control nurse is on board with a plan. I’ll also be running with a scribe, so that will help. Laughter is good medicine and I appreciated one reader’s comment that at least I wouldn’t need to buy a foam finger to cheer my team at the ballpark.

From Florida Orange: “I was reading your post and this sentence jumped out at me: “I know my practice leans heavily towards patient satisfaction scores for determining provider compensation, and the idea that giving patients what they need (rather than what they want) can impact me negatively is always a consideration.” How is satisfaction calculated? HCAHPS scores? Press Ganey? Or Yelp reviews? And what factors make up patient satisfaction?” The methods used vary depending on whether an organization is a hospital or ambulatory group. I’ve actually seen groups use all of the above to assess patient satisfaction, plus other strategies such as anonymous waiting room surveys, online surveys, and more.

In my largely ambulatory world, the factors that come into play include: satisfaction with contacting the office (which may include appointment scheduling and availability); wait time in the office; friendliness and helpfulness of staff; whether patients felt their diagnosis and treatment was explained to their satisfaction; willingness to recommend the office to other patients; and more. My practice uses a third-party survey service that emails a link to the patient and we can see responses via a practice dashboard. They’re not anonymous and we contact anyone who doesn’t give us at least four out of five stars overall or offers narrative comments that are concerning.

Everyone likes getting good reviews, and the percentage of four- and five-star reviews impacts our bonus calculation, as does our ability to care for patients in a timely manner when they arrive. As a member of the executive team, I get an email notification when a patient activates the survey link. Sometimes this happens when I know the patient has to be driving home from the visit, which is amusing. All of our patients are emailed the survey at the time of check-out, even those that we know had less than optimal experiences. The times when we didn’t’ do well are the most important for learning and we really need that feedback.

Different organizations weigh the impact of their results in different ways. I worked with an organization a few years ago that lived and died by their Press Ganey statistics, even when the results didn’t make sense as far as supporting the organization’s overall goals. As organizations evolve along with our changing healthcare system, it’s going to be increasingly important for groups to evaluate their survey strategies on a regular basis. If processes have been improved and responses are flat, maybe it’s time to measure different elements.

Patient engagement is an increasing part of patient satisfaction, and at last week’s ONC Annual Meeting they launched a Patient Engagement Playbook. It’s designed to help organizations improve patient engagement via patient portal usage. The first phase encourages clients through the critical steps of making enrollment easy; activating features that patients want; allowing proxy access for caregivers; and integrating patient-generated health data. Physicians often resist the last item, so if you work with those who might fall into that category, a quick read might be in order.

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From Jimmy the Greek: “OK, Dr. Jayne, tell me why this patient portal view of lab results is useless. That’s right, campers, there’s no ‘normal range’ displayed.  Just how the hell is a non-clinician supposed to interpret these values?  Should I turn to Dr. Google?  Should I make a follow-up appointment with my doc to talk through the results?  Should I expect a phone call to discuss them? I have loads of data, but no way to turn the data points into useful information.” This goes right along with my recent post about trends in organizational patient portal release policies. The mere fact of releasing labs to patients doesn’t necessarily empower them, and without the right supporting information can lead to patient frustration or worry. I don’t immediately recognize this vendor, so I can’t tell whether there are other features that would help the patient understand their results such as hovering over them, but from other correspondence, Jimmy seems to be a pretty astute IT guy and would likely have picked up on something like that.

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Aprima is hosting its annual User Conference at the Omni Dallas Hotel August 5-7th. A piece on their blog caught my eye, since it quoted a client from a practice named “Serenity Now Psychiatric and Counseling Services.” That’s probably one of the best practice names I’ve seen in a long time. The write up also caught my eye since they’re offering a service project where attendees can assist with making blankets, gift bags, and other items for patients at Children’s Medical Center in Dallas. I love seeing companies help the community.

Are you a vendor who gives back? Email me.

Email Dr. Jayne

Breaking Down Blockchain’s Healthcare Potential

June 9, 2016 News 2 Comments

HIStalk looks at the evolution of blockchain, barriers to adoption in healthcare, and its potential to truly put patients at the center of care.
By
@JennHIStalk

The blockchain concept, while not new, certainly suffers from a lack of healthcare-related glitz and glam, a dearth of bells and whistles that seems to have kept the wallets of Silicon Valley insiders tucked tightly in their pockets (or pocketbooks). Like its VC funding, healthcare headlines relating to blockchain are few and far between – a good indication that the concept has some ways to go before reaching critical mass.

Many automatically associate the word with bitcoin – that much ballyhooed digital currency that has tried time and again to take the world by storm. Those more in the know equate it to financial markets, where authentication and security are key. A small but growing number of IT insiders see it as an initially humble solution to healthcare’s many problems (cybersecurity, claims delivery, interoperability, etc.) – one that may mature into a more dazzling and potentially game-changing business process down the road.

