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EPtalk by Dr. Jayne 3/23/17

March 23, 2017 Dr. Jayne 1 Comment

I get a lot of junk mail in my Dr. Jayne account. Most of it is marketing and public relations related, with varying degrees of personalization.

My favorite ones are those that attempt to sound all chummy and personal, but make it clear that the writer has never read HIStalk. “I was looking at your website that mentioned a mental health topic and am curious if you’d be open to me writing some unique content for your audience on the subject?” shows no grasp of your marketing audience. Of course, it’s easy to hit delete, but sometimes they’re just so bad you have to read them and laugh.

I’ve also recently been inundated with survey requests from HIMSS Analytics. Half the time I can barely make it through the fresh items in my inbox, so I’m not likely to be induced to finish a survey of questionable merit.

Hot topic in the physician lounge this week: the looming physician shortage. These reports come out nearly every year and always predict a shortage, although with variable numbers. Our local paper ran an especially Chicken Little version of the story, promising long wait times for appointments, but failing to interview anyone from the multiple medical schools and training programs we have in town.

As a former primary care physician, I’m not sure how much of a shortage we really have vs. how much of an incentive misalignment problem we have. I’d consider going back to primary care at some point if it wouldn’t mean working far more hours and taking a significant pay cut. Until then, I’ll stick with the wild and crazy world of urgent care and healthcare IT.

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I’m already tired of everyone’s marketing tie-ins to March Madness. The MGMA ad featuring “insane savings” was a little tasteless – as a health professional, I don’t typically find insanity funny. I do still like (and highly recommend) my urologist friend’s March Madness promotion. His practice figures there are a lot of men doing a fair amount of sitting and watching basketball during the tournament, so he offers complimentary pizza delivery for patients scheduling their procedures in that time frame. It’s a significant business booster and he’s been doing it for more than a decade, so it must be effective.

Maybe it’s just the blogs I read or the people I follow in Twitter, but I’ve seen a spike in discussion of physician burnout. There are many stories about physicians retiring from medicine in their 40s (often to choose another career entirely) or going part time as soon as their loans are paid off. A recent study looks at another consequence of burnout – the loss of the sense of medicine as a calling.

The study defines “sense of calling” as, “committing one’s life to personally meaningful work that serves a pro-social purpose” and surveyed over 2.200 US physicians across all specialties. The study had a 63 percent response rate, with 28.5 percent reporting some degree of burnout as measured by responses to six true/false statements:

  • I find my work rewarding.
  • My work is one of the most important things in my life.
  • My work makes the world a better place.
  • I enjoy talking about my work to others.
  • I would choose my current work life again if I had the opportunity.
  • If I were financially secure, I would continue with my current line of work even if I were no longer paid.

According to the authors, physicians who don’t see medicine as a calling see it more as a means to learn a living. That’s what most of us call “having a job” or “earning a paycheck.” Physicians who are burned out are less socially motivated as well.

The authors go on to note that physicians who don’t see practicing medicine as either personally meaningful or as a service to society may see performance impacts, including negatively impacted quality of care. They also interestingly note that monetary bonuses to improve performance may backfire, as they undermine professional autonomy and physicians’ sense of competence.

Due to the study’s construction, it’s not clear whether burnout itself reduces that sense of calling or whether physicians with a higher calling are somehow protected from burnout. More research is needed.

I did some anecdotal research myself, asking physicians if they would stay in practice if they inherited a large sum of money or won the lottery. The only ones who said they would stay in practice would move to a cash-only model and/or work only part time. There were several comments about dreaming of the opportunity to tell Medicare and commercial payers which parts of the posterior anatomy they can kiss.

My friends who happen to be physicians have a variety of strategies for trying to avoid burnout, although some ultimately do leave practice and that’s a shame. Every day there are articles about the catastrophic events that happen to physicians and other healthcare providers: sleep deprivation-related accidents; pre-term labor and birth; stress and anger management issues; and suicide. We lean on our families and friends to try to help us cope or to find a little slice of ‘normal’ among the chaos.

Several of my physician colleagues have taken up traditional handicrafts to try to relax. Two guys I went to medical school with do crochet – I sometimes see them at conferences with their projects. I have three friends who make soap. There are a couple of woodworkers (not surprisingly, neither are surgeons). At least if there’s a collapse of the world’s infrastructure, I know who I can barter with for socks, furniture, and toiletries.

As for me, my knitting skills are marginal, but I wield a mean cast iron skillet, so you’ll find me in the outdoor kitchen if the dystopian future arrives. Until then, I leave you with a recent revision of the Hippocratic Oath for today,courtesy of Paul Simmons, MD:


I swear by Epic, by eClinicalWorks, by Allscripts, by Athenahealth, and by all the coders and accountants, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my mouse in this art equal to my own hand; to make it right-click as well as left-click; when my ACO is in need of money to share an “at-risk” portion of mine with it; to consider Joint Commission inspectors as my own brothers, and to answer their questions, no matter how obscure, without hesitation or resentment; to impart coding, billing, quality measures, and all other vital instruction to my own sons and daughters, the sons and daughters of my teacher, and to indentured employees who have taken the physician’s oath, but to nobody else competing with my health system.

I will use mouse clicks to help the sick according to my ability and judgment, but never trusting my own judgment over that of guidelines, directives, policies or best practices. Neither will I administer a poison to anybody when asked to do so, unless the poison is properly linked to a diagnostic code and reconciled in the medication list.

Similarly, I will not give to a woman a pessary to cause abortion, especially if the pessaries aren’t covered by her insurance plan. But I will keep pure and holy both my problem list and my billing codes. I will not use the knife unless credentialed by a committee, not even, verily, on sufferers from the stone, but I will give place to such as are craftsmen therein, and will do my best to decode their two-sentence notes should they choose to leave one.

Into whatsoever houses I enter, I will enter to help the sick, without expectation of payment because no one pays for house calls. I will abstain from all intentional down- or up-coding and premature closing of encounters, especially from abusing the computers on which I labor, for they are my true patients. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets, but mainly because HIPAA says so, and that comes with monetary fines and jail time.

Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my mad abilities to click boxes and buff the chart; but if I transgress it and forswear myself, may the opposite befall me, and may I be banished to a Third World nation where I might labor in obscurity to help truly sick people with my medical skills.

Email Dr. Jayne.

Morning Headlines 3/23/17

March 22, 2017 Headlines No Comments

GOP Leaders Search for Health-Care Bill Votes

The Wall Street Journal reports that House Republicans do not appear to have enough votes to pass AHCA during its scheduled voting session Thursday.

Latest draft of AHCA still doesn’t measure up

AMA President Andrew Gurman, MD voices concerns with the revised AHCA, saying that the tax-credit structure will not maintain health coverage gains achieved in recent years.

Cleveland Clinic’s financial results worse than predicted

Cleveland Clinic reports a 2016 operating income of $139.4 million, a 71 percent drop from 2015’s year end numbers. In February, CEO Toby Cosgrove said during a “state of the clinic” address to staff that operating income for the year would be $243 million, but that was prior to audits.

Science sting exposes how corrupt some journal publishers are

A investigation of pay-for-publication “predatory journals” finds that 48 questionable journals accepted a fictional researcher onto their own editorial boards based on a fake CV.

Morning Headlines 3/22/17

March 21, 2017 Headlines 1 Comment

Former Louisiana Rep. John Fleming to join HHS under Trump

President Trump appoints former House Representative John Fleming (R-LA) to the newly created position as deputy assistant secretary for health technology within HHS.

A 40-year ‘conspiracy’ at the VA

Politico recounts the history of the VA’s homegrown VistaA EHR, as it moves forward with plans to replace the 40-year-old with a commercial system.

Patient Mortality During Unannounced Accreditation Surveys at US Hospitals

A JAMA study finds that patients admitted to the hospital during Joint Commission inspections have significantly lower mortality rates than those admitted during the three weeks prior, or after, the inspection.

The World’s Billionaires

Forbes releases its list of the richest people in the world, with Epic’s Judy Faulkner listed at  number #867 with $2.4 billion, and Cerner’s Neal Patterson listed at #1376 with $1.5 billion.

News 3/22/17

March 21, 2017 News 18 Comments

Top News

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President Trump appoints former US Rep. John Fleming, MD (R-LA) as deputy assistant secretary for health technology. That’s apparently a newly created HHS position whose connection to ONC has not been stated.

The 65-year-old Fleming says his understanding of the job is as a champion for innovation, describing his goals of improving EHR productivity, spurring EHR vendor competition, paying doctors to use technology, and reducing physician administrative burden.

Fleming tells Politico that he thought he was interviewing for the National Coordinator job, but says of the one he took, “I think it’s the same or a similar position – I really don’t know.”

Fleming lost his Senate bid in 2016 after an eight-year term as Congressman, finishing fifth in the primary after giving up his House seat to run. He has criticized the Affordable Care Act as “the most dangerous piece of legislation ever passed in Congress.” The former Navy doctor also owns 36 Subway sandwich shops and suggests that he plans to eventually return to Louisiana politics.


Reader Comments

From Not from Monterey: “Re: patient self-scheduling as mentioned in the Jim Higgins interview. I want to turn on patient self-scheduling for our site, which will use Cerner’s own patient portal and integrates with Cerner’s Scheduling product, but I’d love to hear about other sites’ experiences with patient self-scheduling. As Jim mentions, this is a patient satisfier that can easily be botched, both internally and externally. Heck, I’d love to hear from Epic sites about this. Who is doing this well?”

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From Bandana: “Re: Welltok. Quietly laid off 100 employees last week from the Silverlink acquisition.” A company spokesperson responded to my inquiry: “I can confirm that this information is factually incorrect. In full transparency, we did transition out a handful of individuals from the company last week. At the same time, we also proactively hired a handful as well. This business decision was made to reduce duplicative roles within our organization and maximize resources so that we can stay focused on our collective mission – to empower consumers to achieve their optimal health.” Consumer health rewards vendor Welltok acquired Silverlink, which offered consumer communications technology, in December 2015.

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From Grab Them By the Headline: “Re: your favorite HIMSS-owned publication. I’m sending them a thesaurus to help them find words other than ‘grabs’ and ‘nabs’ for their re-worded press releases about company funding.” I don’t read their site, but Googling makes it obvious that they over-use those annoying, child-like verbs in describing equity investments. It’s not like those companies are stealing a cookie from the plate and running away, nor does health IT need to be a Bat-fight full of “Kapow! Blam! Powie!” I can never tell whether their goal is to attract a less-intelligent audience or to diminish the collective IQ of the one they already have.

From Confused: “Re: blockchain. I’m looking for a layman’s primer, preferably with real-world healthcare examples.” I’ll invite readers to suggest resources they have found useful as an introduction.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mrs. S in South Carolina, who asked for spelling games and an organizer. She reports, “My students were overjoyed to hear that others care about them enough to contribute to their classroom and education without even meeting them. This is such a sweet reminder to them of the good in the world. The rolling cart provides my students with an organized way to access their word work materials and the board games are an excellent addition to that.”


Webinars

March 29 (Wednesday) 1:00 ET. “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.” Sponsored by Voalte. Presenters: James Jones, MBA, MSN, VP of patient care services and nursing operations, UW Medicine Valley Medical Center; Wayne Manuel, MBA, SVP of strategic services, UW Medicine Valley Medical Center. UW Medicine Valley Medical Center dramatically improved patient outcomes after moving to a smartphone-based platform for clinical communication and alarm and alert notification. Before-and-after analysis shows a reduction in hospital-acquired pressure ulcers and skin integrity events, fall and slip events, and medication errors. By limiting overhead paging, the medical center also created a calmer, quieter environment and improved engagement among nursing and hospitalists. Hospital executives will describe their experience and vision for the future in addressing quality, cost, and the patient-caregiver experience.

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Ivenix closes a $50 million equity financing round that will allow the company to pursue FDA approval to market its Ivenix Infusion System smart IV pump.


Sales

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Coffeyville Regional Medical Center (KS) will upgrade to Meditech’s Web EHR.


