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Readers Write: Chicken or Egg?

April 27, 2015 Readers Write 3 Comments

Chicken or Egg?
By Niko Skievaski

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HIStalk recently released these poll results: “Which #1 reason would cause you to avoid doing business with a startup?” (*n=350):

  • Fears that the company isn’t financially viable (47 percent )
  • Offering a product that solves a non-strategic problem (21 percent)
  • Lack of integration with existing IT systems (17 percent)
  • Lack of comparable reference sites (10 percent)
  • A CEO who doesn’t have poise, polish, or healthcare experience (5 percent)

These embody much of the technology adoption barriers facing healthcare. Startups are perceived as being unable to commit to long-term contracts and lack reference sites to build confidence in buyers– just as the first chicken couldn’t have been hatched without the egg from which it came. These things combined make for a very difficult landscape for healthcare technology startups to thrive in. So who lays the egg?

Fears that the company isn’t financially viable. It’s extremely costly for a health system to adopt new technology. Beyond the price tag, there are real costs associated with implementation and training necessary to successfully go live. The last thing they want is to be left hanging if your company goes under. Jason Bornhorst, who exhibited the last two years in the HIMSS startup neighborhood, said, “I’d estimate that about two-thirds of the companies that were here last year aren’t around any more.” The fact of the matter is that you need to have the resilience to ride the bone-breaking sales cycle. They’ve been practicing medicine without your software for 100 years; they can wait another 1-2. How do you bootstrap financial viability to last the long sales cycles and combat this perception? Raise more money, find alternative revenue sources, join an accelerator or two to buddy up with health systems, and surf the cycle efficiently.

Offering a product that solves a non-strategic problem. This isn’t so much a market failure as it is a customer development failure. Start a better startup. Don’t start a bakery because you’re a good baker. Start a bakery because there is excess demand for baked goods. I just hope that the buyers at health systems are delivering this intuition directly to the startup in addition to anonymous HIStalk polls.

Lack of integration with existing IT systems. Integration is a must. It’s not enough to say, “Use our product in a standalone capacity during the pilot and we’ll figure out integration later.” Providers hate double documenting and clicking. Forget switching windows. Their complaints bog down IT teams. Both of these groups will throw a block at your pitch if you don’t have a solid answer for interoperability with existing systems, both from a technical perspective as well as implementation. There’s a new wave of startups out there providing modern integration strategies for startups attempting to interoperate with the EHR.

Lack of comparable reference sites. One of the mantras I learned back at Epic is that every single customer should be able to be considered a reference site. It’s that level of customer service and do-anything-ness that makes them stand apart as a vendor. The space is too small to simply write off any customer as a lost cause. If a health system chooses to work with us, we need to do everything possible to make sure they’re a good reference site for future customers.

A CEO who doesn’t have poise, polish, or healthcare experience. Have you met Judy Faulkner, Chris Patterson, or Jonathan Bush?  Just a few examples of eccentric, throw-caution-to-the-wind type personalities who oversaw a successful EHR startups. But you need to know the audience of decision makers. If you’re new to healthcare, welcome to the wild world of buzzword bingo. Get conversational stat (yep, that’s a healthcare word). Read books, blogs, HIStalk.  Listen to podcasts. Go to HIMSS and actually listen to some sessions that relate to your domain. You wouldn’t buy a car from a guy that didn’t know the difference between a carburetor and catalytic converter. Be sure that you can demonstrate that this isn’t your first rodeo. Manufacture your “experience” by becoming an expert in the domain.

Mr. H, maybe a survey on top reasons to work with a startup next time?

Niko Skievaski is  co-founder of Redox.

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April 27, 2015 Readers Write 3 Comments

Readers Write: The Journey to Value-Based Care: Lessons Learned from Aviation

April 27, 2015 Readers Write 1 Comment

The Journey to Value-Based Care: Lessons Learned from Aviation
By David Nace, MD

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The Affordable Care Act (ACA) and healthcare reform have impacted providers in all aspects, from the way they are and will be paid to how they engage patients. To meet the deadlines and demands of an industry shifting to value-based care (VBC), physicians must change their thinking from independent to team-oriented in order to succeed in this new world.

VBC is empowering an evolution within the overall healthcare community, especially amongst physicians. This is enabling a focus on delivering high-quality of care to patients. The Meaningful Use and EHR certification programs have helped all provider organizations get closer to the more meaningful use of information technology, but the requirements also pose many challenges for providers.

These challenges should not be met with resistance. The physician community should embrace the call for change. Similar to the revolution of the aviation industry, reform required them to adapt to new methods of communication and technology to ensure safer flights.

Traditionally, physicians are independent and competitive in nature. They didn’t go through rigorous selection and testing over nearly eight years of higher education to merely coast by – they have an innate drive to be successful and help people. Value-based care, in theory, plays to their personality traits and gives them the motivation to achieve even higher goals.

However, physicians have a hard time trusting data or measures that they do not understand, especially when their evaluation is out of their control and input. For example, a 2014 survey of 4,000 physicians found 78 percent reported patient satisfaction ratings moderately or severely affected their job satisfaction and 28 percent considered quitting their job or leaving the medical profession.

To add to this statistic, most organizations do not have the appropriate communication, technologies, and data collection sources and processes put in place to understand the measurements being imposed on them. To tackle this challenge, hospital executives and physicians need to improve physician communications and transparency in regards to measurement.

Pilots faced a similar disconnect during the 1980s. Training a pilot occurred in an apprenticeship model — you learn from a “master” and through them learn their personal techniques and strategies. It really was a “master craftsman” mentality of mentorship.

This method of training and learning lead to a variations in practice and high accident and death rates associated with aviation. The practice was not based on teamwork or leveraging technology for standard operating procedure. There were no Global Positioning System (GPS) and Cockpit Resource Managements (CRM) utilized – it was all based on the techniques and approach of pilots. To understand the technologies imposed on them and to improve quality of flight, the way pilots were taught changed to a team-based approach that focused heavily on communication and transparency, data, and standard operating procedures.

There is a similar revolution coming to the world of medicine. Many of the physicians of tomorrow are beginning to prepare through team-based, information driven training. Young physicians in training are being proactive in understanding the methodologies and technologies of today and starting grass root movements — for instance, Primary Care Progress — to inform and inspire newcomers to the industry. Medical students are increasingly being trained in groups (versus one-on-one) to leverage the concept of teamwork and to better understand the evolving healthcare industry and their role in the transformation.

Change is inevitable in any organization. New rules, methods, and technologies will always cause a shift. These transformations should not and cannot be met with resistance, but with an open mind, as everyone needs to work together toward the end goal.

Pilots needed to adapt and alter their training and methodologies during flight to fly in a safer, more efficient manner. Similarly, providers must do the same with value-based care. The more collaboration, the smoother the ride will be.

David Nace, MD is vice president and medical director of McKesson Technology Solutions.

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April 27, 2015 Readers Write 1 Comment

Curbside Consult with Dr. Jayne 4/27/15

April 27, 2015 Dr. Jayne No Comments

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CMIOs Gone Wild

One of the challenges of being anonymous is missing out on get-togethers at HIMSS. Sometimes vendors invite me to participate in events as myself, but other times the invitations come to Dr. Jayne. Even though most of them promise to either maintain my anonymity or allow me to register under whatever name I choose, attending such invitations has risk. Plus, I generally don’t attend events that I didn’t get invited to as my “real” self (or at least couldn’t tag along as someone else’s +1).

Although I trust Lorre and Mr. H to protect my identity, I had mixed feelings about attending the HIStalk CMIO lunch at HIMSS. I was excited about meeting other CMIOs outside the settings where we normally cluster in the wild – symposia, conferences, and of course the AMIA Clinical Informatics board review course. I get together with other CMIOs in my health system at least quarterly.

But it’s different when you have the opportunity to talk to people from other parts of the country that may be facing challenges that haven’t hit your market yet. It’s also different when you get a group of CMIOs who face the same pressures every day and they’re put in a relatively “safe place” where they can speak their minds.

My original plan was to cruise by, see who was at the table, and drop in if feasible. Most of the time though the table was packed and Lorre reported that they had to swipe chairs from the McKesson table because more people kept arriving. She was gracious enough to take notes on some of the discussion so that I could attend vicariously, as well as some pictures.

I thought about running the photos, but then I remembered my own hospital’s rules about vendor interactions and I certainly don’t want to get anyone in trouble by calling them out. I’ll keep the attendees anonymous, but here are the group demographics:

  • University hospital or major health system – 4
  • Physician group or IPA – 2
  • Government or public health – 3
  • Industry or vendor – 6
  • Other – 2 (multiple roles, consulting, etc.)

Since women in technology leadership has been a hot topic on HIStalk lately, I’ll give the breakdown: two were women, the rest were men. There were more vendors than I had expected, but several were either notable personalities or had been CMIOs in a previous position.

Although I had given Lorre some conversation starters in case the group was quiet, from her notes, it sounded like the discussion did just fine on its own. Hot topics included:

  • Patient portals. What strategies are CMIOs using to increase patient portal use? Most agreed it needs to be more valuable to the patient to get them to engage. One mentioned that at Duke the only way to pay a bill is through the portal. Others agreed that the ability to schedule appointments was key. There are different strategies to gradually add the appointment piece to the portal since physicians are sometimes reluctant to allow patients to self-schedule. Appointment cancellation is also important. The topic of no-shows came up and the general thought was that if patients are willing to go online to schedule, they’re typically willing to go online to cancel.
  • Physicians opting out of MU. Several felt that MU is not useful. One commented that, “There are no opt-outs in malpractice.” Another commented that the penalties aren’t high enough to force providers to engage – some have done the math and if they can see one more patient a day and do less work, that’s more economically favorable even with the penalty.
  • Board certification. CMIOs discussed fellowships vs. on-the-job training. Many would not choose to spend time in a fellowship if it was required. There was discussion about Maintenance of Certification and the fact that the American Board of Preventive Medicine has not certified enough relevant content for Clinical Informatics. One CMIO is going to take a dive medicine trip because those credits count and she gets to SCUBA dive.
  • Various CMIO challenges. New problems seem to crop up daily. One physician found that lab analysts were rounding the numbers for lab values rather than displaying them as they were reported from the analyzer machines. Another cited the difficulty getting clinical photos into the EHR and the problem of physicians taking photos on their iPhones and sending them around. They also noted the problem of dealing with operational issues that are uncovered by an EHR implementation. For example, labor and delivery nurses that could no longer “preorder” for physicians before the patient was admitted. Since there weren’t any formal standing orders, the nurses were ordering on paper what they knew the physicians would want. When they couldn’t do it in EHR, it became an issue, requiring discussion of their scope of practice.
  • Documentation was a hot topic. Attendees felt that what EHRs are putting out isn’t clinical documentation — rather it’s all about billing documentation. They’d like to ask CMS whether clinical documentation should be required to support clinical decisions rather than billing decisions. Evidence-based documentation is necessary and needs to be pertinent. CDS should be a major part of documentation, but it needs to be filtered to the situation and actionable. Context is key. Alerts should be standardized. Use of documentation templates and order sets is increasing. One site is using Lean Six Sigma principles and Kaizen events to create disease specific clinical note templates to help communicate information to help nurses and social workers with post-discharge care. We need to better identify what parts of the documentation need to be discrete. What is the important information? What is the minimum needed?
  • Global healthcare models are being examined. One attendee recently visited hospitals in Japan. He liked their clinical pathways, where grids are used for each day of the treatment plan. Each role had guidelines on what should be documented.
  • Interoperability. FHIR was discussed as was the use of SNOMED and LOINC. What will the next standard be? There are still problems between systems. We need to broaden interoperability for problems like visual diagnostics. Providers should be able to take a photo and send to dermatologists behind the scenes for decision support. Another wants to be able to take a photo and have it count for documentation and billing/coding bullet points – rather than describe the rash inadequately, put a picture in the chart. But CMS doesn’t allow providers to do that.
  • Retail healthcare was mentioned. Some CMIOs are having interactions, receiving referrals, and being part of the feedback loop. One mentioned his experience with a specific retail clinic, saying that working with them was “as complex as working with the Department of Defense.”
  • HIPAA Omnibus Rule requirements were discussed. If patients declare they are paying cash, the encounter data can’t be reported to payers. How are various vendors handling this? Some are suggesting providers use a “shadow chart” for the protected content. Others are just starting to discuss tagging the data. There is concern that allowing patients to choose which portions of the chart can be shared will interrupt care and cause possible misdiagnosis if physicians don’t have all the information.

