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News 6/1/16

May 31, 2016 News 7 Comments

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An ONC survey finds that 84 percent of US hospitals were using at least a Basic EHR at the end of 2015, a nine-fold increase since HITECH was adopted in 2009, although adoption by psychiatric and children’s hospitals lags. A Basic EHR must have the capability (even if the physician doesn’t actually use it) of accepting physician orders, recording meds and allergies, documenting encounters, recording problem lists, and viewing lab and imaging results.

Someone tweeted out what an inarguably great thing this is, but for the $31 billion in taxpayer bribes that were required to make providers use the same EHRs they were otherwise avoiding like the plague, maybe we should expect a bit more than just market penetration and instead look at outcomes, access, and data portability. I’m not so sure that I as a patient feel any safer, better cared for, or more appreciated as a customer just because I’ve seen some spotty,  half-hearted technology use amidst the still-mountainous piles of provider paper.


Reader Comments

From Burnt Steak: “Re: Epic’s mandatory employee arbitration clause. Whose side would you take?” I really dislike the idea of mandatory arbitration, especially when it’s buried (as it is with most retail contracts, like for credit cards and cell phone service) in small print. However, a lack of willingness to walk away means those employees or customers accept the terms offered. I have limited respect for employees who complain about their jobs, go on strike, or file employer lawsuits – they should prove their point by finding a better job elsewhere. The market will quickly tell them if they are underappreciated, and if it turns out nobody else is willing to give them more money or benefits, that should be a clue that they are sitting precisely at the intersection of supply and demand for their services and shouldn’t embarrass themselves further by complaining. You’re not going to make yourself look better by griping about the employer (or your spouse or the city that you live in, for that matter) that you freely chose.


HIStalk Announcements and Requests

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Mrs. McCullough says her Georgia kindergartners are using the six Kindle Fires we provided in funding her DonorsChoose grant request to engage with reading and math apps and to participate in a weekly learning center, where they listen to stories and play phonics games.

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It’s hard to accept rampant healthcare inefficiencies and indifference when people in many US cities can place an Amazon order by noon and receive it by bedtime that same day. Although maybe there’s hope from companies like Capsule, a just-launched New York startup that delivers prescriptions by bicycle at no extra charge and that uses technology for refill requests, medication instructions, and patient communication, although the founders wisely decline to label the company as the inevitable “Uber for drugs.”

I finally had my appointment with a new doctor (actually, her PA) last week for my annual physical, following the miscue from a few weeks back where I showed up for my appointment, filled out a mountain of paperwork, and waited for some time before being told that the doctor was out of the office for previously scheduled surgery (they said they tried to call me earlier, but had incorrectly entered my phone number). This time wasn’t perfect, either – all of the paperwork I had completed previously (medical history, insurance information, NPP, etc.) had been mysteriously lost, meaning I had to fill out the clipboard full of forms all over again. To add insult to injury, the PA either didn’t see or didn’t use the information, repeating questions about allergies, meds, smoking status, and other topics that I had already documented minutes before but that hadn’t yet been entered into their Practice Fusion free EHR. At least the EHR wasn’t intrusive during the visit (since she mostly documented on paper) and the e-prescribing worked OK.

My latest linguistic peeve: the use of “unpack” as a synonym for “explain,” which doesn’t save syllables or add nuance and is therefore pointless other than to make self-aware authors feel smugly clever.

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

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Webinars

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

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


Acquisitions, Funding, Business, and Stock

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DrFirst acquires Meditech consulting firm The IN Group, saying the acquisition will allow DrFirst to help its customers make the most of their healthcare IT investments. 


Sales

MD Anderson selects Nuance’s Dragon Medical and PowerScribe 360 for physician documentation as part of its Epic rollout. MDA will also use services from Epic consulting firm Physician Technology Partners, which the announcement says is now owned by Nuance.

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Pontiac General Hospital (MI) chooses Medsphere’s OpenVistA EHR. The financial turnaround of the hospital, which has filed bankruptcy twice as Doctors Hospital of Michigan, is being led by 25-year-old Sanyam Sharma, whose computer scientist parents started eligibility software vendor Infrahealth and put him on the payroll when he was 14. He’s now EVP of the company and heads up Sant Partners, a company his parents created to buy Pontiac  following his father’s discovery as a consultant that the hospital had extensive revenue cycle problems. 

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Ohio State University Wexner Medical Center chooses Strata Decision’s StrataJazz for decision support, cost accounting, and contract analytics.


People

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Home monitoring technology vendor Sentrian hires Bryan Ness (Wellcentive) as chief revenue officer and Molly Cogan (Wireless Life Sciences Alliance) as VP of marketing and communications.


Announcements and Implementations

Liaison Technologies will launch its Alloy Health cloud-based integration service in Europe.

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Peer60 publishes “Hottest Trends in Medical Imaging IT (UK).”

UPMC (PA) signs its third agreement with organizations in China, collaborating with for-profit First Chengmei Medical Industry Group to offer clinician training and to advise the hospitals on hospital operations, including IT.

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Cincinnati Children’s Hospital Medical Center (OH) will use the Curelator Headache app to study the factors that precede migraine headaches in children and adolescents. The study’s 60 participants will use visual data entry tools to document emotional, dietary, physical, and environmental factors in 2-3minutes per day to show them their associated migraine triggers so they can make lifestyle changes. The app is commercially available in a limited-functionality free version and as a $50, six-month subscription that includes trigger tracking.


Government and Politics

A Congressional stalemate forces the CDC to cut emergency public health funding in many cities—including lab services, mosquito control, and disease surveillance — to free up money to address the Zika virus. It’s amazing given the amount of federal money that is wasted on low-quality, unneeded, and sometimes questionably billed hospital care that CDC has to choose which outbreak to fund with a fixed few million dollars.

China’s FDA reverses its push toward making non-prescription drugs available online, ordering e-commerce provider Alibaba to tell its vendors – include drug store chains — to immediately stop selling OTC drugs on its online marketplace.

In other Alibaba news, Hong Kong regulators say the company violated takeover rules in its 2014 investment in pharma data and barcode tracking company CITIC 21CN (now known as Alibaba Health Information Technology) because the deal included buying a medical technology company from a shareholder who was also the brother of the company’s vice chairman, giving the company an unfair advantage. The acquisition raised some eyebrows at the time because Citic 21CN’s small amount of revenue came from sales to the Chinese government and both companies have Communist Party and military leaders as investors. The acquisition and subsequent rise in Alibaba’s share price made Chen Xiaoying, wife of a former general, a billionaire. She bought a $68 million home two days before the deal was announced. 


Privacy and Security

The ED physician staffing service used by two Carondelet hospitals in Arizona notifies 1,000 patients that their information was disclosed when an ED logbook was stolen from the car of one of its doctors.


Technology

USA Today summarizes a report indicating that telehealth usage would increase if it was more affordable to hospitals and if medical studies prove that it works. I think it’s time to separate vendor-provided telehealth (online services that connect cash-paying patients with whatever doctor the vendor has available in the belief that patients think all doctors are equal) versus using the technology to interact with the patient’s trusted ongoing provider in a more convenient way. Some patients and conditions can be treated by a doctor in a speed-dating type of consultation where they don’t know anything about the patient except what they can learn by asking a few quick questions, but few would argue that an encounter of that type will be as successful as having a virtual visit with their regular provider who is armed with their medical records (although “successful” to most patients means, “I got the prescription I wanted.”)


Other

A man presenting to the ED with atrial fibrillation is successfully treated after the team notices his heart rate-recording Fitbit and determines that his AF was triggered by a seizure, therefore making him a candidate for electrical cardioversion. The case was described in a journal article that is mildly entertaining while not being all that medically useful since AF is treated all the time without consulting the patient’s wearable and instead asking them their history.

A London newspaper profiles a hepatitis C patient whose only hope for survival is the new drug Harvoni, which has a 95 percent cure rate at an astonishingly high price. The man finds a doctor in Australia who imports a cheaper version of the drug from India and China, where drug company Gilead Sciences was forced to license the manufacture of local versions since those governments say Harvoni is almost identical to older, cheaper drugs and therefore won’t pay for it. The doctor tests the imported drug’s purity and mails it to patients who pay his consultation fee. Some NHS doctors will work with such “buyer’s club” patients since NHS can’t afford to provide the drug to everyone who needs it and buying prescription drugs from other countries isn’t illegal in England. However, the British pharma trade group says patients who buy drugs offshore are stifling innovation and taking away treatments intended for poor countries. US insurers and governments are struggling to pay for Harvoni, which costs $1,125 per pill and $95,000 per treatment. The same pill in India costs $10.

Here’s a pretty funny “EHR in the exam room” video from Athenahealth that I ran across while looking for something else. 

The Wall Street Journal profiles the use by Northwell Health (NY) of an evidence-based calculator that assesses the likelihood of strep throat, respiratory infection, and deep-vein thrombosis based on physician answers to questions popped up in the EHR and then guides appropriate ordering of medications and tests. A medical school professor overseeing testing of the software in Wisconsin primary care clinics says physician participation in the optional program  is low, however, because “there is a big backlash against clinical decision support.” 

The speaker at a Memorial Day ceremony in Anthem, AZ is Bill Krissoff, MD, a since-retired orthopedic surgeon who shuttered his practice following the 2006 death of his Marine son in Iraq. He joined a Marine Corps medical battalion at age 60, deploying to Iraq and Afghanistan “to finish Nathan’s unfinished tasks” in serving on the resuscitative surgical team as primary or assisting surgeon for 225 serious casualties.