People

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Laboratory-focused analytics vendor Viewics hires Keith Laughman (TRG Healthcare) as CEO. He replaces co-founder Dhiren Bhatia, who will move to chief strategy officer.

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Operations planning platform vendor Hospital IQ hires Paris Lovett, MD, MBA (Thomas Jefferson University) as chief medical officer; Jason Harber (TeleTracking Technologies) as VP of product management; and Cheryle Cushion (OneCloud Software) as VP of marketing.


Announcements and Implementations

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IBM announces a public, cloud-based service for creating blockchain networks based on the Linux Foundation’s open source Hyperledger Fabric. The starter plan and beta are free, while the business network subscription costs $10,000 per month for four peers and a certificate authority on IBM LinuxOne. The first customer is Canada-based SecureKey Technologies, which is developing a consumer digital identity network and has as investors Canada’s leading banks.

Mercy goes live on the Visage 7 Enterprise Imaging Platform, replacing nine imaging systems used by over 50 locations in less than six months.

GetWellNetwork launches the Person Engagement Index, an 18-question survey that assigns each patient a score representing their capacity to participate in their care. The score can be used by individual clinicians to decide how to educate and engage patients, by care managers to improve risk stratification, and by marketing people to tailor their communication messages.

AHIMA publishes a good brief on enhancing HIM practices to support LGBT populations that includes:

  • Making sure both partners sign provider HIPAA forms.
  • Suggesting that partners share each other’s patient portal log-ins.
  • Allow patients to submit pre-visit information via the patient portal to alleviate privacy concerns in sharing the information at registration.
  • Allow patients to list their preferred name and gender along with the legal versions.
  • Allow lab reference ranges to be modified by gender, such as in the case of someone undergoing a female-to-male reassignment.
  • Add EHR fields for gender identify, sexual orientation, sex assigned at birth, and organ inventory.

Government and Politics

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The government of India responds to complaints about the drug supply chain and illegal Internet sales by proposing to require drug manufacturers to register on a new online portal and enter all of their sales there, including the drug’s batch number, quantity, and expiration date, with the pharmacy receiving the drug shipment also being required create an entry on the site. Pharmacists would also have to record each drug prescription on the site and include prescriber and pharmacist information, and for some drugs, the patient’s information. Hospitals would also have to record all medication dispensing activity, including details of any adverse reactions. 

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An opinion piece in The HIll says the American Optometric Association is lobbying hard to support state laws that would prohibit online vision tests, not because they don’t work, but because they don’t provide in-office optometrists a chance to upsell new, high-markup glasses or contacts. AOA spent $1.8 million on lobbying in 2016. The target of much of the optometrists’ wrath is Opternative, which offers a $40, 15-minute online refractive test that includes a prescription for glasses or contacts.

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ONC updates its SAFER Guides, best practices driven self-assessment tools and templates that allow medical practices to review their EHRs for patient safety issues.


Privacy and Security

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Metropolitan Urology Group (WI) announces that basic, pre-2010 patient information was exposed in a November 2016 ransomware attack.

A journal essay questions why the NHS signed a deal with Google-owned DeepMind for kidney injury alerting, noting that Google gains access to patient information without sufficient controls being spelled out in the contract. It also notes that UK law requires patient consent for sending their data to a third party, and while kidney patients are covered by a patient care relationship, DeepMind was given the data of every patient admitted to Royal Free London NHS Foundation Trust over five years without the consent of those patients. It concludes,

The 2015–16 deal between a subsidiary of the world’s largest advertising company and a major hospital trust in Britain’s centralized public health service should serve as a cautionary tale and a call to attention. Through the vehicle of a promise both grand and diffuse––of a streaming app that will deliver critical alerts and actionable analytics on kidney disease now, and the health of all citizens in the future––Google DeepMind has entered the healthcare market. It has done so without any health-specific domain expertise, but with a potent combination of prestige, patronage, and the promise of progress. Networks of information now rule our professional and personal lives. These are principally owned and controlled by a handful of US companies … If these born-digital companies are afforded the opportunity to extend these networks into other domains of life, they will limit competition there, too. This is what is at stake with Google DeepMind being given unfettered, unexamined access to population-wide health datasets. It will build, own, and control networks of knowledge about disease.


Innovation and Research

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The Miami paper describes the health IT project involvement of Miami Children’s Health System (FL), which includes investment, internal development, and pilot projects with accelerator startups.

The American College of Cardiology reports on the multi-center “Genetic InFormatics Trial (GIFT) of Warfarin Therapy to Prevent DVT,” which concludes that dosing the blood-thinning drug based on patient genotype reduced complications by 27 percent vs. the usual method of starting the patient on 5 mg daily and then titrating to INR results. The computer-based, real-time interface estimates the dose and provides recommendations  for adjustment based on other patient factors. The lead author expresses hope that EHR vendors will add genetic and clinical dosing algorithms to their systems to suggest doses early in the ordering process.


Other

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Banner Health says the two Tucson, AZ hospitals it acquired in 2015 in absorbing the former University of Arizona Health Network lost $89 million in 2016, will lose $45 million this year, and will require $30 million to be converted to Banner’s Cerner system. The Tucson hospitals went live on a $115 million Epic project in 2013. The 28-hospital Banner, which is Arizona’s largest private employer, is trying to reduce its corporate service department expense by $65 million this year.  

In New Zealand, the health board blames its since-replaced computer system after discovering that critical radiology results that were viewed but not acknowledged would disappear from the physician’s inbox. A woman died of cancer when her doctor took a quick look at a new X-ray showing a lung mass in 2013, but then left for vacation with plans to contact the patient when she returned. When the doctor came back to work, the alert had disappeared and she forgot to follow up. The woman died of cancer in 2015 without having been contacted about her lung mass.

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A study finds that hospital death rates drop during the week of unannounced Joint Commission inspections compared to the three weeks before or after. The authors conclude that hospital employees pay more attention to patient care when inspectors are observing them.

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Politico ehealth editor and author Arthur Allen writes a nice piece – which may turn out to be a fond eulogy or celebration of life kind of thing – about the VA’s VistA system that seems sure to be mothballed soon in favor of a commercial replacement. I’m intentionally not calling VistA an EHR as I usually do since it does far more than that and maybe that’s important in this context – I’m pretty sure the VA will need more than just Cerner or Epic to replace VistA since has many non-clinical modules. Allen makes the broader point that perhaps the decisions about VistA over the years illustrate “just how difficult it can be for the government to handle innovation in its midst.”  Most fascinating is that the “Hardhats” who built VistA in a skunkworks project were subjected to open hostility from the centralization-obsessed VA, its IT contractors, and unknown folks who fired or transferred them, sabotaged their computers, and at one point, unwittingly symbolically tried to burn their stacks of programming printouts in a computer room by lighting paper medical records on fire.

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Forbes publishes its annual list of billionaires, with Epic’s Judy Faulkner coming in at #867 with $2.4 billion. The “healthcare” section is littered with drug company and medical device billionaires, which might suggest where the excess profits generated by sick people accrue. Snapchat’s Evan Spiegel is the youngest self-made billionaire at 26 years old, joined by his Snap co-billionaires and the 20-something guys who started Ireland-based credit card processing firm Stripe.

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I’d like to say it could never happen here, but lately I’m not so sure. India sees three examples of the family members of patients attacking clinicians. Family members of patient who later died beat a government hospital doctor with chairs, rods, and scissors when he recommends taking the patient to a tertiary care hospital to see a neurosurgeon. The relatives of a man who died of swine flu attack a doctor and nurse. Finally, a first-year resident is beaten up by the family of a 60-year-old woman who died of chronic kidney disease. Doctors say attack mobs are a problem only in state hospitals since private hospitals don’t accept desperately ill patients and also don’t allow more than one visitor at a time, limitations that state hospitals aren’t allowed to impose.


Sponsor Updates

  • Agfa Healthcare releases a video compilation of its time at ECR 2017.
  • Arcadia Healthcare Solutions will exhibit at the annual AMGA Conference March 22-25 in Grapevine, TX.
  • QuadraMed Patient Identity Solutions, a division of Harris Healthcare, announces that the QuadraMed EMPI has earned the top 2016 EMPI ranking from Black Book Research.
  • Besler Consulting’s DeLicia Maynard will speak at the Annual Hospital/Physician Collaborative Meeting March 22 in Lancaster, PA.
  • Bottomline Technologies will exhibit at the Health Care Compliance Association Annual Compliance Institute March 26-29 in National Harbor, MD.
  • Carevive Systems will exhibit at the NCCN Annual Conference March 23-24 in Orlando.
  • CompuGroup Medical will exhibit at CLMA KnowledgeLab 2017 March 26-29 in Nashville.
  • The Connecticut Technology Council names Diameter Health Chief Data Scientist Chun Li a finalist for its 2017 Women of Innovation Award.
  • ECG Management Consultants will exhibit at ACHE’s Congress on Healthcare Leadership March 25-30 in Chicago.
  • EClinicalWorks and Evariant will exhibit at AMGA March 22-25 in Grapevine, TX.
  • The NFL and GE partner to advance understanding and treatment of concussions.
  • Consulting Magazine recognizes The HCI Group’s Stephen Tokarz as one of the “Rising Starts of the Profession” in the healthcare category for 2017.
  • Healthwise exhibits at Ehealth Initiative’s annual conference March 21-22 in Washington, DC.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Summary of ONC Interoperability in Action Day

March 21, 2017 Digital Health 1 Comment

Digital health updates are written by LoneArranger, an anonymous industry insider.

On Monday, March 20, the ONC held an Interoperability in Action session featuring a day of presentations from participants in a number of their innovation challenges as well as a few presentations by ONC staff. Many of the presentations covered applications that utilize FHIR resources to support discrete data exchange.

Patient Data Aggregator App Challenge

Two Patient Data Aggregator App Challenge winners were presented, including MyLinks (PatientLink Enterprises) and Green Circle Health. The MyLinks application uses cloud technology, FHIR, and secure messaging to help patients gather data, participate in research, access information Direct remotely, and engage with interactive tools.

Green Circle Health uses FHIR to power an integrated patient health data dashboard, allowing users to gather information from wearables and other Internet of Things Devices as well as schedule health reminders through a single interface.

Provider Experience Challenge

Two Provider User Experience Challenge winners also gave presentations, including Herald Health and a collaboration of Duke Health, Intermountain Healthcare, and University of Utah. The Herald Health application allows users to manage EHR alerts and alarms. The system offers the ability to create customizable push notifications that can be tailored to personalized preferences and the priorities of specific patient groups. It is currently live at Brigham and Women’s Hospital and will be implemented at Boston Children’s in the near future. The application uses SMART on FHIR integrations with Cerner and generates alerts based on rules driven by test results and other data.

The Duke Health / Intermountain / University of Utah collaboration has produced a clinical decision support tool for detecting and treating infants with jaundice. Their Bilirubin app is in production in the Epic system at the University of Utah and also available in the CareWeb EHR. They are updating it to the CDS Hooks specification in the future.

Move Health Data Forward Challenge

Five groups that  were selected as Phase 2 prototype winners presented during the Move Health Data Forward Challenge session. The focus of this initiative is to promote the development of solutions to authorize movement of data by patients. They included CedarBridge Group, EMR Direct, Docket, Live and Leave Well, and the Lush Group. The next phase is the test these solutions in “real life,” with submissions due by May 1 and two finalists to be selected by May 31.

CareApprove: Cedarbridge Group

A patient-mediated solution for sharing information between providers based on a Javascript platform and uses the IHE MHD profile and FHIR for clinical data exchange. Patients have a mobile app to review and approve each transaction, authorizing providers to exchange records between their EHRs. They can also limit the amount of information that is exchanged by category if desired.

EMR Direct: HealthToGo

This presentation highlighted that there are too many different portals for patients to access, resulting in “portalitis.” However, APIs and FHIR offer potential opportunities to solve this issue. Based on HEART profiles and UMA, it allows patients to authorize access to their records. It is also soon to be Direct secure messaging enabled.

