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News 8/31/16

August 30, 2016 News 4 Comments

Top News

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Athenahealth acquires 12-employee, Austin-based care coordination system vendor Patient IO, in which Athenahealth had invested in October 2015 via its More Disruption Please Accelerator program. This is the second company Athenahealth acquired from the MDR accelerator, the first being scheduling system vendor Arsenal Health.

The three-year-old company had raised $4.3 million in three funding rounds. Its app offers collaborative care plans, secure messaging, wearables integration, medication management, and notifications.


Reader Comments

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From Mick Mars: “Re: HIMSS Analytics vs. Definitive Healthcare for primary intelligence for vendors. People at our company hate HIMSS Analytics, but you lose HIMSS points and thus get a worse booth location if you drop them. Both companies are dropping their prices by the day, but it’s still a six-figure decision.” I’ll invite vendor readers to weigh in on the pros and cons of each since as a non-vendor, I haven’t worked with either company.

From CEO Cynic: “Re: KLAS. We stopped paying their ransomware fees last year.”

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From Mobile Man: “Re: farming tech bubble. I find interesting similarities with our approach to healthcare IT. I wonder what would happen if we had Meaningful Use money for agriculture?” A Fortune article describes technology companies that create expensive sensors and data tracking software for farm equipment while keeping the data rights for themselves so they can sell it to fertilizer and equipment vendors. Venture capital firms are investing hundreds of millions of dollars in Silicon Valley-designed agtech such as GPS-guided tractors and aerial imaging drones that farmers aren’t buying, with experts saying farmers just need basic technology to track people and equipment, digitize their paper notes, and to display history of previously recorded problems. The market is soft because startups have bailed out and left farmers holding expensive equipment, the systems can be difficult to install and use, and those systems often don’t tell the farmer anything they don’t already know. At least some farmers already have their form of Meaningful Use in which they, like doctors, are paid by taxpayers to reduce their productivity (leaving fields unplanted or seeing fewer patients, respectively). We’re lucky government market interference doesn’t lead us into either starvation or death from unmet medical needs.

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From Chilblains: “Re: Athenahealth. This is kind of a big deal – Doran was a huge asset and his departure, along with that of Ed Park, makes me wonder whether Kyle Armbrester and the new CTO can fill the holes.” Athenahealth GM of AthenaCoordinator Doran Robinson leaves the company to work for an online furniture company. ATHN shares have slid 6 percent in the past year vs. a 13 percent gain in the Nasdaq.


HIStalk Announcements and Requests

Here’s my ingenious, semi-technical solution for patient engagement. Insurers look you up on Facebook to find your friends and family members, then bribe them secretly to encourage your healthy behaviors by applying peer pressure in the form of, “That’s a lot of wine for a weekday,” or, “You might want to sew on those shirt buttons with fishing line so they don’t shoot off under pressure and put someone’s eye out.”

I ran a comment last week from a reader who observed staff at Suburban Hospital (MD) operating under downtime procedures for a handful of hours. I’ve found that the problem wasn’t Epic, it was a connectivity problem among Johns Hopkins hospitals due to a power surge that overheated conduit. It’s interesting to me that hospital systems have become reliable enough that when someone says “XX system was down,” it’s usually not the system itself but rather the connectivity to it or a workstation-related issue. It’s not much consolation that a given system is running perfectly even though users can’t access it, but that is the case most of the time these days except during application software upgrades.

Listening: the new single from the Pixies, preceding the September 30 release of their new album, their first without Kim Deal. Their new stuff is familiarly full of droning guitar riffs and the quirky pop culture references of Charles Thompson IV (aka Black Francis, Frank Black). I can never get this song out of my head, nor do I wish to. 


Webinars

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


Acquisitions, Funding, Business, and Stock

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Digital engagement vendor Zillion raises $28 million in a Series C funding round. I interviewed President Bill Van Wyck in May 2016. He summarized Zillion’s market position then as:

The differences in the market exist where healthcare has been trying to build vertical silo products to address specific conditions. The reality is that patients don’t typically have just one condition. They are overweight and may have depression, or they may be diabetic and need other types of procedures and support. There are co-morbidities and multiple chronic conditions that exist in the real world.  Having a common backbone platform like Zillion where you can design, create, and deploy programs to patient populations and then refine and refine and modify those programs at scale is a differentiator for healthcare stakeholders. When you look at what they’ve been building, typically none of them interact with existing systems. They’re not interoperable. They don’t always reach patients on the devices and the technology that they use day to day.

