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News 3/11/16

March 10, 2016 News 19 Comments

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As reported here as a reader rumor on Tuesday, McKesson sells its ambulatory PM/EHR products to E-MDs, including Practice Choice, Medisoft, Medisoft Clinical, Lytec, Lytec MD, and Practice Partner. Marlin Equity Partners, which acquired E-MDs in March 2015 and AdvancedMD in August 2015, says the newly acquired products will provide economy of scale that will allow the company to extend its brand.

McKesson acquired Lytec and Medisoft in its 2006 acquisition of Per-Se, the same year it acquired RelayHealth. It acquired Practice Partner in 2007. McKesson has been rumored to be shopping its Enterprise Information Solutions business, which includes Paragon, to potential buyers.


Reader Comments

From Busted Flush: “Re: HIMSS. I’m curious if you’ve heard from your readers that they contracted a cold or flu after the conference. I have a nasty cold that’s now in Day 3 and at least 3-4 people have told me they’re sick, too. Hundreds of handshakes, close proximity, and exchanging money at the concession stands may have exposed a significant number of attendees.” I’ve been annoyingly sick since the conference ended, with congestion, achy fatigue, a slightly sore throat, and frequent coughing and sneezing. Anybody else?

From Coolio: “Re: HIMSS rumors. Biggest one I heard was that IBM offered $65 billion to acquire Cerner.” That seems highly unlikely given that Cerner’s market cap is only $18 billion. On the other hand, IBM seems willing to overpay for anything that makes Watson look real.

From Pickle Loaf: “Re: EHR vendors signing an interoperability pledge at the HIMSS conference. Why didn’t you report that?” They signed a pledge, not a contract. The same vendors would also have signed a statement that they already aren’t practicing information blocking. It’s a little late to be seeking voluntary compliance after the horse carrying the HITECH billions has already left the taxpayer barn.

From Brandon: “Re: TrakCare. I just heard that a rehab facility in Saudi Arabia achieved EMRAM Stage 6. I haven’t run across this product in 15 years as a CIO and wondered if anyone knows about it?” InterSystems Trakcare is used in several countries, the US not being among them. InterSystems acquired Australia-based TrakHealth in 2007. It recently won Best in KLAS for non-US EHRs.

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From Flaming Dirigible: “Re: HIMSS keynotes. If HIMSS decided to ever truly think out of the box and invite an interesting speaker like Mike Rowe (the ‘Dirty Jobs’ guy) to do one of their keynotes, I might actually attend. I’ve been going to HIMSS for nearly 15 years and just don’t care about seeing yet another CEO or politician drone on and on.”

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From Four Toppled Pillars: “Re: QuadraMed. A large reduction in force happened today.” Unverified. Googling “QuadraMed + layoff” returns 2,570 hits, however, so it wouldn’t be particularly shocking. I doubt sales of QCPR, standalone scheduling systems, Affinity Revenue Cycle, or even its EMPI have been brisk.


Sexual Harassment at the HIMSS Conference

Results of my poll asking whether HIMSS conference attendees experienced unwanted sexual overtures or comments that made them uncomfortable were as follows, with 274 responses:

  • 14 percent of male respondents said yes.
  • 42 percent of female respondents said yes.
  • Overall, 22 percent of respondents say they were made uncomfortable at the conference.

I received several comments about the poll from female attendees. One says she was appalled at the “rampant misogyny” on display. I heard stories of (married) male executives aggressively pursuing female attendees, another offering to send nude photos of himself, and another who complained that he can’t stand listening to female presenters.

Obviously the conference has a problem with making all of its attendees feel welcome and safe in a professional environment. It also seems that the majority of complaints involve vendor executives.

What, if anything, should HIMSS do about it? My suggestions, assuming that HIMSS either hasn’t done any of the following or hasn’t done a good job of promoting its efforts:

  • Publish a zero-tolerance Code of Conduct anti-harassment policy for HIMSS conference participants that includes not just gender, but sexual orientation, appearance, age, race, religion, and disability. This policy should cover all official venues – the convention center, hotels, and all sanctioned events. You agree to the policy when you register to attend or exhibit.
  • Define the activities that are not permissible – verbal comments relating to the above, making suggestive remarks, and showing unwanted sexual attention, for example.
  • Prohibit exhibitors from using sexually related images or suggestive attire as part of the exhibitor policy.
  • Allow attendees to report incidents anonymously, naming names, and have someone available to investigate their reports promptly.
  • Warn those for whom sufficient evidence exists that they have violated the Code of Conduct, then expel them on the second verified report. 
  • Record complaints in a permanent database to identify repeat offenders.
  • Allow attendees who feel unsafe or uncomfortable to easily request help from HIMSS, conference security, or hotel security. We’re healthcare IT people – surely there’s an app out there that can offers one-click requests for help.
  • Offer easy access to safe rides and physical escorts when indicated.

It’s been said that the people who roll their eyes at policies like these probably aren’t the ones who make them necessary. Hundreds of conferences have addressed the issue directly despite hesitation about potential legal issues, so surely there’s a wealth of resources for HIMSS to use in ensuring a conference environment where everyone is comfortable. Just setting expectations would be a great start.

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If you agree with these ideas, sign and promote my petition to HIMSS. I didn’t include Joyce Lofstrom’s email address since it’s not really fair to swamp her inbox every time someone signs the petition, but I’ll make sure the results are known. I’ll also report back if HIMSS has had something already in the works, which is entirely possible since they’re pretty sharp.


HIStalk Announcements and Requests

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Ms. Yoder from Texas reports that her kindergartners are “the most excited they have ever been since receiving our DonorsChoose package … The Read and Solve Word Problem center has been the most effective. I use it when I pull small groups during M.A.T.H for my students who are struggling with addition and subtraction. The students being able to have a hands-on center to work on this concept has increased their understanding and allowed them to master it. The Unlock It center has been very popular as well. The resources being donated to our class has given my students a real world view of how generous people can be.”

Epic Reader donated $100 to my DonorsChoose project, which with matching funds provided math manipulatives for the Canton, TX first graders of Mrs. Boggs.

I went to the county health department today to get travel immunizations. It took two hours in what could have been done in maybe 45 minutes, most of it because the employees were baffled by their new EClinicalWorks system. Checkout took 30 minutes even though nobody else was present, so I can imagine the line if they were actually busy. They had put up a sign warning that they will close 45-60 minutes early if they’ve been busy because they have to catch up in the system before going home. I suspect they didn’t train their people well, and not to perpetuate stereotypes, they were mostly older folks who said they were using their first EHR after converting from paper. The nurse apologized for staring at the screen to type instead of looking at me, but she did OK.

This week on HIStalk Practice: Morehouse School of Medicine taps Dominic Mack, MD to lead its National Center for Primary Care. IOC selects GE Healthcare health IT for 2016 Rio Games. Summit Medical Group rolls out MModal’s new outpatient CDI tools. Allscripts integrates AssistRx’s e-prescribing software into its ambulatory offerings. Florida Orthopaedic Institute Business Director Larry Bronikowski offers best practices for health IT adoption. Physicians and IT professionals take top salary spots in annual Glassdoor list. Telemedicine expansion bill heads to Indiana governor’s desk. Health2047 CEO Doug Given, MD describes the AMA-backed organization’s plans to tackle physician pain points with technology.


Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.


Sales

New York’s Care Transitions program will use Netsmart’s CareManager for care coordination and care management.


People

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GE Healthcare IT names Charles Koontz (CSRA) as president and CEO. He will also serve as GE Healthcare’s chief digital officer. Predecessor Jan De Witte will leave the company.

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LifeImage names Frank Brilliant (Wolters Kluwer) as SVP of sales and partnerships.

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Microsoft Kinect-powered tele-rehabilitation software vendor Reflexion Health promotes interim CEO Joseph Smith, MD, PhD to the permanent role.


Announcements and Implementations

GE Healthcare’s Centricity Practice Solution is chosen as the official EHR of the Rio 2016 Olympic Games.

Memorial Sloan Kettering’s surgery center goes live with Versus RTLS to monitor patient flow through 12 ORs via Glance-and-Go whiteboards with bi-directional Epic OpTime integration.

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Ochsner Baptist Medical Center (LA) goes live with PeriGen’s PeriCALM clinical decision support system.


Government and Politics

The VA awards 21 IT infrastructure upgrade contracts totaling $22.3 billion.


Technology

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A Cambridge, MA startup begins shipping a $200 seizure-warning wristband containing sensors for body heat, movement, and skin conductivity following a IndieGoGo fundraising campaign last year that raised $780,000. The wristband, which buzzes to warn the wearer of an impending seizure, can also measure stress. A researcher-only version offers real-time patient monitoring. The MIT scientist who co-founded the company also co-founded a startup that detects emotion by reading a person’s facial expressions via their smartphone.


Other

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Doctors at Australia’s Port Augusta Hospital write a letter to its CEO demanding that its $315 million EPAS system (provided by Allscripts) be scrapped because it is endangering patients. They cite a case in which employees failed to notice that a woman who had just given birth was bleeding because they were “preoccupied with data entry.”  The doctors also claim that log-in takes up to seven minutes, nurses mark meds as given but they still show up as due, and long-discharged patients still display as being in the waiting room. The doctors conclude that while their previous complaints were dismissed as “resisting change,’ nearly all of them use EHRs in their private practices 100 percent of the time and would like EPAS replaced  “with something much better.” Doctors at Repatriation General Hospital complained last year that EPAS cut their productivity by 50 percent. SA Health says rollouts will continue, including at the new Royal Adelaide Hospital, due to open in November. 

Nordic made a short video of HIStalkapalooza that will probably take you back a few days. Looks like our Elvis had some dance moves, although as in his 1957 Ed Sullivan appearance, he’s shown only from the waist up.

A study finds that American workers rank dead last of 18 industrial nations in using technology to solve problems, with 80 percent of us unable to figure out an error caused by transferring two-column spreadsheet data to a bar graph. Experts note that the United States is the only country where people aren’t embarrassed to say they’re not good at math.

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HIMSS sent a link to its HIMSS16 conference evaluation, which was really more like an on-screen focus group given that it contained 10 pages packed with questions. I’d like to see the metric of how many people clicked the link to start the survey but who then bailed out before completing it (I can say with confidence there was at least one).

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HIMSS provides a touching story of homeless US Navy veteran Kevin Phillips (center, above), sponsored to attend the HIMSS conference by the Gateway chapter. A local group helped him buy clothes appropriate for a professional conference, but an unexpected airline change on the second leg of his flight placed him on a 2 a.m. connection that required a $25 checked bag fee that he didn’t have (he had only $11 in his pocket, just enough for the hotel shuttle). He couldn’t get help, so he started walking from Chicago back home to Fort Wayne, IN. Members of the Chicago Police Department picked him up, chipped in to pay his baggage fee, and gave him a ride back to the airport. He made it to the conference and is getting career coaching through HIMSS Veterans Career Services.