Foxwall Wythe: Docket

This is an augmented patient intake application which includes a superset of patient intake templates that are questionnaire based and can be tailored to meet the needs of specific provider practices. It uses a “Boarding Pass” tool to load information on providers and includes appointment check-in capability and appointment cards, and generates reminders and alerts. Fitbit and other wearable data can be automatically linked via Bluetooth and the Apple Health app and providers can suppress information they don’t need.

Live and Leave Well

This tool provides access to trusted end-of-life medical documents when and where needed via secure access and sharing and includes a mobile app. Their focus is on people at end of life and also people who want to ensure access to appropriate care in the event of hospitalization. The tool includes the ability to create and share documents online and maintains a to-do list of pending actions and shows the status of the completeness of information. It leverages the HEART profile to connect providers and patients, provides personalized guides based on patient values, and allows providers to invite their patients to sign up. They are looking to partner with emergency medical providers and geriatric providers.

Lush Group: HealthyMePHR

This tool is based on FHIR and HEART standards and allows patients to access and share health data securely. It is focused on patient mediated information sharing where patients control all aspects of the process. Policies are created by the patient for each provider and they can limit timeframe when data is shared. Transactions leverage an authorization server using Google IDP but it can use other methods as the industry evolves. Data can be imported by patient from a FHIR enabled portal which enables patients to start using the app immediately.

Med List Project

During the afternoon, the program shifted to presentations addressing the Med List Project, with over 150 vendors, providers, and other organizations involved. The focus is on interoperable medication lists using FHIR-based APIs. Demos were conducted at the Connected Health Conference in December and at HIMSS in February.

MediSafe: This tool provides medications adherence reminders and notifications and also provides patient education. It has over 3.5 million registered users and is integrated with Google Fit.

CareEvolution: Offers a medication list summary and identifies therapeutic alternatives that may be less expensive. It reviews discount card opportunities for medications for cash payments and also looks at medications eligible for patient assistance payments.

MyFHR: An untethered version of the cFHR platform, which aggregates data from multiple sources. It is FHIR based and provides access to medication data and other information from other sources.

Cedars Sinai and Epic: An implementation at Cedars Sinai using Epic. There is an issue of FHIR resource maturity (production ready). Epic supports 16 resources with read capability. It will support write capability and CDS Hooks in the near future. A provider gave a demo of access to multiple sources of medication data and a presentation in a mobile app via interfaces with Epic MyChart.

Hackensack Medical Center: They have created an app using API-based tools built on Epic API framework and integrated with HealthKit. It uses biometric identification to access and share data with other providers. Using an API management layer, it allows integration with trusted vendors and partners using tokens. They demonstrated a method for exchanging medication data between different organizations.

Trinity Health: They have created a virtual pill box of medication reminders utilizing data from many EHRs across their organization including Cerner, Epic, Athena, Care Evolution, and NextGen. They maintain their own MyID Care consumer ID store and a data lake for patient-generated information and leverage Cerner mPages for providers. There is a mobile app for the patient with access to medications and other information.

NY Columbia Presbyterian: They have developed a medication reconciliation app based on the HL7 Argonaut FHIR specifications. They leveraged their CSC integration engine and the Allscripts EHR sandbox to enable the integration. The system is connected with other systems at Weill Cornell Medicine, which uses Epic. They are using the MyFHR app for consumer access and can present an integrated medication list across multiple facilities.

High-Impact Pilots

The next session covered the High-Impact Pilots which last for one year, with about six months left to go. The categories include:

  • Comprehensive medication management
  • Care coordination
  • Lab results
  • Self-identified topics

Four awards were given to:

  • Health Collaborative: Patient-centered data home
  • Lantana Consulting Group: pharmacist care plan
  • RxRevu: prescription decision support
  • Utah Health: closed loop surgical referrals

Health Collaborative: Their approach routes data between HIEs based on the patient home address. This Heartland Pilot includes seven HIEs in the Midwest. Safety, privacy and security, and interoperable exchange were the areas of focus. They are using IHE cross-gateway profiles and HL7 ADT and CDA standards and VPNs and web services for connectivity.

Lantana: They are working with Community Care of North Carolina and six pharmacy organizations on a pharmacy care plan use case based on the C-CDA on FHIR specification. They have created bi-directional transforms to convert between the HL7 CDA care plan and CDA on FHIR care plan formats. They will update to STU 3 when completed and the transforms for CDA on FHIR when updated. Their system can also convert to JSON format.

RxRevu: This presentation covered prescription decision support tools at Banner Health via a SMART on FHIR integration using their RxCheck platform. The focus is on consistent prescribing, optimized spend, and patent safety. Leveraging Cerner Ignite APIs and the Cerner Millennium EHR, they concentrate on Medicare Blue Advantage members at Banner Health to provide a medication reference with therapeutic alternatives and medication reconciliation and adherence tools. Clinical quality, cost efficiency, and interoperable exchange were the primary areas of focus.

Utah Health: This initiative involves closed loop surgical referrals based on a SMART on FHIR dashboard within the Epic EHR. It is also deployed at Intermountain using Cerner. It includes care coordination and closed loop referrals with a focus on clinical quality, cost efficiency, and practice efficiency. While developing the dashboard, they interviewed end users, including PCPs and surgeons, and conducted a usability session. Referral requests initiate the workflow, which includes a visual timeline of the status of activities related to the procedure and hospitalization. The tool also provides follow-up guidance to the PCP after the procedure. It is based on the FHIR US Core Encounter and Care Plan resources.

Standards Exploration Awards (SEA Program)

The next session covered winners in the SEA program including Arkansas SHARE, Cincinnati Children’s, and SysBioChem.

Arkansas SHARE: The State Health Alliance for Record Exchange is a statewide HIE in Arkansas. The focus of the program is on bi-directional integration of behavioral and physical health records. Using role-based access, it leverages XDS.b exchange standards and the HL7 C-CDA document standards. HISP secure messaging and a virtual health record portal are used by most behavioral health users across 10 hospitals and 133 clinics that lack integration capabilities. They are planning to survey providers after the pilot to evaluate outcomes and user experiences. Barriers included the cost of a Netsmart module to connect to SHARE, lack of IT knowledge, and concern about duplicated expenses.

Cincinnati Children’s CCHCP: The biomedical informatics department was challenged by case review forms for clinical trials, which are created manually now. Their focus was on cost efficient pre-population of eCRFs to reduce manual data entry. They retrieve the form for data capture (RFD) using FHIR web services to capture common data elements and populate the forms. This will ultimately be deployed to production, but they are expecting validation challenges with FHIR.

SysBioChem: The purpose of this initiative is to make family health history available to drive better risk predictions for clinical care. There is a problem with lack of standardization and a need to harmonize different approaches. The focus was on building a minimal viable product initially. They use an interoperable message based on FHIR resources across many data silos include lab, EHR, family health history, genomics, and others. MGH/Dana Farber and Intermountain Healthcare are involved in the project. They use the Hughes Risk Module Analytics Module and make a round trip to get a risk profile from the analytics module using FHIR and HL7 V3 conversion. They are building a harness to submit large data sets from IMH and hoping to consume 3,000 patient family histories during the project. They also identified the need to create a US realm profile for family health history Their architecture is housed in AWS.

Blockchain in Healthcare

The last session of the day covered the recent Blockchain in Healthcare code-a-thon event and presentations from the top performers. All of these applications were created in 24 hours or less.

Team TMI: Trust My Identity is an approach for provider identity credentialing based on Identity Management and APIs. Inaccurate information and limited sharing between institutions creates a lengthy and laborious credentialing process which is cumbersome with lots of duplication of effort. The technology is based on IPFS, Monax Blockchain, and BigChain DB (noSQL DB). The provider creates a profile and launches the process. A payer then certifies their network affiliation and board credentials reviewed and approved. In the future, they feel distributed provider directories should include blockchain since significant cost savings can be achieved.

Nucleus Health: Project Health Genesis involves identity management and medical record sharing for images. Cloud-based medical imaging systems are growing, which affords the opportunity to use an approach based on blockchain. They demonstrated a provider to patient sharing use case. ID Management is via Ethereum, authentication is done with digital signatures and they use Smart Contracts for authorizations. DICOM Web requests are made to a VNA and the patient can then retrieve and view images. The code is available on GitHub – Open source, and a complete Docker container system was built to support the test implementation.

Health Passport: This group won the ONC Blockchain code-a-thon with a patient-centered health record system involving patient identity verification and medical record sharing. Either MetaMask or uPort identity management can be used with a QR code used to access information and this approach can also integrate wearables data. Transactions currently take many seconds to complete with Ethereum taking 14 seconds to respond due to the distributed block confirmations required. The objective is to get it down to three seconds per block in the near future, but the speaker cautioned that the industry still needs to be cautious about the privacy aspects.

More information is available at:

www.healthit.gov/blockchain

Morning Headlines 3/21/17

March 20, 2017 Headlines No Comments

Common Blood Tests Can Help Predict Chronic Disease Risk

Researchers at Intermountain Health report that a risk stratification algorithm they developed can predict whether someone would be diagnosed with diabetes, kidney failure, coronary artery disease, or dementia in the next three years with a 78 percent accuracy by analyzing the results of two common lab tests: a comprehensive metabolic profile and a complete blood count.

IBM launches enterprise-ready blockchain service

IBM announces that developers building enterprise applications on its cloud service can now use blockchain technology within their applications.

Google DeepMind and healthcare in an age of algorithms

In England, a Cambridge University law professor and an Economist journalist co-author an academic paper in Health and Technology arguing Google’s DeepMind partnership with the Royal Free Hospital has suffered from “a lack of clarity and openness, with issues of privacy and power emerging” in response to public privacy concerns.

iPads In Every Hospital: Apple’s Plan To Crack The $3 Trillion Health Care Sector

Fast Company profiles Apple’s continued effort to enter the enterprise healthcare market.

Curbside Consult with Dr. Jayne 3/20/17

March 20, 2017 Dr. Jayne 1 Comment

I’ve had a couple of questions about my other “unplanned trip to the hospital.” I was due last Monday for my post-op clearance visit. I had seen patients the day before and had been having some leg pain and swelling that was bad enough that I had to sleep with my leg elevated.

As a physician and knowing all the bad things that can happen to a post-operative patient, I didn’t want to just assume it was from being on my feet all day. There’s a small but real risk of deep venous thrombosis after surgery, and that risk can go on for a couple of months. Anecdotally speaking, physicians have bad luck with complications, so I wasn’t taking any chances and wanted to get it checked out.

By mid-morning, most of the swelling was gone, although I still had some weird leg pain. Other signs of DTV were absent, so I decided to not head to the urgent care since I had a post-op visit in a couple of hours and would see what the surgeon thought since I’m fairly low risk.

I headed to the office a little early since it was snowing and I knew I was the first patient of the afternoon and didn’t want to make my surgeon start his office hours late. What I didn’t know was that his last operating case of the morning had taken a turn for the lengthy. Of course, the office staff didn’t mention this when I checked in, so I was treated to 15 minutes of bad infomercials in the waiting room while they answered lots of phone calls but acknowledged no one in the waiting room. I finally learned that the surgeon was still in the OR when I overheard someone mention it to a phone caller.

Just about the time the makeup infomercial was driving me crazy, another patient arrived and signed the clipboard. He was hand-carrying his records and he and his wife sat and read physician notes aloud and generally second-guessed all the care he had received thus far. He was clearly there for a second opinion and I couldn’t help but pity my physician for what he was about to endure. They were loud and opinionated, even when they admitted they didn’t know what they were taking about. It was entertaining to watch them pull out the copies of the scans and try to interpret them against the waiting room lighting.

Finally when I was called to the window, the receptionist argued with me about not having signed a records release. She said I needed to send my records to my PCP. I told her I didn’t have a PCP and she continued to insist that I put someone down to receive the notes. I finally wrote “no PCP” on the release and just handed it back. She finally got the message.

At the bottom of the hour, the TV programming changed to some daytime interview program and the topic of the day was post-traumatic effects of sexual assault. Although I have utmost respect for the topic, it’s not what you expect to have playing in the waiting room and doesn’t set the stage for a calming, healing environment.