Although I’ve mostly summarized from Lorre’s outstanding notes, one of the quotes caught my eye. I’m not sure who said it, but, “The CMIO is the face of dysfunction” might just be my new mantra. We (or our respective EHRs) certainly get blamed for everything. We’re also expected to figure out how to solve it without hurting anyone’s feelings while helping the operational, clinical, and technical teams play nicely together.

Based on the number and caliber of attendees who stuck around for a fairly long time during a very busy HIMSS week, it sounds like they found the event valuable. I hope Mr. H will consider doing it again in Las Vegas.

Email Dr. Jayne.

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April 27, 2015 Dr. Jayne No Comments

Morning Headlines 4/27/15

April 26, 2015 Headlines No Comments

Health and Human Services Fiscal Year 2016 Budget

HHS Secretary Sylvia Burwell faces tough questions from Sen. Lamar Alexander (R – TN) over the EHR Incentive program which Alexander says is driving physician dissatisfaction.

Scientists are skeptical about the secret blood test that has made Elizabeth Holmes a billionaire

Business Insider covers Silicon Valley-based lab test vendor Theranos and its 31 year old billionaire founder Elizabeth Holmes. Despite its incredible early successes, the process Theranos uses to run its lab tests is still being kept secret and the company has yet to publish peer-reviewed studies comparing its results to traditional ones.

MEDITECH Announces Avera Health Moving Forward with 6.1 Web Release

MEDITECH announces that it has been selected to implement its “groundbreaking, completely Web-based EHR” across Avera Health System’s (SD) 33 hospitals and 208 clinics.

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April 26, 2015 Headlines No Comments

Monday Morning Update 4/27/15

April 26, 2015 News 14 Comments

Top News

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HHS Secretary Sylvia Burwell, testifying on the department’s $84 billion 2016 budget request, is challenged by Sen. Lamar Alexander (R-TN) who stated that half of doctors don’t like their EHRs to the point that they’ll accept Medicare penalties rather than deal with workflow disruption, adding that the AMA found that 70 percent of doctors say their EHRs weren’t worth the cost and that EHRs are the leading cause of physician dissatisfaction. Burwell responded that HHS will work with Congress on a list of administrative action items related to EHRs, which seems to refer to the work of the HELP committee that most recently talked about interoperability and interviewed Epic’s Peter DeVault. What worries me most about the entire exchange is that nobody questioned whether HHS or Congress have any business involving themselves with how doctors use EHRs, where Burwell’s response might have logically been, “Respectfully, our job is making taxpayer payments to providers who choose to participate in Medicare and HITECH, but otherwise the EHRs that providers buy, use, and complain about really aren’t under the government’s purview. We should be monitoring the outcomes, not prescribing the process, which is how government works with all other industries.”


HIStalk Announcements and Requests

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Poll respondents grade the HIMSS conference with somewhere in the C-plus range. A consulting company vendor says it was successful in meeting with clients and networking with peers, while a CIO observes that the HIMSS conference is all sizzle and no steak as it keeps growing and ratio of vendors to providers seems to be going up as well. New poll to your right or here: what do you think about the fact that most health IT vendor executives are white men? (“I’m not thinking about it at all” is a poll option as well). Add a comment to support your position if you like.

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We were signing up for our microscopic booth for HIMSS in Las Vegas and were surprised to find that nearly all of the exhibit spaces have already been taken in the booth signup frenzy that occurs even before the previous conference is over. I don’t have the money or HIMSS points to play with the big boys, but even the 10×10 spaces in weird locations were mostly booked up. The tiniest parcels run around $5,500 and I declined the $2,500 extra HIMSS wanted for a corner space (they didn’t charge extra for our corner spot the past two years). We’ll be in #5069, with our presence probably annoying our next door neighbors Varian Medical Systems and Patient Prompt even though we’ll keep their area busier than it would be otherwise as we have a fun cast of characters running around. At least we don’t have much stuff to stick in there – we brought everything we used in our McCormick Place booth in one large duffel bag and set it up in maybe 20 minutes. There’s no ROI since we don’t have anything to sell, but we like just saying hello and giving our boothless friends a place to hang out.

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Speaking of our McCormick Place booth, patient advocate Regina Holliday wrote a nice summary of the time she spent there and her HIMSS experience in general.

I forgot to mention an unpleasant encounter Lorre had with the “HIMSS police,” who were a little bit snippy in confronting her at our booth and demanding that we stop using the name “HIMSS Bingo” in referring to a contest that we had nothing to do with other than allowing winners to pick up their prizes there. The HIMSS person was too busy scolding to hear that she had the wrong scoldee.

Most people think of Epic first on the list of Madison-connected companies. Here’s another that just came to me: John Holton, who graduated from UW in 1975, founded Atwork in 1983 and then Scheduling.com (now SCI Solutions) in 1999, although both operated out of California rather than Wisconsin.


DonorsChoose Project Updates

Feel free to skip this section if you aren’t following our project as it winds down – the normal stuff follows.

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Thanks to new participant The Breakaway Group, who donated $500 to get on Centura SVP/CIO Dana Moore’s dance card. I’ve funded $10,478.21 in projects, including these new ones, including some I chose in Colorado since that’s where Dana lives:

  • A printer, tablet supplies, and early literacy books for an elementary school teacher’s graduate courses in education, Los Angeles, CA.
  • A camera and photo printing equipment for creating a time capsule for a high school in Atlanta, GA.
  • Math games and learning activities for a second grade class in Garland, TX.
  • An iPad case and AV adapter for English language learners at an elementary school in Las Vegas, NV.
  • A TV and flash drive to promote newly arrived books in the library of a high school in Walden, CO.
  • Drums for rhythm and movement activities for special needs students at an elementary school in Centennial, CO.
  • Six iPad keyboard cases for a fourth grade class in Lone Tree, CO.
  • Globes, maps, and books for a K-2 class in Denver, CO.
  • A tablet with keyboard for English as a second language students at an elementary school in Fort Lupton, CO.
  • A Chromebook for an earth sciences class at a high school that can’t be accredited due to lack of hands-on learning tools in Norfolk, VA.
  • A complete library of high-interest, low-readability books for a class of severely intellectually disabled students at a middle school in Conway, SC.
  • Four boom boxes and 12 sets of headphones to create a literature listening station in the reading area of an elementary school in Seattle, WA.
  • A library of classic books for a third grade class in Clarksdale, MS.
  • Hand sanitizer and tissues for profoundly mentally disabled K-5 classroom in North Charleston, SC.
  • Baby wipes, diapers, a food blender, wheelchair supplies, and insect repellent for a handicapped K-2 students at an elementary school in North Charleston, SC.

Webinars

None scheduled soon. Contact Lorre for information about webinar services.


Last Week’s Most Interesting News

  • Infor signs an agreement to distribute its hospital data integration products in Cuba.
  • A RWJF study of personal health records finds that consumers value their own subjective narrative entries more than anything else, while doctors rarely even look at them.
  • Seven disabled veterans sue the VA for failing to deliver copies of their disability-related medical records for up to 25 months after their requests.
  • LabCorp announces a direct-to-consumer testing program.
  • Kaiser Permanente announces plans to open a 900-job healthcare IT campus in Atlanta.
  • A judge orders MyMedicalRecords to pay the legal defense costs of Allscripts and WebMD after those companies prevailed in two of a nearly endless number of questionable MMR patent infringement lawsuits.

Acquisitions, Funding, Business, and Stock

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Business Insider runs the first skeptical article I’ve seen about Silicon Valley lab darling Theranos and its $4.5 billion net worth, 31-year-old founder Elizabeth Holmes. Experts say they have no idea how the company’s technology works because Theranos won’t publish peer-reviewed studies about its tests, won’t let independent experts review its labs, and doesn’t acknowledge whether it’s actually using the same analytical machines as other labs in addition to its small-sample size equipment that other labs use as well. The article also questions whether can scale given its plans to perform 1 million tests in 2016, less than 0.2 percent of the number performed by Quest. Quest and other competitors are questioning whether tests performed by Theranos using capillary blood (microfluidics) are accurate.   


Sales

Children’s Hospital Association chooses Clinical Architecture’s Symedical for global terminology management for analyzing comparative data.

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Avera Health System (SD) selects Meditech 6.1 Web EHR for 33 hospitals and 208 clinics. The press release isn’t clear as to whether this is an all-new product and Googling the term “Meditech Web EHR” brings up a non-specific mention on the company’s website, which used to be a no-nonsense list of information but is now maddeningly glossy and detail-free, with artsy scrolling pages and oversized type crying for Internet attention without providing much value in return. Click “EHR Solutions” and you won’t see a list of them. I don’t fully understand how a product can be “groundbreaking” if it’s in version 6.1 or whether this is just a new Web front end for the same old products.


People

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Mark Young (StayWell Health Management) joins PatientSafe Solutions as COO.


Announcements and Implementations

Phynd Technologies will analyze the cost to Nebraska hospitals of managing their provider information manually vs. using its provider information management platform in a project funded by the state.


Government and Politics

The VA forms an 11-member medical advisory group to advise it on healthcare delivery issues.

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Here’s a pretty funny tweet from CMS Chief Data Officer Niall Brennan.


Technology

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Healthcare is always a lagging chaser of consumer technologies, so I’m not quite sure what to make of the just-announced Amazon Dash, a WiFi-connected, product-specific stick-on electronic button that lets users restock a particular product with a single press. It’s either a brilliant time-saver that creates even more loyalty to Amazon and the products it sells or, as The New Yorker opines, “an uneasy image of our homes as giant Skinner boxes, and of us as rats pressing pleasure levers until we pass out from exhaustion” that bypasses the brief thinking moment of “Why am I using all this stuff?” while driving to the store. I didn’t realize that Amazon already offers a speech recognition and barcode scanning version of Dash for users of its expensive AmazonFresh grocery delivery service in Seattle, California, and New York metro areas.


Other

USA Today profiles the involvement of patients in the EHR selection of Partners HealthCare (MA), which invited a patient who sits on its advisory board to help choose its $700 million system. I like the approach, although I can’t help but think of the economic strong-arming and brand name-brandishing Partners does to squeeze out competitors and force insurers to pay its exorbitant rates, which isn’t really in the best interests of patients or the healthcare economy in general.

An investigation has been underway in Texas to review the state’s issuance of a no-bid Medicaid anti-fraud system contract to a local bidder with zero experience. The Houston newspaper points out that the state was already using a similar system that had recovered $56 million against its original cost of $16 million, while the new $20 million system (with a pending $90 million extension) has recovered zero dollars. Nearly all of the funds came from all of us who pay federal taxes. State government was asleep at the wheel, with a prime example being that the contractor (21CT) billed it the full price of a $452,000 project the day after the purchase order was signed and the state paid it immediately. A few state employees have been fired and a criminal investigation is underway. The state’s HHS inspector general who arranged the deal lied to CMS by claiming that a competitive bidding process had been conducted and then resigned after local newspapers exposed the scandal.