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Cardinal Health acquires 18-employee Iowa City, IA-based telepharmacy software vendor TelePharm, which allows pharmacists to verify prescriptions and counsel patients by video from any location.


People

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Col. Mike Regan, former VP/CIO of Lower Bucks Hospital (PA) and an executive with Siemens Healthcare while he also pursued a 35-year career in the Air National Guard, is named Deputy Adjutant General-Air of the Pennsylvania National Guard.


Announcements and Implementations

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Cerner will use episodes of care software from 3M Health Information Systems in its HealtheIntent population health management system.

In Australia, two northern Queensland hospitals go to market for for a clinic and hospital EHR, with $26 million budgeted. Cairns Hospital, the major health system, is already live on Cerner, which probably places it in a strong bidding position.


Government and Politics

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ONC announces the winners of its Blockchain in healthcare challenge, which drew 70 submissions. The 15 winners from which up to eight will be selected to present at the ONC/NIST workshop September 26-27 are:


Privacy and Security

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Two West Virginia hospitals owned by Appalachian Regional Healthcare go back to paper when their computer systems are infected by unspecified malware. The systems went down last weekend, and according to a Tuesday update on AHR’s site, are still down.

A judge rules that a lawsuit brought by the mother of a murdered TV news anchor against two hospital employees who viewed her medical records can proceed, although the judge finds that the hospital is not liable for the actions of its employees.


Innovation and Research

Researchers question whether physicians should order more diagnostic imaging tests or inform patients when their studies turn up incidental findings of unknown significance. The authors say genetics testing may provide a model that’s applicable to radiology, where patients decide upfront how much they want to know and their medical experts don’t disclose minor, low-risk findings. Others caution that it’s not practical in a litigious malpractice environment to withhold information of unknown future significance, especially when a lot of diagnostic imaging tests are performed purely to avoid malpractice claims. 


Technology

Huffington Post covers the hospital use of virtual reality as an alternative to drugs for pain management and relaxation.  

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Two radiologists in Canada create Tipso, which projects PACS images onto a surgical drape so that surgeons can manipulate them with their hands without breaking the surgical field. Tests suggests that the system can reduce surgery time by up to 15 percent.


Other

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A former Mount Sinai School of Medicine researcher who was fired in 2010 for data fraud and then sued the school unsuccessfully for discrimination shoots two men outside a Chappaqua, NY deli, one of them the dean of the medical school, in an apparent revenge attack. Both the dean and a bystander suffered non-life threatening injuries.

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A Gallup poll finds that healthcare, pharma, and the federal government take the bottom three spots in consumer perception. Restaurants and the computer industry top the list.

Researchers find that one-fifth of genetic research papers whose authors used Microsoft Excel to analyze their data contain incorrect gene names, as the authors fail to notice that the worksheet software automatically translates symbols (SEPT2) to dates (September 2).

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In China, a state-run newspaper covers a hospital’s Internet addiction treatment center that has used electroshock on 6,000 people, mostly teenagers who are sent there by their parents. The patients are forced to attend ideological education and military training and are given shock treatments for breaking any of 86 rules, which include not taking their meds on an empty stomach and not sitting in the dean’s chair. Such treatment would be equally popular with providers here if insurance would pay for it.


Sponsor Updates

  • Gibson Consultants publishes “Independence remains a rewarding choice for doctors” by Aprima CEO Michael Nissenbaum and Chadwick Prodromos, MD.
  • Arcadia Healthcare Solutions analytics earns NCQA PCMH pre-validation.
  • Impact Advisors is recognized as one of the largest healthcare management consulting firms. 
  • KLAS recognizes Nordic as a top performer in optimization services.
  • Besler Consulting publishes a “2017 IPPS Final Rule Analysis.”
  • Leadership Columbus selects CoverMyMeds Communications Manager Mike Bukach for its Signature Program Class of 2017.
  • The Mental Health Association of Erie County will honor CTG for its contributions to the cause at its annual Benefactor Society Reception on September 7 in Buffalo, NY.
  • Elsevier Clinical Solutions receives a Merit Award for Patient Education from Health Awards.
  • Fortune features comments from Extension Healthcare CEO Todd Plesko in an article on WhatsApp.
  • Built in Colorado profiles Healthgrades CTO Bill Bell.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
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August 30, 2016 News 4 Comments

Morning Headlines 8/30/16

August 29, 2016 Headlines No Comments

Health Insurers’ Pullback Threatens to Create Monopolies

Analysis from the Kaiser Family Foundation finds that health insurer pullback from ACA marketplaces will leave 19 percent of 2017 enrollees with only a single plan available in their area, while another 19 percent will have to chose between just two plans.