Its true potential in healthcare and in any number of other industries will only be realized once stakeholders truly understand its nature, barriers to adoption, and potential, including moonshots and more down-to-earth applications.

Understanding What Blockchain is (and isn’t)

Definitions of blockchain abound, and, depending on the resource, can be either fairly easy to understand or almost too abstract to contemplate. Techopedia defines it as “a critical part of the bitcoin peer-to-peer payment system.” Investopedia goes a bit further, defining it as a “public ledger of all bitcoin transactions that have ever been executed. It is constantly growing as ‘completed’ blocks are added to it with a new set of recordings. The blocks are added to the blockchain in a linear, chronological order.” These summaries are, in fact, too narrow, given that a blockchain does not in fact have to be tied to bitcoin.

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“To begin with, blockchain is not equal to bitcoin,” explains PokitDok Chief Scientist Bryan Smith, who is ushering the healthcare transactions technology company into early blockchain adoption. “A blockchain, at its essence, is a distributed database containing records whose contents, authenticity, and security are guaranteed. It drives efficiency, protects rights through immutable records, and establishes a system of accountability – an imperative in the often murky world of healthcare claims and reimbursement.

“With blockchain,” he adds, “engaged participants could opt in to share information that they want to share. That data could be accessible to authorized parties through a variety of front ends – from a mobile device to a sensitive compartmented information facility. There’s no other database that exists with that kind of functionality.”

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Smith’s evangelism seems well founded. What provider, patient, or payer wouldn’t want access to a single database that could act as one source of truth for health data? Jerry Cuomo, vice president of blockchain technologies within IBM’s new cloud group, believes blockchain has the potential to consolidate disparate versions of the truth – a concept that would seem to play well with industry efforts around interoperability and a national patient identifier. “In the current world,” Cuomo says, “everyone is keeping their own version of the truth, their own system of record. When something comes in, everyone is working in silos. Each organization has to look at that transaction and determine if it matches their view of the truth. If not, they have to make it match by converting it to their preferred format. Those are all opportunities for things to go wrong. With a blockchain, you’re working across a replicated, encrypted, shared ledger that has an audit trail. It reduces the attack surface because now it’s just one ledger that everyone is sharing.”

Gauging its Potential

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Brian Behlendorf, executive director of The Linux Foundation’s Hyperledger blockchain project, says. “Blockchain addresses concerns of security, scalability, and privacy of EHRs.”

Cuomo, whose team is working to develop blockchain pilots across a range of industries, envisions several “moonshot” applications for healthcare, including a patient-centered blockchain that would give providers limited access to a patient’s health record during time of service. “Just imagine a patient who is about to go into the hospital for an overnight stay,” he says. “The patient could set up a contract with the hospital, giving it 24-access to their healthcare records via blockchain. After the 24 hours are up, the hospital can’t add or make changes to that record, which reverts back to patient ownership. The patient sets the terms of who sees the record, for how long, and under what conditions. It becomes a truly patient-centered healthcare record that follows that patient from doctor to doctor.”

Cuomo also believes that new business models around healthcare blockchains are bound to spring up. “Imagine having the ability to advertise your healthcare information via your blockchain – to let organizations know that you’re interested in participating in clinical trials. You could proactively shop out your healthcare information to improve healthcare and better mankind. If those trials offer payment, you could theoretically offset the cost of your healthcare premium for the year. There’s no systematic way to do that today because your healthcare information is all over the place. In a blockchain and a corresponding ecosystem built up around that, patients might be able to more easily – and securely – contribute to medical research.”

From Big Ideas to Practical Applications

Moonshots often trump more practical use cases when a technology is just getting off the ground. While big ideas are essential to generating buzz around an up-and-coming innovation (Tricorder, anyone?), it is the less sexy application that ends up being a springboard for future headline-generating products and services. Where healthcare is concerned, blockchain may be poised to have the most immediate impact on the claims process.

“If you look at the healthcare ecosystem,” Smith explains, “there’s the patient, the insurance companies, and the providers. Sitting between each of them is some kind of intermediary. On average, processing a claim accounts for anywhere between 20 and 40 percent of the total bill. Overhead is significant, and it may be three months after a medical visit that you get an annoying bill that is often impossible to understand. Five years from now, we’ll see blockchain foster dramatic gains in economic productivity and authenticity much like the Internet introduced.”

