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Monday Morning Update 1/2/17

January 1, 2017 News 5 Comments

Top News

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Eric Topol, MD lists his “10 Tech Advances That Can Change Medicine.”

I have to be a quibbler in suggesting that changing “medicine” is far less important than changing “health” – none of these advances would move the needle on the overall health of the US population very much, although listing magic technology bullets makes for sexier reading than advocating exercise, dietary changes, and the other health determinants that drive 90 percent of health and quality of life.

We don’t really need wearable sensors or increasingly sophisticated diagnostic tools to tell us what people could do to improve their health the most, but Topol’s world view is as a cardiologist, technologist, and geneticist rather than that of a frontlines generalist. Telling people to use their own intelligence instead of being overly enamored of the artificial kind doesn’t earn many grants, procedure payments, or technology board seats.

That said, Topol isn’t the only one with the “I have a hammer, so everything looks like a nail” problem. Hospital people mistake their often clumsy episodic interventions as the most important aspect of health.

In both cases, the fact remains that the most significant health decisions are made when people are far away from their providers and the bustling business of healthcare services delivery, often when they are in fact alone. For that reason, maybe health charge should be led by public health marketing people rather than providers whose education and experience causes them to overestimate their importance to health.


Reader Comments

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From Lucid Moment: “Re: patient privacy. Patients do not realize that they give up their HIPAA rights when they use an app or system that connects to an EHR via an API. CMS requires providers to send patient information to any application that patients want to use. If a patient clicks ‘I agree’ on the usual multi-page terms of whatever app they’re using, the app vendor will gain access to their data under the FTC’s minimal privacy rules rather than HIPAA’s. Google and Microsoft will benefit because they can read patient data for choosing ads to display. That’s always been the case, but new phone access to data such as through the new Apple services opens the pipe for them.” Interesting. The above is from CMS’s November 2016 update on patient access to health information.

From Spoon Bread: “Re: misused words. This article list some good ones.” Indeed it does. Some good examples that I’ve seen:

  • adverse (harmful) vs. averse (not willing)
  • bemused (bewildered) vs. amused (entertained)
  • disinterested (unbiased) vs. uninterested (not interested)
  • flaunt (show off) vs. flout (disregard)
  • opportunistic (exploiting a situation immorally), confused with taking advantage of an opportunity
  • simplistic (oversimplifying a complex issue to the point of being misleading) vs. simple (an issue that is uncomplicated)
  • tortuous (twisting) vs. torturous (involving physical torture)

HIStalk Announcements and Requests

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Poll respondents are slightly negative on using scribes to free doctors up from doing EMR data entry work. Linda is concerned about the wide variability in scribe training and their lack of certification, while Furydelabongo says scribes are like transcriptionists who can create a standardized narrative in the absence of a usable EHR (which he or she says is at least two generations away). Frank says having the most expensive labor unit – doctors – entering data is inefficient, no different than if hospital VPs were required to enter transactions.

New poll to your right or here: Should physicians be held accountable for patient satisfaction survey results? Your thought process would interest the rest of us, so click the Comments link after voting and explain it.

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Here’s a last chance to participate:

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We funded Mr. C’s “Art of Science and Performance” video equipment grant request through DonorsChoose. He checks in from California to say that the class has recorded a school production so that everyone could watch it and will next make a San Jose Tech Challenge film as its keystone project.

I had some final site upgrade work performed over the holiday weekend. Let me know if you see anything that’s not working.


Last Week’s Most Interesting News

  • President-elect Trump meets with the CEOs of several large health systems, with privatizing some aspects of the VA being a rumored topic of discussion.
  • A study reports the benefits of adding EHRs as a topic in a hospital’s daily executive safety huddle.
  • The local paper reviews a patient death at St. Charles Medical Center (OR) in which an IV error was not caught, partly because the hospital had turned off its IV checking system after finding that it wasn’t compatible with its EHR.
  • The New York Times profiles the failure of a North Carolina physician group to move to an ACO model, with physicians who left for higher-paying hospital jobs and a big investment in technology forcing the group to sell out to a large health system.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.


Acquisitions, Funding, Business, and Stock

Here’s the 2016 stock performance of some publicly traded health IT companies. It obviously wasn’t a great market year for them, even as the Dow rose 15 percent, the S&P 500 ended up 11 percent, and the Nasdaq increased 10 percent. Cerner shares, for instance, are trading at their March 2013 price, with their longstanding steep climb up having ended in March 2015 even before its July 2015 DoD contract win was announced.

Castlight Health – up 19 percent
Premier – down 14 percent
Aetna – down 14 percent
Cerner – down 19 percent
Quality Systems (NextGen) – down 22 percent
McKesson – down 28 percent
Allscripts – down 29 percent
Athenahealth – down 34 percent
Medical Transcription Billing – down 34 percent
Inovalon – down 39 percent

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The Philadelphia paper profiles Forerunner Holdings, which offers software that helps hospital pharmacies track prescription drugs through the supply chain to detect counterfeit medications. The company has 50 hospital customers who pay around $5,000 per year to connect with the fulfillment systems of drug wholesalers and manufacturers. The 14-employee company, which is about to launch a $10 million Series A funding round, plans to add a drug shortage warning app and a system to allow hospitals to share access to expensive, rarely used drugs such as antivenin. The company CEO and CTO both came from a Germany-based analytics software vendor and this is their first company.

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Fortune magazine profiles investors in “fake it till you make it” startups (of which Theranos is provided as an example) who refuse to believe their companies are doing anything unethical to provide the false appearance of growth. The article ponders whether startup culture has changed now that “the Valley looks as crooked and greedy as the rest of the business world.” The magazine proposes a Startup Scandal Scale that rates companies “on a scale of one to Theranos.” It summarizes,

Some founders grow into talented CEOs. Most don’t. That’s an inevitable by-product of Silicon Valley culture, where everybody fetishizes engineers, designers, and inventors while managers get little respect. “We have an epidemic of bad management,” says Phil Libin, a partner at venture firm General Catalyst. “And that makes [bad] behavior more likely, because people are young, inexperienced, and they haven’t seen the patterns before.” So inexperienced people are handed giant piles of money and told to flout traditions, break rules, and employ magical thinking. What could possibly go wrong? “We hope that entrepreneurs bend the rules but don’t break them,” McClure says. “You know the saying ‘There’s a fine line between genius and insanity’? There’s probably a fine line between entrepreneurship and criminality.”


Other

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Someone tweeted about Crohnology, a “patient-powered research network” in which people with Crohn’s disease are invited to contribute information about treatments they’ve tried so that the collective experience can be shared with all participants. It’s still in beta testing after several years, but it’s a great idea.

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The New York Times profiles the rapidly increasing world of “fake academia,” where shoddily produced but impressive-sounding journals and conferences feed the “publish or perish” needs of academics – many of them from third-world countries – who pay for the privilege of adding substandard articles and presentations to their CVs. An India-based company runs several of its conferences simultaneously from the same hotels in resort destinations; another’s 17 journals are published by one guy sitting in his apartment; and a third company warns prospective authors that its journals don’t accept papers longer than six pages. One journal accepted for publication a professor’s manuscript that contained one sentence: “Get me off your &@$! mailing list.”A company that the FTC has charged with deception offers the 4th International Conference on Biomedical and Health Informatics in Chicago and other informatics conferences, described with sometimes hilariously fractured English and illustrated with badly resized photos.

Bill Gates warns that the misuse of antibiotics has raised the odds of a pandemic spread by resistant bacteria. 

Connecticut home care agencies worry that the January 1 implementation of a Medicaid fraud prevention system will cause claims processing problems. The electronic visit verification system requires home care workers to call a centralized telephone number upon entering and leaving the client’s home. The agencies also complain that the state chose as its single vendor Sandata, requiring interfacing and loss of functionality. One agency already has a similar system in place that’s integrated into its EHR, but the change will require workers to go through the verification steps a second time just for the state’s records. An agency with 1,500 Medicaid clients says it won’t use the state’s system and will stop serving those patients if the state insists.


Contacts

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How My 20 Predictions for 2016 Turned Out

December 30, 2016 News No Comments

Here’s what I predicted on December 28, 2015 and how right or wrong I turned out to be.


Cooled-off funding markets will leave unprofitable startups struggling, IPOs will be postponed, but Health Catalyst will go public.

no

It’s hard to say whether my first two predictions were correct, but I was wrong about Health Catalyst – they weren’t as anxious or as prepared to go public as I expected. I was right in predicting a poor 2016 IPO market as successful companies in all sectors seemed to prefer increasing their private valuations instead of going public. SEC filings suggest that the trend will continue into 2017. I’m guessing many startups are indeed struggling, mostly because of their own shortcomings. Without the Health Catalyst miss I would have given myself a solid checkmark.


Healthcare costs will be a contentious point in the presidential election, provider mergers will continue, and at least one presidential candidate will timidly suggest cost controls.

yes

Seems right to me. Hillary Clinton touched lightly on cost controls and certainly the cost and premium aspects of the Affordable Care Act became a campaign issue.


Consumers will lose interest in fitness trackers.

yes

I’ll give myself a check even though “lose interest” may or may not be broadly accurate (perhaps, to quote Spinal Tap manager Ian Faith, their appeal is just becoming more selective.) The Apple Watch flopped and some fitness tracker companies sold out or shut down.


The CEOs of Epic, Cerner, and Meditech will start to pull back from day-to-day company involvement as they approach retirement.

no

This is a toss-up. Epic’s Judy Faulkner is actively involved but talking more about a succession plan because people keep bugging her about it, Cerner’s Neal Patterson was sidelined temporarily by cancer but plans to come back in a few weeks, and I don’t really know about Meditech’s Howard Messing but he seems to be active. I’ll compromise by giving myself an X despite being “directionally correct.” It’s not like they’re just going to disappear while still holding the title, so only Epic and Meditech insiders would know how actively involved their executives are, unlike the publicly traded Cerner who has to be more transparent about what’s going on and Neal has made it clear he’s phasing himself out. In any case, all three companies are likely be replacing their longstanding top executive (and founder in two of those cases) within a few years, introducing the possibility of change.


ONC and Meaningful Use will become increasingly less relevant and more contested as ONC replaces Karen DeSalvo with a new National Coordinator who lacks her experience and bipartisan support.

yes

Meaningful Use was replaced with MACRA while ONC’s influence is debatable – 21st Century Cures gives it more scope. I could score this one either way. Certainly the “more contested” part is true as healthcare member organizations constantly issued press releases and letters complaining about everything MU-related.


Several mid-tier consulting firms will be downsized or acquired as their implementation and advisory business dries up.

yes

I should know better than to make predictions that are hard to quantify. Some companies certainly did cut back or sell out although obviously their reasons for doing so weren’t publicly announced. Like a vendor’s crafty RFP respondent, since I can’t definitively say “no” I’ll go with “yes” since that’s to my advantage.


At least three big health systems will be breached in exposing the information of 100,000 or more patients. The government and organizations like HIMSS will try to help providers share information.

yes

The 100,000-patient number seemed huge a year ago, but breaches of that size are unfortunately not uncommon these days.


The VA will announce plans to eventually replace VistA with a commercial product.

yes

The VA hasn’t specifically said, “We’re dumping VistA,” but their RFIs and conceptual descriptions – not to mention Congressional pressure — clearly suggest such a direction.


At least one customer each from Epic and Cerner will switch to the other’s product to get a better deal on maintenance fees. Epic will expand its hosting service to better compete with Cerner.

no

I’ve given myself a check on some debatable predictions, so I’ll assign myself an X here even though hospitals have certainly switched both ways between Epic and Cerner and Epic is indeed expanding its hosting services. Most of the swaps were probably related to acquisitions and Soarian customers who were pushed into RFPs that sometimes went Epic’s way, so I don’t have proof that anyone replaced a product just because its ongoing cost was too high.


The terms “telemedicine” and “mobile health” will become antiquated as they simply become another accepted aspect of care delivery. “Information blocking” will also fade away as a hot term when everybody realizes the concept involves speculation without proof.

no

The terms “mobile health” and “mHealth” are getting long in the tooth and irrelevant since everything is mobile to some degree, but “telemedicine” lives on and “information blocking” is still being thrown around indiscriminately to describe unproven shady behavior by EHR vendors and providers. I was quite wrong in thinking the accusations about information blocking would fizzle due to lack of evidence proving intention. I still haven’t seen the evidence, but the accusations are still flying but with no change in the status quo for patients.


IBM Watson will continue to produce mostly hype. No convincing studies will demonstrate its value, but newly announced, high-profile partnerships will keep IBM shareholders hopeful.

yes

I grade it as all hype so far.


The dark horse publicly traded company best positioned to succeed in health IT and related areas without a lot of fanfare will be Premier.

no

I didn’t see much of a health IT splash from Premier and its shares are down on the year.


Athenahealth won’t get much inpatient traction with the former RazorInsights and BIDMC’s WebOMR.

yes

It seems logical in hindsight that Athena would need more than a year to become a significant inpatient player if indeed it ever does, but a lot of post-acquisition hype was flying a year ago and this prediction was bolder than it seems now. ATHN share price has dropped 33 percent in 2016.


McKesson will consider packaging and divesting its many health IT offerings as non-core business.

yes

That’s exactly what is happening as the company prepares to create a new, publicly traded company with Change Healthcare and is shopping its Enterprise (Paragon) business around without any takers so far.


Epic will not join CommonWell, but will leapfrog its competitors in offering APIs and slowly building a carefully controlled third-party ecosystem.

yes

I’ll give myself a check since Epic didn’t join CommonWell, but I’m not so sure that Epic has leapfrogged Cerner in offering APIs.


Software for population health management and analytics will enter Gartner’s Trough of Disillusionment as providers implement it poorly and without a commitment to truly change their profitable business models.

yes

I wasn’t speaking literally about Gartner’s hype cycle and I can’t say if population health management software is on it since I don’t subscribe to Gartner, but I think it’s generally true that providers are struggling to wean themselves off fee-for-service business and haven’t done a whole lot with the many software and analytics products that are being sold. You could make a convincing case that I’m wrong, however.


Cerner and Epic will continue to poach the business of Meditech, CPSI, and best-of-breed vendors whose small-hospital customer bases are being acquired by larger health systems.

yes

This is true, although it wasn’t really a bold prediction since the trend was obvious even a year ago.


“Big data” will support a few meaningful clinical studies performed using only aggregated electronic information, but “little data” will provide more impressive but less-publicized results as doctors design the treatments of individual patients by reviewing the outcomes of similar patients.

no

I’ve given myself some checks for predictions that were partially correct, so I’ll balance it with an X here even though I still believe in the “little data” concept. Certainly some big data-driven studies have turned up some interesting and useful clinical information, so in that regard it probably contributed more than I expected. I could have given myself credit for foreseeing the precision medicine movement that was announced a few weeks after my prediction, but I’m undeserving — that’s really based more on genetic information instead of the “patients like this one” small-scale aggregate data analysis by an individual provider.


Consumer healthcare apps will continue to be plagued by inconsistent use, questionable design, and an unremarkable impact on health or outcomes.

yes

This is another accurate but not especially bold prediction. FDA crackdowns were obviously coming and app vendors rarely bothered to prove that their products influenced patient outcomes.


CHIME and AMIA will follow the HIMSS model of increasing conference attendance and revenue by catering to high-paying vendors willing to buy access to prospects.

no

I’ll give myself an X since I’m not involved with either organization and thus can’t say how much influence vendors are able to buy. I haven’t heard of any egregious behavior by either organization.


News 12/30/16

December 29, 2016 News 2 Comments

Top News

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President-elect Trump meets with the CEOs of Mayo, Hopkins, Partners, and Cleveland Clinic, with the topic speculated to be changing the VA to allow veterans to seek care at any hospital.

There’s also the strong possibility that the group tried to convince Trump to leave intact those parts of the Affordable Care Act that boosted the profits of big health systems by insuring people to whom they would otherwise be required to treat free.

Cleveland Clinic CEO Toby Cosgrove, MD, who is a Vietnam War veteran, is rumored to be on Trump’s short list to run the VA.

Also among the pod of rich, white males was facial plastic surgeon Bruce Moskowitz, MD (who founded the non-profit Medical Device Registry for reporting problems with surgically implanted devices) and the reclusive CEO of Marvel Entertainment, who had previously donated $50 million to the cancer center of NYU Langone Medical Center that is now unsurprisingly named after him and his wife.