Sponsor Updates

  • YourCareUniverse publishes a new whitepaper, “Closing the Loop Between Chronically Ill Patients and Providers to Reduce Readmissions.”
  • Ingenious Med will exhibit at South by Southwest March 11-14 in Austin, TX.
  • The local business paper profiles Leidos Health’s work with the VA in light of its merger with Lockheed Martin.
  • LifeImage posts video interviews from the HIMSS show floor.
  • Navicure will exhibit at the MA/RI MGMA – Westborough Meeting Payer Day March 17 in West Borough, MA.
  • Netsmart will exhibit at the National Association of Psychiatric Health Systems March 14 in Washington, DC.
  • NTT Data will exhibit at the IT Summit – Blue Cross and Blue Shield of North Carolina March 17 in Durham, NH.
  • Obix posts new Ask the Expert and System Integration videos for its perinatal software solution.
  • Oneview Healthcare will exhibit during Australian Healthcare Week March 15-17 in Sydney.
  • CloudWave EVP Jim Fitzgerald discusses the reasons behind Park Place International’s rebranding.
  • Experian Health will exhibit at AAHAM Florida March 10-11 in Palm Coast.
  • Patientco releases a new e-book, “The Healthcare Provider’s Guide to Selecting a Payment Processor.”
  • RelayHealth Financial reports claim denial trends.
  • The SSI Group and Streamline Health will exhibit at the 2016 NC HFMA Annual Conference March 13-15 in Pinehurst.

Blog Posts


Contacts

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

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March 10, 2016 News 19 Comments

EPtalk by Dr. Jayne 3/10/16

March 10, 2016 Dr. Jayne 1 Comment

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Good news from the people at Microsoft, who are listening to the user community’s pleas to return critical functionality for those using Office 365 on tablets. They’ll be adding back the ability to use the pen/stylus as a mouse. That makes me happy on multiple fronts, since not only will I be able to go back to previous workflows, but I won’t have to spend hours stripping my Surface Pro to return it to the store. There’s no ETA on the fix yet, but other than that recent failure, I really have been satisfied with my purchase.

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Friday is the last day for providers and hospitals to attest for 2015 Medicare EHR Incentive Programs. If you’re on the provider side, I hope your attestation is long complete. I’ve been helping a client with a last-minute effort and we ran into a lot of issues, mostly on their side, but some with website slowness which I can only assume is due to volume. Fortunately, we finished their attestations last night and I can breathe easier going into the weekend.

Last-minute projects always make me cringe, but as a small business person, they are valuable. It’s a way to help clients in a pinch, which can bring considerable work in the future when they’re happy with your services and realize you saved their backsides. Several of my steady clients have met me while in dire straits and I’m happy to continue working with them. It can make the work unpredictable, though. I’ve been fortunate to have a couple of clinical informaticist friends that I can ask to help out when one of those situations hits or when I need coverage to take some real time off. It’s been an informal arrangement, though, and I’ve been on the fence about whether I should engage someone to work with me on a more dedicated basis.

Finding someone who knows the space in the same way I do but who isn’t already crazy busy or who doesn’t have a full-time job has been a challenge. There are a lot of inpatient CMIOs that are interested in branching out, but in order to service my clients, I needed someone with solid ambulatory experience who can also cover the softer disciplines like change leadership and team development.

After talking with multiple candidates and conducting a trial run, I’m happy to say that I officially have a partner. He’s one of my long-time mentors and I suspected that his recent retirement wouldn’t last long, so was glad to hear of his interest. It has been fun working together on projects. I’m sure that due to the difference in our ages and his more prominent career, some people might assume that I’m working for him. It’s a risk I’m willing to accept. However, my company logo (which involves a figure in a dress and stilettos with a briefcase) should make for a good icebreaker when he hands out business cards.

I’ve had quite a few emails from readers this week, which always makes me smile.

From Think Twice: “Re: MU. Your recent Curbside Consult describes all that is/was wrong with MU. Instead of ‘certifying’ systems, MU should have defined a data ontological framework, a file standard (standard XML/CCDA), and an information bus that all systems that handle PHI must comply with. In that world, we wouldn’t be certifying vendors, but rather required capabilities. It would have opened the door to innovation. I’m not sure how we would handle, app-app communication across the workflow (like SMART is supposed to address), but we’d still be much better off.  More importantly, this wouldn’t have dealt with how providers protect their data (just to keep patients inside), while using HIPAA to hide behind (another story!) Although Meaningful Use as we knew it is on the way out, there are plenty of regulatory and quasi-regulatory bodies waiting to take us to the next level as they drive towards value-based care and other buzzword-worthy initiatives. I hope they’re listening, and look at how much money has been spent vs. how many provider hours as being wasted. The recent piece on providers spending hundreds of hours keeping up with quality measures was telling (especially since we haven’t seen a commensurate uptick in patient outcomes). It may be too early to tell, but my sense from the trenches is that it hasn’t been worth it.”

From Keeping Up: “Re: HITECH. I read most of the HHS report. It’s the same garbage we hear every month about the ‘numbers’ of EPs and EHs that used a certified EHR. They may ‘use’ them, but do not attest to MU or any of the other BS. It’s the same stuff — we gave out $30 billion in incentives, EPs and EHs took that and paid it all and more to EHR vendors (they don’t say that), and it’s still a mess. The lack of vision of ONC and HHS about this is amazing to me. EPs and EHs were moving towards EHRs prior to HITECH, but instead, HHS and ONC made this artificial market. Sure, it moved the adoption needle, but to what effect? Now you have the same problems as before, but EHR vendors made a ton of money. That bubble is about to burst and it will be ugly.” He goes on to mention the lack of improved patient care, safety, security, efficiency, and costs worrying that providers will bear the blame. I don’t disagree – we’re already seeing practices who have more staff than they did five years ago but are less productive and feel like they are providing a lower quality of care. Certainly there are people who have been able to make it work, but not without a considerable amount of resources or without sacrifices at the financial or personal levels. He mentioned watching his peers leave practice due to the pressures and I’m seeing that in my community as well. Given the costs of training, the risk of burnout, and the constant external pressures, I don’t think I would recommend a career in medicine unless someone felt a true vocational calling.

From St. Elmo’s FHIR: “Re: LOINC. Regarding your comments on regulations requiring customers to use LOINC for reporting laboratory measures but not requiring lab vendors actually send the codes with the results, amen. This is one of the stupidest things that’s been done. Although you mentioned that interoperability isn’t going to change the culture of competitive advantage, eventually companies learn that interoperability isn’t in competition with this. My view is that the vendors have learned this – based on working with development teams – but it’s a time-to-market problem. The solutions they are working on today haven’t hit the market, but when they do, it will be clear that competitive advantage is built on interoperability.” As much as I’m a bit pessimistic about the future of medicine, I do want to have hope. The old adage of “knowledge is power” would seem to lead organizations to want to share as much as possible. There is a leadership training game I use called “Win All You Can,” which ultimately shows that the only way for everyone to prosper is for everyone to work together for the common good. I first ran into it during an outdoor leadership course and have used a variation of it ever since. Maybe we can get ONC to require knowledge of it (or something similar) in the next round of incentive or penalty programs.

Is interoperability really the answer? Will knowledge set us free? Email me.

Email Dr. Jayne.

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March 10, 2016 Dr. Jayne 1 Comment

Morning Headlines 3/10/16

March 9, 2016 Headlines No Comments

VA names companies to share in $22 billion IT overhaul

The VA awards $22.3 billion in contracts to Booz Allen Hamilton, IBM, and Accenture as part of a department wide initiative to revamp IT systems. The project does not include funding to modernize or replace Vista, the EHR platform used by the VA.

e-MDs to Acquire Ambulatory Software Technology Assets from McKesson

E-MDs will acquire a number of McKesson ambulatory practice products, including Practice Choice, Medisoft, Lytec, and Practice Partner. Financial terms were not disclosed.

Theranos Ran Tests Despite Quality Problems

The Wall Street Journal reports that results from a 2015 CMS inspection of the Newark, California-based Theranos lab suggest that the company had been knowingly processing PT/INR tests on equipment that was generating erroneous results.

How Nash UNC improved care and added $1.5 million in revenue by deploying smartphones in the ER

UNC Nash Health Care (NC) generated $1.5 million in new revenue after issuing clinicians in the ED dedicated smart phones that were integrated with the hospital’s EHR. ED length of stay fell by 27 minutes and wait time for an inpatient bed assignment fell by 57 percent.

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March 9, 2016 Headlines No Comments

HIStalk Interviews Dan Michelson, CEO, Strata Decision Technology

March 9, 2016 Interviews No Comments

Dan Michelson is CEO of Strata Decision Technology of Chicago, IL.

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Tell me about yourself and the company.

Strata has been around for 20 years. We work with roughly one-fifth of the hospitals in the country, 185 healthcare delivery systems. The focus of the company is to help healthcare providers drive margin to fuel their mission. We do that with a cloud-based platform that hospitals deploy on top of their ERP and EHR. That platform becomes essentially a Microsoft Office for the finance team.

The other day someone used the analogy that we are kind of the Intuit for the healthcare space and that’s a good way to think of it.  Health systems use our application for financial planning — including their long-range financial plan, operating budget, and capital budget — as well as their cost accounting, where we are #1 in KLAS. Also payer contract modeling, so they can understand their true cost and true margins as they negotiate bundled care contracts.

We have algorithms that identify opportunities to reduce cost by eliminating waste, reducing unnecessary variation, and reducing the cost of harm events. Then we provide the workflow for managing that cost out. What many companies have done over the last 50 years in revenue cycle management, we’re now doing around margin management in healthcare. A typical Strata client is billion-dollar healthcare system with eight hospitals, so the opportunity to make an impact is significant.

Do  hospitals accept responsibility for their significant role in ever-rising healthcare costs?

They do now. They didn’t three years ago. The world has changed.

Cost accounting has become a required core system on the financial side to prepare for a value-based world, just as population health has become on the clinical side. People need to know their cost to negotiate bundled care contracts. Not their charge-based cost, but their true cost and their true margins. Even if they’re going to be losing money in that contract, they need to know the levers that they can pull to drive margin over time to be profitable.

That’s in the fee-for-value world, but it’s also a requirement in the fee-for-service world. Over the last three years, the average reduction in inpatient admissions nationally is 2.2 percent per year. Couple that with the fact that hospitals are operating at 2 percent margins and one-third of them are unprofitable and that’s a pretty scary future.

With that kind of pressure on the top and bottom line, the one thing that they know they need to focus on is their cost. But it’s not about just taking 5 percent or 10 percent of their cost out and then moving on. We did some research and talked to 100 different organizations. Eighty-eight percent them had a cost reduction initiative in place. The range they were looking to take out was between $50 million and $400 million, but only 17 percent of them were successful in hitting that target.

For all the automation and technology that we have around revenue cycle, it is missing on cost and margin. To make this point, I often tell people that focusing more on revenue cycle is like trying to squeeze a raisin for a little bit more juice. Cost is a like squeezing a grape — there is a lot of opportunity right now.

We have clients with 600 people in their revenue cycle organization, but only six people who are involved with performance improvement and cost. Clearly that’s going to change now that the reimbursement structure has changed and risk-based contracts are coming into the mix. Roughly 80 percent of large health systems either have a health plan or are building one. Clearly they are going to be taking on risk. The only way they can manage it long term is to understand their return.

Hospitals I’ve worked in are careful about supply costs, but not so good at managing the big-ticket items of labor management and utilization management. How are hospitals approaching cost reductions?

The state of the art for what you just described is PowerPoint and Excel. The level of sophistication is completely absent.

People approach those problems that you mentioned — managing the cost of labor, supplies, and purchased services — episodically. They go after it at one point in time with one initiative. Contrast that approach with revenue cycle, which they are looking at every hour, every day, every week.

The best organizations are approaching it now as a continuous process. They’re not approaching it as, we’ve got take out 5 percent or 10 percent of cost. They’re saying, where do we need to eliminate waste? Where do we need to eliminate variation, or at least reduce variation, or reduce unnecessary variation? Where are we doing things, like harm events, that are making matters worse?