The receptionist called me up again to fill out a post-op form, which included questions about my pain, how much pain medication I was taking, etc. Some of it was pretty standard, although the pain scale ran from 1-10 instead of the normal 0-10. As the questions progressed, some of the scales were inverted, with 10 being the least and 1 being the most, which I’m sure might be confusing for many patients. I was confused enough that I missed the back of the form, resulting in me being called to the window a third time.

The surgeon finally arrived and I was called back. He was apologetic. He mentioned a little about his previous case and I understood why he was late. I felt bad that I was about to make him more late after I threw out the leg pain and swelling complaint. Although he agreed I was low risk, I was scheduled to fly in less than 48 hours, so he wanted to proceed with the ultrasound.

His staff called down to the vascular lab, where apparently only one technician showed up due to the snow. He asked for a favor to work me in, which I appreciated, although they said it would likely be a two-plus hour wait. You can’t complain when you’re a work-in, so I took my form and headed downstairs. I guess if your physician doesn’t call in a favor, you would have to wait until the next day, which isn’t an ideal situation for patients with potential blood clots.

When I finally made it to the imaging department, I realized it was nearly 2 p.m. and I hadn’t eaten lunch. The receptionist confirmed that I was an add-on and asked if I knew it would be a couple of hours’ wait, and I said yes, and could I pop out to the cafeteria and come back? She said that was fine. 

When I returned from the café (where only the salad bar remained), I was shamed by the registration clerk, who had apparently been looking for me while I was gone. Despite all my time in healthcare, it didn’t occur to me that this was going to be a quasi-inpatient experience until I was sitting in the registration booth and they had asked the fall risk questions and were getting ready to slap the hospital band on my wrist. Although I had only been discharged two weeks prior and my information should have been up to date, I discovered that my emergency contact had been changed to a peripheral relative who in no way would I want to be my emergency contact. It was baffling until I realized (days later) that he had been in the hospital in the interim and had put me as HIS contact. Still, that should not have changed MY contact information.

It’s unreal that you have to go through the hospital admission process for a straightforward outpatient test. It’s also unreal that there is no accommodation for people’s potential illnesses in the waiting room. How about a footstool for the patient with the swollen leg to prop it on? I got the evil eye from the receptionist for using an empty chair to elevate my leg. While I was waiting, though, I did receive my surgeon’s email message welcoming me to his patient portal (yay, another one!) and inviting me to peruse my records. I now have a total of five portals that I can log into and view my fragmented charts.

After a couple of hours, the tech appeared to take me for my test. I apologized in advance since I knew I was an add-on and said I appreciated that she was having to stay late for me. She was pretty cool about it, although she mentioned she hadn’t had a lunch break and hoped to be able to make it out of the hospital by dinnertime.

I felt bad as a former member of the medical staff that this is how the hospital runs, that two people can fail to show up for work and the third remaining staffer gets crushed with no help in sight. One would think that in a hospital system with nearly 30,000 employees there would be systems in place to prevent these kinds of events from happening. Of note, by 1 p.m., the snow was melting, so bad roads were no longer an excuse.

I didn’t end up having a blood clot. Not surprisingly, once I started treating my leg like a musculoskeletal problem, it got better. Heat and NSAIDs work wonders, but they don’t keep deep clots from breaking off and killing you, so I’m glad I had the test for my own piece of mind.

It will be interesting to see what the hospital charges for an ultrasound vs. what we charge at my urgent care. Rumor has it our prices are about 80 percent less than the hospital, so we shall see. Hopefully this will be the end of my medical adventures for a while, at least until the bills start arriving in a few months.

Email Dr. Jayne.

Like the Rest of Healthcare IT, Limited Interoperability is a Big Challenge for Digital Health

March 20, 2017 Digital Health No Comments

Digital health updates are written by LoneArranger, an anonymous industry insider.

In the Connected Health Pavilion at the recent HIMSS17 conference and exhibition, several attendees commented during a Q&A session that “connected health doesn’t seem to be very well connected.” It is easy to understand why they may feel that way.

There has been a proliferation of individual consumer health apps over the past several years, though many of these could be classified as “fitness” vs. “health” apps. Although consumers are increasing their adoption of digital health tools according to a 2016 Rock Health report, they are not necessarily connected in any way to each other or to mainstream provider or payer HIT systems.

Tethered apps offered by healthcare providers and payers don’t always include data from other healthcare settings or insurers and often don’t accept wearables data. Therefore, most consumers (and their providers) cannot easily maintain a complete longitudinal health record.

Most major EHR vendors offer customers mobile apps that are extensions of their patient portals, but these are essentially closed systems. Although some vendors offer platforms to exchange data across their different customer sites, they do not generally include the ability to share data easily across different vendor platforms. The CommonWell and Carequality initiatives are starting to address this gap, but it will take time to expand their footprints.

Wearables are not growing as fast as anticipated and although younger consumers are adopting them in large numbers, older consumers are not, even though they might actually benefit more from doing so. In fact, only 10 percent of Baby Boomers own a wearable device.

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According to the same Rock Health report, the majority of health tracking is done mentally, with 54 percent of people who track weight and 58 percent of people who track medications doing so in their heads. Of those tracking their health electronically, the most common metrics recorded using an app are physical activity (44 percent) and heart rate (31 percent), which are clearly more related to fitness and performance than diagnosed health conditions.

There are many innovative platforms and apps emerging that offer more comprehensive capabilities, but they are still often limited by the inability to exchange data with legacy systems and other digital apps. Although HL7 FHIR offers substantial promise for the future, there are few implementations that are currently operational in production environments and the normative standard is not yet finalized.

For providers, the data from external sources also need to fit into their workflow to be useful. This requires full semantic interoperability, or at least cross-mapping of common data elements, beyond just basic data exchange. In most cases, this requires customized integration and terminology services.

There are some glimmers of hope emerging in this market space, with a variety of middleware solutions for feeding patient device data to EHRs starting to gain traction, and increasing willingness by providers to accept external health data and share data with others. Remote patient monitoring seems to be gaining ground recently and is delivering real value to both patients and providers. The remote patient monitoring market grew considerably in the last year, with 7.1 million patients worldwide enrolled in some form of digital health program featuring connected medical devices as a core part of their care plan, according to recent research data.

These tools are generally prescribed or recommended by providers and connected to their EHRs and/or care management systems. However, their focus is primarily on patients with chronic conditions or those who are recovering from acute procedures. The clear benefit is keeping track of these patients and reducing hospital admissions and readmissions while allowing patients to remain at home or in a community rehab setting.

In the long run, digital health applications have tremendous potential for adding value and improving care, but they must first overcome similar interoperability hurdles as those faced by the rest of the HIT industry. They must also become more tightly integrated with clinical and financial systems and associated workflows and offer a more nearly seamless user experience to both patients and providers. The future of digital health is looking brighter, but the open question is how long it will take to get to the tipping point where these tools are fully integrated with mainstream healthcare infrastructure.

HIStalk Interviews Jim Higgins, CEO, Solutionreach

March 20, 2017 Interviews 4 Comments

Jim Higgins is founder and CEO of Solutionreach of Lehi, UT.

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Tell me about yourself and the company.

I started Solutionreach in the year 2000. For me, it was about changing the relationship between the provider and the patient.

I’ve got a daughter with an autoimmune disease, so my wife and I have seen a lot of specialists over the course of the last 12 years. We’ve had a lot of questions after leaving appointments with confused faces, feelings, and thoughts and not being able to reach those providers in an easy manner. It’s just very, very difficult feeling disconnected and on a patient island. That’s what we’re trying to do at our company. That’s why I’m here doing what I’m doing.

I’ve been here 16 years. It’s gone by fast. I’ve been in technology for a long time and I’m excited about focusing my efforts in a way that’s very personal to me and making a difference overall, versus just pounding away at great technology solutions that are not really making an impact on the lives of people in a way that I think need to happen.

What technologies work best for physician practices that are interested in improving or expanding their patient relationships?

Anything that extends the accessibility of two-way communication between patients and the practice. There’s just too much stuff going on right now. There’s too much change, too many questions. There’s a lot of information out there, which is a good thing, but that breeds questions.

For instance, patients going into self-diagnosis mode — which we all tend to do at times, because there’s so much information, which is fantastic and I love that — puts practices and physicians in a spot. They have to unwind a little bit what we as patients perceive we may have. Then we may already be down a path of diagnosis as we’re coming in, and then just the care that’s associated with that. We need that guidance from our physician to say, "You’re going to read a lot of things. You’re going to see a lot of things. This is what I really want you to stick to."

That’s the most important thing that we can do for our health. Any kind of tools or technology that you can put in place to extend that kind of communication in a very simple and effective manner. 

There’s a lot of technologies out there that are not very simple and effective, meaning they don’t match up with patients in terms of the consumer and what we actually do on a daily basis. It’s one thing to think about logging into a portal, but I might be five clicks away from a simple message. I might not get that response for days.

Those types of things don’t stand the test of time. We’re in a society where our expectations are very different now, where we expect to have information quickly and accurately. Accessibility needs to be there, not only from a velocity perspective, but ease of use. We’re out and about and trying to think about, "I’ve got to get to my doctor," and somehow do that in a way that it doesn’t really fit into our lifestyles, one where you’re going to have limited communication. Limited communication leads to fewer questions, and overall, leads to worse outcomes for patients.

Hospitals and practices are set up under the Jiffy Lube model, where they don’t want to get to know you – you just show up, get work done, and leave until next time. Calling them up sends you to a phone tree and maybe they’ll return your call or maybe they won’t. It’s hard to get in touch after business hours that may not be convenient. Does the motivation exist to change that to make patients feel more valued as individuals?

Well stated. That’s exactly what’s happening. I’ve been in a lot of different industries with technology and it’s amazing the amount of information and the service levels that we can provide. Just think about the financial industry. It’s crazy. I can be in Europe walking down the street, see an ATM, put my card in, and in seconds I can  get cash out. It recognizes who I am, where my home location is, what bank I use, and all that stuff routes in seconds. It’s amazing that we go into healthcare, we check in, and someone doesn’t even know what’s going on with us.

In other industries, any company might be thinking about their customers. They know their customers, they stratify their customer base, they have a CRM program. You have to have at least that to even start a business nowadays. Then they have targeted marketing. All these things where you’re saying, I know my customer, I know what predictive models say they’re going to buy. For instance, on Amazon. 

We see that with technology and we expect that now. We expect that, "I bought this. The next five things I’ll likely buy would be these. I want to get information." The knowledge that companies have about us makes the experience better, whether it’s shopping, e-commerce, or finance.

It should be that way in healthcare, but the PCP is just trying to stay above water. They’re giving great care when you’re with them and they’re engaging you on a face-to-face basis. Of the many PCP customers we have, they talk about, "I do my very best and I care about my patients." We say, absolutely.

The issue is, they don’t really know what their patient base looks like. They don’t have a feeling for, how many chronic care conditions do you have? How many patients have multiple? Which ones are those? What do you do about them? How are you trying to motivate your patients? How are you trying to communicate with your patients, based on what they have and then their history of all this information and data that you already have in your system, and then more data that you can utilize with technology? That’s a critical part of what’s happening, where people don’t know who you are.

The other point I would make is that a customer of ours said, I’m there at eight o’clock. I’m trying to leave at six o’clock. I see a ton of patients, I’m doing my very best. I care, but I have a family. I try to have a semblance of a life, but I have 60+ calls waiting for me after six o’clock. It will take everything from me. There’s no way I can be there around the clock all the time. There’s no way I can really get back to those people.

Those are things that stack up — the questions that are asked. If you can be proactive and if you can have a system that helps you scale the care you’re providing, that’s what everyone’s looking for. Technology can do that in a personalized way.

In both clinical care and IT, the recipient of services usually likes and respects the person they worked with, but their satisfaction may tinged by other factors, such as how long it took to be seen, how polite the first-level people were, and how friendly the end result was, like a patient bill or a service call summary. Do you wonder how much patient satisfaction is driven by the red tape we wrap around the clinical encounter and not something the clinician themselves can influence?

