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December 4, 2014 News 10 Comments

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HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources). Working with HL7 will be athenahealth, Beth Israel Deaconess Medical Center, Cerner, Epic, Intermountain, Mayo, Meditech, McKesson, Partners HealthCare, SMART from Boston Children’s, and The Advisory Board Company. HL7 says the group will create FHIR-based EHR data sharing API specification by the spring of 2015. The big news here: (a) the second JASON report called for a big vendor to propose an open API standard instead of waiting around for the government to do it; (b) FHIR and APIs are a heck of a lot better than today’s document-based interoperability standards and probably better than the customized jungle that the HL7 standard has become; and (c) getting Epic, Cerner, Meditech, and McKesson together at the same table covers nearly all of the hospital EHR market and Epic, particularly, is a key member given its non-participation in CommonWell (and Epic and Cerner already have customers using APIs).

I asked an expert who shall remain unnamed to summarize Project Argonaut:

Project Argonaut is beginning the hard work of not only formalizing the API calling sequence (the easy part and something most vendors already do), but to formalize a set of vocabulary objects – Problems, Allergies, Notes, etc. with controlled vocabularies and predictability. To make FHIR really work, both must be done well. If FHIR succeeds, it will allow third parties to create an “app” and be able to run it in any FHIR-compatible system without the meet and map exercise with each implementation. What we’ll need to do with FHIR is to ensure people don’t get ahead of themselves and customize the “resources,” otherwise we’ll be back in the same boat as HL7 v2. FHIR is at the peak of inflated expectations. It will be great as a minor plug-in where there’s a UI or visualization, but not so great for machine-to-machine communication where one of the endpoints might not always be reliable for high-volume transfers at scale – some of the simpler web service configurations can be horribly inefficient, like making separate grocery store trips for each item on your list. There may be audit and security issues as well.

I asked another expert how the Argonaut Project might relate to CommonWell:

There is no immediate connection, but over time, CommonWell could add services that are based on the FHIR standard that the Argonauts are trying to speed up. For example, CommonWell today uses XCA to move CDA documents around, but that can be cumbersome if all the doctor wants is to get a list of known allergies from some other site. FHIR makes the later query much easier than using XCA to move a "fake" document that contains only allergies. So, CommonWell will benefit from the success of the Argonaut work (assuming it’s successful!) But otherwise, there is no direct connection, though some of the same people are involved with both.


Reader Comments

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From Ken L. Ration: “Re: HIMSS. Our designer got a good laugh from this HIMSS15 promotional graphic. One thought it was an attempt to be edgy, but the general consensus is that it’s a marketing fail.” I think it’s an insightful graphic: those benzene ring-shaped items are probably snowflakes burying HIMSS attendees who would much rather be almost anywhere else — Chicago came in seventh of 11 desired HIMSS cities last time I surveyed, with the clear winners being San Diego, Las Vegas, and Orlando.

From Roy G. Biv: “Re: physician billing services. Do health systems keep using them after implementing Epic? Could you ask your readers if, for instance, the keep using athenahealth’s PM and billing service post-Epic?” Readers have been duly notified – responses are welcome.

From HIT5982: “Re: Medhost. Let 71 people go Wednesday all at once. HR cleaned out their desks while they were being told. I was one of them – I worked in the department division (EDIS, Patient Flow, perioperative) and was told the emphasis will shift to Enterprise (clinicals, financials, patient access, revenue cycle). Departmental sales were down this year.” Reported by two readers. I reached out to the company for a response but didn’t receive one. Nothing says Christmas like being laid off.

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I shall digress and pontificate on the topic of layoffs. I’ve seen both sides over the years: (a) I was literally on my way out the door before getting a last-minute reprieve in my one and only vendor job many years ago, where layoffs every quarter were a given as executive bonuses became threatened by poor financial numbers mostly due to their own poor decisions; and (b) I have personally marched at least 20 people out of the hospital IT department through a gauntlet of their peers as I served as judge, jury, and executioner for high-level decisions that I neither made nor agreed with. Both situations were largely created by clueless, spreadsheet-circulating executives who were shockingly indifferent to the havoc they were wreaking on the lives of people and their families. While some of the folks who get axed deserved it and should have been canned a lot sooner, many of them had been given perfectly fine performance evaluations but were singled out for factors beyond their control: changing organizational strategy, their own demographics, higher salaries that they had been voluntarily offered to them, and doing their jobs every day instead of kissing executive butt and backstabbing their co-workers. Readers regularly send me personal stories about being cut loose and I always provide the same response: you’ll be better off in the long term because who wants to work for a company that lays people off? To people all over the industry who have to face the holidays (and their families) with uncertainty, fear, and feelings of personal inadequacy for whatever reason, I am truly sorry. It will get better.

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From Pierre Dukane: “Re: slimy companies. This site [URL omitted] charges consultants $300 per quarter to be on the ‘elite’ list for go-live job notifications, using information it gathers from other members and online job postings (duh). The ‘About’ page doesn’t say who runs it and the domain registration information is blocked. I can’t believe people pay for this garbage. Also, an HIT consulting firm’s recruiter is sending emails offering entry into a gift certification drawing if they ‘forward any email you receive from another recruiter or company regarding current opportunities or referral incentives.’ What happened to working the old-fashioned, honest way? No wonder clients and consultants feel so negatively about consulting firms.” It wasn’t hard for me to track down the operator of site you mentioned, which doesn’t seem to be offering much for $1,200 per year. But hey, it’s a free country, and he’ll either get business or he won’t depending on the value he provides. I’ve had both good and bad experiences with recruiters that I’ve either hired or been placed by, but I agree that quite a few questionably motivated people see it as nothing more than making easy money by matching Resume A to Job Posting B. Nearly everything in life can be explained by supply vs. demand.

From Elsa: “Re: BJC’s core clinicals replacement. Vendors were to have been notified Friday. I was shocked that it wasn’t Cerner – my source says it’s Epic. Not sure how they’ll justify the cost when they laid off staff, cut charity care, and froze raises.” Unverified.

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From Not Quite: “Re: JASON report. ONC is putting a lot of stock in it, but it’s a fake that is partially plagiarized from Wikipedia. The report lists many references, but fails to list Wikipedia, from which many things were copied. ONC should ask for our money back!” No report should ever reference Wikipedia since it’s not a vetted reference, but hopefully the JASON folks cited their primary references properly, at least where a source contained something that isn’t common knowledge.


HIStalk Announcements and Requests

Voting for the US capital of healthcare IT has been heavy, with Madison leading the pack and Nashville and Boston pulling up as a distant second and third. Voting ends this weekend – my poll is here.

This week on HIStalk Connect: Data scientists with athenahealth are monitoring the onset of the 2014-2015 flu season and note an early uptick in flu-related visits. Google is said to be revamping the internal components of Google Glass in an effort to boost battery life. Personal genome testing startup 23andMe will begin selling genetic tests in Canada and the UK after a year of trying and failing to secure FDA approval for US sales. 

This week on HIStalk Practice: Payers in Colorado build online claims data-sharing tool for physicians. HIPAA compliance at physician practices is found to be woefully lacking. Gila River Health Care goes with NextGen, while Advocate Community Partners selects eClinicalWorks. Practice Fusion VP argues for net neutrality, while Amazon takes advantage of lightning-fast consumer Internet connections. AMA winner Nancy Adams asks, “Interoperability? How about achieving operability first?” Thanks for reading.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Integrated payments network vendor InstaMed raises $17 million in a private placement, $2 million more than it was seeking.


Sales

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Rio Grande Valley Health Alliance (TX) and Lakewood Health System (MN) choose Lightbeam Health Solutions for population health management. I interviewed CEO Pat Cline a few months ago. 

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Western New York’s HEALTHeLINK HIE chooses Stella Technology’s clinical data access technology for analytics and reporting.

Children’s Hospitals and Clinics of Minnesota chooses Strata Decision’s StrataJazz for decision support and cost accounting.

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Granite Health Network (NH) selects athenahealth’s athenaCoordinator Enterprise Population Manager.

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The Medical Center at Bowling Green (KY) chooses ProVation Medical for its cardiac cath lab.


People

CompuGroup Medical US promotes Navid Asgari to VP of service and support for its ambulatory information services division.


Announcements and Implementations

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Lehigh Valley Health Network (PA) announces that its physician group will move to Epic.

Levi, Ray & Shoup announces release of a new user interface for Epic users of its VPSX output management solution.

Imprivata announces OneSign 5.0, a new version of its authentication and access management product.

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Children’s National Health System (DC) opens an Innovation and Learning Center to house Bear Institute, its partnership with Cerner. The announcement is confusing, but I think it’s just a new physical space to house the existing project, which was announced just over a year ago.

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CareSync launches its Chronic Care Management service that allows providers to earn Medicare’s monthly CCM payments.

Perceptive Software launches Perceptive Interact for Google Apps, which allows users to integrate Gmail content into Perceptive Content for review, routing, and collaboration.


Government and Politics

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ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.

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Someone tweeted out this fascinating article from March called “Sinkhole of Bureacuracy,” which describes the 600 federal government employees who push paper in the abandoned limestone mine run by Iron Mountain in the middle of nowhere in Pennsylvania at a cost of $56 million per year. Previous federal government automation efforts of the government’s retirement program failed despite spending well over $100 million. A former employee described the manual process as, “I used to chase people for months — literally — for one signature on one piece of paper. You want to talk about an egregious waste of taxpayer money? … On a daily basis, we would get from five to 50 e-mails, asking everybody to take time out of their day to search their desks for case files.” The article says the old mine is legend in the federal government, quoting former CTO Aneesh Chopra as calling it “that crazy cave.”

Massachusetts says it has repaid most of the $2.1 million in Medicaid EHR incentives that were incorrectly given to 19 hospitals that were identified by the HHS OIG. The state blamed requirements that are hard to understand and hospitals that reported incorrect data to the federal government.


Innovation and Research

A small study finds that a computerized symptom questionnaire that was turned into a History of Present Illness narrative using computer algorithms created a better HPI than physicians doing it themselves.


Other

Hospitalists at two Oregon hospitals form a union, hoping to remain as hospital employees rather than being outsourced to a national firm.

A review of a tiny sample of the 100TB (!!) of data hackers took from Sony finds medical information, in the form of doctor letters for medical leaves of absence. The responsible hacker group, possibly from North Korea, has posted some of the information publicly, including salaries, scripts, and video files of unreleased Sony movies. The hackers also released a Word document titled “Passwords” that some idiot Sony executive had used to store all of his computer passwords and credit card information. Sony was burned by hackers in 2011 who stole credit card numbers and took down its PlayStation network for weeks. 

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New York police arrest radiologist James Kessler, MD, MPH for copying the information of 97,000 patients of his former employer onto a portable hard drive with intention of starting a competing business.

Singer and cancer survivor Melissa Etheridge, just announced as a keynote speaker for GE Healthcare’s Centricity Live user conference, creates a line of prescription-only “cannabis-infused fine wines” that provide “a delicious full body buzz.”


Sponsor Updates


  • An Imprivata video provides an overview of electronic prescribing of controlled substances.
  • HCS provided 50 tickets to the Los Angeles screening of the overwhelmingly positively reviewed Glen Campbell documentary “I’ll Be Me” in support of Alzheimer’s awareness. The company will be contributing to the Salvation Army through the holidays on behalf of its clients.
  • DataMotion earns accreditation as a Certification Authority and Registration Authority from DirectTrust.org and EHNAC, allowing it to issue and manage digital certificates in addition to its role as an accredited Health Information Service Provider.

EPtalk by Dr. Jayne

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ONC will hold its annual meeting February 2-3, 2015. The email announcement caught my eye in mentioning that “the two-day meeting will gather over 1,200 health IT fans,” but on the registration website, it had been toned down to “health IT partners.” The event includes “an exciting panel of ONC’s former National Coordinators,” according to the email. I’m not sure if that’s enough of a draw to convince me to head to Washington in February. If you’re planning to attend, keep us in mind for rumors and newsy tidbits.