Weird News Andy finds it ironic that “smart” tampons double as a blood collection tool that allows women to track their reproductive health via an iPad (WNA snickers right about there). I can’t decide if this is a great use of technology or the moment where we collectively jumped the quantified-self shark.


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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May 31, 2016 News 7 Comments

Morning Headlines 5/31/16

May 30, 2016 Headlines No Comments

Jawbone has stopped producing its fitness trackers and sold the remaining inventory to a third party

Jawbone stops manufacturing its line of UP fitness trackers but makes no announcement suggesting that it will exit the market entirely.

Doctors Test Tools to Predict Your Odds of a Disease

The Wall Street Journal profiles Norwell Health’s (NY) use of a clinical decision support tool that scrubs EHR data and predicts which condition the patient being treated most likely has before lab or imaging tests are ordered.

A New Way to Report College Sexual Assault

The New York Times profiles Callisto, a startup that hopes to improve sexual assault reporting on college campuses with a website that lets college students file sexual assault reports online.

Intel backs AI-powered analytics startup Lumiata in $10M funding round

AI startup Lumiata raises a $10 million Series B fund from Intel Capital. The company is building algorithms to quantify and manage risk within population health programs.

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May 30, 2016 Headlines No Comments

Morning Headlines 5/30/16

May 29, 2016 Headlines No Comments

US IPO Week Ahead: Billionaire doctor back with another IPO

Patrick Soon-Shiong, MD, will bring NantHealth public this week in a $91 million offering.

Court Rules Companies Cannot Impose Illegal Arbitration Clauses

A federal appeals court ruled against Epic on Thursday, deciding that companies cannot force their employees to sign arbitration agreements that prevent them from filing lawsuits against their employer.

Nanaimo doctors say electronic health record system unsafe, should be shut down

In Canada, providers at Nanaimo Regional General Hospital are unhappy with the recent $174 million Cerner go live, returning to paper charts in both the ICU and ER “out of concern for patient safety.”

Stung by Yelp Reviews, Health Providers Spill Patient Secrets

ProPublica reports that doctors, dentists, and other clinicians are responding to negative Yelp reviews left by unhappy patients inappropriately, sometimes posting confidential patient information within their responses.

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May 29, 2016 Headlines No Comments

Monday Morning Update 5/30/16

May 29, 2016 News 3 Comments

Top News

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NantHealth’s previously postponed IPO will happen this holiday-shortened week, with insiders taking the majority of the $91 million offering. The company’s IPO documents don’t specify how it will spend the money, saying only that it will be used for “general corporate purposes.” NantHealth’s filings indicate that the company lost $72 million on $58 million in revenue in 2015, with $291 million in liabilities.

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Meanwhile, shares of Patrick Soon-Shiong’s cancer therapy company NantKwest have dropped 79 percent since its July 2015 IPO, erasing $3.1 billion of the company’s $3.7 billion first-day valuation and creating a legal boom as law firms line up offering to represent shareholders in class action lawsuits. Above is the share price of NK (blue) vs. the Nasdaq (red).


Reader Comments

From Mutton Dipper: “Re: the ‘Women in Health IT’ section of that industry rag. I don’t think they’re doing women any favors by carving them out as a special interest curiosity.” We’ve talked about this previously, but perhaps it’s time to see the content they think women in health IT need that isn’t available elsewhere. Stories on the site are: (a) the Gates Foundation donates money to study gender inequality, which has zero to do with health IT; (b) HIMSS celebrates nursing informatics, apparently in the gender-biased belief that it’s a female-only profession; and (c) two women took new jobs, something us menfolk apparently wouldn’t care about. Every story was just a padded out rehash of a press release (without crediting the press release).


HIStalk Announcements and Requests

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It is Memorial Day, created not as a nonchalant summer kickoff, but rather to set aside time to remember those who died while serving in the armed forces (unfortunately, people usually forget to observe the latter in celebrating the former). 

In Flanders Fields
By John McCrae

In Flanders Fields the poppies blow
Between the crosses row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

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More than half of poll respondents say exposure of their financial and contact information would be the worst part of a medical records breach, while 22 percent say they would be most upset about having their mental health history made available. The results don’t surprise MobileMan, who says he’s always believed that people worry more about their money than their health. JaneOrJohnDoe just lies when clinicians ask about potentially embarrassing behavior, avowing that he or she never has sex, smokes, drinks, or uses drugs because co-workers and the HR department don’t need to know. Missy C22 takes the opposite approach, saying people can get any information they want, so she doesn’t worry about breaches.

New poll to your right or here: what level of unexpected medical expense would you struggle to pay?

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My insurance company told me my travel-related malaria prevention medication was covered and would cost $80. The Walgreens pharmacist said no, actually it’s not covered, so he offered me the cash price of $268. I looked online while standing at the Walgreens counter and found a coupon on GoodRX that Walmart accepts. I called Walmart from the Walgreens parking lot and asked them to call for a copy of my prescription, which they priced at $140 for cash-paying customers. It was ready when I arrived – I just showed them the coupon on my phone to make my final price $70, saving me nearly $200 for just a couple of minutes of effort since I was going to Walmart anyway. This is a great example of screwy American healthcare for several reasons:

  • The old drug is unreasonably expensive and going up all the time.
  • The insurance company would apparently prefer to treat me for malaria than to pay upfront to prevent it (the same lack of logic that leads them to decline to pay for birth control pills).
  • Prices are all over the place – how can Walmart sell the same drug for half the Walgreens price?
  • A less-persistent customer would have wasted a lot of money by not shopping the drug price and not being aware of GoodRx.
  • Sometimes a discounted cash price is cheaper than using insurance.
  • GoodRx makes money by using an unspecified PBM’s negotiated discounts, passing the savings along to their customers while taking a transaction fee for themselves and giving the PBM big volume. That’s a brilliant business model in which everybody wins.
  • The price varies wildly even when using the GoodRX coupon – Walgreens actually accepts the same coupon but charges $127, while the PillPack online pharmacy tops the price curve at $275 (the first two examples lead me to assume that the PBM’s discount on this drug is 50 percent since it cut the price in half at both Walmart and Walgreens).
  • Maintenance drugs offer even more savings. A month’s supply of generic Lipitor whose cash price ranges from $90 to over $400 depending on the pharmacy is just $19 using a GoodRX coupon.
  • Healthcare is the only example I can think of where paying cash carries a penalty rather than a discount. I remain unconvinced by arguments saying it’s not reasonable to force providers to give cash-paying patients the lowest price they’re willing to accept from any other payer.

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We providing kits and equipment for the inaugural robotics team of Ms. Sobosan’s Nevada  high school in funding her DonorsChoose grant request. Team member Bryan concludes, “The robotics resources changed the way I looked at programming. I’m not very good, but it has inspired me to learn even more when I program apps, robots, and games. Although it won’t be easy, I will push myself to keep learning. The robot we are building is taking a while to assemble, but so far it is going very well and I expect to have fun with the projects you have sent.”

I was thinking about CMS Acting Administrator Andy Slavitt’s comment that interoperability isn’t like sending a man to the moon. Actually, it is — if you told the 1960s-era US and Soviet Union that it would be optional but nice if they shared information for the good of their respective space travelers even while they are desperately trying to beat the other in getting there first.


Last Week’s Most Interesting News

  • A federal appeals court finds that Epic’s mandatory employee arbitration clause violates federal labor law.
  • A renowned cognitive science expert says IBM Watson Health should stop “making up nonsense” about analyzing cancer and admit that its technology doesn’t really use cognitive computing.
  • Apple CEO Tim Cook says health use of the Apple Watch is a major company priority.
  • Kansas Heart Hospital pays ransomware demand but declines to make further payments as the hackers demand to release its files.
  • The ACLU sues a genetic testing company to force it to give patients their complete results rather than just a subset.

Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Cerner says in its annual shareholder meeting that:

  • More hospitals run its systems than anyone else’s.
  • The company has 22,000 employees who are paid an average annual salary of $80,000, with an average age in the mid-30s.
  • Cerner will spend $750 million on population health management R&D.

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Last Thursday’s Chicago federal appeals court ruling that Epic violated federal labor laws in requiring its employees to agree to arbitration clauses is reverberating throughout the country. The three-judge panel ruled that the National Labor Relations Act gives employees the right to band together even if they aren’t represented by a union. Conflicting previous rulings in other cases may take the issue back to the US Supreme Court. Studies have found that mandatory arbitration clauses often result in employees simply giving up their complaints, while federal and state officials worry that forced arbitration allows companies to hide employment wrongdoing. Cerner is certainly watching closely since it told employees in December 2015 that they had to choose between signing arbitration clauses or giving up future salary increases.


Announcements and Implementations

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The board of ETMC-Tyler (TX) approves the purchase of MedHost, Athenahealth, and Novarad.


Privacy and Security

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A dozen FBI agents, one of them armed with an assault weapon, raid the home of a Texas software security researcher and take him away in handcuffs after he reports to dental software vendor Eaglesoft that the information of 22,000 patients on their servers is freely visible over the Internet. The company, instead of thanking him, notifies the FBI that he illegally accessed its server and thus violated the Computer Fraud and Abuse Act, leading the FBI to haul him away from his family in his underwear. The same researcher previously alerted the FTC that Henry Schein Dental was misleading customers by claiming it encrypts their data. He had also alerted a Pennsylvania dental practice in December 2013 that their patient information was visible online, only to receive a cease and desist letter from the practice demanding that he never mention their practice or doctors again.