For example, Yale New Haven Health saved $150 million taking a quality-first approach and then tying cost to it via our cost accounting solution. If they have a harm event, a PSI, or HAC, they know exactly what that’s costing them on a macro level, or even with that individual incident. They know exactly what it’s costing them. They’ve created what they called Quality Variation Indicators, QVIs, and we’ve married cost accounting data to that. They went to their clinicians, and in a very integrative fashion between physicians and finance, they’ve had conversations about cost, resources, and waste.

They’ve done two things on top of that are interesting. One is there’s some gain-sharing. If the physicians are doing better and they’re managing their resources more effectively, the physicians have some upside. Then, they’ve embedded cost within order sets, so that when a physician is placing an order within Epic, they have the cost information and are aware of it.

When you took a flight to Las Vegas, you looked up the cost on a website. There’s no such thing for somebody who works in a healthcare institution. Where would you even go to find information on cost? Two issues are holding back that scenario. The information is not accessible. Even if it may exist somewhere, people can’t get it. Second, no one is accountable. If you’re paying for a flight, regardless of work or personal, you’re going to look at that cost and look at the alternatives. We haven’t done that for clinicians.

Opening up that conversation is an enormous opportunity, especially when you understand that 80 percent of the costs in healthcare are driven by physicians and their decisions. To not provide them that information and make it accessible is crazy.

Are hospitals more freely telling physicians exactly what their true incremental cost is if they order a given test, procedure, or drug?

They’re starting. Johns Hopkins embedded costs within order sets and they drove down volume by 10 percent. University of Miami showed physicians phlebotomy costs retrospectively, and just by sharing data, they were able to drive down volume by 25 percent. We’re in the early innings of that game, but take these examples and stitch them together and you can see a path.

In 2002, people said doctors weren’t adopting EHRs because they were technophobic. It’s not like we solved technophobia in the last 14 years — it turns out that that premise was never actually correct. Then once EHRs started getting used and people saw order sets, the reaction of physicians was that it was cookbook medicine. Now you’re telling me what to do? It’s pre-prescribed? Now, when is the last time you heard the term cookbook medicine? It’s been absent for the last three or four years. That premise was wrong as well.

Now we’re operating on the third premise –that doctors don’t know and don’t care about cost. Data proves that’s not the case. A study surveyed 503 orthopedic surgeons and gave them a simple challenge. Here’s 13 commonly used implantables — guess the cost. All you have to do is get within 20 percent. The got it right 20 percent of the time. This was at Stanford, Mayo … six academic centers.

Then they asked those same physicians, if you had the cost, would you incorporate the information in your selection of a device? Eighty percent said yes. That’s two out of 10 who get the information or could guess it correctly, and eight out of 10 would use it if they had it. That gap is an enormous opportunity.

We see that conversation changing, but it’s in the early innings. People are uncomfortable at first. If they approach it as a witch hunt and a condemnation — you’re an outlier, you spend too much, there’s got to be a problem — the clinicians will say, "My patients are sicker," and then obviously, “They’re more complex and they get better outcomes.”

You have to weave together the clinical and financial, which is starting to happen now, in order to make this work. The chief medical officer at Yale, Dr. Tom Balcezak, also calls himself the medical director of finance. We’re seeing that woven together more often in more places.

As people go after value, if the top part of the value equation is quality — and quality is defined as not only clinical outcomes, but also obviously the experience of care — and the bottom part of that equation is cost, how do you deliver value if you don’t know your cost?

Here’s the problem. Even for the organizations in the past that have provided cost information, it was done on a ratio of cost to charges. It was based on the charge master, which is fiction, then taking a percentage of that, which is a made-up amount. You’re taking fiction based on fiction. It’s no wonder that nobody, including doctors, really trusted the information.

The cost accounting process historically has been run two or three times a year. It only had inpatient information, not ambulatory or outpatient information. The actionability, the accuracy, the accessibility of the data just wasn’t there.

Strata has grown rapidly and was acquired a year ago by Roper Technologies. What has changed most in the company?

Let me first talk about Roper. Roper is a publicly traded holding company that operates very similar to Berkshire Hathaway. They make investments in companies, but they let them operate independently. Roper has been around for 110 years and they own 49 companies. I believe they’ve sold one company in that history of 110 years.

The acquisition gave us the opportunity to continue down the path we were on, but with a permanent home and even more support. They don’t get involved in operational or budgeting decisions. There’s no revenue synergy or cost synergy target. There was no integration team or transition team.

It was 14 months ago when we became part of Roper and it has been everything they promised and more. It really is an amazing place to bring your company if you want to have it have permanence and continue down the path that you’re on. It’s a perfect partnership we have with Roper. I mean that sincerely.

The biggest thing that’s changed in the company is the acceleration of decision support — which is the combination of cost accounting and payer contract modeling — and the movement of the product into becoming more of a platform. What Epic or another EHR is on the clinical side, we have become on the financial side – a single database solution for all of the core operations and analytics in finance and operations. For a CFO, it’s their financial planning, budgeting, and control system. It’s their cost accounting and decision support. It’s their cost and performance management application.

We added about two years ago what we call continuous improvement, which is the ability to not only identify cost reduction opportunities or ways to use your resources more effectively, but then also the project management on top of that. We have automated cost and margin management. Because of that, the company is seen as a strategic platform versus a tactical tool set, which is how it used to be seen.

Do you have any final thoughts?

There’s an opportunity to do a tremendous amount of good here by opening up this conversation in healthcare around understanding cost and how resources are used, providing a level of sophistication around it that has been largely absent. The last 10 years of healthcare IT has been focused on the clinical side of the house and we’ve received a great benefit from that. Now we can do things that we couldn’t do before, not only sharing information, but being able to look at quality.

Clearly there’s more work to be done on the clinical side, but the missing piece is now the financial side of the house. While we’ve had all this innovation on the clinical side, we’ve fallen behind on the financial side. Now is the time to address that. Many good things will come from us all collectively doing this work.

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March 9, 2016 Interviews No Comments

Morning Headlines 3/9/16

March 9, 2016 Headlines 1 Comment

US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures

Health Affairs publishes a study estimating that US physicians spend 785 hours and $15.4 billion per year  dealing with reporting quality measures,

Cerner Approves $300M Common Stock Buyback Plan

Cerner’s board of directors approves the repurchase of up to 5.7 million shares, or 1.7 percent of the company’s outstanding shares, at a cost of up to $300 million. No time limit was set for the completion of the buyback plan.

Analysis of Prescribers’ Notes in Electronic Prescriptions in Ambulatory Practice

A JAMA study finds that 66 percent of e-prescriptions contain information in the free text field that should have been entered as discrete data, while another 5 percent contain comments that are irrelevant to the dispensing pharmacists.

Aetna moves to combine iTriage and WellMatch, confirms layoffs

As rumored on HIStalk this weekend, Aetna has laid off an undisclosed number of employees from iTriage and merged the business unit with WellMatch, an Aetna business focused on cost transparency.

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March 9, 2016 Headlines 1 Comment

News 3/9/16

March 8, 2016 News 3 Comments

Top News

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A study finds that physician practices spend 785 hours per doctor on the “unnecessarily costly” reporting of quality measures, totaling $15.4 billion annually. 


Reader Comments

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From Spiffy Shades: “Re: McKesson’s ambulatory EHR/PM products. They are selling all of them to E-MDs.” McKesson will apparently exit the physician practice business by selling Medisoft, Lytec, Practice Partner, and Practice Choice to E-MDs. Marlin Equity Partners bought E-MDs in March 2015 and AdvancedMD in August 2015 to add to its MDeverywhere holding. It seems to have some synergistic plan for the hodgepodge of EHR/PM products of McKesson, which I speculate is slowly but surely divesting its way out of healthcare IT except maybe for RelayHealth.

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From Robert Lafsky, MD: “Re: article on EHR free-text notes. One colleague wryly laments that a lot of doctors just use the EMR as a word processor and this is a good example. The inability to deal with structured fields seems endemic. Are we just doomed to wander the desert for 40 years until a new generation has replaced us?” A study of 26,000 electronic prescriptions that were sent to community pharmacies by community-based prescribers finds that in two-thirds of them, the prescriber placed information in the free-text field that should have instead been entered as discrete data. Nearly one in five of the prescriptions had free-text instructions that didn’t match what the prescriber actually entered. Another 10 percent of prescriptions were actually cancellation requests, sent either because the EHR vendor doesn’t support the standard cancellation message or the prescriber didn’t know how to use that function. More than half of the inappropriate free-text messages involved  insurance benefits or dispensing quantities. The authors conclude that EHR and e-prescribing vendors need to improve product design and usability testing, apparently holding prescribers harmless for using their software incorrectly.

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From Dingo: “Re: HIMSS conference app. You should create one so that readers can connect with each other, see a sponsor event schedule, and find social events.” HIMSS had its own app, but I didn’t try it. I assume it focused on the educational session schedule. If you used that app, what did you like and dislike about it? If not, what kind of app would you use?

From Bill Earry: “Re: consulting companies. I’m a physician informaticist interested in exploring whether consulting is right for me. What are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems?” I’ve never been a consultant, so I’ll ask those who are to weigh in, especially physician consultants.

From I.C. O’Jay: “Re: innovation. It’s pointless talking to a health system CIO about innovative products. They have no interest or insight.” IT executive management is very much like public health. You’re trying to do the most good with the biggest impact given a limited budget and headcount. Do I vaccinate 1,000 children or launch a nutrition education program? Do I keep a marginal but inexpensive department system and use the money to fund a revenue cycle technology project? How should I prioritize the need to apply endless system upgrades and infrastructure projects to keep the lights on against some startup’s cool but unproven app? The hardest part about running an IT organization is enlightening departments, end users, and vendors about the constant constraints under which the organization operates – enterprise IT isn’t like buying an Office Depot computer or installing an iPhone app and it never will be. Part of the job involves watching well-meaning but naive users storm off in a huff because their shallowly-researched bright idea is not feasible given the organization’s budget, tolerance for risk, competing projects, and strategic focus. You say “no” a lot, and rightfully so. In fact, I might speculate that CIO success is predicated more on what projects they don’t undertake rather than the ones they do.

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From NextGen Customer: “Re: the former hospital systems business sold to QuadraMed. During a recent conference call, a comment was made that QuadraMed bought NextGen for the customers and will not be making any enhancements. One individual said we will have to move to the other product. I contacted another NextGen customer and they said they had already been approached.” Unverified.

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From Court Watcher: “Re: Epic v. Tata. There’s a new order on a motion for summary judgment. The court said there’s compelling evidence of unauthorized access by Tata’s employees over an extended period of time. The court found Tata guilty of violating the computer fraud laws and the Wisconsin computer crimes act. They also apparently violated their contracts.” I’ve written about this case a few times. Epic says Tata’s India-based employees claimed to be working for Kaiser Permanente in trying to slip into Verona-based classes and to download everything in the consultant portion of Epic’s UserWeb system for enhancement ideas for its Med Mantra hospital information system. Most of the legalese is over my head, but the Tata people seem to be real scumbags. People claim Epic is paranoid about protecting its intellectual property, but more than one example exists of people in a foreign company trying to steal Epic’s information to create a competing product.

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From HIT Banker: “Re: HIMSS conference. For the last two years, one of our female junior staffers has been solicited by various male executives to join the guy in his hotel room. I wonder how much debauchery is going down behind the scenes at HIMSS? I would like to see a poll on this, although I doubt you would get honest responses. I might simply ask, ‘Did you do anything at HIMSS that you would not tell your significant other?’” What HIMSS attendees do as consenting adults is their own business, but I will modify your curiosity into this poll: did you experience unwanted sexual overtures or comments during the conference that made you uncomfortable?