No question. When I started the company, I said, there’s the concept of Doc Mayberry coming down the country lane with a medical bag and caring a lot. Doc Mayberry, you can always see him and he knows you from cradle to grave. He has taken care of you and your family for generations. That personal relationship is so strong and so important. 

Yet you’re right — we have gotten away from that. The bureaucracy has played a part. In patient relationship management, our cause is to use technology in a personalized way in such that you return to Mayberry a little bit.

That personal relationship is critical. I can tell you in my experience with my daughter, it’s very critical in terms of the relationships that we have. That contact that we get, that trust, and that history that we understand, versus somebody just coming in and we see somebody different every time. Even though they pull the EMR and see the records, “OK, I see that this has happened in the past," for us, that doesn’t work. It just doesn’t. We don’t want to explain our story over again, and then afterwards, we feel like we’re on our own. That’s not a good place to be.

Patient self-scheduling seems like it should be universal since it offers benefits to both patient and practice, yet I don’t see much of it. What’s holding back its use?

The challenge with self-scheduling is the integration into the EMR. EMRs with scheduling systems don’t do a great job at connecting with the patients on a personalized, one-on-one basis. Other companies fill that gap. They build really beautiful software and great workflows, make it simple, and outreach to the patient in the right context so the patient understands why they need to book an appointment. Not just to have it out there, but the fact that, "Oh, I really do need to come in." Outreach has happened — the invitation to come back in because their condition is there that they need to be seen. Then the presentation of booking and making it consumer-centric.

The challenge is that these independent companies that are trying to accomplish that don’t have enough technology under their belt in terms of the integration into the different EMR systems to make that a seamless process. It’s almost standalone. When we get to this standalone basis, practices go, "I’ve got to maintain three different schedules in different systems.” They’re not syncing together. Wouldn’t that be great if they could?

My belief is that you can do that if you put the time and effort into it. It comes with experience and time and a lot of effort, but when you do it right, it’s a seamless transition. We don’t care as consumers what happens on the back end of stuff. I don’t care about my plane when I fly. I want to have a decent experience, but mostly I just want to get there safe and on time. How it all works and how all the baggage gets there, I don’t know and I don’t care. I just want to see my bag come out when I get there.

That’s true about anything that consumers interact with. They just want to make it work and make it easy. On the back end, it’s fairly convoluted. There’s different systems in a clinic, for instance — different EMRs, different PMs, different schedules for providers, different ways that providers are using their schedule to book breaks and lunch breaks, and different things like that. It’s tough to read that and get it right so that when a patient books an appointment, it’s done — with the right provider, in the right location, and when they’re actually available. That’s been a challenge for a lot of companies that are trying to make their way through that process.

Is it now common for practices to use text messaging to send appointment reminders and to allow patients to text a cancellation message so the practice can open up that appointment slot to someone else who would most likely pounce on it?

It’s definitely available. Technology can do that. We’ve been doing that for a long time. But when you think about widely used, I would say it’s not.

It’s interesting to compare medical care to dentistry in sending text messages and connecting those to workflow. It’s around 50 percent in dentistry and 6 percent in the ambulatory space. Why is that? The adoption isn’t there yet. That’s why companies like ours and others are out there beating the drum and saying there’s a better way.

At some point, we’re going to ask, when we’re looking at a new practice, what insurances do you take and are you text enabled? The ability to get to that practice whenever we need to in a reasonable fashion. The phone number and the text lines are the same. There’s no app to download, no new numbers to learn, no short codes or all those crazy things that some companies get caught up in that don’t make any sense. The consumer experience in understanding how to make that easy and accessible. That’s what patients will start talking about and expecting. 

Once that kicks in, everything you talked about takes place. It can be a completely automated fashion, whereas today it’s just archaic the way we do things. One practice’s goal is to completely eliminate the telephone. You think about that and go, how could you do that? Well, it can be done, and they’re well on their way to becoming a completely 100 percent text-enabled practice, period. That’s an interesting dynamic when you start thinking that practices are starting to actually think about that. That’s revolutionizing the way that we communicate.

It was the same way when the telephone first came into practice. Why wouldn’t you have people walk in and talk face-to-face? You’re going to have a telephone? That was a revolution. Now it’s going away from that and getting to communication that’s more efficient, more effective, more cost-effective, and more scalable. Practices win and the consumers or patients win, too.

Do you have any final thoughts?

When I think about healthcare and the experience that we have, both on the provider side and the patient side, I’m pretty sure I know how the movie ends. I think I can see in the future and I think everybody can envision it in 25 years or 50 years. We’re going to have accessibility and it’s going to be almost immediate. We can all picture how much better it will be, but you have to do something now to get there.

It’s really important for practices to evolve, and consumers will push that evolution because their expectations are already there. It’s important for physicians to embrace technological change because that’s what the expectation is.

Healthcare can improve and not lose that personal touch when you’re thinking about what the end of that movie looks like in the next 20 years or 30 years or 50 years. That’s what inspires me personally. That’s why I’m involved with healthcare and in building technological solutions. It’s a shared goal that we should all have in building a better future. We can do so many amazing things with technology today. It’s just a matter of embracing that, understanding that, and feeling good about change.

Morning Headlines 3/20/17

March 19, 2017 Headlines No Comments

Medication Errors Attributed to Health Information Technology

Analysis of a Pennsylvania medical error reporting database that allows submitting agencies to indicate when health IT was a contributing factor finds that system downtime and incorrectly entered patient weight are both contributing to medical errors.

Developing and Evaluating an Automated All-Cause Harm Trigger System

A review of Adventist Health System’s use of IHI’s Global Trigger search algorithms to find possible medical errors in EHR data turns up far more potential errors than manual chart audits.

Stratasys and VA hospitals create first hospital 3-D printing network

Five VA hospitals are working together to incorporate 3D printing into care delivery, allowing doctors to make customized prosthetic and orthotic devices for veterans.

Doctor’s lawsuit against hospital turns on care v. market share

The former chairman of the surgery and cardiovascular departments at Memorial Hermann hospital (TX) is suing the hospital for defamation, arguing that after he told executives he planned to leave the hospital to work for Houston Methodist Hospital, his former employees began distributing manipulated outcomes data questioning the quality of his care.

Monday Morning Update 3/20/17

March 19, 2017 News 8 Comments

Top News

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Pennsylvania’s mandatory medical error reporting — which requires submitters to indicate if health IT caused the event or contributed to it – shows an increasing number of HIT-related medication errors. Patients were harmed in eight incidents in the state during the first half of 2016.

Interestingly, the most common cause of dose omissions was system downtime, while the most frequent cause of wrong dosage errors being incorrectly entered patient weight, with one frightening example being a 46 kg patient whose Lovenox dose was calculated based on a mistyped weight of 146 kg.

In another example, a doctor ordered 65,610 mg of aspirin, explaining that she ignored the overdose warnings because she was just re-entering the home med (and in doing so, typed 810 tablets instead of 81 mg daily).

CPOE was involved in half of the incidents, with the pharmacy and eMAR systems each being tied to about one-fourth of incidents.


Reader Comments

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From SkidMark: “Re: Epic. Continues its expansion into niche markets by partnering with Acumen Physician Solutions, which is part of Fresenius. Acumen offers a specialty EHR for nephrologists who round in dialysis clinics, but who also visit ESRD patients during their frequent hospital stays. What are the chances the Fresenius will also migrate its 2,500 dialysis clinics from Cerner Soarian to Epic’s legacy or emerging EHR for better integration with their nephrologists?” Fresenius announces that the next version of its Acumen EHR will be “Acumen 2.0 powered by Epic.” Fresenius chose Siemens Soarian in early 2005. It would seem to make sense that choosing Epic for nephrologists would improve the chances of replacing organization-wide Soarian with Epic rather than Millennium.

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From McChange Pissed: “Re: Change Healthcare’s board of directors. What is McK thinking? They made one bad IT decision after another, starting with Pam Pure, and now she’s back?” Change Healthcare’s board includes Pam Pure, now CEO of HealthMEDX, but she has served on Change’s board since 2012, long before McKesson was involved (when it was Emdeon). Also on the board (for many years, too) is Phil Pead, who was CEO of Eclipsys and chairman of the Allscripts board following its acquisition of Eclipsys, but who later was fired in 2012 after clashing with CEO Glen Tullman, who was fired himself just a few months after. At least Change Healthcare’s management team includes three females among 12 executives (25 percent) vs. just one of eight board members (12.5 percent). 

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From Springy Insole: “Re: after-visit summary. Have you seen any organization that has a patient-friendly one? The ones I’ve seen are pretty unhelpful and improvements could make a world of difference.” I’ll open it up to readers to weigh in and hopefully provide examples. Those I’ve seen look like they were uncreatively designed by programmers. The above came from the VA’s Robert Durkin, MD, MS, just to give you a refresher of what we’re talking about. While I like the format, I might suggest these changes:

  • Indicate which diagnoses were new vs. existing, or perhaps include a date for each diagnosis. In fact, a problem I see with a lot of AVS is that programmers proudly regurgitate everything they have on file about a patient along with boilerplate reference information from third-party products, creating a bulky document that makes it hard to figure out what’s new (a pervasive problem with EHRs in general).
  • Don’t mix diagnoses with health indicators, i.e. “ex-smoker” is not a diagnosis.
  • Don’t use medical jargon like “vitals.”
  • Indicate either the percentile or the risk of each vital sign listed so the patient doesn’t have to figure out what a BMI of 32 means.
  • What I would really like to see on all AVS printouts is a few sentences from the doctor that summarize what he or she found, what the patient should be doing, and what the goals are and when those goals will be reassessed. That should be the first set of items on the document, under the assumption that the patient won’t read all of it and thus should see that first. The purpose of an AVS isn’t to print out the information that already exists in the EHR, except of course in the case where lack of interoperability makes the patient the integration engine in handing it off to their next provider.
  • It would also be nice to use the summary as some type of agreement between doctor and patient of how they will work together.
  • In fact, maybe that’s my takeaway – the AVS should not be considered an efficient but poor substitute for doctor-patient communication. A pretty printout is fine for a Jiffy Lube oil change summary, but a slam-bam medical encounter that results in a handed-over sheet of paper while discouraging patients to ask questions or seek follow-up isn’t ideal. A doctor visit often reminds me of a church confessional – the parishioner quickly states his or her issues and is sent away equally quickly formulated instructions — except that in medicine’s case, the church only offers the confessional while omitting the other important aspects of the church that might have prevented the need for confession in the first place.

HIStalk Announcements and Requests

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I’ll take the glass-half-full viewpoint in celebrating the fact that 25 percent of poll respondents were able to view their records from other providers in their most recent encounter. Clarence is frustrated that his providers all use Epic, but even as a former Epic employee, he can’t convince the clinicians that they can actually retrieve his information from other sites. Greg’s specialist could access his chart and test results, but he had to tell them he’d had new tests. Brittney was impressed that her urgent care clinic records were not only automatically placed into her PCP chart, but that the doctor even asked about the outcome. Susan says we all need to educate patients and support consumer-mediated health exchange because they don’t realize that we aren’t already exchanging information.

New poll to your right or here: what was your patient portal experience from your most recent provider visit?

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Mrs. H in Michigan exclaims, “This is amazing!” in describing how her students are using the listening center we provided in funding her DonorsChoose project. She says they listen to stories every day, write about what they heard, share their thoughts with classmates, and then take the physical book home to read on their own.


This Week in Health IT History

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One year ago:

  • Apple announces the CareKit developer framework for creating iPhone health apps.
  • McKesson announces that it will take a $300 million restructuring charge and lay off 1,600 employees.
  • NYC Health + Hospitals President and CEO Ram Raju, MD defends the organization’s Epic go-live date and says a CMIO who quit over the patient safety implications is a disgruntled former employee.
  • Several hospitals are hit by ransomware.
  • Allscripts and a private equity firm acquire post-acute care EHR vendor Netsmart for $950 million.
  • New York’s e-prescribing mandate takes effect.