CMS proposals would alter ACA marketplaces, risk adjustment in 2018

Following months of complaints from insurers about the methodology used to calculate risk adjustment payments in ACA exchange plans, CMS publishes a proposed rule stating that it will begin including patients’ current medications as part of the risk adjustment criteria used to calculate payments.

athenahealth Acquires Patient IO to Accelerate Patient-Centered Care

Athenahealth acquires patient engagement app developer Patient IO for an undisclosed sum. Athena initially invested in Patient IO in October 2015, when it accepted the startup into its More Disruption Please accelerator program.

Teladoc Secures Second Consecutive Win in Patent Dispute

Teladoc wins its legal challenge against fellow telehealth vendor American Well after the US Patent and Trademark Office invalidates major elements of American Well’s telehealth patent.

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August 29, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 8/29/16

August 29, 2016 Dr. Jayne 1 Comment

Many of us who work in the informatics space full time are attached to academic medical centers, large hospitals, large physician groups, or vendors. We’ve been working with electronic health records, billing systems, and interfaces a long time.

In my case, I was fortunate to work with a large health system that saw the value of electronic health records and data exchange long before Meaningful Use or any kind of payer incentive programs. We decided to move forward with technology because it was the right thing for us, allowing better data capture and the ability to track towards better outcomes.

Although I worked for a large health system, many of our employed physicians ran offices that looked a lot more like private practices than anything else. When I went into consulting, that was naturally one of my sweet spots, working with small to mid-sized practices that might not know much about informatics or the forces changing healthcare.

I still do work for large health systems as well, but my partner and I are fielding more requests from independent practices than we can handle. Quite a few of the requests involve things that most of us take for granted, such as lab interfaces. My most recent client has three physicians and six support staff. They outsource their billing functions and revenue cycle and use a major vendor’s EHR and practice management software on a hosted platform. Their installation is pretty vanilla, with very few customizations. They haven’t participated in the Meaningful Use program in the past, but with the increasing penalties for failure to do so, they have decided to start increasing their use of the system. They’re still not sold on MU, but want to be closer to ready in case they decide to take the plunge.

I’m not sure why they didn’t implement a lab interface when they went live. They are an internal medicine group and order a large volume of labs. I’m guessing that at the time they installed their system, they had been managing well with their paper orders workflow and basically just automated it. They do order their labs in the EHR, but print a paper requisition and either send it with the patient to the lab, or send it in the pouch with blood drawn in the office. The laboratory vendor delivers results through a Web portal, which they had been using pre-EHR and were comfortable with it. They print the labs, scan them into the EHR, and then the physicians manage them either through a telephone messaging template or by sending a letter to the patient.

It’s fairly efficient, although you can’t graph or track or trend the results. You also can’t mine them for outreach purposes, which is the key driver of their interest in having a lab interface.

Working with someone who knows why they want a particular feature and what they hope to achieve by implementing it is always a pleasure. There are plenty of groups who embark upon technology projects due to penalties or fear of penalties, and that makes it more difficult because the team may not have a sense of buy-in or understand why the extra work needed is valuable or important. This group wants to be able to easily identify patients whose lab values show that the patients need extra attention or need to be brought back into care. Most of us take this functionality for granted, so it’s been refreshing to work with someone who is seeing it through new eyes.

Although at times there has been a sense of wonder, there has also been significant frustration. The EHR vendor hasn’t been terribly helpful. The EHR vendor supports multiple lab vendors, but didn’t make it clear that some of the lab vendors have multiple business units with different lab compendia, so my client downloaded the wrong one. The client doesn’t have any dedicated IT resources and the vendor didn’t require the client to attend any training prior to attempting to install a lab interface, so they immediately wound up off track.

They hadn’t talked to their lab vendor about installing an interface prior to starting work with the EHR vendor, either. They got in touch with their lab account rep to figure out which business unit they were using, and the lab sent the required test plan as they normally would during an interface project. When the practice saw it, the project ground to a screeching halt because they didn’t feel they had the resources to take on a testing effort while doing their regular work.