Reader Comments

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From Meltoots: “Re: readmissions article. It ignored the data showing that hospitals simply shifted readmissions to observation beds. Plus, the CHF death rate actually increased over the past several years as hospitals are penalized less for a death than a re-admit. It’s silly talk that the ACA reduced readmissions.” The readmissions penalty was too specific to have a predictably positive impact on patient care, being a primarily financial, incidentally clinical carrot (like other major payment methods that are driven by the patient’s midnight location). Providers have learned to play the Medicare shell game well, always finding a new way to preserve profits when the government removes one. Here’s one I was involved with at my health system. We quietly bought up some oncology practices, then made their patients come to the hospital to get their chemo infusions because it paid us better and we could milk the government’s 340B program to wildly increase drug margins. The patient, however, had to drive to our hospital (which had the usual stress-inducing lack of parking), pay a co-pay since they were now reclassified as hospital outpatients, deal with our often-indifferent registration people and financial counselors, and endure the bustle created when we funneled all those folks into hastily created infusion rooms that resembled happy ending-type massage rooms rather than places of healing. I would not have liked it as a patient — just being in a hospital would make me feel sicker and less hopeful than getting treatments in a quiet, pleasant doctor’s office. Our execs loved the idea, though, since it swelled our bottom line, which is the biggest ego stroke (other than erecting phallic, lavish buildings) that a C-level hospital executive can get.

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From The Truth: “Re: Mercy Hospital in Des Moines. Fined over a million dollars for patient safety scores and that doesn’t make HIStalk? C’mon man.” I’m constantly surprised when readers complain that I haven’t mentioned some story that is unrelated to health IT and thus amply covered elsewhere. I guess I should be honored that folks expect or encourage me to write about other topics. The hospital gets three stars from CMS, a D from Leapfrog, and poor patient satisfaction scores, so naturally they announce that all of those measures use flawed data that underreport its medical pre-eminence.

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From AnonTip: “Re: Deborah Heart and Lung RFP. I worked on it as a vendor. Some of the RFPs ran 800 pages as they demanded extensive screen shots of workflows and details, then required three days of on-site demos and then site visits. [Vendor’s name omitted] bid $40 million for the 89-bed hospital. They ended up choosing Meditech Web Ambulatory and 6.1, so they will probably dump Allscripts Touchworks at some point.” Unverified. They must have hired consultants to lead their search since it seems like overkill for a tiny hospital that has been using Meditech for decades, although maybe the threat of bolting gave them a stronger negotiating position. The hospital’s 2015 financials show patient service revenue of $163 million and expenses of $166 million, so I can understand passing on the one vendor’s $40 million bid.

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From State-Sponsored Actor: “Re: Joint Commission. They’ve flip-flopped again, now declaring that providers can’t send patient orders via secure messaging.” Joint Commission first banned sending orders via secure text messaging in 2011, then decided in May 2016 that it was OK as long as the messaging system met specific requirements. Since then, Joint Commission met with CMS and now declares, “The use of secure text orders is not permitted at this time” because its impact on patient care is unknown, specifically:

  • How much nurse work is required to transcribe those orders into the EHR.
  • The asynchronous nature of orders sent via text message requires extra steps to clarify and confirm.
  • The transcribing nurse has to deal with any clinical decision support messages and relay them to the ordering provider.

From Kilt-Lifter: “Re: DonorsChoose. Do you personally fund the projects you mention?” Not usually. I mention projects in which readers decide to donate through me to enjoy the collective good will created when I share the stories of how the projects I funded with their money (and matching funds) turned out. There’s nothing in it for me and my personal donations are separate.

From Lookie Here Now: “Re: HIStalk email updates. I’m no longer receiving them.” This happens all the time as companies ramp up their protective defenses against spam and my email system cancels the recipient as “bounced.” Just sign up again since that often works.


HIStalk Announcements and Requests

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I’ve opened my once-yearly HIStalk Reader Survey. Like last year, I’ll randomly draw respondents for a $50 Amazon gift card. I was surprised in looking over last year’s responses how many reader-suggested changes I have since put in place, although some were just too ambitious for my energy level and capabilities and the #1 response by far is always “don’t change anything.” Some good suggestions from last year and my comments:

  • Improve the site search. That’s always a challenge since Google Site Search doesn’t allow date filters, which would be really cool.
  • Find an inside-the-Beltway anonymous writer. I’m not super-interested in government and politics, but I’m open to the idea if someone is interested.
  • Write less about HIMSS (which is for vendors) and get provider input from AMIA. I don’t really have contacts in AMIA other than I was a member for a while, so I don’t have much to add there except occasionally mentioning something published in JAMIA that someone sends me.
  • Get more input from “small people” like analysts or support desk people. I would love to, but vendor executives are paid to write guest articles and otherwise contribute visibly, while those in the trenches don’t have the time or the approval of their employer to participate. I wish that weren’t the case since I suspect they are at least equally interesting.
  • Get more contributors. As in the item above, it sounds great, but even well-intentioned contributors quickly drop off as they realize the time required. One of my favorite sayings is, “I hate writing, but I love having written.”
  • Do more polls. I will consider that.
  • Send the morning headlines via an email update. I keep thinking I should do some sort of daily email update, perhaps using a separate mailing list so that it doesn’t bug those readers who aren’t interested. Given the previous suggestion, here’s a poll: Would you regularly read a daily email containing expanded HIStalk headlines? Last year, the most-loved HIStalk element was news, but clustered tightly in the next three spots were humor, rumors, and the morning headlines.
  • Cover more conferences like CHIME’s spring and fall forums, ACHE, AMDIS, RSNA, and JP Morgan. Sounds good on paper, but I don’t get invited to these meetings and I don’t really enjoy attending conferences. The only one that’s appealing is JP Morgan and I’m pretty sure my low BS threshold would be overwhelmed by all the besuited money guys running around leaving an olfactory wake of expensive cologne and self-importance.

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Reader Ed donated generously to my DonorsChoose project, allowing me to fully fund these teacher grant requests with double impact from matching funds provided by my anonymous vendor executive:

  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • A Chromebook and supplies for Mrs. I’s high school class in Orangeburg, SC
  • Math kits for Mrs. V’s elementary school class in Norfolk, VA
  • A library of 45 science and environment books for Ms. H’s third grade class in Anchorage, AK
  • Two Chromebooks for the high school health education classes of Mr. S in Bay Shore, NY
  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • Shot puts and relay batons for the track team at Mr. H’s middle school in Las Vegas, NV
  • Five sets of headphones, an electric pencil sharpener, and a programmable robot for Ms. S’s second grade class in Gladstone, MO

Ms. S replied this morning to the news that her project was funded with, “Thank you for kicking off our return from break in a great way! I can’t wait to share with the class that, because of generous people like you, we will now have some much-needed tools in our classroom. It is an amazing thing to be supported! It reminds us how valuable we are and impacts student motivation for reaching their unique potential.”

All the recent celebrity deaths made me envious of artists whose work lives on forever and finds new fans year after year, unlike the rest of us charge-leading foot soldiers who are simply replaced by the next warm body when we fall without leaving much of a non-family trace. I suppose the consolation is that it doesn’t really matter anyway once you’re dead.


Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.


Government and Politics

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@Cascadia notes the existence of the Plum Book, which identifies presidentially appointed federal positions. Those marked NA are non-career appointment, CA is career appointment, and SC is a Schedule C listed appointment. Obviously it’s not quite up to date with correct names despite a December 1 publication date. Former National Coordinator Karen DeSalvo, MD, MPH, MSC is Acting Assistant Secretary for Health, which is noted as a PAS (presidential appointment with Senate confirmation) and she was never confirmed by the Senate, but I haven’t seen her officially say she’ll be leaving by January 20.


Privacy and Security

From DataBreaches.net:

  • Brandywine Pediatrics (DE) is hit by ransomware, but recovers from backups.
  • Desert Care Family & Sports Medicine (AZ) remains down from a ransomware infection that occurred in August.
  • The Dark Overlord hacker who breached several healthcare systems earlier this year penetrates a precast concrete vendor and releases information that includes contracts, a dump of a manager’s cell phone that includes photos of his children, and video of an apparently fatal workplace accident. He or she is demanding extortion payments to leave the remaining information private.
  • A hospitalized psychiatric patient breaches systems run by New Hampshire’s Department of Health and Human Services using a computer in the hospital’s library and posts some information of 15,000 people to social media.
  • A hacker breaches the paging system of Providence Health & Services, posting some of the organization’s pager messages on the hacker’s website.

SNAGHTML2269f415

This ZDNet security editor is trying to contact a New York hospital to tell them that a network-attached storage device is open to public FTP, with no luck so far. Update: Saint Joseph’s Medical Center has taken the device offline, he reports.


Technology

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A journal article describes how scientists use the workplace messaging tool Slack, which a geneticist user says is better than email that is “disastrous for group communication.” They’re using it to work on research papers, discuss conferences, monitor experiments via device integration plug-ins, create custom apps, award points for collaborative activity, create to-do lists, and train new members. Slack offers a free, endless trial, with regular packages priced at either $7 or $13 per user, per month. There’s also an open source, self-hosted alternative that offers a free team edition or an enterprise version for $20 per user, per year.


Other

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A JAMIA-published study describes the hospital-reported benefits of adding an EHR topic to daily executive safety huddles. EHR safety issues made up 7 percent of the safety concerns discussed in one year.

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A study published in JAMA finds that US healthcare and public health spending increased significantly from 1996 to 2013 — now accounting for 17 percent of the economy – with the biggest costs involving diabetes, ischemic heart disease, and low back and neck pain. The biggest spending jumps were in emergency care and prescription drugs. The only injury that made the top 20 spending list was falls. Government public health spending accounted for just 2.8 percent of the total. It’s interesting that females incurred significantly higher expense – sometimes more than double – for all age groups over 15 in 2013, with their extended longevity and thus higher numbers incurring $130 million in the 85-plus age group vs. just $51 billion for males (although per-capita spending in that group was also 29 percent higher for females at $31,000 – maybe due to loneliness?). Overall cost ramps up smoothly until ages 65, which the jumps start to get dramatic and the challenges in funding Medicare in a mostly cost-unconstrained model become obvious, although the cost-benefit ratio of applying all those expensive treatments – not only to longevity, but also quality of life – is decidedly less certain. An accompanying editorial notes that the largest public health expense category is HIV – which kills comparatively few people – but little money is spent to address lifestyle conditions, some of which involve consumer products that are backed by massive advertising campaigns.

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England’s Secretary of State for Health Jeremy Hunt touts the benefits of barcode-tracking and identifying patients, staff, and equipment that can prevent harm and provide data for studies.

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A Harvard Business Review article asks, “Are You Solving the Right Problems?” and questions whether frameworks like Six Sigma and Scrum or even root cause analysis and 5 Whys cause people to “overengineer the diagnostic process.” The answer, it observes, is often not a solution to the stated problem, and problem-defining technology or checklists can be “the subtlest of traps.” Sometimes Disney can’t speed up the ride wait, so it just entertains those waiting.

The Watertown, NY town ambulance service blames a computer upgrade for the inability of crews to open its narcotics lock boxes for several days. Ambulances from the next town over were called in when the drugs were needed. They probably could have just asked around since most towns have plenty of people stockpiling opiates.

A social worker fired by Erlanger Health System (TN) for not knowing how to call a Code Blue sues the health system. A nurse trying to revive an inpatient who had hanged himself in his bathroom asked the social worker to call a code. She says she had not been trained to do so and instead rushed to the nurses station, but found only a clinical documentation improvement employee there who didn’t call the code. She finally found five on-duty nurses in the break room, but they didn’t call the code, either. The hospital fired her for failing to call the code, for spreading rumors that the nurses were goofing off, improperly documenting the incident, and missing a meeting in which the incident was reviewed. The social worker claims racial discrimination since everyone who was involved except her is white and nobody else was fired.

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In Germany, an unimaginative (and, much to my surprise, sober) 22-year-old imitates a viral YouTube video in trying to scare a sleeping friend by thrusting a running chainsaw near his head. The 18-year-old victim might want to find smarter friends – the chainsaw prankster missed that part of the video in which the saw’s chain was removed, leaving his unintended victim with a nearly amputated hand.

Odd: the HR director of home health software vendor Axxess Technology Solutions sues a company called Dicks By Mail (whose founder claims to have made millions from the insult-oriented business), seeking to learn the identity of the anonymous individual who sent her a box of penis-shaped candies. She thinks it may be the same unknown person who keyed her car and posted phony Craigslist ads about her. Ordinarily I would suggest that surely she must already know anyone who hates her that much, but then I remembered that she’s in HR.


Sponsor Updates

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 12/29/16

December 28, 2016 News No Comments

Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre–Post Analysis

A study published in the Annals of Internal Medicine measuring readmission rates before and after ACA’s Medicare Hospital Readmissions Reduction Program went into effect, finds a reduction of 60 to 90 readmissions per 10,000 discharges.

Abbott gets FTC approval for $25 billion St. Jude deal

Abbott Laboratories wins FTC approval to acquire medical device manufacturer St. Jude for $25 billion, under the condition that the two companies divest their cardiac device business units.

Value-based insurance coming to millions of people in Tricare

The recently-signed Defense Spending Bill includes a mandate to test value-based reimbursement initiatives stemming from the DoD’s Tricare insurance program.

Trump Picks Thomas Bossert as Top Counterterrorism Adviser

President-elect Donald Trump names cybersecurity expert Tom Bossert as his homeland security advisor.

News 12/28/16

December 27, 2016 News 11 Comments

Top News

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An Oregon district attorney says he was “on the verge of filing criminal charges” against St. Charles Medical Center-Bend (OR) for halting the use of Baxter’s DoseEdge barcode-driven IV checking system, thereby contributing to the death of an inpatient who received a mislabeled and ultimately fatal IV. The DA backed down when the hospital agreed to make safety changes.

The hospital said both McKesson and Baxter promised that Baxter’s DoseEdge system was compatible with its newly purchased McKesson Paragon EHR, but the hospital had to revert to manual medication checks when it found those claims to be untrue.

Hospital employees claim the hospital turned the DoseEdge system off in a cost-saving move and complain that the Paragon equivalent was too slow to be used.

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The fatality occurred because of the usual “Swiss cheese effect” of having several safety steps break down sequentially:

  • An expert pharmacy technician who had worked at the hospital for 37 years prepared the patient’s IV with the surgery muscle blocker rocuronium instead of the ordered seizure drug fosphenytoin.
  • A pharmacist at the hospital didn’t notice the pharmacy technician’s mistake and approved the IV to be sent to the patient’s room.
  • A nurse hung the bag even though it was clearly labeled with a “neuromuscular blocker” warning  sticker that she says she didn’t understand.
  • The patient was left unmonitored despite her physician’s order for continuous cardiac and pulse oximetry monitoring, which the nurse admitted she ignored.
  • The nurse had to leave the patient’s bedside when a fire drill was called right after the IV was started.

The patient was found unresponsive 42 minutes later and was taken off life support two days after the incident.

The hospital has improved its processes, but it still won’t have a replacement IV checking system until it goes live on Epic in April 2018.


Reader Comments

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From Ex Epic: “Re: fun with numbers. Epic is replaying the hits related to R&D investment on their site, although they’ve at least left the Google and Apple nonsense out this time. Oddly, the site’s chart doesn’t match the corporate overviews shared across the campus. Epic’s 2014 and 2015 charts showed Allscripts spending more than Cerner, but their 2016 trend line (which includes those years) has Cerner outspending Allscripts. Which is it?” The trend line shows Cerner and Allscripts spending around 22 and 18 percent, respectively, in 2015, while the bar chart shows 19 and 25 percent. I wouldn’t put much faith in the numbers anyway since Epic compares itself with three publicly traded competitors that follow GAAP recognized accounting standards, while privately held Epic is under no such limitation. Companies can also elect to capitalize as R&D such items as allocated indirect costs (such as a portion of expensive office buildings), maintenance costs, support expense, and other gray areas that may provide little customer benefit. The bottom line (no pun intended) is how products perform and are viewed by customers regardless of how the vendor’s accountants book R&D expense, no different than with any other product. McDonald’s supposedly spends a gazillion dollars trying to invent new menu items that never catch on, but that R&D usually earns the company scorn rather than admiration and their food tastes the same regardless.

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From Publius: “Re: Toby Cosgrove as a potential VA secretary. Since Cleveland Clinic is an Epic shop, does this increase the likelihood that the VA procures Epic as its commercial EMR solution, or is Cerner a foregone conclusion given the DoD project?” That’s a tough one. The VA and DoD have disdainfully declined to work together in advancing interoperability until mandated by Congress (and sometimes not even then), so while Cerner might make more sense, I would expect the VA to choose Epic just to be contrary. I think it’s a done deal that they will replace VistA with one or the other. Epic must still be stinging after losing to Cerner for the DoD’s MHS Genesis, so I assume they are using whatever DC influence they have (see: Paul Ryan) to bag the VA deal.