Sponsor Updates

  • Nordic offers a recap of #HIMSS15 through its Twitter feed.
  • PatientKeeper offers thoughts on “HIMSS and hEHRs.”
  • MBA HealthGroup offers “Skin in the Game: Keys to Success in a Private Dermatology Practice”
  • MedData breaks down the 2015 PQRS payment adjustment statistics.
  • Wellsoft will exhibit at the EDPMA Solutions Summit April 26-29 in Amelia Island, FL.
  • Sandlot Solutions will exhibit at the Big Data in Healthcare Summit April 28-30 in Boston.
  • Netsmart’s e-prescribing solution attains certification for controlled substances.
  • TeleTracking asks, “Who’s Looking Out For Nurses?”
  • PDS offers “Five Tips for a Trend-Setting Healthcare IT Strategy.”
  • NTT Data offers “Wearables in the Enterprise – What are Industries Saying?”
  • Patientco adds 2.4 million patients to its patient revenue cycle platform.
  • PeriGen recaps last fiscal year in “Another 48,611 births powered by PeriGen.”
  • PMD offers “Keeping Priorities Straight and Scaling Support.”
  • QPID Health CMO Michael Zalis, MD is featured in “Diagnosing Imaging: Maximizing Appropriate Use with Smart Decision Support.”
  • Sagacious Consultants offers “ICD-10 Training for Providers, Coders, and CDI Specialists.”
  • New York eHealth Collaborative offers “The Healing Power of Your Own Medical Records and SHIN-NY.”
  • Stella Technology offers “HIMSS15 Conference Highlights and Takeaways.”
  • Summit Healthcare declares that “HIMSS 2015 Did Not Disappoint!”
  • T-System will exhibit at the UCAOA National Urgent Care Spring Convention April 27-30 in Chicago.
  • Truven Health Analytics offers “Appealing the CMS Risk Adjustment and Reinsurance Calculations: Making Sense of the Discrepancy Regulations.”
  • Versus Technology publishes “Reflections on the Oklahoma City Bombing, from a Nurse Who Was There.”
  • Huron Consulting Group is named one of America’s best employers by Forbes.
  • Winthrop Resources will exhibit at Interop Las Vegas 2015 April 27-May 1.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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April 26, 2015 News 14 Comments

Morning Headlines 4/24/15

April 23, 2015 Headlines 2 Comments

U.S. cancer institute, software firm reach deals in Cuba

Two New York-based healthcare companies are among the first to sign commercial agreements in Cuba. The Roswell Park Cancer Institute of Buffalo, New York will work on lung cancer vaccinations with Cuba’s Center for Molecular Immunology, and Infor has found a partner that will resell its integration engine software in Cuba.

Few People Lost Jobs With V.A. in Scandal

A New York Times investigation finds that only three VA employees lost their jobs over the VA wait-time scandal, far less than the 60 people that VA Secretary Robert McDonald reported during a NBC television interview he did in February. Additionally, only eight of the VA’s 280,000 other employees were punished in some way for their involvement in the scandal.

WebMD Deserves Fees In Failed Patent Case, Judge Says

MMRGlobal, which sued both WebMD and Allscripts over frivolous patent infringements claims, has lost both claims and will now have to pay each company’s legal fees.

Oxycodone overdose deaths drop 25 percent after launch of Florida’s Prescription Drug Monitoring Program

Oxycodone-related deaths dropped 25 percent after Florida implemented a controlled prescriptions database. However, the project went live in tandem with state-wide efforts to shut down prescription mills posing as pain clinics, which likely also contributed to the reduced deaths.

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April 23, 2015 Headlines 2 Comments

EPtalk by Dr. Jayne 4/23/15

April 23, 2015 Dr. Jayne 1 Comment

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It was only a couple of weeks ago that I was lamenting a slow health IT news cycle. Now I’m up to my eyeballs in things I want to write about.

The physician lounge is buzzing about the Medicare Access and CHIP Reauthorization Act of 2015, also called the “SGR bill” or “Doc Fix” bill. Unfortunately, most of them didn’t read beyond the AMA headline — “Medicare payment formula bites the dust” — to see what is really heading their way. Although they won’t be threatened frequently with Medicare payment cuts, the entire Medicare payment game is changing. For those who participate, there will be annual payment increases of 0.5 percent through 2019 and then a variety of other changes.

Although that’s certainly better than a cut, it doesn’t even keep up with inflation. Physicians can’t ask their suppliers to limit their price increases to 0.5 percent. Many hospitals and health systems that only offered employees that level of salary increase would see feet moving towards the door. AMA leadership is lauding it as historic legislation that “finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians.” Based on the discussion around the physician lunch table, anyone who thinks this is going to end uncertainty about physicians and Medicare might be confused.

I have to admit I haven’t read the whole thing, but rather several strategic digests and quite a few chest-thumping press releases. Colleagues who are savvier about the actual contents of the legislation are appropriately skeptical. Those that were considering a departure from Medicare haven’t changed course, and today, additional physicians were jumping into the discussion. Although Medicare’s quality reporting programs should be streamlined, many physicians still are not on board with pay for quality if physicians will continue to be graded on outcomes beyond their control.

Although the new payment models are voluntary, I can see employed physician organizations immediately heading in that direction. Administrative bloat will increase as teams are hired to review and comply with what will undoubtedly be reams of new CMS requirements and regulations. While physicians around the table were initially applauding the end of MU as we know it, the room became quiet when the detail-oriented ones pointed out its replacements. The more unified incentive program will be based on quality metrics, resource and cost utilization, practice improvement, and also Meaningful Use. Physicians in the so-called “Alternative Payment Models” will also have to continue using certified EHR technology, so vendors aren’t off the hook either.

Physicians are particularly leery of metrics that include untested patient satisfaction or engagement metrics. A piece in The Atlantic this week addresses the issue. My favorite quote: “Patients can be very satisfied and be dead an hour later.” It cites research by a professor at the University of California-Davis that concluded the physicians may be reluctant to have difficult conversations with patients due to fears of lower patient satisfaction scores. There’s not a tremendous amount of data looking at patient satisfaction scores compared to morbidity and mortality data. We all know of patients who continue to go to physicians that we know have horrendous disciplinary records and poor clinical skills, yet when a change is suggested, they profess happiness with their care.

I’m encouraged that legislators included some level of protection so that plaintiff’s attorneys can’t use Medicare quality data to support a standard of care, but there are plenty of other organizations collecting and analyzing the data and where no such protections exist. As CMS goes, so go the commercial payers and eventually we’ll all find ourselves dealing with all kinds of different flavors of payment schemes from the large health insurance companies.

Interoperability is also a key feature of the legislation. HHS will have to figure out how to measure whether national priorities are being met and determine how providers will be evaluated. This means additional rulemaking and additional burdens on providers and vendors. As specified in the title, the bill also extends the Children’s Health Insurance Program (CHIP) as well as community health center funding for another two years.

The good news is that the bill didn’t include anything delaying ICD-10, so those of us making plans can get on with it. I had a good laugh reading an AMA fluff piece on prepping for ICD-10. “Spend your time in the month ahead identifying the changes you need to make in your practice for ICD-10. For example, you’ll need to update your systems, forms, and work flow processes.” Just a couple of small things you can do in your spare time, right? The next sentence was even better. “Pull together a group of all staff members involving coding, billing, claims processing, revenue management, and clinical documentation, then figure out each task necessary to bring your practice in line with the new code set.” That’s pretty much everyone in a typical physician practice. If practices are just figuring out what they need to do now, they’re way behind and oversimplification doesn’t help things.

The bill also includes provisions on competitive bidding; Medicare face-to-face documentation requirements; chronic care management services; funding for the National Quality Forum; and requirements that Medicare Administrative Contractors establish “improper payment and outreach education” programs. It also includes a section on what happens to monies recovered by Medicare Recovery Audit Contractors. The Secretary of Health and Human Services is required to use that money for alternative payment model incentives, additional Medicare Administrative Contractor functions, reducing payment errors, prior authorization for repetitive scheduled non-emergency ambulance trips, and improving chiropractic documentation.

You never know what you’re going to find in a piece of legislation this size, which illustrates the old adage about the devil being in the details.

What’s your take on this recent legislation? Email me.

Email Dr. Jayne.

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April 23, 2015 Dr. Jayne 1 Comment

News 4/24/15

April 23, 2015 News 8 Comments

Top News

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Two New York-based, healthcare-related organizations strike deals that will make them some of the first US firms to conduct business in Cuba now that sanctions have been relaxed. Roswell Park Cancer Institute (cancer research) and Infor (hospital data integration) announced their plans following a trade delegation visit this week led by New York Governor Andrew Cuomo.


HIStalk Announcements and Requests

I decided to follow through on looking at female representation on vendor executive teams as listed on company webpages since it came up on HIStalk last week. Companies have the incentive to hire the most qualified people regardless of demographics, but just in case you’re interested for whatever reason, here’s the percentage of females they’ve chosen.

Percentage of Females on Leadership Team (highest to lowest)
Wolters Kluwer Health 50
Meditech 41
Merge 33
TriZetto 25
Advisory Board 25
Optum 23
Athenahealth 22
Quality Systems 22
InterSystems 22
Cerner 19
Nuance 18
Greenway Health 18
Leidos Health 17
GE Healthcare 15
Premier 15
Surescripts 12
Philips North America 11
MModal 10
Emdeon 8
Allscripts 0
McKesson Technology Solutions 0

Some other percentages:  Facebook (20), Microsoft (19), Google (15), and IBM (27). HIMSS comes in at 17 percent.

I was reading a tweet that referred to pilot turned safety expert (and 2010 HIMSS keynoter) Sully Sullenberger as a “national hero.” The cynic in me (which has a significant presence) cringes at how we’ve devalued the term “hero” to label anyone who experiences adversity (including the randomly applied kind) rather than reserving the term for those who exhibit bravery or noble deeds in intentionally sacrificing themselves on behalf of others. Sully landed his plane safely in the Hudson River, but he was saving himself as well as his passengers. He was cool under pressure, humble, and performed the job he was being paid to do better than most would have done, but “hero” might be a stretch, just as it is when referring to athletes, victims of violence, someone who calls police to report a crime in progress, or groups that may well contain some but not all heroes (firefighters, service members, or even clinicians, for instance).

This week on HIStalk Practice: interoperability melancholia sets in after HIMSS. Matter Chicago CEO previews AMA physician office of the future. Radiology practices select new rev cycle technology. Azalea Health takes on telemedicine. Physicians’ Alliance of America looks for PCP feedback on EHR charting productivity. New study finds that online physician reviews don’t have much to do with clinical expertise. Modernizing Medicine CEO Dan Cane dives into the company’s relationship with IBM Watson. StatDoctor CEO Alan Roga, MD outlines the benefits of video in telemedicine.

This week on HIStalk Connect: Tech-savvy health insurance newcomer Oscar Health raises a $145 million funding round on a $1.5 billion valuation in just its second year in business. Ernst & Young creates a digital maturity index focused on quantifying the sophistication of telehealth programs. Color Genomics unveils a $259 genetic screening test that looks for 19 key mutations, such as BRCA1 and BRCA2, that are known risk factors for developing breast or ovarian cancers. Gravie, a private health insurance exchange startup, raises a $12.5 million Series B to expand its presence into Texas and Illinois.


DonorsChoose Fundraising Project Update

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Our total now stands at $10,000 thanks to new participation from ZirMed, TransUnion Healthcare, BlueTree Network, and Orchestrate Healthcare. BlueTree Network was notable in donating $1,000 instead of the requested $500, while TransUnion Healthcare VP Patrick Gilmore missed the chance to meet with Centura SVP/CIO Dana Moore at the HIMSS conference but said he wanted to donate anyway. Dana will provide a summary of his conversations with these companies later. I’ve funded $6,656 in projects and will get the remaining $3,344 out to classrooms by this weekend.


