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Curbside Consult with Dr. Jayne 6/8/15

June 8, 2015 Dr. Jayne No Comments

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I was visiting some friends this weekend and we drove past a niche primary care clinic. It advertised “Healthcare for Guys!” which certainly caught my eye. Although the location I saw was next to Costco, a quick Web search revealed that they apparently also have a location next to a home improvement store. I’m always interested in new models of care and thought I’d find out a little bit more. Unfortunately, their website was pretty sparse without even a listing of their physicians or the fact that they now have multiple locations. Their Facebook page had multiple posts with grammar errors and typos. Not exactly a vote of confidence, but a great example of why physicians need to pay attention to their social media presence and webpages.

On the flight home, I noticed that the ever-present SkyMall catalog was missing — apparently it’s gone digital-only. After some procrastination (check out the automated pill dispenser above), I was forced to read journals instead. An article in the Annals of Family Medicine caught my eye: “Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians.” The study set out to assess “the feasibility and acceptability” of some of the care coordination objectives in the proposed Meaningful Use rule for Stage 3. Specifically, they looked at referrals, transfer of care, clinical summaries, and patient dashboards.

Researchers surveyed primary care practices that had been recognized as patient-centered medical homes (by the National Committee for Quality Assurance) in addition to participating in Meaningful Use. They also surveyed community health centers with patient-centered medical home recognition. The survey looked not only whether the sites had implemented the proposed objectives, but also at whether the practice thought those objectives were important. The results were similar to anecdotal comments I’ve heard in the field. While 78 percent of the physicians thought it was important to be notified of hospital discharges, only 48 percent were using IT systems. Conversely, while 77 percent of practices were providing clinical summaries to patients, only 48 percent of them considered providing summaries to be “very important.”

Similar to what we know about vaccine delivery (namely that non-physicians do a better job of following protocols and ensuring vaccination), the study found that care coordination was more often done using IT systems when a non-physician was responsible. The practice’s “capacity for systemic change” was also positively associated with using health IT for care coordination as was being in a non-urban area. The study concludes that “health IT capabilities are not currently aligned with clinicians’ priorities” and that “many practices will need financial and technical assistance for health IT to enhance care coordination.”

Those aren’t earth-shaking conclusions for anyone who has been in the trenches during the Meaningful Use era. While those practices that had already transformed care coordination prior to MU will continue to do so, those arriving later to the dance are struggling. It’s hard to identify dedicated resources to manage patient panels without negatively impacting the bottom line of practices already on thin margins. Although there is the promise of future money for demonstrable outcomes, you have to demonstrate quality to get the money. It’s a somewhat perverse chicken-egg-chicken loop.

I also wasn’t surprised by the fact that the survey only had a 35 percent response rate. Additionally, the study found that the most commonly implemented care coordination processes were not those with the most IT involvement. Respondents cited the top barriers as time, money, and IT systems. There were several other interesting data points from the practice demographic data: approximately one-third of clinicians were concerned about practice financial health; more than three-quarters of practices received help improving care coordination; and referral tracking was less than 100 percent. My former risk/compliance department would have a field day with the latter statistic since everyone was expected to track 100 percent of referrals 100 percent of the time.

Now that we’re getting a critical mass of providers involved using IT systems, we need more surveys such as this to determine where physician priorities really are and whether we can align systems to support those clinical priorities rather than trying to drive clinicians based on what systems will support. Interestingly, the next article I read discussed the idea that payment reform isn’t the only factor turning medicine on its ear. The NPR headline caught my eye: “A Top Medical School Revamps Requirements To Lure English Majors.”

Having been a non-science major myself, I support approaches like this aimed at bringing more diversity into the field. Some of the problems we’re trying to solve are extremely complex with a high number of psychosocial factors. It’s going to take more than biochemists and fruit fly-counting biology majors to help solve them. There were a decent number of non-traditional majors in my entering medical school class, but it certainly wasn’t the norm.

What was your undergraduate major? Would you do it again or is it just good for cocktail party discussions? Email me.

Email Dr. Jayne.

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June 8, 2015 Dr. Jayne No Comments

HIStalk Interviews David Lee, CEO, Huntington Medical Foundation

June 8, 2015 Interviews 1 Comment

David Lee is CEO of Huntington Medical Foundation of Pasadena, CA.

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Tell me about yourself and the medical group.

I’ve been in the medical group practice for over 20-plus years. To a community clinic, from an FQHC, to a private practice, to a mid-sized medical group like we are here,  I have a vast experience in healthcare over a long period of time. Most of it’s been from an operational standpoint, so it gives me some good background of knowing the different lines of healthcare business. Not just in the commercial world, but also in the community side of it.

We’re a multi-specialty group, about 75 physicians, eight locations, and with a handful of subspecialties in the group. We are spread out primarily in Pasadena, but east is Arcadia and also north is La Canada.

 

What are your primary systems?

Our EHR system is the Allscripts Enterprise system.

 

What do you think about the Meaningful Use program?

The ambition is the right ambition. There’s no perfect EHR system. A lot of times, it’s how it gets mapped and capturing the right information. There are times of trying to capture the information in a meaningful way is not always the most meaningful way to capture the information, to be quite frank with you. It’s just trying to navigate into some of the complexities of an EHR system. 

I don’t think there’s a perfect system out there that does it all. Having a strong IT team and a clinical team to be able to make sure that the execution takes place is a critical piece for us and what we do. That’s how we’ve been successful in Meaningful Use.

 

What is your real-world experience in exchanging information with other providers?

My end goal is to get to the predictive analytics side of it and create an ecosystem that has self-reporting data to be able to aggregate the data. As you’re well aware, today it’s all disparate. 

On our end, what we’re doing is not relying on our EHR system to pull out data. We have someone who’s dedicated on the analytics side who will dive in deeper into the data. But we’re also being innovative and thinking outside of healthcare. 

We’re engaged today in working outside of the healthcare industry to have some of these solutions to creating, for example, a master patient index, so that the disparate systems are being connected and to be able to exchange information. Not so much in an HIE, but similar to an HIE. As simply as getting an order to a specialist that’s outside of our organization. It’s always been a challenge, but I’m very optimistic – we are very close on our end to making this connection happen in the near term.

 

Are physicians are pushing back against the idea that everything that they do should be summarized by clicking a box or choosing a dropdown and in doing so losing the ability to quickly determine afterward what’s wrong with the patient or what they need to do?

Absolutely. Part of the challenge is completing a form online. A lot of those forms are converted in a PDF and it’s not discrete. Once it comes into our system, it’s still fragmented. Part of what we’re trying to do is getting this form that’s filled in discretely completed and moving that discrete information into that patient’s profile in the EHR system. 

There’s been a lot of work on our end of creating that type of system so that it becomes seamless and it tells the right story at the right time for our physicians. If it’s a scanned document, it gets filed away and then scanned. The frequency of those being viewed is probably not as good if it was on a dashboard created on the screen as a summary of what’s currently in our system. That would be much more effective than as a scanned document.

 

How are you doing with exchanging information with hospitals?

We’re fortunate that with our partnership through Huntington Hospital, Huntington Hospital has an HIE. We’re able to get the information from an inpatient standpoint. Obviously it’s not perfect and I think there’s some challenges with that, but half of the battle is that there’s an HIE already established to be able to get ED visits, inpatient information, lab information, anything that resides in their system that involves one of our patients. We can get that information today and we are fortunate in that sense.

 

Have you started the move toward value-based care in a way that has increased the need for that same kind of connectivity to outside organizations?

Absolutely. The culture has definitely changed for our organization in moving to a value-based. A lot of things, even from the physician standpoint, are changing some of our compensation model for our physicians to incentivize in the right away, a lot of it based on the value. But not just the segmentation of that. Our entire population is all based on this value-based, taking the baby steps incrementally to get that in place.

But the importance of it is the data. We also have an ACO that is very critical in how we hand off care, especially with the high risk and trying to look at readmission rate. We leverage resources from the hospital, but also with that leverage of not just resources, but the data. Trying to get that aggregated is an important piece that we’re working through, too.

 

In terms of population health management, who drives the initiative and what information is collected and aggregated to allow you to manage a population outside your own encounters?

Today we are taking just a segment of the population. It’s a Medicare population with the ACO. That is a start. That also includes independent physicians in the community that are into some ACO. Obviously there’s different challenges in that sense, but we have just embarked with a segment of that population. 

On our end, from an ambulatory standpoint, we look at it as the entire population. But when we’re looking at it from an enterprise and a value-based with the hospital, we’re just taking the Medicare population and specifically the ACO population.

 

Are you learning anything in those steps of  trying to understand more about the patient outside their visits and trying engage with them even when they don’t initiate the conversation?

Overall, patients are very receptive. We collected data and looked at our readmissions. We took a segment in that ACO population and took some of the high-risk patients to reduce readmission rate. When we first started, our readmission rate was 16 percent. By leveraging, for example, resources from the nurse navigators that then come into one of our three primary care offices, internal medicine offices, to be able to go into our EHR system to look at the data. We reduced it to eight percent readmission rate, a substantial amount of percent reduction. Leveraging some of the resources, and those are resources being able to tap into our information to be able to then manage the patients. Obviously the outcomes have been successful in what we’re trying to do.

 

What is that patient’s recourse if they have a problem at nine at night other than to go to the ED?

We have an urgent care. That’s something positive on our end. It closes at 10, and when you’re in one system, the navigation internally makes it more seamless. We’re able to leverage that instead of them going to the ED. 

The nurse navigators, for example, are always connected. If they’re in the skilled nursing facility, they are always informing the primary care physician about keeping them in the loop if there’s any activity that needs to be contacted. Again, it’s not perfect. We just started this program about eight months ago. But it’s been a good work in progress of looking at where those gaps are, and the ones we identify, we’re able to put some solutions together.

 

For-profit retail clinics can be either competitors or partners, and in some cases, they are offering community outreach services and off-hours coverage. Do you have any relationships with them?

We currently don’t have any partnerships with these retail businesses, but I am looking into creating this. A lot of our patients want care right now. Creating access is always a challenge in healthcare. 

What I’m looking to do is create a platform that not only engages the patient when they need it from a telemedicine standpoint, but the whole patient experience along with the whole continuum. Create a platform from a technology standpoint so that I’m not relying on a retail business … not knowing if they got services in that sense, but when the services are performed that we have that information.

As I mentioned early on, the end goal of what I’m trying to achieve is getting to the predictive analytics side of it. Why am I interested? Because for us, we need to transform and focus on the prevention and the wellness side of it. For so long, healthcare has not put any emphasis on that. We’re really driven on this outcome-based. We need to focus a lot of our efforts on the prevention side. From the prevention side, we’ve got to dive in deep to look at the analytics to be predictive before they get sick and we’re managing patients at that point, before they enter into the hospital. There’s no follow-up from an ambulatory standpoint. We just need to have much more effective systems in place to be able to do that.

