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Monday Morning Update 10/17/16

October 16, 2016 News 1 Comment

Top News

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HHS publishes the final MACRA rule (2,204 pages, although much of it is draft comments with responses) with a 24-page executive summary (provided the executive in question understands a lot of jargon in sentences such as, “We are finalizing the method to calculate and disburse the lump-sum APM Incentive Payments to QPs, and we are finalizing a specific approach for calculating the APM Incentive Payment when a QP also receives non-fee-for-service payments or has received payment adjustments through the Medicare EHR Incentive Program, PQRS, VM, or MIPS during the prior period used for determining the APM Incentive Payment”) and a website explaining it.

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CMS Acting Administrator Andy Slavitt summarizes the rule:

Other than a 0.5 percent fee schedule update in 2017 and 2018, there are very few changes when the program first begins in 2017. If you already participate in an Advanced APM, your participation stays the same. If you aren’t in an Advanced APM, but are interested, more options are becoming available. If you participate in the standard Medicare quality reporting and Electronic Health Records (EHR) incentive programs, you will find MIPS simpler. And, if you see Medicare patients, but have never participated in a Medicare quality program, there are paths to choose from to get started. The first couple of years are aimed at getting physicians gradually more experienced with the program and vendors more capable of supporting physicians. We have finalized this policy with a comment period so that we can continue to improve the program based on your feedback.

Like every other notable EHR-related legislation, the final rule came out on a Friday. Industry groups seemed mostly happy with it.


Reader Comments

From The Hurricane: “Re: [vendor name omitted]. Laying off half its employees and being folded into of the parent corporation’s entities.” Unverified. I’ll keep my eye out.


HIStalk Announcements and Requests

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Nearly 60 percent of poll respondents spend little to no time in their workday talking about patients and their needs. New poll to your right or here: How much work is your organization doing to prepare for Medicare’s 2019 issuance of new ID numbers to replace SSN?


Last Week’s Most Interesting News

  • The Department of Defense moves back its first Project Genesis Cerner go-live from December 2016 to February 2017 and says it will involve only one Washington hospital rather than the originally planned two, although the project’s 2022 completion date remains unchanged.
  • A hedge fund operator and $100 million Theranos investor sues the company for securities fraud.
  • A court orders Parkview Hospital (IN) to release its chargemaster prices and insurance company discounts after an uninsured patient says his bill, which the hospital sent off to collections, is unreasonable because insurers don’t pay the full price he’s being sued over.

Webinars

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Decisions

  • Southwest General Hospital (TX) will switch from McKesson to Cerner in July 2017.
  • Central Peninsula General Hospital (AK) went live with an Infor Lawson human resources system in October 2016 and will follow with time and attendance and payroll go-lives in November.
  • Fisherman’s Hospital (FL) will go live with a Paycom Human Resources System in October 2016.

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


Government and Politics

A military-focused reporter’s article on the delay in the initial rollout of MHS Project Genesis at Fairchild Air Force Base (WA) says the DoD’s new Cerner system will be interfaced to legacy systems that include AHLTA, the ancillary department systems of CHCS, and CliniComp’s Essentris. It doesn’t indicate how or when those systems will be phased out by Cerner.

Intuit and CMS release Benefit Assist, open source software that determines eligibility for income-based government benefits.


Privacy and Security

From DataBreaches.net:

  • The Russians that hacked into the Democratic National Convention servers used a phony Gmail security update message that lured users to reset their passwords, then sent them to a phony log-on page that stole their credentials.
  • The Vermont Health Connect insurance marketplace exposes the information of 700 users due to a payment contractor’s mistake.
  • Vermont’s attorney general reaches a settlement with software vendor Entrinsik to provide more explicit instructions for its business intelligence tool, which when users run reports from their browsers, sometimes creates temporary files that are not automatically erased and fails to warn users of their existence.

Innovation and Research

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CB Insights publishes a list of digital hospital technology vendors.

A UK psychiatric hospital pilots Oxehealth, which analyzes streaming video to monitor vital signs with no attached sensors and alerts staff if a patient appears to be at risk.


Other

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Surgeons at St. Vincent Hospital (MA) remove the healthy rather than the cancerous kidney of a patient after a mix-up with another patient’s CT results. Investigators also found several problems with patient ID bracelets, with a patient’s son receiving his father’s bracelet and another observed being taken to X-ray without any bracelet at all. They also noted that one patient had been registered with another patient’s name and was assigned two medical record numbers.

Texas authorities free the convicted murderer of a four-year-old boy because the county can’t afford to pay his medical bills. The inmate spent 967 days in incarceration in running up $19,000 in medical expenses, nearly 20 percent of the prison’s total annual medical budget. A local resident weighs in with the opinion that he should be just allowed to die untreated in jail as a cost for committing a crime.


Sponsor Updates

  • T-System, Vital Images, and VitalWare will exhibit at AHIMA through October 19 in Baltimore
  • .TierPoint presents “Hackers, Superstorms, and Other Disruptions” October 19 in New York City.
  • Valence Health, Verscend, and ZeOmega will exhibit at AHIP’s National Conference on Medicare, Medicaid & Duals October 23-27 in Washington, DC.
  • Visage Imaging will exhibit at Health Connect Partners October 19-21 in Chicago.
  • Wellsoft will exhibit at the ACEP Scientific Assembly through October 19 in Las Vegas.
  • ZirMed earns Frost & Sullivan’s 2016 Technology Innovation Award for revenue cycle management.
  • Zynx Health will exhibit at the 2016 Meditech Physician and CIO Forum October 20-21 in Foxborough, MA.

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 10/14/16

October 13, 2016 Headlines 3 Comments

Trends in Hospital Inpatient Drug Costs: Issues and Challenges

Hospitals spent 40 percent more on inpatient drug costs in 2015 than they did in 2013, a change attributed to rising drug prices, rather than an increase in patient volume.

Software ‘freeze’ after network failure at St George’s

In England, St George’s University Hospitals NHS Foundation Trust freezes all ongoing software installs after aging computers and unreliable core software systems, like Microsoft XP, lead to a system-wide network outage.

One of the physicists behind the Higgs boson has made an algorithm to replace the pill

A physicist turned entrepreneur launches a birth control app that tracks the daily temperature of users with the impressive result of helping women avoid pregnancy 99.5 percent of the time, making it as effective as the pill or condoms.

Revised HIPAA Security Risk Assessment Tool Now Available

ONC updates its HIPAA Security Risk Assessment Tool, offering a 156-item questionnaire that evaluates HIPAA compliance by walking users through a series of questions about typical organizational activities.

News 10/14/16

October 13, 2016 News 8 Comments

Top News

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The Department of Defense announces that the first go-live of its MHS Genesis implementation of Cerner is scheduled for February 2017 at Fairchild Air Force Base (WA), moved back from the originally planned December 2016 date that involved two test sites. Three other Washington military hospitals will follow no earlier than June 2017.

The DoD says it pushed the schedule back to give it more time to develop interfaces to legacy systems and for system testing, as well as to allow implementing speech recognition and transfusion management. The project’s budget and planned completion date of 2022 have not changed.


Reader Comments

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From Redacted: “Re: Epic certification. Users are now required to complete proctored exams every five years for each application they’re certified in. As a consultant, it’s not the worst thing in the world for them to remove other certified people from the pond, but I have 10 certs and their time estimate is 6-8 hours for each (doubled between the assessment and booster training). Seems like a huge pain.” Unverified, although the forwarded document above appears genuine.

From Boy Blunder: “Re: Epic‘s 2016 release. My TS contact says there was a two-month period in early 2016 where the entire development division pivoted to fixing issues with the 2015 release, delaying 2016 projects. She tells me we should not upgrade to 2016 for a while because the key features won’t be added until months after the initial release, delaying the discovery and fixing of the kinks we usually find.” Unverified.

From Booster: “Re: Epic’s Boost program. It’s an attempt by Epic to provide consulting services to customers deploying new functionality or optimizing their systems. The concept has been around for years, but was only recently formalized. Boosters tend to be less available and are rarely around for more than a short engagement, with most of them on their way out of the company and working somewhere other than Madison (less than one year). It’s good in theory, but cannot get off the ground because Epic employees have such short half-lives and aren’t compensated competitively to retain them.” Unverified.

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From Little David: “Re: Hillary Clinton’s HIMSS14 speech. Did we get $225K of value?” It appears that the Secretary’s rack rate was $225K per speech, so HIMSS paid the same as everybody else. On the question of value, I’ll side with readers who observe that while we claim we want to hear selfless keynotes from patients, the size of the HIMSS crowd is always directly proportional to the fame of the presenter and Hillary (and Bill the year before) packed the house. I didn’t attend her presentation since I was tired of being at the conference before her Wednesday keynote slot, but I summarized it back then as:

I didn’t hear much about Hillary’s Wednesday keynote other than (a) it was extremely short; (b) like any skilled politician, she didn’t really say anything other than predictably lauding the work of the crowd that brought her there and kissing up to HIMSS. I would have been mad about waiting an hour or two to squeeze into the huge room for her talk given its lack of substance. Hillary’s rumored minimum speaking fee is $200K plus expenses, so she took home a big paycheck in addition to potentially impressing would-be Presidential voters who were apparently happy just to bask in her celebrity.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Healthlink Advisors. The St. Petersburg, FL-based consulting firm was founded by industry long-timer and former SVP/CIO Lindsey Jarrell, who hand-picks the people he (and the company’s client base) wants to work with based on their experience, passion, integrity, accountability, and commitment to social responsibility. Areas of practice include IT operations performance acceleration (leadership coaching, interim management, contract negotiation, application and technology rationalization, roadmaps); engagement (IT governance, system selection, program management, product and sales strategy development); and transformation (future state definition, consumer and digital engagement). I’m fascinated that one of the company’s core values that employees make healthy choices, which it supports by offering healthy foods at meetings, holding meetings while walking, requiring mandatory vacation time away from work, and insisting that no emails being sent after 10 p.m. or while the employee is on vacation. I also liked this insightful nugget in its “have fun” core value – “people leave managers, they don’t leave companies.” Thanks to Healthlink Advisors for supporting HIStalk.