From Meltoots: “Re: integrating state prescription monitoring program (i.e., doctor-shopper) databases with EHRs. We asked our EHR vendor and the state of Ohio for this integration 14 months ago. Here is the click-type data entry nightmare we do today. Does anyone understand this?” Meltoots lists the required steps to perform the patient lookup in the PMP database, which might provide its own deterrent to opiate prescribing:

  1. Find the PMP’s webpage.
  2. Log in using the user name and password that constantly changes.
  3. Click OK that you understand this is private info.
  4. Click Search.
  5. Click and type in first name and last name (spelled perfectly), date of birth, ZIP code, etc., going back and forth locating the information in different EHR areas and then typing it into the PMP’s web form.
  6. Click and hope to find the patient.
  7. If the patient is listed, download the generated PDF file.
  8. Read the PDF and then print it to prove that you read it.
  9. Scan the PDF and attach it to the EHR chart to prove that you did it.

HIStalk Announcements and Requests

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It’s a dead heat between Epic and Cerner in the admittedly subjective “who gained the most ground in 2016” category.

New poll to your right or here: is the increasing use of medical scribes good or bad? Polls need to be simple by design, so if you feel boxed in by my default answers, feel free to click the Comments link after voting to explain your position.

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Fantastically generous donations from Epic Reader, Bucky Badger, Dr. J, Friend at Impact, and Bill – combined with matching money from my anonymous vendor executive and other sources – allowed me to fully fund these DonorsChoose teacher grant requests:

  • 3D pens and printing supplies for Mrs. S’s elementary school class in Oakley, CA
  • Makey Makey circuit kits for Mrs. C’s elementary school class in Walhalla, SC
  • Two Chromebooks for Ms. V’s middle school class in Phoenix, AZ
  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • A Chromebook for Mr. S’s second grade class in Buena Park, CA
  • 18 sets of headphones for Mrs. F’s kindergarten class in Hampton, VA
  • Math centers for Ms. R’s kindergarten autism class in Newport News, VA
  • Five Chromebooks for Mr. V’s high school biology class in Lake, MS
  • Four science activity tubs for Mrs. B’s elementary school class in Fayetteville, NC
  • A document camera, projector, laser printer, and other projection supplies for Mrs. A’s middle school class in Oakland, CA
  • 3D printer pens for Mr. C’s robotics competition team in San Jose, CA
  • Five Chromebooks and 15 sets of headphones for Ms. K’s fourth grade class in Detroit, MI
  • Programmable robots for Mrs. O’s elementary school library maker space  in Katy, TX
  • A bamboo building block set for Mrs. B’s kindergarten class in Sumas, WA
  • 30 sets of headphones for Mrs. D’s elementary school class in Sumter, SC
  • $200 toward getting 10 Chromebooks for Mr. P’s 10th-grade class in Plant City, FL

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Ms. L responded quickly even though Detroit schools were closed Tuesday: “I am beyond excited and grateful for your generous contribution! I can’t begin to explain how much these computers, headphones, and Flocabulary subscription will impact my students. We have been struggling with a lack of technological resources that has made it difficult to use the computer programs that are available to us in a meaningful and effective way. Your donation is helping bring up-to-date, WORKING, technology to our classroom. My students and I can’t say enough thank yous!”

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Mrs. E from South Carolina says her students are learning from the programmable robots we provided in funding her DonorsChoose grant request. A snip of her email: “Many of the students come from low-income families that would never have had an opportunity to work with these tools if we didn’t have them at school. One of my students wrote in his thank you letter, ‘I have never in my whole life seen or touched a robot. They do really cool stuff.’ You have made a real difference in the lives of these students, not only by your donation in allowing the purchase of these materials, but also that someone cares enough about them to donate.”

Listening: new from 19-year-old Irish singer Catherine McGrath, who seems to be minimally known even though that should probably change. It’s sort of like pop-oriented US country music sung by Dolores O’Riordan of the Cranberries. Also: new from Columbus, OH-based science fiction-themed hard rockers Starset. One more: the amazing Christian hard rockers Skillet. Check out UK-born drummer-singer Jen Ledger, who plays with hair-flying, thrashing joy that reminds me of a female Keith Moon. Skillet’s tour starts January 28 and includes health IT towns like Madison, Philadelphia, and Indianapolis; they have over 1,000 Ticketmaster reviews with a five-star average and I’m pretty sure they would be entirely worth the $30 or so ticket price.


Last Week’s Most Interesting News

  • The Department of Justice gives anti-trust clearance to the creation of a new health IT company by McKesson and Change Healthcare.
  • CMS indicates that 171,000 Medicare-eligible providers will receive an EHR Incentive Program downward adjustment in 2017.
  • HIMSS announces the retirement of President and CEO Steve Lieber, effective at the end of 2017.
  • A JAMA-published observational study involving Medicare ICU patients finds that those overseen by female intensivists experience better outcomes than those with male doctors.
  • HHS tweaks the Health Insurance Marketplace rules for 2018, with the most significant changes involving risk pools.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.


Acquisitions, Funding, Business, and Stock

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A business site profiles the South Korea-based hospital-vendor partnership behind Bestcare 2.0, a hospital information system deployed in South Korea and Saudi Arabia that the group hopes to expand into the US market.


Decisions

  • Marina Del Rey Hospital (CA) will switch from Cerner Soarian to Epic.
  • Virginia Gay Hospital (IA) moved from CPSI to Epic In November 2016.
  • St. Mary’s Hospital (CT) will replace McKesson Paragon with Epic in July 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


Government and Politics

A New York Times opinion piece urges President-elect Trump to follow through on his previously expressed support for universal health insurance, warning him that Republicans in Congress (including his nominee for HHS secretary, Congressman Tom Price, MD) are giving him bad advice in pretending to support such a program while actually pushing “repeal and delay” without any plan of their own to replace the Affordable Care Act and thus driving insurers faced with poor risk pools out of the market. It recommends,

The crucial first step is to avoid repealing the insurance expansion without simultaneously replacing it. The new Congress comes to Washington next week, and its members should know where you stand from the beginning. It won’t work to promise millions of people health insurance on spec. If you avoid this trap, you can then push both parties toward a different version of universal health coverage.

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FDA issues final guidance on post-market medical device cybersecurity.


Other

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Lisa “Venture Valkyrie” Suennen posts her annual holiday song lyrics parody “Thriving Here in Venture Fundingland,” sung to the tune of “Walking in a Winter Wonderland.” She just took a job as managing director of GE Ventures.

A Black Book poll of C-suite provider executives predicts these trends for the first half of 2017:

  1. Hospital IT budgets will remain flat while physician practices will cut their technology spending an average of 13 percent from 2016.
  2. Electronic data warehouses will top the list of short-term priorities.
  3. Hospital interest in enterprise resource planning systems will be restored in a value-based care environment.
  4. Most hospitals haven’t budgeted for projects that would increase interoperability.
  5. Large hospital groups fear that cyberattacks will move upstream from the mostly small facilities that were impacted in 2016, expressing concerns about insufficient threat detection systems and the possibility of security alert fatigue.
  6. Hospitals are confident about their cloud application strategies even though most of them haven’t bought cloud-based disaster recovery solutions or don’t understand what they have purchased.
  7. Small-hospital CFOs will revise their RCM strategies and increase their focus on coding and clinical documentation improvement, with many of them considering outsourcing.
  8. Salaries for hard-to-find skills such as healthcare analytics, big data, security, mobile, and cloud technologies will jump as competition heats up and H-1B visa programs could be scaled back.
  9. Providers are interested in precision medicine, but nobody’s really buying systems to address it due to expected implementation difficulty.

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The New York Times profiles the failed attempt of North Carolina physician group Cornerstone Health Care to transition to an ACO care model. The practice lost a third of its doctors (especially its high-revenue specialists) to higher-paying hospitals such as UNC Health Care; it had to borrow $20 million for capital projects such as new IT systems; and some of its doctors sued it in claiming that their compensation was reduced arbitrarily to cover debts incurred due to mismanagement. The practice ended up selling out to Wake Forest Baptist  Health, which experts say is likely to raise costs as the focus changes from keeping patients healthy to feeding the hospital’s revenue-generating departments.

A CDC survey finds that physicians rarely collaborate with laboratory professionals in the 15 percent of encounters in which they aren’t sure how to order diagnostic tests and the 8 percent in which they received results they don’t understand. The primary barriers are that doctors don’t know who to contact or don’t have the time to do so. Physician respondents suggested adding lab ordering criteria to CPOE systems, publishing mobile clinical decision support apps, and adding lab professionals to multidisciplinary rounding teams.

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Medical University of South Carolina will open an Apple-sanctioned retail computer store in its library that will offer discounted Apple and Dell products to students and faculty. It’s also considering using the store to provide health-focused technology, such as healthcare apps, to patients.


Sponsor Updates

  • Horses for Sources and its research division cover a patient experience redesign project at Lawrence General Hospital led by  Sutherland Global Services.

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 12/26/16

December 25, 2016 News 3 Comments

Cornerstone: The Rise and Fall of a Health Care Experiment

The New York Times profiles provider group and accountable care organization Cornerstone Health Care (NC), telling the story of its transition to ACO status and its eventual sale to Wake Forest Baptist Medical Center.

Year in Review: Cerner presses forward despite year of uncertainty

Cerner closes out 2016, a year that brought with it CEO Neal Patterson’s cancer diagnosis, delays on its DoD implementation, and ongoing construction at its new Kansas City campus.

Medical scribes free doctors to spend more time with patients

A local paper reports on the introduction of medical scribes in the CHI Memorial (TN) emergency department, linking the rise of scribes to ARRA and the resulting increase in EHR use by providers.

Morning Headlines 12/23/16

December 23, 2016 News No Comments

Google Deepmind and Imperial in streams deal

Google’s UK artificial intelligence company, Deepmind, will implement its only non-AI app, Streams at Imperial College Healthcare NHS Trust. Streams monitors clinical information and alerts doctors of deteriorating patients.

Analysis of Nearly 51,000 Geisinger Patient Exomes, EHRs Reveal Actionable Variants, Drug Targets

A study analyzing the DNA and EHR data of 51,000 patients finds that 3.5 percent of the study participants had clinically actionable variants.

Eight More Health Systems Join Growing Support for Surescripts National Record Locator Service

Eight new health systems have joined the Surescripts National Record Locator Service, which runs patient record searches within the Carequality HIE.

UMass Memorial posts $68M surplus for 2016

UMass Memorial Health Care reports a $68 million surplus in 2016, up from $47 million last year, despite $125 million in new debt that it is using to implement Epic.

News 12/23/16

December 22, 2016 News 6 Comments

Top News

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The Department of Justice gives anti-trust clearance to the previously announced creation of a new health IT company by McKesson and Change Healthcare, clearing the way for the deal to go through as planned in the first half of 2017.

McKesson will own 70 percent of the new company, to which it will contribute most of McKesson Technology Solutions.


Reader Comments

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From CCOW, MUCOW: “Re: Meaningful Use penalties. A CMS document says it will apply a downward payment adjustment to 171,000 EPs in 2017 for failing to demonstrate MU.” I’ve long lost interest in Meaningful Use and its offspring. We as taxpayers have paid $35 billion to bribe doctors to use old, poor-selling EHRs they wouldn’t use voluntarily, which is maybe a first in any industry. I suppose that as a stimulus package, it delivered the expected economic benefit (although it was late to the party by the time the details were worked out), but I’m not seeing much difference in cost or quality so far. Maybe it’s a laying-the-tracks sort of thing that will pay for itself downstream. Meanwhile, I read somewhere that ONC now has 400 employees, reproducing itself like typically virulent federal agencies, departments, and offices.

From Piezo DeVoltaic: “Re: equipment. Other than the Wi-Fi adapter you mentioned, what else do you use to write HIStalk?” I have a Toshiba laptop that I got from Office Depot for less than $300 several years ago and a 27-inch Acer monitor that I think cost around $130. That’s it other than keyboards, which I go through frequently due to the volume of writing I put out – I buy the basic Microsoft wired keyboards three at a time since they’re only around $12. Starting on a new keyboard is like a new beginning because I’m always snacking while working due to lack of time, so the crumb load is significant (shaking my keyboard upside down looks like a snowstorm). On the non-work front, I have an iPad Mini and my beloved Chromebook. I also need to replace my iPhone 5 at some point, I suppose, although I can’t get excited about the iPhone 7 Plus that seems like its logical successor.

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From LFI Masuka: “Re: article comparing medicine to ‘Moneyball.’ The movie was really about using statistics to better value assets in an environment of limited money to spend on those assets. The vision was not getting the best possible Oakland A’s – it was getting the best Oakland A’s for a reasonable price. The equivalent for medicine would not be best practices – it would be to set up budgeted compensation guidelines to more realistically address those activities that promote long-term health. Getting more bang for our collective bucks. Without the financial aspect, Medicineball is what we used to call ‘science.’” I like that. I would also say that it’s a subtle but important mistake to assume that hospitals are best equipped to do anything more than patch people up and send big bills after they treat ‘em and street ‘em. Somehow everybody just accepts that hospitals are the logical overseers of population health management. I disagree. Most of us see our PCPs a lot more often than we have a hospital encounter, not to mention that hospitals are notoriously bureaucratic and inefficient. Maybe it’s because the doors of medical practices are locked at least 75 percent of the time, sticking hospitals with less-convenient coverage hours but making them the most reliable and accessible provider. I’ve spent most of my career working in hospitals and I would never (a) donate money to them, (b) trust them; or (c) become their inpatient without having someone sitting at the foot of my bed at all times to catch their inevitable mistakes. They’re like universities – too much emphasis on money, overly large employee egos, and an inflated sense of entitlement and global self-importance.


HIStalk Announcements and Requests

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Donations from three HIStalk readers, paired with matching money from my anonymous vendor executive, allowed me to fund these DonorsChoose projects:

  • An Osmo Wonder Kit for Ms. F’s sixth grade class in Costa Mesa, CA
  • Science, STEM, and weather books Ms. H’s second grade class in Fayetteville, NC
  • Scientific calculators for Ms. H’s seventh grade class in Indianapolis, IN

Ms. H responded quickly to the news that her project was funded. “I am so grateful that you are helping us out. We do not get a lot of science materials in second grade. This is exactly what I needed for my students when we come back from the winter break. I can’t tell you how much this means to me to give my students the best so they can learn. My kids love science and now you are giving us materials for them to really dig in and learn. You are the best.”

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Ms. C sent photos from her California middle school showing the daily news show equipment we provided in funding her DonorsChoose grant request (microphones, a $50 camera-equipped drone, iPhone tripods and clips, and accessories).

A TV show is on in the background as I’m writing, in which a limelight-seeking singer is butchering a Christmas carol with overwrought vocal gymnastics in an ill-advised attempt to “make it her own” instead of just singing the damned thing without gimmicking it up. The only worse thing I’ve heard is when a “Nashville recording artist” wearing a laughably misplaced cowboy hat hacks up the National Anthem before a Nascar race, providing 10 bad, rambling notes for every one that was originally written. Even the “artists” who follow the Star-Spangled Banner reasonably well still feel compelled to wing it toward the end, probably in relief for remembering all the words. Apparently they are mistaken in thinking they know better than the composer.

This week on HIStalk Practice: Fallas Family Vision selects RevolutionEHR. Greenwood Genetic Center launches telegenetics program in South Carolina. Michigan will implement Appriss Health’s prescription monitoring program tech. Orthopedic + Fracture Specialists goes with Odoro patient self-scheduling software. MedStar NRH’s John Brickley outlines the challenges PTs face when selecting health IT. Our Children Our Future selects TenEleven Group’s behavioral health EHR. Walgreens looks to Matter for innovation inspiration as it works out Theranos kinks. Palo Alto Networks’ Matt Mellen offers ways to spot spoofing in healthcare emails.

I’m leaning toward taking the weekend off from writing HIStalk, so if indeed I do, have a Merry Christmas or whatever holiday (if any) you celebrate. I don’t gain much wisdom from Facebook, but I liked a quote I saw there: “It’s not what’s under the Christmas tree — it’s who’s around it.”


Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.


Sales

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In England, Allscripts PAS customer Dudley Group NHS Foundation Trust adds Sunrise and dbMotion.

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Deborah Heart and Lung Center (NJ) will upgrade to Meditech Web Ambulatory and 6.1.

In England, Imperial College Healthcare NHS Trust will implement Google-owned DeepMind clinical deterioration detection system.


Announcements and Implementations

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Eight large health systems go live with the Surescripts National Record Locator Service. The company offers EHR vendors free access to the system, which operates under Carequality’s framework, until 2019.