 

Retail clinics have a lot of locations, extended hours, and short wait times. Are you feeling market pressure to change your practice for patient convenience?

No, I haven’t felt it yet. In our area, it’s probably slower on that retail business side of it. But as it grows, we just then need to figure out from an access standpoint how to get that information back. As the world moves into this value-based and more outcome-driven, it’s more about getting that information, that data, back into our system. If we’re not informed or in the loop of that even though the care was taking place, those outcomes won’t go anywhere. They’re getting the care somewhere else.

 

What are you doing or considering to let patients be more involved in the information that you have or to collect information from them?

Patients have access to a portal that gives information. What I hope in the near future is that we get much more push notification in creating that experience, as simply informing patients as they walk into our office to be able to say, “Welcome to your 10:00 appointment” or if our physician is behind. They’re using their own personal device of getting information that we’re helping to provide them so they’re much more informed and much more engaged about their own health. Those are some of the pieces that from a technology standpoint of what we’re looking to do. 

I personally feel that we haven’t leveraged technology and healthcare in general the way we should have. As a lot of good solutions in the healthcare space have been entered,  we need to take advantage of some of these opportunities to create a better experience for our patients and better care. It doesn’t have to be a traditional way of coming to the office to be treated –it can be done with us sending someone into the home or using telemedicine, especially from a technology standpoint. We need to start exploring and creating some of that delivery model in a different way.

 

What are the technologies you need that someone could build?

The interoperability, the connection, the integration to outside systems that are outside of our organization. That’s one of our biggest challenges. When you have the disparate systems out there, it’s hard to get that connection. That would be our number one problem and issue.

That’s where duplications often are created. Primary care sends a referral to a specialist outside of our network or our organization. If the subspecialty is referring to another subspecialty, or a subspecialty wants to see that patient again for a follow-up, primary care is unaware of that 90 percent of the time. That’s the part of the system — how do we get that connection, so at least everyone who’s part of this patient’s care is in the loop of the care that’s being taken care of? That’s a big challenge for healthcare, to  connect all these fragmented systems into a much more seamless and aggregated way.

 

What will be the group’s greatest opportunities and the greatest threats in the next five years?

Healthcare in general is rapidly changing, but I think one of our greatest opportunities will be the technology side. Healthcare in general has not done a good job in collecting that data or even using technology in a meaningful way. But the obstacle and challenge that healthcare faces is culture. A long-time fee-for-service world and mentality changing into a value-based and a focus on prevention and wellness — that’s a culture shift. When you’re doing that, it doesn’t happen overnight. I see that as the biggest challenge for the healthcare in general and the industry — changing culture. It will be a big undertaking.

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June 8, 2015 Interviews 1 Comment

Morning Headlines 6/8/15

June 7, 2015 Headlines No Comments

CSC to pay $190 million to settle SEC charges

CSC will pay a $190 million to settle fraud allegations after the SEC charged the company with manipulating financial results and hiding problems with its largest contract, the UK’s now defunct NPfIT program, from investors. CSC signed a $4.5 billion contract with the NHS to deploy its Lorenzo EHR across 166 hospitals, but a poor implementation track record led to the program being shut down.

Evolent Health Stock Closed at $18.86 in IPO Debut

Evolent Health finishes its first day of trading on the NYSE at $18.86, up 11 percent from the start of the day.

Hawaii Pulls The Plug On Embattled Health Insurance Exchange

Hawaii will shut down its $130 million, state-run health insurance exchange and migrate to Healthcare.gov after a series of technical failures kept it from meeting key ACA requirements. With one of the lowest uninsured rates in the country, administrators acknowledged that the sites 40,000 users would no generate enough revenue to continue operations after federal subsidies ran out.

Data hacked from U.S. government dates back to 1985: U.S. official

Chinese hackers breach the severs of the US Office of Personnel Management, stealing security clearance and background check data going back to 1985 and affecting nearly four million current and former government employees.  

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June 7, 2015 Headlines No Comments

Monday Morning Update 6/8/15

June 6, 2015 News 2 Comments

Top News

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CSC will pay $190 million to settle SEC charges of accounting fraud related to its money-losing NPfIT contracts with the UK’s National Health Service. Five of eight former CSC executives have settled SEC charges of manipulating financial results, with former CEO Michael Laphen agreeing to return more than $4 million in compensation under the clawback provision of the Sarbanes-Oxley Act. The SEC’s investigation found that CSC lied about earnings after falling short of revenue due to missed NPfIT deadlines and also took out high-interest loans from NHS to hide cash flow problems from investors. A Bloomberg report says HP was close to acquiring CSC last month for $9.3 billion but backed out, with CSC’s new plan being to split itself into two publicly traded companies.


Reader Comments

From ICDelightful: “Re: ICD-10. Why didn’t CMS just do ICD-9 to ICD-10 mapping itself to provide a single standard? Even if 20 percent of the codes don’t directly it seems like CMS is in the best position to determine which are the closest match.” I’ll leave it to more HIM-savvy readers to respond, with my guess being that ICD-10 codes have a mandatory additional level of specificity that can’t be automatically and accurately derived from a given ICD-9 code.

From The PACS Designer: “Re: coining a new term. With the advent of cloud-based solutions, it’s becoming apparent that data stored in the cloud and other database solutions need a better term than big data. With transparency being key to move data more efficiently, it would be better to use the term ‘dataware’ to describe the transparent data sources.”

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From Mountain High: “Re: Boulder Community Hospital. Goes down again, this time for only about a day (eight days of downtime in 2013).” It sounds to me like they were experiencing some kind of denial-of-service or malware attack given that the forwarded internal email suggests that its network was overloaded and the IT security director was assigned to investigate.


HIStalk Announcements and Requests

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Poll respondents are equally split as to whether lack of patient data-sharing should be blamed on health systems or their EHR vendors. Will says the correct answer is none of the above – the fee-for-service system treats interoperability as an unreimbursed cost and data will be shared when there’s a business reason to do so, while Frank blames lack of customer (patient) demand and Mobile Man says the biggest payor (Uncle Sam) could change interoperability overnight by changing reimbursement. New poll to your right or here: how will overall health IT vendor revenue change over the next five years?

My latest grammar peeve: capitalizing relationship names when the word isn’t used as a title, as in, “I visited my Dad” (wrong) vs. “I visited Dad” (right). Sometimes people mysteriously do the same in referring to an occupation, such as “I am a Teacher.” Not new but increasing in frequency is the practice of combining words not used as adjectives, such as, “I brush my teeth everyday” (wrong) vs. “My everyday practice is brushing my teeth” (right). I acknowledge that rampantly incorrect word usage will eventually find its way into dictionaries that see their role as observational rather than authoritative, which would make one fine mess in nearly every other discipline where things are either right or they aren’t despite what the questionably knowledgeable masses believe.

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Mrs. H says the two Chromebooks we bought for her Oregon elementary students via the DonorsChoose project (with matching funds from the Bill & Melinda Gates Foundation) have boosted morale and improved reading scores. I have $10,000 in matching money available (courtesy of an anonymous vendor executive’s personal pledge) for companies donating $1,000 or more, who also get a mention right here on HIStalk for their involvement.


Last Week’s Most Interesting News

  • Quality Systems President and CEO Steven Plochoki resigns.
  • BIDMC CIO John Halamka, MD urges CMS to shut down the Meaningful Use program and instead hold providers accountable for patient outcomes and letting the market determine which technologies they need.
  • A M&A publication states that health IT firms Netsmart, Precyse Solutions, Mediware, Edifecs, Caradigm, and Altegra Health are being shopped for sale.
  • A cybersecurity firm warns that unsecured medical devices provide hackers with a nearly undetectable back door into health system networks.
  • Partners HealthCare (MA) goes live on Epic at a total project cost of $1.2 billion, double its original budget.
  • An insurance company demands that Cottage Healthcare System (CA) repay its $4.1 million breach settlement, saying the hospital lied on its insurance application by claiming it was performing IT security maintenance steps when it really wasn’t.
  • A Texas judge issues an injunction requested by telemedicine vendor Teladoc against the Texas Medical Board for its requirement that physicians conduct an initial face-to-face patient visit before prescribing drugs.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.


Acquisitions, Funding, Business, and Stock

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Shares of Evolent Health closed Friday up 11 percent to $18.86, valuing the newly NYSE-listed company at $950 million. UPMC’s stake is worth $278 million, while CEO Frank Williams holds $22 million in shares. 


Sales

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Glytec announces that 13 health systems have chosen its eGlycemic Management System for managing glucose levels using evidence-based insulin dosing recommendations. Among the new clients are Kaweah Delta Health Care District (CA), Edward-Elmhurst Healthcare (IL), Mary Hitchcock Memorial Hospital (NH), and Mission Health System (NC).


Government and Politics

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Hawaii will shut down its $130 million health insurance exchange and move to Healthcare.gov. Hawaii’s high percentage of insured citizens, driven by a mandatory state employer insurance law, gave it too few users and too little revenue to sustain itself once it spent all of its federal grant money.


Privacy and Security

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China-based hackers breach the US federal government’s personnel system and steal the information of up to 4 million current and former federal employees in a just-announced December 2014 incident. Investigators say the cybercriminals, who may be working for the Chinese government, are likely the same ones who recently breached health insurers Anthem and Premera Blue Cross. The message is clear – in-depth information about people is more desirable to hackers (or “actors,” as the security people inexplicably say) than credit card files, and the fact that the Anthem and Premera data hasn’t hit the black market would suggest that a bigger and more organized plan is in place that goes beyond simply making a quick buck. Credit cards can be cancelled after a breach, but in-depth personal information can’t.


Other

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St. Louis Children’s Hospital (MO) says CNN misled readers by including it in an article titled “Is your pediatric heart hospital keeping secrets? We have answers.” The hospital says the CardioAccess software it uses doesn’t collect all of the information, leaving the hospital unable to report it.