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor PatientMatters. The Orlando-based company helps health systems transform the hospital patient’s financial experience with tools, training, and expertise to increase cash and lower debt as self-pay balances increase. The company focuses on seven specific areas of cash leakage: pre-registration and scheduling, ED, POS collection, patient advocacy, early-out, payment plans, and bad debt in transforming patients into educated consumers who can engage effectively. Specific tools include address verification, identity verification, eligibility, patient payment estimation, pay select, patient loans, statements, and a patient portal. One customer increased ED POS collections by 71 percent in three months, increased patient cash payments by 20 percent in six months, and decreased bad debt by 54 percent. Thanks to PatientMatters for supporting HIStalk.

I found this PatientMatters intro video on YouTube.

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We fulfilled the DonorsChoose grant request of Ms. Jones from Georgia in providing her first grade class with an iPad, case, and headphones. She reports, “My students are excited about learning when they are handed an iPad, as if it was a treat or reward. Their little eyes light up and they become engaged in their learning and complete more tasks with a higher rate of success … when they are allowed to use the iPad, their confidence and self-esteem increases and more work is completed in a timely manner. This is mainly due to the immediate feedback after completing each assignment. This gives them a great sense of accomplishment.”

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Also checking in was Ms. K from Tennessee, whose second graders are “having fun while learning” in using the seven math games we provided.

Listening: The Struts, Brit rockers that sound to me like a stew of Queen, Slade, and Quiet Riot. Then it’s off to some harder stuff from the amazing Avenged Sevenfold, to which I’ll be desk-drumming for the next several hours (especially since that particular song was dedicated to drummer The Rev, who died of a drug overdose in 2009 at 28).


Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.


Acquisitions, Funding, Business, and Stock

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The CEO of genetic testing company Ambry Genetics makes the de-identified data of 10,000 breast and ovarian patients available to researchers, bucking the trend of biotech companies that believe they compete on data rather than testing. CEO Charlie Dunlop is blunt about his motivations: “I have stage 4 cancer myself. I don’t care what goes down. This is what we’re doing at Ambry Genetics. We’re here to try to save the world, period." The AmbryShare website defines itself as, “It’s a chance to help stop data hoarding and unlock the promise of the human genome project.”

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Cerner announces a $300 million share buy-back program. Above is the one-year share price of CERN (blue, down 23 percent) vs. the Nasdaq (red, down 4 percent). Shares have dropped to July 2014 prices.

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MedCity News confirms the rumors I ran here this weekend indicating that Aetna has laid off dozens of people working on its iTriage app. Aetna confirms the layoffs without providing numbers, adding that it plans to combine iTriage with its WellMatch price transparency app.

Scotland-based Craneware’s first-half profits rose 17 percent after strong sales and recurring revenue growth.


Sales

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UC Irvine Health (CA) chooses Phynd to unify, manage, and share the data of its 25,000 providers across multiple IT systems.


People

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Culbert Healthcare Solutions promotes Brad Boyd to president. Founder Rob Culbert relinquishes that role but remains CEO.

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Nordic promotes Nicole Meidinger to VP of business development.


Announcements and Implementations

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University of Texas M.D. Anderson Cancer Center (TX) goes live on Epic.

KPMG’s auditing practice will use IBM Watson to analyze customer resource allocation.

Experian Health adds its Patient Estimates solution to Athenahealth’s marketplace.


Government and Politics

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ONC releases the Million Hearts EHR Optimization Guides, showing providers who use Allscripts, Cerner, or NextGen how to use their EHRs to manage aspirin therapy, blood pressure, cholesterol, and smoking cessation. ONC calls for other EHR vendors to develop guides for their products.

A Texas anesthesiologist and hospital owner is convicted of billing $10 million for supervising CRNAs when he wasn’t actually present. The government provided evidence that at the times he was supposedly working in the OR, he was actually (a) undergoing surgery himself; (b) flying on his private jet; and (c) traveling out of state. He also signed medical records attesting to the services he provided before the surgeries even started.

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Wired profiles big data entrepreneur John Mininno, who has built a business around analyzing CMS-released claims data to find likely Medicare fraud, then finding an employee of the organization willing to file a whistleblower lawsuit in return for sharing any settlement. His programmers look for unusual patterns, such as providers who file a normal claim volume on a snowy day when they probably weren’t running at full capacity.


Privacy and Security

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Philips launches the Netherlands-based Philips Blockchain Lab, which will explore the use of the cryptographic technology in healthcare.

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An interesting article explains the motivation of shady people who post idiotic Facebook puzzles, pet photos, and emotional stories that beg users to “like them” or share them in some way. “Like-farming” attempts to rack up a ton of exposure, after which the original post is changed to either spam or malware links that pollute your own Facebook news feed as well as those of your friends in some cases. New South Wales police warned people last week of the phony contest above (posted under a fake Qantas Air account) in which Facebookers were urged to click “like” for a chance to win free travel.

A study of Android diabetes app privacy policies finds that 81 percent have no privacy policy at all and only 4 percent of them say they will ask users before sharing their data. Most apps shared insulin and blood glucose levels, and of those that offer a privacy policy, 40 percent don’t disclose that they share data.

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A stolen, unencrypted laptop belonging to physician practice Premier Healthcare (IN) exposes the information of 200,000 people.


Other

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Marketing firm Cramer brags about being hired by Athenahealth to create the HIMSS16 data sharing presentation of Jonathan Bush and John Halamka, developing the “relatable, human storyline,” creating a PowerPoint to “wow the audience,” and coaching the presenters through a “table read” and “two simulated on-stage rehearsals.”

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A six-hospital study finds that monitoring discharged heart failure patients with telemonitoring, telephone calls, and health coaching had no effect on 180-day readmissions.

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An ED doctor in England faces a disciplinary hearing after tweeting out tirades that include a proposed fine against “ambulatory neurotics with a few aches and pains” who call an “ambulance for a broken nail, an earache, period pain, not being able to sleep …” and who are “crippling the NHS.” He also tweeted, ““I’m sure ADHD is merely a polite term for a child who is just a little sh**”


Sponsor Updates

  • Besler Consulting releases a new podcast, “The Relationship Between Physician Coding and Compliance.”
  • Burwood Group becomes a Citrix Platinum Solution Advisor.
  • Chilmark Research names Caradigm a top vendor among care management vendors.
  • Premier is named to the “World’s Most Ethical Company” list for the ninth straight year.
  • Spok will convert its Connect 16 annual healthcare communications conference to a series of one-day events held in six cities starting March 24.
  • CitiusTech posts a new video profiling its partnership with IBM.
  • CompuGroup Medical will exhibit at the National Association of Community Health Centers P&I Forum March 16-19 in Washington, DC.
  • CoverMyMeds crosses the 500,000 provider account threshold, and is now integrated with over 500 EHRs.
  • CTG recaps its time at HIMSS16. 
  • HIMSS16 attendees help Divurgent raise $5,000 for Children’s Hospital of Nevada at UMC.
  • EClinicalWorks will exhibit at AMGA 2016 Annual Conference March 10-12 in Orlando.
  • The local paper looks at the ways in which API Healthcare is benefiting from its sale to GE Healthcare.
  • Glytec CMO Andrew Rhinehart, MD reviews the American Diabetes Association 2016 standards of care in the latest Annals of Medicine.
  • HCS will exhibit at the National Council for Behavioral Health Conference through March 9 in Las Vegas.
  • SK&A publishes a report on EHR software usage in physician practices.

    Blog Posts

Blog Posts


Contacts

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

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March 8, 2016 News 3 Comments

Morning Headlines 3/8/16

March 7, 2016 Headlines No Comments

Walgreens looks to cut ties with Theranos

Financial Times reports that Walgreens is moving forward with plans to end its relationship with Theranos in an effort to close the wellness centers Theranos runs in 40 of its Arizona pharmacy locations.

‘The data is being collected—now it needs to move’

In a short interview, National Coordinator Karen DeSalvo, MD discusses MARCA and the unclear future of Meaningful Use Stage 3.

MD Anderson rolls out new electronic health records system

MD Anderson goes live with its Epic install. Epic was selected as vendor of choice in November 2013.

Walking Billboards for Patient-Centered Care

Patient advocate and artist Regina Holliday’s work is profiled by the Wall Street Journal.

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March 7, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 3/7/16

March 7, 2016 Dr. Jayne 1 Comment

I’m still recovering from HIMSS, which really gave me a beat-down this year. What started as the usual sore throat and froggy voice from yelling over loud music and being exposed to smoke seems to be turning into something more. On top of that, my self-diagnosed broken toe is actually a pair of fractures.

Fortunately, I scheduled a fairly low-key week, so I am working from the sofa with my foot propped. I’m wading through quite a few press releases that were lost in the HIMSS shuffle. I know vendors like to save them up for the week, but then there is so much noise that they’re easily missed.

I’m also following up on some consulting leads. Although a couple of them are from actual healthcare delivery organizations, most of them are from vendors who like the idea of having a physician informaticist on call, but not necessarily having to keep them on the payroll.

I’ve enjoyed the flexibility of consulting as well as the variety. There are a lot of organizations that have problems they’re trying to solve or could benefit from some outside opinions. It’s actually a lot like being a family physician. Sometimes the problems are straightforward with obvious solutions like cold and flu symptoms. Other times the issues require a lot of analysis and diagnostic maneuvers as well as the possible intervention of other specialists. The “detective work” aspect of medicine is what attracted me to the field in the first place, so I’m glad to be able to put those skills to work in other arenas.

Having worked in the large health system space, I’ve also developed some pretty solid firefighting skills that I’m putting to use assisting a client with their 2015 Meaningful Use attestation. The deadline is Friday, and although they thought they were prepared, it turns out that their internal MU resource hadn’t really been doing much in regards to documentation. Unfortunately, this was only discovered after she left the practice. I’m helping one of their senior clinical leads understand what documentation they have, what they’re missing, and how to go about creating an attestation binder for each eligible provider. It’s not glamorous, but they’re very appreciative, so I’m enjoying the work.

ONC announced three challenges in conjunction with HIMSS. The first is for $175,000 and seeks consumer apps that use open APIs to help patients aggregate their information under their control. I saw the Humetrix iBlue Button app at last year’s HIMSS and gave it a test drive. It was straightforward and easy to use. I know there are other vendors as well, so I will be interested to see what this challenge yields.

The second challenge is for the same amount, but this time for improved user experience for providers. Eligible apps will use open APIs the improve clinical workflow.

I had worked with a vendor last year who had designed a slick-looking bolt-on documentation solution for providers. They were looking for vendor partners. I had to advise them that they’d be hard pressed to get vendors to play along with them since essentially the purpose of their product was to correct clunky and ugly workflows.

They were reluctant to admit that calling someone’s baby ugly isn’t the best way to build relationships. Instead, I advised them towards a more grassroots effort with either provider organizations or specialty societies. They’re still working on their approach. I hope to hear from them again soon, but maybe this challenge will spur even more innovation.

The third challenge is for $275,000 and supports the development of an “app discovery site” to help developers distribute their apps for providers to evaluate. The overall goal of the challenges is to leverage FHIR to build interest in open APIs while advocating user-focused innovation. I agree with them that improving in these areas is important, but don’t think we have enough money on the table yet to really move the needle.

My former health system employer decided to consolidate its clinical platforms primarily because it was tired of supporting 1,000+ applications. It feels a bit like we’re headed back in that direction — having to add on multiple third-party solutions to get the work given the increasing complexity of healthcare delivery. Not to mention that just having interoperable solutions isn’t going to motivate people to send data in a codified way that would make it truly useful.