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Five years ago:

  • Memorial Sloan-Kettering Cancer Center and IBM announce their collaboration to use IBM Watson for oncology decision support.
  • Vocera prices its IPO shares.
  • Thomson Reuters puts its healthcare data and analytics business back on the market.
  • Cerner breaks ground on its new campus at State Avenue and Village West Parkway.
  • HHS launches a developer challenge to use Twitter for real-time public health tracking.

Weekly Anonymous Reader Question

Last week I asked readers to describe the dumbest EHR design flaw they’ve seen recently. I’m omitting vendor names since the point was to show the need for improvement as an industry.

  • Click on Labs and there’s a New button, but that means to add a new historical lab – you can’t actually order from there.
  • It’s impossible to add reference ranges for in-house labs.
  • Free-text drug allergy entry is allowed and users do it all the time despite threats to their unborn children.
  • The end user can click one wrong button and delete a global template that cannot be recovered.
  • Storage of multiple instances of physiologic variables in different parts of the same database – a heart rate entered by a nurse goes one place, one entered by an allied health provider goes into another data element. When reporting on heart rate, which one does one access?
  • Cannot store/send more than one ID for an individual patient visit, which is horrendously inadequate for trying to do conversions, file billing data, and file incoming patient data from another system.
  • Approving med refill requests makes no entry in the EHR.
  • Half of the home screen is taken up with notifications that list only a category and number. I have to open each one and there may be 10-15 at any time. I just want a list, maybe grouped by category, so I can see them at a glance.
  • Can’t put isolation status in the patient header.
  • The medication ordering drop-down sorts as strings instead of integers, so doses are listed as 1, 10, 2, 20, etc. How easy is it to generate an order for 10 mg of warfarin instead of 1 mg? Easy enough to be very glad a pharmacist caught the mistake before “the computer” killed someone with massive internal bleeding.
  • Does not have a unique identifier to send for bi-directional data flow.
  • The lack of design generosity for analysts blows my mind. It’s appallingly easy to hit a key and overwrite something – there’s no way to know what had been there, no undo button, and no way to close a record without saving.
  • Our appointment reminder system can send only the patient’s scheduled start time, ensuring that we will run behind schedule. Is it so hard for the system to subtract 10 minutes for follow-up patients and 20 for new patients to calculate the arrival time?
  • Tiny icons that can’t be enlarged.
  • Scanning in individual TIFF files.
  • Two of our systems can’t handle the Daylight Saving Time change in the fall and must be shut down for an hour.
  • If you click X next to a patient name when entering documentation, there’s no “do you want to save your work” warning like every single other piece of software in existence.
  • When discharging an ED patient, I select instructions, discharge meds, follow-up doctor, and instructions. Back on the discharge screen, the Print button prints an instruction with none of the above listed. I have to jump to another part of the application and reload the page. I’ve had patients leave the hospital without the information and we had to deliver it to them. The vendor’s “reload after selecting” workaround has been in place for 2.5 years.
  • The provider master file should be its own app with a cert and minimum staffing recommendation.
  • A vendor demonstrated their new enterprise system to a large hospital group and discharged the pregnant male demo patient. The risk manager pointed out the flaw.
  • A well-known EHR does not port a female patient’s gyn history into the OB episode when she becomes pregnant, requiring employees to re-document the entire history.
  • The vendor sets up two direct messaging solutions, one that’s DirectTrust accredited and one that isn’t. As a result, not all users can exchange messages with other accredited HISPs and they may not know if they are on the “right” HISP.
  • If an external user sends a Direct message with a C-CDA and PDF, the HISP drops the PDF attachments because the vendor doesn’t support receiving them. Plenty of EHRs have the same problem, but the killer is that there’s no notice back to the sender that only part of their message was delivered.
  • No sandbox for hospital users.

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This week’s question, just to lighten things up a bit:  What’s the most hilariously clueless one-sentence statement you’ve heard an executive of your organization make?


Last Week’s Most Interesting News

  • A GAO report says HHS should question why so many providers say they offer patients access to their electronic information, yet few patients review it.
  • Mayo Clinic says its decreasing margins force it to give appointment priority to patients covered by private insurance rather than Medicare and Medicaid.
  • ECRI’s #1 patient safety concern for 2017 is EHR information management.
  • A House bill would allow employers to require employees to undergo genetic testing and to share their results to earn health insurance premium discounts in corporate wellness programs.

Webinars

March 29 (Wednesday) 1:00 ET. “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.” Sponsored by Voalte. Presenters: James Jones, MBA, MSN, VP of patient care services and nursing operations, UW Medicine Valley Medical Center; Wayne Manuel, MBA, SVP of strategic services, UW Medicine Valley Medical Center. UW Medicine Valley Medical Center dramatically improved patient outcomes after moving to a smartphone-based platform for clinical communication and alarm and alert notification. Before-and-after analysis shows a reduction in hospital-acquired pressure ulcers and skin integrity events, fall and slip events, and medication errors. By limiting overhead paging, the medical center also created a calmer, quieter environment and improved engagement among nursing and hospitalists. Hospital executives will describe their experience and vision for the future in addressing quality, cost, and the patient-caregiver experience.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Decisions

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  • Henry Ford Allegiance Health (MI) will go live with Epic in August 2017.
  • Columbus Regional Healthcare System (GA) switched ERP systems from Infor to Sage in January 2017.
  • Bon Secours St. Francis Hospital (SC) moved from McKesson to Cerner in October 2016.

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


People

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The Missouri Health Connection HIE promotes Angie Bass, MHA to president and CEO. I believe she’s the fourth CEO since the organization was founded in 2012.


Privacy and Security

Children’s Hospital of Eastern Ontario notifies 283 people that the medical information of their children was used in a college class taught by one of its employees, who handed out a surgery schedule will full patient information for an in-class exercise.

Houston Methodist Cancer Center notifies 1,400 patients that their email addresses were exposed when an employee used CC: rather than BCC: for a mass email.

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A North Carolina radiation oncologist and medical school professor is arrested for issuing fraudulent narcotics prescriptions. Adding insult to injury, State Bureau of Investigation officials who raided his home also arrested his son when they examined his computer and found child pornography. That should create some awkward “remember that day” family conversations.

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A Texas woman files a complaint with the state’s medical board and notifies HHS after she says a doctor who performed a “non-surgical tummy tuck” that she complained about on Facebook, after which the doctor allegedly posted near-naked pre-surgical photos and video of her on Facebook and YouTube. The patient claims that Tinuade Olusegun-Gbadehan, MD then threatened her by emailing a link to the video and a message that said, “This video result, when posted as a response to your next slanderous comment about the Dr. O Lift on social media, will be just as damaging to YOUR professional reputation.”


Other

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Five VA hospitals create the country’s first 3-D printing network, allowing doctors to design and build prosthetic and orthotic devices as well as to construct anatomic models for study and surgery practice.

A high-profile cardiothoracic surgeon sues Memorial Hermann (TX), which he claims manipulated outcomes data to discredit him after he threatened to move to competitor Houston Methodist Hospital. The doctor – who had served as chair of both the surgery and cardiovascular departments of Memorial Hermann — says Memorial Hermann ordered him to perform surgeries only under the supervision of another surgeon and then presented the information to a roomful of colleagues to smear his reputation even though the underlying data was flawed. “I was coming between administrators and market share,” he concludes, saying he left because Memorial Hermann’s cost-cutting measures were compromising patient care. The hospital stands by its peer review process that uses data from the Society of Thoracic Surgeons.

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Adventist Health System’s automated, real-time patient harm trigger system – which attempts to identify patient safety issues by reviewing events such as the ordering drugs that might indicate treatment of unreported patient harm – captures a lot more incidents than manual review. The most frequent harms in order of severity were medication-related hypoglycemia, C. diff infection, medication-related bleeding, venous thromboembolism, and post-surgical respiratory complication. The most dramatic increase was for pressure ulcers, which were detected 112 times by the trigger system vs. 0 as previously reported to the PSI 90 regulatory program.

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The FBI charges a man with cyberstalking after he uses Twitter to induce an epileptic seizure in a magazine editor who had written articles critical of President Trump. 29-year-old John Rivello knew that Kurt Eichenwald suffers from epileptic seizures and tweeted him a strobe-like animated GIF with a message, “You deserve a seizure for your post.” Eichenwald had an immediate seizure that left him incapacitated for several days and has since received similar animations from 40 other seriously disturbed Twitter users.

Bizarrely sad: a man plugs his iPhone charger into an extension cord and takes the phone into the bathtub with him, with the resulting water contact electrocuting him. The coroner says he will ask Apple to warn phone-addicted people that bringing a plugged-in phone into the bathtub is little different from using a hairdryer there. The man had plugged the extension cord into a hall outlet, which makes me think that he might still be alive had he instead chosen a GFI-protected bathroom jack. Or, if his bathroom indeed had GFI, whether his bypassing of it was perhaps intentional.

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Miami authorities try to build a case against a porn star who also operated a cosmetic center where a woman died in 2013 after a botched butt lift procedure. Vanessa Luna (her professional name, which is subtly clever if intentional since her trademark feature is her posterior and thus a “moon” reference is sly) says her clinic just sold Herbalife and cosmetics, but several witnesses say she oversaw illegal cosmetic surgeries performed there. Ms. Luna says she ran Facebook ads for plastic surgery and sold the resulting referrals to reputable doctors, but didn’t do any procedures herself. It wouldn’t be a South Florida story without Medicare fraud, for which the patient had served prison time.


Sponsor Updates

  • Versus Technology will exhibit at AMGA March 22-25 in Grapevine, TX.
  • Huron recognizes employee performance with 10 senior-level promotions.
  • ZeOmega releases the latest edition of its ZeExchange newsletter

Blog Posts


Contacts

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

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Morning Headlines 3/17/17

March 16, 2017 Headlines No Comments

HHS Should Assess the Effectiveness of Its Efforts to Enhance Patient Access to and Use of Electronic Health Information

A GAO report investigating why so few patients access patient portals despite widespread availability concludes that having different portals for each provider, with no longitudinal view of data, combined with poor user interface designs, limits the consumer appeal.

The man who helped save HealthCare.gov wants a bipartisan solution to health care

Andy Slavitt, former acting administrator for CMS, has accepted a position as a senior advisor with the Bipartisan Policy Center.

AliveCor raises $30 million for its credit card-sized heart monitor and app

EKG app vendor AliveCor raises $30 million to hire AI engineers and expand the platforms ability to analyze and interpret EKG waveforms.

Dallas City Leaders, T-Mobile Vow to Find Solutions as 2nd Death is Publicly Connected to 911 ‘Ghost Calls’

A still unresolved bug unique to T-Mobile customers in Dallas is causing 911 phone lines to be flooded with hundreds of phony calls, leaving legitimate callers to wait on hold while dispatchers clear the lines. The issue has been a problem for months, but generated national attention when a six month old died while his babysitter waited on hold for more than 30 minutes.

News 3/17/17

March 16, 2017 News 12 Comments

Top News

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A GAO report says HHS should investigate why few patients access their electronic medical information even though 90+ percent of hospitals and practices claim to offer such access.

The report suggests that patient portals are the most common method by which patients look up their information, most commonly that of the provider’s EHR vendor. The report notes the limitations of portals:

  • Patients must often use multiple portals for their multiple providers, meaning they have to go through the sometimes laborious setup more than once and maintain multiple sets of login credentials.
  • Longitudinal data across providers isn’t available.
  • User interface design is often poor.
  • Each provider’s portal may be set up to display a subset of the available information that may be inconsistent, such as one portal showing prescriptions and another not.
  • New information is not always available consistently, such as recent lab results that may not be posted every time depending on which lab processed the sample.
  • Portals don’t usually display historical vital signs and weights that the patient could use for trending.

The percentage of patients who review their health information varied widely depending on which EHR the organization used. Of the top 10 vendors (which were not named in the report), the percentage of patients who reviewed their information ranged from 10 percent to 48 percent.