This week on HIStalk Practice: Chinese Community Health Care Association moves forward with enterprise master patient index tech. Telemedicine companies offer free consults to victims of Hurricane Matthew. NextGen’s Cherie Holmes-Henry and Charles Kaplan offer advice on “Readying the Revenue Cycle for MACRA.” GMed develops patient check-in software for gastroenterologists. AmeriGroup partners with LiveHealth Online for telemedicine services in New Jersey. Health Fidelity co-founder Anand Shroff helps physicians understand the implications of risk adjustment. Zoom+ launches chat-based telemedicine app. Encompass Medical Partners gets into the IT maintenance and security game.

This week on HIStalk Connect: Pager raises $5.2 million. Proposal deadlines loom for the Stanford Medicine X | Withings Precision Research Challenge. Eccrine Systems closes $5.5 million in Series A financing. Bill Evans joins Rock Health. Charlie Rose focuses on artificial intelligence.


Webinars

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Axial Healthcare, which mines a database of 100 million patient cases to give insurers insight into risky pain care practices, raises $16.5 million in a Series B funding round, increasing its total to $26 million.

Nordic completes a minority recapitalization and announces plans to offer equity participation to all employees starting in 2017.


Sales

Providence Health & Services chooses LogicStream Health’s Clinical Process Measurement.

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Meditech customer Hays Medical Center (KS) will implement the company’s Web EHR.

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Cerner customer Olathe Health System (KS) will add Millennium Revenue Cycle and the RxStation automated drug dispensing system.

Insurer Highmark will implement Welltok’s CafeWell Rewards program for its Medicare Advantage policyholders.


People

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Family medicine practitioner Doug Spotts, MD takes a full-time role as chief health information officer at Evangelical Community Hospital (PA).

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Ascension SVP Mike Schatzlein, MD will resign effective December 31, 2016 to focus on his role as chair for the Nashville-based Center for Medical Interoperability. The non-profit was formed in 2015 with a $10 million grant from the Gary and Mary West Foundation, with membership focused on hospitals.

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Population health management technology vendor Altruista Health hires Munish Khaneja, MD, MPH (EmblemHealth) as chief medical officer.

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Zillion hires Cheryl Morrison Deutsch (Kronos) as chief experience officer.


Announcements and Implementations

T-System announces EVolvED, a low-cost, quickly implemented ED documentation system that combines T-Sheets paper documentation with a best-of-breed technology solution.

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Adventist Health System goes live on Imprivata’s PatientSecure palm vein biometric identification system.

InstaMed achieves PCI SSC Point-to-Point Encryption Standard version 2.0 validation for protecting credit card payment data, the first company in healthcare to earn that recognition.

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Portland, OR-based clinic model insurer Zoom+ launches a free medical chat service for its members that provides advice, diagnosis, treatment, prescriptions, and visit scheduling, with the chat transcript being added automatically to the EHR. I’m not sure if the apparently missing “with” in the “chat our doctors for free” page above is a mistake or intentional hipster wit.

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National Decision Support Company will debut its CareSelect Imaging decision support solution at RSNA, offering expanded Appropriate Use Criteria.


Government and Politics

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ONC and HHS OCR update their HIPAA Security Risk Assessment tool.

CMS will review MACRA-required documentation and hold regional meetings with practices in trying to reduce the clinician administrative burdens involved.


Privacy and Security

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Canada-based online medical advice startup Ask The Doctor becomes the first healthcare company to accept Bitcoin, providing users with extra privacy over charging services on their credit card. I can’t find any mention of how much the company charges to answer questions.


Innovation and Research

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Women who avoid having sex on the days a physicist’s temperature tracking app says they are fertile avoid pregnancy 99.5 percent of the time, offering the same reliability rate as oral contraceptives and condoms and much better than the 75 percent success rate of the rhythm method alone. The company is in Sweden, which is probably a good thing since its claims might otherwise interest the FDA and the lawyers of unexpectedly pregnant women.


Other

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A study of mobile health apps finds a crowded market in which downloads are limited and  declining, users aren’t willing to pay, newcomers have saturated the market, and 78 percent of publishers make less than $100,000 per year from their entire healthcare app business. Most app-related revenue comes from sales of sensors or other required hardware. Features seen as easiest to implement that have the highest user impact are personalized messages, dashboards, and the delivery of educational content. Publishers see their best hope of success as addressing users with chronic illnesses, but insurance companies haven’t shown much interest in getting them involved. Still, it’s a growing market even if it’s more competitive and selective.

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In England, St. George’s University Hospitals NHS Foundation Trust freezes all software rollouts following a June 6 infrastructure failure in which its Cerner-provided downtime system didn’t work. The trust is out of storage capacity, can’t perform backups, runs Windows XP on 2,000 PCs, and has network stability problems.

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An American Hospital Association report finds that hospitals spent nearly 40 percent more on drugs for each inpatient inpatient in 2015 than they did in 2013 due to higher drug prices rather than increased volume, saying that the price jumps “appear to be random, inconsistent, and unpredictable.” Prices increased from 52 percent to 3,263 percent for the 10 drugs on which hospitals spent the most money, with even the journeyman drug acetaminophen recording a 135 percent price increase from 2013 to 2015. It’s interesting to me that a couple of decades ago, the field of pharmacoeconomics was created to make sure drugs delivered outcomes commensurate with their cost, which turned on a light bulb over the heads of drug companies that realized they could price based on those same outcomes rather than simply defend a markup based on their research and manufacturing costs. These top 10 drugs are all old, work inarguably well for mostly specific uses, and have little competition. The pharmacoeconomics model then supports high prices and thus high drug company profits.

The local paper covers the November 1 Epic go-live at Vernon Memorial Healthcare (WI), which is working with Gundersen Health System (just writing that even with a different spelling makes me think of the police chief in “Fargo” or The Swede in “Hell on Wheels,” yah).

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I ran across an article that mentioned Twine Health, which I’ve written about a couple of times. The company’s team-based coaching and primary care app offers shared action planning among patients, coaches, and clinicians; secure messaging; real-time population monitoring; and analytics. Practices can use its system for $1 per patient per month for up to 1,000 patients. The company has raised $6.75 million in a single December 2015 funding round. The founders are serial entrepreneur and former MIT professor Frank Moss, PhD  and John Moore, MD, PhD.

A UCSF hospital medicine professor makes his case for “clinician data scientists” to analyze complex and sometimes inconsistently entered EHR patient information. He suggests training in clinical systems, data extraction, report writing, and statistical methods.

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Cerner can honestly say that the company sits at the intersection of “Health Care” and “Information Technology” as it names the streets of its new campus. Other avenues are named after medical scientists and computing pioneers.

Eighty volunteers from HCA’s IT division participated in a 36-hour “Hack the Community” hackathon in Nashville this week, supporting local non-profits with limited technology resources.


Sponsor Updates

  • Florida State University recognizes Vyne CEO Lindy Benton with its 2016 Distinguished Alumni Award.
  • Forward Health Group COO Subbu Ravi will serve on panel discussing Wisconsin state health IT initiatives at a Wisconsin Technology Council innovation lunch in Madison on October 18.
  • Iatric Systems will exhibit at the Hospital & Healthcare IT Fall Reverse Expo October 19-21 in Chicago.
  • Momentum Partners includes ID Experts in its list of top 10 private cybersecurity companies to watch in Q3 2016.
  • Impact Advisors will exhibit at the Scottsdale Institute CIO Summit October 13-14 in Scottsdale, AZ.
  • Optimum Healthcare IT posts a white paper titled “The Problem (and Solution) With Data Governance.”
  • InterSystems, Intelligent Medical Objects, NVoq, PatientKeeper, Streamline Health will exhibit at AHIMA October 15-19 in Baltimore.
  • Kyruus will exhibit at the HMA Fall Forums October 19-22 in Laguna Beach, CA.
  • MedData will exhibit at the ACEP Scientific Assembly 2016 October 16-19 in Las Vegas.
  • Meditech Senior Manager Corinne Proctor Boudreau will speak at the Western Pennsylvania Healthcare Summit October 14 in Pittsburgh.
  • Nordic will sponsor Piedmont Healthcare’s Southeast User Group Meeting October 18 in Atlanta.
  • NTT Data announces its return to Chip Ganassi Racing Teams.
  • Obix Perinatal Data System will exhibit at the ACOG Annual District II Meeting October 21 in New York City.
  • Recondo Technology will present at the Michigan HFMA Fall Conference October 17 in Plymouth.
  • Experian Health will present at NEHAM October 17-18 in Providence, RI.
  • Red Hat accepts speaking proposals for Red Hat Summit 2017 through December 2.
  • The SSI Group will exhibit at the AHCA/NCAL Annual Convention & Expo October 16-19 in Nashville.
  • Sunquest Information Systems will exhibit at ASHG 2016 October 18-22 in Vancouver.
  • Sutherland Healthcare Solutions VP and Global Health of RCMS Healthcare Tina Eller will speak at the Region 2 HFMA Fall Institute Conference October 20 in Verona, NY.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/13/16

October 13, 2016 Dr. Jayne No Comments

Several of my clients applied for the CMS Comprehensive Primary Care Plus initiative. One reached out to me after receiving a letter from CMS that required a response in an extremely short time frame. It sounds like practices that offer services other than just straight primary care may have been flagged in the application process to provide additional information. CMS was concerned about whether they could isolate their primary care providers and data if they were selected to participate in the program.