Acquisitions, Funding, Business, and Stock

Navicure announces a 32 increase in year-over-year sales of its billing and payment solutions.

India-based Wipro expects its healthcare business to hit $2 billion in annual revenue by 2018, double its 2015 expectations, mostly due to increased technology spending triggered by US healthcare reform. The company will target acquisitions in the $100-$200 million range, saying it passed on acquiring TriZetto (acquired by Cognizant for $2.7 billion) because of the price.

The Illinois Hospital Association will merge with the Metropolitan Chicago Healthcare Council effective January 1, meaning the state hospital association will be running an HIE (MetroChicago HIE) and insurance company.

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A federal judge orders the legally prolific MyMedicalRecords to pay the defense fees of WebMD and Allscripts, which beat some of MMR’s bottomless patent infringement lawsuits after refusing to pay “licensing fees” for ubiquitous technologies.

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Jeff Bezos discloses the financial performance of Amazon Web Services for the first time in the unit’s nine-year history, stating that it’s a $5 billion business that’s growing fast.

A Wall Street Journal article finds that universities (Vanderbilt, Emory, and University of Arizona) are cutting ties with their cash cow academic medical centers as their high costs threaten to exclude them from exchange-based insurance networks.


Sales

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Swedish Cancer Institute (WA) chooses the Synapse Precision Medicine Platform to provide oncology clinical decision support using patient genomic information.

Mount Sinai Health System (NY) selects the InterSystems HealthShare interoperability platform.

CareWell Urgent Care chooses Athenahealth’s EHR and practice management system for its 49 providers.

LTPAC EHR vendor SigmaCare chooses Liaison EMR-Link hub to connect with lab and imaging vendors.

Augusta Health will use Meditech performance monitoring tools from Goliath Technologies. The company’s press release doesn’t bother to mention where its new client is located (who writes this stuff, anyway?), so I’ll take a Google-inspired guess and say Virginia.


People

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Davide Zaccagnini, MD (Nuance) joins SyTrue as CMIO.

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Dominick Bizzarro (Value Informatics) joins insurer MVP Health Care as EVP of business development and informatics.

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Cerner co-founder and Chief of Innovation Paul Gorup is retiring, insiders tell me. He helped develop PathNet in the 1980s, left Cerner in 1987 to run a radio station monitoring company, then returned to Cerner in 1999 to develop its hosting business. Gorup said in a 2013 interview, when asked why Cerner succeeded in healthcare while IBM and GE fizzled, “That’s easy. What does the head of IBM get up and think about every morning? I guarantee you it’s not healthcare. Same with the head of GE. He might think about energy or finance, but not healthcare. You have to think about it 24 hours a day. It’s not a part-time business. If healthcare becomes a part of something else, you’ve lost your focus.”


Announcements and Implementations

Referral software vendor EHealth Technologies announces a partnership with Box to support PDF viewing, medical image display, and structured document viewing.

Craneware announces enhancements to its Chargemaster Corporate Toolkit that include a single consolidated view, corporate chargemaster change distribution, and advanced workflow integration.

Capsule releases its Early Warning Scoring System for its SmartLinx Chart Express charting solution to alert clinicians of patient deterioration based on real-time vital signs analysis.

Zynx Health enhances the secure text messaging capabilities of its ZynxCarebook mobile coordination platform.

A TransUnion Healthcare analysis finds that increasing healthcare expenses and lower consumer credit lines have left consumers less able to pay their medical bills than last year. A big driver of the increased patient cost involves joint replacement procedures, which are 20 percent more expensive than they were a year ago.


Government and Politics

In Australia, the Victoria medical association calls on the state to spend $39 million to improve connectivity between hospitals and practices, hoping to at least enable delivery of discharge summaries and lab results after several expensive IT projects failed to deliver that capability.

Minnesota’s health commissioner says he’s concerned about pushback on the state’s 2008 requirement that all providers use EHRs by the end of this year. He debunks four privacy myths that are apparently the crux of the unstated opposition’s campaign.

A New York Times investigative report finds that the VA’s wait times scandal cost only three jobs vs. the 60 firings the VA claimed. One VA employee was fired for accepting gifts not directly related to wait times, one retired to avoid being fired, one is awaiting termination, and five employees were reprimanded. The VA often transfers problem employees and those who appeal their terminations can collect their paychecks for up to two years while awaiting a decision. 


 Innovation and Research

HHS will support three projects via its Ventures Fund: a website that allows providers to crowdsource possible new uses for existing drugs, an evaluation system for funding disaster preparedness, and a smart phone based diagnostic tool for malaria.

A Robert Wood Johnson Foundation study of personal health records finds that while consumers believe the most important information contained in PHRs is their own recorded daily observations (diet, exercise, mood, medication response), physicians usually don’t even look at them, instead turfing such review off to nurses and health coaches. The study also found that consumers think their information is valuable enough to outweigh any privacy concerns. It also concludes that demand for PHRs is surprisingly low because nobody is sure what problems they’re supposed to solve. I’ll extend my own musing: technology-powered lusting for discrete data capture and big data analysis cannot overwhelm the essential nature of the encounter, which is to listen to what the patient (and not necessarily their data points) is saying. Not everything that’s health related can be described by passively collected data dropped into convenient little buckets, and not everything that’s important will come up without skilled engagement of the “tell me how things are going” variety. My takeaway is that we need to make sure that technology enhances rather than limits the use of the patient’s own voice in the participatory guiding of their health.


 Technology

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Heal releases a house call app for the Apple Watch that allows users to request a doctor visit with a single touch. Doctors equipped with mobile diagnostic apps such as the AliveCor ECG and CellScope otoscope arrive at the desired location within an hour and spend as much time as needed for a fixed fee of $99. One of Heal’s investors is Lionel Richie.


Other

Hospitals are moving inner city hospitals to suburbs where better-paying patients live, a Kaiser Health News article reprinted in Newsweek points out. Hospitals defend the practice by saying it’s cheaper to build a new suburban hospital than to renovate a old, land-locked downtown facility, but city officials say their core areas are being medically abandoned as hospitals chase patients who have better insurance.

Oxycodone-related deaths dropped 25 percent following Introduction of Florida’s doctor-shopping database of controlled substance prescriptions, a University of Florida study finds. However, deaths were already decreasing after the state shut down hundreds of pill mills posing as pain management clinics.

A study finds that 28 percent of Americans did not perform even one physical activity in 2014, increasing the “totally sedentary” number to the highest it’s been since 2007. Experts blame reduced physical education time in school and the competitive nature of school sports that leaves most students on the sidelines.

HealthLoop founder Jordan Shlain, MD says he started the company when he realized as a doctor that his mental model was wrong – inviting a patient to contact him when in need is not the same as proactively checking up on them, which he summarizes as invalidation of the “no news is good news” attitude since that means the same as “no data is good data.” He also says hospitals dehumanize their treatment failures by giving them the blame-free, dumbed-down label of “readmission.” He warns that probability-challenged people often make bad decisions in using data and algorithms as a blunt instrument without paying attention to what it means for individual patients.

An Australian blogger who built a business (including a wellness app) by claiming she cured her terminal brain cancer by diet and lifestyle alone admits that she was lying – she never had cancer. She was caught when she failed to donate $300,000 in app sales to charity as promised.

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Weird News Andy titles this article as “A Rocky Experience in the OR.” A professor and facial surgeon in England loses his license after punching an anesthetized patient in the face 10 times to correct a broken cheekbone. The doctor admits that he “manually reduced the fracture” because the patient wasn’t fit for surgery, adding that doctors punch patients all the time while doing CPR. The patient is fine, while the surgeon is now offering his services in Dubai.


Sponsor Updates

  • Valence Health is convening its second annual Pediatric Collaborative for Value-Based Care forum in Chicago this week.
  • DocuSign is named among Silicon Valley’s “Best Places to Work 2015” for the fourth consecutive year.
  • E-MDs will exhibit at the MGMA regional meeting April 29 in Galveston, TX.
  • Galen Healthcare recaps the “Top 5 Themes from the Super Bowl of HIT.”
  • Hayes Management Consulting offers “Planning for the Unexpected EHR Downtime: 4 Key Steps.”
  • HCS will exhibit at the National Association of Long Term Hospitals 2015 Annual Meeting April 30-May 1 in Washington, DC.
  • HCI group offers “7 Essential Items Every McKesson Horizon Customer Should be Considering.”
  • Healthfinch’s Karen Hitchcock offers “A First-Timer’s First Impressions.”
  • Healthwise will exhibit at the Annual NPSF Patient Safety Congress April 29 in Houston.
  • Holon Solutions offers “RightFax End of Life Support Dates: Are You Ready?”
  • Impact Advisors offers its top 10 takeaways (and HISsies Award coverage and predictions) from HIMSS15.
  • The Atlanta Business Chronicle recognizes Ingenious Med as one of the city’s top 100 fastest-growing privately held companies.
  • PDR will exhibit at the National Association of Chain Drug Stores Annual meeting April 25-28 in Palm Beach, FL.
  • LifeImage celebrates five years in business and 1 billion images exchanged.
  • LifePoint Informatics offers a new white paper explaining “Why Access to Lab & Diagnostic Data is Important to Providers, Payers, and Patients.”
  • Logicworks explains why it sells managed cloud services rather than consulting services.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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April 23, 2015 News 8 Comments

Morning Headlines 4/23/15

April 22, 2015 News No Comments

FDA grant to determine drug safety through EHRs

The FDA is offering a grant worth up to $1 million to fund research focused on mining EHRs for data that will support post-market drug safety assessments.

Comparative Effectiveness of Childhood Obesity Interventions in Pediatric Primary Care

A study published in JAMA Pediatrics finds that the use of clinical decision support prompts in the pediatric primary care setting had a positive effect on reducing BMI in obese children. The CDS alerts presented clinicians with obesity screening guidelines and links to relevant weight management programs.

Senate hearing examines telehealth benefits, barriers to expansion

More than a dozen bi-partisan senators attended yesterday’s Senate Commerce Subcommittee meeting on telehealth to lobby for expanded access to telehealth services for Medicare beneficiaries and for infrastructure investments that would expand internet access in rural areas.  Kristi Henderson, chief telehealth and innovation officer at the University of Mississippi Medical Center, explains ‘Right now, the greatest challenges lie in winning the federal level reimbursement parity that will make telehealth attractive in the marketplace and securing the reliable, high quality connectivity that telehealth requires.”

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April 22, 2015 News No Comments

Morning Headlines 4/22/15

April 21, 2015 Headlines 1 Comment

Lawsuit: Long delay in getting VA medical records could be affecting crucial benefits

Seven disabled veterans have filed a lawsuit against the VA, claiming that they have waited between 10 and 24 months for copies of their medical records, and that the wait is causing delays in the veterans’ ongoing benefits applications. The suit asks that the VA produce the records within 20 days.

Judge issues temporary restraining order in Ebola nurse Nina Pham’s lawsuit

A Texas judge has halted efforts by Texas Health Resources to file a workers’ compensation claim on behalf of Nina Pham, the nurse that contracted Ebola while treating a patient at one of THR’s hospitals. The health system, which is being sued by Pham, claimed that a workers compensation claim would resolve many of the issues outlined in Pham’s lawsuit.

Color Genomics Sells $249 Breast Cancer Gene Test to Masses

Silicon Valley startup Color Genomics announces a $259 genetic screening test that evaluates a patient’s risk of developing breast or ovarian cancer by testing for 19 pertinent genetic mutations. The company is bypassing the FDA requirements that hindered 23andMe by requiring that a doctor order the tests and that results be explained by a trained genetic councilor.