The report suggests that providers provide portal brochures, promote the portal during each interaction, make computers available in the hospital or practice, send reminder emails, reward clinical staff, or offer patients prizes or discounts for using the portal.


Reader Comments

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From Inquiring Mind: “Re: Soffet. We’re converting to Cerner Patient Accounting and the reference site mentioned a product called Cerner Charge Integrity from Soffet. We’ve searched HIStalk and haven’t found it. Where can I find this mythical company and product?” Some pretty impressive Googling (if I do say so myself) turned up Softek Solutions, which offers EHR performance and revenue integrity solutions for Cerner sites.

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From Shoulda Shorted: “Re: fitness trackers. You wrote in 2015 that fitness trackers had run their course. I sent that comment to my broker when Fitbit was trading at $35, but I should have also shorted shares – they are now at $6.” I also now see that Microsoft has killed off its poorly designed Band tracker that I had panned after trying it, with its demise going unnoticed due to indifference. My take today: the only fitness tracker that will ever be consistently used will be built into your phone, with any required sensors being effortless and invisible. Nobody wants to wander around like Dick Tracy with a big old gadget on their wrist or risk embarrassment after missing a fad shift in still wearing one of those once-ubiquitous but now-defunct Livestrong yellow rubber bands. My weekend poll might ask how many trackers you’ve owned and whether you still use one (my early 2014 survey found that 37 percent of respondents claimed to use their tracker at least five days per week, “use” being loosely defined). The early-market churn as companies rushed supposedly improved products to market and convinced consumers to change brands created the illusion of ongoing demand, but there’s only so much to be gain health-wise by counting steps and most Americans don’t really want to take a lot of steps anyway. At least you can hang clothes from unused treadmills.


HIStalk Announcements and Requests

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Readers funded the DonorsChoose grant request of Ms. H in Indiana, whose seventh graders are using the scientific calculators we provided to perform complex experiments in calculating the volume of cylinders using popcorn.

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Lorre’s post-HIMSS specials for new sponsors of the site and of webinars ends when March does, so interested companies have a couple of weeks to speak up before we slack off during those lazy, hazy, crazy days of summer.

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I was reading a questionably authoritative article that proclaimed that data centers will be obsolete within five years because of the cloud. I think they missed the fact that data centers aren’t going away – they’re just being centralized. What has changed is ownership and the length of the cord attaching the end user. As I often say, the cloud is just someone else’s computer, although that’s a flip response if a vendor really offers a “cloud” – a pool of interchangeable, commodity servers that are physically touched only when installed and discarded and that are managed collectively, spun up quickly via software, scalable, and are sold as a metered service. It would be interesting to know which health IT vendors are truly operating in this type of cloud vs. just parking the same old server in their own building instead of one owned by the customer. And speaking of Dilbert (which I wasn’t, except to include the strip above), Scott Adams is putting together a list of startups that could lower healthcare costs and is seeking submissions in case you work for one of those.

Listening: new from Norway-based but American-sounding Beachheads, jangly, hook-laden power pop that defies your toes to stop tapping even with a pleasant soupcon of the punkish minor chords that I require.

This week on HIStalk Practice: CaptureRx expands, relocates in San Antonio. Southwest Behavioral & Health Services implements EnSoftek IT. Compulink develops EHR for pain medicine providers. Primaria Health launches ACO in Central Indiana. Ingenious Med CEO Joe Marabito calls out lack of vendor support for physicians. Price, Verma reassure governors of their commitment to Medicaid. MGMA takes CMS to task for lack of 2017 MIPS eligibility information.


Webinars

March 29 (Wednesday) 1:00 ET. “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.” Sponsored by Voalte. Presenters: James Jones, MBA, MSN, VP of patient care services and nursing operations, UW Medicine Valley Medical Center; Wayne Manuel, MBA, SVP of strategic services, UW Medicine Valley Medical Center. UW Medicine Valley Medical Center dramatically improved patient outcomes after moving to a smartphone-based platform for clinical communication and alarm and alert notification. Before-and-after analysis shows a reduction in hospital-acquired pressure ulcers and skin integrity events, fall and slip events, and medication errors. By limiting overhead paging, the medical center also created a calmer, quieter environment and improved engagement among nursing and hospitalists. Hospital executives will describe their experience and vision for the future in addressing quality, cost, and the patient-caregiver experience.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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CareDox, which offers a free EHR for K-12 public schools, raises $6.4 million in a Series A funding round, increasing its total to $13.5 million. The company is vague about how it makes money, but it appears to sell de-identified student information and to send care reminder-type advertising messages to parents.

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First Databank acquires Polyglot Systems, which offers the Meducation patient medication instructions product line.

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FDA-approved EKG app vendor AliveCor raises $30 million to add AI-powered EKG analysis to its service.

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Livongo Health, the diabetes monitoring and coaching company led by former Allscripts CEO Glen Tullman, raises $52 million in a Series D round, increasing its total to $143 million.

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McKesson is rumored to be selling its San Francisco headquarters building for $300 million. The company previously announced plans to sell and then lease back the 38-story building.


Sales

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Hawaii’s leading health plan HMSA selects Sharecare’s consumer health and messaging platform for a statewide rollout and also makes an unspecified investment in the company, started in 2010 by WebMD founder Jeff Arnold and TV’s Dr. Oz. Sharecare acquired the population health business of Healthways in July 2016.

Mount Sinai Health System (NY) will use Salesforce Health Cloud to coordinate and manage care of Medicaid Performing Provider System.


People

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Influence Health hires Dave Morgan (Recondo Technology) as CFO and Rupen Patel (NCR) as CTO.

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Former Acting CMS Administrator Andy Slavitt (and our HIStalk Industry Figure of the Year) joins the Bipartisan Policy Center as senior advisor.


Announcements and Implementations

Mayo Clinic says that its tighter margins have forced it to start giving appointment priority to privately insured patients over those covered by Medicare and Medicaid. Mayo had a $475 million profit in 2016. What’s most surprising is that Mayo announced publicly what most health systems do privately – market to those with private insurance and, all things being equal, give them smoother passage through the system without affecting clinical outcomes. Perhaps there’s a market for a targeted patient dissatisfaction program to keep the low-paying customers away without actually banning them.

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IBM Watson Health licenses AI-powered medical imaging analysis software from Israel-based MedyMatch Technology, which IBM will offer to EDs for assessing patients with suspected head trauma or stroke.


Government and Politics

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The White House’s budget proposal, which would cut NIH funding by 19 percent, would also move HHS’s AHRQ into the National Institutes of Health.


Privacy and Security

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A phishing employee awareness test by BayCare Health System (FL) creates headaches for the tax collector’s office when appropriately wary workers call to verify the phony government-looking email. The health system expected unsuspecting employees to click on links as the email instructed, which would have automatically presented them with a lesson on why their actions were inappropriate.


Other

A second Dallas death is attributed to a “ghost call” problem in which 911 callers can’t get through because the lines are overloaded by calls from T-Mobile cell users who didn’t actually dial 911. The Dallas-only problem seems happen when someone completes a 911 call, then sometime later the cell service thinks the call didn’t go through and tries again. The city admits that a six-month-old died while his babysitter was on hold with 911 for 30 minutes last week, with records indicating that 360 callers were waiting on hold at one point in the day.

A federal judge dismisses a lawsuit brought against Amtrak by Temple University Hospital that demanded payment of $1.63 million for treating a passenger injured in a May 2015 derailment. The passenger was covered by Medicare but the hospital didn’t submit its claim in time to collect the $269,000 that Medicare would have paid.

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I mentioned last time that a new app measures the percentage of time men vs. women speak in a meeting, but here’s one I like better. Woman Interrupted allows measurement of “manterruption,” when a male interrupts a female who is speaking. I’m sympathetic since there’s nothing that drives me crazier (and often into pouty silence) than when someone of either gender repeatedly interrupts me, either in a one-to-one or group setting. It’s usually one of two extreme personality types: (a) an egotist (often the highest-ranking person in a meeting) who thinks they possess super-human insight into what needs to be said; or (b) someone so lacking in self-confidence that they have to talk over someone else to feel validated. I’m pretty sure those interrupters hate being interrupted themselves (since everybody does), so I always wonder if I should just say, “I’m going to leave now since you’ve turned our dialog into monolog and thus rendered my presence superfluous.” For the app, I suggest a Nuance-powered enterprise version that maintains speech profiles on every employee so it can provide a meeting recap indicating: (a) how much time each person talked; (b) how many times they interrupted someone or were interrupted themselves; and (c) who the primary interrupters are on the rudeness leaderboard. Perhaps it could also record which ideas each person argued for or against and then reconvene the groups six months later to see whose thoughts most closely aligned with the eventual reality and then automatically remove the chatty but wrong ones from future invitations.


Sponsor Updates

  • Billings Clinic Hospital (MO) goes live with Versus Wi-Fi RTLS asset tracking.
  • InterSystems posts its HIMSS17 presentation by Mental Health Center of Denver VP & CIO Wesley Williams, MD.
  • Intelligent Medical Objects, Kyruus, Meditech, and PerfectServe will exhibit at AMGA 2017 March 22-25 in Grapevine, TX.
  • Liaison Technologies will exhibit at the SCOPE Spring Conference March 19-21 in Atlanta.
  • LifeImage publishes a new primer, “Image Sharing: Is It Missing From Your Enterprise Imaging Strategy?”
  • Gartner names LogicWorks a leader in its 2017 Magic Quadrant for Public Cloud Infrastructure Managed Services Providers.
  • MedData and The SSI Group will exhibit at the HFMA Texas State Conference March 26-29 in Austin.
  • Netsmart will exhibit at the NAPHS Annual Meeting March 20 in Washington, DC.
  • News: NTT Data awarded contract by the CDC
  • NVoq will exhibit at the ACC Annual Scientific Session & Expo March 17-19 in Washington, DC.
  • Experian Health will exhibit at HFMA KY March 30-31 in Lexington.
  • Reaction facilitates a study on the ways in which independent physician referrals represent millions of dollars in revenue for hospitals.
  • Harris Healthcare will exhibit at the NYONEL Annual Meeting March 19-21 in Tarrytown, NY.
  • Sagacious Consultants releases the latest edition of Sagacious Pulse.
  • Sunquest will exhibit at ACMG 2017 March 22-24 in Phoenix.
  • Surescripts will exhibit at the Patient Adherence and Engagement Summit March 21-22 in Philadelphia.
  • Sutherland Healthcare Solutions releases a new case study featuring Palomar Health, “Turning ICD-10’s Transition from Anticipated Calamity into a Resounding Success.”

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 3/16/17

March 16, 2017 Dr. Jayne No Comments

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It’s been a whirlwind of a week with two more trips to the hospital, one planned and one not. Long story short, though, I’m back in the air and off to see clients, which is a good feeling.

I’m also headed somewhere warmer than my current snowy state, which is definitely something to look forward to. Many of my spring plants were up or blooming when the snow hit, so the garden will have a bit of a setback this year. I’m just glad I’m not traveling to central Florida, where CNN reports that a cobra escaped captivity and is now in the wild.

In follow-up to my post about having a partial EHR outage this weekend, the vendor never did send an update about the situation. We also had an outage today of the patient portal, and again after 12+ hours, no follow up. If they’re not going to follow up, their emails shouldn’t say they will send follow-up emails as further information becomes available.

In healthcare IT, we tend to think about our work within the contexts of inpatient vs. post-acute vs. ambulatory vs. community vs. population health, etc. As humans begin to spend more time in space, that’s going to be the next frontier of healthcare IT. NPR recently reported on microbiologist/astronaut Kate Rubins, who was the first person to sequence DNA in space. I was interested to learn about the microbiome of the International Space Station, something you don’t hear about much but that opens the door for some unique research activities.

In other news scientists in China have completed gene editing on viable human embryos using the CRISPR technique. Although the study was small and the results were not perfect, they were promising. Gene editing could reduce the incidence of heritable diseases, but we have a lot to learn about the technique, impact, and ethics of doing so.