GE Healthcare announces its Centricity Live 2015 meeting April 29-May 2, 2015 at the Walt Disney World Dolphin Resort. Keynote speakers include Atul Gawande, Melissa Etheridge, and LeVar Burton. That lineup looks pretty good compared to some I’ve seen. I stayed at the Dolphin a couple of nights before HIMSS and it’s in a minimally mousey part of the Disney compound. Given the recent weather in my neck of the woods, I’m sure by April I’ll have a complete deficiency of Vitamin D, so if anyone wants a sassy traveling companion, let me know.

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My good friend Anjali called last week asking for a favor. The annual Christmas Party at her hospital (it’s a faith-based institution, hence the name) was looming. Her husband had to travel and she didn’t want to go alone. She’s run three half marathons with me and has had my back in countless clinical situations, so how could I say no? She works at a hospital across town where I only know a handful of medical staff members, so I was looking forward to a holiday party where I could have a couple of glasses of wine without being interrogated about our EHR.

We were a little late heading out. She had picked up a dose of flu vaccine from the local retail pharmacy and was planning to vaccinate her daughter. The pediatrician’s office was already out of vaccine and the pharmacy won’t vaccinate children under 8 even with a physician’s order, so she decided to get creative. Unfortunately, she’s a surgeon with few pediatric vaccine skills, so I was persuaded to step in.

It’s a sad commentary when you have to work the system to vaccinate your child. Most parents don’t have that option, but I was happy to help. Needless to say, that vaccine won’t be making it into the state immunization registry, but I did email her the Vaccine Information Statement so I don’t run afoul of the feds.

The tables were packed when we arrived. We grabbed the first open space we found. We were next to a husband/wife physician couple – she’s a radiologist on staff and he’s an internal medicine physician elsewhere in town. The odds of a physician conversation (regardless of setting) eventually turning to EHRs and healthcare IT is nearly 100 percent if you talk long enough, and tonight didn’t disappoint.

The radiologist is pretty happy with the hospital’s system. She appreciates being able to view the entire patient chart when there are questions about what an ordering provider hopes to achieve with a diagnostic test. She also enjoys not having to help the radiology staff decipher cryptic physician handwriting.

Anjali told them she preferred handling patient messages from home after her daughter goes to bed rather than having to stay in the office. A couple of other people chimed in and I thought for a brief moment that the EHR love fest might continue in the spirit of holiday togetherness.

The bubble was burst when the internal medicine physician started complaining about his EHR. He complained of the burden of data entry with little return. He said he didn’t understand why there wasn’t any data exchange with other practices or hospitals or why he doesn’t have access to reports on his patients’ health status.

I asked a couple of questions about his practice and his system and was able to deduce that he is actually on my hospital’s platform, through our affiliate subsidy program. Anj picked up on this as well and gave me a little eyebrow raise. She knows I led deployment of our private HIE more than six years ago and that our users regularly exchange data between owned and affiliate practices as well as our multiple hospitals.

She’s also on the same ambulatory EHR although on a different platform, so was able to provide some positive counterpoints to keep him from going too far. I didn’t want to reveal myself as the owner of the platform due to the potential for turning a holiday gathering into a debate, so I excused myself for another glass of wine.

Most of our providers are satisfied with our system and are seeing the benefits of our patient registries, actionable reports, and interoperability. I’m going to need to get to the bottom of why his practice isn’t having a good experience and figure out what we need to do to get them to the same level satisfaction. I’ve reached out to our affiliate program manager so that I can review his implementation documentation and support tickets to try to identify what might have gone awry. I just wish I had heard about it through or formal processes rather than as an aside at a party.

Anj has never seen me in full Administralian mode and told me she was impressed at how I kept my cool while the physician was ripping apart the system I’ve spent the better part of a decade implementing, optimizing, and personally ensuring that practices receive value for their efforts. I must say I haven’t always been unflappable in these situations, but they have become easier over time. I’ve learned to pick my battles and not let situations get out of control.

We did enjoy some seafood and a nice string quartet, as well as good conversation with other physicians.

Have any strategies for enjoying the company holiday party? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 4, 2014 News 10 Comments

Morning Headlines 12/4/14

December 4, 2014 Headlines No Comments

Efforts To Improve Patient Safety Result in 1.3 Million Fewer Patient Harms

US hospitals have reduce medical errors by 17 percent since 2010, with a majority of the improvements coming from reduced adverse drug events, according to an AHRQ report. The improvement is credited with saving an estimated 50,000 lives and $12 billion in healthcare spending.

Jon White, MD, Acting Deputy National Coordinator/Acting Chief Medical Officer

The ONC promotes Jon White, MD to the position of Acting Deputy National Coordinator. White has been with the ONC since 2004, and is also the ONC’s current Chief Medical Officer.

DNA-screening test 23andMe launches in UK after US ban

After being shut down by the FDA in 2013, personal genetic testing provider 23andMe will begin marketing its genetic health assessments in the UK and Canada.

Organizations achieve EMRAM Stage 7

Six hospitals are added to the HIMSS Stage 7 list, including Ontario Shores Center for Mental Health Sciences, the first  hospital from Canada, and first behavioral health hospital, to reach Stage 7.

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December 4, 2014 Headlines No Comments

Readers Write: 10 Talent Trends to Watch in 2015

December 3, 2014 Readers Write 1 Comment

10 Talent Trends to Watch in 2015
By Anthony Caponi

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The entirety of my career has been spent in the healthcare staffing industry. Consequently, I have been at both ends of the spectrum. There were tough times in 2008 and 2009 as the nation’s economic recession spilled into healthcare hiring. Then, as part of the American Recovery and Reinvestment Act of 2009, numerous jobs were created with the promotion of EHR adoption.

The healthcare IT industry is absolutely on the rise. However, we will also see some obstacles, including a talent and skills gap. Below is a list of 10 increasing trends for 2015.

Increasing Mergers and Acquisitions

Healthcare reform is becoming a powerful catalyst for the consolidation and integration trend in the hospital industry. A study conducted by Kaufman Hall found that hospital mergers and acquisitions increased 10 percent in the first quarter of 2014 compared with the same time frame the previous year. Overall, studies indicate a continuation of several trends, including increasing numbers of acquisitions. These mergers and acquisitions that are taking place are resulting in a number of highly qualified CIOs in the job market.

Big Data Employment Boom

The data economy needs dedicated people — 4.4 million of them by 2015 in the IT field alone, according to a Gartner Research analysis. In the U.S., a McKinsey & Company report projects a shortfall of between 140,000 and 190,000 big data professionals with deep analytical skills by 2018. Additionally, the impact of big data on employment goes far deeper than the deep analytics and IT fields. Companies need professionals at all levels that are not necessarily educated in deep analytics but are nevertheless big data-savvy.

New C-Level Positions

The chief data officer (CDO) is a new position coming into play in the healthcare IT industry. Hospitals are using the role to try to "leverage data as a strategic institutional asset … It’s about how to transform data into information, how to transform information into better-informed decisions," according to Seattle Children’s Hospital CDO Eugene Kolker.

Another position that is becoming more popular in the healthcare IT space is the chief nursing information officer (CNIO). According to a Modern Healthcare report, about 30 percent of hospitals and health systems now have a CNIO and that number is expected to grow. CNIOs are helping hospitals implement their EHRs and other healthcare IT projects because of their expertise in how nurses use patient data.

Growing Job Market

The healthcare sector is poised to add 5 million jobs by 2020, according to a report by AMN Healthcare. The increased use of technology for healthcare applications is the primary factor for the growing job market. Healthcare job growth averaged 26,000 positions per month between March and September of this year, jumping significantly in the second quarter and continuing into the third quarter, according to the Altarum Institute’s Center for Sustainable Health Spending.

More Interim Executives

The number of interim executives is growing and the demand for interim talent has become apparent. This trend will become a growing part of the employment movement, especially in healthcare IT-related roles like CIOs and CMIOs. With the expected sizable number of baby boomers retiring, combined with the number of independent delivery networks and hospitals in the U.S., it’s easy to see that the demand will grow. This means that there will likely be a shortage of experienced healthcare executives in 2015, which means demand for interim healthcare executives will only grow over time.

Talent Shortage

As baby boomers retire in record numbers, the healthcare IT industry is feeling the pain of a talent shortage. In an article in InformationWeek.com, Asal Naraghi, director of talent acquisition for healthcare services company Best Doctors, says she “absolutely” sees an IT talent shortage. Tracy Cashman, senior VP and partner in the IT search practice of WinterWyman, also says she sees a genuine talent shortage. "There are more jobs than people who are skilled," she says. While she’s starting to see an uptick in engineering graduates, "we’ve been feeling this since the [dot-com] bubble burst," Cashman says, when college students were worried that all IT jobs would move to India. "And we’re still fighting that," she says.

Universities Offering Healthcare IT Degrees

Cloud computing, big data, mobile technology — three of the biggest trends in IT are changing the way the healthcare industry deals with information and creating a big need for trained healthcare IT professionals. Thus, colleges and universities have started offering healthcare IT as a major, where students learn what it takes to function as a fully capable software developer in any professional environment, but specifically tailor their skills to the rapidly expanding healthcare IT field.

Specialists in Demand

Today’s IT shops don’t just want experience, they want deep experience. “IT organizations are under intense pressure to deliver projects faster than before — and that need for speed necessarily influences IT hiring. The IT generalists, and even some topic generalists, such as infrastructure managers, have found their roles left by the side of the road, as project leaders hire for deep experience in specific niches, such as cloud security, DevOps, and data analysis and architecture.”

McGraw-Hill Education CIO David Wright says, "More and more, the hands-on coders, we’re looking for people who are just really deep in whatever discipline we’re trying to hire." And he isn’t the only one advocating for specialization; Asal Naraghi, Director of Talent Acquisition for healthcare services company Best Doctors, also says, “The trend has gone into more specialized skill sets."

Video Interviewing and Skype More Popular

The use of remote yet face-to-face interactions such as video interviewing and Skype is on the rise. Advanced technology is giving people a way to present themselves with depth and personality to hiring managers and recruiters. In addition, new hires meet the team before they even step in the office.

Interview Process Becoming Lengthier

The interview and hiring process have become more elongated in recent years, a trend that we can expect to see more of in 2015. According to Anne Kreamer, a journalist who specializes in business and work/life balance, “Data compiled for the New York Times by Glassdoor found that an average interview process in 2013 lasted 23 days versus an average of 12 days in 2009. And time-consuming assignments and auditions for candidates … are the new normal.”

Anthony Caponi is vice president of healthcare IT of Direct Consulting Associates of Solon, OH.

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December 3, 2014 Readers Write 1 Comment

HIStalk Interviews Lou Silverman, CEO, Advanced ICU Care

December 3, 2014 Interviews No Comments

Lou Silverman is chairman and CEO of Advanced ICU Care of St. Louis, MO.

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Tell me about yourself and the company.

The company has been doing tele-ICU work for the past seven or eight years with clinical founders. We’ve been growing steadily ever since.

I’ve been at the company for just a little bit under a year. My experience spans healthcare IT, revenue cycle management services, and clinical services. I’ve also had some exposure via being a board member to pharmaceutical companies as well as home care companies and data and analytics companies.

 

What are the key issues hospitals have with delivering ICU services?

The ICU units happen to be a place where a disproportionate percentage of dollars is focused and spent. ICUs typically have the very sickest of patients for the hospitals.

The staffing in ICUs can be challenging for a number of hospitals. The ICU obviously should be staffed 24x7x365. The gold standard for staffing includes 24×7 intensivist involvement. The supply — and therefore the ability to recruit intensivists — is variable across many hospitals, many markets, and in fact many geographies.

 

How many hospitals meet that 24×7 intensivist monitoring standard, and of those, how many do it using a remote service?

It’s a relatively small percentage of hospitals that have the gold standard of 24x7x365 bedside intensivists. The number of hospitals that are using tele-ICU services to supplement that is growing fairly nicely, but we are still in the very early stages of adoption of tele-ICU services.