I understand the need to make sure applicants can meet the requirements, but the short turnaround time and unexpectedness of the letter created a lot of stress for my client. We were able to gather the required information for the response, but it was a good example to remind them that if they’re selected, they will be even more at the beck and call of CMS.

Speaking of CMS, a friend of mine who works for a vendor mentioned her concerns about the Social Security Number Removal Initiative. This is a big deal for people who are worried about identity theft since Medicare patients have long been identified with their Social Security Numbers. During 2019, Medicare will issue new identification cards to all beneficiaries. This also means that vendors have to adjust their systems to accommodate the new numbers while preserving the old numbers for historical purposes, rebilling, etc. Depending on the timeframe for mailing the new cards and what portion of a practice’s payer mix is made of Medicare patients, we could see some serious check-in delays and billing issues. I’m not sure if contractors have been selected to deliver the cards, but I hope it goes better than Healthcare.gov did.

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Pet peeve of the week: I had mentioned previously that people who try to share Web addresses verbally (unless they’re really short, like “Amazon.com” or “CMS.gov”) drive me crazy. I was on a conference call this week where the panelist not only read enormous Web addresses aloud, but also didn’t know the difference between slash and backslash. I hope the people who were on audio-only connections wait for the slide deck to be distributed before they try to reach any of those sites.

The Wall Street Journal published a piece this week about physicians “deprescribing” when patients are taking too many medications or risky combinations. For all the pressures on physicians and other healthcare providers to cut costs, this is an often overlooked solution.

There are many cultural factors at play with individuals preferring to take a pill to making the effort to change their habits and lifestyle. Patients don’t want to believe that they have a virus that will take 10 to 14 days to run its course — they want it cured now. Some of our love of pharmaceuticals is also generational, with older patients who came of age with the advent of penicillin and other lifesaving medications believing that pharmaceutical advances are heaven sent.

Unfortunately, there are too many people who are overmedicated. My grandparents, who are almost 90 years old, are on multiple medications for diabetes prescribed by a physician who advocates tight blood sugar control even in their age group and even with newer literature saying this might not be a good idea. It doesn’t make sense medically and they could certainly benefit from a reduced prescription bill each month, but they don’t believe in questioning their doctor.

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Speaking of technology advances, there have been tremendous strides in caring for premature infants over the last several decades. A friend of mine who works for Proctor & Gamble clued me in to the recent release of a new diaper for micro-preemies who often weigh in close to 500g. That’s roughly one pound. Years ago I laughed when my friend, who is a mechanical engineer, took his job at P&G right out of school and told me enthusiastically, “You would never believe what goes into a diaper.” Having changed quite a few, I thought that was funny at the time.

It’s definitely true of the new release. The P-3 diaper is three sizes smaller than the regular newborn size and was created after three years and 10,000 hours of research, including input from over 100 neonatal intensive care unit nurses. Sometimes it’s good to be reminded that often technology and innovation brings us new problems that we never even thought of and that require solutions that are outside of our expertise.

Pet peeve, part 2: I was on a call this week waiting for key attendees to arrive. One participant announced that another would be “at least 30, maybe 40” minutes late for the meeting, which was only scheduled for an hour. I appreciate that the delayed participant called someone to say she was going to be late, but since she was the CIO and this was an executive briefing, it would have been helpful for her to indicate whether she wanted us to go ahead without her, wait for her, or reschedule. Instead, we were left guessing and trying to reach her by phone, which went straight to voice mail.

From Nurse Engineer: “Thanks for the heads up on the Healthcare Data Analytics course (Free!!) through OHSU. I am through four modules and thoroughly enjoying the class. I went into informatics way before it was chic – so far it has been a good review with very timeline information. I hope to complete the course next week before work travel interferes.” I appreciate the way they have it formatted. You can either watch the videos or read from a transcript, which allows people who learn in different ways to leverage the content in the way that most meets their needs. It also lets students make progress while traveling on flights with abysmal Wi-Fi.

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One of the joys of being a consultant is experiencing life in different parts of the country. Sometimes that involves trying new foods (cheese curds anyone? Nashville hot chicken?) and sometimes it involves trying to translate the local vernacular. My Texas client shocked me this week by mentioning that in their city, “You can’t swing a dead cat without hitting a barbecue place.” I must have had a horrified expression on my face because they asked me if I was OK while I sat there trying to figure out if I really just heard what I thought I heard or whether I was on Candid Camera or being set up by PETA or something like that. I’ve traveled a lot but somehow missed that phrase before now. There are various theories on its origin and my client spent the next ten minutes schooling me on other colorful expressions they felt I needed to know. My thoughts go out to any cats, real or imaginary, who might have been swung.

What’s your favorite local or regional expression? Email me.

Email Dr. Jayne.

Morning Headlines 10/13/16

October 12, 2016 Headlines 1 Comment

New DOD health record to go live in February

DoD announces that will bring four pilot sites live on Cerner in February 2017, and affirms that it still anticipates having all sites live by 2022.

Shareholder sues Tenet over $514M Medicaid settlement

Shareholders have filed a class-action suit against Tenet Healthcare following its decision to pay $514 million to settle kickback allegations.

Cerner names roads in its new south Kansas City office campus

Cerner renames the roads on its Kansas City Three Trails campus, honoring Jonas Salk, Alexander Fleming, Marie Curie, Louis Pasteur and other notable researchers in medicine. The two main roads through campus have been named Health Care and Information Technology.

Do Clinicians Have the Interoperability They Need

A KLAS survey on interoperability notes that only six percent of providers report that information accessed through an exchange from a different EHR vendor is being delivered in a way that facilitates improvement to patient care.

Morning Headlines 10/12/16

October 11, 2016 News 2 Comments

Unintended Consequences of CPOE

An emergency physician describes an event in which an intern using a CPOE system they were unfamiliar with ordered a CT scan of the abdomen and pelvis with contrast, and then separately ordered oral contrast, the combination of which resulted in contrast nephropathy.

Epic Fact Check

Epic responds to a recent Jonathan Bush interview during which he suggests that achieving interoperability with Epic sites was difficult until recently.

Google DeepMind has doubled the size of its healthcare team

Google’s UK-based AI team DeepMind has doubled its healthcare division from 20 to 40, including some of the biggest names in the AI industry.

Siemens Healthineers and IBM Watson Health Forge Global Alliance for Population Health Management

Siemens Healthineers announces an agreement to start reselling IBM Watson as part of a new population health management solution.

News 10/12/16

October 11, 2016 News 2 Comments

Top News

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Hedge fund operator Partner Fund Management sues Theranos for securities fraud, saying Theranos and CEO Elizabeth Holmes told “a series of lies” about its lab testing capabilities and prospects in soliciting a $100 million investment.

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Above is Holmes holding the company’s remaining credibility.


Reader Comments

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From Ken Bone: “Re: Athenahealth. JB got Trumped.” Epic posts a fact check for a recent interview with Athenahealth’s Jonathan Bush. Thankfully, JB’s brother Billy was not available to facilitate an uncomfortable Judy-JB hug.

From Looming Presence: “Re: HIStalkapalooza. Here’s video of Jonathan Bush doing his Donald Trump imitation at HIStalkapalooza earlier this year.” I had forgotten about that. JB, the most politically connected person in health IT, has said that he can’t support his Republican party’s nominee in calling him “a clinical narcissist” and “a wack job,” but says he’ll vote Libertarian instead of Democratic, explaining, “Why going for the nut on the right or the nut on the left when you can have the Johnson?” Bush downplayed his own political aspirations a few weeks ago by saying, “We need another Bush like I need a hole in my head,” although technically speaking, all of us need a hole in our head, just not another one that isn’t a mouth, nose, eyes, or ears (or in cases of emergency, a surgical trepanation). 

From PitViper: “Re: blockchain conference in Nashville last week. Humana’s CIO gave the keynote and his team participated in many of the breakout sessions. Nothing is production-ready and vendors themselves admit the technology is immature, but the ideas are interesting and if there’s truly a common trusted data layer in our future, it will address a lot of the issues we face.”


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Agfa HealthCare. The company, which provides eHealth and digital imaging solutions to half the world’s hospitals, offers Care You Can See, an enterprise-wide approach to medical imaging that provides a single patient record within a single EHR view. Its product line includes enterprise imaging (VNA, universal viewer, ECM, image exchange, patient portal, scheduling, business intelligence and clinical apps); integrated care (data aggregation for multiple sites, patient engagement); and digital radiography. The company focuses its radiology commitment to maximize the value of medical images within an interoperable ecosystem to support collaboration and the availability of image to all caregivers under value-based care. Its Engage suite provides a first step toward an integrated care model, offering patient-centric views and actions, native mobile functionality, support for clinical networks, and integration with third-party systems. The company is the #1-recommended image sharing vendor in a recent Peer60 report. Thanks to Agfa HealthCare for supporting HIStalk.

Here’s an Agfa HealthCare intro video I found on YouTube.


Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Siemens Healthineers will resell  IBM Watson Health’s population health management solutions. The companies will also work together to create new solutions in a five-year strategic alliance.

3M Health Information Systems and Verily Life Sciences will work together to analyze population-level datasets into usable quality measures for complications, readmissions and mortality, and cost.

Pharmacy software vendors Rx30 and Computer-Rx announce their merger.


People

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AMN Healthcare-owned contingent workforce management systems vendor ShiftWise names Steven Rodriguez (Asure Software) as president.

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Outpatient rehabilitation therapy technology vendor Clinicient hires T. Kent Rowe (ZirMed) as CEO.

CTG promotes Rick Sullivan to VP of strategic staffing services.


Announcements and Implementations

HIMSS Europe is conducting a “Women in Health IT” survey whose results it will use to tailor future female-focused offerings. 