Reno, MV pediatrician Ron Aryel, MD says syndicated columnist and non-practicing physician Charles Krauthammer is wrong in blaming physician dissatisfaction on EHRs. “My electronic medical record is my most powerful tool in the office. It helps to organize my thinking, prevents mistakes, and helps me spot important trends within my practice. My time ‘entering data’ rewards both me and my patients with better outcomes and more effective medicine. But doctors should focus on what they do best. I am good at getting patients healthy, and Krauthammer is good at being paid to write opinion pieces. I think he should keep doing that.” Krauthammer might not even be all that good at writing opinion pieces – he doesn’t offer one shred of proof to back up his assertion that an “EHR mandate” is causing physicians to quit. Nobody “mandates” that physicians accept insurance, deal with Medicare, sell their practices to health systems, or use EHRs – they voluntarily did all of those things for the money and now have seller’s remorse, leaving them with three basic choices: (a) deal with it while complaining to anyone who will listen; (b) start over in a cash-only concierge practice; or (c) quit and do something else. The problem with (c) is that doctors nearly always find the market value of their non-medical capabilities to be much less than they themselves believe, with the threatened loss of income and status steering them back to (a) in most cases. Actually I don’t have any more data than Krauthammer cites, but I suspect there’s a (d) choice in which doctors take purely transactional 9 to 5 physician jobs, such as working for insurance companies, telemedicine providers, consulting companies, and contracted physician staffing firms, accepting the notion that doctors rarely hang out their own shingles these days and that means becoming a begrudgingly obedient time-selling corporate widget like most everybody else who doesn’t drape a stethoscope around their neck as a status symbol.

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Here’s yet another questionably useful gadget for quantified selfers to embrace: The Lovely, a wearable sex tracker / sex toy (already tagged as the “Fitbit for your penis”) whose app tracks intensity and calories burned and provides suggestions for improvement and experimentation. I’m fearful of a future in which lust-crazed users flood Facebook with their Lovely-generated updates and boastful historical dashboards.

Weird News Andy says this spine transplant wasn’t about politicians, but rather a 35-year-old woman who faked romance with an 86-year-old man and then scammed him into giving her $1.2 million to pay for her “spinal transplant.” WNA’s rim shot conclusion is that “her story really struck a chord with the victim.”


Sponsor Updates

  • Zynx Health offers “Restricting Low-Volume Hobbyists: Translating the Volume-Outcome Relationship Into Health Policy.”
  • Streamline Health will exhibit at the 2015 CHIA Convention & Exhibit June 8-10 in Palm Springs, CA.
  • Sunquest releases the agenda for its 2015 Executive Summit July 13 in Scottsdale, AZ.
  • Xerox Healthcare offers “Healthcare C-Suite Sets Sights on Population Health Management.”
  • SIS COO Doug Rempfer pens an article for HFMA’s magazine entitled, “Using Perioperative Analytics to Reduce Costs and Optimize Performance in the OR.”
  • T-System offers “Leading with Passion: Checking in on Your People.”
  • TeleTracking will exhibit at the Digital Health and Care Congress 2015 June 16-17 in London.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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June 6, 2015 News 2 Comments

Morning Headlines 6/5/15

June 4, 2015 News 1 Comment

Quality Systems, Inc. Announces Retirement of President and Chief Executive Officer Steven T. Plochocki; Names Rusty Frantz Successor

Quality Systems announces that President and CEO Steven T. Plochocki will retire from the Company, effective June 30, 2015. He will be replaced by Rusty Frantz, former Carefusion SVP/GM.

So What is Interoperability Anyway?

John Halamka, MD and CIO at Beth Israel Deaconess Medical Center, calls for the end of the Meaningful Use program, proposing instead that Congress hold providers accountable for outcomes and let the free market dictate which technologies will work best to pursue those goals.

How hospitals hope to boost ratings on Yelp, HealthGrades, ZocDoc and Vitals

The Washington Post covers the impact patient satisfaction scores are having on clinical economics and the various efforts being undertaken by hospitals and practices to monitor and improve their online reputations.

Former Facebook CFO Ebersman Launches New Health Tech Startup Lyra Health

Former Facebook CFO David Ebersman launches a new business, backed by a seed investment from Venrock, focused on improving population health efforts in the behavioral health space.

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June 4, 2015 News 1 Comment

EPtalk by Dr. Jayne 6/4/15

June 4, 2015 Dr. Jayne 1 Comment

Pharmaceutical companies are major users of direct-to-consumer advertising. Although we see a lot of EHR vendors advertising in medical journals and at conferences, I haven’t seen a lot of direct mailings to non-administrative physicians. This week at my clinical office, I received a direct-to-physician mailing from Imprivata regarding electronic prescribing of controlled substances (EPCS). It was actually a nice piece – educational with respect to Meaningful Use requirements and the current status of EPCS.

Rather than relying on MU-related scare tactics, it appealed to the concepts of streamlining physician workflow and reducing prescription fraud and abuse. Enclosures explained the DEA ruling in detail and laid out strategies for planning a successful implementation. They did, of course, market their solution, but it was tastefully done. I also appreciated the fact that the entire packet was devoid of flashy marketing distractions. Maybe I’m getting more boring with age, but it’s nice to see something straightforward.

Health Datapalooza took place this week in Washington, DC. The agenda listed sessions on personalized medicine, patient-reported outcomes as quality indicators, data privacy and security, and advancing technology. I’d be interested in hearing from readers who attended. What were the best sessions? Anything earth-shaking?

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The May-June issue of the Journal of the American Board of Family Medicine surprised me with a special issue including multiple healthcare IT articles. One reviewed existing studies on physician use of scribes, concluding that scribes may improve clinician satisfaction and productivity. The researchers were only able to find five studies done between 2000 and 2014, so the validity of the results is limited. Another discussed the notion that “primary care researchers are uniquely positioned to inform the evidence-based design and use of technology.” It suggests leveraging existing research programs and methodologies from human factors engineering, which sounds like a great idea. A third examined how physicians use previous visit notes to prepare for an upcoming visit, suggesting that the note output of EHRs needs an overhaul to reduce cognitive load.

A friend shared Atul Gawande’s recent piece titled “Overkill,” which discusses continued recommendations for unnecessary tests and treatments. These not only drive up the cost of healthcare, but can lead to additional testing, which often leads to a spiral of waste. It also leads to overdiagnosis, which creates stress for patients and can also lead to additional unnecessary treatment. Theoretically our EHR systems should help us avoid these pitfalls through the use of clinical decision support and better availability of patient data at the point of care. However, until we spend time educating the populace that there are risks to “doing too much,” we won’t be able to take action on the information before us.

Gawande cites specific examples, stating, “We’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all.” It’s not just the United States facing this issue – South Korea is seeing similar problems. I often hear patients talking about the nation having the most advanced technology in the world and the best procedures, so it’s challenging to help them understand that often less is indeed more.

We’re putting steps in place to encourage physicians to proceed thoughtfully and avoid unnecessary expenditures, but I haven’t seen the level of national programming needed to bring patients around to this new way of thinking. Choosing Wisely presents evidence-based lists of tests and procedures to reconsider, but I don’t see them being used on the front lines of care. Patients often don’t want to rely on a physician’s education and clinical judgment; they want hard proof and this leads to testing. The relentless pursuit of higher patient satisfaction scores doesn’t make it easy to say no to patients, either.

It will be interesting to see how the healthcare landscape shifts over the next five to 10 years. Billions of dollars in Meaningful Use funds haven’t shifted the needle as much as we’d hoped, so it might be time to try new strategies.

How can we make the most of the next decade? Email me.

Email Dr. Jayne.

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June 4, 2015 Dr. Jayne 1 Comment

News 6/5/15

June 4, 2015 News No Comments

Top News

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Quality Systems (NextGen) announces the retirement of President and CEO Steven Plochoki. He will be replaced by Carefusion SVP/GM Rusty Frantz. QSII share price dropped 14.5 percent in Plochoki’s seven-year tenure vs. the Nasdaq’s 111 percent gain. 


Reader Comments

From LearnHealthTech: “Re: Florida Governor Rick Scott. Thanks for the new article on the stunningly corrupt and hypocritical governor. After defrauding taxpayers as a hospital CEO, he wants to go after non-profit hospitals for turning a profit.” Both for-profit and non-profit hospitals have plenty to be ashamed about, but Columbia/HCA’s felony fraud guilty pleas and $2 billion in settlement costs top the list. I suppose I shouldn’t be so critical because: (a) our healthcare system rewards aggressive business tactics, as evidenced by the stock market success of for-profit hospital operators and big healthcare-focused companies like McKesson and any number of insurers; (b) CMS’s “pay and chase” payment methods encourage health systems and companies to interpret its rules favorably in asking forgiveness rather than permission, no different than companies dealing with the IRS; and (c) Scott is right about the non-profit hospitals that still manage to have hundreds of millions of dollars in “excess revenue” that never seems to result in their overpaid CEOs offering to return the money, which usually means they just spend it on outcomes-indifferent activities such as buying up physician practices or erecting fancier buildings.

From Marshall: “Re: Connecticut hospital CEO salaries. Boosted handsomely.” Ten non-profit hospital executives made between $1 million to $3.52 million, with one CEO’s compensation increased 133 percent from $1 million to $2.3 million in just one year, while a second CEO saw his pay bumped by 85 percent to $3.1 million in the same year. The health systems didn’t provide a response to the newspaper’s inquiries, but it’s always the same anyway: (a) we have to pay that to keep him and we’re lucky he hasn’t left for greener pastures; (b) it’s not our fault that the market commands such high salaries and it’s a really hard job; or (c) we’re not really paying that much – it just looks that way because of one-time benefits such as payout of accrued retirement or severance benefits.


HIStalk Announcements and Requests

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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This week on HIStalk Connect: Dallas-based telehealth provider Teladoc enjoys its first victory in its antitrust lawsuit against the Texas Medical Board. The National Cancer Institute announces the start of a multi-arm cancer research project that will attempt to match cancer drugs with cancer-related genetic mutations. Google’s artificial intelligence research team is working on an app that will calculate the total calories in a plate of food by analyzing a picture of it. Rockwood City, CA-based digital health startup BaseHealth launches a genome API that will enable developers to integrate personalized care plans and risk reports into wellness applications.

This week on HIStalk Practice: Persivia CEO Mansoor Khan gives Jenn the scoop on starting up a new population health management company. Northwestern Counseling & Support Services connects to the Vermont HIE. Dr. Gregg describes the “bastardization” of HIT. CVS Health partners with HHS. Hughston Clinic rolls out TrainerRx software. TMA PracticeEdge COO Dave Spalding lays out the vision for ACOs in Texas. CMS opens up data for further research and development, and gives physicians an easy way to rat out information blockers. Solutions Recovery Center goes with ZenCharts. Gastro Health launches virtual support community.

I was thinking about the plethora (and increasing number) of proprietary body sensors tied to specific apps or services. That sensor-app connection is mandatory at the moment, particularly with FDA-approved systems, but at some point the sensor overlap and need for economy of scale would seem to make it desirable for a single universal sensor that all health and fitness apps can talk to. It seems inefficient for every app vendor to develop and maintain yet another heart rate or calories-burned gadget, especially when consumers need or want information that requires more than one of them.


Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.


Acquisitions, Funding, Business, and Stock

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Genstar, owner of behavioral EHR vendor Netsmart, has reportedly retained an investment bank to either take the company public or sell it, with a potential price of $750 million. Also on the block, according to insiders, are health IT firms Precyse Solutions, Mediware, Edifecs, Caradigm, and Altegra Health.

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Telemedicine provider Carena receives $13.3 million in funding from Cambia Health Solutions and McKesson Ventures to continue development of its virtual clinic solutions, which it says can be brought live 90 days after signing as a branded virtual clinic.

GE is rumored to be shopping its GE Capital Healthcare Financial Services unit for up to $11 billion as it dismantles GE Capital.

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Shares of value-based care consulting firm Evolent Health begin trading on the New York Stock Exchange Friday at $17, which values the company — formed in 2011 by UPMC Health Plan and The Advisory Board Company — at $800 million.


Sales

East Jefferson General Hospital (LA) signs up for MedCPU’s clinical decision support system. I interviewed EJGH CMIO Beau Raymond, MD a couple of weeks ago.

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Penn State Hershey Medical Center chooses PeraHealth’s clinical surveillance system.


People

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Patient engagement solutions vendor TeleHealth Services names Gary Kolbeck (GK Consulting Services) as VP of business development.

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Ted Reynolds (CTG Health Solutions) joins Impact Advisors as VP.


Announcements and Implementations

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Provide Medical Park (WA) goes live on the Advantages RTLS patient flow system from Versus Technology, which allows patients to skip the waiting room and proceed directly to an available exam room.

CitiusTech launches CQ-IQ, a cloud-hosted quality analytics platform for CQM reporting that includes 250 pre-built quality measures across several care settings. I interviewed CEO Rizwan Koita in January.  

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Former Facebook CFO David Ebersman launches Lyra Health, which offers behavioral health screening tools and care coordination. His co-founder and chief medical officer is Dena Bravata, MD, who left Castlight Health in December 2014 after five years as chief medical officer and head of products.

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Two public relations firms, one of which focuses on sensitive federal government issues, form ATDigitalHealth, which will promote interoperability and telehealth services to lawmakers.


Government and Politics

The opening of the Topeka, KS VA hospital’s ED – closed for almost a year and a half due to staffing shortages — is delayed for at least six more weeks as the VA’s central office requires it to upgrade its EDIS.


Privacy and Security

A report by cyberdefense vendor TrapX finds that most healthcare organizations are vulnerable to Medjack (medical device hijack), where hackers locate unpatched, Internet-connected medical devices and use them as a back door to penetrate the health system’s network. The attacks, which are made easier by FDA restrictions on keeping devices it has approved updated, are hard to detect since security teams can’t view a device console and can’t just disconnect them for maintenance.

Plans by the Federal Employees Health Benefits Program to launch a claims database of federal employees for third-party cost analysis are criticized by privacy advocates, unions, and consumer groups who question the potential privacy exposure.


Technology

A Harvard-developed blood test that costs as little as $25 can detect nearly every virus to which a person has been exposed, potentially allowing epidemiologists to track diseases and to determine optimal vaccination ages.


Other

East Texas Medical Center sues Blue Cross, Aetna, and Cigna for excluding the hospital from their PPO networks in what it says is a violation of Texas insurance code.

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I’m not surprised by Will Weider’s tweet. What we think patients want, as often is the case, isn’t what they really want. It’s smug paternalism to presume either way without actually asking them or letting their actions speak for themselves.

Clint Eastwood will direct a movie version of  US Air pilot Sully Sullenberger’s biography, most likely dramatizing the “Miracle on the Hudson” story of his saving his own life (and in doing so, the lives of his passengers) rather than his later, less-dramatic safety efforts.

A Washington Post article says hospitals struggle to meet unrealistic consumer expectations as they try to manage their social media reputations, with patients rating doctors and nurses on bedside manner and convenience while providers are focused instead on delivering clinical outcomes. It mentions HealthLoop’s tailored follow-up messages and responses that help doctors know when to intervene after an encounter, citing an unnamed hospital whose satisfaction scores jumped 11 percent after implementing HealthLoop.

BIDMC CIO John Halamka, MD says the Meaningful Use program should be shut down and replaced with outcomes-based CMS incentives, with ONC refocusing its work to create a national provider messaging directory, encourage the use of a voluntary national patient identifier, work to streamline state-specific privacy laws, coordinate federal health IT priorities, and support private sector initiatives. He says interoperability demands have changed in a value-based care world and that the private sector is best equipped to meet market needs, urging that the industry “help providers do their job and improve satisfaction to the point that Congress no longer wants to legislate the solution to the problem.”

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Several high-profile health IT bloggers who are patients of One Medical Group call out the supposedly tech-savvy concierge medicine company on Twitter for not providing online bill payments and for being unable to give patients digital copies of their records.  

British Medical Journal reorganizes its software development teams as it moves from publisher to a vendor of point-of-care clinical guidance.

An anesthesiologist says it’s not just OR personnel who are distracted by screwing around with their phones instead of doing their jobs. He provides a first-hand example of a teen struck by a car and awaiting surgery who was taking selfies from his hospital bed while one parent was texting and the other was posting to Facebook, all of them scolding the anesthesiologist for interrupting them as he tried to take a pre-op history. He urges health professionals to educate the public about addiction to texting and social media.


Sponsor Updates

  • Patientco CFO Kurt Lovell is recognized by the Atlanta Business Chronicle as a CFO of the Year finalist.
  • Anthelio’s Engage mobile patient engagement app earns ONC’s 2014 Edition Modular Certification.
  • Impact Advisors is named to Crain’s Chicago “Fast 50 List” as the #21 fastest-growing Chicago company.
  • Healthloop is featured in an Economist article titled “Small data from patients at home will mean big cost savings.”
  • Nordic profiles practice director and cheese carver Joey Vosters, who says he’ll carve the company’s logo for the next work party if Nordic will get him a 45-pound block of cheese.
  • Patientkeeper offers “About Nurses, Patience, and EHRs.”
  • Iatric Systems announces successful integration of Welch Allyn and Nihon Kohden medical devices with the EHR of Halifax Regional Medical Center (NC) using its Accelero Connect solution.
  • MedData will exhibit at the Coastal Emergency Medicine Conference June 5-6 in Kiawah Island, SC.
  • Navicure offers “Setting Goals to Improve Patient Collections and Total RCM.”
  • Nordic hosts a meetup for Houston-area consultants and candidates on June 5.
  • Oneview Healthcare Head of Solutions Niall O’Neill talks to NewJobRadio.
  • Orion Health offers “Why you should be an engaged patient.”
  • Passport Health will hold a Northeast User Group Meeting June 11-12.
  • PatientSafe Solutions offers “Patient Centered Care: Is It Really That New?”
  • PDS publishes “Technology and the Group Purchasing Organization Business Model.”
  • Phynd Technologies offers “My Time at the More Disruption Please Hill Day.”
  • New York eHealth Collaborative will exhibit at NYHIMA’s 2015 Annual Conference June 7-10 in Syracuse, NY.
  • PMD posts “Purpose Build: EHR Mobile Apps vs. PMD Charge Capture.”
  • Qpid Health offers “’Human-Digestible’ Documentation Tops AMIA EHR 2020 Task Force Recommendations.”
  • Extension Healthcare offers “Bridging the Gap Between Clinical Users and Health Tech Managers.”
  • Galen Healthcare Solutions recaps its experience at the 2015 MUSE conference.
  • Beth Israel Deaconess Medical Center CIO John Halamka, MD contributes to the debut of Hayes Management Consulting’s new Healthcare Leaders series.
  • HDS posts “The High Price of Health IT Security Breaches: $6B.”
  • The Atlanta Journal-Constitution profiles entrepreneur Greg Foster’s battle with brain cancer while starting Brightwhistle, which was recently acquired by Influence Health.
  • InstaMed publishes a new white paper entitled, “New Expectations: The Payment Experience Members Want from US Health Plans.”
  • Intellect Resources offers “Healthcare IT Jobs: Carpe Diem.”

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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June 4, 2015 News No Comments

Morning Headlines 6/4/15

June 3, 2015 Headlines 1 Comment

ICD-10 Medicare FFS End-to-End Testing: April 27 through May 1, 2015

CMS reports the results of its latest end-to-end ICD-10 testing period: 88 percent of the test claims were accepted, up from the 81 percent in February. Two percent were rejected due to invalid ICD-10 codes, while the remaining rejections were due to errors unrelated to ICD-10.

Why CMS should stop Stage 3 of meaningful use

AMA joins the growing list of industry organizations calling on ONC to delay MU3. AMA proposes a one-year pause in the program in 2017, giving providers and vendors a much needed break, before moving forward with MU3 in 2018.

We the people want easy, electronic access to our health information

Farzad Mostashari, MD and former National Coordinator for Health IT, unveils a new petition called Get My Health Data that is soliciting signatures from people that are passionate about patient’s access to medical data. He also encourages patients to test the current environment by requesting their medical records from local health facilities and then reporting issues they run into under the Twitter hashtag #tracer.

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June 3, 2015 Headlines 1 Comment

HIStalk Interviews Asif Ahmad, CEO, Anthelio Healthcare Solutions

June 3, 2015 Interviews No Comments

Asif Ahmad is CEO of Anthelio Healthcare Solutions of Dallas, TX.

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Tell me about yourself and the company. 

I was in academic medicine for 18 years. I was a CIO and head of globalization at Duke University Health System and prior to that at Ohio State. About five years ago, I moved onto the corporate side. I had done a lot of startup companies out of academics. I was at McKesson for three years. Now I’m CEO of Anthelio. I come from 23 years in healthcare, specifically in technology, with a big focus on clinical optimization and driving efficient and effective utilization of health IT.

Anthelio is the only independent, vendor-agnostic, full-breadth IT services and technology company. I thought it would be a great marriage of my background and a company with the footprint to start defining some interesting new models of service delivery and service management with what is happening since Meaningful Use.

We are privately held and the largest technology company in the pure healthcare space. We have about 2,000 employees and close to $250 million in revenue, which makes us a pretty big, mid-cap privately held company.

We provide three product lines. One is pure IT services all the way from full IT outsourcing to prioritized IT services, including EHR implementation and optimization. Then we have a second line, which is revenue cycle and health information management, from coding to revenue optimization to clinical documentation improvement. Then we have our products portfolio, which is a vendor-agnostic patient engagement product, data solution products like data warehousing and operational data store, and our analytics products. That’s what defines the company — a IT solutions group, an HIM revenue cycle solutions group, and vendor-agnostic across the board products.