I think it’s fair to say that those hospitals that have elected to adopt tele-ICU services have developed a keen understanding of, and keen appreciation for, the benefits that accrue to a hospital across many different parameters for making that selection. Recruitment of intensivists is difficult. Retention, just by the very nature of the job, can be a little bit difficult. Some markets are far easier to recruit from than others. 

In addition, just getting to uniformity of care, implementation of agreed-upon best practices … there are just many, many elements that hospitals are dealing with in their ICU.

We try to organize our thinking around focusing on outcomes, patient outcomes, implementation, and sustained use of clinical best practices. Doing all of those things in a ROI-appropriate manner.

You can group virtually all issues that hospitals face in the ICU into those one or more of those three areas. A good tele-ICU partner will help address in a compelling way each and all of those key areas.

 

What is the regional span or the geographical span of the services that you provide or that you could provide? Could it be a global service like radiology nighthawking with appropriate licensure?

Our company specifically is in 20 states today, but that’s just simply a nod to the fact that we’re growing and we’re adding states in a rapid way. The answer to your question from a U.S. perspective is that this is a model that would work in any state.

We focus on having  U.S. board-certified, U.S. board-eligible clinicians working with and for us and with and for our partner hospitals. Historically at least, that has kept the focus of our recruitment on U.S.-based physicians.

It is fair to say that there are some small companies that are starting up in other geographies outside the U.S. and trying to get into the business. Some of those, in fact, also are using U.S. trained and board-certified clinicians to staff their operations. Historically, I’m not aware of any situations where U.S. companies are providing services to hospitals in other geographies. I am certainly aware that tele-ICU services are starting to start up in countries other than the U.S.

 

How much of the care that’s delivered to ICU patients is driven by formal protocols and accepted evidence? How does the technology take that and turn it into your service?

At a high level, the technology that we are using is driven toward having excellent access to the patients and the relevant patient health data. We have in the technology that we use algorithms that give us advanced alerts when certain patient trends are moving in a negative way. That gives us a way for us to be alerted and for us to also work in partnership with the bedside teams that we collaborate with to ensure a rapid attention to deteriorating patient conditions.

In terms of clinical best practices, that is very much a collaborative approach that we engage in with our partner hospitals. We have developed, over time and over the 60 hospitals that we have under contract, a very good understanding of what clinical best practices are and how they’re best deployed in an ICU. But it’s also fair to say that in some cases, there is perhaps more than one opinion on what the best practice is or the timing for implementing that best practice. 

It is at some level not a “one size fits all” approach that we take. It is much more of a collaborative approach that we take with partner hospitals to establish an agenda of best practices that we want to collaborate and implement together. Once we have agreement on what we’re going to do and in what sequence, we work collaboratively to execute on that plan.

 

If a hospital has its own local intensivists but needs coverage assistance, can you do that and how is the technology used in that case?

A significant percentage of the hospitals that we partner with do in fact have some level of intensivist staffing. All of them have some level of bedside staffing. We’re not at the bedside. That’s an obvious condition of the partnership.

In terms of collaborating when there are intensivists in place, that is a regular practice for us. We are a 24x7x365 service. We provide is a robust and always-on data capture practice, where we are able to take data across all of the patients that are coming through the ICU. We are able to convert that data into actionable and informative reports that we provide to our clients and collaborate with our clients to understand exactly what’s going on with their patient flow in the ICU. How the ICU patients are faring across a variety of metrics in terms of outcomes and utilization of best practices.

That is a value-added service, even in the context of a collaboration with a hospital that has a certain number of intensivists at the bedside. ICUs historically have been not really robust in terms of the modern data that they’re able to pull on what’s going on within the ICU itself. That’s part of the service that we provide for all of our clients.

 

The deal that you signed recently with Adventist Health System — are they seeing results yet?

It is still relatively early days. We’ve had a very robust and on-time implementation process across all of the pilot hospitals that we have been working with at Adventist. I’m not prepared to share specific results publicly, but I can tell you that even though it is relatively early days, the returns thus far, both from a quantitative and qualitative perspective, have been extremely positive and extremely well received across all aspects of the partnership.

 

Do you have any final thoughts?

The whole notion of tele-ICU is a very timely idea. It’s certainly one we’re seeing increased interest as an industry. We’re seeing increased interest in us as a company. 

When you look at trends that are impacting the overall healthcare ecosystem — with people having much more to do than they have time for, budgets are strained, outcomes are a clear increasing focal point — what we do as a tele-ICU provider is very consistent with all of the directional trends that are going on in healthcare, going on in hospitals, going on in the ICU. It is still an emerging market.

Our own company, without making this an advertisement, is the largest player in the space. It’s a very interesting company. The cliché is being in the right place at the right time, but it’s not a cliché for us. We are at that place at that time.

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December 3, 2014 Interviews No Comments

Morning Headlines 12/3/14

December 2, 2014 News No Comments

Health Data Outside the Doctor’s Office

National Coordinator Karen DeSalvo, MD publishes a blog post touting a JASON report that HHS commissioned to explore “how to create a health information system that focuses on the health of individuals, not just the care they receive.”

Electronic patient records systems not ‘good enough’, says NHS CIO

In England, David Walliker, CIO of Liverpool Women’s NHS Foundation Trust says that he will pursue an electronic document management solution, rather than upgrading to a modern EHR, because the current systems available from CSC, Cerner, and Meditech are not yet viable options for the hospitals specialists.

Epic Systems backs down on noncompete clause

Epic backs down from an earlier decision to up its non-complete cause from one year to two for any recently departed employees that were trying to join Vonlay, a local health IT consulting firm. The employees in question had already left Epic and had only signed a one-year non-compete when they were hired.

Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care

The Bipartisan Policy Center will live stream a six-hour meeting on Wednesday called “An Oversight Framework for Assuring Patient Safety in Health Information Technology.” Speakers include National Coordinator Karen DeSalvo, MD, and McKesson CEO John Hammergren.

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December 2, 2014 News No Comments

News 12/3/14

December 2, 2014 News 13 Comments

Top News

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An ONC blog post by Karen DeSalvo, MD called “Health Data Outside the Doctor’s Officer” references a new JASON report titled “Data for Individual Health” (JASON is a highly regarded independent science advisory group run by DoD contractor MITRE Corporation). The report addresses the steps needed to move to “a system focused on health of individuals rather than care of individuals” in creating a learning health system. Some of its recommendations:

  • HHS: take action on previously created reports and measure progress.
  • HHS: adopt interoperability standards and incentives.
  • HHS: support open API standards and pay providers more (the report suggests a 0.25 percent bonus in CMS’s Hospital Value-Based Purchasing Program) for using “ecosystem-friendly EHRs” that follow those standards.
  • HHS: encourage non-profits (such as disease-specific advocacy groups) to mark consumer apps with their stamp of approval to increase their adoption.
  • Joint Commission and professional schools: add informatics training requirements.
  • FDA: loosen control of product services that could be construed as practicing medicine, for example, allowing apps to report their information to both provider and consumer as a risk mitigation strategy.

With regard to interoperability, JASON says the market is moving in the right direction and specifically notes that Epic (which the report says is regarded as “among the most closed systems”) has announced that it will develop APIs to allow external programs to interact with its systems. However, it says that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs. The new report suggests that the government encourage “an incumbent vendor with significant market share” to propose an open API standard to encourage the market leaders to step forward rather than being forced to follow a competitor-proposed standard. It also says FHIR is a significant improvement over CDA document-based exchange.


Reader Comments

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From Enumerator of Legumes: “Re: Laurens Albada. You mentioned that he appears to have left as CFO of Greenway Health. He’s now managing director of financial services with the consulting group of Vista Equity Partners, Greenway’s owner.” Verified, according to his LinkedIn profile. That’s a nice move up.


HIStalk Announcements and Requests

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Reminder: I’m collecting questions for CommonWell. If you want more information about its interoperability technology or strategy, send me yours

“Utilize” has been at the top of my “most annoying words” list for a long time since it is just a needlessly complicated way to say “use.” However, its top position has been recently threatened by “leverage,” which in a remarkable coincidence is yet another pompously pointless way to say “use.” Give marketing people their way and system users will be renamed “leveragees.”

Listening: Green River, an obscure mid-1980s hard-rocking Seattle band that arguably created what would later be known as grunge. They’re angry and armed with loud guitars that require me to provide air drums accompaniment. Two of the members later formed the similarly intense Mudhoney. I’m also enjoying the amazing Dinosaur Jr., late 1980s indie rock that remains fresh (and loud).


Webinar

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Microsoft acquires 18-month-old, 20-employee Accompli — which developed a slick, free, Exchange-enabled smartphone email management app — for $200 million. I’ve tried it with my Gmail accounts and it has some nice features, such as smart messaging organization, easy calendar access, Dropbox enablement, and one-swipe conversion of an incoming email to a calendar event. I don’t know how Accompli planned to make money other than by being acquired, so maybe it cleverly noticed Microsoft’s mobile email weakness and figured MSFT would eventually wave money in its direction with hopes of renaming it Outlook Mobile. Accompli had raised only $7 million of VC money in its short history, so that’s quite a score.

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Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group. The paper says that Epic got involved with the acquisition at the last minute by insisting that Huron not hire any Epic employees within two years of their resignation from Epic, meaning Epic would be enforcing a requirement to which its employees hadn’t agreed. The article says local speculation is that Epic is beginning to fear being held liable for violating antitrust laws, especially after Silicon Valley software engineers filed a successful class action against big-name tech companies for conspiring to not poach each other’s employees. According to the paper, Epic has also warned consulting firms that they can’t put up Madison area billboards or advertise within 50 miles of its Verona no-fly zone, also extending its workforce control by giving hospital clients maintenance fee discounts for honoring Epic’s non-compete agreement. Epic’s only official response to the non-compete issue was, “This is being reverted to a one-year term. We’d rather not comment on the policy as a whole.”


Sales

Gila River Health Care (AZ) chooses NextGen’s ambulatory PM/EHR.

Advocate Community Providers (NY) chooses eClinicalWorks for population health management and interoperability to support its Delivery System Reform Incentive Payment program for 437,000 patients.

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Grand View Health (PA) chooses Cornerstone Advisors Group to upgrade its Meditech Client/Server 5.6 system to 6.1 and to support its early adoption of Meditech’s web-based ambulatory product.


People

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Anthelio Healthcare Solutions names Gary Trickett (Allscripts) as SVP of IT services.

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Anthony Caponi is named VP of healthcare IT at Direct Consulting Associates.

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Allana Cummings (Northeast Georgia Health System) joins Children’s Healthcare of Atlanta as CIO.

Payer software vendor Healthx names Sal Gentile (TriZetto) as CEO.


Announcements and Implementations

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MedAssets will use Procured Health’s data intelligence and workflow solution in its product value analysis services.

Jackson General Hospital (WV) goes live with CrossChx’s SafeChx biometric patient identification solution in its registration area.

NextGen connects its Share platform with Merge Healthcare’s iConnect Network to allow NextGen Share users to send orders to Merge systems and receive images back.

The American College of Radiology and Massachusetts General Hospital (MA) will use Nuance’s PowerShare Network to present clinical guidelines in radiologist workflow and to automate PQRS data collection.

Ricoh will offer Levi, Ray & Shoup’s VPSX software to its healthcare enterprise output management customers.

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Hosted infrastructure vendor SingleHop had me all impressed with their announcement that they would sign Business Associate Agreements with healthcare customers, at least until I hit the part of their press release that said HIPAA is “also known as the HITECH act.” Close enough for government work, I suppose, and it is kind of confusing.

EHR vendor CureMD chooses DrFirst’s EPCS Gold to add e-prescribing of controlled substances (EPCS) to its system. DrFirst reports that EPCS volumes jumped by 200 percent in the most recent three-month period, likely boosted by New York’s I-STOP mandatory e-prescribing requirement for all drugs beginning March 27, 2015.

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Lawrence Memorial Hospital (AR) goes live with electronic forms from Access.