Privacy and Security

In India, Chennai city police have filed 43 cases against people they say have spread rumors about the health of the chief minister of Tamil Nadu, who has been hospitalized since September 22. The latest two arrests are of a website manager who published audio claiming to be from an Apollo Hospitals employee and an IT engineer who they said posted false information on Facebook. They’re charged under a law prohibiting statements intended to cause public panic.

The incarcerated human rights activist who coordinated an Anonymous-led denial-of-service attack against Boston Children’s Hospital in April 2014 to protest the involuntary commitment of a teenager stages a hunger strike to protest behavior modification programs for non-adults.


Technology

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China-based search engine Baidu launches Melody, a smartphone chatbot app that asks consumers AI-generated questions in performing basic triage before sending the information to a doctor to take over. The company says it’s talking to US healthcare companies as a potential market.

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London-based, Google-owned DeepMind has doubled its team to 40 employees since its February 2016 launch, hiring experts in artificial intelligence and from the NHS to help develop its products.


Other

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The Wall Street Journal says apps that help migraine sufferers predict their attacks or identify their triggering factors hold promise, but they struggle to distinguish triggers (causation) from warning signs (correlation).

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CMS Acting Administrator Andy Slavitt is one of my favorite tweeters, with refreshing recent examples above.

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Family physician, CMIO, and AAFP board member Carl Olden, MD says that EHRs provide important benefits despite the extra work they require of doctors. He suggests that documentation responsibilities be spread to non-physician care team members and that payment reform “get us off the E/M treadmill.”

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An emergency medicine professor blames CPOE for an error in which an intern ordered “CT Abdomen and Pelvis with contrast” and somehow thought she would need to order oral contrast separately, which she did in sending the patient into contrast nephropathy when both agents were administered. I disagree with blaming CPOE for these reasons:

  • The intern ordered an item without understanding it.
  • The same error would likely have occurred with paper-based ordering, especially if the hospital was equally sloppy in how it phrased the orderable’s description on paper.
  • All the other doctors appeared to have understood and used this orderable without problems. 
  • Receiving a non-paper, non-verbal order does not eliminate the responsibility of the employees acting on it to review it for mistakes, electronic or otherwise.
  • It’s hard to understand how an undertrained intern’s one-off mistake – without the author’s seeing even basic evidence, such as how the hospital built the pick list in question — provides sufficient rationale to throw CPOE under the bus.
  • I agree with only one point of the article – system administrators should monitor cancelled or replaced orders to help them understand where there system setup might be confusing users.

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Kaiser Permanente CEO Bernard Tyson says in a conference presentation that 52 percent of KP’s 2015 physician-member interactions were conducted via technology rather than face-to-face visits. The article’s author calls those encounters “virtual visits,” but I would bet that the huge number is mostly portal text messages, refill requests, and lab test communication. KP has turned in those big numbers going back to at least 2014, so this is really not news.

Canada-based drugmaker Valeant, known for acquiring old drugs and then jacking up their price, does it again with a drug for lead poisoning it bought in 2013, raising its price from $950 to $27,000. The company’s excuses (short shelf life, low sales volume) don’t hold much water since they haven’t changed since the previous owner was presumably making a nice profit at $950.

An expert criticizes vendor-operated company wellness programs, saying that data from the program that was recently chosen as the industry’s best suggests that employees were actually harmed rather than helped. He also cites the 2015 winner McKesson, who claimed savings despite no change in employee biometric risk factors.

In India, illegible doctor handwriting forces medical examiners to switch to computer-completed autopsy forms that police and juries can more easily read.

The Atlantic profiles Tristan Harris, a former Google employee who created an advocacy group called Time Well Spent that is trying to convince app developers to take a Hippocratic Oath that they won’t turn their users into slot machine-like tech addicts by exploiting their psychological vulnerabilities. He says app developers are like junk food vendors in introducing the digital version of sugar, salt, and fat into their apps to profitably satisfy user craving in earning “likes” and impressive LinkedIn connections via pointless yet hypnotic auto-play videos and clickbait stories. He’s thinking about developing an app to measure app usage vs. user-reported benefit in calling out apps that create addiction without satisfaction. Harris responds to the magazine’s reporter who expresses anxiety at trying not to check his cell phone during their interview:

Our generation relies on our phones for our moment-to-moment choices about who we’re hanging out with, what we should be thinking about, who we owe a response to, and what’s important in our lives. If that’s the thing that you’ll outsource your thoughts to, forget the brain implant. That is the brain implant. You refer to it all the time.


Sponsor Updates

  • AHIMA will add Meditech’s EHR to its Virtual Lab for HIM student training.
  • Haystack Informatics publishes a white paper on insider data breaches.
  • Aprima will exhibit at the Texas Association of Community Health Centers meeting October 17-18 in Dallas.
  • Arcadia Healthcare Solutions CMO Rich Park, MD will present at the inaugural meeting of the American Association of Strategic Regional Organizations October 17 in Philadelphia.
  • Bernoulli will exhibit at AARC16 October 15-18 in San Antonio.
  • Besler Consulting, Clinical Architecture, Direct Consulting Associates, and FormFast will exhibit at AHIMA October 15-19 in Baltimore.
  • The Chartis Group adds three principals: Mary Jo Morrison, Mark Pasquale, and Robert Schwartz, MD, MPH. 
  • Besler Consulting releases a new podcast, “Five keys to mitigating risks associated with hospital-physician contracting.”
  • Dimensional Insight and Hayes Management Consultants will exhibit at the Centricity Healthcare User Group October 13-15 in Austin.
  • MedScape includes E-MDs as a leading vendor for usability and customer satisfaction in its latest EHR report.
  • Elsevier Clinical Solutions features predictions from Geeta Nayyar, MD in its celebration of 100 years of medical clinics.
  • EClinicalWorks will exhibit at the AOAO Annual Meeting October 13-15 in Washington, DC.
  • HCS will exhibit at the NASL annual meeting October 16-18 in Nashville.Healthgrades will exhibit at the Built in Colorado Fall Startup Showcase October 13 in Denver.

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 10/11/16

October 10, 2016 Headlines 1 Comment

More Than Half of Kaiser Permanente’s Patient Visits Are Done Virtually

Kaiser Permanente CEO Bernard Tyson reports that last year, 52 percent of the health systems 110 million patient interactions were done via smartphone, videoconference, kiosk, or other technology tool.

Major Investor Sues Theranos

San Francisco-based hedge fund Partner Fund Management sues Theranos, arguing that Elizabeth Holmes lied in order to secure nearly $100 million in investments from the firm.

Trade-Off or Turn-Off? The Privacy Dilemma

Joseph Kvedar, MD discusses common health data privacy concerns raised by the public and argues that providers need to address these concerns with patients because the potential benefits of data sharing outweighs the risks.

Physicians beat symptom checkers in test of diagnostic accuracy

A JAMA study measuring the accuracy of online symptom checkers concludes, not surprisingly, that doctors are still far more reliable diagnosticians.

Curbside Consult with Dr. Jayne 10/10/16

October 10, 2016 Dr. Jayne 3 Comments

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I picked up an additional clinical shift this weekend to help out one of my partners whose travel was interrupted by Hurricane Matthew. Weekends in the urgent care world are always busy, especially on Sundays when people who have put off care earlier in the week decide they can’t wait until Monday to try to get an appointment with their regular physician. Others don’t have a regular physician and just see us when they’re sick. Another subgroup of patients tries to use us as their primary care home even though we’re really not equipped to do so.

When you’ve seen 40 patients in the first six hours of a shift, that’s a bad sign. Even with a scribe I couldn’t keep up, so we had to send up the bat signal and try to get more reinforcements. Flu season is moving into high gear, overlapping with a bad run of hand/foot/mouth disease for kids in our area. Most of our patients were acutely ill and we always try to move patients into exam rooms rapidly so that they’re not cross-contaminating each other in the waiting room.

For a while, things were backed up, though. Looking at the roster of patients in the waiting room, I couldn’t help but think that telemedicine would have been a good option for quite a few of them.

There are many conditions we treat regularly that can be diagnosed with accuracy based on the patient’s history and some targeted questions. Important data points are the duration of the illness, the specific symptoms, anything that has made it better or worse, and the patient’s health status and other existing conditions. Although the physical exam can confirm a working diagnosis, it usually doesn’t make a difference in the treatment plan for these patients.

Offering telemedicine services would have keep these patients at home where they could be recovering rather than potentially exposing them to other communicable diseases. In my area, however, insurance doesn’t cover telemedicine services, so they’re not being offered.

Assuming insurance would cover the services, our EHR isn’t equipped to handle telemedicine. It’s not just this system, though. The last three platforms I have used for patient care wouldn’t have supported it very well, either. The closest workflow they could offer was to couple the documentation pathway for a telephone call with some of the elements of a standard office visit. It certainly wasn’t a streamlined workflow and there wasn’t a good way to include video links or patient-provided pictures of rashes or other findings.

Although the new federal programs seem to encourage these types of alternative visits, it seems to me that many EHR vendors are just trying to keep up with all the reporting requirements and specifications of the new certification scheme and don’t have many development resources to shift into these kinds of nice-to-have workflows.

Some of the cases I saw today really made me think about how our country is addressing (or not addressing) healthcare delivery. We’re so focused on cost reform that we’re missing other significant factors that influence care-seeking behavior.

Many of our patients come to the urgent care due to access issues – they can’t get a timely appointment with their primary care physician or they can’t leave work during the hours the office is open. Although many employees have sick time benefits from their employers, the reality for many of the patients we see (as well as many of my friends and colleagues) is that it’s often difficult to use that sick time.