 

Your background as an academic medical center CIO and a biomedical engineer makes you unusual among large-company CEOs. What was the transition like and how would you advise CIOs with similar interests?

The transition for me was really easy, because even in the academic medical center, I was really the one who was going against the norm. Things can be done faster, quicker, more efficient. Cost should be an issue, revenue, opportunity losses should be an issue, and also making a bigger footprint for your academics. When I was at Duke, for example, the three hospitals weren’t integrated a lot at all, so I was brought in to bring that together. Nobody was even thinking about outpatient care — this was pre-population health — and I, working with the chancellor, put that big footprint together. In two to three years, we had full adoption of CPOE. This was all pre-Meaningful Use. We had integrated physician-hospital billing as a single CBO. We spun a lot of companies out of there like Sentillion, a company that Microsoft bought, which was out of my department at Duke. I was always working to optimize whatever the opportunity was for the parent organization.

What I would advise for a CIO is to get yourself organized to learn the operations of healthcare. I think there’s a big movement there. The CIOs don’t really get involved in learning and being held accountable for driving the operations of healthcare. At both Duke and Ohio State, I had P&L responsibility. I was running almost a billion-dollar business for Duke. I had volunteered to run the lab and radiology business, which is a very technology-based business, and my biomedical background was in imaging. I’ve always utilized my technology background to drive operations.

You are right, you don’t see too many people like me in business. There should be more of my kind because part of the problem is that CIOs are always on one end of the board room and the CEO is on the other end calling up Deloitte or Accenture or somebody else to advise them how to use technology. There’s not really that much of a connection between the two groups. 

I have always prided myself in being that bridge, somebody who understands technology, but who wants to grow, drive, and be held accountable for managing the operations of healthcare. I always have had physicians reporting to me from a P&L perspective. At Ohio State, I was building the heart hospital with the doctors there. I was doing a lot of things that were eventually very strongly technology enabled, but we started first with, what’s wrong with the process? What’s wrong with the current way of delivering care? Then technology got introduced. But I was the one who drove both the clinical side and the technology side.

 

What is the trend for health systems to outsource infrastructure, security, or application management?

I think it’s going to start moving. There’s going to be a huge tailwind towards that. Everyone has invested a lot of money in big systems. A lot of people have bought the Epics and the Cerners and now they’re sitting with huge amounts of cost which is depreciating.

Previously most hospital CIOs were a little afraid of outsourcing because the whole idea was that you have to manage, maintain, and contain it. With cloud services and the advent of cybersecurity issues, you cannot have enough competency within your own portfolio to do it. You have to take chance of things where you think scale matters. When I look back on my days at Duke, I would never manage IT security on my own with what I know now being on the commercial side. Similarly, I built a $30 million data center. Why should you be building data centers in academic medical centers or hospitals when that’s just a huge cost sink? You should be working with somebody else to outsource.

Similarly, application management and application hosting. Why would you want to put an Epic and a Cerner or whatever else out there with the SaaS model? Take it out of your portfolio. I have to manage everything close to my chest because the whole technology evolution has told us that that’s not the way to manage in the most cost-effective or effective way because you’ll have a lot more downtime. You put all your eggs in one basket in one building and one server.

Everybody invested a lot of money, and yet the cost of IT has not borne the benefits that one was to see in how the impact of these EMRs were to be had from an outcomes perspective or what needed to happen from patient safety or better financial outcomes. People are not seeing it used for that. You’re seeing post some of these big implementations hospitals taking a hit on their credit ratings. So I think you’re going to see a lot of trends towards outsourcing. I’m able to relate to it because I was also on the other side and we work with our clients now.

But the plan is not to fully outsource everything you have. Take the pain points, take where the scale matters, and let’s take that. That’s where the idea of productized  services solutions comes in. It used to be that everything needed to be outsourced, that you would give me everything because I can’t do just parts of this business. Now we’re in an ecosystem that CIOs of the health systems can work with companies like Anthelio and we can take the headaches off you because we have the scale. Then you should focus on clinical optimization, driving changes with your physician behaviors and the patient engagement. We talk about population health, but yet a patient portfolio itself doesn’t give you that. You have to have the patients engaged in some kind of mobility solution. So focus your interests there and then companies like ours handle the back-end infrastructure. Historically, everything had to be very close to you, but now because of the cost structure and evolution of technology, people are easing up on that. I think it’s the right thing to do.

 

Is offshoring increasing or decreasing?

I’m glad you asked. Almost 30 percent of our workforce at Anthelio is based out of India. The whole trend for offshoring is different. Ours is growing because we don’t think of it as an offshore. I always tell my team that Mumbai is no different than Michigan. By the way, we have a huge delivery center in Michigan, so that’s why I use that analogy. If you align operations tightly, you don’t think of India or Philippines or wherever else you’re offshoring as some destination or location where there is a buffer and a black box. If you tie every community working from home and diffuse services, big vendors have already shown that it can be done. You don’t have to be in one location. The fact that you could have a remote workforce really changed offshoring. That’s one thing that is helping offshoring at the moment. If you align your accountability, it doesn’t matter where the employee is with the right confines in place.

The number two thing that helped us is that it’s not just a cost arbitrage to us. You look at where the best talent is, where the best access to talent is to scale, and how to drive growth from there. People used to send just the back-office jobs to India or somewhere else like that. I’m going to send my billing clerks to India, for example, with ICD-10 coming. I think that has changed. India has some really good talent. I have turned India into an innovation hub for us. We do combined product development. We do combined software delivery as well as service delivery there, not just cost arbitrage.

Offshoring done right should have never been an issue, but the problem is that it wasn’t done right. People took chunks of cost — the quarter end is coming, so let’s just thrown this out to India or wherever else and let’s drive the cost. But it’s not a cost equation. It should be a value equation. Where do you drive the most value? The way we have done offshoring is to balance that out. You can have access to some lower-cost talent in India, but what should that be, and how do you mix that talent then with the talent pool in US so it’s one combined talent pool and not just this bifurcated or trifurcated talent pool who never see each other? 

In our case, the people at all levels between our teams in India — in two locations in Mumbai and Hyderabad — and our locations here Dallas, Tennessee, Michigan, Chicago — they keep going back and forth. There’s a true sense of one combined team. Offshoring is going to continue, but in the context of where the value is driven. It’s not just a cost arbitrage, which is  bound to fail. It needs to be seen as value arbitrage.

 

What will the most important healthcare IT implications be over the next five years?

There’s been this big push to buy new integrated EMRs, and yet you don’t see an impact of it to the outcomes. I think there’s going to be a litmus test. Patients are going to push to ask for more access to their information. The traditional EMR systems can’t provide it, so I think there’s going to be a disruption.

I see in the next five years there should be a disruption in how we manage health technology in the US, which is done in vacuums and silos still. It’s gotten somewhat better, but you’re not going to get your value-based reimbursement. There’s going to be more consolidation, but at the same time, I think the patients themselves are going to push for a much more holistic kind of view. More mobility solutions are going to come forward, not just the enterprise systems that are out there.

In five years you should see a lot of non-profit and for-profit collaborations in a very meaningful way, and hopefully more transition of roles going back and forth. There’s a big vacuum in what the actual understanding of healthcare delivery is versus what the vendors perceive, both on the service and the product side. Hence, many products don’t work. The ones that do work are the ones who understand.

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June 3, 2015 Interviews No Comments

EHR Design Talk with Dr. Rick 6/3/15

June 3, 2015 Rick Weinhaus 9 Comments

The Story of My Leukemia

Dear Friends and Readers,

I can’t begin to tell you how happy I am to resume writing about EHR user interface design and to share my ideas with the HIStalk community. I am grateful for this opportunity. By all odds, in the long view of human history, I should not be alive.

In the fall of 2013, while jogging I noticed that my exercise tolerance had decreased – I couldn’t run up a hill which a few months earlier had presented only a slight challenge. At the time, I attributed the change to just getting older. A little later, however, after climbing a single flight of stairs at work, I found that couldn’t utter a sentence without first stopping to catch my breath. Although I was still in denial, I reluctantly took time off from work to see a colleague of my PCP who was available that afternoon.

Although I had minimal findings on physical exam and my ECG was negative, by this time it was clear even to me that something was wrong. My labs were drawn and sent off. A little later that evening I got a call from my primary care doctor and friend. She advised me to go to the hospital to be admitted via the emergency department, as my hematocrit was 18 and I had other hematologic abnormalities as well.

When I asked if I could delay admission until the next morning, the answer was a tactful but emphatic ‘no.’ So with my wife Karen’s help, I packed a toothbrush and a few other things, drove to Mount Auburn Hospital (where I had done my internship 30 years before), and was admitted.

A bone marrow biopsy performed the next day revealed acute myelogenous leukemia (AML). That evening I was transferred by ambulance (although I insisted on walking and carrying my own bag) to Feldberg 7, the inpatient Bone Marrow Transplant (BMT) Unit of Beth Israel Deaconess Medical Center (BIDMC), where I received extraordinary, life-saving care over the next three months.

Quite frankly, when I was told I had AML, I thought it was more or less a death sentence. My last training in AML had been more than 30 years ago when I was a medical student. At that time, the likelihood of successful treatment was very low. My mind went to practical issues such as whether I would have enough time to organize important family documents. It was easier to focus on these kinds of things than wonder how I would say goodbye to my family and friends.

The attending physician on call that week for Feldberg 7, who has since become my trusted primary oncologist, came in from home to see me. By then it was nearly midnight. We had a long talk. Although she did not minimize any of the very real risks of the disease, the induction chemotherapy, or the eventual stem cell transplant if I should get to that point, I regained hope. I learned that my chances not just for life-prolonging treatment but for a cure were approximately 50 percent.

After two courses of induction chemotherapy complicated by several medical issues, I received a stem cell transplant on December 9, 2013. I am now a year and a half out from my transplant. Although my recovery has been complicated by mild chronic Graft versus Host Disease, I am doing very well. My most recent bone marrow biopsy showed no evidence of relapse, and at this point, there is a good chance that I am cured.

I have been transformed by my journey through illness and back to health. I am grateful beyond words to my doctors, including the fellows and house officers who took care of me; to my nurses, who in addition to providing extraordinary care, were also the main emotional support for me and my family; and to all the other members of my BIDMC health care team whose contributions often go unacknowledged.

My experience has also made me keenly aware that, day after day, at hospitals and clinics across the country (and the world), healthcare teams like mine put in the same kind of long, hard hours and devote the same kind of demanding cognitive effort in order to take care of their patients.