We’re seeing issues with regulations that require customers to use LOINC for reporting laboratory measures, yet there is no requirement that lab vendors actually send LOINC codes with the results. This has put provider organizations in a bind. Although I’m grateful for the work that problem has provided my consultancy, we’d be better off if the codes were required as so many other things are.

Interoperability also isn’t going to change the culture of companies wanting to maintain competitive advantage. There’s too much at stake from a market share and financial perspective for most organizations to truly cooperate, whether they are on the vendor or provider side.

Like most patients, I’m still having to log into three or four different patient portals to track down my information. There is no incentive for the systems to share, and in some cases, the focus on accountable care organizations is making patient care less accessible as groups vie to maintain control over patients in an effort to control costs.

The Department of Health & Human Services recently released its annual Report to Congress, providing an update on the adoption of health information technology and the exchange of health information. Although it documents the progress that has been made, it also describes some key barriers, including:

  • Lagging adoption by providers who were not eligible for incentives.
  • Insufficient specificity of standards.
  • Varying interpretation and implementation of government policies and legal requirements.
  • Safety and usability issues.
  • So-called “information blocking”

So far, the only real instances of information blocking I’ve seen are in the provider community, and range from lack of education in some smaller practices to activities that cry out for antitrust scrutiny. I haven’t seen much of a response to the Report, which was issued right before HIMSS. I’d be interested to hear what readers think about it.

Have you read the HHS Report to Congress? Email me.

Email Dr. Jayne.

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March 7, 2016 Dr. Jayne 1 Comment

Readers Write: Trend Watch: Innovation Forges On in the Provider Sector

March 7, 2016 Readers Write No Comments

Trend Watch: Innovation Forges On in the Provider Sector
By John Kelly

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Provider organizations face tremendous innovation challenges. The success or failure of new systems and technology will depend on their ability to adapt and anticipate the impact of major industry changes. Looking ahead to a successful 2016, hospitals and provider organizations should still expect barriers to using EMR data, should be wary of the hype surrounding cognitive systems, and should prepare for a value-based care partnerships world where providers and payers share information in ways not imaginable until recently.

EMR data will not be fully liberated in 2016

Barriers that exist to move data in and out of EMRs will not abate in 2016, despite pressure. The business model of EMR vendors and real technological barriers will continue to thwart the goals of interoperability sought under the concept of Meaningful Use.

The good news is that providers and payers are establishing pockets of innovation using edge technologies to support better care and risk sharing based upon shared data, and the public outcry over data blocking from EHRs will eventually force vendors to adopt standard APIs. We can expect the personal health data train to gain momentum with hundreds of new market entrants, but not in 2016.

Don’t trust the hype around cognitive systems

Technology-based cognitive systems in healthcare are not in our immediate future. There is lack of clarity around the FTC’s rules regarding software that makes a medical decision — when do they have to be certified as a medical device? Without medical device certification, can the output of cognitive systems be loaded into an EMR? What about malpractice liability?

Analytics vendors and their customers have been tentative in applying the technology to direct patient care, and counter to what other prognosticators believe, this liability and the fear of the unknown will slow down the cognitive market in the US.

ACOs will invest in payer technology

Successful ACOs will require the technology to support all-payer data ingestion. They will need to see the patients as a single population, but within the context of separate payer contracts. These organizations are beginning to invest in the technology that payers have used for years to successfully acquire and integrate claims data with their population health registries.

If providers are to succeed assuming risk, it will be by employing a highly-focused health management approach that addresses the specific risks associated with specific populations of patients. Population and risk analytics infrastructure requires capital investment beyond the reach of many small and mid-size provider organizations. To encourage providers to assume greater risk for performance, payers will offer shared information exchange platforms that augment provider capabilities with analytic services.

Accountable care continues to evolve

Healthcare market transformation will gain momentum in 2016 and provider organizations should also consider the following:

  • Most first-generation ACOs will fail because they don’t know what it means to truly manage risk. They do not have the ability or will to modify how they treat patients. CMS, commercial payers, and the provider community have to figure out how to hold providers harmless on what they can’t control while also rewarding them for doing the things they can do well, then help them bet on their ability to delivery consistently on their promises.
  • 2016 will see an assault on post-acute care providers, who until this point have long been profitable even as many provide little relative value. This will affect nursing homes, outpatient rehabs, and even vendors who sell to post-acute care providers. The release of Medicare data for public research, particularly in the area of Medicare fraud, combined with the high-profile budget line for post-acute care will accelerate the move to overhaul the post-acute care industry.
  • Finally, don’t expect a change in administration to affect CMS innovation. Regardless of the 2016 Presidential election outcome, payment reform will continue, primarily both macro-economic reasons, but importantly as well, the political reality that both parties favor fundamental reform.

John Kelly is principal business advisor at Edifecs of Bellevue, WA.

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Readers Write: The Many Flavors of Interoperability

March 7, 2016 Readers Write 9 Comments

The Many Flavors of Interoperability
By Niko Skievaski

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As the shift towards value-based care persists, the demand for data is as hot as ever. That means the term “interoperability” will be thrown around a lot this year. Let’s describe the various flavors in which it will inevitably be discussed. I’ve seen many conversations become confused as the context for the buzzword is mixed. Here’s an attempt at outlining the various i14y use cases. (Can we start abbreviating it like we do i18n?)

Interoperability for Care Continuity

This is the iconic use case that first comes to mind. Chronically ill patients with binders full of paper records and Ziplocs bulging with pill bottles. As patients bounce around town seeing specialists, they often need to repeat demographic data, med lists, allergies, problems, diagnoses, prior treatment, etc. The solution to this use case calls for ad hoc access to a patient’s data at the point of care. A provider’s chart doesn’t necessarily need to be synced to all other providers in the disjointed care team. Rather, the data needs to be available upon request from the relevant provider.

New payment models have fueled demand for this solution. In a fee-for-service world, redundant tests actually brought more income to the health system,  whereas in value-based models, excessive costs are eaten by the organization. This aligns the provider and patient by incentivizing only the tests and treatments that have the highest likelihood of impacting the patient’s health. Understanding the value of any given treatment also requires looking across a wide set of patients. This brings us to the second use case.

Interoperability to Measure Value

In order to understand how to pay for healthcare based on value, we must make an attempt to measure the impacts to health: a patient’s health is a function of the healthcare they receive as well as a slew of other variables. Estimating this relationship requires a magnitude more data than we’ve traditionally measured. Beyond knowing the diagnosis and treatment, we’d need to control for behavior, family history, comorbidities, prior treatments, etc. Basically everything we can know about a patient’s health. And that’s for a single patient. To build a model, we’d need this information from a large sample of patients to determine the impact of each of these variables. But as treatments are provided to patients and we receive more results, we’ll need to be updating our models to refine their accuracy over time.

Much of this data is stored in an electronic health record over the time period a patient was cared for by that health system. But it’s likely missing data from care outside of that health system. And beyond that patient, how could we combine this record with a sizable population to make a predictive (or even representative) model? Even at very large health systems, limiting their records down to the few who have a rare diagnosis for a given sex and age, the sample set can become insignificantly small.

This i14y use case requires large sets of longitudinal data, rather than single patient records in an ad hoc query. Current attempts at producing such data sets have been extremely resource intensive and normally centered around research efforts focused on a single diagnosis in a de-identified manner. We’ve also seen rampant consolidation in the industry, partially driven by the notion that taking care of larger and larger populations of patients will enable more accurate estimations of value.

Interoperability to Streamline Workflows

This i14y use case has been around since before the term garnered widespread adoption in healthcare. HL7 was created back in 1987 to develop a standard by which health data could be exchanged between the various systems deployed at a health system: electronic health records, lab information systems, radiology information systems, various devices, and pretty much everything else deployed in data center. These systems are most often tied to a centralized interface engine that acts as a translation and filtering tool bouncing transactional messages between each.

So problem solved, right? Not quite. Over the past few decades, health systems have customized their HL7 deployments just as isolated communities evolve a language into a dialect. This proves problematic as each new software application adopted by the health system requires extensive interface configuration and the precious FTE that entails. Interface teams are increasingly the most backlogged tranche of the IT department. As health systems search for more efficient ways to deliver care, they’re more often turning to cloud-based software applications because of the dramatically reduced infrastructure costs and mobility.

This use case likely requires upgraded infrastructure that allows a health system to efficiently connect with and communicate with cloud applications. The customized HL7 dialects will need to be replaced or translated into something consistent and usable for cloud applications. HL7, the organization, is currently developing FHIR as a much needed facelift to a graying standard. In the coming years we look forward to seeing more FHIR adoption in the industry, and hope to avoid the level of customization we have seen with HL7v2 — although initial feedback and documentation from EHR vendors is not promising.

Interoperability to Engage Patients

This is likely the most interesting need for i14y because of its potential. Patients don’t currently walk into doctor’s office and demand that their health data be electronically sent to applications of their choosing. But then again, where are these applications? The inability for patients to authorize API access to their health data has undoubtedly stifled the development of innovative applications. Instead, new application creation has focused on the B2B space in search of enterprise revenue.

If a patient could download an app on their phone and authorize it to pull their medical history, an army of coders would mobilize in creating apps to engage patients as consumers. Application adoption would be holistically democratized and new apps would get to market instantaneously, as opposed to the usual 18-month B2B sales cycles. Applications would be developed to help patients decipher the complexities of care, track care plans and medication adherence, and benchmark against others with similar comorbidities. They could effortlessly download and store their records and be the source of truth. They could contribute their records to research banks that would be willing to pay for their use. Widespread adoption of patient authorized access to health data would almost make the other i14y use cases moot.

Luckily, we’re getting closer. There’s mention of its mandate in MU3. One of the challenges is solving for the chicken-or-egg problem. We need enough widespread adoption of a single authentication framework and data standard to simultaneously sway the development community and health systems to adopt. MU3 seeks to force the right hand side of that equation, however failing to mandate a prescriptive framework or standard in its current draft while wavering in its timeline. As written, it’s possible that health systems can comply with differing technology making the problem only slightly better.

I’m optimistic as accelerating demand has spurred i14y innovation across the sector. HL7 is rapidly organizing support around FHIR and SMART. Incumbent integration engines are stepping up their game and outside integrators are rapidly moving into healthcare. Startups are sprouting to tackle pieces. Some health systems are proactively standing up their own i14y strategies. EHR vendors are vowing to adopt standards and roll out tools to encourage application development. I don’t doubt that we’re beginning to see the fruits of the solutions that will be adopted in the years to come. But it’s on us — as providers, technologists, developers, and patients — to continue the rally cry by demanding i14y now.

Niko Skievaski is  co-founder of Redox.

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March 7, 2016 Readers Write 9 Comments

Morning Headlines 3/7/16

March 6, 2016 Headlines No Comments

VA may abandon VistA as its long-term electronic health record solution

The VA publically questions its commitment to modernizing Vista, its homegrown EHR platform, after requesting $40 million less for Vista modernization projects in 2017 than last year.

Main Line Health employees snared in security breach

10,000 employees at Main Line Health System have had their personal information compromised after an employee responds to a phishing email. The health system reports that no patient information was compromised.

Madison Memorial to move forward with $16 million purchase of records software

Madison Memorial Hospital (ID) contracts with Cerner to replace its existing Meditech EHR. The initial price of the contract was $6 million, and the ten year total cost of ownership is budgeted to reach $16 million.

2016 Student Technology Prize for Primary Healthcare

Mass General launches its “Ambulatory Practice of the Future” development challenge, calling on college students to design innovative solutions for primary care. The contest will award a $150,000 first place prize.