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April 21, 2015 Headlines 1 Comment

News 4/22/15

April 21, 2015 News 10 Comments

Top News

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Seven disabled veterans sue the VA, claiming that they’ve waited 10 to 25 months for copies of their medical records, delaying their eligibility for benefits.


Reader Comments

From CIO: “Re: patient engagement survey. Do CIOs really think they own it?” A HIMSS-sponsored poll finds that nearly half of health system CIOs believe they own patient engagement in their organizations, but I think there’s a definitional issue here. CIOs often mislabel the tools vs. the program when it comes to analytics, population health management, and patient engagement. The software is just one part of the initiative even though Meaningful Use muddies the picture with its purely technical requirements for patient engagement. I’m fairly certain CIOs don’t really believe they’re in charge of the entire program, but if they do, either they or their employer have a big problem. Non-clinicians (especially IT and marketing people) should not be trying to engage patients.

From Nasty Parts: “Re: Allscripts. What’s going on? Lots of recent senior departures: Diane Bradley, John Dragovits, Peter Mcclennen, Perry Sweet, and Chad Baugh, to name a few.” Unverified. The LinkedIn profiles of all of these folks still list Allscripts as their current employer, although I’ve found that in general people don’t update their profile until they get another job.

From Little Suzie: “Re: [publicly trade vendor name omitted]. I’ve heard from a not-necessarily-reliable source that they may be acquiring [publicly trade vendor name omitted]. True?” Lips are typically and justifiably sealed when publicly traded companies are involved in M&A talks. This one would be huge. I don’t see the synergy, but the first vendor is on a roll and the second is wheezing, so it’s possible that a fire sale is being discussed.

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From Pirate Wench: “Re: interesting sexual harassment lawsuit against a healthcare IT executive.” It’s juicy, but keep in mind you’re reading only one of the inevitable two sides of the story. The lawsuit, filed by a demoted employee, says Quality Systems, Inc. (parent of NextGen) protects its male employees who harass female employees. The real story will be how the lawsuit is disposed of, which I strongly suspect will be by a sealed settlement since a trial would be unpleasant for both sides.

From Candid Cameron: “Re: females at HIMSS. I saw a big drop in booth babes, which I think is due to pressure from publications such as HIStalk. I’d like to see recognition of companies with at least 40 percent female executives or 40 percent female speakers at the conference.” I’m wary of assuming intentional bias (gender, age, nationality, etc.) in observing executive team demographic composition, but it would be interesting to see the percentage of VP-and-up females in each company.


DonorsChoose Project Updates

This isn’t directly related to healthcare IT, so feel free to skip on down to the next section if it’s not your thing.

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Our DonorsChoose project donations have jumped as another company offered a $500 donation in return for 20 minutes of Dana Moore’s time by telephone and our anonymous matching vendor agreed to match this donation as well. That brings our total to $8,000. I’ll be funding new projects as a result. Meanwhile, above is another of the many teacher thank you emails I received, this one from a kindergarten classroom for which we donated a projector. I was so moved that when I saw that Mrs. Henry had an open grant request for an AV cart to house their new projector that I funded that as well.

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Meanwhile, here are a couple of student-written thank you notes from an earlier project we funded. DonorsChoose defaults the option to receive student notes to “yes” when you fund a project, but I unchecked it this last time because it’s a fair amount of work for the students and we funded so many projects I would be overwhelmed by all their notes anyway. Still, it’s gratifying to hear from the students who are actually benefitting from the donations.


HIStalk Announcements and Requests

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One of the more disturbing things I saw at the HIMSS conference was people running around wearing giant red noses, courtesy of a Walgreens fundraiser for children’s poverty. I like the cause but not the noses, which make me think of Stephen King’s evil clown in “It.”


Webinars

April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.


Acquisitions, Funding, Business, and Stock

Israel-based drug maker Teva will pay $512 million to settle charges that it paid competitors $200 million to delay rollout of a generic version of its sleep disorder drug Provigil. The company  also offers an unsolicited $40 billion bid to acquire generic competitor Mylan, which recently moved its headquarters to the Netherlands to avoid US corporate taxes and to take advantage of anti-takeover laws.


Sales

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St. Luke’s University Health Network (PA) chooses Strata Decision’s StrataJazz Continuous Cost Improvement.

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University of Florida Health (FL) chooses Visage Imaging’s Visage 7 Enterprising Imaging Platform for both Shands and UF Jacksonville.

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Beth Israel Deaconess Hospital-Plymouth (MA) selects Voalte for caregiver communication and secure texting on personal smartphones.

IntegraMed Fertility chooses the Patient Pulse portal from Anthelio Healthcare Solutions.

University of Vermont Medical Center chooses ReadyDock’s disinfecting device docking station for its NICU.

Erlanger Health System (TN) will implement an unnamed $100 million EHR, replacing the current system that the CEO says is the #1 source of hospital dissatisfaction. I found their RFI online, which says they are running Siemens Invision in the hospital and GE Centricity in most of the practices, but I didn’t run across anything that says which system they’ve bought.

Henry Mayo Newhall Hospital (CA) chooses Summit Healthcare’s Provider Alert solution for ambulatory information sharing.


People

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Awarepoint names Thomas Warlan (Medlee) as SVP of software engineering.

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Besler Consulting hires John Slaby (Siemens Healthcare) as VP of product strategy and Heather Swanson (Wolters Kluwer) as regional VP.

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Ahmed Haque, ONC’s director of the office of programs and engagement, will join former National Coordinator Farzad Mostashari’s Aledade.

Source Medical names a new leadership team that includes former executives of Dell, Allscripts, and NextGen.


Announcements and Implementations

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Extension Healthcare announces upgrades to its alarm management solution that include enhanced voice-annunciated alarms, enhanced RTLS-enabled care team availability, extended iOS and Android device support, and a way for physicians to view their patient’s care team members and contact them securely from outside the hospital.

LabCorp will launch a direct-to-consumer lab testing business to compete with drug chains and other competitors that have offered those services for years, many of which were using LabCorp to draw and process their samples. Patients won’t need a physician’s order if their state permits them to request their own lab tests. LabCorp hasn’t said which tests it will offer or how they will be priced. Sounds great for patient empowerment, but then again, so did the idea that drug companies should be allowed to advertise directly to potential patients.

Netsmart enhances its vendor-agnostic HIT Value Model that helps providers develop IT adoption strategies and benchmark progress.


Government and Politics

Congress finally acts on a 2004 GAO recommendation to remove Social Security numbers from Medicare cards to prevent identity theft despite CMS complaints about the effort involved. The mandate was included in the SGR doc fix bill.


Technology

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Software vendors always state that you legally don’t own their software – you’re just licensing it. Tractor maker John Deere takes it to the next level, telling the Copyright Office that farmers aren’t actually buying their tractors, they are instead purchasing an implied lifetime license to the John Deere software that runs them. It’s an important argument as companies try to favorably position their products as being software that end users or potential competitors can’t tinker with under the Digital Millennium Copyright Act.

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Color Genomics announces a $249 saliva test kit that detects 19 genetic markers for breast and ovarian cancer. The company, sensitive to the limited population for which screening is indicated and the potential patient concerns about the results, requires that one of its designated physicians order the test and then provides a board-certified genetic counselor to explain what the results mean. Similar tests were priced at up to $4,000 until the US Supreme Court denied a competitor’s assertion that nobody else should be able to perform such testing since it held a patent for naturally occurring genetic sequences such as the BRCA1 and BRCA2 genes.


Other

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Emails exposed in the Sony Pictures breach show TV huckster-physician Dr. Oz trying to get Sony to sign him up as a pitchman for its wearables line, although his interest seems entirely commercial rather than medical.

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Health Catalyst SVP David Burton, MD provides six predictions in an HFM Magazine article: (a) health systems and payers will address at-risk contracting as strategic thinkers, bet-hedgers, or ostriches with their heads in the sand; (b) population risk evaluation will shift from reviewing actuarial buckets to being driven by delivery systems that focus on improving specific clinical areas where they can perform optimally; (c) virtual shared accountability networks will form as ACOs and clinically integrated networks realize the cost of out-of-network services; (d) the emphasis on quality and safety improvement will spur development of analytic software and best practices starter sets; (e) providers will focus cost reduction efforts on the 80 percent of patients for whom evidence-based guidelines apply; and (f) sponsors will seek more flexible analytics systems that can respond more quickly to external changes.

Reporter Joe Goedert shares my disdain for turning marketing and PR people loose to make illogical decisions, specifically as related to the HIMSS conference: (a) CPSI not only changing its name questionably, but providing a confounding buzzword-heavy and thoroughly unconvincing explanation of the need to do so; (b) an unnamed analytics vendor that bussed reporters offsite for a roundtable discussion but then informed them that the discussion was off the record and nobody could leave until it was over, which means it was a complete waste of their work time; and (c) President Bush and HIMSS telling reporters 90 minutes before his keynote that his remarks and the softball questions asked by HIMSS CEO Steve Lieber (the guy who wrote him a huge check – his speaking fee is around $150,000) were off the record.

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A vendor friend gave me a $200 Microsoft Band smart watch at the HIMSS conference. I gave it a try yesterday but put it back in the box after an hour or so. It is huge, bulky, and rigid (since it has a touch screen) to the point I couldn’t even get it under the cuff of my long-sleeved shirt and it barely fit around my wrist besides. It has a continuous pulse monitor, which is interesting but of marginal value for most people, and it pops up calendar and message alerts provided you’re willing to leave your phone’s Bluetooth turned on at all times. I gave it to an initially enthusiastic friend for a second opinion and got the same feedback: it’s cool, but not cool enough to be worth permanently hanging a heavy handcuff on your wrist even though it packs the heart sensor, GPS, light sensor, skin temperature sensor, and galvanic skin response measurement. I think my friend may end up reconsidering, though, after using it for a workout and seeing the results in Microsoft Health.

A judge issues a temporary restraining order that prevents Texas Health Resources from filing a worker’s compensation claim on behalf of Nina Pham, the Ebola nurse who is suing the health system. THR says such a claim should settle her issues and that Pham’s claims against it are unjustified since she’s an employee of one of its hospitals, not the corporation itself, and she’s not suing the hospital. 

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Weird News Andy says “Some day my prints will come – you can bank on it.” A NEJM case study profiles a woman whose chemotherapy treatments caused her fingerprints to disappear, which she discovered when her bank’s biometric ID system rejected her transaction.

I’m sure WNA would have caught this story: an Irish bank presses charges against customers who discovered that a temporary bug in the bank’s ATM software allowed them to withdraw more cash than they had in their accounts, inspiring one woman to make 115 ATM withdrawals totaling $60,000 in one afternoon to pay a Nigerian man to donate a kidney to her father.