Even before my illness I had a strong interest in applying what we know about human perception and cognition in order to create simple, powerful, elegant EHR user interface designs – designs that make it easier for doctors and nurses to care for their patients. Now that I have experienced a life-threatening illness first hand, this interest has taken on an added personal dimension.

As a patient, I could not of course (and was far too sick to) sit next to my doctors and nurses and observe them as they entered, reviewed, and interpreted my data in BIDMC’s EHR (WebOMR), but I was certainly aware of the long hours they put in at the computer. From what I have subsequently seen of WebOMR, despite being homegrown, it is an excellent system that rivals those of the major EHR vendors.

By the same token, it shares many of the same EHR usability issues that are becoming increasingly recognized as a major barrier to achieving the Triple Aim of enhancing patient experience, improving population health, and reducing costs. I believe that John Halamka, BIDMC’s CIO, would agree – in a recent interview, he described today’s EHRs as “a horribly flawed construct.”

One ‘benefit’ of my long illness is that I have accumulated my own rather extensive electronic medical record data set (although I wouldn’t recommend obtaining one in this way). In the posts that follow, I look forward to using my data set as the basis for sharing ideas about how to display EHR information so that we can perceive it using our lightning-fast, high-bandwidth visual processing system, sparing our more limited cognitive resources for patient care issues.

Specifically, I look forward to presenting a design where we can use our visual system to grasp both the subject matter and the temporal sequence of EHR documents. The design is not intended to be a finished product, but rather a starting point, a springboard for discussion and deliberation. I welcome input from healthcare IT professionals, interaction designers, vendors, and clinicians. I would love nothing more than to see some of the design concepts incorporated into innovative open source applications that could serve as new front ends for existing EHR systems, and eventually, for personal health records as well.

Next Post: My Data Set

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

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June 3, 2015 Rick Weinhaus 9 Comments

Morning Headlines 6/3/15

June 2, 2015 Headlines No Comments

Partners’ $1.2b patient data system seen as key to future

Partners Healthcare goes live on Epic across nearly all locations except for its Massachusetts General Hospital facility. The total cost of the implementation grew to $1.2 billion, double the $600 million initially budgeted, making it the largest investment the health system has ever made.

Revisit Rates and Associated Costs After an Emergency Department Encounter: A Multistate Analysis

A study published in the Annals of Internal Medicine finds that 8.2 percent of ED patients will readmit within three-days, often going to a different hospital for the second visit. Skin infections generated the highest rate of revisits at 23 percent, and the second visit was typically far more expensive than the initial encounter.

Comvest Partners Acquires McKesson Care Management Business

McKesson sells its care management system, marketed to payors and risk-bearing health systems, to investors for an undisclosed sum.

Governor: Update fixes health exchange delays

Vermont updates its health insurance exchange to fix problems that were causing delays of up to two-hours for users trying to update their coverage mid-year due to life changes such as marriage or the birth of a new child. The HIE is still unable to enroll businesses, a requirement of ACA, and the governor has reported that he will push to have the requirement dropped before attempting to add the functionality to the site.

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June 2, 2015 Headlines No Comments

News 6/3/15

June 2, 2015 News 7 Comments

Top News

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Partners HealthCare (MA) goes live on Epic at a cost of $1.2 billion, double its original $600 million estimate, making the project the single largest investment the health system has ever made. The Boston Globe article quotes a Tufts professor and Health Policy Commission member as saying, “We will ultimately all pay for it. Will we get dividends back in terms of better care and greater efficiencies? We don’t know yet.”


Reader Comments

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From Around St. Louis: “Re: SLU Hospital. The university is buying their hospital back and conjoining with SSM to run it. SLU Hospital was the only Tenet hospital with Epic – all others are on Cerner.” The 356-bed hospital wasn’t happy that buyer Tenet, which paid $300 million for the hospital, failed to establish a regional network. The city will lose $6 million in annual tax revenue that for-profit Tenet was paying that SSM won’t, although the mayor’s office say it’s happy with the hospital providing “quality healthcare, jobs, and expansion,” thus neatly illustrating that it’s tough to control healthcare costs when everybody likes the huge employment it creates at public expense.


HIStalk Announcements and Requests

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Mr. K sent a photo of students with the Bluetooth speaker we provided to his Wisconsin PE class via DonorsChoose, which apparently was a great student motivator for our $178 donation. Mrs. F’s Ohio first graders are using their STEM kits in summer school sessions where they learn “while they think they are playing,” she reports. Meanwhile, companies donating $1,000 or more to our DonorsChoose project get mentioned and double their impact via matching funds provided by an anonymous HIT vendor executive – contact me.

I was thinking about complaints that providers don’t make EHR data available to patients vs. the tiny percentage of patients who actually request it. Someone should perform a study to determine the level of demand and the reasons people aren’t requesting their information. I haven’t seen anything to suggest that providers are denying those requests, so targeting them as the villain doesn’t make sense. Proponents should be taking their case to the public, not to providers and EHR vendors. I’ve never requested my own information or changed providers just because I couldn’t get it easily – have you?

I was also thinking that among all the unrealistic expectations placed on health IT to improve health, a big one is caused by consumers who think a huge problem is misdiagnosis. That’s a minor issue compared to lack of consistent, evidence-based treatment of easily diagnosed conditions in which the patient accepts full responsibility for their outcome. Improving outcomes and cost for obvious conditions such as COPD, diabetes, and heart disease unfortunately isn’t as sexy as uncovering a gene for an obscure disease or using Watson to suggest treatments. The transition to a public health mindset is slow and patients don’t like hearing that the answer to their problems is willpower, moderation, and acceptance rather than a decisive, inconvenience-free prescription or procedure.


Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.


Acquisitions, Funding, Business, and Stock

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Post-hospital care coordination systems vendor Careport Health closes $3.8 million in financing.

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McKesson sells its Care Management business, which offers case and disease management services to payers, to investors who will rename it AxisPoint Health.

Premier acquires CommunityFocus, a community health needs assessment management solution jointly developed by UNC-Charlotte and Premier that will be incorporated into PremierConnect.


Sales

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Kingsbrook Jewish Medical Center (NY) will use CipherHealth’s Echo to provide secure, online audio recordings of verbal discharge instructions to visually impaired patients.

Kentucky Medical Services Foundation chooses MedAptus Enroll for managing provider credentialing.


People

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Payor platform vendor Healthx names Sean Downs (Enclarity) as CEO.


Government and Politics

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Vermont Governor Peter Shumlin says a successful software upgrade to the state’s troubled health insurance exchange system this week will reduce the time required for “change in circumstance” updates, but adds that consumers will still need personal staff help until more changes are made in the fall and that warns that it will take time to catch up on the 10,000 changes that have been backlogged. Optum met the May 31 deadline for applying the update but must clear the backlog by October 1 to keep the state from considering shutting down the exchange and moving to Healthcare.gov.


Privacy and Security

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Cottage Healthcare System’s (CA) cybersecurity insurer demands that the hospital repay $4.1 million it provided in settlement costs following a 32,500-patient data breach in 2013, saying the health system lied on its application in saying that it was applying patches, performing annual audits, and verifying the security capabilities of its outsourcers. The hospital failed to update the default FTP settings of servers, allowing patient information to display on Google searches.


Other

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County-operated 439-bed Riverside County Regional Medical Center (CA) requests $53 million to convert to Loma Linda University Health’s Epic system, which I believe would replace Siemens Soarian for inpatient and NextGen for ambulatory.

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A Northwestern University study finds that 84 percent of teens have looked up health information online (mostly by Googling a topic and clicking on the first link presented) and 21 percent have download health-related mobile apps, although two-thirds of them say they didn’t change their behaviors based on health information or tools. Three-fourths of teens were at least moderately satisfied with the information they found, but a significant percentage also ran across negative information such as how to manufacture drugs, play drinking games, or create eating disorders. Only seven percent had ever used a fitness tracker. 

A New York Times analysis finds that hospitals are jacking up their list prices (paid only by uninsured and out-of-network patients) at double the rate of inflation, while their Medicare payments remain flat.

A study finds that 8.2 percent of ED patients returned within three days, with a third of them choosing a different ED and the second visit often costing a lot more than the first. The highest revisit rate involved skin infections that probably shouldn’t have required an ED visit in the first place, but of course most doctors in private practice work banker’s hours in rarely being available without an appointment and nearly never between 5 p.m. and 8 a.m., leaving the ED as the only medical “open now” sign on for well more than half the day unless you count urgent care clinics that actually expect patients to pay upfront instead of if and when they get around to it.

Your cutting edge, contemporary, and fresh HIMSS16 presentation proposal is due June 15, a mere 8.5 months before you’ll actually present it.

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AOL founder Steve Case, now an investor, says healthcare is one of the big economic sectors that will be disrupted by startups, for which he advises perseverance, partnerships, and policy. On the other hand, Steve’s one hit was dumping AOL on the clueless and Internet-terrified Time Warner in a disastrous and scandal-driven 2001 dot-bomb merger, with his follow-up Revolution Health sinking without a trace and his current healthcare IT investments being companies I’ve never heard of. He spoke at HIMSS08 back when it still looked like he might disrupt healthcare.

Weird News Andy flipped over this story that he titles “spatuvula.” A woman tries to clear her allergy-swollen throat using a foot-long kitchen spatula handle, removal of which (and part of her esophagus)required emergency surgery. WNA loves the bonus story at the end that describes a doctor removing a fish from a boy’s throat on camera, leading WNA to question whether he was paid scale.


Sponsor Updates

  • Valence Health is named as one of Chicago’s fastest-growing companies with its 50 percent annual growth rate and 800 employees.
  • Cumberland Consulting Group’s Annamarie Lee will present “Navigate Complexities of Contracting and Government Compliance” at CBI’s Medicaid and Government Pricing Congress this week in Orlando.
  • Health Catalyst is named as one of the best places for millennials to work.
  • Forward Health Group CEO Michael Barbouche is interviewed by a Madison newspaper.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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June 2, 2015 News 7 Comments

Curbside Consult with Dr. Jayne 6/1/15

June 1, 2015 Dr. Jayne 2 Comments

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I had lunch this week with some former colleagues. One of the topics of discussion was the 21st Century Cures initiative that was approved by the House Energy and Commerce Committee in May. Supporters such as Representative Frank Pallone state that it “will ensure that innovative treatments are getting to those who need them most, giving real hope to patients and their families.”