Cuomo sees immediate potential in the area of dispute resolution. “A lot of these healthcare insurance environments are always dealing with disputes, often in the tens of thousands range,” he says. “It could be innocent things stemming from improper documentation. These things get held up in the system. They take time to resolve, and money isn’t flowing. When money isn’t flowing, it’s bad for everyone. You can’t pay your bill, people aren’t getting paid, etc. A blockchain could be used to enrich claims processing by tracking events. Those events could be used and consented on to be a source of truth – maybe not eliminating disputes, but reducing the time it takes to settle them. A great win-win for everyone.”

Behlendorf, who spent several years helping the White House and HHS use open-source software to drive adoption of shared medical records, also sees potential in blockchain’s ability to drive the sharing of patient records. “While we moved the needle substantially in our work on CONNECT and Direct,” he says, “there are still many who view patient data as their proprietary edge, not something that belongs to the patient. This is not just unfortunate and archaic; it is life-threatening when relevant health data isn’t shared.

“But, there are stakeholders who have a much greater interest in seeing a comprehensive record of patient care, and are in a connective position in the ecosystem. Insurers, for instance, will play a large role here, as well as the new wave of ACOs, and, by proxy, Medicare and the VA. Here, patient care and outcomes are comprehensively consulted, and the blockchain can provide not only a history of care (with permissions managed via keys), but it can also provide proof of authenticity for records shared between such organizations.”

Lessons Learned from Interoperability

Obtaining industry consensus on a common set of standards that levels the competitive playing field has historically been hard to achieve in healthcare. While Behlendorf, Cuomo, and Smith are certainly idealists in their take on the technology’s potential, they are also realists when it comes to calling out barriers to adoption.

“The barriers to adoption of information-sharing standards in the healthcare industry are many and difficult,” Behlendorf explains, “and few have to do with inadequate technology, but instead with alignment of incentives. What blockchain technology might do is introduce new players and new incentives to the market, thus potentially changing that landscape. It also introduces new risks, since we’re talking about widely shared data (even if encrypted), so we can’t be in a rush to implement. We’re very eager to work with the healthcare industry to investigate where we might see some early wins. The challenge, as always, is to find a set of stakeholders with enough of a common interest that they are willing to invest and collaborate. I’ve seen that first-hand in the healthcare industry, so I know it’s possible.”

Cuomo emphasizes the “network effect” necessary to get blockchain off the ground in healthcare. “It starts with a group of companies working together,” he says. “I think the network would be sparked by a set of influencers, like a set of major hospitals coming together, with sponsorships from one or more payers, which would motivate patients to come in and manage their health records via blockchain.

“But,” he adds, “therein lies the rub. That social pact has to be made. There has to be benefit for groups to come together. There’s a social side to it that’s probably more important. The technology facilitates businesses working together with less friction, with a heightened sense of trust and accountability, but you’ve got to agree on those things.”

Moving Ahead with Early Adoption

Smith is confident that every healthcare stakeholder – from providers to banks – will soon be evaluating how blockchain will impact their business processes. PokitDok, which itself is in the process of developing a blockchain system that Smith believes will significantly improve the security of sensitive health data while simultaneously making that data more readily accessible to authorized parties in real time. The company has also founded a Healthcare Blockchain Consortium to further evangelize the technology. While not quite ready to share specifics, Smith says that the consortium will “develop collective efforts to truly effect meaningful change in how healthcare is administered, delivered, and consumed worldwide.”

Cuomo and his team at IBM launched cloud-based blockchain services in April for healthcare, government, and financial services, and are working on internal and external proof-of-concept projects (including collaboration with the Linux Foundation’s Hyperledger Project) that he hopes will further escalate healthcare’s interest.

Behlendorf also takes an early-days approach to moving forward with blockchain in healthcare, stressing that the Hyperledger Project is not a standards effort. “We are here to build software,” he says, “and in doing so, lift the blockchain ecosystem as a whole, across all industries. We would be very excited to see new members from the healthcare industry participate so that we can understand their needs, collaborate, and build the core platform. As open-source software communities have shown, those companies that participate end up with an operational advantage in understanding how this technology can transform their business. They also see their staff develop expertise in a domain that is difficult to simply buy or outsource. This is about building an ecosystem and everyone has new roles to play if they recognize that and invest in transformation.”

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Reader Comments

  • HIT Girl: Amazingly, he's the CEO of a patient-payment company. You'd think he'd have bothered to pop the hood on the whole billi...
  • Johnny B: ACP paper - I don't know that providers will ever be able to come to a consensus on how they want to document. Some want...
  • FLPoggio: What this piece totally ignores is that you and the provider (roofer) dealt directly with each other. Now what if you ha...
  • AC: That's not an apt comparison. Imagine instead if while the roofer was doing his thing, another random roofer dropped by ...
  • HIT Girl: I've worked in EHR design & support for the last 14 years or so, and when I was hospitalized in I think 2007 I got m...

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