Sponsor Updates

  • Medicity Network 5.6x earns Healtheway Vendor Validation.
  • CenterX Co-Founder and CEO Joe Reinardy will moderate a session on real-time benefit verification and electronic prior authorization at this week’s CBI conference in Philadelphia, PA.
  • Kareo announces a new version of its outsourced billing solution.
  • SyTrue publishes a story  about how healthcare organizations are unlocking the value of unstructured data.
  • Accreon’s work on the NB Cancer Network project is nominated for a 2015 Kira Award.
  • ADP AdvancedMD offers “Recent enhancements to the EHR charge slip.”
  • CommVault posts the second part of its series on “Disaster Recovery: Past, Present, and Future.”
  • Aventura posts a brief explanatory video on awareness computing.
  • Caradigm staff offer reviews of HIMSS, one featuring a great pic of HIStalk friend Regina Holliday.
  • CareSync offers “The Top 6 Reasons Why CareSync is For You.”
  • CitiusTech exhibits at Bio-IT World 2015 through April 23 in Boston.
  • ZeOmega releases its annual content update of best practices in evidence-based medicine care management.
  • Columbus CEO ranks CoverMyMeds as a Top Small Employer Workplace in Central Ohio.
  • Culbert Healthcare Solutions offers  “A Consultant’s Perspective: Teach ‘Em How to Fish.”
  • HIMSS15 attendees help Divurgent raise $5,000 for Lurie Children’s Hospital.
  • Peer60 offers a new report on mobile health and patient engagement.
  • Burwood Group is named to The Channel Company’s CRN Tech Elite 250.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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April 21, 2015 News 10 Comments

HIMSS15 Patient Advocate Recap – Carly Medosch

April 21, 2015 News 3 Comments

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This year was my first time attending the HIMSS conference. I definitely like to be prepared, so I took advantage of the pre-conference materials such as guidebooks, maps, and an hour-long webinar orientation in the week before the event.

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I knew McCormick Place was a large venue and I knew HIMSS would have a lot of attendees, but when I walked in Sunday afternoon, I felt like yokel in the big city for the first time “Golly gee, this sure is a big building!” And that was just the lobby of the North Building – one of four (plus a hotel) that make up McCormick Place.

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I spent most of Sunday on the hunt for a suit jacket that would become my very first Walking Gallery jacket. In fact, Regina Holliday would be painting it in the HIStalk booth during HIMSS! The jacket had to be perfect because I plan to treasure it for years to come, but it also had to be stylish since I intend to wear it every chance I get. As a patient suffering from a variety of symptoms that include pain, fatigue, and brain fog, it’s important to me to look my best as a way to compensate.

Although I have an undergraduate degree in design and a masters in business, my symptoms often cause me to feel inadequate. In a crowd of healthcare professionals, I still often struggle to be taken seriously as “just the patient.”Never mind the fact that my 21 years of daily on-the-job experience often exceeds that of other healthcare professionals.

Garment bag in hand, I arrived for the first party of HIMSS — the speakeasy-themed opening reception. It was impossible to spot anyone I might know in the huge, dark ballroom. Eventually I met Vincent McGee, a healthcare IT executive from Atlanta. He later emailed me to say that one of the highlights of HIMSS was the conversation we had. Later, I found Colin Hung, someone I have known online for years but never met. In fact, earlier this year, Colin volunteered to call my mom and walk her through the live stream set up so that she could watch me in a keynote panel at Stanford. These types of friendships exemplify social media and the online health community for me.

At the end of the party, I finally met up with Regina. Of course she had been held up on the way to meet us, recording an impromptu interview calling for everyone in America to request their medical records on July 4!

Next, I was on to a glitzy party at the top of Wit hotel, where I met up with friends and basically ate my weight in cheese and bread. This event was notable as a place where I finally met #HITsm maven Mandi Bishop. I was warned that these parties have a reputation for people drinking too much and getting a little “handsy.” I am grateful to my friends for allowing me to tag along to some parties, never making me feel out of place for not being an HIT insider and, of course, not getting handsy! I only had one drink and turned in early because I had a long, busy Monday ahead of me.

In Chicago, I used the city bus and the subway system to get around. Monday morning I walked a block, picked up a dozen Dunkin’ Donuts, and caught the city bus for the mile ride to McCormick. I didn’t know anybody at the Walgreens / Alex Gourlay keynote, but I made friends with the gentleman sitting next to me, who had attended all the way from England. We discussed the pros and cons of the NHS vs. the American healthcare system. After the keynote, I offered donuts to the people sitting near me. Then it was off for the exhibit hall.

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I ended up spending most of Monday and Tuesday in the exhibit halls, and even then I was not able to walk past every section, let alone visit even a fraction of the booths. In fact, there was allegedly an entire disaster response section with a tractor-trailer that I never even saw.

The exhibit halls, occupying the North and South Buildings of McCormick Place, totally blew my mind for a number of reasons. In a past life as a graphic designer, some of my work involved designing exhibit booths—of course these were the standard backdrops and pop-ups. The booths at HIMSS ran the gamut from these small, standard types to truly massive structures, many of which had two levels and included large conference tables or enclosed rooms for discussing business deals.

In the weeks prior to the conference, I was surprised at the volume of direct mail I received, each full-color glossy postcard extoling the virtues of one booth or another and describing the fabulous prizes I could enter to win when I visited. This all seemed extremely lavish to me, especially since I know many people dealing with chronic illness who are unable to work and struggle every month covering basic expenses such as $4 prescriptions. The Walgreens keynote mentioned their program to donate a vaccine to an underprivileged person in a third-world country for each customer who purchased their vaccine at Walgreens. I wonder how many vaccines could be provided with the money spent at HIMSS?

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In fairness, I should say that once I experienced the exhibit floor, the lavish giveaways seemed more practical. I certainly made sure I attended my pre-booked appointment at the Mirth booth. How did I decide to book this 30-minute demo? They promised a Fitbit fitness tracker to every person who completed their demo. I am happy to report that they treated me fairly, explaining their products to me and giving me the Fitbit without complaint.

The really neat thing about demos like Mirth’s was that it afforded me a rare opportunity to experience HIT tools from the provider side, something I’m not likely to see an my next checkup. I’m sure that for many vendors, offering prizes and giveaway offers better ROI than large, flashy booths. As a consumer and a patient, I want vendors to keep their costs as low as possible. I am not convinced that a gigantic booth at HIMSS actually pays off.

I was definitely concerned about how vendors would react my presence. I was “just a patient” and I definitely did not have thousands or millions of dollars to spend on their products. Thankfully, Mr. HIStalk reassured me prior to the conference that he would happily call out any vendor who treated us especially poorly. It’s not that I wanted to get people in trouble, but fear of reenacting the shopping scene from the movie “Pretty Woman” kept playing through my head.

Luckily the vendors I visited at HIMSS pleasantly surprised me. I did have one vendor tell me not unkindly that they didn’t have anything that I would be interested in seeing.

Only two unpleasant experiences stand out in my mind. One day I was behind two very unsavory sales dudes as they discussed their annoyance at having their time wasted talking with someone who obviously was not going to make a purchase. Luckily for those guys, I did not see what company they represented. Another instance was when I tried to enter a prize drawing and was met with a bit of a sneer from the woman working there. It might have just been a matter of luck, however, because fellow HIStalk patient advocate scholarship winner Amanda told me that she did not have very pleasant interactions with many of the vendors.

I was relieved that the most common reaction to my presence was a little confusion and then mostly excitement. On Wednesday I had several hours of demos booked with people interested in my opinion and expertise as a patient. I was also lucky to know a handful of people from previous events or from Twitter who were happy to introduce me to other vendors. Some positive reactions that stand out in my mind are those from the Dell booth, the Panasonic booth, and of course the CTG booth who provided the registration badges for the patient advocates.

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It was such an honor for me to be interviewed by Joe Lavelle and Rayanne Thorn at the CTG booth. I laughed when they thanked me for taking the time to tell my story. As I explained, it’s easy to talk, but the real honor is when someone is willing to listen. We came up with the idea to have a patient for every booth at HIMSS16. Will your organization step up and sponsor a patient?

There were two cool things about the Dell booth. Instead of the usual swag (most of which probably ends up in the trash), Dell had glue guns and flower petals so visitors could make colorful, sparkly flowers which would then be donated to Brooke’s Blossoming Hope for Childhood Cancer Foundation which provides fun headbands to children who’ve lost their hair from chemo. The Dell employees were also really excited to hear that HIStalk had sponsored patients to attend HIMSS. They enthusiastically told me about programs where Dell used feedback from actual patients.

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While checking out products on the outside of the Panasonic booth, I got called over by an acquaintance to try out their Connected Patient Room Solution. They had a display with information, education, and entertainment for the patient and their caregiver. The system also featured audio technology that could be used to isolate sounds for patients sharing a room (or just those with alarm fatigue). I have no idea how it works, but if you are directly under the speaker, you can hear music (or other audio), but as soon as you shift a bit, you can’t hear anything. The sound also has the effect of drowning out the other noises in the room.

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The Sonifi Health booth had similar types of displays for patient education and entertainment. They had modules with specifics on medications, and the program could also utilize videos as part of the discharge process. I appreciated that they had an RN on staff to help with education and engagement. From my months in the hospital, I know that nurses interact far more with patients than anyone else, although they often don’t get the respect they deserve within healthcare.

The most creative swag was from Nick Adkins, who (lacking a booth) wandered HIMSS wearing a kilt and handing out pink socks with mustache designs to promote his HIPAA-compliant video service Reel Dx. I was happy to trade donuts for socks with Nick and his business partner.

I was pleased that HIMSS had a Connected Patient Gallery, but the actual experience left me disappointed. At one point, they were using the theater to run a trivia game about Walgreens. On another visit, I tried to find someone from Patients Like Me, but only found a video, no actual humans. I spotted some devices to record blood glucose, weight, blood pressure, etc. but the vendor (who admitted their products weren’t capturing the older, less techie demographic) got agitated when I persisted in asking why something like a scale needed to use a smart phone anyway. My older, less techie relatives barely leave their house, and I’m sure transmitting the data via dial up would suffice, if necessary. This strikes me as a prime example of a business not really understanding or caring about their customers. It’s worth noting that I did not see any patients in the Connected Patient Gallery on any of my visits.

Overall, I’d give HIMSS a B rating. The event was way too big. I’m concerned about the professionals there to make important business deals for their organizations. There’s no way to keep everything straight and the pace and atmosphere is exhausting and confusing. The keynotes were mostly overly optimistic, glossy commercials presented by rich white men. We need to see more patients on stage. The options for food were so expensive and the lines so long that at one point my favorite booth giveaway was cucumber water. I’m not sure why the transportation was such a problem — Chicago has a train, a subway, and city buses, along with shuttles to nearly every hotel, taxis, and Uber cars. I’m concerned that health IT purchases are being made by people willing to wait an hour for a taxi or pay 4.5x surge pricing for an Uber rather than walk to the curb to catch a bus for $2.

The best parts of HIMSS for me all involved people. My favorite thing was meeting up with old friends and making new ones. I loved vendors who were genuinely excited to talk to a patient. It was an honor to be able to tell my story and to represent patients who could not attend. I had a lot of fun live tweeting and was especially happy when my “normal” followers (non-HIT) thanked me for the coverage. The best swag I brought home was the stack of business cards and new connections for future advocacy opportunities.

The buzzword for HIMSS seemed to be interoperability. I also heard a lot about engagement and compliance. Hopefully the campaign to bring more patients next year takes off. I think many vendors want to involve patients, but are genuinely baffled about how to do so. I hope that with the presence of more patient advocates at HIMSS, vendors will begin to understand that they must learn how to engage with patients and that we need them to comply with their oaths to serve us.

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April 21, 2015 News 3 Comments

Morning Headlines 4/21/15

April 20, 2015 Headlines No Comments

Health insurance startup Oscar gets unicorn valuation with $145 million in new funding

Oscar Health, a tech-focused health insurer in New York that offers free telehealth visits and free activity trackers to its customers, raises a $145 million funding round on a $1.5  billion valuation in only its second year of operation.

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)

CMS publishes its proposed 2016 policy and payment changes, which includes a 1.35 percent penalty for hospitals that have yet to attest under the Meaningful Use program, and new reporting requirements that will help align MU’s clinical quality measures reporting with the Inpatient Quality Reporting program, in an effort to ease the administrative burden on hospitals.

CMS commits $3 billion to modernize Medicaid-enrollment systems

CMS will spend $3 billion to make permanently adopt changes introduced in 2011 that established a 90 percent reimbursement rate for costs expenses associated with building state Medicaid eligibility and enrollment systems, and 75 percent reimbursement rates for ongoing costs associated with maintaining the systems.