For those of you who may not have seen the non-IT details, the bill has significant goals:

  • Reauthorize National Institutes of Health (NIH) funding through FY2018
  • Establish an innovation fund at NIH
  • Require strategic planning and greater accountability at NIH
  • Increase funding for pediatric research
  • Require sharing of data generated through NIH-funded research
  • Standardize patient information across trials housed in ClinicalTrials.gov
  • Establish a public-private Council for 21st Century Cures to “accelerate the discovery, development, and delivery of innovative cures, treatments, and preventive measures”
  • Increase patient-focused drug development
  • Require the FDA to issue guidance on precision medicine
  • Streamline policy to facilitate development of new antibacterial and antifungal agents
  • Formalize vaccine recommendation processes
  • Modify FDA review requirements for certain categories of drugs and devices

Most of us have heard about the language on ensuring interoperability and “holding individuals responsible for blocking or otherwise inhibiting the flow of patient information throughout our healthcare system.” There is also a section on expanding telehealth under Medicare.

As a primary care physician, I also liked the section addressing issues where Medicare beneficiaries can’t get certain services covered because care is delivered in the home setting. My favorite part, though, is Medicare site-of-service price transparency. I hope all the health systems doing so-called “provider-based billing” take note of this. It’s going to be harder to trick patients into paying exorbitant facility fees if this makes it through. Rebranding free-standing physician offices as hospital departments as a thinly-veiled cash grab is one of the more despicable practices I see among hospitals and health systems.

The Senate is working on its own version of the bill, so it remains to be seen whether all of this passes, and if it does, how much the individual sections are modified. Funding research and cutting edge therapies is important, as is dealing with various Medicare oddities that complicate care delivery. In talking with my colleagues, however, we all balk a little at the call-out for precision medicine. Although it’s an interesting concept, is it really going to be pivotal for the majority of patients?

I’m a huge fan of public health. Basic sanitation and preventive measures have made a tremendous difference in quality of life for people around the world. However, I’d like to see more discussion (and also funding) of the basic health services that many people either cannot access or lack understanding of their value. It is still difficult to get insurance companies to pay for nutrition counseling or sessions with a registered dietician except for certain disease states. We can try to get patients to self-pay for these services, but it’s a difficult proposition when some are already paying large premiums for minimal coverage.

I’d like to have the time and resources to try to convince patients of the return on investment for these interventions (both in quality of life and lower health costs), but it’s hard to make headway during a 10-minute office visit. Watching Congress debate legislation that impacts rare diseases and drug development is difficult when one realizes how much work is still yet to be done on diseases that have 19th and 20th century cures already. A good number of the diseases on which we spend the most can be markedly improved (if not cured) through behavioral and lifestyle interventions, but these are the most difficult to implement. It’s much easier to take a pill for many Americans.

I’m not sure what primary care will look like in the next century. I can’t wait for the next generation to be able to scan patients with a Tricorder and synthesize antidotes and treatments Star Trek style. That seems such a long way away, though, when we’ve yet to figure out how to implement some of the basics such as universal vaccination, healthy eating habits, and regular exercise.

Looking back through the Bill’s history, I did see a small step that actually will make an immediate difference. At the same time the House of Representatives Energy and Commerce Health Subcommittee was hearing about 21st Century Cures, they were also considering HR 1321, the Microbead-Free Waters Act of 2015. It caught my eye because I’ve been aware of the microbead problem for a while, especially the fact that the US lags other countries in banning them. I must say, this Act is probably the shortest piece of legislation I’ve seen in a long time – a grand total of two pages and 14 numbered lines. If only Meaningful Use was that simple.

What’s your favorite Act of Congress? Email me.

Email Dr. Jayne.

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June 1, 2015 Dr. Jayne 2 Comments

Startup CEOs and Investors: Bruce Brandes

All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part VI – A Festivus for the Rest of Us 
By Bruce Brandes

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Is necessity still the mother of invention? Edison with the light bulb. Bell with the telephone. Ford with the automobile. Costanza with the Mansiere (or was it Kramer with the Bro)?  

Given the clear market need for all of these innovations, was there ever any question that these entrepreneurs would become wildly successful? Or were men content with candlelight, telegraphs, and horse-drawn carriages, which caused their man-boobs to jiggle as they rode along?

Today, conversely, as suggested by Jared Diamond, invention may be the mother of necessity. Did we know we needed an iPhone until Steve Jobs showed us the compelling device? Unfortunately in healthcare, too often it seems entrepreneurs and investors are introducing products believing they have invented the next iPhone-like phenomenon, to eventually realize that not only does the market not have a need, in many cases does not even have a want.

When looking to invest in an early stage venture which seeks to address a well-understood but yet-unsolved problem, how does an investor know with which one of the multitude of aspiring inventors to bet? 

An important consideration is understanding the motivation and passion of the founder to launch the undertaking in the first place. An example lies in the prolific innovator, Frank Costanza, and the remarkable global embrace of the sensation that is his Festivus, whose origin is summarized in the exchange below.


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FRANK: Many Christmases ago, I went to buy a doll for my son. I reached for the last one they had, but so did another man. As I rained blows upon him, I realized there had to be another way!

KRAMER: What happened to the doll?

FRANK: It was destroyed. But out of that, a new holiday was born. "A Festivus for the rest of us!"


In Venture, we often meet bright entrepreneurs seeking funding motivated to build a company that will make them rich and famous. Each time we make this assessment, I am reminded of Philip Rosedale, founder of SecondLife, who once said, “If you have an idea and you know you won’t earn a dime from it but you have to pursue it anyway and solve the issue, then you’re a true entrepreneur.” 

While in hindsight most investors would prefer to have backed Mark Zuckerberg ahead of Philip Rosedale, I suggest that if becoming rich and famous is your primary goal, you are very likely going to fail. Financial rewards may be the result of a more noble primary goal being achieved, but should not be your first focus.  

I believe this is particularly true in healthcare. Two excellent examples (from reality rather than Seinfeld) of promising healthcare technology-enabled solutions that were founded by purpose-driven entrepreneurs and briefly their inspirations.


Wiser Together – Shub Degupta

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In the fall of 2007, my wife and I went through a difficult pregnancy. In particular, the decision about whether to undergo invasive and expensive genetic tests daunted us. There were plenty of sources of information: friends, family, the Internet, helplines, genetic counselors, even academic literature.

In fact, in some ways there was too much information, often out of context. Our friends were helpful, but the information was anecdotal. Health websites had good information, but it was overwhelming, not actionable, and not personalized for our situation. It was nearly impossible to get to a decision that gave us peace of mind.

What we really wanted was the right information for us: What did other couples like us do? What tests did they have? What treatments did they seek? And, always lurking in the background, what was covered in our insurance plan?

We had to make some of the toughest decisions of our lives with insufficient information. Our experience was very stressful—and yet extremely common.

I realized this didn’t have to be the case. With new technology, extensive data, and a thorough understanding of how people make health decisions, WiserTogether was founded in early 2008, a few weeks after our eldest daughter was born. Today, WiserTogether helps millions make health decisions efficiently and intelligently, achieving better outcomes at a lower cost .. and with peace of mind.


Rallyhood – Patti Rogers

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I created Rallyhood after witnessing the power of community and kindness during my long battle with breast cancer. The love and support from family, friends, and neighbors truly changed my life and made a significant impact on my ability to heal. The truth is I could not have done it alone. I needed my doctors and medicine to kill my cancer, but I needed my people to bring me back to life. 

While the people were amazing, my family and I experienced the frustration of trying to organize the support effort with fragmented, difficult-to-use tools. It added unnecessary stress and burden for all of us. After getting well, I was inspired to build a platform for purpose-driven communities that made it easy to rally around a person, event or any common cause. Blending the best of social and and the best of productivity in one place. 

Today, Rallyhood has helped more than 20,000 communities organize emotional, practical, and financial support in one place. By engaging the person’s trusted community, providers can now extend the continuum of care in a more holistic way—improving outcomes, enriching the patient (human) experience, and expanding their brand into the daily mobile lives of the people they serve. Everyone wins.


Ultimately, growing a viable new company and achieving valuable business outcomes takes more than just an inspired founder. There will be conflicts where your team must air grievances if there is any hope for a Festivus miracle. We all know that any success story, over time, will reflect fondly on the feats of strength required to achieve greatness.  

What is the mother of your invention? 

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Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

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June 1, 2015 Startup CEOs and Investors No Comments

Morning Headlines 6/2/15

June 1, 2015 Headlines 1 Comment

New Medicare data available to increase transparency on hospital and physician utilization

CMS releases its latest Medicare payment dataset, covering all inpatient and outpatient hospital billing and reimbursement figures for 2013. The latest data breaks down what hospitals charged, and what Medicare reimbursed, for the 100 most common inpatient DRGs and outpatient procedures.

AMA Weighs Ethical Telehealth, Doctor Care Via iPhone

At the 2015 AMA Annual Meeting this week, the AMA’s Council on Ethical and Judicial Affairs will debate and vote on a new telehealth policy that will advise doctors on everything from patient privacy, diagnostic procedures, and follow up care.

Providers want CMS to slow down EHR superhighway

Several provider organizations weigh in with their concerns over the proposed MU3 rules, with Catholic Health Initiatives saying “We are concerned that CMS is trying to force providers to move toward meaningful use of EHRs at a pace that is too fast and impossible to meet,” and the AHA saying “We do not yet have sufficient experience at Stage 2 to be confident that the proposals for Stage 3 are feasible and appropriate.”

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June 1, 2015 Headlines 1 Comment

Morning Headlines 6/1/15

May 31, 2015 Headlines 23 Comments

Federal Court rules in favor of Teladoc, blocking Texas Medical Board rule and preserving telehealth in Texas

Dallas-based Teladoc wins an early victory in its anti-trust lawsuit against the Texas Medical Board, which passed a rule earlier this month requiring a face-to-face consultation before any telehealth services could be provided in the state. A US District Court has blocked the rule from going into effect until after the trial.

Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs

The American Medical Informatics Association publishes the recommendations of its EHR 2020 Task Force in a report on the status and future direction of EHRs.

Erlanger spending $91 million on major IT overhaul

Erlanger Health System approves a $91 million contract to implement Epic across its system, with an additional $97 million budgeted to maintain the system over the next 10 years. The hospital’s selection committee, made up of clinical and operational leaders, voted in favor of Epic 28 to two over Cerner.

Big Data Beats Cancer

IEEE Spectrum profiles John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, who helped pioneer several big data initiatives in healthcare and in 2011 turned to big data to help create a personalized treatment plan for his wife when she was diagnosed with stage III breast cancer.

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May 31, 2015 Headlines 23 Comments

Monday Morning Update 6/1/15

May 31, 2015 News 9 Comments

Top News

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A judge approves an injunction requested by Dallas-based telemedicine provider Teladoc against the Texas Medical Board for its new rule that requires doctors to conduct a face-to-face patient visit before issuing a prescription.