Employers put a variety of strategies in place to keep people from abusing the benefit, but those strategies can also function as a barrier to care. The rise of high-deductible health plans is also a barrier to care, and we sometimes see people with serious illnesses who have deferred coming to care because they can’t afford the deductible. It’s not an overall cost savings if the patient has to have an amputation because they didn’t have a $90 visit that could have mitigated the condition weeks ago.

We try to engage our patients and encourage them to follow up with a continuity physician, providing them View/Download/Transmit access to their note as soon as the physician completes it. We also have nearly-real-time surveys of patient satisfaction, which can be a bit unnerving when you receive an email with your rating before the patient is even out of the parking lot. It’s definitely a different world than what I thought I was getting into when I went into medicine.

I’m not sure how many patients actually engage via a records download, though. Although we can accept and consume inbound records, I’ve not seen any in the two years I’ve been working with this organization. I have had a couple of patients who have personal health records that they access on their phones during the visit and many who have accessed their pharmacy records to tell me about previous treatments if I can’t download them via our EHR’s pharmacy management link. But I’ve never seen a C-CDA and I’m betting that my staff would be confused if one turned up.

Our organization is growing steadily. We’ve doubled in size in the last two years. Although it’s great from a business perspective, when you really think about it, it’s terrible from a patient care strategy standpoint. Although patients come to us because it’s convenient and we’re fast and economical, we’re not a primary care office and we don’t handle preventive screenings or other universally recommended services.

I firmly believe that patients do best when they’re cared for by a physician and/or care team that knows them well and can manage their issues over time, looking for trends or linked events. This is what old-school family physicians used to do, before insurance companies pushed patients into networks based on costs and contracts. When I was in solo practice, I had patients who were forced to change primary physicians every year or two because their employer would change insurance plans or the insurance plan would change their roster of contracted physicians.

With the rise of the medical home movement in the last decade, you’d think this trend would be somewhat reversed, but we’re not seeing as much change as we need to solve the healthcare delivery problem. Physicians are stressed and don’t want to provide after-hours services without additional compensation and patients don’t want to pay for it.

We’ve thrown billions of dollars of technology at it, but it doesn’t feel like we’re much better off than we were before. Physician practices have been disrupted. Once they settle in, there is a tremendous opportunity to harness the technology, but now we’re seeing a second wave of disruption as providers and organizations change EHR vendors, often sending provider workflows back into chaos.

Programs such as the Comprehensive Primary Care Initiative and its successor CPC+ are trying to shift care delivery to the medical home model through additional payments and support, but it’s still tremendously difficult for organizations to make these changes, especially since they’re already coping with additional federal and payer regulations.

I’m not sure what the answer is, but it feels like we’re reaching the breaking point. Is anyone building the killer app that will help providers and care delivery organizations truly transform how we care for patients in the 21st century? Or will the regulators just keep tightening the screws? As we sit here on the edge of our chairs waiting for the next Final Rule, it feels more like the latter.

What do you think is the answer to truly reforming healthcare delivery? Email me.

Email Dr. Jayne.

Morning Headlines 10/10/16

October 9, 2016 News No Comments

Court won’t take Parkview rate suit

Parkview Hospital (IN) has been ordered to release its chargemaster prices and insurance discounts after an uninsured patient that was charged $625,000 for his care sues the hospital, arguing that the bill is inflated and unreasonable since insured patients receive the same care at a significant discount.

Physicians’ Take on EHRs

A Peer60 survey of physician EHR satisfaction finds that usability and missing functionality still top the lists of physician frustrations.

Millions of Australians caught in health records breach

In Australia, Health Minister Sussan Ley apologizes at the annual conference of the Royal Australian College of General Physicians after the health department inadvertently published confidential data from three million patients.

How body-worn cameras improve EMS documentation

A pilot study finds that EMS documentation improves significantly if body-worn cameras are used so that EMS staff can review events after care is delivered.

Monday Morning Update 10/10/16

October 9, 2016 News 18 Comments

Top News

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The legal effort by Parkview Hospital (IN) to keep its chargemaster prices and insurance discounts secret fails, forcing it to provide the information demanded by an uninsured patient who sued the hospital after receiving a bill for $625,000 for a three-month stay after a car accident. The patient says the bill isn’t reasonable since the hospital discounts its services to insurance companies while charging uninsured patients list price. The state’s Hospital Lien Act allows patients to negotiate bills when a hospital files a collection lien against them.

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The hospital’s attorney argues that insurers are given discounts because of the patient volume they provide and that the patient’s guardian signed a an admission agreement that included a 35-word “agreement to pay” paragraph. “We don’t think a person who is not a member of the club should get the benefits of the club,” he said. Other healthcare lawyers say hospitals don’t have a choice in offering discounts because insurers won’t sign a contract with them otherwise.

Legal experts say that if their debt collection practices are questioned by a ruling for the plaintiff in this case, hospitals will probably switch tactics to instead use breach of contract lawsuits, which have favorable legal precedents in Indiana.

A billing expert hired by the patient concludes that the reasonable value of the services he received was $247,000, which would represent a 60 percent discount to billed amount.


Reader Comments

From Stick and Rudder Man: “Re: Epic. Does its Boost program even exist? Our experience from making requests is that no one is ever available. Recent networking with other clients suggests that our experience is not unique.” I’m not familiar with that program and found no references to it on Epic’s site, so I’ll ask knowledgeable readers to comment.

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From Golan Heights: “Re: MedCPU. Looks like leadership change.” I didn’t see an announcement, but comparing old vs. new versions of the company’s executive page calls out the removal of the company’s two co-founders, promotion of the CFO to the CEO position, and the departure of two other executives. MedCPU has raised $51 million, $35 million of it in May 2016.

From Block and Tackle: “Re: HIStalk. It’s being blocked in the Middle East countries, which I experienced when traveling to Bahrain and Dubai over the past two weeks. Not sure if you care much about getting traffic from there, although given the level of IT activities and the global nature of your sponsorship base, it could be an expansion opportunity. Not getting our weekly dose of HIStalk news causes a lot of anguish!” I’ve heard that before, although reports were inconsistent.


HIStalk Announcements and Requests

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Attention speakers and Webinar presenters: people hate it when you: (a) read from your slides; (b) place your pitch ahead of the educational needs of your attendees; (c) cram too much material on your slides; and (d) talk too much about yourself and your employer. I’ll side with the majority: PowerPoint, when used by unskilled presenters as a Teleprompter instead of as a visual aid to complement their enthusiastic and not overly rehearsed verbal narrative, is pure evil.

New poll to your right or here: how much of your work day involves talking about patients and their needs?

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

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Thanks to the IT department of Centura Health (CO), which raised $1,500 for my DonorsChoose project, doubling last year’s total. I applied matching funds in fulfilling these STEM-related grant requests Friday and have already received grateful emails from all of the teachers. Classroom photos will follow once the students begin using their new materials.

  • Genetics kits (plant lights and seeds) for Ms. T’s high school class in Juneau, WI
  • A document camera and wireless keyboard for Ms. N’s third grade class in Lugoff, SC
  • Math games for Ms. L’s kindergarten class in Chicago, IL
  • A math gaming system for Mrs. S’s second grade class in Virginia Beach, VA
  • A media studio for producing a daily school news show for Ms. C’s middle school class in Citrus Heights, CA
  • Multimedia teaching technology for Ms. C’s high school class in Philadelphia, PA
  • Math manipulatives for Ms. R’s elementary school class in New York, NY
  • Six tablets for Mrs. P’s kindergarten class in Dry Ridge, KY

I also received a donation from Mark and Tammy, which provided programmable robots for Mrs. E’s elementary school class in Greenwood, SC.

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Welcome to new HIStalk Platinum Sponsor Black Book. The Tampa, FL-based company offers unbiased, transparently collected, survey-powered research services such as Black Book Rankings, vendor comparisons, customer satisfaction, and market and competitive intelligence. It measures image, attitudes, opinions, awareness, and market share. Users are invited to participate in its user satisfaction and loyalty surveys via its app, with their responses validated using sophisticated data quality tools to ensure accurate, authentic results. Kudos to the company for recently fine-tuning its methodology after noticing and fixing questionable results caused by hospitals completing surveys on behalf of their EHR affiliates, which it likened to a salesperson rating their own merchandise. Here’s the best part: nobody at Black Book has a financial interest in a vendor; the company doesn’t allow companies to pay to participate; and vendors don’t get to review the results until they’re published for the whole world to see. Thanks to Black Book for supporting HIStalk.

I’ve worked in hospitals affected by hurricanes. I would be interested in hearing about your experience with Hurricane Matthew. People might forget that while they’re being urged to evacuate or stay home, hospitals are being staffed by people who are protecting someone else’s family instead of their own.


Last Week’s Most Interesting News

  • Theranos exits the laboratory business, laying off 40 percent of its staff to focus on commercializing its MiniLab testing machine.
  • A single Brigham and Women’s researcher gets a $75 million, five-year grant to analyze study participant data, including that generated by wearables, hoping to find early predictors of heart disease.
  • Warburg Pincus Private Equity files FTC documents indicating that it will acquire Intelligent Medical Objects.
  • Evolent Health completes its acquisition of Valence Health for $219 million.
  • Cerner tells the local newspaper that it will aggressively expand its revenue cycle business.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Decisions

  • Logan County Hospital (KS) will go live on Athenahealth’s RCM system in January 2017.
  • Bayhealth (DE) switched from McKesson Horizon to Epic in August 2016.
  • Franciscan Missionaries of Our Lady Health System (LA) will replace Cerner with Epic.

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


People

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Kyruus hires John Downey (McKesson Health Solutions) as SVP of sales.