The project stalled for several months until one of the partners decided to push it again, and obtained some referrals for consultants. There are at least a dozen consulting companies that work closely with the EHR vendor, so I’m surprised that no one on the vendor side had suggested that the practice go that route to get the project moving. They ended up contacting me because I was local, which ended up not really mattering since I’m not doing anything for them in person. All they really needed was someone to run interference with the vendors and help execute the test plan. Since they were already ordering and managing tests in the EHR, there was maybe 30 minutes of training to do for the staff.

I put together a bid and they were surprised at how small the effort really was. I quoted them 15 hours to complete the project from their side and it ended up only taking 12 hours over less than two weeks to get them live. However, when you don’t know what you’re getting into or how to accomplish what needs to be done, that 12 hours is a mountain. It stood in their way for months because they didn’t know how to get over it. Guides were available, but they didn’t know how to find them and their vendors didn’t suggest ways to get help.

I’m glad I was able to help them, but it’s sad that it took so long to get a simple interface live. There are hundreds of practices facing similar issues every day, and unfortunately they’re choosing to sell out to big hospitals or health systems because they don’t know where else to turn and are weary of trying to figure it out.

It’s like the Benjamin Franklin quote about the kingdom being lost for want of a nail. Having come from private practice roots, I don’t like to see physicians give up and sell because they feel there isn’t another option. They are struggling with things that many of us find routine, and that’s sad since the knowledge is out there it’s just not in the right place at the right time. Some feel it’s better that we move into larger organizations and the Accountable Care movement certainly supports that. But we’re losing a little bit of our identity as physicians along the way.

What do you think is the answer for small practices to keep up with technology? Email me.

Email Dr. Jayne.

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August 29, 2016 Dr. Jayne 1 Comment

HIStalk Interviews Hank Jones, III, Technology Lawyer

August 29, 2016 Interviews No Comments

Henry W. “Hank” Jones, III is an attorney in private practice and owner of Intersect Tech. Consulting of Houston, TX.

Tell me about yourself and your firm.

I’m a 36-year lawyer in information technology who works as a midwife, birthing transactions and products, usually software or e-commerce. I’ve been in six companies, full-time on the exec team of three in blended roles doing firefighting, utility infielder multi-department tasks, sales, and product design. Coming from an intellectual property background, then doing more and more in healthcare over the 36 years.

We first connected from your comments about market research firms. What do you think about their methodologies and potential conflicts of interest?

Too many customers of IT in every domain, medical or otherwise, are unfortunately naïve that market research is both necessary and insufficient, at least for significant transactions, for multiple reasons. Number one, their methodologies and, therefore and their goals and missions are limited. Number two, there are necessary data, if you’re trying to be safe and excellent and surviving on transactions for a long time, they’re really beyond the market research companies’ skills or traditional efforts. In particular, failure analysis, customer disputes, litigation, and government regulatory filings.

The occasional project leader, IT manager, sourcing "professional," or even worse, healthcare professionals venturing into an IT transaction for the first time, don’t know what they don’t know. Unknown unknowns can be mission critical in choosing what the scope of the transaction should be, how you do the selection exercise, and what negotiating plan or terms and conditions you need. The market research firms vary among themselves significantly on their skill, their processes, and how they get paid. Even then, to do any kind of medium- or large-sized transaction, it’s not enough.

How common is it that companies have legal skeletons in their closets that prospects should know about?

Actual lawsuits are intermittent, but necessary market knowledge. The real question is, what’s the risk profile for the individual transaction and proposed solution? Which involves, number one, looking at other competing vendors’ track records. Number two, disputes that never got to litigation, which always outweigh the quantity that actually get to litigation. Number three, arbitration and mediation. Most stuff never goes to court. Number four, the latest move to automation with the stimulus money, etc.

Many IT customers don’t understand that there’ve been massive sea changes in how the technologies get built upstream and under the hood. They don’t know that every deliverable is a hybrid with many components from many owners. Many don’t know that a lot of what gets delivered was designed using tools and languages that come from third-, fourth-, fifth-tier removed vendor who built good stuff, but it may or may not be available long term. It may or may not have been customized to a significant degree. Further, there’s open source in everything now. Not only in testing activity, but actually in the deliverable.

Too many customers are using 1980s and 1990s assumptions that were then valid regarding software development and content that are archaic and therefore somewhat dangerous now. You wouldn’t use old virus scanning software on your PC for your house to know what’s on the inside. Similarly, the procurement processes and the project plans, negotiation skills, the contract provisions and exhibits that healthcare providers want now should reflect modern, appropriate technology norms, which have changed in the last five or 10 years.