Privacy and Security

From DataBreaches.net:

  • A security firm’s analysis finds that the black market price of a patient’s complete medical record has dropped over several years from $50 to less than $10, which has caused cybercriminals to refocus their efforts on spreading the more profitable ransomware.
  • Fairbanks Hospital (IN) notifies an unspecified number of patients that their information was visible to unauthorized employees for several years, adding that it’s not even sure who viewed the information.
  • Henry County Health Department (OH) alerts 500 of its home health and hospice patients that their information was contained on a nurse’s stolen laptop, adding that it will start encrypting laptops.
  • Community Health Plan of Washington notifies 400,000 current and former members that a security vulnerability in the network of contractor NTT Data exposed their information. 

Innovation and Research

A Geisinger study in which patient genomes were matched to their EHR information finds actionable variants for familial hypercholesterolemia in 3.5 percent of those studied.


Other

The $125 million that UMass Memorial Health Care (MA) borrowed for its Epic implementation reduced its fiscal year operating profit, but it still made $47 million vs. $58 million last year.

Saint Vincent Hospital (PA) is forced by the Equal Employment Opportunity Commission to rehire six former employees it fired in 2013 for refusing to take a flu shot and then providing questionable clergy-signed documentation of their claimed religious beliefs. EEOC says the hospital’s requirement constitutes religious discrimination. The hospital must now accept any excuse an employee offers for declining to be immunized.

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Denver Health (CO) fires $360,000-per-year pediatric anesthesiologist Michelle Herren, MD for posting Facebook comments about First Lady MIchelle Obama that said, “Doesn’t seem to be speaking too eloquently here, thank god we can’t hear her! Harvard??? That’s a place for ‘entitled’ folks said all the liberals! Monkey face and poor ebonic English!!! There! I feel better and am still not racist!!! Just calling it like it is!" She apologized, saying she didn’t realize “monkey face” might be taken as racist, that her comments were taken out of context,  and that she thinks it’s a double standard that everyone can make fun of Melania Trump but the First Lady is off limits. Unlike Ms. Obama’s degrees from Princeton and Harvard, the exclamation point-shrieking Dr. Herren earned her medical degree from Nebraska’s Creighton University, ranked among the bottom 15 US medical schools.

Weird News Andy offers his Merry Christmas story. New Mexico Department of Health epidemiologists investigate their own agency’s catered holiday lunch after 70 of its employees get sick afterward. I don’t usually worry about catered food, but I’m nervous  about eating at potlucks or picnics, where you can’t verify the food safety standards employed by well-intentioned people who don’t understand that food needs to be refrigerated as soon as it’s cooked and until it’s heated and eaten. Compounding the problem is that hospitals and office buildings don’t always have a real kitchen with big enough refrigerators to hold everybody’s dishes for several hours or a range to heat them up, so there’s always a big line waiting for the cheap, countertop microwave. Think twice before you take leftovers home. Sometimes I think that every American should take a food safety course since it’s surprising how many people leave food out after cooking or after eating, somehow thinking that simply covering it keeps bacteria out.  


Sponsor Updates

Holiday Activities

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PeriGen and its new acquisition WatchChild hold their first combined team meeting in Cary, NC, with employees also building 10 bicycles for the local Big Brothers, Big Sisters organization, They were surprised afterward to be joined by the children whose bikes they had just built.

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Xerox Healthcare donates gifts to the Northern Rivers Holiday Giving Campaign.

  • Consulting Magazine awards Impact Advisors VP Jenny McCaskey a Lifetime Achievement Award.
  • Everest Group places NTT Data Services in the Leader quartile for three of the 2016 Peak Matrix Assessments, including the new EHR category.
  • PatientKeeper releases a new video featuring customer reviews of their charge-capture solution.
  • The SSI Group raises money to place over 400 wreaths on the graves of veterans.

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 12/21/16

December 20, 2016 News 15 Comments

Top News

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HIMSS announces that President and CEO Steve Lieber will retire at the end of 2017. The organization has opened a search for his successor.

Lieber seems a bit young (63) to be retiring. The timing is interesting since EVPs John Hoyt and Norris Orms announced their retirement in February 2016, yet both are still working – Hoyt is consulting back with HIMSS Analytics and Orms is a VP of a recruiting firm.

About the only long-time senior executive left will be Carla Smith, who would seem to have a good shot at replacing Lieber unless the intention is to start over with a clean slate for whatever reason.


Reader Comments

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From Spilt Infinitive: “Re: like/dislike buttons for comments. Have you considered adding them? I like that online articles in the Economist, WSJ, NYT, etc. show me which comments are most liked by readers. It’s also satisfying when people ‘like’ my comments.” Good idea. I’ve added that capability to both articles and comments. You are now free to like and be liked as much as you like.


HIStalk Announcements and Requests

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An anonymous vendor executive has once again donated $10,000 for use as DonorsChoose matching funds, meaning that for every dollar donated by HIStalk readers, the executive will match it (along with likely other available  matching money from the corporate partners of DonorsChoose). I’m not soliciting donations since charitable contributions are a personal decision, but those who want to get extra bang for their educational donation buck can do this:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

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Ms. M from Illinois expressed a lot of appreciation for our funding of her small DonorsChoose grant request (around $100) to provide nine sets of headphones for the reading center of her elementary school special education class. Students started using them the day they arrived, as she explains, “The morning of this grant getting funded, I had to throw away all of our classroom headphones because the ear pieces broke from wear and tear. All I can say, is that you made my students feel so special and they had the biggest smiles on their faces. I sincerely thank you for making such a significant sacrifice to our classroom.”

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HISsies nominations remain open. I’ve received only 12 responses that may or may not be representative of popular opinion (I can tell you for sure that some of them are way out there), so don’t blame me if major omissions creep onto the final ballot because you didn’t nominate obvious choices.

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Welcome to new HIStalk Gold Sponsor Dynamic Computing Services. The nationwide staffing and IT consulting firm — founded in 1990 by Gary Sherrell — has offices in Austin, TX and Maple Valley, WA. Healthcare makes up more than 50 percent of its business, where it has placed more than 3,100 resources and earned an 80 percent repeat business rate. DCS services include staff augmentation, legacy support, optimization, project management, analytics, and technical services. The company has completed 1,200 health IT projects – 200 of them involving Epic’s systems – and supports all major EHR vendors. Candidates can check out their open positions. Thanks to Dynamic Computing Services for supporting HIStalk.

A slight majority of poll respondents think I should list contract extensions and upgrades in my “Sales” section, but some commenters agree with me that we’re mostly interested when a hospital switches vendors. Others, however, point out that the hospital may have undertaken a full product search before re-upping with their same vendor (even though we have no way of knowing if that’s the case) and that might make it newsworthy. I think I’ll go this route – I won’t run contract extensions or seemingly minor expansions of the original agreement (like adding one more minor module when re-upping), but a product conversion like Meditech Magic to EHR or Soarian to Millennium is probably newsworthy.

To my fellow progressive music fans: Yes is finally chosen for induction in the Rock and Roll Hall of Fame after three tries. The Hall-accepted lineup contains the obvious choices from the dozens of musicians who have been part of Yes over its nearly 50 years – Anderson, Bruford, Howe, Rabin, Squire, Wakeman, White, and Kaye (I would have omitted Rabin and included Peter Banks). Yes shares a dubious distinction with its fellow 2017 inductee Journey: both bands tour today with a sound-alike replacement lead singer they found by watching YouTube videos of crappy tribute bands covering their hits, keeping the cash registers ringing from non-purist fans who just want to hear familiar heyday hits in a slightly elevated form of karaoke. It will be awkward if the bands play at their induction since they have three choices: (a) reconfigure in an uncomfortable, temporary reconciliation that omits current members who weren’t named; (b) play without key personnel from their glory years; or (c) fill the stage with a bevy of former and current members like Yes did on its cobbled-together and dishonestly named Union tour of 1991 that was more of a redundancy-filled, synergy-seeking corporate merger than an organic (no Wakeman pun intended) artistic effort.


Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.


Acquisitions, Funding, Business, and Stock

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TPG Capital will acquire healthcare software vendor Mediware from its private equity owner Thoma Bravo. TPG’s portfolio also includes Evolent Health, PatientSafe Solutions, and Quintiles.

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India-based cloud services provider 8K Miles will acquire healthcare consulting firm Cornerstone Advisors Group for $10.25 million in cash and stock. Cornerstone was founded in 2008 by Keith Ryan, who was previously CIO at Stamford Health System and Elmhurst Memorial Hospital. Reader Dave notes that the acquiring US entity had $5 million in profit on $27 million in revenue last year, with the overall entity reporting $40 million in revenue.

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Active aging app vendor GreatCall acquires remote monitoring technology company HealthSense.


People

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Gil Enos (EHealth Intelligence) joins WiserMazars LLP’s healthcare consulting group as principal.

Digital rehab technology vendor Reflexion Health hires Sudipto Sur, PhD (Signal Genetics) as CTO.


Announcements and Implementations

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BayCare (FL) implements an electronic screening system for newborns that allows sending EHR-stored patient information electronically to the state’s department of health.

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University of Miami Health System (FL) will take over 17 Walgreens retail clinics in South Florida and will use the drug chain as its exclusive retail pharmacy provider. Both organizations use Epic.

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Caradigm enhances its population health management solutions to support MACRA and bundled payments, adding Care Bundles, Content Builder, MACRA solutions, Advanced Computation Engine, and Utilization and Financial Analytics.

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A Healthgrades survey finds that most consumers would choose a doctor who has limited appointment openings but who offers online scheduling over a more available doctor who schedules appointments only by telephone. Two-thirds would be willing to trade a convenient location for being able to schedule online. The company’s new physician directory enhancements include online scheduling, smart reminders, and Google Maps integration. I only wish Healthgrades would eliminate the entirely incorrect inclusion of the non-specific, redundant social title “Dr.” in front of the name that already includes the correct designation of “MD.”

Iatric Systems is developing IV-EHR interoperability with Hospira’s smart infusion pumps using its Accelero Connect technology. 


Government and Politics

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ONC’s Director of Public Affairs and Communications Meghan Roh joins Epic as director of public affairs. I don’t know if this is a newly created position, but it’s interesting that Epic is hiring someone with quite a bit of political and government experience.

A Massachusetts law takes effect January 1, 2017 that requires doctors to give patients electronic access to their medical records and to use EHRs that are connected to the Massachusetts Health Information Highway.


Privacy and Security

From DataBreaches.net:

  • A Texas company that provides elective ultrasound baby pictures exposes its images, physician reports, and employee information to Web searches after misconfiguring a server to activate an unsecured RSYNC directory synchronization protocol.

TMZ reports that UCLA Medical Center (CA) may discipline several dozen employees who couldn’t resist snooping around in the medical records of Kanye West during his recent breakdown-triggered stay. It’s not the most reliable source, but the story is easily believable since not only is Kanye a big celebrity, he lost it publicly while performing


Innovation and Research

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Glytec earns its sixth patent for precision diabetes management technologies related to its SaaS-powered eGlycemic Management System that provides personalized insulin dosing, enterprise glucose surveillance, and analytics.


Other

An AHRQ-authored Health Affairs article raises concerns about the financial burden caused by high-deductible health insurance policies. I might take the contrarian approach in suggesting that high-deductible plans were created for exactly that reason – to encourage better self-care and rational health choices while exposing high prices in hopes healthcare competition will kick in (note: it hasn’t – the big just keep getting bigger). Our healthcare dollars provide way too much profit for the companies and people involved, but we also need to change the attitude that health and healthcare costs should be convenient.

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Jordan Shlain, MD is a good writer whose latest work, “Medicineball is the new Moneyball,” argues that doctors need to develop a data perspective for the good of patients. He says,

The crazy thing is that doctors, and I am one, have historically not participated in the data collection game. This was just a artifact of geeky computer science engineers building crappy code that doctors hated using (and still, mostly do.) Data will give us a new perspective — A data perspective. This new illuminating presence is an opportunity that presents itself once in a generation. We can now see things in a new light.

This puts doctors into the precarious position of being in the “if you’re not at the table, you may be on the menu” paradigm. Physician data is currently collected by EMR vendors, insurance companies, laboratory and radiology companies, pharmacies, revenue cycle management companies, and a host of other third parties — but not the doctor….or if they do, it’s the exception. I have a hard time believing that your friendly, local insurance company will happily supply doctors all they data they want. This data is expensive, comes at a premium, and is viewed through the lens of market share; not necessarily patient care. Doctors need to step up and start collecting their own data.

A New York Times article questions whether taxpayers get a good deal when NIH researchers help develop promising immunotherapy cancer drugs that are then licensed to drug companies that will make millions of dollars. Critics point out that taxpayers paying for the drugs twice — once to develop them, then again in buying them at high list prices since Medicare isn’t allowed to negotiate prices. NIH gets a tiny chunk of the proceeds as royalties, but has removed from its contracts a requirement that the drug companies sell the products at a “reasonable price.” The article notes that a  prostate cancer drug that sells for $129,000 per year in the US (two to four times what other countries pay) netted UCLA $500 million when it sold its royalties, but NIH says it’s not qualified to determine whether the price is reasonable and thus likely to make it unavailable to most people. 

An article notes indignantly but unsurprisingly that “pharmaceutical distributors have been quietly stocking pharmacy shelves with these pills in areas where addiction is the highest,” with a single West Virginia pharmacy in a town of 300 people receiving 9 million narcotics tablets to resell in two years. The article fails to mention that those doses were dispensed because they were prescribed by doctors and presumably requested by patients, both of whom escape the article’s misplaced wrath in shooting the literal messenger. The same investigative reporting methods could probably self-righteously proclaim that McDonald’s, during the same time period, sold a lot of hamburgers to massively overweight West Virginians. The key in both cases is to reduce demand, not complain that suppliers meet it.

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A JAMA-published observational study finds that Medicare patients managed by female intensivists experience lower mortality and readmission rates than those who are managed by their male counterparts. The authors cite previous studies in which female doctors were found to be more likely to practice evidence-based medicine, deliver more patient-centered care, and approach problem-solving more deliberately. The difference is not large enough to get excited about (despite the moronic USA Today headline above), but my takeaways are: (a) anyone who thinks female doctors are somehow less competent – if indeed any of those folks are still around — can see how wrong they are; and (b) it would also be interesting to similarly look at outcomes by country of medical training and the age and personality type of the doctor. I’ve worked with some flamingly incompetent physicians and many of them were questionably qualified foreign medical graduates, but that was a long time ago when standards were lower and this was in geographically undesirable areas where most of the dangerous docs were unmotivated locals or overseas opportunity-seekers. I would be happy now to have a doctor who graduated outside the US, especially since their educational system is a lot better than ours.


Sponsor Updates

Holiday Activities

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PerfectServe employees are supporting charitable programs that include donating duffel bags packed with personal items for adolescents completing treatment services; providing financial support to a co-worker who lost belongings in an apartment fire; collecting food and supplies for families affected by the Gatlinburg, TN fires; and collecting food for the Chicago food bank.

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Cumberland Consulting Group team members wrap presents for the Youth Villages Holiday Heroes Program in Nashville.

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The Ingenious Med sales team creates care packages for The Packaged Good.

  • The Chartis Group publishes a white paper titled “Post-Election Analysis: Strategic Imperatives for Providers in an Uncertain Landscape.”
  • Besler Consulting releases a new podcast, “The potential impact of the Tom Price nomination as HHS Secretary.”
  • MModal is awarded a three-year agreement as an awarded supplier to Vizient’s Novaplus, its exclusive provider of clinical documentation improvement.
  • Black Book’s latest user survey ranks Oracle Healthcare Cloud the number one ERP solution for value-based care processes.
  • InstaMed opens registration for its User Conference 2017 March 27-29 in Philadelphia.

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 12/20/16

December 19, 2016 News No Comments

How Geisinger Health System Uses Big Data to Save Lives

Harvard Business Review profiles Geisingers use of analytics and natural language processing to drive earlier identification of sepsis, improve post-acute follow up care for patients who have non-critical conditions diagnosed during a hospitalization, and track surgical outcomes and costs.

The Children of Agent Orange

ProPublica and the Virginian-Pilot analyze decades-old data from the Department of Veterans Affairs and find that the odds of having a child born with birth defects is significantly higher among veterans exposed to Agent Orange during the Vietnam War.

Amidst Political Uncertainty, the shift to Value Continues: PwC Health Research Institute’s Top Health Industry Trends for 2017

PwC publishes its list of top issues healthcare issues for 2017, which includes shifting to value-based reimbursement models, engaging patients more effectively, modernizing payment processes, and adopting new technologies to drive each of these initiatives.