Announcements and Implementations

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Peer60 publishes “The Physician’s Take on EHR Suppliers 2016,” which surveyed around 1,000 doctors (75 percent of them in ambulatory practice) about EHRs. Adoption was 85 percent, with the most common systems being those from Epic, Cerner, and Allscripts. Most respondents say they aren’t planning to replace their current systems. Top-ranked Epic joined its competitors in scoring low in Net Promoter Score, but few of Epic’s users reported specific problems or plans to replace it. Usability topped the list of user concerns for all systems, while first-time adopters say cost is what’s holding them back. As Peer60 points out, the market seems to violate Economics 101 in that users are nearly universally unsatisfied with their systems, but don’t see more attractive alternatives.


Privacy and Security

The health minister of Australia apologizes to doctors for publishing a file of de-identified claims data covering 10 percent of the country’s population that was quickly re-identified by researchers who matched the records with other publicly available datasets. 


Technology

A small study finds that paramedic documentation improves significantly when they are equipped with body-work video cameras that allow them to review their work afterward.


Other

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The Green Beret brother of Maggie Stack, who played the lead role in the Epic UGM production of “Alice in Wonderland” two weeks ago, was killed by an IED while on patrol in Afghanistan last week. Staff Sgt. Adam S. Thomas of the 10th Special Forces Group (Airborne), 31, had earned several Army medals in deployments to Iraq and Afghanistan. ISIS has claimed responsibility for his death.

Vince and Elise close out their “Rating the Ratings” series with ideas on a “do it yourself” rating.


Sponsor Updates

  • Nordic is recognized in “Best Places to Work in Healthcare” for the third straight year.
  • T-System and Wellsoft will exhibit at ACEP16 Scientific Assembly October 15-18 in Las Vegas.
  • TierPoint completes a $12 million TekPark data center expansion.
  • Valence Health will exhibit at TAHP Annual Conference October 14-16 in Dallas.
  • Huron offices across the country donate over 4,000 backpacks to local nonprofit organizations.
  • ZeOmega will exhibit at Washington State Hospital Association’s annual meeting October 12-14 in Seattle.
  • Zynx Health will exhibit at the 2016 Meditech Physician and CIO Forum October 20-21 in Foxborough, MA.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Morning Headlines 10/7/16

October 6, 2016 Headlines No Comments

An Open Letter From Elizabeth Holmes

Theranos announces that it will close all of its clinical labs and wellness centers, and layoff the employees that work there, to focus its efforts on securing FDA clearance of its MiniLab.

This is how far phishers will go to make you click on a bogus link

In England, NHS Digital COO Rob Shaw discussed a situation in which hackers crafted a personalized phishing attack against an NHS employee, using his LinkedIn profile to learn about his background, and creating a fake email account in the name of one of his past colleagues. The extra effort paid off and the hackers managed to infiltrate the hospital’s network undetected for two weeks.

Chelsea and Westminster picks Cerner, and Jarrold as CIO

In England, 430-bed Chelsea and Westminster Hospital NHS Foundation Trust will implement Cerner in partnership with fellow NHS trust Imperial College Healthcare.

Remarks by Andy Slavitt: Talking with the industry about the future of health care in America

CMS Acting Administrator Andy Slavitt discusses the transformation the health insurance industry is facing in a Wednesday speech.

News 10/7/16

October 6, 2016 News No Comments

Top News

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Theranos CEO Elizabeth Holmes announces that the company will close all its clinical labs and wellness centers and lay off nearly half of its employees to focus exclusively on trying to commercialize its MiniLab testing platform.

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Theranos investors continue their high level of cluelessness by inexplicably keeping Holmes as CEO, although at this point her train wreck behavior is about all that remains interesting about the former high flyer.

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My bet: Theranos will bleed out all its remaining investor cash before it can get its machine through the FDA to market, and even if the company is successful, nobody’s going to buy a MiniLab given the company’s historical lack of transparency and shady business practices (would you really want to buy diagnostic equipment from someone who is federally banned from all lab involvement?)


Reader Comments

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From Tripp the Lite Fantastic: “Re: Drummond Group. A shakeup after it was sold – President Kyle Meadors has left.” Unverified. He’s still showing on the certification company’s executive page (which lists only two people), but his LinkedIn profile shows that he left the company in July. He took the job in November 2015 after the two co-founders stepped aside. I don’t recall that I knew (or cared) that the company was acquired. Drummond and CCHIT were named by ONC as the first authorized testing bodies for EHRs in 2010.

From Nasty Parts: “Re: NextGen. There’s a sales book on the street, according to contact there. The only insiders who will benefit are the Cardinal hires brought over by CEO Rusty Frantz, such as the new CFO whose package included 75,000 restricted stock units.” Unverified.


HIStalk Announcements and Requests

Sixteen companies have joined my little HIStalk sponsor family in the past handful of weeks, motivated in part by the fall new sponsor special offer that throws in the rest of 2016 free for a full-year 2017 sponsorship. Contact Lorre to join them.

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Welcome to new HIStalk Platinum Sponsor Learn on Demand Systems. The company’s OneLearn training management system allows organizations of all sizes to deliver experience-based training, software demos, and performance-based assessments in managing programs, instructors, classrooms, schedules, and metrics. Its OneLearn lab-on-demand platform automates the delivery of hands-on labs and product demonstrations, using the hospital’s custom EMR instance (a mirror image, not a simulation) to deliver an Interactive Digital Lab with testing to identify those departments that are (or aren’t) ready for an implementation or upgrade go-live. Everybody gets a sandbox to play in whenever their schedule allows – no more marathon classroom sessions. You can try a live preview of a training lab – I did and it’s very cool (scroll down on the page to launch a sample environment with no sign-up required).  The company has reached users in 145 countries, launched 10 million labs, and trained 5 million students for customers that include Google, Microsoft, Citrix, and Caradigm. Thanks to Learn on Demand Systems for supporting HIStalk.

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Here’s a screenshot of my playing around with a live preview of Learn on Demand Systems. It presented an exam on the right with links to resources such as a network diagram while in the middle of the screen was a virtual live session of Windows NT (browser based, no setup required), allowing the student to work on a live server while completing a test on how to configure user e-mail accounts.

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We provided math games for the third-grade class of Ms. Burkett in Missouri in funding her DonorsChoose grant request. She says her students get excited about math every day because the activities are fun and allow them to work together to solve problems.

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The industry’s most talked-about HIMSS party is on. Would your company like to help me pay for it since I’m otherwise personally on the hook for the rather shocking price tag in entertaining 800 or so industry notables? Contact Lorre for sponsorship options that can range from small to blow-out.

This week on HIStalk Practice: Central Virginia Coalition of Healthcare Providers selects CCM software from Smartlink. CityMD partners with Par80 for referral management. Survey shows patients want pricing up front, but providers aren’t prepared to comply. Internet icon advocates for an "NIH for Cybersecurity." AMA unveils new MACRA tools for physician prep. MTBC acquires MediGain and Millenium Practice Management. NHHIO ED Jeff Loughlin helps New Hampshire providers set up a centralized data repository now that they’ve gotten over the EHR implementation hump.


Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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ICU surveillance monitoring technology vendor Sotera Wireless, which offers the ViSi Mobile wireless sensor, files for Chapter 11 bankruptcy. The company had raised $84 million in nine funding rounds, but none since early 2014.

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Consumer wellness software vendor Welltok raises $33.7 million in a Series E funding round, increasing its total to $164 million.

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In an unpleasant health IT flashback special, Vista Equity Partners will take England-based Misys public again on the London Stock Exchange, valuing the company at $7 billion in England’s largest IPO of 2016. Vista bought the company for $1.6 billion in 2012, five years after the banking software company sold off its Sunquest and CPR product lines as well as its majority stake in Allscripts in its hasty exit from the healthcare market (they’ve since added “financial software” to their logo to remind themselves of their unsuccessful sector unfaithfulness). I remain amused even now that two British banking software vendors – Misys and Sage – nearly simultaneously made a major mess in their pathetic and fortunately short-lived attempts to milk a US healthcare IT market that they clearly didn’t understand.

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Evolent Health completes its acquisition of Valence Health, paying $219 million rather than the originally announced $145 million since the sale price was tied to Evolent’s share price. Evolent says Valence will generate revenue of around $85 million this year.

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UPMC Enterprises makes an unspecified investment in RxAnte, a UPMC vendor that uses analytics to predict medication adherence. The company reports $4.6 million in fundraising, all of it in 2012.

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Xerox, preparing to split itself into two publicly traded companies, names its business process services segment (which includes healthcare) Conduent. You’ll either be inspired or appalled by the lengthy, marketing-heavy explanation of what every aspect of the made-up word and logo signifies other than that they let creative types run expensively amok (“A bold typeface conveys stability and complements the symbol while acknowledging a 30-year history supporting the critical operations of businesses and governments. A connection between the ‘N’ and the ‘T’ in the typeface of ‘Conduent’ reinforces that the constituent is at the core of the company’s business model. The connected letters also draw the reader’s eye to this unique pronunciation of the coined name.”) Apparently the most important factor in the new company’s eventual success is allowing those last two letters to touch.


Sales

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Harrison Memorial Hospital (KY) chooses Santa Rosa Consulting’s InfoPartners subsidiary as its Meditech 6.1 Ready implementation partner.

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Island Hospital (WA) chooses Meditech.

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In England, Chelsea and Westminster Hospital NHS Foundation Trust selects Cerner, sharing its implementation with Imperial College Healthcare NHS Trust. 

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In Canada, William Osler Health System will implement Extension Engage for unified clinical communications and collaboration.

Choosing Wellsoft’s EDIS are Angleton ER (TX) and the third freestanding emergency center of Cypress Creek ER (TX).


People

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Harry Greenspun, MD (Deloitte) joins Korn Ferry as chief medical officer and managing director of its KF Health Solutions business.