How often do company executives or founders get into legal disputes with their boards or investors?

It depends on the size and age of the company. It’s very common to have a founder displaced after taking an additional round of investment. It’s common to have management teams nudged out, and often financially rewarded for it, after a merger as opposed to an initial venture cap round. It’s even more common in software now.

A third factor that’s newer is the large software-only private equity firms, which have a ton of gunpowder. There’s three or four or five of them that only do software company acquisitions and radical overhauling. They take best practices with an elite specialist consultant team and then do mash-ups. We’re seeing that with the McKesson and e-MDs products getting smooshed together on an ambulatory level, for example. 

In Austin, where I just moved from, there’s a PE company with $16 billion who are doing 20 or 30 transactions a year. Many of them are mid-sized companies, but including some whales like Misys out of London, the deal they did a while ago. Greenway got taken private, so we don’t know their financial disclosures any more.

Everyone should assume that the vendor isn’t who it will be at the end of the expected useful duration of a product. My metaphor is that you and your significant other go out for dinner and a movie and the babysitter has outsourced and subcontracted by the time you come back. Somebody else is watching over your kids.

Is it fair for publications to sensationalize the details about a lawsuit that’s just been filed even though they have only one side of the story at that point?

There’s a problem of inadequate business journalism. There are tons of interesting action items for HIT managers in those 960 Epic-Tata pleadings, but it takes a lot of effort, and frankly, domain expertise, to sift and parse and differentiate what’s normal or not in the legal environment. The splash — yellow journalism would be the technical term — is a problem, but I would say the larger problem is inadequate follow-up and inadequate domain translation. There’s another problem too, which is that things get sealed, although I’ve had some success over the last couple of negotiations with judges later having them unseal some things, one of which was a medical software OEM deal.

What are your thoughts about Epic, Cerner, and other companies that make their employees agree to arbitration rather than labor lawsuits as a condition of ongoing employment?

I’m not a labor lawyer, so I don’t think my comments are that useful. It’s clear that in all parts of US industry, arbitration has been a mega-trend. There’s been push-back in every industry of it being, in some contexts, suppressive and unrealistic.

Real business people and lawyers, however — back on health transactions and other IT transactions in every industry — know that a careful scalpel in contracting, meaning a sharp pen, is a useful tool because what you want is to see prevention processes, governance clarifications, and then dispute-handling processes. The IT outsourcing, multi-year contracts have for years contained customized processes to deal with disputes. Over a period of time, priorities, technology, and the leadership economics are going to shift somewhat.

What people should be doing — and a few smart, creative ones do, but most don’t — is port the transactional tools, the terms, the rules of a contractual relationship, from outsourcing into pure software licensing, on the argument that the software’s going to change, ownership may change, the features are going to change, the security specs are going to change. Why not treat software not as a physical product, but as an evolving thing that it realistically is? Particularly in healthcare where you’ve got changing regulations, security specs, and patches that are more important from the privacy stuff. ADR should be for us in HIT a detailed, customized, thoughtful exhibit in every contract, rather than a two-sentence paragraph that nobody looks at. That’s like ignoring anesthesia in a prep for surgery.

Are patent trolls a big problem in health IT?

Yes. There’s lots of economics, there’s studies on that. The America Invents Act did not solve it. The Eastern District of Texas is still a whorehouse. Not La Grange, where the film with Burt Reynolds and Dolly Parton came from. The judges went to the Dallas bar and recruited the work. There’s not yet a legislative fix. It’s a problem that’s broader, although most visible in technology. A lot of people have worked on that. 

I used to be vice-president of intellectual property development for a $3.5 billion revenue per year company. I’m not really a patent specialist, but I know and work intermittently with people who really are deep in this. It’s still a problem that in healthcare is inadequately understood by customers who don’t know that a shotgun, financially speaking, could be placed to the head of their supplier. In particular, do the hospitals require due diligence by their people and then contractual warranties and insurance purchasing by providers, because patent expenses and threats to their vendors upstream from these third parties are a realistic business concern. It’s not even on the checklist.