Rethinking the Role of Retail Clinics

December 19, 2016 News 3 Comments

HIStalk takes a deeper dive into a recent study that found retail clinics have a negligible impact on nearby ED admissions.
By
@JennHIStalk

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Retail clinics have gotten a bad rap lately, thanks to an Annals of Emergency Medicine-published study that found the clinics had a less-than-hoped-for impact on local ED visits. While that particular statistical nugget certainly made for good headlines, a deeper dive into the research finds that such clinics may well be on their way to not only alleviating low-acuity ED visits, but to finally becoming a trusted part of the care continuum.

Evolution of a Business Model

Since debuting in 2001, retail clinics seem to have grown exponentially, taking up valuable real estate in strip malls, pharmacies, shopping malls, and even the local commuter train station. Accenture predicts that their numbers will close in on 3,000 within the next several months – a 46 percent increase over 2014 figures. Patients – primarily those with private insurance – have become accustomed to their convenient hours, accessibility, and increasingly transparent pricing.

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Health systems have certainly jumped on the retail clinic bandwagon for a variety of reasons. “Hospitals and health systems are employing a variety of strategies to reduce the use of emergency department and hospital readmissions,” says Nancy Foster, AHA’s vice president of quality and patient safety policy. “One such strategy is partnering with existing retail clinics or creating their own. This helps patients by giving them an additional access point for critical follow-up care after a hospitalization. And by having a formal partnership, the hospital or health system can more easily share follow-up instructions with clinical staff at the retail clinics.”

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Mount Sinai Health System (NY) is one such health system that has recognized the need to offer additional access points as part of broader population health programs. The system, which has seven hospitals and over 140 physician practices, announced a partnership with urgent care company CityMD earlier this month, and seems intent on closing the loop between urgent care and primary and specialty care visits. The partners plan to jointly establish quality metrics for a shared network of preferred providers, ensuring that CityMD patients have immediate access to specialty care through Mount Sinai providers. They will also share EHRs for faster data access, though they haven’t gotten into specifics as to how their respective Epic and EClinicalWorks systems will talk to one another.

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Some clinics, like the new Westmount Place Walk-in Clinic in Ontario, are opening with the express intent of alleviating the local ED’s physician shortage. “We know we are in a crisis from an emergency room perspective if our hospital is fundraising for an emergency room resident,” explains local government official Catherine Fife. “Having urgent care centers like this, which are community based, is an important asset we need to have in more communities across the province.”

Rethinking the Results

Though the Westmount clinic’s provenance puts it outside the purview of the AEM study, it provides a concrete example of the potential role retail and urgent care clinics can play in a community’s care continuum, including significantly reducing ED visits.

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This potential did not show up in study results because, according to MinuteClinic President and CVS Health Executive Vice President and Associate Chief Medical Officer Andrew Sussman, MD, it looked at data from 2,053 EDs between 2007 and 2012 – a time when awareness and general usage of retail clinics was very early on.

“The results show statistically significant reductions in low-acuity ED use for commercially insured patients in communities where retail clinics were open,” he explains. “While the reduction may be small (1.2 percent), you should keep in mind that the old data evaluated in this study had only 1,200 clinics at its peak. MinuteClinic alone has 1,100 clinics today across 33 states. The effect of retail clinics today is far greater than the early phase of their development in this study.”

“The study also doesn’t take into account the presence of any urgent care clinic sites in a particular area,” he adds. “There are far more urgent care sites, around 9,000, than retail clinics in the US overall. Urgent care has been growing at about 8 percent annually, compounding their effect. Without knowing the precise location of the large number of urgent care sites, it is impossible to interpret the trends of low-acuity care seen in EDs.”

From Concept to Cost-Savings

Sussman goes on to point out that the study’s results should ultimately be viewed through the lens of today’s healthcare ecosystem rather than that of five years ago, when “coordinated care” was still in its infancy and “value-based care” was a concept confined to a cocktail napkin. “We have far more clinics, much higher levels of utilization, and higher awareness of retail clinic services,” he says. “Also, transparent retail clinic pricing is particularly attractive to today’s growing number of Americans with high-deductible health plans, not present prior to 2012, and as consumerism in healthcare grows. In addition to private insurance, today more retail clinics accept Medicaid than they did during the study period.”

Sussman brings up a good point: Retail clinics, which traditionally have opened in suburban communities with higher-income, privately-insured consumers, are seeing reimbursement opportunities increase thanks to Medicaid expansion. Couple that with the burgeoning interest of health systems – especially where shared referral networks and healthcare technology are concerned – and you have a recipe for retail clinic success when it comes to significantly impacting ED visits and even hospital readmissions.

Sussman sums up by saying, “in today’s retail clinic world, we would expect to see even more significant reductions in ED low-acuity visits due to retail clinic presence. Many millions of patients appreciate the access to care and cost savings that retail clinics provide.”

Monday Morning Update 12/19/16

December 18, 2016 News 7 Comments

Top News

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HHS tweaks the Health Insurance Marketplace rules for plan years starting January 1, 2018, assuming it’s still around then (670,000 people signed up on Healthcare.gov last Thursday alone in its busiest day ever). The new rules, most of them addressing risk pools, include:

  • An interim final rule on the payment of premiums by third parties.
  • A pilot program program to test whether it’s worth checking the eligibility of people who sign up during special enrollment periods.
  • Risk models that take partial year enrollment and prescription drug utilization into account.
  • Creating a high-risk enrollee pool.
  • Increasing the out-of-pocket maximum to $7,350.
  • Showing an indicator of each plan’s network breadth and flagging those plans offered by a provider delivery system.

Reader Comments

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From Truven Watcher: “Re: Truven Health Analytics. Rumor was that new owner IBM was deep-sixing its Unify and Unify ACO population health initiatives, which never got off the ground. The website now shows no references to population health or those products – you get a 404 error. How long before CareEvolution, the engine for several of Truven’s products, goes away too?” Searching Truven’s site for “Unify” brings up links to now-deleted press releases and product pages. IBM acquired the company for $2.6 billion in February 2016 and rolled it into Watson Health, joining its mishmash of puzzlingly unrelated and expensive acquisitions that include Phytel, Explorys, and Merge Healthcare.

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From Stock Doc: “Re: Athenahealth. It’s hard to believe that ATHN can sustain the price bump from this week. Upping earnings guidance after a year of misses reeks of desperation to placate the Street.”

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From HIT-A-Go-Go: “Re: HIStalkapalooza. Where is it written that it must be a free event? I’d still go if there was a modest charge.” I’ve thought about requiring those who RSVP to put some financial skin into the game in hopes of reducing the maddening no-show rate of 40-60 percent, but the big challenge is that a modest payment doesn’t have much impact on the overall cost of $150-$200 or more per attendee. The facility’s minimum buy-out and the band’s fixed cost means I can’t really flex it down (I created a horrifically complex Excel worksheet to try to find the sweet spot in telling me how many people I can invite vs. the bar, food, and endless service charges). The amount of financial risk and work makes me yearn for my original vision – a do-it-yourself kind of keg and barbeque party with a marginally skilled but really loud local band blasting away in a vacant parking lot where anyone with a HIMSS conference badge is welcome to attend. Every year I swear I won’t do it again because it’s too much to manage, but then I see how much fun people have and I soften up.


HIStalk Announcements and Requests

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Half of poll respondents expect their overall 2017 health spending to be modestly more than in 2016, while 29 percent say they’ll probably spend a lot more next year.

New poll to your right or here: Which inpatient EHR vendor seemed to gain the most ground in 2016? Your answer will be subjective, but that’s OK since perception is often reality in HIT-land.

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Mrs. M says her Virginia third graders are using the science equipment we provided in funding her DonorsChoose grant request to make real-world connections to what they’re studying. They are working with a gemstone dig kit, a microscope, a terrarium, and a chain reaction kit.

While reading “Between You & Me: Confessions of a Comma Queen” last week, I was grammatically inspired to think about which conversational traits I find most puzzling. Maybe it’s blurting out “Yeah, no” or “No, yeah” in an excited response to a question or statement that the original speaker has barely completed. It’s often young uptalkers who do it, I’ve noted, and who are also prone to beginning sentences with “so.” It’s not so much the usage, but that it’s peculiar to their demographic, maybe due to sloppy phone-texting habits carried over from virtual social situations into real-life ones. I have my own conversational crosses to bear since I drop G’s at the end of words like “talking” due to being raised in a hardscrabble holler so far back that we had to pipe in daylight.

Listening: Blood Ceremony, 1970s-style, prog-influenced “flute-tinged witch rock” from Canada (think Jethro Tull mated with Coven). Singer, flutist, and organist Alia O’Brien is unsurprisingly eloquent and thoughtful given that she’s in her fourth year of her PhD studies in ethnomusicology at the University of Toronto with emphasis on the music of North American Muslims.

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My broadband provider sent a tech out to investigate my connection speed problems, which he apparently resolved by replacing some of the wiring connectors out by the street. He also mentioned that my modem is dual band and thus puts out a faster 5 GHz Wi-Fi signal that my old laptop doesn’t recognize, so it defaults to the slower connection. He suggested I try a USB wireless adapter that supports higher speeds and the $25 Net-Dyn is doing the trick – obviously the broadband provider’s throttle won’t let me greatly exceed the speed I’m paying for, but it’s definitely faster than before.


HIMSS Conference

I’m struggling to believe that it’s just nine weeks until the HIMSS conference, meaning I should get some of my many to-dos out of the way now. I say it every year, but health IT newcomers don’t appreciate the seasonality of the industry in which 75 percent of the year’s work happens between January and April when companies spend a big chunk of their marketing budgets (because of the HIMSS conference), the first financial reports of the calendar year set the tone, and lots of job-hopping and acquisitions take place.

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I’ve opened the HISsies nominations. It’s like the presidential elections – skipping the primaries means you lose the right complain about who’s on the final ballot. I’ll email the final voting ballot HIStalk readers who subscribe to my email updates (to avoid ballot box stuffing) in the next couple of weeks.

February 13-17 will be New Sponsor Intro Week on HIStalk, which I just made up. I’ll interview the CEOs of new Platinum sponsors who sign up between now and then during that prime, pre-HIMSS week (a maximum of five). Assuming they say something interesting, perhaps folks will drop by their expensive booths to check things out. Contact Lorre.

It’s not quite time to open up HIStalkapalooza invitation requests (even though I’m getting inquiries regularly), but look for that in the next 2-3 weeks.


Last Week’s Most Interesting News

  • SocialWellth resurrects the mobile health app certification program of the former Happtique, which it acquired in late 2014.
  • Scanadu ends support for its Scout, which was once touted as the early phase of tricorder-like development.
  • Carequality and CommonWell Health Alliance announce plans to allow their users to exchange information.
  • The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia, which will establish best practices for mobile health apps.
  • President Obama signs the 21st Century Cures Act into law.
  • The consumer app of Quest Diagnostics is breached, exposing the information of 34,000 users.
  • Cost estimates of California’s prison system implementation of Cerner are doubled to $400 million due to a poorly designed contract that omitted key items.
  • The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.

Webinars

None scheduled soon. Contact Lorre for webinar service


Acquisitions, Funding, Business, and Stock

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West Corporation acquires 911 ETC — which allows companies to identify the location of 911 callers within their premises — for $10 million in cash.


Decisions

  • Erlanger Bledsoe Hospital (TN) will go live on Epic in 2017.
  • FirstHealth Richmond Memorial Hospital (NC) will switch from McKesson to Epic in 2017.
  • NYC Health and Hospitals/Jacobi (NY) will go live with Epic In 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Henry Heimlich, MD, inventor of the namesake choking intervention, died Saturday at 96. He performed his own technique for the first time earlier this year in saving a fellow senior living resident.


Privacy and Security

From DataBreaches.net:

  • LA County reports that more than 100 of its employees fell for a phishing attack in a single day this year, exposing the information of 756,000 people and resulting in felony charges against the Nigerian national behind the attack.
  • A Florida man is sentenced to four years in federal prison for attempting to sell the information of 1,000 patients stolen as printed records from medical device vendor Rotech Healthcare.
  • East Valley Community Health Center (VA) announces that it was attacked by ransomware in October, although it didn’t pay the ransom. The hackers used the Shade ransomware, whose control servers were seized by Dutch police in July 2016, allowing Intel Security and Kaspersky Lab to create free unlock tools as part of the “No More Ransom” project.

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The latest Protenus breach report shows that 57 health data breaches were reported in November, although the number of records affected was lower than in June and August since no massive breaches were reported. Just over half of the breaches involved insiders, nine were due to hacking, and three of the hacks involved ransomware.

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The Yahoo breach provides a reminder that everyone should use a password management program (it also reminds me how superior Yahoo Mail is to the incredibly clunky and frustrating Gmail, having used both for years). I use the free and life-changing LastPass. Benefits:

  • You only need to remember the master LastPass password.
  • Passwords are synched and shared not only among devices, but among other people you designate for accounts you share.
  • It will automatically log you into sites if you choose.
  • It will store multiple credentials for the same site, so that if you have both a business and personal Facebook or Twitter account, you choose which one to launch.
  • Changing a password is no big deal since it’s invisible afterward – LastPass logs you in normally using the new password behind the scenes.
  • Best of all, you can create complex passwords (or let LastPass create them for you) because you don’t have to remember them. Alt-G brings up a password generation menu, I just figured out. It even has a one-click change option where it logs into a site, changes the password to an automatically generated complex one, and then saves it.

Technology

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A startup in Kenya is developing Flare, an Uber-like app for summoning an ambulance, hoping to reduce the two-hour delay involved with getting help from private ambulance companies in Nairobi. Users will be able to call an ambulance, stay in contact with the driver, and send their location with directions.


Other

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A hospital in Canada blames a parking company’s software bug for charging a visitor’s credit card $320 for one hour of parking instead of the correct $6 shown by his receipt. The hospital is about as consumer friendly as most – it advised the man to fill out a form and wait 4-6 weeks, after which he “may” get a refund check.

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@EricTopol always finds interesting articles to tweet about, including this brilliantly written one in the New York Times Magazine (so good, in fact, that I subscribed to the digital version of the paper for the first time since good journalism and sharp writing is nearly impossible to find – the holiday special is just $98 per year). It describes how Google has rebuilt its popular Translate service to use artificial intelligence — allowing it to provide results much closer to those of human translators — and the rapidly evolving state of AI in general. The article notes that artificial intelligence is built without rules or assumptions and “learns” from what it observes, just like children who learn to speak without studying dictionaries first. It provides the work of radiologists as an example:

Medical diagnosis is one field most immediately, and perhaps unpredictably, threatened by machine learning. Radiologists are extensively trained and extremely well paid, and we think of their skill as one of professional insight — the highest register of thought. In the past year alone, researchers have shown not only that neural networks can find tumors in medical images much earlier than their human counterparts but also that machines can even make such diagnoses from the texts of pathology reports. What radiologists do turns out to be something much closer to predictive pattern-matching than logical analysis. They’re not telling you what caused the cancer; they’re just telling you it’s there.

John Halamka visits Israel with a Massachusetts trade delegation, leaving impressed with the confidence and self-sufficiency of children there (vs. the US, where he says “we’ve become helicopter parents and consider child self-sufficiency a risk”) and the large number of students who participate in military service before going to college. He will create a program for Israel-based companies to pilot their software in Boston.

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This is pretty cool: Visage Imaging sends up a drone inside the RSNA exhibit hall (before it opens) to provide an unusual perspective of their booth. I wonder if conferences will have to implement no-fly zones to prevent competitor espionage? It’s probably that or an overzealous vendor will shoot down another vendor’s drone and display it proudly in their booth. It would be cool to film HIStalkapalooza from a drone inside the House of Blues, but lawyers would have a field day if it came crashing down on the heads of unsuspecting attendees.

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Bizarre: a panicked passer-by calls 911 when she spots what appears to be a elderly woman frozen to death in a car in Hudson, NY (a not-unreasonable assumption since it was only 8 degrees there). Police rush to the scene and smash through the car window hoping to save the woman, who turned out to be the very lifelike CPR dummy of a medical training aids salesman who indignantly explained that he always straps it into the front seat beside him for transport (want to bet he travels solo on highways with an HOV lane?) I’m skeptical of his story because nobody’s CPR dummy is that realistic and dressing them up doesn’t make sense.

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‘Tis the season: Bethlehem, PA police arrest a local woman for stealing a baby Jesus from a nativity scene and dropping it off at the “safe space” of a hospital with a note signed by “concerned citizens” that said, “Child has a broken right foot which has been neglected. Parents Joseph and Mary Christ got a warning.” The woman says it was a joke, the long-tail humor of which she can contemplate during her court-mandated psychiatric evaluation.