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April 20, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 4/20/15

April 20, 2015 Dr. Jayne 1 Comment

HIMSS Wrap-up and Final Fashion Commentary

I’m still recovering from HIMSS. Apparently there was a lot of craziness at the hospital while I was gone, but I’m grateful to my second in command who handled all the issues. That lets me know that they’ll be in good hands down the road.

I’ve been going through my notes and arranging follow up with a handful of vendors that caught my eye. I’ve also been sorting through the scads of business cards I collected and am trying to remember who I met at which events. The week was quite a whirlwind.

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From Bright Lights, Big City: “Re: my boots. As requested, here’s a better picture. They are one of my favorite pairs of boots (my blue suede ones are killer too). Thanks for the compliment on HIStalk. I was totally flattered. The House of Blues was so much fun!” Mr. H and Lorre outdid themselves with the event. Although I wasn’t an official shoe judge, after discovering these boots I’m thinking that next year we need a “Jayne wishes she had my shoes” sash to hand out. I’m also thrilled that she responded to my plea for a photo of the boots. It’s fun to connect with readers, even if it’s just email. It also lets us know you’re actually keeping up with HIStalk, unlike the two guys at the bar at the House of Blues who had never heard of Mr. H or Dr. Jayne.

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Although Nordic’s Drew Madden won our official shoe contest, a reader emailed a picture of this pair of blue suede shoes that he snapped at the NextGen party. I’m thinking they could be a contender next year. Drew also sported an inlaid wood tie clip and I’m thinking we need to add some additional categories for best accessories.

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I’m declaring HIMSS 2015 to be “The Year of the Sock.” I saw more fetching hosiery this year than ever before. Special mention goes to Colin at the Patient IO booth. The socks were kind of a teal/aqua color with several accent colors below the shoe line, and coordinated perfectly with his bow tie and pocket square. His described his companies app as being “like Legos for patient engagement,” which drew my attention when I was fading partway through the exhibit hall.

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Speaking of bow ties and pocket squares, the Aventura team had it going on all week long with different combinations every day. The ties, pocket squares, sweaters, Converse sneakers, and strappy sandals spotted at the booth were perfectly matched to their specific shade of orange, as were their giveaway candies. I didn’t know you could Pantone match M&Ms, but they just might have done it. I heard they also had cufflinks that honored their owl mascot, but I missed them.

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After my final lap around the show floor, it was time to head to the airport. I chuckled at the seat sign which promised no extra charge for payment by credit card since I was charged a processing fee every time I used an actual taxi. Usually I’m just changing planes at Midway and hurrying to another gate, but this time I had time to stop for lunch and more hydration at Harry Caray’s. I was people-watching when a vendor rep I haven’t seen in a while stepped up to the host stand. I waved him over and we caught up over a burger. He’s starting a new venture soon and I can’t wait to hear more about it.

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The other bonus of arriving at Midway early was being able to help welcome in an Honor Flight group from Kansas that was changing planes in Chicago. Honor Flight sends veterans to Washington, DC to visit their respective war memorials. This looked to be largely a group of World War II veterans. Travelers stopped and lined up a good way down the terminal, applauding as each veteran deplaned. The applause followed them down the concourse as they passed different gate areas. Many of their family members and escorts were moved to tears and I was as well. This generation sacrificed so much and being able to thank some of them really put the week in perspective.

My flight home had multiple vendor reps still in booth attire, including scrubs. Everyone appeared tired and I almost had to use my doctor skills when a passenger nearly dropped her bag on our row while trying to get it in the overhead bin. “Heavier than I thought” almost caused a head injury, which makes no sense on an airline that checks bags for free. Based on the backpack (carry-on number three for her), she was a HIMSS attendee. Maybe a first timer – HIMSS is the one event I take my expandable suitcase to, because you never know what you might bring back. Thank goodness the folks at Medicomp agreed to ship the six gallons of popcorn I won playing Quipstar. As a reminder for those of you who are not road warriors: If you can’t lift it, it’s not a carry-on.

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The in-flight Wi-Fi allowed me to file most of my expense report before landing and I also had a chance to get caught up on email. One of my readers had reminded me on Monday that running would be my sanctuary this week. It had me wondering how many steps are in a HIMSS. Although I didn’t participate in the BYOD wellness challenge, I can state with confidence that it’s at least 65,000. I don’t know exactly because I didn’t wear my Garmin to HIStalkapalooza, so all that dancing didn’t get captured. I’m not sure on mileage since the data from the Garmin (29.2 mi) doesn’t match Garmin Connect (50.4 mi). I’m more inclined to believe the wrist unit, but I’m glad Garmin isn’t building healthcare software.

How many steps were in your HIMSS? Email me.

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April 20, 2015 Dr. Jayne 1 Comment

DonorsChoose Fundraising Project at the HIMSS15 Conference

April 20, 2015 News 1 Comment

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Dana Moore, SVP/CIO at Centura Health, offered to give vendors 20 minutes of his full attention during the HIMSS conference in return for a $500 donation to support classroom projects via DonorsChoose. Seven companies signed up, plus another company that wishes to remain anonymous offered to match the money pledged. Dana said it was the best hours he spent at the conference.

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The project made $7,000 available to help teachers. The grant requests I funded with the money (some of which I announced previously) are as follows, some of them made possible because of available matching funds from other donors such as the Bill & Melinda Gates Foundation:

  • Two Fire HD devices for a middle school reading program in San Diego, CA.
  • A projector for a kindergarten class in Erie, PA.
  • Professional development books for kindergarten teachers in Charlotte, NC.
  • A Chromebook for an elementary school class in Toppenish, WA.
  • Algebra calculators for a high school class in Auburn, WA.
  • A sand and water table for K-2 children, all with multiple disabilities, in Rosamond, CA.
  • Headphones for K-2 classes in Portland, OR.
  • A drawing tablet for the iPad for grades 3-5 in Lockhart, TX.
  • Three iPad Minis for a sixth grade class in Oklahoma City, OK.
  • A television and wall mount for presenting Spanish learning materials for a middle school in Magna, UT.
  • Speech therapy learning tools for a speech pathologist for an elementary school in Hawkinsville, GA.
  • Two Chromebooks for web-based reading and writing programs for an elementary school in Springfield, OR.
  • A science, technology, engineering, and math (STEM) bundle for an elementary school in Herminie, PA.
  • Studio furniture for a TV show news set for a high school in Atlanta, GA
  • An iPad Air 2 and strategy workbooks for an elementary school in Phoenix, AZ.
  • A Chromebook for a high school in Gilroy, CA.
  • An iPad Air 2 with classroom management tools for a high school in Conway, MO.
  • A microphone and recording equipment for creating video documentaries for an elementary school in Pea Ridge, AR.
  • Teacher lodging expenses for attending a national educator’s conference for an elementary school in Greenville, SC.
  • Math learning centers for an elementary school in Wilder, ID.
  • Math learning centers for a kindergarten in Chicago, IL.
  • An iPad Mini for teacher professional development for an elementary school in Memphis, TN.
  • A STEM bundle for a second grade class in East Islip, NY.
  • A Surface Pro 3 for math practice for deaf students in Grades 4-5-6 in Seatac, WA.
  • Seven laptops with robotics programming tools for an elementary school in Tukwila, WA.
  • A Surface Pro 3 and iPad Mini for math exercises for an elementary school in Seatac, WA.
  • Six iPad Minis for math practice for an elementary school in Auburn, WA.
  • Math problem solving centers for an elementary school in Fort Walton Beach, FL.

Dana Moore’s Recap

I wanted to give a report on my experience at HIMSS meeting with companies who each generously donated $500 to DonorsChoose.org.

In order to give some perspective, it is important to note that Centura is in the early stages of replacing our current EHR with Epic. Two areas of focus for me related to the Epic implementation were supplementing our training and go-live support and helping us jumpstart our Connect program.

With that background, here is a brief synopsis of each of the companies I met with at HIMSS. Please remember that I had 20 minutes with each firm, so these are impressions and not endorsements.


Leidos

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Full disclosure: we currently are working with Leidos.

Scott and team were checking in on the team in place at Centura and then we discussed our potential needs on training support and Connect. We had a very casual conversation due to the current working relationship.


QPID Health

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Early Wednesday, I ran into a colleague from Colorado and we were discussing our never-ending pursuit of analytics. We both commented how great it would be if our HIE could find a company that could jump start such efforts. Enter QPID. Their platform seems to be an answer to the problems I had been discussing earlier and they are currently working with two HIEs as well as numerous health systems.


Nordic

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Drew and the team at Nordic were very informative on their experience supporting health systems implementing Epic. We discussed our challenges and will be having further discussions with Nordic on the areas where we may need assistance.


TeraRecon

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Full disclosure: we currently are working with TeraRecon. 

This was a reminder that every organization needs to have regular meetings with all of their current partners to ensure they fully understand the solutions offered. Paul and his team quickly outlined a way we could potentially leverage our current solution to reduce our interface costs with Epic as well as bring outside images into the organization in a more efficient manner than is happening today. Follow up meetings are being scheduled.


Serra Health Consulting

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Loyal readers will remember Mr. H writing that one donor was planning to teach me how to make balloon animals. Serra generously wanted to make a donation and also donated their time since I was behind schedule.


EDCO

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One of the issues we have at Centura is indexing of scanned documents, especially with our clinics. While we will be dramatically reducing the number of scanned documents with the implementation of Epic, it will never go to zero. EDCO appears to be a solution to help. They offer several solutions from total outsourcing of scanning to outsourcing the indexing of the documents. EDCO does not sell a document management system and we are not in the market for one. Their solution seems to be a good fit to solve an issue for us so further meetings are being scheduled.


Physician Network Advantage

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PNA was on my list of people to talk to at HIMSS so I was excited to see them on my calendar. My interest was on their Connect offering and how they might help Centura jumpstart our efforts. If you are an Epic client and considering offering Connect, ask John to show you their eight-foot long Visio on the Connect process. It is impressive and sobering at the same time.


I had a lot of fun meeting with everyone and came away with follow up for the team at Centura. I want to apologize to all of the people who patiently waited for me when I fell behind schedule due to travel time between booths.

The most exciting part of this experience is that we raised $7.000! Thank you to the companies listed above and to the anonymous donor who matched everyone’s contributions. I would also like to thank Mr. H and Lorre for all of their work to make this happen.

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April 20, 2015 News 1 Comment

Morning Headlines 4/20/15

April 19, 2015 Headlines 1 Comment

Kaiser Permanente to put IT campus in Midtown Atlanta; create 900 jobs

Kaiser Permanente will build a $20 million medical information technology campus in Midtown Atlanta, spanning 150,000 square feet and resulting in 900 new jobs.

The Problem With Satisfied Patients

The Atlantic takes the ACA’s patient satisfaction mandate to task, suggesting that if hospitals and providers are overly concerned with patient satisfaction, they might avoid having unpleasant but necessary conversations about weight loss and smoking status, and instead spend money on flashy satisfaction wins like valet parking and VIP programs.

CPSI Announces Formation of Evident, LLC

CPSI rebrands itself as Evident, and rebrands its EHR as Thrive EHR, which it says will scale to meet the needs of the 100-300 bed hospitals and help it penetrate that market.

EY Telemedicine Adoption Model Unveiled at HIMSS Conference

Ernst & Young creates a Telemedicine Adoption Model that establishes seven stages of telemedicine maturity based on technology used, integration with core IT systems, and specialty services included.

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April 19, 2015 Headlines 1 Comment

Monday Morning Update 4/20/15

April 18, 2015 News 7 Comments

Top News

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Kaiser Permanente chooses midtown Atlanta for a $20 million IT campus that will create 900 jobs.