A big HIT transaction is like a major surgery. A pacemaker installation, if you want to be metaphorical about it. Have they worked up the patent risk and risk mitigation scenario of each prospective vendor and worked that into their spreadsheet or their evaluation? Some vendors are, and some vendors aren’t, holding their own tools, munitions, and ammo in terms of patents and patent licenses or membership in patent-sharing defense arrangements. There’s a publicly traded company that all it does is provide a shared defense. That tells you that the need is that large, that people could commercialize this reactive requirement.

Do you have any final thoughts?

My hunch — and my possible book, as I look at expanding that 3,000-word article about avoiding health software heart attacks — is whether the industry has a problem with assigning, in effect, pre-med students to do neurosurgery. The observation by many HIT specialists is that a lot of providers only plan and then procure their solutions intermittently. Therefore, they attempt to negotiate against vendors who are professional and have a different set of objectives.

I had a software manager at a very large academic institution come to me and say, "Please help us. My sourcing people know sutures and Band-Aids, but not medium- or large-scale software transactions." It’s a minority of transactions that get done well, resulting in HIT organizations having operational health risks that don’t happen in other industries.

There’s a majority view that’s whispered or shared over drinks that because so many healthcare organizations are relatively new at automating, they have the naiveté of thinking that it’s like any other skill. CIOs  who are fine human beings, very smart, or physicians who aren’t careerists in IT might not have the transactional, life cycle, and vendor management experience that CIOs do in other industries. This is hard. You could argue that health software and health IT is harder because it’s in an environment different than other industries, with more regulation, more change, more third-party roles, government paying for some, and health privacy.

You need more skills and ruggedness in your contracts, supply planning, and IT strategy than in finance, manufacturing, or consumer goods. Maybe I can find some non-profit funding and lure some graduate students to work on their practicum or internships to do records requests. Some of the contracts that I’ve pulled from government hospitals under sunshine laws show work and current supply chains that extend maybe to the dangerous degree that would be unacceptable to the boards of companies in other organizations.

You don’t want to buy the first car off the manufacturing line of a new model. You don’t want to be a first patient of a newly-minted surgeon. Do you want to be a manager of a healthcare provider where the EHR was the first and only IT transaction by somebody? It’s hard.

I know one systems integration vendor who says CIO secretly stands for Career Is Over, because the demands are greater than the time, the funding, and the commercial support in a lot of cases. Unlike some other industries, people haven’t gone and done the epidemiology, the autopsies. In other industries, the selection exercises are way more diligent. They are larger than the selection process. The planning on the front end. Exhibits are process specific, twice as long than in other types of transactions.

What happens is that in a lot of these EHR deals, the customer becomes a captive. That’s evidenced, literally, by the documents that have surfaced in some of the materials that I’ve hunted up and would be the anchor or the database of my possible book. All that’s before the regulatory changes, the more open source software in there. Doctor Gawande’s great book “Better” is the watchword for all of us. A lot of organizations, at least in HIT, are not even at “good” yet. They’re trying to be competent and they’re striving, but whether they’ve gotten to good, much less any best practices, is a real question. Particularly when you drill down and do the lab tests on the actual documents that people are actually operating under.

I’ve pulled out some half a billion dollar, 10-year EHR deals to smaller ambulatory ones and specialty groups. It’s scary how weak the supply chain is in healthcare software as opposed to some other industries. You wouldn’t rely, you wouldn’t invest in it if you knew the standards of others knowing the delta of the difference.

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August 29, 2016 Interviews No Comments

Morning Headlines 8/29/16

August 28, 2016 Headlines No Comments

Epic EHR costs push ProMedica into the red

Ohio health system ProMedica reports a $1.9 million loss in its first-half 2016 financial statements, attributing the poor performance to “significant expenses due to the implementation of the Epic electronic health record launch,”

Schedule of Events For Board of Regents’ Meeting

M.D. Anderson Cancer Center reports a 77 percent drop in net income that it attributes to higher expenses and reduced patient revenue associated to its Epic implementation.

Medscape EHR Report 2016: Physicians Rate Top EHRs

Medscape publishes EHR ratings based on physician satisfaction, finding that the VA’s CPRS system was rated higher than any other system, including Epic, Cerner, and Meditech.

Citius, Altius, Fortius: Announcing 6 new pilot projects across 10 states

NIST announces its first six NISTIC pilot projects focused on exploring options for deploying national trusted identities for use on the Internet, including a $1 million grant to Cedars-Sinai Medical Center (CA).