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PM/EHR vendor InSync Healthcare Solutions promotes Roland Therriault to president, replacing Tom Wilson.

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Gregg Waldon (RedBrick Health) joins Kareo as CFO.


Government and Politics

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CMS discloses that it (meaning we taxpayers) paid over $1 billion per year for the past five years buying Mylan’s EpiPens for Medicare and Medicaid patients. The government also claims that Mylan misclassified the allergy injection as a generic drug –which earns CMS only a 13 percent rebate– instead of a brand name product for which CMS would have received at least a 23 percent discount. CMS indignantly tells the press that it has repeatedly warned Mylan that they were mischaracterizing the drug, but doesn’t explain why it kept paying the inflated price anyway.

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CMS Acting Administrator Andy Slavitt describes the state of healthcare insurance marketplaces in a Wednesday speech:

We’ve chosen to address the need to transform in most traditional American way possible– through the private sector. Which means we’re relying on innovation and competition to serve consumers best … If anyone’s premise was that by passing one law, we would fix the affordability of health care all at once, that’s just not how it works. We’re here because the law sets a path in motion … Particularly if you see churn in your book– as people move in and out of jobs and struggle with affordability, how do you build loyalty? Are you building on-boarding processes, monthly touch points, and other initiatives that create “stickiness?” Remember, consumers don’t like churning any more than you do … do you have your first tier hospitals contracted to manage aggressive ER utilization so people can get care in the right setting? Have you set up telemedicine, nurse lines, and other convenient forms of both coaching and steerage? Is there free primary care and other incentives to detect health concerns early?

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CMS opens a search for a replacement for former CIO David Nelson, who was brought on to save Healthcare.gov before moving to the Nuclear Regulatory Commission in August.

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CMS adds hospice payment information to its publicly available datasets.


Privacy and Security

In England, an NHS security official provides a specific example of how far hackers will go to penetrate a hospital. They targeted an employee, looked up his background on LinkedIn to find that he played college rugby, spoofed an email account using the name of the team captain he played with, and included an attachment claiming to be an old team photo of the two of them together. The victim clicked on the attachment, clicked OK to allow it to open, and in doing so permitted the installation of Trojan spyware that probed the network for two weeks until it was discovered. NHS’s particular problem is that 15 percent of its PCs still run the insecure Windows XP either because old apps and devices require it or that money is too tight to upgrade everything.


Innovation and Research

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The American Heart Association, Verily Life Sciences (Google), and drugmaker AstraZeneca award a $75 million, five-year grant to Calum MacRae, MD, PhD, chief of cardiovascular medicine at Brigham and Women’s Hospital (MA), for a big data-powered study in which he will apply engineering, computing, and genomics expertise to the data of heart study participants to look for early markers for heart disease. His team will use data from wearables and patient-reported information in attempting to answer the question of why so many patients get heart disease despite having none of the currently known risk factors.


Technology

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The RWJF-funded project The Mood Challenge names the finalists of its competition to use Apple’s ResearchKit to assess mood and its relationship to PTSD. BiAffect tracks and predicts mood episodes by the speed and accuracy of the user’s typing, while Aware Study administers weekly surveys and two daily tasks.


Other

In Australia, doctors at Cairns Hospital request an independent review of its Cerner rollout after learning that 48 mislabeled blood specimens have been identified this year vs. nine in all of 2013. Employees say the specimen collection workflow is convoluted and that printing tube labels for multiple patients on a single printer has caused mixed-ups.

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The AMA publishes new MACRA tools for doctors: a calculator to predict the impact of payment changes on a given practice, new MACRA tools for its STEPS Forward practice redesign program, and a podcast series.

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Internet pioneer and venture capitalist Marc Andreessen says in an interview that rising-cost sectors (mostly healthcare and education) are dragging down the economy in canceling out the benefits and lower prices created by technology, leading to stagnant incomes, loss of jobs, and a bigger chunk of personal income spent on those sectors:

You have the sectors in which prices are rapidly rising: healthcare, education, construction, prescription drugs, elder care, and child care. Here there’s very little technological innovation. Those are sectors with insufficient productivity growth, innovation, and disruption. You’ve got monopolies, oligopolies, cartels, government-run markets, price-fixing — all the dysfunctional behaviors that lead to rapid increase in prices. The government injects more subsidies into those markets, but because those are inelastic markets, the subsidies just cause prices to go up further … The problem is insufficient technological adoption, innovation, and disruption in these high-escalating price sectors of the economy. My thesis is that we’re not in a tech bubble — we’re in a tech bust. Our problem isn’t too much technology or people being too excited about technology. The problem is we don’t have nearly enough technology. These cartel-like legacy industries are way too hard to disrupt.

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Odd: a closed Ohio bridal shop sues a Texas Health Resources hospital for $1 million, saying it lost hundreds of thousands of dollars after one of the two THR nurses who contracted Ebola in 2014 tried on dresses there before she knew she was infected, after which the stigma of being known as “the Ebola store” caused the store’s failure.

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I would say drug pricing and profits are way too complicated when I can’t even understand a dumbed-down graphic of where prescription money goes. I do understand, however, that despite the title that suggests middlemen are raking it in, the last line shows that the brand-name manufacturer still keeps 75 percent of whatever made-up price they choose (thus encouraging them to price accordingly).

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A writer whose 34-year-old wife died in CHA Cambridge Hospital (MA) pens a moving letter to the ICU employees who cared for her:

When I needed to use a computer for an emergency email, you made it happen. When I smuggled in a very special visitor, our tuxedo cat, Cola, for one final lick of Laura’s face, you “didn’t see a thing.” And one special evening you gave me full control to usher into the ICU more than 50 people in Laura’s life, from friends to co-workers to college alums to family members. It was an outpouring of love that included guitar playing and opera singing and dancing and new revelations to me about just how deeply my wife touched people. It was the last great night of our marriage together, for both of us, and it wouldn’t have happened without your support.


Sponsor Updates

  • VMware shares its vision for intelligent analytics from VMware AirWatch.
  • Impact Advisors volunteers with SCARCE DuPage as part of its annual Operations Team meeting.
  • Catalyst’s HITRUST CSF certification is extended to customers using Microsoft Azure.
  • InstaMed recaps its event at Epic’s UGM.
  • HCI Group will exhibit at the Ministry of Health & HIMSS Middle East conference in Riyadh, Saudi Arabia next week.
  • Glytec is named an innovation award finalist for its diabetes management solution.
  • John Yurkschatt of Direct Conulting Associates is named to “2016 Millennials in Staffing.”
  • MedData will exhibit at the ACEP Scientific Assembly October 16-19 in Las Vegas.
  • A Spok survey finds that most hospitals are formalizing their mobile strategy, often with the help of outside experts, but are challenged by deficiencies in Wi-Fi and cellular coverage.
  • Meditech celebrates October’s health literacy heroes.
  • Wellsoft will exhibit at ACEP October 16-18 in Las Vegas.
  • Medicity President of HDMS Analytics Patrice Wolfe will keynote the New Jersey & Metro Philly HFMA Annual Institute taking place this week in Atlantic City.
  • Obix Perinatal Data System will exhibit at the Tennessee State AWHONN Conference October 7-8 in Memphis. 
  • Experian Health will exhibit at the HFMA SoCal/Imperial Chapters Fall Conference October 9-11 in Newport Beach.
  • Red Hat will host its North America Partner Technical Exchange October 10 in Chicago.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/6/16

October 6, 2016 Dr. Jayne 1 Comment

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At my clinical practice, we frequently use scribes to document in the EHR while we focus on patients. While most of our scribes are cross-trained emergency medical technicians or medical assistants, some are college or graduate students who are looking for experience in the field while they apply to medical school.

My favorite scribe was recently admitted to medical school. Since he doesn’t have any family in town, he invited me to sit in for his family at his school’s white coat ceremony. We didn’t have that ceremony when I went to medical school, but quite a few schools have them now. Often in their first year of training, students are presented with the traditional white coat and may take an oath.

Schools have gotten away from the traditional Hippocratic Oath (mine used the Declaration of Geneva), but his school encourages each class to write their own oath. It was quite moving to see the students promise to keep the patient at the center of care and to deliver care equitably regardless of gender, race, religion, or sexual orientation. I didn’t hear anything about sacrificing patient care time to address burdensome regulations and reporting requirements, but they’ll be learning about those aspects of medicine soon enough.

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October is Health Literacy Month, aimed at helping promote the importance of understandable health information. Greater health literacy can lead to improved health status and may be more of a contributor than other factors such as race, ethnicity, or socioeconomic status. Although many EHR vendors try to increase health literacy by making sure their patient education materials are at an accessible reading level, there are other factors at play. The National Patient Safety Foundation is promoting its “Ask Me 3” program that encourages patients to ask three questions to better understand their health: 1) What is my main problem?; 2) What do I need to do?; and 3) Why is it important for me to do this? I’d love to see more EHR-generated patient plan documents that address these questions in a readable format rather than just spitting out codes and canned phrases that may not make sense for patients.

The rising cost of health care and subsequent attempts at reform are impacting care delivery across the country. My local school board just voted to investigate the possibility of onsite health clinics for employees and their families. They’re not ready to address health clinics for students, but the employee clinics are seen as a possible way to not only get employees back to work more quickly, but to control costs. We perform similar corporate health services at my clinical practice and can generally get patients treated and back to work with their medications in under 45 minutes. I’ll be interested to see how it turns out and whether the promise of efficiency and cost-control outweighs any privacy concerns.