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A ProPublica study finds thousands of examples where doctors, dentists, or their employees responded to negative Yelp patient reviews with information that included PHI. The HIPAA violations ranged from the simple (acknowledging that the Yelper was indeed treated, for example) to posting extensive medical, dental, and family information.


Other

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An 87-year-old senior living resident choking on a hamburger is saved by a fellow resident who springs to her side to perform the Heimlich maneuver. That fellow resident was 96-year-old Henry Heimlich, MD, the surgeon who created the technique in the 1970s, who had never actually performed it on an actual choking victim. On a less-upbeat note, Heimlich’s son has bitterly renounced his father for years as a fraud and claims he stole the idea from peers, adding that he has advocated bizarre therapies for AIDS and cancer. Back on the upbeat side of the story, Heimlich’s nephew is 66-year-old Anson “Potsie” Williams from “Happy Days,” whose affected, white-bread musical warblings on the show also caused Heimlich-like projectile vomiting.

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In Vancouver, ED and ICU doctors at Nanaimo Regional General Hospital refuse to continue using its nine-week-old Cerner EHR and instead go back to paper due to patient safety concerns. The doctors say Cerner calculates drug doses incorrectly and is causing meds and lab tests to be delayed, adding that it takes them twice as long to enter orders and that serious patient errors are happening every day. Island Health will spend $134 million on the project, which will be rolled out to hospitals in Victoria next year.

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In Australia, Cairns Hospital’s budget crisis is so significant that it’s telling doctors to stop using pens and to turn off unused lights. The medical staff says the real problem is its new Cerner EHR, described as slow and impeding accurate documentation for payment.

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Blue Shield of California, pressured to review the salaries of its executives as non-profits always do, issues a report showing that its CEO made $3.5 million in 2015, while SVP/CIO Mike Mathias was paid $1.2 million.

 

Vince and Elise recap the top physician practice systems vendors in their latest installment. Feel free to add comments if you agree or disagree with their conclusions.


Sponsor Updates

  • For the Record magazine features a story about clinical process measurement by LogicStream Health’s Dan Rubin, MD, MHI.

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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May 29, 2016 News 3 Comments

Morning Headlines 5/27/16

May 26, 2016 Headlines No Comments

Epic Systems Takes Out Troll Patent on Abstract Idea

Epic wins a patent infringement lawsuit filed by patent troll Preservation Wellness Technologies. Epic argued, and a judge agreed, that the patent in question vaguely described “unpatentable subject matter” related to managing and sharing medical records.

CMS’s Andrew Slavitt talks with MMS about MACRA

In an interview with Massachusetts Medical Society, CMS Acting Administrator Andrew Slavitt discusses MACRA and interoperability, saying, “If you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice. We’re doing everything we can to make sure that the technology vendors stop focusing on meeting the regulations, so they can start focusing on their customers and their users.”

Upgrading the Certified Health IT Product List: Understanding Corrective Action Information

ONC updates its Certified Health IT Product List to include information on vendors that have at any point fallen out of compliance with certification requirements.

The Fraudulent Claims Made By IBM About Watson and AI

Cognitive science expert Roger Schank, PhD calls out IBM for marketing Watson as a cognitive computer, calling the company and its advertisements fraudulent.

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May 26, 2016 Headlines No Comments

News 5/27/16

May 26, 2016 News 6 Comments

Top News

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A federal judge grants Epic’s request to dismiss a patent infringement lawsuit brought by patent troll (or “non-practicing entity” in legal terms) Preservation Wellness Technologies, which sued Epic, Allscripts, Athenahealth, and NextGen for violating its 2009 patent covering the idea of giving patients and doctors access to electronic medical records with different levels of authorization. Apparently the US Patent and Trademark Office thought this was something new since they granted the patent.

The “inventor” apparently runs Carlo Coiffures, a beauty salon in New York. The lawsuit was brought by a Texas corporation with a Texas mail drop address that filed the suit in the rural Eastern District of Texas, which attracts 25 percent of the patent lawsuits filed in the entire US because that district’s troll-friendly practices make it hard for defendants to get a ridiculous lawsuit dismissed. A fascinating episode of “This American Life” describes a building in Marshall, Texas (population 24,000) whose long corridors contain locked offices representing the only physical presence of companies whose entire business is filing frivolous patent infringement lawsuits. Kudos to Epic for not just paying off the troll, although you have to wonder how much it had to spend to prove that it did nothing wrong.

Meanwhile, Epic didn’t fare as well in a federal appeals court where it had asked to have an unpaid overtime lawsuit brought by its technical writers dismissed. Epic argued that the arbitration terms that it forced all of its employees to accept to keep their jobs precludes employee class action lawsuits like the overtime one. The judge sides with the employees, ruling that  Epic’s mandatory arbitration clause violates the National Labor Relations Act because it prevents employees from acting together on employment issues, which they are allowed to do even if they aren’t union members.


Reader Comments

From Pumice Stone: “Re: vendor agnostic. Pet peeve time! Agnostic means someone who claims neither faith nor disbelief in God.” I agree. “Vendor-neutral” is a better way to convey a lack of bias, although the grammatical horse has left the barn and dictionaries that strive to reflect rather than define usage will no doubt be adding “vendor-agnostic” along with other recently added non-words like “WTF,” “beer o’clock,” and “awesomesauce” as lexicographers use the “everybody gets a trophy” model in rewarding those who create cutesy new words despite their obvious lack of mastery of the perfectly fine choices already available.

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From Maple: “Re: Evariant. They just took Series C money this month but apparently laid off 30+ folks. No jobs are listed on their jobs board. A new CFO was announced this week, too.” Evariant, which has received $69 million in funding, sells a patient marketing system. I checked their executive page from a year ago and seven of the 10 people listed then aren’t on the current version of the page. 


HIStalk Announcements and Requests

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Mrs. Steele says her Tennessee kindergarten class is using the headphones and wireless mice we provided in funding her DonorsChoose grant request to listen to level-tailored stories to help them read better.

This week on HIStalk Practice: Compulink debuts an EHR for gastroenterologists. Pavlovian wearable helps curb user behaviors. Direct Urgent Care sends heart and lung sounds to its EHR via connected stethoscope. Duke University physicians share advice for PCPs in need of MACRA help. Connecticut passes telemedicine-friendly Medicaid legislation. Ohio physicians will soon have real-time access to controlled substances prescriptions.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

The software half of HP’s November 2015 split into two publicly traded businesses will spin off its enterprise services business in a tax-free merger with CSC that will create “a pure-play global IT services leader.” CEO Meg Whitman, who predicts industry consolidation, said on the earnings call related to corporate spinoffs, “We have this thing down to a science” in “unlocking the value of these two companies.”

Wellth, which rewards high-risk patients for taking their meds or testing their glucose correctly, raises $2 million in a seed round.

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IMS Health acquires Privacy Analytics, which offers data de-identification tools.

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Zebra Medical Vision, which sells a medical imaging analytics engine that supports diagnosis, raises $12 million in a round led by Intermountain Healthcare, increasing its total to $20 million.


Sales

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Shore Medical Center (NJ) chooses Phynd to manage the information of its 5,000 providers within Cerner and other systems.


People

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WEDI gives interim CEO Charles Stellar (AHIP) the permanent position.

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Paul Tang, MD (Palo Alto Medical Foundation) joins IBM Watson Health as VP/chief health transformation officer.


Government and Politics

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ONC publishes a list of health IT products and vendors that have not complied with its certification program.

The FDA will collaborate with Flatiron Health to explore how the de-identified treatment data of patients who aren’t enrolled in clinical trials could be used to investigate the safety and effectiveness of immunotherapy.

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Health insurers stung by Affordable Care Act losses follow through on warnings of premium increases as a sicker-than-expected insured pool drives up their costs. The highest increase requested so far is in Western Pennsylvania, where Highmark wants to hike premiums by 38 percent. The administration continues to downplay the high premium costs, saying that most people will get federal premium subsidies.

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A House committee wants the Justice Department and the state attorney general to investigate former Oregon Governor John Kitzhaber and CMS for the botched rollout of the Cover Oregon insurance exchange, which spent $305 million in federal money and never enrolled a single person before shutting it down and moving to Healthcare.gov at no cost.

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CMS Acting Administrator Andy Slavitt — about whom I’ll editorialize is the most transparent, visionary, patient-focused executive in federal healthcare (I’m even placing him ahead of Karen DeSalvo because he gave up a huge income to work for CMS and he took a thankless job) — speaks to the Massachusetts Medical Society:

[User-driven policy] is actually not that radical a concept in the real world. In the real world it might be called “talking to your customers about what they want.” Perhaps in Washington, though, it is a bit of a new concept … Interoperability in some respects needs to just be as simple as this: how can we collaborate for the best outcomes when a patient is going to experience different parts of our fragmented healthcare system? What we want out of interoperability is simple: having a patient referred for other care and understanding what happens at that visit; or communicating with the physician when a patient is discharged from the hospital to make sure they are taken care of and are healing at home … We are not talking sending a man to the moon. We are actually expecting technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care. Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of APIs in the next version of EHRs which will spur innovation by allowing for plug and play capability. But the reason that the pledge is important is because the private sector has to essentially change or evolve their business practices so that they don’t subvert this intent.


Privacy and Security

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Apple posts a job opening for a HIPAA-focused privacy lawyer.