Sponsor Updates

  • KLAS names Talksoft the highest-rated vendor for outreach services in its patient outreach report.
  • Computerworld recognizes TransUnion Chief Information and Technology Officer Mohit Kapoor as a 2017 Premier 100 Technology Leader.
  • Consulting Magazine recognizes Huron Consulting Group for its commitment to corporate social responsibility.
  • In England, Countess of Chester Hospital NHS Foundation Trust will pilot the Care Coordination Center Model using technology from TeleTracking to manage beds, patients, employees, and equipment.

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 12/16/16

December 15, 2016 News 2 Comments

Top News

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SocialWellth — whose parent company DHX on Monday revived the Xcertia mobile health app guidelines program with HIMSS, the AMA, and the American Heart Assocation – brings back the Happtique app certification program.

Happtique closed its doors in late 2013 after researchers found obvious security holes in apps that had passed Happtique’s certification criteria that included security. SocialWellth acquired the dregs of the company in December 2014.

Apparently SocialWellth stripped app certification out of the new Xcertia and is separately offering “to showcase their proprietary apps, offer promotions, and provide discounts and services” at an unstated cost. 


Reader Comments

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From In Poor Taste: “Re: Epic VP Eric Helsher. He took to Twitter to throw shade at CommonWell once the CEQ/CW announcement was released. He then deleted the tweet. Wonder who got to him? It was mentioned in Politico’s daily email and that probably brought unintended attention. Don’t think for a minute that Epic doesn’t take an aggressive or competitive stance on the interop topic. Shame that at least he (if not all of Epic) are keeping score on such an important topic.” The deleted tweet apparently said, “Welcome @CommonWell to the interoperability party,” which seems innocent enough. His colleague, Epic VP Peter DeVault, left this comment on my Tuesday night post that explains the company’s position:

As for Epic’s ‘notorious’ non-participation in CommonWell, I’ve been saying for years that it’s likely there will always be multiple health information exchange networks such as Care Everywhere, CommonWell, various state-run HIEs, etc., and new ones not yet born. What Carequality neatly does is provide the governance and technical framework for any of those networks to communicate with each other. What that means is that not everyone needs to belong to everyone else’s networks in order to exchange information. That was never going to happen (just as it’s never happened, to my knowledge, in any other industry). What it means most importantly is that patients who receive care at facilities that belong to different networks that have implemented the Carequality framework are much more likely to have their complete record available at the point of care.

In addition to the networks themselves implementing the Carequality framework, individual organizations that are part of those networks have to agree to the Carequality rules of the road. Almost all Epic clients have already done so, as have clients of several other vendors. Assuming many CommonWell members’ customers also agree to those rules of the road, this will be seen as having been a great day for patients.

This has never been about us versus them, although that makes better copy for the press. It’s about deploying the right technology and agreeing on the right governance to make interoperability widespread, easy, and realistic – regardless of the endpoints, so that patients get the best care. 2016 has been a good year for that.

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From Jack Polarity: “Re: rags rewriting press releases. The plagiarism checker I tried showed the so-called news item to be mostly just repurposed vendor verbiage.” And you were surprised?


HIStalk Announcements and Requests

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Our long-time HIStalkapalooza red carpet sponsor Elsevier has declined to participate this year, so I’m looking for a replacement who will get a ton of invitations and exposure. I’ll even allow the red carpet sponsor CEO to greet attendees personally, hang around backstage or in my inner sanctum, and welcome guests from the stage – because otherwise I’m writing a scarily large (and probably NSF) personal check to cover a significant chunk of the event’s cost, which will then render this 10th annual HIStalkapalooza the last one since I’m not going into debt to throw a free party. Contact Lorre. Meanwhile, thanks to the several companies that are helping to underwrite the event — I’ll recognize them soon.

I need your advice: Should a health system’s vendor contract extension or product upgrade be listed in my "Sales" section? I set up a poll so you can tell me. I’m slightly leaning toward “no” since I think readers are mostly interested only in sales involving new products, but I’m torn because of new contracts like Soarian to Millennium or Meditech Magic to Web EHR, which require the customer to sign a new contract and implement a new system.

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Mrs. G from Minnesota says her first graders are already using the new science books we recently provided in funding her DonorsChoose grant request, where she allows them to choose a book to read for 20 minutes each day and then take home to read with their families.

This week on HIStalk Practice: The Los Angeles County Dept. of Health Services selects the Ez-Cap managed care tool from Allscripts. GAO reports on a plethora of data-sharing practice challenges. Physician Retraining and Re-entry Program finds slow going in impacting physician shortage. McKesson Specialty Health expands. Seven health IT CEOs make the "Best Value" list. First Choice Healthcare Solutions CEO Chris Romandetti recounts the importance of disaster recovery preparedness in the wake of Hurricane Matthew. Marathon Health goes with Quippe documentation tech. Humana consolidates its quality metrics by 80 percent. Kansas City Care Clinic VP of Behavioral Health and Community Programs Dennis Dunmyer details the IT challenges involved with integrating primary care, behavioral health, and oral care.

Everybody has poetic songs that make them a bit sniffly. One that’s been one of my favorites for a very long time: “The Drinking Song” by the long-defunct, fantastic Moxy Fruvous. The band wouldn’t say if it’s about the obvious (alcoholism), the subtle (the AIDS epidemic), or perhaps even death-caused loss in general. On the other hand, when I want to raise some goose bumps, it’s usually the live version of  Rush’s “Working Man,” which I was fortunate to have seen played live with stunning virtuosity on their Time Machine tour.


Webinars

None scheduled soon. Contact Lorre for webinar services.

Here’s the recording of this week’s webinar, “Three Practices to Avoid Drift Between Audits.”


Acquisitions, Funding, Business, and Stock

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Athenahealth raises 2017 earnings guidance, sending shares up 23 percent Thursday. They’re still down 26 percent in the past year.

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Publicly traded physician practice EHR/PM/RCM vendor Medical Transcription Billing will sell $10 million in Series A Preferred shares to help pay for its October 2016 MediGain acquisition and to acquire more companies. Shares of the money-losing MTBC face Nasdaq delisting since they trade for $0.82, having dropped 33 percent in the past year, and are down 84 percent since the company’s July 2014 IPO. The company’s market value is $8.5 million.

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CareSync will hire 350 people as it moves its headquarters to Tampa, FL. I interviewed CEO Travis Bond a few weeks ago.

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Scanadu, the one-time disruption poster child for its Tricorder-like diagnostic device, ends support for its Scout product, explaining that it was an investigational device and the FDA required the study to be closed (the accuracy of last statement is questionable). It’s not much of a loss except to those who paid $150 and more to participate in the $1.6 million online fundraising project of Scanadu (or “Scamadu,” as upset users are calling it). Scout never lived up to the Tricorder hype anyway, having been stripped down to record just a few rather boring vital signs like temperature and heart rate for all the dozens of millions of dollars it spent on research. The company is now pitching Scanadu Vitals, which measures blood pressure, temperature, heart rate, and pulse oximetry (which it manages to spell wrong on its site). It’s not as shady as Theranos or as predictably flawed as Google Glass, but it the similarities are increasing. The product also didn’t give users access to their own data.


Sales

Workplace health center operator Marathon Health chooses Medicomp’s Quippe and its MEDCIN Knowledge Engine to transform unstructured data into meaningful information and to streamline encounter documentation with templates and workflow tools.


People

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Rachel Neill (Nordic) joins Carex Consulting Group as president.


Privacy and Security

From DataBreaches.net:

  • A single-doctor medical practice in New Jersey notifies 4,277 patients that it was hit with a ransomware attack on October 6. 
  • Yahoo says 1 billion of its accounts have been breached in an incident going back to 2013, just three months after the company reported that the information of 500 million accounts was stolen in an unrelated breach. My bet is that this second huge breach will kill Verizon’s plan acquire Yahoo for $4.8 billion.

Kent Murphy, MD of Summit ENT Associates (TN) left a comment on a recent HIStalk post stating that his practice was hit by a ransomware attack on Wednesday. He paid the demanded $1,600 ransom but his EHR isn’t back up yet.

In India, hackers breach the systems of Apollo Hospitals, the country’s biggest private hospital chain, and gain access to the medical record from the recent 75-day stay of now-deceased Jayalalithaa Jayaram, chief minister of Tamil Nadu. The hackers also breached the accounts of several journalists and found emails suggesting that Jayalalithaa was given the wrong diabetes medication. Another article notes that  her stay will cost the government at least $2 million, as the entire floor of 30 rooms surrounding hers were vacated, 39 doctors were involved, and experts were brought in from the UK and Singapore.


Innovation and Research

Amazon announces completion of the first autonomous, GPS-directed drone delivery in its Prime Air service, which dropped the customer’s package in his yard 13 minutes after he placed his order.


Other

University of Louisville pays go-away money to two former executives who are targeted in a federal investigation. The university paid former VP of Health Affairs David Dunn, MD, PhD $1.15 million to leave the school, while former CIO Priscilla Hancock received $250,000 before she retired. Also under investigation is Russell Bessette, MD, former AVP of health affairs and health informatics. The FBI is reviewing the possible misuse of federal grant money. Dunn’s attorney says he was attempting to make U of L “a leader in healthcare informatics” as authorized by the university president. Dunn and Bessette previously ran the now-defunct Health DataStream, which sued SUNY Buffalo for stealing its health status-scoring algorithms.

MD Anderson Cancer System considers layoffs and research cutbacks as its losses hit $102 million during the first two months of its fiscal year. Officials name its Epic implementation as one of the four issues affecting its financials, but its president concludes, “The situation requires serious attention, but it is not out of control, our long term balance sheet is strong.”

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As just about anyone could have predicted, Pokemon GO turned out to be a quickly-abandoned fad offering minimal long-term health benefits, with BMJ-published research concluding that while users moderately increased their daily step count right after installing it, they had returned to their old levels of inactivity within six weeks (at least those who weren’t run over by cars or shot for trespassing in wandering around in a zombie-like trance at a rate only slightly higher than among regular phone users). 

A newspaper’s field test of presenting prescriptions for two dangerously interacting drugs at 255 Chicago pharmacies finds that half them dispensed the medications with no warnings or intervention. Independent pharmacies failed 72 percent of the time vs. 49 percent for drugstore chains. The newspaper concludes that pharmacists cut corners to keep up with crushing workload demands and computer system alert fatigue may contribute, while one pharmacist said the pharmacy tech receives the warning and may or may not alert the pharmacist. “The patient will get mad if you call the doctor and take time, “ said a pharmacist who caught the potential error. “Sometimes they think it is fast food.” The report notes that while most Kmart pharmacists dispensed the risky drug combination without question, they were good about pestering the patient into signing up for the company’s loyalty program.

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A fascinating New York Times article frames the US economy (and its world-leading inequality) around the much-ballyhooed 2013 revival of the Twinkie. Private equity firms bought the brands and bakeries of bankrupt and PE-owned Hostess for $186 million, then flipped the company four years later for $2.3 billion after closing plants, slashing the workforce from 8,000 to 1,200, eliminating union contracts and pension payments, and saddling the company with a $1.3 billion loan that was used to pay the PE owners and investors in advance. The article notes that the highest-earning CEOs in the country run private equity firms, with their one-year compensation listed above (note that the group is about as diverse as Hostess’s Wonder Bread). Those CEOs defend their activities by saying their firms provided much-needed capital and expertise to turn the companies around, which nearly always involves employee takeaways. You would think news like that would encourage people to start businesses rather than serve as wage slaves for others, but I’m not sure our educational and social system is geared to produce people willing and able to become something other than faceless widgets in the means of production.

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The Pope — visiting a Vatican children’s hospital whose former president is charged with using $440,000 of its money for apartment renovations — urges its employees to resist the urge “to transform a good thing like a children’s hospital into a business, where doctors become businessmen and nurses become businessmen.” He apparently hasn’t seen the salaries that US children’s hospitals pay their executives.

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The feel-good, viral story about a terminally ill five-year-old hospital patient who died in the arms of a man portraying Santa Claus turned out to be another example of sloppy journalism intended to draw eyeballs without editorial control. The Knoxville newspaper says it can’t stand behind its original story since it can’t verify anything written by its columnist, who took the fake Santa’s description of the event at face value even though he refused to provide identities, dates, or even the name of the hospital that was supposedly involved. The worst part is that the average Facebook user wants to be entertained, not informed, and probably will neither notice nor care that the story as written was crap. I bet both the editor and the columnist (not to mention the snotty big-name papers that ran the story without question) are secretly high-fiving each other for drawing clicks at the expense of accuracy and objectivity. Just because analytically challenged readers react emotionally to a story doesn’t mean it’s true.


Sponsor Updates

  • The Orange County Register includes MedData in its list of Top Workplaces for 2016.
  • Infor will offer its customers McKesson Strategic Supply Sourcing and McKesson EIS, in turn, will offer Infor CloudSuite Healthcare to its user base.
  • Two hundred Meditech customers receive an ‘A’ hospital safety rating from The Leapfrog Group.
  • GetWellNetwork will participate in the VA’s “Telehealth Education Delivered” mobile showcase that will visit 200 VA medical centers.
  • Buyers Laboratory awards Lexmark its BLI PaceSetter 2017 award for Healthcare: Group Practices.
  • PeriGen hosts a team-building bike challenge for Big Brothers Big Sisters.
  • Surescripts recaps its video chat on the “abysmal” prior authorization process.

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 12/14/16

December 13, 2016 News 6 Comments

Top News

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CommonWell Health Alliance and Carequality will connect their respective systems, allowing their members to share information.

Most notable (but unstated) in the announcement is that Epic uses Carequality’s Interoperability Framework but is a notorious non-participant in CommonWell, with the agreement potentially allowing Epic to connect to other systems outside of its own proprietary connectivity suite. Likewise, Cerner is a CommonWell founding member but doesn’t participate in Carequality.

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I’m not sure if the announcement can be accurately characterized as health IT’s version of the transcontinental railroad’s golden spike, but it has potential to become a significant joining of the patient data tracks, assuming of course that competing health systems are actually willing rather than conveniently unable to exchange patient information.


Reader Comments

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From Much Too Much: “Re: HIMSS17 registration list. Vendors received it Friday. For the first time, this list does not include a postal address. Vendors wishing to send direct mail will have to have the campaign approved by HIMSS and then use HIMSS preferred mailing vendor. The cynic says this is just expanded vendor extortion, while the optimist says that maybe we’ll get less junk in the mail before the conference.” I surmise that the motivation was income rather than junk mail curtailment. However, from a purely economics standpoint, HIMSS should keep raising the exorbitant prices it charges vendors for the annual conference until they push back by not participating. The frenzy to rack up HIMSS points to allow spending even more money on prime exhibit hall square footage suggests that the supply-demand curves do not yet intersect.


HIStalk Announcements and Requests

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HIStalk reader Mike sent a DonorsChoose donation that, with some pretty amazing matching money, will give Ms. A’s fourth grade class in Stone Mountain, GA an iPad Air, Amazon Echo, and Amazon Fire and also economics books and games for Mrs. M’s gifted classes in Springdale, AR. Mrs. M responded, “It is so exciting to have others help in providing amazing resources to my students. Your generosity is appreciated more than you can imagine! I can not wait to receive these resources to share with my students! Your help allows my students to experience hands-on real world economics.”

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Mrs. G in Wisconsin says the best part of the day for her elementary school students is using the makerspace materials we provided in funding her DonorsChoose grant request, as their confidence is growing from making decisions together as teams. 

Listening: the latest album from Australia-based Wolfmother, which is down to just one of its three original members but still rocks it out well in the fashion of Black Sabbath or perhaps Led Zeppelin. If rock ever makes a comeback, these guys should be part of it.


Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.

Here’s the recording of the recent webinar titled “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” 


Acquisitions, Funding, Business, and Stock

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Analytics vendor Inovalon lowers full-year revenue and earnings guidance after a collaboration agreement with an unnamed partner fell through last week unrelated to the company’s offerings. Inovalon expects annual revenue of $426 million instead of $470 million and net income of $25 million vs. the previous guidance of $43 million. Shares were predictably hammered on the news, shedding 36 percent of their value by the market’s close on Tuesday. INOV shares are down 64 percent in the past year vs. the Nasdaq’s 12.5 percent increase.

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EHR vendor IMedicor warns that three of its financial statements from 2014 and 2015 should not be relied on because they misstated liabilities that were later discovered in a year-end audit. The amount involved was only $471,000, however, caused by double-recording the same set of warrants in two accounts. The greater question might be how a money-losing company with a market cap of barely $1 million can afford to remain publicly traded with a current share price of $0.0009, which suddenly makes that $471K seem more significant.