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PeriGen is awarded a patent for its software that assesses fetal descent in helping OB-GYNs determine when it’s appropriate to perform a C-section delivery. I really like the company’s laser-sharp focus on fetal monitoring and the innovations it has introduced there. One of my favorite interviews was with CEO Matt Sappern a couple of years ago, when he succinctly explained the company’s products as, “Our ability to apply technology to what has been a subjective part of labor and delivery is important. Probably 80 percent of medical malpractice comes back to bad interpretation of the fetal monitoring strip. We’ve figured out a way to apply technology to help interpret that strip. ” 

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Boston-area Gillette Stadium, home of the New England Patriots, announces plans for an upscale, expensive, members-only end zone suite that will be called Optum Field Lounge, named for the healthcare IT division of UnitedHealth Group that’s sponsoring it.


Government and Politics

The Bipartisan Policy Center will live stream a six-hour meeting Wednesday titled “Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care” with participants that include Karen DeSalvo from HHS and McKesson’s John Hammergren. The former is not surprising; the latter, a bit so.


Technology

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Google Glass is a consumer bust that hasn’t even made it out of beta status, but it appears that Intel will get involved in selling it to enterprises, according to a Wall Street Journal report. A new Intel-powered version of Glass will be released next year and Intel will promote it to workplaces that include health systems. The new Glass is expected to have a longer battery life because of Intel’s power-conserving chips.

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Victoria’s Secret launches a sports bra that includes hidden heart rate monitor sensors.

Dropbox will launch its business API on Wednesday, which will allow third-party developers to create enterprise applications on top of the storage service using their own rules for security, compliance, and workload integration.

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An investigation by cybersecurity firm FireEye finds that an apparently US-based hacker group called FIN4 is using email phishing (without the usual obvious mistakes made by non-native speakers) to obtain insider information from 100 publicly traded companies, two-thirds of them in healthcare and pharma, that it then uses to play the stock market. Two of the identified targets are unnamed healthcare providers. The hackers embed VBA code in a copied document that mimics the Windows authentication prompt, leading the user to think they’ve lost their network connection and need to log on again. Those credentials are then used to probe the victim’s email for useful information and then to use that account to send compromised documents to colleagues at other firms. They even create Outlook rules to delete incoming emails containing words like “hacked” or “malware” that might have been sent as warnings from associates or IT departments. Recommended security actions include disabling Office VBA macros, blocking specific domains the group uses, and checking OWA logins from known Tor exit nodes since real users don’t use Tor (an anonymity network) to read email.


Other

USC cardiologist Leslie Saxon, MD provides some fascinating quotes in discussing her rather startling recommendation that patient biometric data should be placed on Facebook for doctors to review and share.

Oftentimes, you’ll see a patient and they have a vague symptom. You see them for 0.00001 percent of their life and you have to contextualize, use your experience, do some guesswork and diagnostics to understand what’s going on. Your car has over 100 sensors. They’re wireless, it’s continuously monitoring itself and telling you when it’s going to get sick, providing you with this A.I. so people’s cars don’t break down as often any more. One of the things that’s really interesting about digital health and sensors is that we haven’t seen a lot of the data that’s being captured before, so we’re not sure how to contextualize it. I’ve been doing cardio electrophysiology for over 25 years. Now that I’m monitoring some of my patients all the time, I don’t know what some of this stuff means. We’re going to have to build these data sets, track clinical events, then go back and contextualize it—say, oh, okay that was a sign of that.

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In England, the CIO of Meditech client Liverpool Women’s NHS Foundation Trust says EHRs from CSC, Cerner, and Meditech can’t handle hospital specialty areas such as neonatology and OB-GYN and he’s putting efforts instead into implementing the open source Alfresco electronic document management system. He says, “As long as you’re seeing all the information pertaining to a patient, why should I put it in a single box and sacrifice the good things on the specialist systems so it’s all in one place? I think I could do a lot more good for patients with the money it would cost.” Once Alfresco is live, Microsoft Sharepoint will get the boot because he says it’s too expensive. Alfresco is available as a free online trial or download.

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In Australia, Royal Children’s Hospital, which will go live on a $41 million Epic implementation in 2016, is looking for a medical device integration vendor.

The Russian economy continues to tank (no pun intended) beyond mass doctor layoffs and hospital closures as sagging oil prices and Western sanctions apply a double chokehold, with Apple raising prices up to 25 percent to offset the devalued ruble, which dropped 6 percent against the dollar on Monday alone and 42 percent in the past year. That puts the ruble as the world’s worst-performing currency behind only the subject of its aggression, Ukraine. Food prices are skyrocketing and banks have restricted the swap of rubles for other currencies. Up to 10,000 healthcare reform protesters took to the Moscow streets Sunday morning, carrying signs saying “Save money on war, not doctors” and demanding that the city official in charge be fired.

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Highland-Cashiers Hospital (NC) mails letters to 25,000 patients explaining that its HIM contractor TruBridge made a configuration mistake that opened up some of their information to the Internet.

A literature review finds that while HIE usage probably has reduced ED visits and cost in some cases, no studies have been conducted that prove any particular benefit even though the government has subsidized their operation with $600 million in taxpayer money.

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Several children’s hospitals will offer their patients televisits with Santa in the eighth year of the Cisco Santa Connection program that uses the company’s Telepresence system.

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Bizarre: a corporate guy buys a USB-chargeable e-cigarette from an eBay user in China. He plugs it in and the cigarette phones home and plants malware.


Sponsor Updates

  • TeraRecon offers an upgrade program for its enterprise imaging customers.
  • Perceptive Software is demonstrating new features of its Acuo Vendor Neutral Archive and the newly announced Clinical Archive this week at RSNA. 
  • University of Arkansas for Medical Sciences reports significant nurse time savings from using Capsule’s SmartLinx to send medical device data to Epic.
  • PerfectServe posts a blog entry titled “Evolving Healthcare: Six New Realities for the C-Suite.”
  • Extension Healthcare CEO Todd Plesko will present a session on alarm management at the mHealth Summit in National Harbor, MD December 7-11.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 2, 2014 News 13 Comments

Morning Headlines 12/2/14

December 1, 2014 Headlines No Comments

Could Congress delay ICD-10 again next week?

Congress will soon vote to extend a $157 billion HHS spending bill that is scheduled to expire on December 11. Advocates working to delay the looming ICD-10 deadline, including the National Physicians’ Council for Healthcare Policy and the Texas chapter of the American Medical Association, are lobbying for a last minute edit to the “must pass” spending bill to include language that would push out the ICD-10 deadline by two years.

Penn Medicine uses predictive analytics to reduce sepsis mortality

After two years of use, Penn Medicine measures the perceived effectiveness of an early warning system it implemented to identify sepsis in undiagnosed patients. 46 percent of Penn’s nurses said the system alerted them to new information, and 34 percent of its physicians said the system was helpful.

How Do Alternative Payment Models Fit In With State And National Reform Efforts?

Health Affairs profiles the state-wide Medicaid payment reform effort being attempted in Oregon.

Hackers phish for advance word on healthcare mergers

A new report suggests that hackers targeting healthcare organizations are not just looking for PHI. Hackers have started targeting senior-level email accounts, looking for information that they can use on the stock market, specifically as merger and acquisition intelligence.

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December 1, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 12/1/14

December 1, 2014 Dr. Jayne 1 Comment

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As much as some of us complain about our jobs or life in the healthcare IT trenches, most of us have a lot to be thankful for. I experienced that first hand this week with an emergency department shift that was unlike any I’ve ever worked.

I was called to work at the last minute. That should have made me suspicious, but it was a post-holiday shift so I figured it was just poor planning on someone’s part.

To start things off, the entire hospital was on lock-down due to protests across the country and a specific threat of protests near our facility. Unfortunately, there wasn’t any mechanism to communicate that to staff members in advance.

The only entry is through the main lobby. Nurses, patient care techs, and physicians were wandering around the building swiping our badges since we didn’t know what was going on. Once people got to the other side of the building and made their way in, they were late for their shift, which is never a good way to start.

Instead of having clear communication from hospital leadership (not like we all have email addresses or anything), we had to rely on what people had heard through the rumor mill. About 30 minutes into the shift, we finally got a straight story from the charge nurse. It didn’t make any difference to the way we were caring for patients, but it allowed us to mentally prepare for what might be coming our way should we have an actual protest at the hospital or receive casualties from nearby incidents.

Mentally preparing was all we could do since there apparently isn’t a policy and procedure for how to handle civil unrest. The other doctor on shift with me joked that we were ready to handle Ebola, yet had no plan for something that was actually likely to happen given recent events.

I fired up Twitter on my phone and immediately subscribed to the local media, figuring that would be a decent way to keep tabs on the situation. All of the local TV stations had been blocked by IT, but one of the EMS guys pulled up Broadcastify at the nursing station, which let us hear police scanner traffic. Patients were another good source of information since the threat of a protest certainly didn’t keep anyone from coming in.

As a safety-net facility, the staff is used to working under stressful conditions. Most took it in stride. I work at this hospital only a handful of times each year and it always impresses me how well it holds together even though there may be a substantial amount of duct tape and some baling wire involved.

I was running the fast track side of the ED, so I didn’t expect to see any major trauma if things got rough, especially since the hospital lowered their trauma center level a couple of years ago. In the morning, most of my cases were truly primary care – people who had run out of their medications due to the clinics being closed and not having refills, sinus infections, colds and flu, and so on.

I was grateful for the defaults in my EHR that let me document the visits quickly since our volume was picking up. Towards the lunch hour, there was an announcement that protesters were at an intersection about a quarter of a mile from the hospital. We expected things to slow, but they didn’t.

I saw a couple of Thanksgiving-induced casualties (pro tip: if you cut yourself while cooking, you need to have it stitched up within 12 hours or there’s not much we can do) including a woman who had her hand smashed in a shopping center door during the Black Friday madness. What really made me think of Thanksgiving, though, was realizing just how many times I had searched for non-English versions of patient education handouts during the shift. As much as we sometimes complain about EHRs, this time ours performed like a champ.

I looked through my “complete chart” board and realized I had seen patients from Somalia, Ethiopia, Bosnia, Iraq, Guatemala, Mexico, and China. It’s powerful to know that despite its flaws, we live in a country where people are willing to leave their homes and families for a chance at something better.

Ultimately, the protesters never approached the hospital. Other than being one of the busiest shifts I’ve ever worked, it was pretty unremarkable. I feel privileged to be able to care for such a diverse population and am definitely glad the EHR was up to the test.

Have a story about the EHR actually making life easier? Email me.

Email Dr. Jayne.

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December 1, 2014 Dr. Jayne 1 Comment

HIStalk Interviews Ken Graboys, Managing Director, The Chartis Group

December 1, 2014 Interviews No Comments

Ken Graboys is managing director of The Chartis Group of Chicago, IL.

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Tell me about yourself and the company.

Every firm is, to some degree, at its outset a reflection of the values of the motivations of its founder. I started in the Peace Corps, opening feeding centers and health centers in the drought areas of Africa back in the mid-1980s. When I came back to the US after several years, I knew that in my life, healthcare was where I wanted to try to elevate the human experience. In our country alone, there were enough challenges to keep me busy for a while. 

I began work with a gentleman named Ira Magaziner, who at the time had a small consulting firm. It was a public policy and industrial policy firm that did some work in healthcare. After a couple of years, he was brought into the Clinton White House to help with healthcare policy. He asked some of us if we wanted to go to Washington. 

I really loved consulting because I thought it created the opportunity to make change happen in real time in a customized, localized way. And that if you do it the right way with forward-thinking clients, it has the chance to create solutions that would be a beacon that the rest of the industry could look towards and take their direction from. While I believe that public policy and regulatory influences can do a lot to drive healthcare towards a better place, I also think there’s a place for real-time development and prototyping of solutions. It is something I enjoy immensely.

He went to Washington and I went to work for a company called APM and worked there for 10 years, ultimately leading a large part of that firm. When APM sold to CSC to go into the space of IT outsourcing, myself and another individual named Ethan Arnold decided that we would start Chartis under a dual proposition. One, that a consultancy could exist that could help advance healthcare, predicated on thought leadership and conducted in such a way that we work side by side with our clients. Kind of like a great doubles team in tennis, where we work with folks who are the best at what they do where we both love what we do and together we can elevate each other’s game and make something wonderful happen.