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March 6, 2016 Headlines No Comments

Monday Morning Update 3/7/16

March 6, 2016 News 10 Comments

Top News

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The VA is reassessing whether VistA has a long-term place as its EHR and has halted some of its VistA modernization steps following a business case analysis ordered by new VA leadership. The VA says it requested $40 million less in 2017 VistA modernization money because it will focus instead on making its existing systems interoperable.

According to Assistant Secretary for Information and Technology LaVerne Council (photo above), “We want to take a step back and look at what we really need an EHR and a healthcare system to do. There are multiple needs that are different than in 2014 around the area of women’s health, the Internet of Things, and how we manage private sector care.”

House Appropriations Chair Hal Rogers (R-KY) wasn’t happy with the VA’s testimony to the committee, saying, “We’ve been at this for 10 years and we’ve given you billions of dollars. I’m hearing muckety-muck here. I don’t know what you’re saying. Apparently, you’ve not made your mind up yet about whether you’re going to replace VistA with something off the shelf. Is that right or wrong? Yes or no?”

Council replied that the VA hasn’t decided yet, blaming her VA predecessors for not developing a sound plan but extolling the virtues of the VA-DoD Joint Legacy Viewer. She joined the VA in July 2015 after retiring as corporate VP/CIO of Johnson & Johnson.

Council also says that a visual overlay to the VA’s 30-year-old patient scheduling system may eliminate the need for its planned $690 million replacement depending on how the VA-wide rollout in April is received.


Reader Comments

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From Vegas Blues: “Re: healthy health conventions. Is it a foregone conclusion that we can’t eat healthy at a Las Vegas conference venue?” Plenty of sugary snacks, fatty sandwiches, and coffee were available, but I didn’t see much fruit or unprocessed food. It’s a fine line between providing what attendees want vs. what’s good for them, however. The H in HIMSS stands for healthcare, not health. It’s like McDonald’s, which offers a lot of healthy food that nobody orders, earning it scorn for the choices its customers make.

From Jardin: “Re: delegating computer tasks to non-physicians. The Senate unanimously passed this because, according to the committee chair, ‘hospitals and providers dread EHRs’ and “MD documentation is burdensome.’ After a year-long review that included HIMSS and physician lobbyists, Congress proposes a solution that adds costs, introduces errors, and eliminates many EHR benefits. After spending billions on health IT, we’re regressing back to the e-secretary model, pushing the burdens of the same EHRs to scribes or RNs. Nurses continue to be invisible in the law. Why isn’t there an industry outcry to actually fix the problem instead of just passing it off?”

From Flaming Introvert: “Re: HIMSS conclusions. As a near-entry level vendor employee, this is my second HIMSS and I’m not sure if I love it or hate it. It’s upbeat and our customers provided positive feedback about our changes and their needs. It’s refreshing to connect with patient advocates, even if most conversations end with the defeatist consensus of, ‘It really sucks, but what can we do about it?” Low point was getting to HIStalkapalooza too late for the shoe judging – I don’t normally parade around in six-inch heels without potential ROI. Maybe that same sentiment applies to HIMSS overall – it continues to yield enough return to induce me to participate, but I’m always glad to get home.”

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From Bonus Room: “Re: iTriage. Just laid off 33 employees and CTO Patrick Leonard is leaving.” Unverified. I haven’t seen any official announcements from the medical question and doctor finding app vendor that’s owned by Aetna. However, the report came from a non-anonymous iTriage employee.

From Love American Style: “Re: Epic’s 2015 release. I’m a project director for an Epic customer. We are still in the testing phases and the severity and number of patches at this point in the release cycle has been unprecedented. Patient safety problems, patches that break workflows, performance problems all abound. Things I would have expected Epic in prior years to have nipped in the bud long before now.” Unverified.

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From Delled: “Re: Michael Dell at HIMSS. He’s my hero, but I was stuck in the overflow room for his keynote. The moderator was so bad that people left in droves like the session was over. At one point Dell had to remind the moderator that he was supposed to ask a specific question. Finally I worked my way to the front against the crowd streaming for the exits, and at the end when he was leaving the stage, I asked to shake his hand (photo attached). He ignored me.” Michael Dell would have been an awful choice to keynote even if he wasn’t trying to sell out Dell’s pitiful healthcare offerings so he can finance his $67 billion passion for computer storage in acquiring EMC. EMC owns VMware, which has watched its shares drop 40 percent and has laid off 800 people since Dell came sniffing. Other than funding Dell Medical School, his healthcare accomplishments are zero or less, hoping desperately to sell Perot Systems for the same price he paid in 2009, backpedaling on the the idea that the future is in services rather than hardware.

Here’s my formula for becoming a highly-paid, well-received HIMSS keynote speaker, not inspired by Michael Dell since I didn’t attend any HIMSS keynotes:

  1. Be famous for any reason. Healthcare relevance is unnecessary and even detrimental – the goal is to raise the spirits of attendees by making them think they are as cool, rich, good-looking, or smart as the celebrity podium-gripper.
  2. Negotiate a speaking fee of several hundred thousand dollars, making sure to insert contractual clauses requiring approval of the introduction and the freedom to sell whatever product or service the speaker offers on the side.
  3. Arrange travel to minimize the time hanging out with the insufferably fawning organization people who hired you and who therefore think they’re entitled to face time or the privilege of escorting you through the exhibit hall that makes you glaze over.
  4. Announce to the worshipful masses how utterly delighted you are to be in their midst, carefully omitting the fact that you could have attended any time you wanted in previous years if your delight didn’t carry a price tag.
  5. Begrudgingly allow a high-ranking executive of the group running the conference to (a) hug you before or after your speech; (b) ask carefully scripted softball questions after the stage is reset into a fireside chat type configuration; and (c) annoy the audience by prattling on instead of letting you talk as you’re being paid to do. At least moderator verbosity prevents audience members from asking their own pointed questions that might result in an unfortunate, life-ruining off-the-cuff answer. After the friendly chat, allow the executive to magnanimously present your foundation with a big check above and beyond your personal speaking fee.
  6. Have your hired copywriter modify the harmless, standard speech you’ve given dozens of times to conventions ranging from car dealers too the Bowling Proprietors’ Association of America, penciling in four seemingly insightful anecdotes as provided by the people writing the check that are sure to make the audience feel that you understand them even though you have no idea what they actually do. You don’t  have to review the scripted comments in advance – they will be right there in front of you on the Teleprompter per your contractual requirement.
  7. Include a handful of humorous, self-deprecating, name-dropping insider anecdotes to allow geeky non-profit IT people to live your celebrity life vicariously and to brag afterward that they briefly shared your aura.
  8. Be vaguely motivating in a boilerplate-type way that won’t require actually thinking up something new, extolling the generic virtues of teamwork, leadership, doing what you love, and being true to oneself.
  9. Close with over-the-top accolades that defer glorification to whatever the audience members do for a living, telling them that they are the real heroes even though (a) they’re paying to see you and not vice versa, and (b) you just made more money in 60 minutes than they make in a year.
  10. Go straight offstage to a limo with the engine running to minimize unpaid downtime before the next cookie-cutter speaking gig.

HIStalk Announcements and Requests

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A little more than half of poll respondents doubt that Athenahealth and eClinicalWorks will become major inpatient systems vendors. Skeptical says that if eCW’s entry into inpatient is like its interoperability solutions, “we should expect major-league hype and minor-league results.” Vote Early and Often says eCW employees stuffed the ballot box and the company can’t service enterprise customers that expect project discipline and management maturity. Frank Poggio says it’s too late – the market has been sewn up by Cerner and Epic with Meditech, the only small-hospital vendor, losing ground. It’s All Good says there’s a long history of companies aspiring to be what they aren’t (Allscripts) and that eCW should stick to ambulatory.

New poll to your right or here: HIMSS attendees, will the hard-dollar benefit of your attendance cover your employer’s cost to send you within one year? Click the Comments link after voting to explain.

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Here’s an extra, reader-requested poll for HIMSS15 exhibitors: in the year that has elapsed since, did you make a sale that you wouldn’t have made had you not exhibited?

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Ms. Livingston says her New Mexico elementary school students “have the idea that they don’t deserve what the schools that have more money enjoy having” and therefore are having great fun with math story books we provided in funding her DonorsChoose grant request.

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Also checking in was Mrs. Jochum from Nebraska, who sent photos of her students using the Osmo learning systems we provided.


Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.


Sales

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Sixty-nine bed Madison Memorial Hospital (ID) will implement Cerner at a cost of $6 million upfront and $86,000 per month in maintenance fees. They chose Cerner over Epic and their incumbent vendor Meditech.

Virtua Health System (NJ) chooses Epic, which apparently beat Cerner in offering a replacement for Siemens Soarian.

Steward Health System chooses Imprivata Cortext for provider communication across its nine hospitals.

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Aurora Health Care (WI) chooses Strata’s StrataJazz as its full financial analytics and performance platform.


People

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Healthgrades hires C.J. Singh (Backcountry.com) as CIO.

Ross Martin, MD assembled video good wishes for Deloitte’s Chris Brancato, who is recovering from unfortunately eventful spine surgery that has left him hospitalized and therefore unable to attend the HIMSS conference. Some of the greetings were recorded at HIStalkapalooza.


Announcements and Implementations

CPSI announces a program by which its revenue cycle customers can apply their additional revenue toward buying its Evident Thrive EHR with no upfront costs. CPSI shares have rallied a bit in the last few months, beating the Nasdaq slightly by increasing 3 percent in the past year.

Health Catalyst arranges its product roadmap around nine subject areas.

Intelligent Medical Objects will work with Northwestern University’s medical school to support pharmacogenomics clinical decision support through creation of terminology to support concepts such as “ultra-rapid metabolizer of clopidogrel.” IMO will make the results available to members of the federally funded eMERGE consortium at no cost.

Vital Images launches an ACO imaging analytics solution and announces a personalized HIE/EMR viewing platform.


Privacy and Security

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The personal information of all employees of Main Line Health System (PA) is exposed when one of them replies to a spear phishing email.


Innovation and Research

Mass General’s “Ambulatory Practice of the Future” calls for undergraduate and graduate engineering students to compete for $400,000 in prizes for creating innovations in primary care (technology, instrumentation devices, etc.) Pre-proposals are due April 18, 2016. Ten finalist teams will be awarded $10,000 and the top three winners will receive $150,000, $100,000, and $50,000. Last year’s winner was Hemechip, a point-of-care diagnosis device for sickle cell disease.


Other

The HIMSS16 final attendance count was 41,885, down 3 percent from last year’s 43,129. This is the first time I can recall attendance going down year over year unless maybe it was in 2000 due to the Y2K scare. Possible reasons I came up with:

  • Industry hangover from MU and ICD-10.
  • Fatigue with the novelty of having the federal government drive so much of the conference agenda.
  • Lame keynote choices.
  • Election year uncertainty.
  • A move to immediately valuable vendor user group meetings instead of a massively broad conference that is more useful to providers who are shopping products.
  • A cutback in travel funds from vendors anticipating a market slowdown.
  • Questionable return on investment for both providers and vendors.
  • An increasingly less-useful education track that favors just pushing attendees into the exhibit hall nonstop.