Reader Comments

From Talking About BS: “Re: Athenahealth. Has spent almost $1 million on lobbying so far in 2014-15 and VP Dan Haley is listed in OpenSecrets.org as a ‘revolving door’ lobbyist, described as federal employees turned lobbyists and vice versa. Athena’s cloud vapor simply isn’t selling to real customers and instead is being sold to Wall Street and Congress. Einhorn has this company pegged.”

From Travlinman: “Re: Epic. Guarantees ongoing interoperability with TeleTracking. Are they going to start playing nice with other vendors?”


HIStalk Announcements and Requests

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More than half of poll respondents think Cerner is the HIT stock to buy. New poll to your right or here: who is most to blame for lack of patient data sharing among providers? Vote and then click the poll’s comments link to make your case.

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I have no idea what a Rekenrek is, but Ms. S says her Indiana first graders are using the ones we bought via our DonorsChoose project daily for Math Warm-Up, adding that, “We had been using Rekenreks that we made on our own that are falling apart, so to see professionally made ones is wonderful!”

I seem to be especially cranky about grammar these days, so add these to my already long list: (a) starting sentences with the word “So” like a drunken bar patron launching into a long, dull anecdote; (b) sloppy use of geographic terms such as “a German doctor” that could mean a doctor from Germany, a doctor in Germany, or both; (c) using “less” rather than “fewer” in describing a collection of individual items, as in erroneously stating, “The event had less people than before”; (d) confusing “I” with “me” as in incorrectly proclaiming, “My brother came to visit Mary and I.” There, now I feel better.

I’m also annoyed by the expression “EHR mandates.” Nobody requires doctors to use EHRs except perhaps their employers – they just pay them extra if they do.


Last Week’s Most Interesting News

  • HHS names Susannah Fox as its new CTO.
  • Two entrepreneurs who sold DiagnosisOne to Alere in 2012 buy back the business – now known as Alere Analyics – to form Persivia. 
  • Athenahealth VP of Government and Regulatory Affairs Dan Haley said in a New York Times article titled “Tech Rivalries Impede Digital Medical Record Sharing” that customers typically pay EHR vendors $1 million upfront, $500,000 per year, and $2 per patient record to exchange information with other systems.
  • Forbes names Epic CEO Judy Faulkner as the wealthiest women in all of technology with an estimated $2.6 billion net worth.
  • Cerner told shareholders that it recorded $4.25 billion in sales for 2014.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.


People

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Tim Theriault, global CIO of Walgreens Boots Alliance (the former Walgreen), resigns for personal reasons. He will be replaced by Anthony Roberts, SVP/international CIO. Roberts came on board with the December 2014 Boots acquisition.

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Former Meriter CIO Peter Strombom died May 18 at his home in Costa Rica. He was 75.

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Jeremy Delinsky, chief product officer at Athenahealth, resigns after five months in the position to take a CTO position with an online furniture company. ATHN shares dropped more than 5 percent Friday following the announcement.  His interim replacement will be VP Kyle Armbrester. ATHN shares are down 20 percent so far in 2015.


Announcements and Implementations

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Athenahealth offers athenaCommunicator Enterprise to new customers who participate in an ACO for a flat 10 percent of their MSSP shared savings payouts.


Government and Politics

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Florida Governor Rick Scott, former CEO of for-profit and fraud-admitting Columbia/HCA, wants to hold the state’s non-profit hospitals more accountable for their huge profits, topped by Lee Memorial Health System’s $230 million.


Technology

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Ashish Jha of Harvard tweeted out rave comments about Doc Stats, an app that shows the approximate number of procedures a doctor performs as derived from CMS data.

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A Bay Area recycling firm is looking for a woman who dropped off garage junk following her husband’s death that included an Apple I computer, one of only 200 that were hand built by Steve Jobs and Steve Wozniak in 1976. The company wants to give the woman $100,000, her half of the amount a private collector paid to buy it from them.


Other

AMIA’s EHR 2020 task force publishes its recommendations. Many of them are observations of the current state or non-specific ideas about long-term changes that I didn’t find especially compelling or novel, but a few actionable items are:

  • Use natural language processing to convert free text notes to discrete data and reduce reliance on documentation templates.
  • Spend government money to study data entry methods and encourage the use of those that improve provider efficiency.
  • Slow down or freeze the Meaningful Use and certification requirements.
  • Eliminate requirements for providers to enter EHR information that isn’t used for direct patient benefit.
  • Eliminate E&M codes and checkbox-driven data entry that fails to capture the patient’s voice.
  • Allow vendors to meet MU certification with less-prescriptive methods and require them to post video recordings of their system so that EHR purchasers can see how they work.
  • Create the national Health IT Safety Center.
  • Require vendors to offer APIs to earn certification.

The board of Erlanger Health System (TN) approves its $91 million Epic contract, which will also require $97 million in maintenance costs over the next 10 years. The CFO says Epic beat Cerner on price and the selection committee preferred Epic 28 votes to two.

The Indianapolis business paper profiles ICUcare, which puzzling offers both a smartcard-based PHR (the company owner says he spent $25 million to develop it) and a telemedicine platform. The owner says the company has 12 employees and $3.5 million in revenue, some of which should probably be directed to updating the website, whish announces plans to release new technology in June 2010 and that lists Windows Vista as the required operating system (those are just the tip of the “ice-burg,” it says).

A Florida hospital tests the Internet lag time in performing telesurgery using the da Vinci surgical robot, finding that surgeons can’t tell the difference whether they are a few feet or a few states away from the patient.

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Influential healthcare IT expert Jess Jacobs of Aetna’s Innovation Labs recounts her recent and current experiences (with photos) as an inpatient of a hospital that can’t do anything right – a bathroom sink clogged for three days with her roommate’s bloody vomit, having to use her own cellphone to coordinate the work of several attending doctors who hadn’t talked to each other, mixing up mouthwash with handwash, a nurse call system that didn’t work, the nursing staff’s disregard of her roommates sickle cell crisis pain, and the barring of her patient advocate (who is a medical student at the same organization) from participating in her care. She complained to hospital administration after an earlier visit and received a halfhearted apology blaming her being housed in a treatment room as due to unplanned admissions, an acknowledgment that it was “unfortunate” that the hospital didn’t allow her friend to serve as her patient advocate (without offering an explanation as to why), and defense of her roommate’s pain management as being appropriate based on medical evidence. She’s back in as an inpatient for intractable vomiting and says nothing has improved – the hospital missed her abnormal lab results, security guards confiscated her prescribed drugs and supplies and threatened to arrest her for objecting, and the hospital assigned a “sitter” who sleeps, talks loudly in the hall, and eats bacon in her room. The scary thing about her story is that it’s not unusual from my experience – everybody who lives through an inpatient stay can relate equally horrifying stories about the incompetence and indifference they encountered.

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A good article in IEEE Spectrum describes how BIDMC CIO (and gentleman farmer) John Halamka, MD helped develop early big data platforms I2B2 and SHRINE that later may have saved his wife’s life as he researched the best treatment options for her newly diagnosed cancer based on historical outcomes. He adds in describing future innovation, “All these big companies are fine, but do we really think the next cool innovation is going to come out of an 8,000-person company? No. It’s probably a two-person garage operation.”

Another interesting IEEE Spectrum article addresses the healthcare uses of IBM’s Watson, which it concludes isn’t ready for prime time and may not be for some time because: (a) it not only has to find existing answers in existing content but also has be trained to think like a doctor; (b) journal articles Watson uses as source material aren’t always current or based on actual medical practice; (c) EHR databases are full of errors and focus more on billing rather than clinical usefulness. The article mentions other companies working on medical artificial intelligence such as QPID, DXplain, and CancerLinQ.

A small study of Facebook users finds that those with low self-esteem post often about their romantic partners, while those who brag about diet, exercise, and achievements are often narcissists who crave “likes” and positive comments from annoyed “friends” just trying to be nice.


Sponsor Updates

  • Medicity posts “ICD-10: Are We There Yet?”
  • MedData will exhibit at the Coastal Emergency Medicine Conference June 5-6 in South Carolina.
  • First Databank customer Joshua Schmees, PharmD of Hospital Sisters Health System describes the organization’s success in reducing alert fatigue by using FDB’s AlertSpace.
  • Quest Diagnostics employees raise over $11,000 in the American Cancer Society’s Relay for Life.
  • WeiserMazars posts pictures from its nationwide community service day.
  • NTT Data offers “Predictive Intelligence Brings Increased Value to Data.”
  • Versus Technology will exhibit at AAMI 2015 June 5-8 in Denver.
  • Truven Health Analytics posts “Understanding Your Exchange Population: Are You Asking the Right Questions?”
  • Microsoft summarizes the origins of Oneview Healthcare as part of its Customer Stories series.
  • Orion Health and Passport Health will exhibit at AHIP Institute 2015 June 3-5 in Nashville.
  • Patientco offers “Out-of-Pocket Costs are Increasing Faster Than Expected.”
  • PatientPay Founder and CEO Tom Furr asks “What Would Steve Jobs Say?”
  • ZirMed posts “Leveraging Data Analytics, Keeping Up with Value-Based Care, and Rev Cycle Success at Stanford Children’s Health.”
  • PMD offers “Reusing Code to Improve Care Coordination.”
  • Wide River will host an educational event, Health IT: Compliance & Innovation, June 4 in Lincoln, NE.
  • Sagacious Consultants posts “What You Don’t Know Can Hurt You: the Importance of Measuring Productivity.”
  • Huron Consulting will sponsor the 2015 Aria Health Golf Classic June 1 in support of Philadelphia-based Aria Health’s ICU renovations.
  • The Nashville Business Journal features Shareable Ink CEO Hal Andrews in its “The Boss” video series.
  • Streamline Health will exhibit at the 2015 CHIA Convention & Exhibit June 8-10 in Palm Springs, CA.
  • T-System will exhibit at NYHIMA’s 2015 Annual Conference June 7-10 in Syracuse, NY.
  • TeleTracking offers “Making Interoperability a Commonplace.”
  • Valence Health Project Manager Jacob Krive will present a session on big data and population health at the University of Illinois College of Medicine Chicago June 3.
  • Verisk Health, West Corp., and ZeOmega will exhibit at the AHIP 2015 Institute June 3-5 in Nashville.
  • Voalte offers a new blog showcasing the successful deployment of its smartphone solution at Massachusetts General Hospital.
  • Winthrop Resources will exhibit at the NY Tech Summit June 4-5 in Verona.
  • Xerox offers “The Best Kept Secret in Healthcare.”

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

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May 31, 2015 News 9 Comments

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