I’ve certainly got genetics on the mind following my consultation with the genetic counselor earlier this week. Although she didn’t give me the initial speech about the science of genetics, I appreciated that she didn’t assume that I had done a ton of research or had preconceived notions about what we were talking about. We talked about my specific concerns based on family history as well as what kinds of testing are available and the ramifications of having positive testing.

Although the Genetic Information Nondiscrimination Act of 2008 restricts the use of genetic data in health insurance and employment issues, it doesn’t prevent issues with the underwriting process when you’re talking about life insurance, disability, long-term care coverage, and more. One of the first questions she had for me when we were talking about testing was whether I had addressed those types of coverage or not.

Although I’ve worked out the life insurance and disability pieces, I haven’t addressed the long-term care coverage issue. Still, I decided to go forward with the testing, but on a limited basis, looking only for a couple of specific mutations. There are plenty of panels available that test for up to 80 genes, but I’m not going to go looking for something that isn’t a concern and wouldn’t potentially change my management plan for preventive screenings.

Based on the dramatic increase in our knowledge of genetics over the last decade, we agreed it would be prudent to meet again in a couple of years and discuss whether there are new recommendations for testing someone in my situation. To answer the previous reader question, she uses panels from Myriad Genetics.

We also walked through a couple of risk models based on my family history without the genetic testing component. This is where the discussion quickly became academic, because one of my personal risk factors is considered a “borderline” risk factor in that some models consider it a risk and others don’t. When the model is run with the risk factor in place, my lifetime risk of breast cancer is pretty alarming. Without the risk factor, the risk is cut in half. Even with the diminished risk of the second model, it was enough to qualify me for a high-risk screening program, which seems like a reasonable option compared to the alternatives. We’ll have to see what my insurance thinks, however.

Being in the high-risk program at the medical center is tied to their imaging center, which of course involves hospital facility fees for the studies. In my area, though, the cost difference for a screening mammogram isn’t much more than at the independent imaging center where I had my previous studies, so I opted to get mine done at the hospital while I was there. I realized as I was getting dressed, however, that moving my care to the hospital meant giving up the “real time” reads done at the independent center. I hadn’t thought of that prior to the test, which made me wonder how many other patients might not have thought of it. It really is amazing to me how easily your reasoned clinical and analytic process can go out the door when you become the patient.

My experiences as a patient over the last few weeks have given me a better understanding of how hard we make it for patients and their caregivers and how much individual variation there really is in our healthcare system. It also made me realize that despite thinking I had a pretty solid handle on my family history, there were quite a few questions I couldn’t answer. Most patients probably don’t have as much information as I walked in there carrying and that certainly impacts the patient experience and the specificity of the counseling.

It will be a while before I get the genetic testing results back, and in the mean time, I’ll be reading up on some novel genes that the counselor mentioned may have interesting implications for my family but that aren’t being commercially tested yet.

Friday is Match Day, when thousands of medical students learn which residency programs they’ll be headed to for the next three to seven years. Good luck to everyone waiting for their envelope. And to those who didn’t match to the residency of their dreams, keep your chin up and learn all you can wherever you go.

Email Dr. Jayne.

Morning Headlines 3/16/17

March 15, 2017 Headlines No Comments

Health Insurance Marketplaces 2017 Open Enrollment Period Final Enrollment Report

CMS reports that this year’s final ACA enrollment total was 12.2 million individuals, half a million less than last year.

It’s Time to Adopt Electronic Prescriptions for Opioids

Atul Gawande, MD, MPH calls for greater use of electronic prescribing for opioid prescriptions in an Annals of Surgery article.

What Your Therapist Doesn’t Know

The Atlantic describes new algorithms being used to predict which patients are at risk of dropping out of therapy treatment.

CRISPR Could Change The World, But Right Now $90 Million Is Enough

Botox-maker Allergan will pay $90 million for exclusive rights to CRISPR-based treatments being developed by Editas Medicine that are targeting a rare form of blindness called Leber Congenital Amaurosis.

Readers Write: Data Security Comparison: Healthcare vs. Retail, Finance, and Government

March 15, 2017 Readers Write No Comments

Data Security Comparison: Healthcare vs. Retail, Finance, and Government
By Robert Lord

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Robert Lord is co-founder and CEO of Protenus of Baltimore, MD.

In 2016, the healthcare industry experienced, on average, more than one health data breach per day, and these breaches resulted in 27,314,647 affected patient records. Clearly, criminals are targeting patients’ medical information with great frequency and success.

How has the healthcare industry responded to this continuing epidemic? Data suggests there is still a lot of work for healthcare organizations to do in order to improve the security of their patient data. It’s important to look closely at and analyze how healthcare organizations’ security practices and spending compare to retail, finance, and government — three industries known to have proactively advanced their security posture to protect their sensitive data.

Compared to the retail and finance industries, the state of healthcare data security is sorely lacking. Since 2015, 140 million patient records have been compromised, equating to one in three Americans experiencing their health data being inappropriately accessed. Ransomware attacks hit the healthcare industry especially hard, as 88 percent of all ransomware attacks target a healthcare organization.

Criminals are increasingly targeting healthcare because patients’ medical information is incredibly profitable on the black market and it’s more easily accessible when compared to more protected industries, such as finance. Within the finance industry, if a customer’s credit card or bank account number is stolen, that information can simply be changed, rendering it useless to the criminal. Patient data, on the other hand, is a repository of information that can be used to steal an individual’s identity – Social Security numbers, DOB, and addresses.

When combined with sensitive medical information like diagnoses, claims history, and medications, it can create the perfect storm for wreaking havoc in a patient’s life. This kind of information cannot be easily changed, and because of the lagging security in the healthcare industry, this data is incredibly easy to obtain and increasingly vulnerable to criminals’ sophisticated attacks.

There is no question that when compared to other industries, healthcare falls short when it comes to data security. A 2015 survey found that only 31 percent of healthcare organizations used extensive methods of encryption to protect sensitive data and 20 percent used no encryption at all. Another study found that 58 percent of organizations in the financial sector used encryption extensively. These results are concerning because the information healthcare organizations must protect is far more sensitive and potentially damaging than the information retail and finance organizations gather and protect even though the latter group is more proactive in keeping this information safe.

Retail and financial service organizations have more experience protecting customer data from cyber criminals.This gives them an advantage over healthcare organizations, who are relatively new to the game and whose unique security challenges require specially designed solutions. It’s past time for healthcare organizations to invest substantially in protecting patient data. Sadly, according to KPMG, this has not yet occurred at the necessary scale, as IT security spending in the healthcare industry is just 10 percent of what other industries spend on security.

Incentives exist for healthcare organizations to improve their security posture because the cost of a healthcare breach is significantly higher than in other industries. The average cost per lost or stolen record is $158 across all industries. In the retail sector, the cost is $200 per record lost or stolen. In the financial sector, the cost is $264 per record.

Compare this to the healthcare industry, where the average cost per record lost or stolen is $402, double that of the retail sector. Why are healthcare data breaches so much more expensive? In the aftermath of a breach in a heavily regulated industry like healthcare, the breached organization must conduct a forensics investigation and notify any affected patients. These organizations must also pay any HIPAA fines or penalties incurred because of failure to comply with federal or state regulations. This is in addition to legal fees, lawsuits and most importantly, the long-term brand reputation of the affected organization and lost patient revenue.

However, it’s important to note that healthcare is not the only industry to have fallen behind when it comes to data security. The US government has also struggled to institute effective data security practices. A study by SecurityScoreCard examined the security posture of 600 local, state, and federal government organizations and compared them to other industries. The study found that government organizations had some of the lowest security scores, trailing behind transportation, retail, and healthcare industries. It also found that there were 35 major data breaches of the surveyed organizations from April 2015 to April 2016.

In the summer of 2015, the Office of Personnel Management (OPM) announced that it had suffered a massive data breach. The sensitive information of over 21 million people had been stolen, including fingerprints, Social Security numbers, and sensitive health information. A report from the House Committee on Oversight and Government Reform alleged that poor security practices and inept leadership enabled hackers to steal this enormous amount of sensitive data. OPM immediately began to implement changes aimed at improving their security posture and ensure that such a future massive breach would be prevented. However, one can’t help but consider how much less damage would have been done if OPM had made these changes as a proactive data security measure instead of a reactive one.

While healthcare organizations have had their fair share of data breaches, the OPM breach must serve as a lesson to the industry. Since that incident, the government has prioritized cybersecurity and focused on finding solutions to protect our nation’s sensitive information, data, and assets. Healthcare organizations must follow suit.

Here are five things healthcare organizations can do now to improve their health data security:

  1. Frame security risk assessments as an ongoing process rather than a once-per-year event, ideally, but at the very least ensure they are done annually.
  2. Encrypt data stored in portable devices.
  3. Assess other third-party security risks.
  4. Proactively monitor patient data for inappropriate access.
  5. Educate and retrain staff on how to properly handle sensitive data.

Healthcare must make privacy and security top priorities, learning from the past, applying knowledge from other industries, and creating unique solutions specifically designed for the complicated healthcare clinical environment. This will ultimately provide healthcare organizations with the tools to keep sensitive patient information safe, maintain the organization’s brand reputation, and most importantly, increase patient trust.

Readers Write: Beyond the Buzzword: Survey Shows What EHR Optimization Means to Providers

March 15, 2017 Readers Write 3 Comments

Beyond the Buzzword: Survey Shows What EHR Optimization Means to Providers
By David Lareau

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

I was intrigued by this recent KPMG CIO survey that found “EMR system optimization” was currently the top investment priority for CIOs. The survey, which was based on the responses of 112 CHIME members, revealed that over the next three years, 38 percent of the CIOs plan to spend the majority of their capital investment on EHR/EMR optimization efforts.

The key word here is “optimization,” since over 95 percent of hospitals already have an EHR/EMR, according to the Office of the National Coordinator (ONC). Given the high level of provider dissatisfaction with their EHRs/EMRs, it’s not surprising that CIOs are seeking ways to make their doctors happier with existing solutions, since starting over with a new system would require a major capital investment that few hospitals are willing or able to afford.

In the KPMG report, the authors suggested a few ways CIOs could optimize their EMRs/EHRs, including providing effective user training and making more technology available remotely and via mobile devices.

Coincidentally, at HIMSS this year, we conducted our own survey to get a better understanding of what providers find most frustrating about working in their EHR/EMR. I am the first to admit our survey wasn’t the most scientific – the primary reason that almost 700 people agreed to participate in the survey was because it allowed them to enter our drawing for a vacation cruise – but nevertheless, the results were compelling.

We asked HIMSS attendees the following question: What is most frustrating about working in your EHR? We then offered the following response choices:

  1. Relevant clinical information is hard to find
  2. Documentation takes too long
  3. Doesn’t fit into my existing workflow
  4. Negatively impacts patient encounters
  5. Doesn’t frustrate me
  6. My organization doesn’t use an EHR

A whopping 44 percent selected the response, “Documentation takes too long.” For the sake of comparison, the next-highest response was, “Relevant information is hard to find” (18 percent), followed by, “My organization doesn’t use an EHR” (13 percent).

What I glean from these results – aside from the fact that CIOs would be well served to invest in solutions that improve documentation speed – is that CIOs and other decision makers may not be focused on the right solutions.

I am a big proponent of user training, but let’s be realistic: if you have a propeller-driven airplane, it’s never going to perform like a jet aircraft. CIOs must accept that even with all the training in the world, the documentation process within some legacy EHR systems will never be significantly faster, nor will it be particularly user friendly.

Rather than investing resources in trying to teach users how to make more efficient use of an inefficient system, why not consider investing in a solution that can easily be plugged into legacy systems and give clinicians the fast documentation tools they desire? CIOs can find technologies that work in conjunction with existing EHRs to alleviate provider frustration because they work the way doctors think, do not get in their way, and do not slow them down.

The KPMG survey confirms what most of us in healthcare IT have long known: EHRs have not yet achieved their full potential, providers are weary of the inefficiencies, and more resources must be spent to optimize the original investments. As CIOs and other decision-makers consider their next steps, I encourage them to assess what they now have and look for solutions that give clinicians what they want and need at the point of care.

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