The second proposition was that as a mission-driven firm built around improving healthcare, we could influence the industry and enrich the experience of those who are the recipients of healthcare, those who work in healthcare, and those that support it.

Those two sets of values were the cornerstones of the firm. We had no idea what we would be working on. We just knew that on our deathbeds we wanted to say we tried. 

Thirteen years later, we’ve been very, very fortunate. We work in an industry filled with visionaries, filled with incredibly smart, thoughtful folks who are also about enrichment. There’s been a resonance between what we try to do and our clientele. This made for a wonderful experience, and I think in many cases, real advances for healthcare and the communities that have been served.

Today we’re about 130 people pre-Aspen. We have offices in Boston, New York, Chicago, and San Francisco. Our principal area of focus has been strategic planning, accountable care solutions and network development, and clinical transformation.

 

Which of the projects you’re working on show the most promise in making healthcare and society better?

I’d like to believe that every one of our projects has in its way contributed to advancing the state of healthcare. Some have been from large national systems, thinking through, what does it mean to be a national system? What does it mean to provide care in respective communities across the country? How can that model bring more benefits to bear? 

In some cases, we work with large regional health systems and help them move in a material way from their being volume-based to value-based, being based around care of a population, care of a defined group, care of a community in ways where the business model, the clinical model, and the overarching health and wellness model are intimately combined. 

We do a lot of work with rural hospitals, metropolitan, urban hospitals that are challenged. Their world may be 10 blocks, or in some cases, it could be a 60-mile radius, underserved populations that are rethinking how care is delivered and with whom access is improved and outcomes are enhanced.

Everything we try to do is built upon our mission and our clients’ mission. Those are the things that endure. Those are the things that are material in their impact.

 

What led to the acquisition of Aspen Advisors and how do you see that organization fitting into your mission?

Beginning about three years ago, it became very clear to us — and it should have, if you’re a halfway decent strategist — that the role of information technology in the future of care delivery was evolving at a hyper rate. From a historic role as an enabler –  the downstream to-do list for a health system or provider — to a business tool, to the future of care delivery. Information technology as defined in its broadest terms becomes the means of taking care of a community’s health. Your capabilities around aggregating, re-imaging, and employing information and the means by which those data are relayed and transmitted and applied is going to become central to what it means to be a healthcare delivery provider and to be a patient or a consumer of those services. 

The  role has evolved very quickly. If we were to continue to be at the vanguard of the advisory services for our clients and making big things happen, we had to be able to provide our clients leading edge thinking on that front and do so in a way that’s fundamentally integrated with their strategy, their clinical models, and their financial models. 

We knew we would have to bring that to bear and began a process of saying, who would be the right organization to work with? Is there another organization out there that is similarly mission-driven whose values and culture are around enrichment and around impact, and around the collective. Is there another organization out there? This is really hard to do, bringing two organizations together like this. We also need one that’s intellectually compatible and thinks about the world the way that we do and wants to do the same things and is seen by clients the same way that we hope we are. 

We felt incredibly fortunate to have crossed paths with Aspen at a couple of different clients. Dan Herman and I spent time together. Our world views, our organizational aspirations, and our missions were aligned. After about eight or nine months, it entered our minds that we can maybe do something really special in the industry. Life’s too short not to try.

 

What technologies or what use of technologies do you see as most promising and what will you work on with the talents that Aspen brings to the table?

Aspen brings the magic of thought leadership to bear that we think marry it well to where the industry is headed. Chartis, historically and now with a combined organization, hopes to provide some relative contribution.

At the broadest strategic level, we have clients that are asking the question, as we think about our next five- to seven-year strategic plan, it’s not enough to think about traditional growth. I had one CEO of a $10 billion-plus system ask me, how do I get our care delivery platform in the palm of one-third of this city’s population? That’s where I believe healthcare’s going and I believe that’s going to be the first visit in the future. We may not be able to provide every element of care along the way, but we want to be that guide, we want to be that starting point, we want to be that to the patient.

That’s emblematic of the belief that the relationship between the patient, the consumer, and his or her health data and his or her health management and the means by which that occurs through technological tools and capabilities are going to fundamentally change. The nature of that relationship will change, the relationship between the provider and the consumer and provider and physician and the underlying business model. Helping our clients think about that has become an increasingly important question and Aspen has great strategic thinking about that.

There’s a second set of questions around how we apply the business model to our population health capabilities and what’s the underlying information technologies associated with that. But again, it’s like a missing bridge for some of our clients, and to some degree the industry itself. It’s another area where Aspen is incredibly helpful.

The third area is that for the organizations that have made major investments at this point in the EMR, how do we take it to the next step in terms of how an EMR can help us transform our care delivery platform and the alignment amongst our caregivers across the continuum and do so in a way where outcomes are much better and the underlying processes more efficient and safer? This has been an area where Aspen really shines.

For a lot of our clients, the CFO is concerned that as as the economic model shifts and the clinical model shifts for the organization, can we make sure that our revenue cycle technology manage a divided reimbursement? This is again a center of excellence for Aspen.

Finally, I think where Aspen started and the core of its strength is that for a lot of organizations, you have this huge blueprint of things that have to be done. You have an information technology platform, department, and set of capabilities internally that is left with the incredible challenge of getting it all done. The best means of doing that and how to do that, the sequencing that’s most effective at furthering that, can be a significant piece of work for an organization. It’s an area where we can be helpful as well.

 

You mentioned the health system that wanted to have their presence in palms everywhere. That made me think of the retail drug chains, which are way ahead of the average health system in putting out technology that not only captures more business for them, but also captures the engagement with their end user and provides them a lot of entry points along with their physical entry points — stores, retail clinics, that sort of thing. Are the technological capabilities of health systems up for that competitive challenge?

I don’t know that any particular segment is ideally situated to own that future component of the care delivery landscape. There’s an obvious real advantage that the retail space and those that put capital behind it, be that Walmart or CVS. 

If you spend time out in California and you see where the venture dollars and private equity dollars are going in terms of healthcare technologies and what they’re trying to do for access, they want to be everywhere. Some have prognosticated–and I’m not saying this is an informed prediction by any stretch — that they can imagine a day where a vast majority of private care business will occur through WebMD and will be paid for through insurance.

I don’t know that anyone knows where the data revolution will end and who will own what, except that the end state will be that the patient will have a different relationship with their own data and what they can do with it that where they are today. To that end, certain providers will have the opportunity to have a meaningful role in that, be that because they have enough scale or capability or because they’ve decided to participate in the commercialization of some of the required technologies outside their own house or because they’ve formed an appropriate consortium to do that. But I think we will see organizations emerge — and mixed partnerships we’ve seen in the past — where providers will do this, to play in that space in a meaningful way and not be downstream from it. 

These are these the questions that we try to help our clients answer on a strategic basis. We’re even better at it now that we have Aspen as a part of the thought leadership around the solutions.

 

You experienced during your time in Africa the perception that public health projects are exported from countries with highly developed healthcare services delivery to those with less-developed healthcare services delivery. Do we understand in the US that we can’t ignore public health?

I don’t know that anyone would suggest that public health can be ignored. I think there’s a belief that it’s essential. I think the strength of that belief is opposed by some economic realities of our superstructure that challenge the ability to place resources against the merits.

When you look at the dollars in Massachusetts, for example, that over the past decade have been spent to support interventional care delivery today for those who are underinsured or uninsured, they directly offset the dollars that have historically been spent on not only public health, but the socioeconomic programs that actually influence the health of the public, such as education, economic development and employment programs, housing programs. All the factors that contribute to the public health.

The challenge we have is that public health is well believed in, but the resources are increasingly drained from being applied against it. That burden, that unfounded mandate of shifting the economic superstructure towards health, falls upon the providers. They have to manage and capitalize and fund that cost of change. It’s a real challenge. 

Sociologists define problems as discrete problems and wicked problems. Discrete problems are those that have normal inputs and outputs. You just want to build a bridge across the Hudson. You know the inputs, the distance, the amount of traffic that will go over it, the weight requirements, etc. You can define a discrete output.

Dealing with the health disparities in this country and the underlying economics — that’s a wicked problem. The inputs are multi-variant and some of them are latent.  The best we can all do together – providers, physicians, advisors, public health officials – is just work our best to advance the ball down the field as far as we can get it and just keep making it better.

 

You are an altruistic person whose primary business is helping big health systems that are economically motivated to act in their own self interest. If you can help make them successful, is that enough to satisfy you that you’re helping humanity in general?

I have two thoughts if you’ll let me share them both with you. The first is that we feel very fortunate because the clients we work with are similarly mission-driven as we are. It’s about improving healthcare and it’s about swinging for the fences. The folks we work with want to make meaningful change happen for their communities in big ways. We feel very privileged to work with those types of clients. I feel not only very, very good about the impact our clients are having that we play some small part in, but I feel very good about what it means from a mission and social perspective.

When I was in Africa back in 1986, I opened a feeding center in the Sahara on the Malawian border. Every day we would give out several metric tons of food, mostly raw grains that would come in these big burlap sacks. On the burlap sack, there would be a shield symbol representing USAID – US Agency for International Development. Coming in with the food supply shipments would be a report showing where the source dollars came from that provided that food. Often there would be workers in various factories and plants that were taking part in this African food initiative where they checked the box on their forms and gave a dollar a week to famine relief, back during “We Are the World.” It was a very big social issue.

I’d be there handing out these sacks. On one hand, it felt great to be a part of a solution. On the other hand, I realized the only reason I was there is because someone in Dearborn or Flint, Michigan had said, “I’ll give a dollar.” You realize that we’re all just links in a chain. We’re threads of a fabric that together can do great things, but apart, not much. 

I feel really good about the link in the chain that we are and what we can do, but I feel even better about the chain. We’ve worked with great folks over the last 15 years. There are a lot of good folks doing a lot of great things. We feel very fortunate to be a part of it.

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December 1, 2014 Interviews No Comments

Morning Headlines 12/1/14

November 30, 2014 Headlines No Comments

Cloud solutions firm 8K Miles buys electronic health record co SERJ

8K Miles, a technology company that offers cloud-based software solutions, acquires SERJ Solutions, a consulting firm focused on Epic EHR implementation support. 8K intends to use its newly acquired healthcare IT expertise to build a cloud-based healthcare solutions business.

Vista Equity Partners to Pay $1.1 Billion for British Software Maker

Vista Equity Partners acquires UK-based Advanced Computer Software Group (ACSG) for $1.14 billion. ACSG is a 20-year old EHR vendor with a growing market presence in primary care, home health, and mental health markets.

Google Glass Is Dead; Long Live Smart Glasses

MIT’s Technology Review forecasts the demise of Google Glass, but predicts that the first generation device has created enough interest in a glasses-based form factor that Google and others will continue working on it and eventually develop a glasses-based wearable with consumer appeal.

Electronic Health Records; How Will Students Learn If They Can’t Practice

An article in the Annals of Family Medicine calls on medical schools to incorporate hands-on EHR training into traditional medical education curriculum, despite concerns over the effect medical student contributions would have on billing practices and overall data integrity.

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November 30, 2014 Headlines No Comments

Monday Morning Update 12/1/14

November 30, 2014 News 3 Comments

Top News

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Cloud solutions provider 8K Miles Software Services acquires 30-employee Epic consulting firm SERJ Solutions. 8K Miles says it will use the newly acquired expertise to create cloud-based healthcare solutions. I was curious about SERJ’s self-proclaimed marketplace difference, which it describes as follows: “Through our unique and multi-faceted approach, SERJ is able to ensure your EHR implementation is successful by providing strategic and subject matter expertise, software tools to increase productivity and provide an immediate return on your investment, and a proven post-implementation support model.  We are committed to our clients, every step of the way.” Here’s a challenge: name one consulting firm’s “why we’re different” statement that suggests that they really are different in specific ways. I’m not saying there aren’t any, just that they are rare. 8K Miles is headquartered in San Ramon, CA and has an office in Chennai, India, which might explain why all seven members of its leadership team have Indian names. Meanwhile, even though 8K Miles declined to announced what it paid for SERJ, its CEO tells a financial site in India that it paid what I think is $2.5 million cash (if I did the conversion from Rupees Crore correctly) plus a potential earnout, with SERJ taking in annual revenue of $6.4 million.