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A reader sent a link to the Sands Expo’s brochure describing its “green “ practices conference planning tool that should relieve HIMSS attendees worried about the lack of obvious recycling efforts. Interesting facts from it:

  • The Sands Expo facility earned LEED Gold certification for existing buildings.
  • Meeting rooms are equipped with sensors that control energy-efficient lighting.
  • Onsite solar panels address some of the energy requirements.
  • The convention center recycling rate is 80 percent, with waste sorted at both on-site and off-site recycling stations.
  • Leftover food is made available in the employee dining room with the unused amount composted and sent to a local pig farm.
  • Carry-out and concession serviceware is compostable.
  • The entire property is smoke free except for the casino and 6 percent of guest rooms.
  • The facility offers volunteer opportunities to conferences exhibiting that include helping with soap and shampoo recycling, creating Clean the World hygiene kits from recycled materials for locals in need, helping sort donated products for the local food bank, packaging nutrition bags for senior citizens in poverty, packing food in backpacks for local children, boxing meals for after-school programs, and volunteering with Opportunity Village to support those with severe intellectual disabilities.

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HIMSS barely missed what would have been a huge PR scoop as the Denver Broncos announce that Peyton Manning will retire, just two days after his HIMSS conference keynote.

An 86-year-old woman accidentally strangles herself to death when her medical alert bracelet, which did not have a breakaway clasp, gets tangled in her walker.

Weird News Andy advises people to “Don’t Worry, Don’t Be Happy.” A study finds that joy – along with anger, grief, and fear – can cause emotional stress that contributes to takotsubo (aka broken heart) syndrome. 


Sponsor Updates

  • Huron Consulting Group and Strata Decision Technology announce a partnership to create a value-based care transition solution.
  • NextGen Healthcare integrates CareSync CCM into NextGen Ambulatory EHR and will offer the product to its customers who want to perform and bill chronic care management services.
  • Aventura chooses HealthCast as its single sign-on partner.
  • Catalyze will add support for Microsoft Azure to its HIPAA compliance platform as a service.
  • The Advisory Board Company offers case studies from four health systems that saved $4 million using its Crimson performance analytics program.
  • Nordic will offer its customers visual analytics from Qlik Sense.
  • NextGen Health integrates inMediata’s inBanking payment reconciliation solution with its practice management system, allowing payments to be electronically reconciled against banking deposits.
  • VMware integrates Imprivata’s user credentialing and messaging products into its Workspace One provider digital workspace.

Blog Posts


Contacts

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

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March 6, 2016 News 10 Comments

Dr. Jayne’s HIMSS16–Thursday

March 4, 2016 News 1 Comment

I was able to sleep a bit later this morning – no breakfast meetings or client calls. Trying to determine which sessions I want to catch has been an exercise in frustration. It feels like most of the ones I’m interested in all occur at the same time.

While I was looking at the short list of possibilities for today and eyeballing what I missed, it struck me that some submitters were much better at creating eye-catching titles than others. Some of my favorites:

  • Patient Engagement: No Diamond Ring Required
  • Five States, 700 Physicians, and Four Best Practices for HIEs
  • Just Press Print: Challenges in Producing EHRs in Litigation
  • Patient Identification: Biometric or Botched
  • How to Avoid Getting Sued by Your Cyber Risk Insurer
  • Rise of the Medical Scribe Industry – Risk to EHR Advancement
  • Hard Truth about a Soft Go Live

A couple of the sessions I was particularly interested in happen to occur on Friday, so I’m looking forward to finding them online. I’m also looking forward to reviewing “What Do You Do When Your Improvement Project Fails” because it’s near and dear to my heart. When I went for my Lean Six Sigma certification, my first project was a complete and total bust. It ended up being a good thing, however, since it led to the creation of an upgrade methodology that I still use today, but it was definitely painful at the time, not to mention embarrassing.

I had mentioned yesterday about the lack of recycling (or discussion of single stream management) and a reader commented that there were signs near the waste receptacles. I made a more concerted effort to notice today and still didn’t find any more than I had already seen. The conference center did have divided bins (waste vs. cans/bottles) that I saw previously and failed to acknowledge, but most of the bins I saw in the exhibit area were unmarked.

My hotel had no mention of recycling whatsoever. They did mention on the express check-out card that they don’t issue paper bills for environmental reasons. Still, I needed a paper copy for reasons of my own and the desk clerk actually scolded me, saying I’d receive it via email by the end of day. It’s midnight in my world and I still haven’t seen it, but I guess in Vegas time they have a couple more hours.

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I noticed some bachelorette-appearing ladies coming out of Treasure Island in what appeared to be last night’s clothes. They were sporting some adult-themed balloon hats and I’m just sorry I wasn’t fast enough to get a picture. It’s a good thing that what happens in Vegas stays in Vegas because they were looking pretty rough. Perhaps they were headed up the street to White Castle for some hangover therapy. I didn’t remember seeing it on the strip last time I was here, but the strip can be overwhelming and things are easily missed.

I did a last-minute swing through the exhibit hall and heard quite a few comments about people getting ready to head out. I do wish I had more time to see more products and attend more sessions, but staying through Friday wasn’t an option. I’m not thrilled about the schedule shift that occurs when HIMSS is in Las Vegas and it seems like others aren’t so thrilled either. Next year we’re back in Orlando, which is challenging for its own reasons. I wish HIMSS would reconsider other options for the meeting.

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The show floor was still fairly busy although nothing like opening day. I had equal numbers of reps who were smiling and trying to engage people walking by as compared to those who were looking pretty bored. I popped down to Hall G to see a couple of specific vendors and ended up running into someone I hadn’t seen in ages and chatting took up most of my remaining time.

It takes a lot of discipline to try to see everything and do everything at HIMSS. I’d like to blame my broken toe for slowing me down, but I think the whole event is almost too much. Thanks again to Edifecs and their #WhatIrun for literally making it possible for me to limp my way through the week in comfort.

I was fortunate again this year to have a vendor executive offer to share his car to the airport, allowing me to bypass the taxi queue craziness and providing a nice chat on the way. I enjoyed getting his thoughts on the industry and the move to value-based care. The airport was surprisingly low key and I made it through security in record time, for which I was grateful.

During my flight, I was able to catch up on the unbelievable amount of email that had come in during the week. One was from a PR firm correcting me for not using their client’s full name in my mention. Although I appreciate their position and their diligence to the brand, I hope they understand that (a) HIStalk is not my full-time job; (b) sometimes we write quickly and on the fly; and (c) during HIMSS, I usually end up writing at 1-2 a.m. after hitting the show all day and at least three or four vendor events each night. An email from a different vendor used the analogy of “a tree falling in a vast, cold, poison-ivy infested forest” gets my compliments for best prose of the day.

Weird News Andy wins the award for best fashion advice in the “What Not to Wear” category, sharing a piece explaining the perils of wearing shoes with gun-shaped heels and bullet-shaped accents.

I also received a note from a vendor exec apologizing for missing HIStalkapalooza. Apparently there was an EHRA dinner and awards ceremony that overlapped and they couldn’t make it to Mandalay Bay before the doors were closed. Another physician reader who did attend asked if I had any photos of her team and John Halamka doing the limbo at HIStalkapalooza. I am very sad to say that I do not, but if anyone does, please share.

What has been the best part of HIMSS? Email me.

Email Dr. Jayne.

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March 4, 2016 News 1 Comment

Jenn’s HIMSS 3/3/16

March 4, 2016 News 3 Comments

My last day at HIMSS … how I already miss seeing friendly faces around every corner, the fantastic free food in the press room, readers stopping by the HIStalk booth to tell me why they love (or hate) some of the things we do. I’m already looking forward to Orlando, and can’t say goodbye quickly enough to Pacific Time. But I’m getting ahead of myself.

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My last morning got off to a nice start. I found that chivalry is indeed not dead, as several gentleman helped me cart my luggage between the HIMSS shuttle and conference entrance. I wasted no time in grabbing coffee from the press room before meeting with Lauren Douglass, brand manager for Medhost’s YouCareUniverse. She brought me up to speed on several nuggets of news, including the fact that the company’s YourCareEverywhere mobile app has recently been certified for Meaningful Use – the first of its kind to attain certification, to the best of her knowledge. The company, like many others at the conference, is joining the interoperability conversation in a big way via a project with an unnamed EHR vendor.

Encore Health CEO Dana Sellers joined me afterwards to chat about the show. (I love talking with smart folks that have been in the industry as long as she has; it’s a great way to absorb just a tiny bit of their wisdom.) We talked about everything from The 5 Love Languages to value-based care. She pointed out that, while a theme usually emerges by this point in the conference, she just couldn’t put her finger on one this time around. She equated it to post-Y2K, when the industry settled into a six month lull to catch its breath. “We’re in that same lull,” she explained, adding that her customers are taking a step back to recover from Meaningful Use and ICD-10. Sellers predicts that once they’ve taken a breather, providers will move full speed ahead with figuring out how to derive value from their healthcare IT.

Her comments regarding lack of a theme hit a nerve. HIMSS conference news cycles in years past have been driven by industry-wide EHR adoption, then ACOs, then Big Data (as its history of HISsies attests), and I was fully prepared for yet another buzzword to rear its ugly head. While population health management, analytics, cybersecurity, and value-based care have been tossed around, I haven’t gotten a sense that one is more important than the rest to providers walking the exhibit halls. Yes, everyone is talking about interoperability, but as BIDMC CIO John Halamka smartly said in his session with Jonathan Bush, “Interoperability is a bit like porn. I can’t define it, but I know it when I see it.” I haven’t even heard much mention made of precision medicine, aside from HHS reps talking it up in various sessions. Perhaps readers will offer a different perspective.

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After coffee talk, I walked just a few yards to the HX360 Pavilion, which turned out to be a really nice, open space for its exhibitors, including Matter and Startup Health. I’m not sure how it compared to pavilions past, but it was nice to enter into an exhibit space not filled to the gills with humanity.

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I caught the #HITsm panel featuring illustrious thought leaders like Drex DeFord, a longtime friend of HIStalk and participant in our HIMSS16 CIO luncheon. Host @HealthStandards kept the live and virtual discussion high level by focusing on innovation in HIT. A number of themes emerged, including the consumerization of healthcare and technologies poised to have the biggest impact. My vote goes to any type of tech – high or low – that can alleviate the costs associated with aging in place, long-term care, and palliative care. A big chunk of healthcare dollars goes towards caring for the elderly in these categories, and so it stands to reason that technology that addresses these areas might make some waves (if it’s not already doing so) in terms of cost and outcomes.

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Standards were also mentioned, at which point everybody groaned.

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I spent the rest of my time walking through the exhibit hall one last time. Traffic was light in some areas and heavy in others, as this picture of HL7 International’s booth can attest. Folks were lined up two to three deep to hear Massachusetts EHealth Collaborative President and CEO Micky Tripathi talk about the Argonaut project.

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The #FHIRSelfie photo op just around the corner from where he spoke looked like a lot of fun.

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Healthfinch co-founder and CEO Lyle Berkowitz, MD (and associate CMO of Innovation at Northwestern Memorial HealthCare (IL)) was gracious enough to stop and snap a selfie with me, even though I initially mistook him for Cedars-Sinai CIO Darren Dworkin.

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My last official “drive by” of the day was to say one final thank you to the Xerox team for the lovely dinner the night before. Chief Innovation Officer of Commercial Healthcare Tamara StClaire and I chatted about the fabulous food and conversation (creamed corn = amazing / value-based care = struggle), and Xerox’s new population health management solution, which I’ll cover in HIStalk Practice’s Population Health Management Weekly Wrap Up on Sunday. I threw her a curveball in asking for her thoughts on HealthSpot’s stealthy departure/implosion. She equated Xerox’s partnership with HealthSpot as a learning lesson – one that has left the company now fully committed to remaining in the telemedicine space with an eye towards offering virtual queuing and payment processing. She wouldn’t name names, but did say that the company is in talks with several telemedicine vendors to prop up their IT infrastructure in the coming months.