Innovation and Research

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Cognitive science expert Roger Schank, PhD, says IBM Watson is “not doing ‘cognitive computing’ no matter how many times they say they are,” adding that “Watson can’t draw real conclusions by counting words in 800 million pages of text.” He concludes, “It would be nice if IBM would tone down the hype and let people know what Watson can actually do and stop making up nonsense about love fading and out thinking cancer. IBM is simply lying now and they need to stop. AI winter is coming soon.”


Technology

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Citrix announces the HDX Ready Pi, a Raspberry Pi-powered thin client that will cost under $90 when it reaches the market in a few weeks. The device configures itself automatically when plugged into an available display; can be simply thrown into the recycle bin if it fails since its cost is negligible and there’s nothing to re-image; and it can be given to remote workers since it doesn’t store data.


Other

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A JAMIA-published study by consultants from Wolters Kluwer Health describes how Huntsville Hospital (AL) reduced sepsis-related deaths by 53 percent following implementation of a program that included change management, electronic surveillance, and sepsis detection algorithms.

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Surveyed single ACOs spend an average of $2 million per year to participate, with $563,000 of that going toward health IT technology, population analytics, and reporting. More than half say they won’t stay in the Medicare Shared Savings Program if they don’t earn the 5 percent MACRA Advanced APM bonus.

A Federal Reserve Board survey finds that nearly half of Americans would struggle to pay an unexpected $400 expense, which might explain why people whose exchange-issued health insurance policies carry a $6,800 annual deductible before insurance starts paying anything aren’t necessarily going to actually seek care (or renew their policies for 2017).

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In China, scalpers are tying up Beijing’s ATMs, which allow scheduling hospital appointments, to book hospital and doctor appointments that they then sell to buyers from $50 to $500.


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May 26, 2016 News 6 Comments

EPtalk by Dr. Jayne 5/26/16

May 26, 2016 Dr. Jayne 2 Comments

My hospital’s “chasing the quality numbers” work is in full swing. This morning I received a five-page packet on how to appropriately document our new tobacco cessation Core Measure.

I’m not sure why it takes that many pages to explain that a) everyone needs to quit using tobacco; and b) we are required to help them do it. What’s worse, the packet didn’t even include instructions on how to do the documentation in the EHR – it was strictly around the philosophy of the core measure.

I pinged the physician who replaced me when I left my leadership position and asked whether they had built the workflow into the EHR. Unfortunately, they haven’t. They didn’t add tobacco cessation medications to the admission orders, nor did they include an easy way to document when you’re not ordering them due to a medical issue. This would seem to be an area that is ripe for order sets and clinical decision support. It wasn’t clear whether timeline or capabilities were the barrier, but either way, it’s a sad commentary on missed opportunities.

Other than that, my visit to the hospital was uneventful. I stopped by the physician lounge to grab a bagel to go. There was some conversation about the pending “star ratings” for hospitals and a recent Washington Post article was being cited. One of the health systems interviewed noted that smaller hospitals that treat less complex patients earned higher ratings than tertiary care centers. According to the article, the preliminary calculations for the stars would result in awarding five stars to only 100 hospitals nationwide. There’s no firm date on when the ratings will be released (it’s been postponed from its July date).

I understand the desire to have some kind of composite rating system for patients to use, but the lack of granularity makes it difficult to truly assess how well a hospital is performing. If I were advising my relatives, I’d recommend they look at specific data for the procedure they were having or the condition for which they were being treated, not an overall “feel good” rating. I’d rather go to a hospital with fewer stars but the top rating for my disease, if I have that choice. When this rating scheme is rolled out at the provider level, as is planned, it will get even more interesting. More to come.

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The last couple of weeks, I’ve had an increase in unwanted email volume. It’s not truly spam, but a combination of things that have to be dealt with, even if it’s just by deleting it. The folks who do the email blasts for the Annals of Internal Medicine apparently sent out a test blast of what looked like an online journal notification. It was followed up by an email saying it was a technical error on a test, and that it included “online journal content that was not valid.” Sure, they may take seconds to read, but it adds up throughout the day. I’m also seeing a deluge of LinkedIn requests. Pro tip: If you don’t have a last name, I’m deleting the email without opening it.

Furthering the email overload, this week AMIA migrated to a new online community platform and asked the Clinical Informatics Community of Practice to confirm receipt of the migration by replying to an individual. This resulted in dozens of “reply all” emails and even a request to be removed from the group. Those were pretty easy to sift out, but the last category of unwanted emails is more insidious. I receive quite a few emails each week from different vendors and organizations wanting to partner with me, often on the recommendation of someone I know. They start along the lines of, “I was talking to X the other day and they said we should consider working together” and then range from a general assessment of interest to a, “We’d like to talk to you on Thursday at 2.”

When I think I have colleagues or vendors who might be a good fit, I say something along the lines of, “I work with someone who does X. Would you be interested in seeing if there could be some collaboration?” If they’re interested, I then talk to the other party to see if THEY are interested and if both are amenable, I do an introduction. I don’t ever give out people’s direct contact information and would be horrified if I connected someone who reached out to my contacts and demanded a meeting at a certain time.

I had one of these situations this week and the vendor (which is actually a competitor) emailed me daily asking for meetings at specific times. Apparently they didn’t get the message that when someone ignores a cold-call email, they’re not interested. I’m usually pretty good at taming the email beast, but lately it’s just gotten out of control.

My HIStalk email has also been fairly full of people asking for advice, career coaching, and more. I try to incorporate as much of the advice and coaching into my posts as possible because the topics in question are usually of interest to a broad segment of readers. I’ve had several recent requests, however, where readers want me to review books or papers they’re writing or give advice about specific situations they’re encountering. I’ve had a couple of people get pretty demanding when I said I wasn’t able to accommodate their requests.

I think people forget that HIStalk isn’t my full-time job. I run a consulting company and also see patients I usually write Curbside Consult and EPtalk while I’m on a plane or sitting in an airport. If I’m at home, I’m usually writing it well after midnight. I still enjoy writing it, but some weeks its harder than others to find the time.

How do you keep your email under control? Email me.

Email Dr. Jayne.

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May 26, 2016 Dr. Jayne 2 Comments

Morning Headlines 5/26/16

May 25, 2016 Headlines No Comments

Congressional panel asks DOJ to investigate creation of Cover Oregon

The US House Committee on Oversight and Government Reform has asked the Justice Department and the Oregon State Attorney’s office to launch criminal investigations into the mishandled launch of Oregon’s health insurance exchange, Cover Oregon.

Evaluating the impact of a computerized surveillance algorithm and decision support system on sepsis mortality

Huntsville Hospital (AL) reduces sepsis-related mortality by 53 percent after implementing an early warning sepsis surveillance system.

To Cut Wait Times, VA Tries MinuteClinics In Northern California

In an effort to reduce appointment wait times for veterans, the VA partners with CVS to offer urgent care services to veterans in San Francisco. The VA will integrate patient records with CVS MinuteClinic and all care provided will be free for veterans.

Flatiron Health and the FDA Embark on Cancer Research Collaboration

Oncology software vendor Flatiron Health will collaborate with the FDA to research the use of immunotherapies in patients with advanced non-small cell lung cancer.

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May 25, 2016 Headlines No Comments

Readers Write: Why HIT Leaders Should Consider Mentoring

May 25, 2016 Readers Write No Comments

Why HIT Leaders Should Consider Mentoring
By Frank Myeroff

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The most successful leaders in healthcare IT tend to have something in common: they all have had a mentor or multiple mentors. A mentorship program can offer support towards an individual’s career as well as help to build knowledge among mentees which ultimately strengthens the organization.

Through four different types of mentorship programs, HIT leaders can use their experiences and knowledge to share with mentees, but also can benefit their own careers.

  • New hire mentorships. Mentors offer insight and guidance through new employees’ first couple of weeks of work. This helps mentees to become acclimated to the new work culture and environment while learning new things from an experienced HIT employee quicker.
  • Career mentoring. Mentors assist in the development of a mentee in the healthcare IT field. This could be formally organized through a mentorship program or informally take place in an organization where managers accept mentoring requests from employees. Professionals who are one or two positions above mentees can give valuable coaching and help to work through challenging work situations.
  • Networking mentoring. This allows individuals to share ideas and contacts throughout the marketplace. Networking mentoring is often informal and can take place at industry trade shows, healthcare IT conferences, or even social media platforms such as LinkedIn. Jeffrey Pelot, CIO at Denver Health, has used networking mentoring in his career. “I have sought out CIOs in various industries that have been willing to provide mentorship or act as sounding boards when I have been faced with difficult situations.”
  • Untapped potential mentoring. This type of mentoring is targeted towards an average or underperforming employee who has great potential, but has other components preventing them from reaching it. This can help an employee develop and discover how to excel in the field, and provide he or she with knowledge to succeed.

HIT leaders can participate in any of these mentorship programs to offer advice, share past experiences, and help up-and-coming leaders in the field. In fact, HIT leaders should view mentoring as an essential leadership skill. Mony Weschler, chief technology and innovation strategist at Montefiore Medical Center (NY) has had many great mentors who helped propel his career. Now he gives back, and according to Weschler, “What I really enjoy is mentoring others and infecting them with a passion for healthcare IT.”

There’s no doubt that mentoring others can be quite rewarding. By participating and becoming a mentor, you are likely to:

  • Obtain personal satisfaction from making a difference to the career development of another person.
  • Help in shaping future leaders and thereby impact the organization’s succession planning.
  • Increase your professional networks.
  • Enhance your people skills in areas such as leadership, interpersonal skills, and communication.
  • Learn more about areas in the organization where you may not be as knowledgeable.
  • Re-energize your career.