HIStalk Announcements and Requests

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Half of the respondents to my poll say they’ll use less IT-related consulting in 2015 as they did in 2014, with 14 percent predicting they’ll use more. New poll to your right or here, in a repeat of my 2011 poll that named a clear and possibly surprising winner: which city has the strongest claim to call itself the US capital of healthcare IT? Perhaps the winning metropolis will arrange an official and expense-paid visit for the award-bearing HIStalk delegation.

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Some folks involved with CommonWell Health Alliance have offered to answer questions from HIStalk readers after seeing several comments here. Send me anything you’d like to know about its technology, plans, business model, or anything else and I’ll get their response.

This week on HIStalk Practice: MediGain acquires Millennium Practice Management Associates. HIE-sponsored patient portals face an uphill adoption battle, while Epic’s portal wins rave reviews. Notes from the Health IT Leadership Summit. Dr. Gregg offers “It Do and It Don’t” observations on the impact of MU. Drchrono integrates biometric authentication into its EHR. James Stevermer, MD answers five questions. PracticeFusion docs see almost zero patient demand for wearable data integration. MD Mama puts being thankful in perspective.

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

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Listening: new from Brooklyn-based power pop band Nude Beach, which sounds like Tom Petty singing lead for The Replacements. I’m also revisiting concert video from the best live band in the world: Sweden’s The Hives, featuring the singer Mick Jagger wishes he could be, Howlin’ Pelle Almqvist.


Last Week’s Most Interesting News

  • ECRI Institutes includes missing or incomplete EHR information in its “Top 10 Health Technology Hazards for 2015”
  • CMS extends the 2014 Meaningful Use attestation deadline from November 30 to December 31 because its attestation software wasn’t ready in time.
  • Beth Israel Deaconess Medical Center (MAI) pays $100,000 to settle a state complaint involving an unencrypted stolen laptop.
  • In Canada, a Montreal newspaper agrees with the health minister that the province’s $500 million EHR project is “an abysmal failure.”
  • Emdeon announces that it will acquire Change Healthcare for $135 million. Change Healthcare markets a benefits management system focused on helping employees make the most of their health benefits,

Acquisitions, Funding, Business, and Stock

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Vivify Health receives a reported $15 million in Series B funding. The Plano, TX-based company offers remote patient monitoring and care coordination tools.

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Vista Equity Partners will buy British software vendor Advanced Computer Software Group for $1.14 billion. The company’s healthcare-related offerings include a community-based EHR and software for home care, ED, and long-term care.


People

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James Parks, former CIO of Box Butte County General Hospital (NE), is sentenced to three years in prison for storing child pornography on his hospital PC, discovered by his own IT staff who were investigating a hospital-spread virus that originated on his device.


Announcements and Implementations

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Johns Hopkins Nursing magazine covers the September switch of Johns Hopkins Bayview Medical Center from skilled nursing facility to specialty hospital, which including moving it from paper to Meditech.

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GE Healthcare announces keynotes for its Centricity LIVE 2015 user conference, April 29-May 2, 2015 in Orlando: Atul Gawande, MD, MPH (surgeon and author), Melissa Etheridge (singer-songwriter), and LeVar Burton (actor, director, and the guy who wore what looked like a car air filter over his eyes in “Star Trek: The Next Generation”).


Innovation and Research

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VGo telepresence robots, tablet devices, network equipment, and software from Vecna Cares are sent to Ebola treatment units in Liberia, moving paper-based recordkeeping to electronic. Robotics researchers hope the telepresence robots can serve as interpreters, deliver supplies, decontaminate equipment, and bury deceased Ebola patients.


Technology

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An MIT Technology Review article titled “Google Glass is Dead; Long Live Smart Glasses” says interest in Glass has rapidly evaporated as Google has lost key personnel and failed to advance the product from geek beta experiment to consumer mainstream. The article says Glass’s biggest problem is the way “Glassholes” look wearing the device and concerns by those nearby that they are being unknowingly recorded. The article says the technology is fine, but the form factor needs to evolve so that the technology is hidden within the glasses instead of being perched like a prism on top of them, perhaps even being incorporated into a contact lens. It’s a tough break to have developed an entire business around an orphan product that may never make it out of beta. Meanwhile, disillusioned Glass Explorers are trying to unload their devices on eBay for less than the $1,500 they ponied up to get preview versions.


Other

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Gilbert Lederman, the former director of radiation oncology of Staten Island University Hospital (NY) will pay $2.35 million to settle Medicare fraud claims. He is best known for (a) his hospital commercials that ran on New York radio; (b) pestering a dying George Harrison to sign his son’s electric guitar; and (c) turning his office walls into a self-promotional billboard, as described by New York magazine as, “the kind of celebrity shrine you see in Italian red-sauce joints.”

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An internal email provided by a reader contains more details on the Epic outage following its October 26 go-live at England’s Cambridge University Hospitals Foundation Trust.

University Hospitals (OH) fires an employee for inappropriately accessing the electronic medical records of 692 patients.

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At least 5,000 Russians, many of them doctors, march through Moscow to protest a healthcare reform plan driven by sagging oil prices and Western sanctions that would eliminate up to 10,000 physician jobs and close 28 hospitals and clinics in the next few weeks. Proponents say the actions are necessary to enact President Vladimir Putin’s pledge to increase physician salaries to twice that of the average employee by 2018.

An Annals of Family Medicine editorial written by ADFM’s Education Transformation Committee says medical school graduates require EHR competence that can be gained only by first-hand experience, recommending that supervised, patient-centered EHR use be added as an Entrustable Professional Activity even though some medical schools bar such access since students aren’t allowed to bill for their services.

The always-entertaining folks at pMD post Thanksgiving-related ICD-10 codes on their blog:

  • W61.42XD – Struck by turkey, subsequent encounter (drily noting, “If you find yourself confronted with a live turkey, you may want to rethink your Thanksgiving strategy”).
  • W29.0 – Contact with powered kitchen appliance, subsequent encounter.
  • K21.9 – Gastro-esophageal reflux disease without esophagitis (aka “heartburn and indigestion).
  • W52.XXXA – Crushed, pushed or stepped on by crowd or human stampede, initial encounter (a Black Friday special).
  • W22.02XA – Walked into lamppost, initial encounter (alcohol-fueled parade mishaps).

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The career development team at Besler Consulting ran a Thanksgiving food drive for the South Brunswick, NJ food pantry.

Also running a holiday food drive, this time a virtual version: Aprima employees are collecting money for the fifth year for Metrocrest Social Services, which serves communities near the company’s offices in Carrollton, TX. They like the “virtual food drive” idea because the organization pays less than retail and can provide fresh foods instead of just canned goods. Last year Aprima’s employees provided more than six tons of food, double that of the previous year. 

 

Vince Ciotti’s inaugural CLAS Report names Epic #2 in a very important category, with the billionaire-led company losing to a thousandaire who packs a size advantage.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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November 30, 2014 News 3 Comments

Morning Headlines 11/26/14

November 25, 2014 Headlines No Comments

Top 10 Health Technology Hazards for 2015

ECRI publishes its annual list of health technology hazards, with inadequate alarm configuration topping the list, and incorrect or missing data in EHRs coming in second.

Nuance Announces Fiscal 2014 and Fourth Quarter Results

Nuance announces Q4 and FY2014 results: for the quarter, revenue was up 6.4 percent to $502 million, resulting in a net income of $107 million, EPS $0.33 vs $0.30. The company ended the year with $1.9 billion in revenue, up from $1.8 in FY2013.

Addenbrooke’s Hospital paperless system’s ‘significant problems’ reported

Addenbrooke’s Hospital, Epic’s first UK customer, is forced to divert incoming emergency department patients for five hours after the ED module became unstable.

MRMC’s fiscal year starts with a loss

The CIO of Magnolia Regional Medical Center (AR) reports that the hospital will need to return $287,000 in Meaningful Use incentive payments, despite passing what he describes as an “intense” MU audit.

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November 25, 2014 Headlines No Comments

News 11/26/14

November 25, 2014 News 2 Comments

Top News

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ECRI Institute announces its “Top 10 Health Technology Hazards for 2015”:

  • Setting medical alarms incorrectly.
  • Incorrect or missing information in EHR and other IT systems.
  • IV line mix-up.
  • Inadequate sterilization of surgical instruments.
  • Ventilator alarms incorrectly set to warn of disconnection.
  • Improper use and failures of patient-handling equipment such as lifts.
  • Inadequate training on robotic surgery systems.
  • Inadequate cybersecurity for medical devices and systems.
  • Lack of hospital resources to manage medical device recalls and software updates.

Reader Comments

From Tank Girl: “Re: consulting downturn. Implementation staff augmentation business is tough and rates are down. Strategic IT consulting is good if not on an upswing.” A couple of readers made similar observations – the hardest-hit companies are those that were just reselling go-live bodies without adding much value otherwise.

From Smitten: “Re: Karen DeSalvo’s closing address at AMIA. A remarkable performance. She walked up to the podium in front of several hundred, spotlight in her face, a stapled speech or whatever it was in hand, but no matter. Without glancing at it once, she spoke close to 30 minutes straight, without hesitation or stumbling, and lost neither the story nor the passion. She lacked neither humor or emotion. National Coordinator is nice, but if this woman does not become Surgeon General, then we’re missing a gift-wrapped package on our doorstep. Count this as a wager.” I didn’t see video from her AMIA talk, but here’s her TedXNOLA presentation from 2010.


HIStalk Announcements and Requests

It appears that a spammer is spoofing the email address Imprivata used early this year for HIStalkapalooza announcements. I’ve been getting a ton of junk mail from histalkapalooza2014@imprivata.com with a purported fax link that’s actually a malware page. Obviously you don’t want to click the link even though the return address belongs to a company offering secure communications technology.

Holidays are good times to recognize the contributions of employees, so consider my “Beacon of Selfless Service” award. Managers, peers, and customers can nominate a non-management employee (vendor or provider) who went above and beyond. I’ll also be running recaps of holiday-related company good deeds or celebrations over the next few weeks, so feel free to send those along, preferably with a photo or two.

Apple’s iOS offers a nice option to disable auto-play videos when visiting a site over a cell connection. Every browser should have the option to suppress auto-play videos (including not just Flash-based video, but HTLM5 too). I haven’t found anything that works reliably yet, so I’m still jumping a foot in the air when I click a story on a new or sports site and the video I didn’t want to see starts playing automatically and loudly. I really dislike auto-play video.


Acquisitions, Funding, Business, and Stock

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CareTech Solutions provided a statement following my Monday report that the FTC granted its approval for an acquisition by IT/BPO outsourcer HTC Global Services: “CareTech Solutions has made an ‘Intent to Sell Filing’ with HTC Global Services, a Troy, Michigan based global provider of IT solutions and business processing outsourcing. We are now undergoing the necessary administrative process that goes along with this filing. At this time, there is currently no agreement.”

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HIMSS acquires the Online Journal of Nursing Informatics, a free, quarterly, online-only journal produced by team of volunteers.

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Streamline Health Solutions gets a $10 million credit facility.

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Nuance reports Q4 results: revenue up 6.4 percent, adjusted EPS $0.33 vs. $0.30. Healthcare sales rose 7 percent to make up 47 percent of Q4 revenue. Chairman and CEO Paul Ricci said in the earnings call that revenue is growing and operating margins are stabilizing after two years’ of decline.

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Covisint will depart the Detroit building of its former parent Compuware, moving its headquarters and 250 employees to Southfield, MI after choosing Michigan’s incentive package over offers from Austin, TX and Raleigh, NC.