Canada-based VSS Medical Technologies acquires a majority interest in Legato Healthcare Marketing. VSS also owns Sigmund Software, MedicFusion, VersaForm, DeviceTrak, and Health:PCP.


Sales

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In Canada, Mackenzie Health chooses Orion Health’s Rhapsody integration engine.

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AtlantiCare Health System (NJ) selects Santa Rosa Consulting to strengthen its analytics program.

Frances Mahon Deaconess Hospital (MT) will upgrade to Meditech’s Web EHR.


People

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Tom Clark (Direct Recruiters) joins Direct Consulting Associates as VP of operations. He is a former US Army captain and Airborne Ranger.


Announcements and Implementations

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The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia, which will establish best practices for mobile health apps. It’s the second time around for Xcertia, having been originally announced a year ago under the direction of Columbia University and vendor Social Wellth, which bought the assets of defunct health app certification vendor Happtique in December 2014 and created its own app guidelines. SocialWellth CEO David Vinson created the non-profit DHX along with the AHIP insurance company trade group with the intention of offering app certification, which apparently isn’t a priority for Xcertia 2.0.

Black Book’s 2016 RCM survey finds that hospital outsourcing of complex claims has jumped from 20 percent to 40 percent in the past three years, with hospitals that previously wrote off those claims because of the effort and expertise required to pursue them realizing they were leaving significant money on the table.

Another Black Book survey finds that competing priorities have killed off hospital ERP implementations, with just a 29 percent penetration and 2 percent growth in 2015. Shockingly, more than one-third of those hospitals that have bought ERP systems aren’t keeping up with available upgrades, rendering those systems basically obsolete. More than half of hospital C-suite executives admit that they didn’t really understand their supply chain (which represents nearly a third of hospital budgets) until the move to value-based care forced them to dive deeper.

Consulting firm RTI International and Validic partner to optimize the use of wearable consumer sensors in health research.

Centralized tele-ICU programs can increase case volume by 44 percent and contribution margins by 665 percent, according to a journal-accepted study by UMass Memorial Medical Center (MA), which uses Philips eICU. 

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Connected home software vendor Orbita releases a development tool for creating Amazon Echo-powered home health voice assistant apps.


Government and Politics

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President Obama signs the 21st Century Cures Act into law.

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CMS’s chief data officer Niall Brennan is among the federal political appointees leaving their jobs (voluntarily or otherwise) with the administration change. He will be replaced in interim by Office of Enterprise Data and Analytics Deputy Director Christine Cox.

The VA creates a website for its Digital Health Platform, which describes its approach and includes use case videos. Previously issued documents indicate that the VA plans to acquire five system components:

  • An EHR
  • An operation management platform (resource allocation, financial, supply chain, and HR system) integrated with the EHR
  • A CRM system
  • An analytics system
  • An API framework

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The FTC settles consumer deception charges it had brought against Aura Labs, which sold $600,000 worth of its $4, smartphone camera-based Instant Blood Pressure app that it falsely claimed to be as accurate as a blood pressure cuff.


Privacy and Security

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Quest Diagnostics notifies 34,000 people that a hacker has breached its systems via a vulnerability in its MyQuest mobile app, exposing their demographic information and lab results. The app also allows users to record their provider contact information, prescription information, allergies, and health statistics.

Financial consulting firm PwC threatens legal action against a security advisory firm that had warned it of a vulnerability in a PwC-developed security tool, insisting that the company not go public with details. PwC says it has fixed the problem and says the security firm wasn’t licensed to work with its software. The security firm ignored the warning and published its security advisory anyway.

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Grammar matters: Russian hackers were able to penetrate the Democratic National Committee’s email system even though a Clinton campaign aide intercepted a phishing email sent to Campaign Chairman John Podesta. In his haste to alert Podesta, the aide mistyped “illegitimate email” as “legitimate email” in his urgent warning, after which Podesta obligingly clicked the phony password update link that compromised his account.


Innovation and Research

Inova Health System (VA) launches a venture capital arm and its Personalized Health Accelerator.


Technology

A surgeon in England uses Snapchat’s Spectacles – $130, camera-equipped sunglasses — to record 10-second video clips of a surgery he performed, allowing medical students follow his progress live and afterward.


Other

Cost estimates for the California prison system’s implementation of Cerner have doubled to $400 million in the past three years as the state realized it signed a contract that omitted the cost of maintenance, hardware replacement, mobile devices, additional required software, and dental recordkeeping capability. The federally appointed receiver in charge of the system mostly blames Cerner, which is being paid $177 million over 11 years, but also says his own office bears considerable responsibility for the overrun in missing several required items. He also says employees are struggling to learn the system, doctors don’t like doing their own data entry and are seeing one-third fewer patients due to the extra work required, and the pharmacy system was “damn near unusable” due to design and implementation problems. The state turned control of the prison healthcare system to the federal government in 2006 to settle lawsuits claiming that poor inmate care constituted cruel and unusual punishment. The receiver’s budget has since doubled to $1.9 billion per year.

The imaging system used by hospitals in South Australia goes down for six hours due to unspecified technical issues. 

A report from Imprivata and the Ponemon Institute finds that misidentification of hospital patients is a regular occurrence and the average hospital loses $17 million per year due to rejected claims due to missing or incorrect patient information, with respondents favoring the implementation of biometric ID at registration to improve both situations.

In England, an woman dies after a hospital admits her for a broken arm but then fails to send anyone to treat her for several days. The hospital had changed the way it lets doctors know they have new patients, moving from an old-school whiteboard to an email-based program. The patient shared a first name with another patient and the unit secretary mistakenly removed the woman’s name thinking it was a duplicate entry.

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AHRQ reports that hospital-acquired conditions are down 21 percent since 2010, with potential savings of 37,000 lives and $28 billion in costs. I guess the good news is that hospitals still harm and kill people every day with their screw-ups, but at least less often than they used to.

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A city in Japan offers free barcoded, personalized fingernail stickers for people with dementia who are prone to wandering, allowing police to scan the QR code to find their families. Stickers were already being attached to shoes or items of clothing, but those weren’t always being worn when needed.

A study finds that veterans with dementia who use the VA healthcare system and who also receive Medicare benefits have twice the odds of medication problems due to lack of connectivity between VA and non-VA doctors.

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The bond ratings agency of PeaceHealth (WA) notes that its $293 million Epic implementation costs have temporarily hurt its margins. The same agency reviews Seattle Cancer Care Alliance (WA), which it says is considering replacing its EHR  (it doesn’t say which one, but I think they’re running Cerner and they have listed Epic jobs).

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Here’s a frontlines report from the war on drugs. The owner of a chain of “clean and sober” residential drug recovery centers called “I.C. Clean People” in Washington State is arrested for drug trafficking, with a raid on his office turning up crystal meth, heroin, marijuana, oxycodone, methadone, and a loaded pistol.

Strange: a mother sues the hospital where she gave birth in a 2012 incident in which employees mistakenly gave her newborn baby to another mom to be breastfed. Abbott Northwestern Hospital (MN) says it has since switched to electronic bracelet baby-mother matching.


Sponsor Updates

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  • EClinicalWorks employees help out families through Project New Hope, Project Just Because, and the United Way.
  • Medecision launches population health management consulting services.
  • CloudMine and Validic will partner to advance integration of patient-generated health data into clinical workflows.
  • Healthgrades SVP Chris Baxley joins the Nashville Health Care Council Fellows.
  • Santa Rosa Consulting publishes a white paper titled “Critical Aspects of a Successful BI and Analytics Program.”
  • The Indo-UK Institute of Health names GE Healthcare a preferred technology partner in its IUIH Medicities program in India.
  • Agfa HealthCare will implement enterprise imaging for radiology in the first Acibadem International Medical Center in the Netherlands.
  • KLAS includes Bernoulli as a top vendor option for clinical alarm management and alarm reduction.
  • Besler Consulting releases a new podcast, Epic Conversion – Revenue Cycle Lessons Learned.
  • Elsevier Clinical Solutions offers predictions for the next 100 years of medicine.
  • Evariant releases a series of best practice guides on a variety of topics.
  • Built In Colorado features Healthgrades Director of Talent Acquisition Jenny Truax.

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 12/12/16

December 11, 2016 News 2 Comments

Top News

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The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.

PCHA — formed in 2014 by Continua Health Alliance, mHealth Summit, and HIMSS – merged with the Partners Connected Health Symposium in October 2016. 

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PCHA’s Connected Health Conference, the former mHealth Summit, kicks off today (Monday), but its speaker star power seems to have dropped off considerably since I saw Bill Gates there in 2010. Here’s what I had to say about the mHealth Summit when I attended in 2013, which anyone attending this week’s show is welcome to compare and contrast:

I felt as though I had intruded on a geeky academic conference in 2010 … Presentations back then were often about public health projects in Africa, government informatics research, and government policy … I felt somewhere between virtuous and bored being there. HIMSS, as it usually does, put all of that unsexy and unprofitable subject matter almost out of sight. Now the conference is a freewheeling ode to capitalism showcasing companies willing and able to pay big bucks for space in the exhibit hall and in the endless number of HIMSS-owned publications. The exhibit hall is like a downsized version of that at the HIMSS conference and most of the educational sessions are either about companies or feature vendor people as presenters or moderators … HIMSS seems to be positioning the mHealth Summit as the minor league of its conference portfolio. Most of the small mHealth exhibitors will be toast in a couple of years, but those who survive will graduate to the big show, the HIMSS conference … The same issues dominated this year as in 2010. Nobody’s really sure what mHealth is, basically punting off by saying anything that runs on a smart phone must be, which means the subject matter is entirely unfocused and confusing. Startup companies keep trying to convince each other that they can hang on long enough to be bought out. Everybody fervently believes that mobile apps and brash startup spirit can transform the US healthcare system into one that’s cheaper, more health-focused, and more consumer driven. It’s always easy for me to be cynical and dismissive, but especially so at the mHealth Summit.


Reader Comments

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From FlyOnTheWall: “Re: SPH Analytics. President and CEO Al Vega is out and the VPs, SVPs, and enterprise teams are all gone.” Unverified, but Vega’s bio has been expunged from the executive page and four of the eight execs listed on the August 2016 cache of the page are equally invisible. Vega’s apparent replacement, J.T. Treadwell, is a money guy who sits on the board of half a dozen companies. I didn’t recall having heard of SPH Analytics, having mentioned them just twice in HIStalk, once for hiring someone and another for choosing an underlying technology.

From The PACS Designer: “Re: CDI with ICD-10. With the launch next month of ICD-10 Procedure Codes, the increased specificity of ICD-10-PCS Clinical Document Improvement will give procedures much improved descriptions of what treatments a patient has endured. For example, a patient having a two stent insertion procedure would have the following ICD-10 Procedure Coded recorded: 02710D6 Dilation of Coronary Artery, Two Arteries, Bifurcation, with Intraluminal Device, Open Approach. This more specific ICD-10 code replaces 5 ICD-9-CM codes which are 36.03,00.41,00.44,00.46, and 36.06. As one can see, ICD-10 is a big improvement over ICD-9.”

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From Smelly James: “Re: IBM. Putting itself at the feet of Donald Trump with several healthcare mentions. It wasn’t shy about suggesting future business interest with the VA. This letter will fit well in future RFP protests.” IBM CEO Ginni Rometty apparently congratulated Trump right after the election, suggesting six areas in which IBM could support his political agenda, including a cognitive computing system for the VA. She also dropped not-so-subtle hints that IBM would appreciate his proposed changes to a “punitive” tax system in which IBM’s $68 billion offshore cash stash would be taxed at a Trump-proposed 10 percent vs. the current rate of 35 percent in bringing it into the US, saving the company (and costing taxpayers) $13.6 billion.

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From Rural HIT: “Re: Smith County Memorial Hospital and Family Practice. Went live on Cerner, the first of 25 critical access hospitals in the Great Plains Health Alliance switching to Cerner CommunityWorks.” The internal announcement suggests that the hospital was using Siemens Soarian and was steered to Millennium by its new owner Cerner.


HIStalk Announcements and Requests

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Most poll respondents are interested in the most significant international health IT news stories. Mobile Man says it’s hard to make comparisons since other countries have different payment models, while Susan is interested because we in the US think we have the best healthcare in the world but really we excel only in spending the most. HIT Geek summarizes, “Innovation has no nationality.” New poll to your right or here: how do you expect your healthcare spending (including insurance premiums) to change in 2017 vs. 2016?

Thanks to Jenn for covering my little pre-Christmas break last week. I waded deep into some HIStalk website technology catch-up when I returned, with some tricky upgrades to newer versions of PHP and other stuff that will hopefully make the site more stable and secure.

I was chatting with someone about terrible singers who still have managed to create hugely successful singing careers – the names that came up included Neil Young, Bob Dylan, Willie Nelson, and Rod Stewart. That doesn’t even count those warblers who sound passably good only through audio techno-trickery. One who could carry a tune, though, was Emerson, Lake, and Palmer’s Greg Lake (also of King Crimson), who died last week at 69. We lost two-thirds of ELP in 2016 with the suicide of Keith Emerson, leaving just P and ensuring that their collective demise will be alphabetical.

Listening: a new cover of the telethon chestnut “You’ll Never Walk Alone” from Massachusetts celt-rockers the Dropkick Murphys.

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We provided 21 sets of headphones for Ms. S’s elementary school class in Tennessee in funding her DonorsChoose grant request. She teaches math and science to two classes totaling 44 students and says the classroom sounded like an arcade as students used the Chromebooks for assigned exercises, but now it’s quiet and they can concentrate.

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Donations from reader Laura and Direct Consulting Associates, plus matching money, fully funded these DonorsChoose teacher grant requests:

  • An amplifier and microphone for Ms. L’s high school class in Center Line, MI
  • Two Chromebooks for the seventh grade math class of Ms. F in Phoenix, AZ
  • Two tablets and headphones for the kindergarten class of Ms. W in Los Angeles, CA
  • A library of 26 science books for Mrs. G’s first grade class in Saint Paul, MN
  • A greenhouse set for Mrs. M’s high school class of severely mentally and physically handicapped students in Elyria, OH
  • Eight tablets for reading and math listening libraries for Ms. B’s kindergarten class in Kansas City, MO
  • A 9×12 reading circle carpet for Mrs. V’s first grade class in Seagoville, TX
  • A document camera for Ms. B’s second grade math class in Phoenix, AZ
  • 15 sets of headphones for Mr. S’s second grade class in Yonkers, NY

Ms. W sent a note saying, “Your kindness and generosity bring tears to my eyes! I love telling my students how amazing and kind people all over the world donated and funded our projects so we can have fun learning and be successful in the future. Then, I remind them when they have accomplished that to remember to pay it forward. For now they will learn how they can help protect our environment with the tablets!”


Last Week’s Most Interesting News

  • The Senate passes the 21st Century Cures act, which includes healthcare IT provisions related to interoperability, privacy, and security.
  • Entrepreneur Sreedhar Potarazu, MD, founder, chairman, and CEO of the now-defunct business intelligence vendor VitalSpring Technologies, pleads guilty to defrauding shareholders of the company by hiding its tax liabilities, overstating its financial condition to the tune of $30 million, and falsely telling investors that the company was on the threshold of being sold for a profit.
  • CompuGroup Medical ends discussions about a possible takeover of Agfa.
  • Epic’s quality assurance employees again sue the company claiming they were misclassified in being ineligible for overtime pay.
  • China-based Apex Technology completes its acquisition of Lexmark, renaming its enterprise software group (which includes the former Perceptive Software) as Kofax and announcing plans to sell it.

Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.

Here’s the recording of last week’s webinar titled “Get Ready for Blockchain’s Disruption.”


Acquisitions, Funding, Business, and Stock

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Asset monitoring vendor Emanate Wireless raises $1.5 million in angel funding.

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Health coaching app vendor Vida Health raises $18 million in a Series B funding round, increasing its total to $24 million.


Sales

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Rusk County Memorial Hospital (WI) chooses Harris Healthcare Affinity ERP.

Los Angeles County Department of Health (CA) selects Allscripts EZCap for benefit management.


Decisions

  • Cogdell Memorial Hospital (TX) will go live on Cerner in 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Ed Park will join Athenahealth’s board following his previously announced resignation as EVP/COO that takes effect December 31.

Steve Holmquist, industry long-timer and SVP of new client development at Allscripts, died on November 29, 2016 in Phoenix, AZ. He was 55.


Announcements and Implementations

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New Zealand primary care provider Pegasus Health chooses Canada-based Intrahealth as its patient management system vendor of choice, ruling out Epic due to its cost.