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Nearly 180 members of the House of Representatives sent a letter to CMS claiming that recent payment reforms announced by the Center for Medicare and Medicaid Innovation (CMMI) exceed the authority of CMS and are therefore illegal. The legislators contend that voluntary programs are acceptable, but mandatory participation in programs such as bundled payment programs can “commandeer clinical decision making and dramatically alter the delivery of care.” They go on to “insist CMMI stop experimenting with Americans’ health.” I’ve spoken with many of my peers who feel that MU and other programs are out of control experiments with no requirement for institutional review board approval. It remains to be seen if using financial incentives against providers will really drive the needle on patient outcomes.

I wrote earlier this week about some downtime/disaster recovery adventures I had with one of my clients. A reader commented on my mention that “since crossing to the IT dark side, I’ve had more late night phone calls for database disasters than I’ve had for patient care issues, but the steps are surprisingly similar,” wanting to know more.

  • Getting to the root cause of an information technology misadventure can be a lot like trying to diagnose a patient who presents with vague symptoms or a complex condition.
  • Like a person with a stroke, it’s important to know when was the last time that the system was normal, what the presenting symptoms were, and how quickly it progressed.
  • Similar to a person having a heart attack, you have to act quickly within a limited time frame so that more extensive damage doesn’t happen.
  • You have to assimilate data from a variety of sources and try to put it all together in the hopes of figuring out what happened, what is currently going on, and how you can identify the best intervention.
  • Sometimes you try maneuvers that are both diagnostic and therapeutic. They may or may not work depending on the status of the patient/system.
  • It’s important to have a skilled team that can work well together and has common goals.
  • When we teach CPR and advanced cardiac life support, we talk about closed-loop communication and following algorithms for prescribed interventions. Both of those apply to downtime and disaster recovery situations.
  • Not unlike medicine, sometimes you lose a patient. But when you make a save, it’s extremely gratifying.

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Mr. H recently polled the reader base on desirable qualities for sales team members. He mentioned that military service ranks #1 on his list. I work with numerous veterans and have to say they’re high on my list of desirable employees and co-workers as well. I recently finished reading a book called CONUS Battle Drills by Louis J. Fernandez. Subtitled “A guide for combat veterans to corporate life, parenthood, and caging the beast inside” it also offers good perspective for those of us who hire or work with people who have been through situations we can barely imagine. I’m grateful for all the men and women who have served and who have continued to serve and look forward to having them on my team.

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I’m going to put my physician hat on for a minute and remind everyone to get a flu vaccine. There was some buzz earlier this year about whether receiving the vaccine too early can reduce its effectiveness, which may have led some people to wait. Although some think the flu is no big deal, it kills nearly 24,000 people in the US every year, including 100 children. It can also cause life-threatening complications. The vaccine used to be recommended only for high risk patients, but now vaccination is universally recommended for everyone over six months of age. Let’s roll up our sleeves and get the herd immunity going.

Does your employer mandate flu vaccinations? Email me.

Email Dr. Jayne.

Morning Headlines 10/6/16

October 5, 2016 Headlines No Comments

Scientist using big data against heart disease wins $75 million award

The American Heart Association, Verily Life Sciences, and AstraZeneca have awarded their $75 million “One Brave Idea” research award to a single researcher, Calum MacRae, MD, chief of cardiovascular medicine at Brigham and Women’s Hospital (MA), who will work with MIT engineers to analyze data from the Framingham and Million Veterans studies to learn more about how heart disease begins.

Surgeon General sends warning to own staff: Your personal information may have been stolen

The Surgeon General’s office confirms that hackers have stolen the personal information of its staff, including 6,600 medical professionals that report to the Surgeon General.

Chinese billionaire says he’s not interested in buying CHS

After increasing his stake in CHS, Chinese billionaire Tianqiao Chen says that the health systems recently enacted ‘poison pill’ defense is unnecessary. A spokesperson states “We believe it is important to reiterate our previously stated position of being a passive investor in the company. We have no intention to influence or control the company and have communicated this to the company on various occasions.”

It pays to be kind at Geisinger

Geisinger Health System has paid out $400,000 in reimbursements as part of a money-back guarantee to patients who say that their experiences were not met with kindness and compassion.

Readers Write: Guaranteeing MACRA Compliance at the Point of Care

October 5, 2016 Readers Write No Comments

Guaranteeing MACRA Compliance at the Point of Care
By David Lareau

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MACRA will affect every physician and every clinical encounter. Current systems have been designed to produce transactions to be billed. MACRA will require that clinical conditions have been addressed and documented in accordance with quality care guidelines. The only way to ensure that happens is to do it at the point of care.

The challenge is that physicians need to address all conditions, not just those covered by a MACRA requirement. One approach is to just add another set of things to do, slowing doctors down and getting in their way. This is the transactional approach — just another task.

Most current systems have different tabs that list problems, medications, labs, etc. Users must switch back and forth looking for data. The data cannot be organized by problem since the systems lack any method for correlating information based on clinical condition. Adding another set of disconnected information to satisfy quality measures will only make it worse for users.

A better approach is to integrate quality care requirements for any condition with all the other issues the physician needs to address for a specific patient and to work it into a physician’s typical workflow. A well-designed EHR should have a process running in the background that keeps track of all applicable quality measures and guidelines for the patient being seen. The status of all quality measures must be available at any point in the encounter in a format that ties all information together for any clinical issue.

This requires actionable, problem-oriented views of clinical data, where all information for any clinical issue is available instantly. Physicians need to be able to view, react to, and document clinical information for every problem or issue addressed with the patient. This includes history and physical documentation, review of results, clinical assessments, and treatment plans as well as compliance with quality measures.

Guaranteeing MACRA compliance at the point of care can be accomplished by using a clinical knowledge engine that presents all relevant information for any clinical issue so that MACRA quality measures are seamlessly included as part of the patient’s overall clinical picture, not as just another task to be added on to the already burdensome workflows of current systems.

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Readers Write: Telemedicine Is Just Medicine

October 5, 2016 Readers Write 6 Comments

Readers Write: Telemedicine Is Just Medicine
By Teri Thomas

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Telemedicine. MHealth. Remote healthcare. What’s the best term for a given use case? A large portion of my job is focused on it, yet my answer is, “I don’t much care what term you use.” 

Well, I guess I care a little if I see confusion getting in the way of progress. Don’t get me wrong — I’m glad that nobody has been saying “mMedicine” yet (would that be like, “mmm…medicine” or “em-medicine?”) I don’t love “virtual health” as it makes me wonder if I watch lots of exercise shows and raw food infomercials, could I get virtually healthy? 

Defining telemedicine as a subset of telehealth related to direct care at a distance vs. provision of healthcare-related services at a distance, while correct—who cares? Consider if when indoor plumbing was new, people discussed “s-water” (out of a stream), vs. “i-water” (from in the home). I guess i-water would be better than p-water from pipes (it’s OK to giggle a little — be a middle-schooler for a minute). We care about perhaps three factors:

  • Is it modified/sparkling/flavored?
  • Do we have to pay for it (bottled water vs. tap water)?
  • Is it clean enough to drink?

Medicine is medicine. Healthcare is healthcare. It’s care: good, bad, and a ton in the middle. Yet I hear murmurs like, “Telemedicine isn’t good quality healthcare.” That’s like saying tap water isn’t good enough to drink because you’ve spent time in Flint.

Good quality care isn’t determined by the location of the provider or patient. Care can be done very well without requiring the patient and the clinician to be in the same room. It can also be done very poorly. Probably the majority of it — just like when the doctor and patient are together in a room — is not perfect, not bad, and mostly OK. 

Not every type of visit is appropriate over video, but many types are. In dermatology, providers have been using photos for decades. Camera cost and image resolution have dramatically improved so that even inexpensive systems can provide more image detail than a physician with the sharpest of vision. Stethoscopes, lights, cameras, video connections, telephones—all are tools to help us practice medicine better.  Sometimes the tools work great and are helpful and sometimes not.

If the Internet connection is slow or the battery dies, quality is impacted. But think for a minute about the impact on quality of care for the physician who had an extra-complex first appointment and is running an hour or more behind. The patients are stacking up and getting upset about their wait times. The clinic day is lengthening. The pressure to catch up mounts. Finally, consider the patient taking off work, driving to a clinic, parking, sitting in a waiting room with Sally Pink Eye, feeling at bored at best and anxious and angry at worst about their wait times.

How high of quality will that encounter be compared to the patient connecting with the provider from home or work? The patient didn’t have to drive, and even if waiting, likely they were in a more comfortable environment with other things to do.

Keep in mind that if the patient were physically there in the dermatology office and the lights went out or the dermatologist’s glasses were suddenly broken, it would be very hard to provide a quality exam. For a remote derm visit, if you can ensure reliable “tool” quality (history from the patient and/or GP, high enough resolution video/images, clear audio), why should there be a care quality concern? Yet these kinds of “visits” — heavily image-focused encounters — are still traditionally accomplished by asking a patient come to the provider. 

Thank you to Kaiser and other telemedicine leaders for providing us with the validating data: remote visits can be done with high quality, lower costs, and positive quality care and patient satisfaction outcomes. On behalf of patients who are increasing expecting more convenient care, healthcare providers who are hesitant — please invest in video visit technology and seek opportunities to provide more convenient care for your patients. Payers, please recognize that this is in everyone’s best interest and start financially rewarding those providers.

Teri Thomas is director of innovation for an academic medical center.

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Reader Comments

  • Publius: Re: Speaker Paul Ryan and Epic. I don't think you should assume a relationship there just because he is from Wisconsin. ...
  • JM: RE: MDA -- Here are the initial contract awards…from 2013: -$60M to Epic (software) -$48M to Encore (services) -$4....
  • Concerned Citizen: While I agree with everything you say about EHR's being way behind on innovation and progress because of the artificial ...
  • meltoots: Halamka- Yes we need to stop trying to solve EHR issues via certification. Let the market work. The policy market crea...
  • Mr. HIStalk: That would be cool. Thanks!...

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