Sales

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Robert Wood Johnson University Hospital extends its Allscripts Sunrise contract through 2020 and will use TouchWorks as the EHR for its network.

Memorial Healthcare (MI) will replace pagers with Imprivata Cortext.

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Kennedy Health System (NJ) chooses eClinicalWorks Care Coordination Medical Record and Electronic Health Exchange.


Announcements and Implementations

Scottsdale Institute releases an IT strategy report from a CIO roundtable at its September summit, sponsored by Impact Advisors.  I didn’t see anything surprising or particularly insightful in its recommendations from eight big-system CIOs to support hospital consumerism:

  • Focus on the patient and family experience
  • Maximize use of patient portals
  • Implement e-visits and telemedicine
  • Improve use of mobile technology
  • Develop a retail strategy
  • Improve IT security via standards and user training
  • Implement analytics carefully
  • Reduce variability
  • Develop software in-house as needed to fill gaps

Lakewood Health System (MN) will participate in the Medicare Shared Savings ACO of Essentia Health (MN) and will use its Epic EHR under Epic’s Community Connect program. Lakewood went live on McKesson Paragon in 2012.

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TransUnion Healthcare announces that the KLAS’s new patient access report rates the company as the highest-performing vendor for its patient pay estimation and propensity to pay solutions.

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University of Iowa Hospital and Clinics wins the enterprise Davies award. They’re on Epic.


Government and Politics

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CMS extends 2014 Meaningful Use attestation deadlines for hospitals from November 30 to December 31, primarily because CMS didn’t get its own software ready in time to meet the original date.

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The CEO of 49-bed Magnolia Regional Medical Center (AR) tells its board that the hospital had to return $287,000 in HITECH money after undergoing a Meaningful Use audit.

A draft bill created by Senators Orrin Hatch (R-UT) and Michael Bennet (D-CO) would limit FDA’s jurisdiction over EHR and other medical technology that its authors label as having low risk to patient safety.


Innovation and Research

A literature review concludes that corporate wellness programs increase employer healthcare costs while providing no net health benefit.


Technology

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Proof that Twitter’s user interface is somewhere between baffling and maddening: Twitter’s CFO accidentally tweets out to the whole world (instead of his intended individual recipient) an acquisition-related message.


Other

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In England, a county review of the $300 million Epic implementation of Cambridge-affiliated Addenbrooke’s Hospital finds that ED performance dropped 20 percent after go-live and the ED had to go on diversion after the system went down on November 1. Hospital executives have been denying significant problems, admitting only minor problems with a blood transfusion analyzer interface. Chief Clinical Officer Afzal Chaudhry, MBBS,PhD (above) says the implementation is going well given its large scope.

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Eight hospitals and several practices went back to paper for several hours Monday when a data center power surge took down the IT systems of Eastern Maine Healthcare Systems (ME), which had eliminated 40 IT positions a few weeks ago to reduce annual expenses.

The Cincinnati business paper covers University of Cincinnati Medical Center’s eight-patient clinical trial in which tablet-powered systems from Intel-GE Care Innovations are being used to monitor discharged liver transplant patients.

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An article written by a former advertising executive and Presidential speechwriter five days before he died of prostate cancer on October 31 describes the fighting between his oncologist and insurer over his treatment. He said he and his doctors followed every rule of Health Republic / MagnaCare, but the insurance company refused to pay after waiting five months to claim his doctors were out of network, ignored his calls, blamed him using for incorrect physician codes, and said his doctors were lying to him about being in network.

For I know now how this company really feels about their customers. It was perfectly expressed in the letter I received last week when they tried to explain why they were turning down my oncologist’s request for that critical cancer test. It was, of course, a form letter. Very legal. “The request for outpatient medical services has been reviewed and has not been certified.” But they gave themselves away with a very strange sentence—their only effort to acknowledge me as a human being. It read: “Member is over 85 year old and continues to smoke.” So, that’s it. According to my insurers, I have already lived too long. And because, until recently, I enjoyed my two or three cigarettes a day, I am a bad boy who is not worth the cost of keeping alive. No wonder they won’t pay.

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The medical license of a New Mexico OB/GYN who is also the incoming president of the state medical society is suspended after charges that he had sex with patients and his employees, was inebriated while seeing patients, left a woman in labor so he could have sex with another patient, and wrote “inappropriate notations of a personal nature into certain patient medical charts.”

Weird News Andy says “8 Million a Second” isn’t Judy Faulkner’s salary, but rather the number of bacteria that are transferred during an intimate kiss, with the result that romantic partners share the same “microbiota” on their tongues for at least hours after kissing and and sometimes permanently. WNA also cites another study in which kissing was found to chemically reduce stress and increase bonding, also observing found that men prefer “sloppy” kisses as a prelude to amorous activity because those kisses transfer testosterone.


Sponsor Updates

  • Salar’s clinical documentation and billing solution, TeamNotes, earns Meaningful Use 2 certification.
  • Fujifilm announces that it has installed 4,000 Synapse PACS, making it the most widely used medical informatics vendor.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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November 25, 2014 News 2 Comments

Morning Headlines 11/25/14

November 25, 2014 Headlines 1 Comment

EHR Program Announcement

CMS extends the Meaningful Use attestation deadline from November 30 to December 31.

Congress ponders health IT regs and the FDA, again

Senators Orrin Hatch (R-Utah) and Michael Bennet (D-Colo) are collaborating on a new health IT regulatory bill that would eliminate FDA oversight and remove medical device tax requirements for most EHR and clinical decision support systems.

Validating drug repurposing signals using electronic health records: a case study of metformin associated with reduced cancer mortality

Researchers are turning to EHR data analysis to help them discover potential new uses for existing prescription drugs. Vanderbilt University and Mayo Clinic demonstrated the effectiveness of the approach after correlating metformin, a type-2 diabetes medication, with improved cancer outcomes.

AHA president and CEO to retire at the end of 2015

American Hospital Association president and CEO Rich Umbdenstock announces that he will retire at the end of 2015. AHA has engaged Korn Ferry, a national executive search firm, to find a replacement.

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November 25, 2014 Headlines 1 Comment

HIStalk Interviews Siva Subramanian, SVP Mobile Products, Zynx Health

November 24, 2014 Interviews No Comments

Siva Subramanian is SVP of mobile products for Zynx Health of Los Angeles, CA.

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Tell me about yourself and the company.

My background is in communications technology. I worked as head of product management for Nortel and Avaya, doing their healthcare vertical products, providing communications solutions to hospitals. That’s how I came across the challenges that hospitals faced in coordinating care. Communications was a big piece of this. They needed something more than just phones.

My wife, also the co-founder at CareInSync, was the head of quality improvement and also a hospitalist by training from UCSF and currently at the VA. Her area of research is care transition. That created a perfect storm for me to understand the challenges, understand the customer needs, as well as what the ideal solution could be like, which led to the founding of CareInSync.

 

Several companies are popping up to offer secure messaging and care coordination, sometimes both. How would you define the broad categories and positioning of competitors with ZynxCarebook?

If you can visualize, I draw a layered diagram. At the very bottom layer are basic communications. Whether they are phone or text messaging, whether it’s a secure text or not secure text, doesn’t matter. That’s basic communications that can connect one to many or one to one, most often one to one.

Above that, the next layer is the patient-centered team communications, which involves not just a formation of the team which is around each patient, but tracking of the work flows associated with each of those team members to keep the team structure integrity as the patient moves from one setting to another. That’s care team messaging and work flow that comes about.

Then on top of that, once we have a team that’s delivering care for a patient continuously connected to a solution such as ours, we can now direct evidence-based interventions based on where the patient is, where they’re going, what the roles of the people in the care team are, based on a set of content that’s been proven out, and work flows that have been proven to be efficient and effective. 

We need to have all three layers to deliver outcomes and improvement through healthcare organizations. If you’re doing just the bottom layer, which is what a majority of the basic secure messaging solutions do, then what you’re doing is trading off a phone for a text-based modality. That is an improvement, but it’s marginal at best.

 

When you talked about the interventions that are based on content and work flow, tell me what that means and how the acquisition by Hearst brings that together with the other elements that Hearst offers.

In my previous company, Nortel-Avaya, as a communications company, you could only do so much. You could replace modalities or perhaps make a more efficient connection. But that’s where you stopped.

To  go to the next level, you needed healthcare domain experience to understand the work flow of the 15-20 different disciplines of care team members that connect around a patient, depending whether they are in an acute setting, post-acute setting, or even at home. That required us to work through and work with healthcare organizations to understand that. Of course my wife was a key player in all this.

Then we leveraged a lot of existing interventions that have been proven to improve care transitions, like Project Boost and Project Red. We realized that if we were to grow beyond CareInSync, we needed a more sound footing and a credible footing in the clinical domain, which is to be able to leverage a much bigger bank or library of clinical interventions. That way we can direct all this information to the right people who are now captured by our solution.

That’s why the marriage with Hearst/Zynx became very timely for our group and an appropriate fit. It helped us differentiate from the lower-layer players.

 

What are examples of improving clinical outcomes from tying together communications, content. and work flow?

A very good example that ties all of these three layers together is a patient who is showing up at the emergency department. The patient’s being tracked by a care manager as part of an accountable care organization. The care manager has no idea that this patient has shown up at the ED.

Our solution can automatically alert when a patient tagged as high risk arrives in the ED. The care manager is automatically notified and brought into the team. They can now input into our mobile solutions key risk factors that they are aware of, which are very important for that ED doctor, who is only going to spend probably two or three hours with that patient and then they will either admit them or discharge them from the ED. That information and communication with someone who knows that patient well needs to happen in a matter of seconds, before the ED physician or nurse has taken some action on that particular patient.

Some of our existing customers have made a footprint in navigating the patient away from a high-cost approach to doing what that patient did not ask for versus what is a better approach for the patient preferred based on their choices of being DNR and things like that. They have had very real examples of cost savings as well as improved outcomes for the patient, not to mention better dignity of care for that particular patient.

 

A study just came out showing what most of us in healthcare already knew, that handoffs and changes in care settings are a big problem. Can technology and content be used to improve the handoff process?

That’s pretty much what we do. When we connect the things together, we provide a very concise set of assessment forms that gauge the barriers that this patient is going to have as a transition. For instance, from an acute setting to home. Those barriers then are married, if you will, to interventions that mitigate those particular barriers.

A good example is, if the patient has no transportation and lack of social support, meaning they live alone, then we automatically trigger a notification and invite a social worker into that patient’s team. This patient requires transportation to pick up medication, transportation to their primary care office. That connection is made in real time.

Normally this would require someone to make several pages and phone calls that may or may not complete and then the receiving person has to dig into the patient’s records to find all this information. We eliminate all that to make these interventions timely and for the right patient at the right time.

 

You saw the potential impact of mobile technology vs. desktop devices early on. What capabilities do you see in the future for using mobile in a clinical setting?

The two examples I described would be either sub-optimal or at worst not even be possible for a web-based solution, because as you know, they all require someone to be sitting in front of the computer looking at the information. The one thing that care providers lack into this environment — maybe two things, because technology is one — but the other thing is time, because they’re taking care of 20 different patients or more simultaneously. To change context in your mind around who needs what, you need a tool that can dynamically present to you which patient needs what in real time.

That push-based technology is going to become more and more prevalent. This is why physicians, if you’ve seen the stats, are moving to smartphones by the droves. They’re leveraging not just solutions, real-time solutions, but also just any type of content. It needs to be at the point of care, and most of the healthcare providers are rarely sitting down in a conference room discussing with other people.

 

A lot of the cost and the inefficiency of healthcare is trying to orchestrate the resources to be in the same place at the same time. Surgery is always a good example, where you’re trying to bring together a team, equipment, supplies, and the patient. Mobile brings people together. Are customers seeing job satisfaction improvement because people know where they’re supposed to be and when?

There are two types of scenarios. One is where there’s no other alternative, that the people have to be in the same place at the same time, as you described. Surgery is one.