Government and Politics

John Halamka summarizes the health IT impact of the 21st Century Cures act. He seems mostly positive, but is concerned about the effort required of EHR developers. His highlights:

  • ONC’s HIT Policy Committee and HIT Standards Committee will be merged into a single HIT Advisory Committee.
  • HHS is charged with developing voluntary certification of health IT for medical specialties and sites where the technology isn’t available or is not mature.
  • Vendors are prohibited from information blocking, are required to publish APIs, and must provide HHS with performance documentation. HHS is empowered to reward or punish performance as appropriate.
  • New interoperability, security, and certification testing criteria will be developed and ONC will get $15 million to support them.
  • HHS will develop or support a trusted exchange framework and ONC will publish an annual list of health information networks that are capable of using it.
  • Vendors must be able to exchange data with registries and will be treated as patient safety organizations for reporting and conducting care improvement activities.
  • The GAO will review ONC’s work on patient matching.
  • The GAO will conduct a study of the ability of patients to review their own PHI.

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NIH issues a challenge to develop a wearable sensor that can measure blood alcohol levels in real time, offering $200,000 for the first-place prototype and $100,000 for second place. The sensor would help researchers study alcohol use disorder and related conditions without relying on questionably reliable self-reported drinking data.


Privacy and Security

Fortified Health Security releases a review of 2016’s significant cybersecurity issues and its outlook for 2017.


Other

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EClinicalWorks issues a curious patient safety announcement about its EHR as part of its “ongoing effort to respond to and minimize such risks,” suggesting that users:

  • Pay attention to the company’s patient safety notices and apply available patches and upgrades
  • Update their Multum or Medispan drug databases
  • Designate a patient safety officer as ECW’s patient safety liaison
  • Confirm that orders are accurate and encourage patients and their families to do the same
  • DC and re-enter changed medication orders rather than modifying the existing order.
  • Limit the use of custom medications
  • Report any patient safety concerns or unexpected software behavior to ECW or by filing an ONC complaint.

ONC cited ECW’s announcement as the key item in its email newsletter, echoing the company’s recommendation to iECW’s customers that they apply available upgrades and report problems to the company and via ONC’s complaints website. I asked ONC If the announcement was triggered by a settlement with ECW over some unspecified issue and they said no, but the announcement suggests some kind of problem that raised ONC’s interest.

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Partners HealthCare posts its largest operating loss ever at $108 million, most of that coming from its Medicaid insurance division. Partners says it isn’t being paid enough by commercial insurers and government programs to cover its labor and drug costs. Including investment performance that must have been awful, Partners lost $249 million in 2016.

India-based media claim that 280 people have died of grief and shock following the December 5 death of Tamil Nadu Chief Minister Jayalalithaa Jayaram, raising the question (at least for me) of how their cause of death was determined. The political party in power says it will compensate their families and will also pay $750 to a party official who set himself on fire and another who cut his finger off in mourning.  


Sponsor Updates

  • Spok publishes a case study of the implementation of its Care Connect Suite at St. Dominic – Jackson Memorial Hospital (MS).
  • TelmedIQ earns a 91.4 score in KLAS’s review of secure communications.
  • Dimensional Insight earns top scores in 14 KPI categories in BARC’s “The BI Survey 16.”
  • The Chartis Group publishes “Election 2016: Implications for Providers.”
  • PeriGen’s PeriCalm Checklist is nominated for an Edison Award.
  • TeleTracking releases a new podcast, “The Essentials: 2017 Regulatory and Compliance Requirements for Patient Flow.”
  • CIOReview names Validic a Most Promising Healthcare Solution Provider of 2016.
  • Glassdoor ranks CoverMyMeds and Health Catalyst in the top 50 places to work nationally.
  • Verscend Technologies celebrates the 20th anniversary of its DxCG risk adjustment and predictive modeling solution that serves as the foundation of CMS’s hierarchical condition categories.

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 12/9/16

December 8, 2016 News No Comments

Top News

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The Senate passes the 21st Century Cures Act in a 94 to 5 vote, sending it to the President’s desk for signature. The President praised the $6.3 billion legislation Wednesday and confirmed that he would sign it. Sen. Lamar Alexander (R-TN), chairman of the Senate health committee and one of the most ardent proponents of the bill, was understandably excited given that it has been circulating for two years and is considered to be one of most heavily lobbied pieces of legislation in recent memory. It provides money for cancer research; funds mental health treatment and resources to combat the opioid abuse epidemic; helps the FDA speed up drug approvals; and bolsters healthcare technology goals related to interoperability, privacy, and security.


HIStalk Announcements and Requests

This week on HIStalk Practice: Arianna Huffington includes Doctor on Demand in new wellness venture. Banner Urgent Care goes with RCM services from Zotec Partners. Health apps found sorely lacking in privacy precautions and safety standards. Marathon Health upgrades its EHR for workplace health centers. Montana preps for statewide HIE. PPJ Healthcare Enterprises raises $5 million.


Webinars

December 14 (Wednesday) noon ET. “Three Practices to Minimize Drift Between Audits.” Sponsored by Armor. Presenter: Kurt Hagerman, CISO, Armor. Security and compliance readiness fall to the bottom of the priority lists of many organizations, where they are often treated as periodic events rather than ongoing processes. How can they improve their processes to ensure they remain secure and compliant between audits? This webinar will cover the healthcare threat landscape and provide three practices that healthcare organizations can implement to better defend their environments continuously.


Acquisitions, Funding, Business, and Stock

Google Ventures founder Bill Maris raises a $230 million venture fund dubbed Section 32 (a likely homage to Star Trek’s Section 31 security operation) that will focus on healthcare investments. Maris, who left Google earlier this year, plans to run the fund solo from San Diego rather than Silicon Valley.

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Augmedix closes a $23 million round of funding led by new investors McKesson Ventures and OrbiMed. It has raised over $60 million since launching its Google Glass-powered remote scribing service in 2012. Jenn talked with CEO and co-founder Ian Shakil about the company’s plans to move beyond its core services in “Value-based Care Prompts Glass to Grow Up.”

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Brentwood, TN-based consulting and staffing firm Vaco merges the newly acquired Pivot Point Consulting and Greythorn – both based in Washington – to form Pivot Point Consulting, a Vaco company. The new subsidiary brings together 50 employees and combines Pivot Point’s EHR implementation and advisory services with Greythorn’s recruitment expertise.

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The patent case over CRISPR-cas9 technology, likely the most valuable patent in biotechnology, begins as the University of California argues to have MIT and Harvard’s patent invalidated and transferred to UC. The patent office awarded The Broad Institute of MIT and Harvard its first CRISPR patient in April 2014, during which time it was reviewing UC’s patient, filed in May 2012.

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After much speculation, Fitbit buys Pebble’s software assets for an undisclosed sum, though Bloomberg has valued the transaction at less than $40 million. Pebble, which launched via a crowdfunding campaign in 2012, will no longer produce or sell its smartwatches.

Looking to further bolster its diminishing wearables market share, Fitbit also will work with Medtronic to add glucose monitoring to its fitness trackers. Type 2 diabetes patients will be able to combine their Fitbit-generated data with Medtronic’s IPro2 Continuous Glucose Monitoring system, which can send pertinent data to a patient’s provider.


People

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Juliana Hart (Verscend Technologies) joins MedCPU as vice president of market development.

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Brooke Patterson (FEI Systems) joins health IT and management consulting firm ARDX as SVP of government services.

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Cricket Health appoints University of California-San Francisco nephrologists Carmen Peralta, MD chair of its medical advisory board, and Anna Malkina, MD medical director.


Announcements and Implementations

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Chicago-based Union Health Service implements RadNet’s RIS, speech recognition, and mammography tracking.

Nemours Children’s Hospital, Seven Rivers Regional Medical Center, and Westchester General Hospital sign up for the Florida HIE’s event notification service, which patient hospital encounter notifications to participating ACOs, physicians, and payers.


Technology

SecureDx.net develops Secure Data Exchange messaging technology featuring two-factor authentication.


Sales

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Looking to set up a private HIE, Chicago-based Rush Health chooses HealthShare interoperability technology from InterSystems.

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Schleicher County Medical Center and Nursing Home (TX) taps CPSI subsidiary American HealthTech to help it implement technology upgrades to its clinical and business management operations. The company will also provide Medicaid AR management services.

TaraVista Behavioral Health Center (MA) signs on for MedSphere’s OpenVista EHR. The inpatient facility will also utilize the company’s Phoenix Health Systems division for IT support.


Government and Politics

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The FBI indicts 21 employees from Forest Park Medical Center (TX), claiming that they paid $40 million in bribes and kickbacks in exchange for referrals to its purely out-of-network health system. Those indicted include owners Alan Beauchamp, Richard Toussaint Jr., Wade Barker, and Wilton Burt; and Jackson Jacob and Andrea Smith, both of whom set up separate shell companies to funnel bribe and kickback payments to surgeons in exchange for the referrals.

The DoD taps Medical Information Network – North Sound to develop and maintain an HIE-like portal that will be accessible in any clinic or hospital within the DoD system. Integration with the department’s new Cerner-built EHR, currently in pilot phase at several bases in Washington, is expected.

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The House passes the telemedicine-friendly Expanding Capacity for Health Outcomes (ECHO) Act, which now heads to the president’s desk after receiving unanimous Senate approval last week. Once signed into law, the act will set in motion an HHS study on the feasibility of training providers to expand technology-enabled healthcare delivery in underserved areas.


Research and Innovation

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NantHealth makes its Quantum Immuno-oncology Lifelong Trial (QUILT) Programs available via ClinicalTrials.gov. CEO Patrick Soon-Shiong, MD believes making the QUILT trials available through the NIH registry will improve patient access to active and future immunotherapy-based trials for a variety of cancers.


Other

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Quite a space oddity: David Bowie treats former astronaut Buzz Aldrin in a New Zealand hospital after Aldrin was rescued from the South Pole after falling ill. The 86 year-old was part of a tourist group that was visiting the Amundsen-Scott South Pole Station through December 12.


Sponsor Updates

  • Imprivata will exhibit at the CIO Forum December 8 in Yorba Linda, CA.
  • Ingenious Med receives the Emerging Company of the Year Phoenix Award from the Metro Atlanta Chamber.
  • Database Trends and Applications Magazine names InterSystems Cache a trend-setting product in data and information management for 2017.
  • Kyruus will present at the Carolina Healthcare Public Relations & Marketing Society meeting December 9 in Charleston, SC.
  • Liaison Healthcare expands its relationship with London-based reseller partner AK Loman.
  • LifeImage releases video insights from RSNA 2016.
  • Gartner includes LiveProcess as a representative vendor in its 2016 market guide for clinical communication and collaboration.
  • Meditech shares a brief case study featuring Anderson Regional Medical Center (MS).
  • Netsmart will exhibit at the Community Behavioral Healthcare Association of Illinois Conference December 12 in Schaumburg.
  • Computerworld names NTT Data VP of Digital Experience Lisa Woodley a 2017 Premier 100 Technology Leader.
  • Black Book ranks Nuance first in CDI for the third consecutive year, and first for end-to-end coding, CDO, transcription, and speech-recognition technology.
  • Health Catalyst receives the 2017 Glassdoor Employee Choice Award.
  • Rock Health names Health Catalyst CEO Dan Burton the winner of its annual Most Beloved CEO award for 2017.
  • Verscend Technologies publishes a new white paper, “The Evolution of DxCG, the Gold Standard in Risk Adjustment and Predictive Modeling.”

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.

125x125_2nd_Circle

EPtalk by Dr. Jayne 12/8/16

December 8, 2016 News No Comments

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The FDA is making available its data on adverse events stemming from foods, dietary supplements, and cosmetics. I found it interesting that the coded symptom data contains numerous British English spellings: hospitalisation; dyspnea; diarrhea; and pale faeces to name a few. Pretty unusual for a United States governmental agency. Repeat offenders included the full range of “5-Hour Energy” products; B-complex vitamins; cabbage; and a number of products with the name “cleanse” in their names, which is not surprising to this physician.

I attended a continuing education session this week. Although I learned a lot, it was the first time that I heard so many gambling metaphors in one place. I’m used to hearing sports phrases, but the gambling references were new to many of the attendees. I had the privilege of explaining what “table stakes” were to a newly-minted pediatrician, as well as the meaning of “double down.” I’m grateful to my former partner who once invited me to be part of a ladies’ poker night, which ended up being less about poker and more about wine and catching up. It’s always a good reminder for presenters to consider their audience before including figures of speech. There were also some Yiddish references and some regional slang, which, although entertaining, might have been confusing to some.

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The reader mailbag brought quite a bit of correspondence this week. I always enjoy hearing from readers, even if it’s just a “thanks for writing” type comment. Being anonymous and doing most of my work solo while watching “Call the Midwife” can feel pretty lonely, so thanks for the feedback.

From Texas Tornado: “I enjoyed your recent mention on MU reporting. Would text analytics be helpful in this MU attestation scenario? I understand the push to do more discrete documentation, but what if you could report on structured and unstructured data combined? Does it really matter if the data is discrete or not as long as you can report on it?” That type of approach would certainly be appreciated by many clinicians who have been clicking their little hearts out over the last half decade. With most of the EHR-based quality reporting platforms I’ve seen, however, most documentation has to be discrete and in a fairly narrow workflow to “count” for quality measures. Ultimately, as natural language processing evolves, I think we will see more information being transformed to discrete data points; but I’d love to see some other approaches.

From Roaring Waters: “Thanks for your discussion of the need for clinical participation in IT projects. As a vendor selling to the acute care environment, I am always shocked at how often patient care workflow solutions are handed to an IT or non-clinical person to evaluate and determine how it will impact clinical workflow. I know people have been talking about end-users making user workflow decisions for decades, but for some reason these basics of project management are lost. Providers themselves are just as guilty, as I see them constantly passing these decisions off to a non-doc or non-clinical user to make decisions about their workflow and ultimately the patient care they deliver. It’s mind-boggling!” The providers that pass the buck for decision-making are often the first to complain when workflows or solutions don’t meet their needs. Another variation on this that I’ve seen lately is to pass the decision to a clinical representative who doesn’t actually practice or who doesn’t have any real buy-in to the clinical situation at the institution. I’ve been working with a group for nearly a year that has a CMO who constantly criticizes the EHR and demands a move to Epic, yet hasn’t shown up at a single executive briefing or strategy session where the EHR has been discussed. His comments are strictly hit and run via email and one-off conversations with the Board of Directors, which hasn’t learned to say no to his shenanigans. His peers are working hard for solutions and all he does is tear down their work, which is unfortunate.

From Science Guy: “Thank you for your comments about clinical staff having to take ownership of the quality reporting. Having worked in healthcare in both the payer and clinical side … there is a paradigm shift taking place that many clinicians have not come to grips with. That is that the payers are driving more and more of the clinical decisions based on outcome data and not clinical judgment. It is becoming increasingly difficult to practice medicine in a vacuum without using clinical information to justify decision making. Having worked at a University Medical Center, I saw this very plainly as the more experienced physicians struggled with this very topic and resented the IT staff for ‘creating additional hoops for them to jump through.’ I heard the statement more than once that ‘my time is too valuable for this … and my time is better spent healing patients than working on the computer.’ On the other side of the coin, there is a whole new generation of physicians coming out of school that are much more computer literate. They embrace using information from the health record to support their decision making. They realize this information could assist them with their clinical decisions, and all of this data was really just another clinical diagnostic tool to improve care. I guess my point is that like any other change, this current shift will cause a lot of frustration for a lot of staff, but it is certainly not going away. Hopefully many of the more experienced staff will be motivated to change as they see their younger peers embracing this technology and ultimately the patients will benefit from these changes. But hopefully, in the meantime, your information will help with the whole ‘shooting the messenger (the IT staff) mentality.’”

As a young physician working in clinical informatics for the first time, it took me longer than it should have to learn to stop shooting the messenger. Looking back, I realize I was working with a very inexperienced IT staff that had no idea how to work with physicians and didn’t understand how much havoc a poorly-run EHR project could have on a practice. I assumed that since the hospital had contractually agreed to provide me a paperless practice with a functional HER, that they would also provide staff that had the skills to deliver it. Some of the individuals involved in that debacle are now some of my information technology BFFs and we continue to learn a great deal from each other. Whether it was encountering chicken wire in the wall that was interfering with wireless connectivity or having providers install their own black-ops routers under their desks, it was kind of fun working in the early days (read “Wild Wild West”) of health IT.

Have you ever used poultry netting as a drywall patch? Email me.

Email Dr. Jayne.

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Reader Comments

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