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I shuffled through tweets as I queued for a taxi to the airport (the line was not that bad), and had to share this one because it is apropos no matter which HIMSS conference.

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As is this chart tweeted by @MandiBPro and @drNic1. The expo’s WiFi actually ended up being pretty reliable, which isn’t always the case at HIMSS.

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My flight home has thus far been fun. The terminal was filled with familiar faces and longtime friends and I’m about to crack open one of the books I splurged on at the airport bookstore. I’m hoping humor – and healthcare IT – will get me through the long flight. Safe travels everyone!


JennHIStalk

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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March 4, 2016 News 3 Comments

Morning Headlines 3/4/16

March 3, 2016 Headlines No Comments

VA leaders cite progress on health record interoperability

David Shulkin, the under secretary for health at the Department of Veterans’ Affairs, testifies before Congress that the VA and DoD are on track to be fully integrated by 2018, though during the same hearing VA CIO LaVerne Council reported that it was time to “take a step back” from planning the modernization of Vista while it considers off-the-shelf alternatives.

Cerner lands another big contract

Dignity Health will implement Cerner across all of its ambulatory clinics. Dignity already runs Cerner in its 39 acute care hospitals

This genetics company claims it just achieved a major milestone in biology — and it could transform personalized medicine

Veritas Genetics breaks the $1,000 genome sequencing threshold, offering full sequencing, interpretation, and genetic counseling for less than $1,000.

Life as a Healthcare CIO: Dispatch from HIMSS

John Halamka, MD recaps his impression of HIMSS16, expressing excitement over Surescripts National Record Locator Service, CommonWell, FHIR, and other initiatives that are gaining momentum.

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March 3, 2016 Headlines No Comments

From HIMSS 3/3/16

March 3, 2016 News 3 Comments

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From Idiosyncratic Reaction: “Re: change. Thought you would like this.” It’s perfect.

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From Civil Discourse: “Re: HIStalkapalooza. I realize that some people like loud music, but I would rather see a provider-only get-together that facilitates making contacts and having more in-depth conversations with peers.” The tug-of-war between “it’s a party” and “it’s a networking event” started in the event’s second year in 2009, but since then, HIStalkapalooza has evolved more into a party and attendees are self-selecting knowing that’s the case. Maybe there should be a two-hour, provider-only networking event before the regular HIStalkapalooza starts, or even a separate event entirely. The downside is that just putting on HIStalkapalooza consumes lots of time for weeks beforehand and I’ve assumed that the conference provides ample networking opportunities already. I’m open to ideas.

From Mutually Assured Destruction: “Re: HIMSS16 observations. See if these resonate.” Here’s what MAD submitted:

  • Best new addition to HIMSS Annual Conference. HIMSS Living Room. We attend the annual conference for the networking and it’s such a pleasure to be able to connect in a comfortable space with food for sale and a nice mix of comfortable seating, mini conference tables, etc. I had more ad hoc face-to-face meetings in two days than in months of scheduled meetings, and the hallways weren’t lined with floor-sitters trying to rest their weary feet.  Well done, HIMSS!
  • Most interesting tone change. I’ve noticed throughout my HIMSS lifetime that each year, a different villain was blamed for problems with health IT. One year it’s physicians who wouldn’t accept change. Next year it was health system administrators who wouldn’t budget more than 3 percent of spending on HIT. Then the government for issuing unworkable mandates. Then health IT vendors whose EHRs weren’t user friendly enough. It was very refreshing to hear Karen DeSalvo say, (paraphrasing) “Let’s stop the blame and shame and look for solutions.”
  • Biggest irony. That a conference focused on developing solutions for improving the nation’s health is hosted in a location where daily exposure to second-hand smoke is unavoidable. Anyone with even the mildest asthma condition spent the week wheezing and coughing. I know there are only so many venues that can handle the HIMSS annual conference, but if we never return to the Vegas Strip it will be soon enough for me.
  • Biggest stressor/biggest regret. Being a no-show at HIStalkapalooza because of a last-minute work command performance conflict, knowing I’ll be blacklisted next year.

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From High Pitch: “Re: HIMSS session on cognitive computing. It was a pure Watson vendor pitch. Don’t they have a customer who is willing to speak on behalf of the success they’ve had?”


Four hospitals in Israel were infected with ransomware in the past month alone.

Dignity Health will expand its use of Cerner.

Some of the DrFirst roving reporter interview videos from HIMSS16:


Lots of folks were wheeling suitcases through the casino this morning and packing up their exhibits this afternoon, foretelling the usual poor attendance at Friday’s sessions. It will be cold where a lot of people are going, with these highs Friday: New York 39, Boston 36, DC 43, Atlanta 59, and Chicago 38. Las Vegas will be sunny and 80 degrees.

Overheard: “I’m a hospital business analyst. I stopped by the booth of Borda RFID to get product information. The rep didn’t want to let me in the booth. I tried to get some collateral and she told me I couldn’t have anything because it was for CIOs who were coming by later. She made me put it down. I pointed out my CIO across the aisle and said, ‘Notice that his bag is empty while mine is full. Guess who initiates product investigation at my hospital?”

I spent the morning wandering downstairs Hall G, walking slowly and offering eye contact at each booth to see which vendors were paying attention:

  • I had great coffee and a brownie at BridgeHead.
  • CaptureProof explained their secure patient-provider photo, video, and comments exchange.
  • Doc IT Solutions is a first-time exhibitor. They offer document management and said they’ve done great this week.
  • Oblong Mezzanine is a telepresence-like visual collaboration conference room setup that is realistic and allows impressive image manipulation via a wand, almost like in “Minority Report.” It’s being used by Mercy Virtual. Their full-scale mock conference room was nicely done. They say it’s being used by tumor boards and other groups that need a lifelike virtual meeting setup. This was the coolest thing I saw today.
  • Stibo Systems is a master data management vendor that serves 34 of the top 50 retailers in the world. They said MDM is not yet widely known in healthcare, but interest is growing.
  • IMAT Solutions offers tools to normalize and aggregate data in real time for reporting.
  • DataMotion Health equips providers with the ability to let their patients download their data.

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I ran across this booth in the Hall G maze. Pretty cool.

I checked out FormFast, which had an iPad-powered self demo. They offer electronic forms, barcoding, and data collection, including online consents.

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The folks at Netskope were giving away this book, which is actually very good. Netskope’s tools allow companies to find situations where PHI or other sensitive information is being sent to unauthorized cloud services, which its studies have shown happens in 21 percent of healthcare organizations. The average healthcare organization uses 1,017 cloud apps. The company’s technology allows creating policies for each risky activity. They offer a free cloud risk assessment.

That’s all I have for the moment. I left mid-afternoon today because I’m super tired (probably like everyone else). I’ll wrap up anything I have left to say about HIMSS16 this weekend. Safe travels home, everybody.

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March 3, 2016 News 3 Comments

Dr. Jayne’s HIMSS16–Wednesday

March 3, 2016 Dr. Jayne 1 Comment

If I thought yesterday was an overwhelming 16 hours of HIMSS-related events, today was even more packed. I started the day with a couple of standing client calls. It’s important for those of us that are here to remember that for the rest of the health IT community, time marches on and no one really cares whether we’re at HIMSS or not.

Fortunately, both of my clients are doing well and the calls were brief, allowing me to use the time zone change to my advantage and still make it to the exhibit hall close to opening. Crowds seemed lighter today and I felt much less like I was trapped in a salmon run.

I had the opportunity to check out Aprima’s new patient portal, which was aesthetically pleasing with very little clutter. They have solid features and are planning to add more during upcoming releases. We had a good discussion about the difficulties of developing a patient portal, including the requirements for proxy users and the difficulty of handling data for pediatric patients. They definitely understand the challenges and I’m looking forward to seeing how their product evolves over the next year.

One of the other areas I focused on today was Chronic Care Management documentation for ambulatory EHRs. For those of you not in that space, Medicare came out with a new billing code last year that allows providers to bill an additional $42 per month for care management services for patients meeting certain criteria involving chronic diseases. Each vendor seems to have its own spin on how to handle the documentation (there are time thresholds that must be met) as well as how to identify patients for the service in the first place.

I didn’t see any vendor with as robust documentation as I would have liked to, but that reflects the slow uptake in the market for the new code. Patients have to consent to enrollment and usually end up paying around $8/month in coinsurance, so adoption has been slow in some markets.

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I met up for lunch with a handful of my favorite women and one of them was packing these fetching flats for later in the day. Due to my broken toe from earlier in the week, I’ve had to resort to some less-fashionable shoe choices, but it was nice to live vicariously through her.

I was also busy today attending sessions. Most of them were sparsely attended and it didn’t seem like the rooms were particularly well matched to the number of attendees. I’ve been to several other conferences where attendees are asked to register their session preferences in advance to the planners can right-size the rooms for the expected audience. One presenter commented that this was the largest room he’s ever spoken in especially given the number of people present. I think there were about 20 people in a ballroom that would seat several hundred. He did a great job with his material, but included a couple of off-color jokes, which would have been better left unsaid.

I haven’t been able to hit nearly the number of sessions I had planned. Rumor has it that HIMSS will be posting the sessions to their website so we can complete the continuing education requirements after the fact. Hopefully they’ll be posted soon because I’d like to cross Maintenance of Certification off my list for the rest of the year. I had the chance to connect with a couple of fellow clinical informaticists and swap war stories, which is one of the main reasons I like to come to meetings like this.

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I always love Epic’s artwork, including this bottle-cap wearing unicorn and a musical cow. I overheard a couple of attendees commenting about the adult coloring books at Aventura. Kudos to them for tapping into a current trend and having a give-away that was definitely out of the box.

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I’ve been plagued by dry skin on this trip, requiring a trip to the store for better moisturizer. I forgot my lip balm at the hotel so spent a bit of the afternoon scouring the hall for another tube. NextGen didn’t disappoint with their high-end giveaway and the mesh bag will be perfect for corralling cords in my bag. I know Mr. H mentioned the apparent lack of recycling and I’m always happy to see something I can reuse. I know some hotels do recycle and do the sorting for you, but I haven’t seen anything about that practice on the signage at the expo center or at my hotel.

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IMO had some technical tee shirts at their booth. I’ll be enjoying mine as I continue to hit the treadmill during the rest of the winter. They also hosted a reception tonight at Hyde, located right on Lake Bellagio. The views of the fountains were stunning and I was impressed by the understated elegance of the event.

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Tonight seemed like the busiest night for vendor events, with offerings from Nordic, Athena, NextGen, Greenway, and a host of others. It seemed like the events were shorter this year than in the past, with many of them only scheduled for two hours. The tight timeline and spread-out nature of the venues made it difficult to get to all of them although I did give it a fighting try.

I’ve never been able to make it to a Greenway event because it usually conflicts with HIStalkapalooza, but due to the date shift this year I finally made it happen. I’m glad I did because it was the best party of the night. Held at the OMNIA nightclub at Caesar’s, it featured a good selection of food and some sassy bling-handled cake pops. The DJ had the party hopping and it continued well past the published end time, with wait staff continuing to circulate for drink orders and offering water to those of us that were starting to wind down. Their photo booth was busy all night, and since it was open and in the middle of the action, we got quite a few laughs.

I met up with a good friend for a nightcap, although I didn’t get to stay as long as I wanted. Luckily he understood my need to go back and finish writing as well as to try to catch up on the hundreds of emails I haven’t been fielding for the last few days. Jet lag has definitely set in but I hope to sleep in a little tomorrow.

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March 3, 2016 Dr. Jayne 1 Comment

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