Another example is where they wish they could be at the same place, same time, but they just cannot, like when you’re rounding on a patient. It’s very important for everybody to write their inputs, get the assessment that is interdisciplinary in nature, and then go back and take care of the patient based on their discipline. That’s very challenging in an acute care environment.

What we enable is a virtual huddle. Essentially, meaning they’re all connected around the patient. Assessments are kind of like a a very simple Google Doc for a patient. They’re real time, shared, simultaneously updated, and interventions are driven automatically. We help, with the mobile devices, alleviate that need for certain types of needing to be together and we make that virtual.

For others, a good example is a physician is talking to a patient. The patient may as a result of the conversation need to talk to some other discipline. With a real-time tool, you can pop open the patient’s page, see who the other provider is. Regardless of what shift or when the time of day is, you can instantly contact that person, and if need be, have them come to the room when the patient needs that.

Just-in-time care is going to become more prevalent. Care is going to become more efficient. Part of the reason is there’s no choice. Hospitals, if they don’t become more efficient, are going to be out of business.

 

I saw the product offers checklists. What are people doing with those?

Two things. When Gawande published “The Checklist Manifesto,” it made absolutely a very big splash. But if you read this book, he says two things — checklists and collaboration. Unfortunately, collaboration didn’t make the buzz when he published that book.

That’s what we bring together. We bring together a dynamic checklist that is driven based on the patient’s specific needs. We bring that collaboration, because the checklist filled by one person alone in the care team is not of any value if the other people have not read it and used it to influence their care.

By taking what would be otherwise a clickable form in an EMR or a paper form and making it a shared item that multiple people can simultaneously update and then it dynamically changes based on these rules and interventions that I alluded to earlier around that care team — that’s what really brings and makes an effective checklist.

 

What level of integration do you need to have to get other information sources such as the electronic health record?

At minimum, our product only requires a registration feed, an ADT feed. We require demographics information to identify the patient and to track as they move from different settings in the acute care environment or when they go into the post-acute environment. Beyond that, any other information that our tool uses is all entered into our tool because it’s primarily a very concise and very specific tool aimed at transitions, handoffs, and transfers.

You don’t need the mountain of information that’s in the EMR to make this process effective and efficient. There are specific touch points such as a discharge summary or an intake risk assessment. Certain customers have asked for that to be brought in, which we do on a custom basis. But the majority of our deployments are based on purely just ADT input. It’s a very lightweight input into our system.

 

Developers who are new to healthcare usually create an easy standalone application that doesn’t touch HIPAA and doesn’t  integrate with anything. What are the challenges when you’re trying to develop and support something that’s enterprise-grade for a healthcare setting and fully connected versus those simple standalone apps that work in their own world?

We went through this dilemma early on. Unfortunately, even the investment world has been caught in that bubble trying to invest in very simple applications, because they feel that that is something that can be understood easily and can grow.

Unfortunately, there’s not a whole lot of those type of applications that can deliver strong value and outcomes to a healthcare organization or even to a patient. That’s just the nature of the healthcare beast. If you’re selling to a hospital, you need a solution that is part of the work flow, even if it’s just a single discipline.

Like for instance, nurse. It’s very hard to do one slice of one small piece of a nurse’s work flow and survive as a company or as a solution. You may get few adoptions. No clinician wants to go to one place for certain things, then go to another place for certain other things.

Where some of this is being made easier or the barriers are being lowered is with mobile phones and tablets. Because of the push technology, the user doesn’t have to make a conscious decision to switch applications. The push can automatically present the information that they need to know at a given time. That’s alleviating some of this, but for a large portion of it, the applications need to be quite sophisticated and enterprise-grade with HIPAA compliance and other characteristics which makes it difficult for a start-up to scale without a significant amount of investment or being acquired. We chose a partner that can take us there. Zynx Health is ideal.

 

It’s difficult for companies to get a foothold. It’s tough to get a pilot. They have to compete for attention on the mobile device. They have to do some sort of outcome study or return on investment. Do you think it’s inevitable that most start-ups will fail and that those do succeed will have to be acquired to get critical mass?

I believe so. There will be many that are not able to even find that initial customer to fully deploy. Those that find it often flounder in the first four or five customers.

Once you’re over 10-plus, then you start getting that mass of implementation experience and references. But getting to 10 customers requires a significant level of runway because sales cycles in this world are … six months is a very good cycle, I would say. You have to have longevity or very significant amount of cash behind you from major investors.

Some start-ups have made it to that point — AirStrip is a good example –  but they’re going to be very few and far. A few of those will be acquired and then there will be many, many of those that just don’t make it.

 

What do you see for the future?

The direction we started out in fortunately didn’t require too many pivots to arrive where we are. Again, we’re extremely fortunate to find a partner like Zynx Health within the Hearst Health network that’s laterally aligned at the Zynx Health level, because care transitions and care continuum as well as just enabling team-based care for patients is a significant part of the Zynx Health vision as well, guided by evidence which they have gathered and are the market leaders. We are very happy to be part of that.

If you look at the Hearst Health Vision, this now takes us into the home environment, there’s the payer environment … Hearst has made investments into all of these areas. Under Hearst Health, now we’re able to share information across these portfolio companies to become bigger than the sum of the parts.

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November 24, 2014 Interviews No Comments

Advisory Panel: Favorite Vendor

November 24, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: Who is your favorite healthcare IT-specific vendor (product or services) right now and why?


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IMO, Intelligent Medical Objects. They have a team that we’ve seen be proactive in finding ways to help ease our physicians’ jobs. Their products are cost effective, especially when we point to amount of provider happiness they return. We’ve partnered with them for at least one beta partnership and are currently considering another, in part because of how easy they are to work with.


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I’m pretty happy with Allscripts right now. It’s a completely different company under Paul Black vs. Glen Tullman. Now that I’ve said that out loud, I’ve probably jinxed the relationship. 


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Epic delivers an adequate documentation system that automates workflow, can be integrated with other clinical and administrative systems, and scales to our very large care delivery system.

Epic. Sorry, that might not be the politically popular answer. But they are continuously focused on making their products better and making their customers successful. And the idea that they are trying to block interoperability in some way is frankly nuts. The recent back-and-forth in the press on interoperability and who is the best or the most committed is mostly posturing in advance of the impending DoD contract. Could Epic do better in this area? Absolutely. Could Cerner and the rest of “CommonWell?” Absolutely. We need a common standard.

Epic. They are the most focused on healthcare reform and the most ready to adopt and support the changes.


I don’t have a favorite company right now as I am dealing with too many that I would like to get rid of.


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Favorite is Wairever. They offer Plexina, which is a content management tool that we use for developing and managing order sets. The tools they provide are fantastic and their responsiveness has been great.


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Fortified Health Solutions. They partner (and I do mean partner) with us to provide security monitoring and consulting. We’re much safer than we were a year ago because of their recommendations and guidance.


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My favorite vendors lately are Vocera and small nurse call vendor called Critical Alert Systems. They have been extremely engaging and get it – they both have engaged individually and collaboratively to figure out how we achieve our desired result. They have been candid, direct, and honest. I wish larger vendors would get off their high horse and act like they did when they were half their size. Every CEO should ask themselves: how did we act when we had half the customers and market share? My favorite services company lately is Beacon Partners. Ralph is easy to do business with, easy to interact, with and hasn’t let me down yet!


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Cerner is my favorite vendor as they are rescuing Siemens from the mud.  (I am a Siemens customer.)


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EClinicalWorks. They have many shortcomings, but are delivering a usable ambulatory EMR at a decent ROI. Their support folks respond and often can help solve problems.


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I am absolutely overwhelmingly impressed with Salesforce.com. They are not an HIT vendor, but they have shown me an ability to provide a malleable platform along with a team of leaders who really get it.


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Meditech. Provides the best level of support, especially with their task management system. Meditech has also become more proactive and letting clients know about software issues and severity of the issues. The stability of the system is still topnotch, with no unplanned downtime in our environment in over two years. Meditech also has a lower maintenance cost then many of our other vendors. Not that you asked, but the vendor that we struggle with the most is eClinicalWorks. Communication with eCW is very, very difficult and they don’t use their task management system very well.


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Microsoft Azure and Office 365. Removes a heavy load of keeping the lights on. CommVault — best solution to backup to Azure and have the ability to preform legal/investigative searches.


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There are two I would highlight. The first is the best staffing firm in the world, iMethods Inc out of Jacksonville, FL. They are the only firm I have worked with that realize that is a person with a resume versus a resume that happens to come with a person. The other company is dbMotion. We are working on a project with them right now where we will connect all of our community data and make it actionable at the point of care, where it is needed most. Great stuff there that will put our community in a great position for the future.


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November 24, 2014 Advisory Panel 1 Comment

Curbside Consult with Dr. Jayne 11/24/14

November 24, 2014 Dr. Jayne No Comments

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I’m getting ready to be a volunteer judge for the local science fair. I’m communicating with not only the school’s science fair coordinator, but with a couple of student ambassadors who have been assigned to make sure the judges know what to expect and have all the materials they need.

It’s been fun seeing the student packet and how they can leverage technology. This year they’re even offering a “virtual science fair” where submissions can be entered via electronic presentations rather than on the time-honored table display.

This is the same school where I’ve spoken at Career Day in the past. It’s always fun to see young people embrace technology when I spend a good chunk of my time helping physicians who are fighting it tooth and nail.

I just hope they’re teaching the students how to use technology responsibly because some of my hospital co-workers seem to be challenged by it. I’m still amazed by the number of people who haven’t yet mastered the art of the blind carbon copy, not to mention restraint where “reply all” is concerned. Those elements are just basic workplace standards, but workplace use of social media is another thing entirely.

Sharing your life with co-workers on Facebook shouldn’t be taken lightly. I’m not a heavy Facebook user, but I do have an account since it’s an easy way to keep up with college and med school friends. It’s tempting to accept friend requests from people at work. Usually I accept them since I don’t have anything to hide and it’s unlikely I’ll be posting any wild and crazy party pictures that could haunt me down the line. Even as a casual user, though, there is a fair amount of content that builds up over a couple of years.

I hadn’t really thought much about it until one of my colleagues started mentioning random things to me. They seemed familiar, but I couldn’t really place them. I have to admit it was a little unnerving since I wasn’t making the connection.

Finally, after a couple of weeks of this, he mentioned seeing something I posted on Facebook. It all made sense. This guy had completely stalked me on Facebook, reading everything I had ever posted and making note of everything I had “liked” for the last several years.

In addition to making me feel completely creeped-out, it made me think a lot about my social media footprint. I don’t accept friend requests from patients, although any patient who tries to friend me will get a friend request from our office’s account instead so that we’re not ignoring them. I have my security settings pretty narrow and I don’t post overly-personal information. Still, one could look at the pattern of comments and likes and end up putting together a profile that really doesn’t fit me at all.

There are also the privacy concerns about companies like Facebook capturing our browsing patterns and selling that data and a host of other scary situations. Their ability to peer into our lives is limited by the power of their algorithms and the data they had to work with.

On the flip side, there are companies that we willingly provide a host of personal data to that can’t seem to present useful information. I receive weekly emails from a couple of job-hunting type sites, and despite my building a fairly decent profile, they still send me junk.

This week one of them found me some interesting positions: System Center Operations Manager; Medical Technologist; Hotel/Resort Sales Recruiter; Business Analyst for Nestle Purina Pet Care; Cardiovascular Pharmaceutical Sales Professional; Infusion Center Nurse; Senior Storage and Back-up Engineer; and Inpatient RN. My favorite was “Intern, software development.”

The only one that remotely fit my profile was for an emergency department locum tenens position. I’m thinking that either their algorithm has gone haywire or it just can’t handle the chaotic scope of keywords a CMIO might have on her resume. It makes me want to think twice about the ways we process big data for patient care and whether we have enough measures in place to flag whether trouble is brewing.

On the other hand, if our HR department uses anything like what this website is using, it might go a long way to help explain why we have such a difficult time finding qualified candidates for some of our open positions.

Do you have concerns about social media or analytics gone wild? Email me.

Email Dr. Jayne.

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November 24, 2014 Dr. Jayne No Comments

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