Overall, mentors can provide so much value for mentees and often mentorship programs are what shape future leaders of companies. When asked about mentors, Sue Schade, founding advisor at Next Wave Health Advisors and serving as Interim CIO at University Hospitals in Cleveland, summed it up nicely: “I’ve had mentors along the way, people I have either worked side by side with or as my boss. These have been some really solid people who have been able to give me good advice and who have been supportive and helped me stretch. Knowing how I have been supported in my career is why I have been so willing to do the same for others, to give back now that I have something to offer.”

Frank Myeroff is president of Direct Consulting Associates of Cleveland, OH.

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May 25, 2016 Readers Write No Comments

Readers Write: Ten Ways to Avoid Making the List

May 25, 2016 Readers Write 1 Comment

Ten Ways to Avoid Making the List
By Ryan Secan, MD, MPH

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In honor of the Year of the Hospitalist, I would like to share some hard-earned wisdom with those just entering our profession.

There are many unique things about hospitalist medicine – the seven on/seven off schedule (don’t get me started on this one – that’s another post), the exclusive inpatient focus, and the unfortunate administrative tasks that always seem to fall on our shoulders. Since we don’t have appointments, our patient assignments are determined early each morning at about 7:00 a.m. And often, ‘making the list’ is a job that falls to one of the hospitalists (despite hospital administrators consistently talking about everyone practicing at the top of their license). This remains a manual process that is time-consuming, painful, and delays everyone’s start to the day.

In my 15+ years of experience as a practicing hospitalist, I’ve never run into anyone who enjoys this process, and in fact have seen lots of creative ways that folks have been able to avoid the job. At one of my prior programs, the first doc who arrived in the morning made the list, so everyone started coming in later and later to avoid it. When you feel like you aren’t up for the task, feel free to borrow from:

The Top Ten Ways to Avoid Making the List

  1. Refuse to shovel your driveway. Even if the hospital sends someone out to get you, the list should be done by then (this will only work in Boston through April).
  2. Delete Waze and just accept that traffic will make you late.
  3. Make the list really badly once. They’ll never ask you again.
  4. Keep handy a picture of your car with a flat tire. Send to your program director in the morning as needed (but remember, you have four tires).
  5. Hide in your car until everyone else has gone in.
  6. Park really far away to get those 10,000 steps.
  7. Schedule 7:00 a.m. family meetings.
  8. Fake an emergency page.
  9. Become a nocturnist.
  10. Talk to IT. Isn’t there an app for that?

Ryan Secan, MD, MPH is chief medical officer of MedAptus of Boston, MA.

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May 25, 2016 Readers Write 1 Comment

Readers Write: Telehealth Can Create a Healthcare Nirvana: More Access, Lower Cost, and Enhanced Experience

May 25, 2016 Readers Write No Comments

Telehealth Can Create a Healthcare Nirvana: More Access, Lower Cost, and Enhanced Experience
By Rohan Kulkarni

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Healthcare in the United States generally inspires a sense of foreboding despite the progress that has been made since the 2010 enactment of the Affordable Care Act (ACA). While there continues to be challenges on both the cost of care and patient experience fronts, I believe that the most progress has and can continue to occur with access to care, which can in turn impact cost and experience.

It’s important to recognize the evolving patient population and how that will impact healthcare over the next 5-10 years.

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The Millennial generation was recently recognized as the largest generation, overtaking the baby boomers. They make up approximately a third of our total population.

The implications of that are highly consequential. Consider this: Millennials are currently low consumers of healthcare, accounting for less than 10 percent of the total spend. But historically, care consumption begins to steadily rise at a dramatic pace after women turn 25 and after men turn 30. This trend indicates that over the next five years, Millennial consumption of healthcare will significantly increase. Given the size and consumption preferences of that population, we are going to see marked changes in how healthcare is delivered.

One area in which Millennials will drive a seismic shift is the engagement of providers through virtual and mobile channels. It is seismic not only because of the size of the generational population, but their impact on the adjacent generation of Gen X who have had to continuously adapt to the new technologies. Let us consider a few ways in which they will manifest the idea.

Access

  • Alternate channels. In early 2016, Oliver Wyman published a white paper titled “The new front door to healthcare is here” in which they describe non-primary care physician interaction such as pharmacy- based clinics, mobile apps, and telemedicine in an alternate setting as the new front door of healthcare. As consumers find these alternate channels better, easier to access, and possibly less expensive, close to $200 billion in current healthcare spend is poised to flow from traditional venues to one or more of these alternatives. In fact, once you use a retail clinic or telemedicine, you are less likely to use traditional care.
  • Increased conditions supported. Telemedicine used to be for the simple stuff. Not any more. It is able to support more complex situations including strokes, intensive care unit situations, and behavioral health. As the number of conditions expands from the simple to the complex and as the monitoring of chronic conditions such as sugar levels for diabetes, heart rate, blood pressure, etc. becomes more stable, telemedicine will potentially become the channel of choice for healthcare interactions.

Cost

  • Impact on cost of care. There is a sense that telemedicine will bend the cost curve. However, it will be a while before the needle begins to move in any meaningful manner. In the short term, providers will need to strategically invest in telemedicine to extend their front offices all the way to patient homes or wherever it is that patients choose to connect from. But this investment will be a fraction of what it would take to build new physical structures. Consequently, there will be near term capital cost benefits with longer term operational savings that will be sustainable and meaningful.
  • Payers are paying. Recognizing the value of telemedicine both in its ability to provide care and optimize costs in the midterm, more payers are willing to reimburse these costs. Today, 29 states require insurers to pay for telemedicine services. Medicare is also beginning to pay for telemedicine-based care, which is a strong signal of the faith in the efficacy of this newer channel.

Experience

  • Convenience. Telemedicine offers new levels of convenience: the ability to get healthcare from the comfort of one’s home is very compelling. Paired with the prospect of having the physician send prescriptions to the local pharmacy that can deliver it to the home enhances medication adherence. This heightened level of convenience will influence the use of care in a timely manner. Patients will be able to avoid driving through traffic and decreased productivity at work but still receive the care they need.
  • Streamlined service. There is a very high likelihood that healthcare is about to be digitized end to end like never before, and that has healthy consequences. The telemedicine platform will be connected to the EMR platform, claims, and revenue cycle management, driving new levels of efficiency and enhanced patient experience. Healthcare will be at the tip of your digits.

Telemedicine is coming of age thanks to the large Millennial population that is likely to consume healthcare through this newer channel and payers’ willingness to pay for it. It is improving access at a fraction of the cost of a new ambulatory setup and giving rural constituents a chance for good healthcare. While still very small as a channel for healthcare delivery, it is about to be turned on its head like never before.

Rohan Kulkarni is vice president of strategy and portfolio for Xerox Healthcare Business Group.

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May 25, 2016 Readers Write No Comments

HIStalk Interviews Brad Huerta, CEO, Lost Rivers Medical Center

May 25, 2016 Interviews 1 Comment

Brad Huerta is CEO of Lost Rivers Medical Center of Arco, ID.

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Tell me about yourself and the hospital.

I am the chief executive officer of Lost Rivers Medical Center. We are a Critical Access Hospital in central Idaho. We are located in two really different communities in the middle of Idaho. One is Arco, Idaho, where we have our hospital and our rural health care clinic. The other is Mackay, Idaho, where we run a rural healthcare clinic.

The hospital itself is in fact a hospital district. We’re a taxing district. We operate in a geographical boundary that is larger than the state of Rhode Island. Despite that, we have fewer than 8,000 people in terms of population in that district. We are in an extraordinarily rural, mountainous area in the middle of Idaho. The census bureau doesn’t even consider us rural – we’re considered a frontier hospital because of the population density. We are in the middle of the wilderness.

As big health systems get bigger, are Critical Access Hospitals getting lost in the shuffle?

One of our biggest obstacles to overcome is the remoteness. You see that a lot with recruiting specialties in here, and sometimes on the technology side. There are a lot of additional considerations that we have to deal with that maybe larger hospitals, tertiary hospitals, and MSAs don’t have to focus on. The flip side of that coin is that one of the greatest benefits we have is the fact that we are remote. We have a very specific audience. We’ve cornered the market, if you will, in our area. That part is kind of helpful as well.

Are you using remote services or telemedicine to access expertise outside your geographic area?

Absolutely. In my own humble opinion, remote technology is the greatest force multiplier Critical Access Hospitals have at their disposal. We utilize a significant amount of telemedicine with a remote presence specialist that comes in from the University of Utah, Level One trauma centers, burn centers, telestroke, tele-STEMI, tele-ED, tele-behavioral health. These are things that, because of our location and our remoteness, we simply could not offer and certainly could never hope to recruit for in our area, short of any physician that just really loves to fly fish or go hunting. We use that quite a bit.

Our hospital was the very first hospital in the state of Idaho to utilize telepharmacy in conjunction with Idaho State University. We rely heavily on it. We are big adopters of it. We oftentimes are on the leading edge of technology for small hospitals. Certainly in Idaho, I think we are. It’s a huge part of our service lines and our mix of how we offer services.

We picked Athenahealth because of that. We talk about recruiting physicians, medical specialties, nurses, or whatever it is, but hospitals of my size in the middle of nowhere also have recruiting issues for IT people. One of the reasons we picked Athena was because at the time that we made this decision, about 18 months ago, they were the only strong platform for cloud-based EMR. We had come from another platform that wasn’t offering that.