Reader Comments

From Justa CIO: “Re: HIMSS. Do you think it’s becoming irrelevant for people in HIT leadership roles? I find it much less compelling since I can find product information or call someone who has experience with something without being away for a week and spending thousands of dollars of my employer’s hard-earned money while plugging away at real issues. I would like to know what you and others think. Your coverage is excellent – it was enough to make me post this question as I realized that the only things I miss was networking and your choice party.” I’m mixed on the value of attending the conference. Networking can be overrated if you aren’t a vendor selling something – I sometimes think CIOs should stop talking to each other entirely (except to check vendor references) and do creative rather than imitative things since healthcare IT sometimes looks like lemmings following each other off the cliff. HIMSS is efficient in bringing people together so they can schedule time together, but otherwise it’s a horribly inefficient mess of social events, glitzy exhibits, job seeking, and glad-handing and you might be better off just buying the education session recordings (which are included free with conference registration). I’m not convinced that the non-profit health systems that spend fortunes to send people there (often more as a personal reward than a business necessity) show measurable ROI or demonstrate care improvement as a result. Here’s a challenge to health system CIOs that I will report anonymously if you respond: list the immediately actionable items you took away from the conference that you couldn’t have done without attending. Or, the actions you took in the past year that were driven entirely by your 2014 HIMSS attendance. Our HISsies “best CIO” winner John Halamka keeps BIDMC running despite his non-attendance this year.

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From Texas Rules: “Re: Next Wave Connect healthcare-specific social collaboration solution. It continues to purge staffers – Drex DeFord and most of the Seattle team are gone.” Drex’s LinkedIn profile indicates that he left the company in February. I asked Chairman Ivo Nelson, who replied,“ It’s pretty common for startups to go through some turnover in the first few years. As you know, I’ve been through this before and getting the right team in place is a sign of health, not illness. Next Wave Connect has steadily grown its staff and will continue to grow this year. We have a good team in place under the leadership of Jim Jacobs and I’ve been very pleased with our progress. Just our March To HIMSS campaign garnered over 15K hits and MyCHIME is has been a huge success.”

From Concerned Tester: “Re: [health system name omitted]. An IT director is under investigation for accepting an Aruba vacation from their [vendor name omitted] rep. That director and his former boss hid a problem with orders that didn’t match after an EHR upgrade. He also pushed out an update that broke the connection to the HIE that caused slowdowns and lost data. The good news that the vendor is being kicked out and Epic will happen in 10 months, but the bad news is that the director was successful in getting them to switch to the previous vendor’s HIE.” I’ve omitted names since I couldn’t verify, but I’m interested in who’s doing the investigation.

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From Magnum PI: “Re: Meaningful Use data from Jamie Stockton at Wells Fargo Securities. The numbers don’t seem to match what CMS provides. I also thought CMS stopped including vendor names in their numbers due to ongoing inaccuracies.” Jamie provided this response: “The only hospitals that needed to attest for Stage 2 in 2014 were the ones that originally entered the program in 2011-12. That cohort of hospitals is 2,600 facilities (vs. the 4,800 that have registered for the program through today). If we look at net attestations (adjusting for the fact that sometimes more than one vendor is listed by a hospital when they attest and therefore one hospital occupies multiple rows for the same attestation year in the CMS spreadsheet), then we calculate that 1,800 hospitals have attested for Stage 2, which roughly matches the number your reader quoted. If you just took 1,800 and divided it by 2,600, then you would get about 70 percent of hospitals having successfully attested for Stage 2. I probably need to make that 70 percent number much more clear in the future and we also need to add a line to the bottom of our Stage 2 table that adjusts the gross number of attestations (which was 2,900) down to the 1,800 net. When we look at vendor success rate, we are excluding the hospitals that have switched vendors since 2011-12. If we didn’t, Epic would have a 130 percent success rate because many McKesson, Meditech, and Siemens hospitals that first showed up in 2011-12 with those vendors have subsequently switched to Epic and would not be in the denominator of the calculation for Epic. Excluding all 400 hospitals that have switched vendors, we get to an average vendor success rate of 55 percent. Obviously that penalizes vendors in their success rate if they have lost market share, but I think that is OK. There is a reason that the hospitals moved away from them. At least with the February data set that powered our most recent analysis, CMS continued to publish the vendor names associated with each attestation.”

From The PACS Designer: “Re: medical 3D printing. At the Washington University School of Medicine, cardiothoracic surgeons are using 3D printing to prepare for heart operations. Recently they used the 3D method to prepare for a difficult heart repair for a 20-month-old toddler at St. Louis Children’s Hospital.”


HIStalk Announcements and Requests

I feel sorry for the housekeeping people who had to discard all the junk HIMSS conference attendees left in the overflowing trash cans of their hotel rooms at checkout. Every year most of the booth swag and handouts that seemed worth grabbing in the exhibit hall fail to earn their luggage space back in the hotel, so rather than pack it and haul it home, it’s easier to just chuck it. Somewhere in Chicago there’s a landfill full of Caradigm-provided HIMSS backpacks, although I actually brought mine home since it’s a nice one. I also brought back the pair of insulated coffee mugs that First Databank cheerfully provided.

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Arcadia Healthcare Solutions provided the most useful handout ever, a conference essentials pack that included a bottle of water, a coozie, breath mints, ibuprofen, foot bandages, antacid tablets, and vitamin C fizzy drink powder.

The conference reminded me of an observation I had years ago after sitting in on a variety of VC and executive meetings. Mid-level executives and startup CEOs always wear impeccable suits and frown at everything to make sure people take them seriously, while the folks with real money and power wear casual clothes and joke around because they’ve earned the ability to do whatever they want and don’t care what the suited second string thinks. I like that a lot. Big-time VC guy Peter Thiel famously says that his fund will never invest in a technology company whose CEO wears a suit.

Speaking of the conference, I didn’t hear any comments or see any tweets quoting something interesting that was said by the keynote speakers. Did I miss anything by not attending any of them? I’m also interested in more definitive comments about what you liked and didn’t like. Did you go to any educational sessions? Did you meet anyone who was particularly impressive or obnoxious? What vendors raised your interest?

Here’s an odd expression I’ve heard quite a few times over the years: “a piece of software.”

Phrases that need to be expunged from the healthcare vocabulary: mobile health, population health, and patient-centered. All of those be assumed when talking about health. They don’t require being defined as a separate novelty category as they once might have been.

I was annoyed at a video interview with Karen DeSalvo conducted by a young HIMSS Media person with unstated credentials (she includes nothing about education or background in her LinkedIn profile) who repeatedly referred to the national coordinator (and acting assistant secretary for health)  as “Karen.” Even if she’s your BFF, she should be referred to as “Dr. DeSalvo” when interviewing her on video – that shows basic respect for her education, role, and age. 

Thursday beat Wednesday’s HIStalk readership record with 14,658 page views from nearly 11,000 unique visits.

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The folks who didn’t attend HIMSS expected their workload to be about the same last week, although a fourth of them admitted that it’s easier when their bosses aren’t around. New poll to your right or here: if you attended the HIMSS conference, how would you grade it?

Lorre has posted some of the interviews DrFirst did at the conference. Here’s one with our HIStalkapalooza host, Forward Health Group’s Barry Wightman.

Here’s another DrFirst HIMSS conference interview, this one with DrFirst CEO Cam Deemer on the one year delay of mandatory electronic prescribing in New York.

For those who attended HIStalkapalooza: what would you do differently? How would you make it more attractive to potential sponsors for a 2016 version? I haven’t decided if I’ll do it again next year, but Lorre has confidently placed a hold on a Las Vegas venue thinking I’ll re-up.

Listening: The Suffers, big-horns Gulf Coast melting pot soul from Houston. This is your chance to tell people about a great band they’ve never heard, but will almost certainly like once they do.

Welcome to new HIStalk Platinum Sponsor xG Health Solutions of Columbia, MD. The clinician-led company brings to the national market healthcare transformation tools and knowledge developed by Geisinger Health System. The company offers care management services (including population health analytics) and offers help with transition to a fee-for-value environment. XG Health solutions announced at the HIMSS conference EnrG, a suite of advanced interoperability software modules that use Geisinger-developed care models to improve acute and chronic care management, connecting via SMART on FHIR to work seamlessly with any FHIR-enabled EHR (the initial partners are Athenahealth, Cerner, and Epic). The evidence-based care modules address procedures and conditions such as CABG, hip fracture, COPD, diabetes, and chronic kidney disease. EnrGRheum, which addresses rheumatologic diseases, will be released in Q3 2015 with six additional apps following. Thanks to xG Health Solutions for supporting HIStalk.


Webinars

April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.


Acquisitions, Funding, Business, and Stock

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CPSI renames its EHR business line Evident. or at least that’s what the verbose yet uninformative press release suggests. It will continue to run its services business under the TruBridge name. The Evident name seems rather generic, not particularly relevant, and likely to get lost in Google searches. Apparently the CPSI name survives as the parent and in the company’s Nasdaq listing. Vince Ciotti tipped me off with the photo above that he took in the HIMSS exhibit hall.

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Streamline Health reports Q4 results: revenue up 1.2 percent, adjusted EPS –$0.04 vs. –$0.13. Shares dropped almost 7 percent Friday on the news. Above is the one-year price chart of STRM (blue, down 49 percent) vs. the Nasdaq (red, up 20 percent).


Announcements and Implementations

Tallksoft launches its Survey+ patient survey app that allows medical practices to benchmark their patient experience and practice performance.

Cerner will offer Healthwise health education content to Millennium users and via its HealthLife Engagement module.

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Ernst and Young announces development of its Telemedicine Adoption Model.


Government and Politics

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The estimated cost of opening the new Denver VA hospital rises to over $2 billion vs. the original VA estimate of $630 million. It’s also two years behind schedule.

The Atlantic says hospitals are chasing CMS patient satisfaction scores that focus on making people happy rather than making them well, encouraging hospitals (even those with low clinical ratings) to redirect funds toward putting in valet parking, live music, and VIP loyalty lounges. They’re also scripting nurse interactions to troll for higher survey scores and tying clinician pay to the results even though everybody knows that the patient isn’t always right. A previous version of the survey allowed comments, where patients complained that their dying roommate was making too much noise and that their sandwich didn’t contain enough pastrami. Experts worry that hospitals trying to appease patients might avoid talking to them about unpleasant topics such as losing weight, seeking mental health treatment, or stopping smoking. Most amazing is that patients with the highest reported satisfaction had higher hospitalization rates, higher costs, and a higher mortality rate.


Other

Here’s the final installment of Vince Ciotti’s vendor revenue review for 2014, this time covering small-hospital vendors.

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I missed that Athenahealth’s Jonathan Bush tweeted this last Tuesday, including a HIStalkapalooza photo taken back stage at the House of Blues.

The latest drug of abuse: amphetamine-based ADHD drugs such as Adderall (aka “mommy crack” or “productivity in a pill”), which mostly young career go-getters are using to increase career competitiveness through short-term improvement in focus and attention. Interestingly, the anonymous executive profiled in the New York Times article is a health IT startup CEO, who says she has no choice but to take the drug because it is “necessary for the survival of the best and the smartest and the highest-achieving people.”


Sponsor Updates

  • HCS sponsored the “Arc of Monmouth Walk and 5K” on the Asbury Park Boardwalk in New Jersey last week and raised more money than all other teams for people with intellectual and developmental disabilities.
  • Strata Decision Technology will add Yale-New Haven Health’s quality indicators into its StrataJazz platform to help providers understand the high cost of quality variation.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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Reader Comments

  • Peanuts: This is about politics? Give me a break. Anyone who has ever done work with any of the federal agencies knows that tho...
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