Now it’s become the standard, but 18 months ago, one of the big things for me was that I can’t afford to have a server farm at my hospital. And even if I bought $100,000 worth of servers, I don’t have an IT person who can come out here and babysit those 24 hours a day. The remoteness piece, we see it on the clinical side in the applications that we use for patient care, but there is also these other externalities that often get overlooked, and part of that is the IT equation. Certainly anything we can throw in the cloud or do remotely — whether it’s patient care or patient records or EMR — that is something that we absolutely adopt.

Every patient room and clinic room utilizes an IBM thin client for uploading patient documentation or patient records, all done in real time. We do have servers and I do have kind of a part-time IT guy who lives here. He also does fire safety and telephones and everything else, but it’s mostly minimal. A lot of the on-site stuff for technical assistance we contract out with a company out of Idaho Falls, Idaho. They come up about once a month just to kind of kick the tires to make sure we have all of the right updates and all of that.

The Athenahealth platform was critical for us because it’s all cloud based. We utilize several components of their platform. Our entire outpatient or clinic population is managed by the Athenahealth platform. Our entire billing department is managed by Athenahealth. Our entire emergency room and acute care wing is managed by Athenahealth, and we are just doing that implementation right now as of last week. We are also doing all of our purchasing with the Athena Jump Stock program. We’ll have a unified platform across all of the hospital operations.

What are the most pressing hospital issues?

We came from a dated 1993 Healthland platform that we were getting no value out of. Small hospitals kick every rock over and hit every bush we can for revenue. One of the important things for us was making Meaningful Use attestation for Stage 1. That was huge. We hit the ground running. I got here about three years ago. We didn’t have a viable EMR. One of the things we had to do to make attestation to get reimbursement was to have an operational EMR right out of the gate. That is really what consumed us for the first 18 months.

Now that we’ve attested successfully and gotten our reimbursement, we are onto different phases of attestation. One of the things that I have enjoyed f is having a unified platform across the clinic, the hospital, the billing, and the purchasing. Instead of having two or three different programs, all of these programs are knit together to give us a unified platform. Not that physicians can’t negotiate different platforms, but the easier we make it on our physicians, the happier they are going to be. If they only have to learn one system, that is a huge employee satisfaction deal for us.

What are you doing with managing populations?

Being a Critical Access Hospital, we want to be the provider of choice. One of the challenges we have in terms of managing our population would be getting the appropriate specialties to  come up here. Like I said, our population is pretty small. The other part of it is that it’s an older population. We don’t deliver a lot of babies, but we do see a lot of trauma. Being rural, we will see a lot of shotgun and hunting incidents, ATV rollovers, horseback incidents, or cattle, these kinds of things.

Having services that cater to an older population from nuts to soup. It’s geriatric psych. Maybe it’s diabetes education or nephrology. We are looking at older population health issues for a crowd that is probably 45 and older, generally speaking. We do have young people, of course, but most of our biggest challenge is focusing on developing service lines that cater to an older population that we can serve by bringing in specialists from outside. That can be kind of a challenge. There’s just not a lot of physicians to be had anyway and there are even fewer that are willing to come out to a remote place like us. That is probably the biggest challenge.

How do you see the next five years?

We have stabilized hospital operations. We’re cash flowing nicely. We are capturing every bit of revenue that we possibly can.

Two main issues concern me. One is a political question, looking at the ongoing election and what is going to happen to healthcare depending on what party takes control. If it is in fact going to be one party, you hear talk of repealing, removing, or replacing the Affordable Care Act. That would cause absolute havoc for every hospital, not just small hospitals.

We’re just now continuing to try to implement the mandates of the ACA. Any type of change now would be catastrophic. That would hurt a lot of hospitals. It’s like steering the Titanic — you just can’t do something one day and turn around and go 180 degrees the next day. These things take time. As we’ve we’ve gone down the path of the Affordable Care Act, whether you like it or not, hospitals have adjusted their operations to start to accommodate that new environment. Any change to that would be extraordinarily difficult.

A component of the ACA is the mandate for accountable care organizations. Or in our case, any type of option that may allow itself to something different, like a CCO, or a community care organization. You are going to be moving towards a value- as opposed to volume-based reimbursement system. On one hand, that is probably a great harbinger for small hospitals because we do great quality care here. Our HCAHPS scores are some of the highest in our state. We are constantly fighting the battle with volume. We do great care, but we just don’t get a lot of patients.

Any payment system that replaces volume for value is a good thing, and I think my hospital in particular is uniquely positioned to do well in that environment. But at issue is some of the restrictions with regards to ACOs, where you are saying, "You have to have population health management.” You have to have a population to do that. If you are talking a population of 75,000 or 150,000 or a half a million people, that is one thing, but I live in a community with 8,000 people. How am I going to share risk and bring value if the reimbursement is tied to a certain percentage or a certain number of covered lives? 

Small hospitals are going to have to look hard at who they want to partner with on these ACOs because you can’t do it by yourself. Rural hospitals with small populations are going to be asked to do population health and we’ve only got small pockets of populations. You are going to have to throw in with shared markets and bigger hospitals. That is not necessarily a bad thing, but certainly you want to be careful of who you partner with.

There is a lot of subtle distinctions between for-profit and not-for-profit and critical access and trauma centers and what kind of trauma centers there are. There is a lot of differences in hospitals. Some of the governing philosophies of what makes sense or doesn’t make sense are going to come into play. There is going to come a time when small hospitals are going to have to decide, are we going band together in an organization — perhaps a community care organization that has maybe a lot of small hospitals making a threshold for population — versus, are we just going to go with the biggest hospital next to us and hope for the best?

That to me is a real challenge that Critical Access Hospitals are going to have to face, probably in the next 18 to 24 months. It’s a mandate. We are going to have to go to value. I guess right now we are all in the dating phase to see who we want to take to the dance.

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May 25, 2016 Interviews 1 Comment

Morning Headlines 5/25/16

May 24, 2016 Headlines No Comments

Soon-Shiong: Why I’m investing $70.5M in Tribune

Healthcare billionaire Patrick Soon-Shiong invests $70.5 million in Tribune Publishing, parent company of the Los Angeles Times and Chicago Tribune, making him the second-largest shareholder, holding 12.9 percent.

New Clarification – $6.50 Flat Rate Option is Not a Cap on Fees for Copies of PHI

HHS clarifies that providers may charge a flat fee of $6.50 for patient record requests, or continue calculating a request fee based on allowable labor costs for either a specific request or for an average request.

Apple CEO Tim Cook reveals the Apple Watch’s ‘holy grail’

Tim Cook reports that Apple is “really focused” on health and that Apple Watch is the company’s plan for entering the market.

Founder and Former Practice Fusion CEO Unveils New Company – iBeat

Former fired Practice Fusion founder and CEO Ryan Howard launches a new company, iBeat, which will develop a wearable heart monitor.

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May 24, 2016 Headlines No Comments

News 5/25/16

May 24, 2016 News 5 Comments

Top News

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NantHealth’s Patrick Soon-Shiong invests $70.5 million in newspaper publisher Tribune Publishing in a transaction arranged by another health IT billionaire. Tribune chairman Michael Ferro, who sold Merge Healthcare to IBM  for $1 billion last fall, enlisted Soon-Shiong’s financial help in fighting off a hostile takeover bid from USA Today publisher Gannett.

Chicago-based Tribune, which publishes newspapers in Chicago, Los Angeles, Orlando, South Florida, San Diego, and other cities, named former Merge CEO Justin Dearborn as CEO in February 2016.

Soon-Shiong says he will use healthcare-developed artificial intelligence to “bring together editors and reporters and create a completely new news network … where you integrate through fiber infrastructure and through cloud computing and you centralize a news network but actually take local news and bring it in on a daily real-time basis.”


Reader Comments

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From Turkish Taffy: “Re: Tampa General Hospital. They’re live on American Well in offering $49 virtual visits. It’s interesting that they decided to outsource instead of using local physicians.” It probably makes sense to scale up quickly with an established provider rather than trying to organize local physicians to respond to instant-on video visits as part of their workday, not to mention the malpractice and billing considerations. They can always insource the service later. I don’t know how the revenue split works, but it’s probably not going to be a big money-maker for the hospital anyway unless it drives referrals.

From Hans Morefield: “Re: Fred Morefield. It’s with sadness but also appreciation that I share the May 22 passing of my father. He was an HIT veteran who established and led SMS’s international business starting in 1978, conceived of and led Healthcare Data Exchange (HDX) in 1990, and contributed to Denver Health’s turnaround during six years there. He was responsible for key industry innovations, and as I hear all the time, for launching many careers, including my own.” 

From Clinically Insignificant: “Re: HIT news. What topics interest you least?” I gloss over at press releases about:

  • Newly announced partnerships. Nobody cares when one company “partners” with another except customers who will be told directly of what is usually just cross-selling.
  • Appointments to advisory boards. If the company really respected that person’s value, they would put them on their real board.
  • Launch of yet another innovation fund. All the good companies have long since found a financial dance partner.
  • Company funding of less than $1 million. I’ll pay more attention when success generates larger investments and Darwinism has weeded out the pretenders.
  • The results of vendor surveys whose methodology is either unstated or indefensible.
  • Companies and publications hoping to milk exposure by giving some other company a questionably devised award. The only award that counts is being awarded business from customers.

HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Ms. Garris in providing headphones so that her students can focus on their learning station laptop exercises while she’s working with small groups. One of the students says the group learning has changed from “chaos” to “peaceful” as a result.

Listening: new from Mudcrutch, Tom Petty’s pre-Heartbreakers band from the early 1970s, which regrouped with Petty to make a 2008 album and has now done so again prior to a US tour that kicks off this week. I don’t particularly like the past music of 65-year-old Tom Petty or even Southern rock in general with its obligatory pedal steel and harmonica all that much, but Mudcrutch has a clean, strong sound with catchy touches of Dylan, the Byrds, and occasional 1960s-sounding throaty organ and fuzz guitar. It’s a good choice for a summer soundtrack.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Orion Health announces FY2016 results: revenue up 26 percent, EPS –$0.23 vs. –$0.28.

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Unstructured data analytics vendor Apixio raises $19 million in a Series D funding round.

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Fired Practice Fusion founder and CEO Ryan Howard launches iBeat, which will offer a heart monitor and emergency notification watch.

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Varian Medical Systems will spin off its imaging hardware and software business into a publicly traded company.

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Forbes says Keith Dunleavy, MD, who founded data analytics firm Inovalon, is now a billionaire due to rising share price.

McKesson acquires Laboratory Supply Company.


Sales

Adventist Health (CA) chooses VitalWare for pricing intelligence, coding compliance, and charge master analytics.


People

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Columbus Regional Health (IN) hires Steve Baker (Indiana University Health System) as VP/CTO/CIO. He was CRH’s IS director for 11 years through 2010, seeing the IT department through the June 2008 flood that destroyed the hospital’s data center and closed the hospital for several months. He replaces CIO Diana Boyer, who will retire after 31 years of service.

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Care coordination software vendor PingMD names Susan Driscoll (Wolters Kluwer Health) as president and CEO. She replaces co-founder Gopal Chopra, who will remain board chair.

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SPH Analytics hires Bill O’Connor, MD (Orion Health) as chief medical officer.


Announcements and Implementations

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SSM Health goes live with Surescripts National Record Locator Service to allow clinicians to retrieve the records of patients seen elsewhere and review them within Epic.

A Nuance study finds that its clinical documentation improvement customers improved their financial performance metrics quarter-over-quarter after implementing ICD-10.


Government and Politics

HHS clarifies an earlier statement involving a $6.50 flat charge for providing an individual with a copy of their medical records, saying that providers are allowed to charge a flat fee of up to $6.50 per request, but otherwise can still calculate their fees  based on the allowable labor costs for either a specific request or for an average request.


Innovation and Research

Apple CEO Tim Cook says the company is focused on health and its entry point is Apple Watch, to which new sensors will be added.


Technology

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Chromebooks (of which I have one) outsold Apple Mac desktops and laptops (of which I have none) for the first time in Q1, with sales of at least 2 million units. I’m very happy with my recently purchased Asus that cost around $200 – it’s like a tablet with a really nice keyboard built in since it’s instant-on, instant-off with a battery life of around 10-12 hours, no need for antivirus or other add-ons, and software that is automatically updated from the cloud. It’s perfect for travel and doing keyboard-intensive tasks (like ordering stuff) while relaxing on the couch with a small, lightweight device with a decent-sized screen in your lap. Just about the only negative is the maddeningly clunky Google apps (like Docs) that it uses by default, even to make a simple list or to edit an emailed Word document. It only works when connected to the Internet, although most parts of the country have adequate cell phone coverage to tether anyway. I’m taking both the Chromebook and my iPad Mini next time I travel to see which one I find more useful – I would bet on the former.


Other

Mike Lynch, the billionaire who sold big data company Autonomy to HP for $10 billion during the latter’s disastrous Leo Apotheker years (not to be confused with the company’s only slightly disastrous Carly Fiorina years a bit earlier), says Google mishandled its patient data deal with England’s NHS. On the other hand, Lynch is an investor in DeepMind competitor Sophia Genetics, which offers hospitals genomics-powered diagnoses.

I’ve written several times about the phenomenon in India of friends and family members forming an angry mob to attack doctors and hospital officials following the death of their hospitalized loved one. The Washington Post says it’s getting worse as medical residents at underfunded government-run hospitals, who work up to 20 hours per day, are requesting permission to carry guns to defend themselves from people who blame them for poor care or long delays.

Iatric Systems President Frank Fortner creates a song parody about virtual visits in which he channels Daughtry in declaring “I’m staying home in the place where I belong, where telehealth is often good enough for me.” For my money, Frank’s version is better than the original.


Sponsor Updates

  • Aprima will exhibit at the Practice Management Institute June 2-3 in New Orleans.
  • Catalyze launches Change Agent, a new publication on Medium.
  • Besler Consulting’s latest podcast focuses on comprehensive care for join replacement quality measures.
  • CapsuleTech will exhibit at the 2016 International MUSE Conference May 31-June 3 in Orlando.
  • Frost & Sullivan recognizes Validic with its 2106 visionary innovation leadership award, calling the company “an industry leader and de facto standard in health data interoperability.”
  • Forbes names The Chartis Group as one of America’s best management consulting firms, with “best firm” distinction in healthcare, data analytics, and digital transformation.
  • CitiusTech founder and CEO Rizwan Koita authors an article about healthcare technology in India for LiveMint.com.
  • ZeOmega will integrate its Jiva population health management solution with McKesson’s InterQual Connect.
  • Crossings Healthcare Solutions will exhibit at the Cerner Great Lakes RUG May 31-June 2 in Chicago.
  • CTG receives a marketing excellence award from its partner, Dynatrace.
  • DrFirst presents  “What good is secure text messaging if no one uses it?” at MUSE 2016.
  • Direct Consulting Associates will exhibit at the Northern Ohio Chapter of HIMSS Regional Conference May 26 in Cleveland.
  • Elsevier Clinical Solutions and FormFast, Galen Healthcare Solutions, and HealthCast Solutions will exhibit at the 2016 International MUSE Conference May 31-June 3 in Orlando. 
  • Extension Healthcare will exhibit at the AAMI Annual Conference June 3-6 in Tampa, FL.
  • HCS will exhibit at the ONC Annual Meeting May 31-June 2 in Washington, DC.
  • HDS and Healthwise will exhibit at the Cerner Great Lakes RUG May 31 in Chicago.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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May 24, 2016 News 5 Comments

Morning Headlines 5/24/16

May 23, 2016 Headlines No Comments

Q&A: Meditech founder Pappalardo says invention was ‘my overall destiny’

Neil Pappalardo, Meditech founder and lead creator of the MUMPS programming language, discusses his early life, his recent health, and his plans for the future of the company in a Modern Healthcare interview.

Making the Comprehensive Shared Care Plan a Reality

Leaders from HHS co-author a New England Journal of Medicine article calling for the use of shared care plans to improve care coordination.

MGH to build Down syndrome portal

Massachusetts General Hospital will launch a “virtual clinic” to improve care for people with Down syndrome that do not have access to local specialists.

San Juan County warns of data breach

San Juan County (NM) warns patients being treated in its drug and alcohol treatment program that 12,000 records were compromised when hackers accessed a computer at the treatment center.

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May 23, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 5/23/16

May 23, 2016 Dr. Jayne 6 Comments

I’m working with a client who hired my partner and me to do a complete review of their practice operations and both financial and clinical workflows. Initially, they had requested us for a system selection engagement since they were ready to jettison their vendor and look for greener pastures.

Since I’ve worked with this particular vendor multiple times, I strongly suspected that the problem wasn’t with the system at all, but with how it had been implemented and was being used. The client has been on the system for a long time and I suspected they hadn’t been keeping up with newer releases, or if they had, that they hadn’t been adopting new features and incorporating them in their workflows.

They understood that paying us for a thorough review and potentially executing a remediation plan would definitely be more economical than completely throwing out the system. My partner started digging through their financial workflows a couple of weeks ago and we didn’t find anything too surprising there.

The practice is a group of procedure-driven subspecialists. In our experience, those groups tend to be fairly strong at maximizing their financial returns. We found some opportunities as far as them not using some of the automation available in their system. Although it may save them a couple of staffing FTEs, in a group their size, it wasn’t truly earth-shaking. If we had to give them a grade on how well they’re using the system and keeping up with the times, we’d give them a solid B+.

The clinical team’s use of the system was something else entirely. As we worked through their clinical workflows, it was apparent that they hadn’t taken advantage of many of the system upgrades that had occurred since their initial go-live more than five years ago. Once we review the user workflows, we typically meet with the physician champion or super users to determine whether they are aware of new workflows and made a conscious decision not to use them or whether they were not aware of the best practices. We try to avoid having these conversations with end users because they become frustrated when they learn that there were enhancements that could have helped them and their practice didn’t implement them for one reason or another.

The group has had a fair amount of turnover with regard to EHR super users, although the same EHR lead has been present since system selection. With every feature we discussed, her answer was, “Nobody told me about this” despite the vendor offering free Web-based training every time a system upgrade was available.

The physician champion just wanted to argue about how poor the system was and how they were going to replace it anyway rather than wanting to learn about the features that would eliminate their pain points. He clearly was not on board with the practice’s executive committee decision to bring us in to try to fix the current system rather than chuck it.

We also found that essentially they had been doing what needed to be done to get their Meaningful Use incentive payments, but hadn’t at all embraced the clinical realities of the metrics they met. For example, they made sure that every patient had an entry on his or her problem list, but the lists were not up to date; nor was there any policy or procedure in place to cover how often they should be updated or by whom. As far as they were concerned, since their vendor provided documentation that the problem list was “in use,” that’s all they needed.

One of the providers I interviewed told me that he didn’t put any problems on the patient’s list that he didn’t personally treat. This is the classic view of the problem list as “the physician’s problem list” rather than “the patient’s problem list.” I tried to have a conversation with him about the goals of Meaningful Use in providing more comprehensive records for patients, making it easier for practices to integrate data, the evolution of patient-driven medicine, etc. but he was having none of it.

He mentioned that his job was to take care of patients and made statements that sounded an awful lot like he felt he was above making sure he was aware of all the different problems impacting the patient. I tried to use logic with him, noting that although he doesn’t manage a patient’s hypertension or diabetes, they’re certainly important factors to consider prior to putting the patient on an operating table.

I also demonstrated his system’s functionality to filter the problem list by sorting the problems that are attributed to him to the top of the list, but he continued to push back. Although he seemed to agree in principle, he wouldn’t arrive at the point where he admitted that he (or his staff) should be keeping an updated problem list.

Having tried the “it’s good clinical care” angle and failed, I decided to press a little more on the MU aspect. I asked how he felt about the fact that he accepted federal incentive payments for doing something that he clearly wasn’t doing.

Mind you, I had no problems pressing this guy because he’s taking home more than half a million dollars a year. He’s also pontificating about being there to care for the patient, but refusing to do the basics. I tend to get a little aggravated with people like this, having come from the primary care trenches where many of my peers were working long hours updating charts to provide complete and accurate data for their patients (simply because it is the right thing to do) while making 70 percent less money than this guy.

He rationalized his actions (or lack thereof) by saying that the EHR vendor provided documentation that he met the performance threshold. I explained that the reports deal with the fact that the problem list contains data, not that anyone is actually working with it or keeping it current. Ultimately the physician is responsible when someone attests on his behalf that he has done something that he clearly hasn’t.

Although this guy may be a technically brilliant surgeon, I’m not impressed with his professional ethics. When I told this story to a friend, he assumed the surgeon in question was older and had been trained in a more paternalistic model. This physician finished his training within the last decade, so I’m not buying that excuse.

Medical schools are doing a lot of work trying to shift physician culture and educate in the benefits of patient-centric care. Regardless of whether you use an EHR to document your work or not, we need to be doing things differently and this guy clearly doesn’t get it.

Still, as one of the highest-compensated physicians in his region, he’s being rewarded because we still value procedures over cognitive skills. Ultimately the drive towards value-based care should help with some of this, but I don’t think I’m going to see the change in my career lifetime.

Is it just me, or are there still a lot of physicians like this out there? Do you have to deal with them? Email me.

Email Dr. Jayne.

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May 23, 2016 Dr. Jayne 6 Comments

HIStalk Interviews Peter Butler, CEO, Hayes Management Consulting

May 23, 2016 Interviews 2 Comments

Peter Butler is president and CEO of Hayes Management Consulting of Newton Center, MA.

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Tell me about yourself and the company.

I’ve been with Hayes for 22 years. I’ve been running the company since 2007. From a company milestone standpoint, at the end of 2015, we did a management-led buyout and bought Paul Hayes, our founder, out of the company so he could go off into retirement and enjoy the fruits of his work. We’re excited to continue carrying on the legacy.

Hayes started as a consulting company. We started in revenue cycle management and optimization. We grew from there into clinical optimization, always with an IT component, but also the business of delivering care and operating a business. That’s where we got our grounding.

We got into the software business in 2006. We have a software solution that we call MDaudit to help billing compliance managers run their business more efficiently and identify risk areas for their organization.

Sometimes it’s hard to tell whether a given company does true consulting versus providing staffing services. Is that ratio changing in the industry in general?

We’ve seen over the last several years firms that started as consulting firms have become staff augmentation firms, mostly around Epic implementation services. There’s just been so much demand in the industry. Those services have been commoditized over the years.

There’s still a need for consulting firms. Where I see the differentiation is where people can come in and do interim leadership, management, business process change on those levels, coupled with the IT implementations as well.

How does a company grow from just letting their individual warm bodies wing it versus developing mature, repeatable processes?

From repeat types of projects or very similar projects, you develop a methodology that’s  packageable. You can replay that and bring in along with it best practices. What the client is getting is for that targeted effort — whatever that might be, a revenue cycle improvement project — here are the top six steps that we follow and it’s a methodology. Sometimes it’s not a software solution or something that’s easily demoable, but it is a methodology that could be followed.

For example, bringing in key leadership stakeholders, interviewing at that level, understanding what they have a need for, and then dropping down a level into the management level and saying, "What are you really executing in the delivery of your business?" Then looking further, you get into the IT side of things and have a certain methodology there as well that you’re looking for these top 25 items. You put that together in one methodology and you can make some improvement.

Is it easier or harder to recruit people into consulting compared to two or three years ago?

It hasn’t been harder. We tend to see a lot of people who are later in their careers who want to get into consulting if they haven’t been there previously. For them, it’s the thrill of a new project and not being tethered to the politics of any one organization. They also have to have a pretty strong willingness and interest in travel.

For us, it’s been fairly easy to recruit people that are interested in making a difference one project at a time. We haven’t see many people pulling back from the consulting ranks from the types of projects that we’re hiring into.

How important is developing relationships with prospects or current customers?

It’s absolutely critical. I was under the misunderstanding when I solicited Paul Hayes and said, "Can I go out to the West Coast? I’d really like to live out there first of all, but I think there’s some business opportunity.” I thought it would be a matter of setting up a shingle and publishing a phone number on a website.

What I found was a lot of hard work over the next couple of years being a face of an organization, meeting a lot of people, and seeing them on a regular basis at industry conferences or speaking at industry conferences to the point where they knew you and knew what you were capable of and could trust you enough to ask questions. It took awhile to get to that point because, typically, people are very defensive of a new face or new player. Being able to build up that trust  opened up a lot of doors through many many conversations.

What makes someone decide to hire a new firm instead of continuing working with their current one?

You’re really only as good as your last project. Typically, firms will get replaced if they if they stub their toe. The client will cut you some slack if you put a resource if it’s not quite a good cultural fit. They’ll give you an opportunity to replace that person. If you have a couple of events like that, they start to lose confidence in you. Or if you’re asked to present before their board and you’re not prepared enough, or you don’t understand the politics in the room when you walk in, you can really stub your toe there.

Those provide opportunities for firms like us to get an opportunity to, “Give me a shot — I think we can make this right.” Then, you just got to put on your A game.

Can you usually tell ahead of time when a consultant or engagement is having problems?

We try as hard as we can. One of the best ways to do that is a regular touch point with the client. We’re checking in and you’ll hear, "Hey, everything’s going great. Everything’s going great." On a regular tempo, as you’re checking in, you might start to hear, "This meeting didn’t go as well as we thought it would." You make some changes and identify potentially what the reasons were and address it early and often. That’s key to managing client expectation and the way the consultant is presenting themselves.

What are the biggest changes that have occurred in consulting in the last few years?

There’s an incredible amount of anxiety in the industry and attention to detail around expense management and revenue. As we know, there’s a razor-thin line on the healthcare bottom line. That’s only getting tighter. We’re seeing an increased level of need or concern around, “Are we getting every dollar we possibly can? Are we leaving anything on the table? What tools can we employ to help us run our business more efficiently? What reporting functions can I get, dashboards or analytics, that will help us identify risk areas before they become problems?”

What does MDAudit do?

When it first launched, it was really a work flow improvement tool. Clients were using spreadsheets and so forth, a very manual process for conducting physician audits and identifying physicians on a manual basis with no audit. Where are they improperly coding? Where are we as an organization at risk for fraudulent billing?

What it’s morphed into in the last couple of years is, as organizations are buying up practices and adding physicians at a very rapid clip, they’re going out and auditing those physicians — usually after they’re bought — and identifying risk areas and then providing educational opportunities to those physicians to fine tune their coding practices.

What we’re seeing now as a trend is more risk-based audits. Rather than looking at every individual physician, it’s looking at what the RAC auditors are looking for in the current coming year.

There’s a whole list of other auditors who are coming knocking and looking for improper billing practices. Where is my organization most at risk? Seeing that on the dashboard, and being able to drill in and say, the greatest risk is coming from this particular department or these physicians. Let’s go target a training effort there to get them coding properly so we can mitigate that risk and move on. We also see that as an important area with the new billing regulations that are coming out and the diminished need for fee-for-service type billing and being able to run a proactive effort as you’re managing physician billing and facility billing.

How will MACRA impact the industry?

It’s going to be a huge burden to the industry. I feel for the physicians, as Dr. John Halamka mentioned in his blog. It’s going to be difficult to manage. It’s very onerous. But it’s a necessary direction that we need to go as an industry. The larger organizations should be able to deploy the resources around helping position the organization and physician billing appropriately to manage against those metrics. It’s the smaller practices that are going to struggle in meeting the requirements.

Do you have any final thoughts?

It’s an exciting time in the industry. I know it’s painful for many clinicians and physicians. There’s so much work that needs to be done and so much modernization. I look forward to the next 10 years working in this industry and helping our clients to migrate and manage through the process of transitioning from fee-for-service into more of a value-based delivery system. As a patient, I’m really looking forward to that.

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May 23, 2016 Interviews 2 Comments

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