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August 28, 2016 Headlines No Comments

Monday Morning Update 8/29/16

August 28, 2016 News 15 Comments

Top News

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Promedica (OH) attributes its first-half 2016 losses to the cost of its Epic implementation. The 12-hospital health system swung from a $43 million operating surplus in the first half of 2015 to a $2 million loss in the same period of 2016. Higher employee costs also contributed.

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University of Texas says  M.D. Anderson Cancer Center’s 77 percent drop in net income (down $405 million) in the past 10 months was due to higher expenses and reduced patient revenue, both resulting from its implementation of Epic. MDACC went live on Epic in March 2016 and says it anticipated the negative financial impact, but hopes to “return to normalized operations by year-end.”


Reader Comments

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From Carl Kolchak: “Re: Suburban Hospital (part of Johns Hopkins). My father is a patient there and the whole Epic system was down. They are on downtime procedures, which is interesting to watch.” Unverified.


HIStalk Announcements and Requests

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More than 80 percent of poll respondents think hospitals should be required to bill uninsured patients at the lowest prices they offer to insurers or anyone else. Sally B says it’s just plain wrong that those who can least afford it are expected to pay the most, while Mind Blown offers personal experience of an $85,000 hospital stay that his or her insurance company negotiated down to $16,000, something the average person wouldn’t have been able to do. Ron is encouraged that local health systems are offering big upfront discounts for elective procedures, although they take a long time to return calls. Mindy also has personal experience, in her case a $2,400 CT scan that despite not having hit her insurance deductible, cost her only $808 thanks to her insurer’s negotiated price. Nick says a benefit of forcing hospitals and health companies to offer everyone the same rates they accept from big insurers would be the creation of a price book that would allow people to comparison shop.

New poll to your right or here: who is most responsible for high US healthcare costs?


Last Week’s Most Interesting News

  • In Canada, grocery and drug store operator Loblaw offers $132 million for EHR vendor QHR Technologies, which holds 20 percent of that market in Canada.
  • Fast Company discovers that Apple acquired consumer EHR data collection and sharing startup Gliimpse earlier this year.
  • CommonWell Health Alliance adds patient-facing services that several vendors have committed to incorporating into their EHRs.
  • The Office for Civil Rights announces that it will expand its investigations into data breaches involving the information of fewer than 500 people.
  • Canada-based Harris acquires OB/GYN EHR/PM vendor DigiChart.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Some recent ones that are available for replay:


Acquisitions, Funding, Business, and Stock

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Verisk Health renames itself to Verscend Technologies. Veritas Capital acquired the now-independent business from parent company Verisk Analytics in April 2016. The company hired Emad Rizk, MD (Accretive Health) as CEO and board director two weeks ago.


People

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Scott Newton, DNP, RN (The Johns Hopkins Hospital) joins TeleTracking as VP of care model solutions.

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Lisa Elias (Leidos) joins Orchestrate Healthcare as area VP.


Announcements and Implementations

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Summit Healthcare launches Provider Alert, which allows hospitals to send electronic notifications and documents to physicians whose patients have been treated in the hospital. Parkview Medical Center (CO) will implement it.

In England, Yeovil District Hospital NHS Foundation Trust goes live on InterSystems TrackCare.


Government and Politics

NIST’s National Strategy for Trusted Identities in Cyberspace funds six new pilot projects that include a $1 million grant to Cedars-Sinai Medical Center (CA) to implement single sign-on and two-factor authentication for both patients and providers to simplify transition to post-acute care settings. The project was awarded in partnership with ONC.


Technology

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Vital Images is exploring the use of Microsoft’s HoloLens in its enterprise visualization solution, with use cases that include guided surgery and education, telemedicine, and virtual care.

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Business Insider covers the problems DocGraph and its CEO Fred Trotter had last week when Google automatically shut down the company’s access to its storage and analysis services due to suspected hacker activity, which turned out to be justified because the company’s misconfigured server had allowed a hacker to use it to launch denial-of-service attacks. Experts say Google’s cloud services are immature compared to those of competitors such as Amazon, to which Trotter has turned as a backup in case Google’s cloud becomes unavailable again.

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A photo of Donald Trump’s doctor – who admits that he spent only five minutes dashing off a bizarre, hyperbolic assessment of the health of the candidate, who has not released his actual medical records — apparently uses a Windows XP computer in his office, based on video from NBC.


Other

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Medscape’s 2016 physician EHR survey finds some interesting facts:

  • Epic is by far the most widely used EHR, beating out Cerner 28 percent to 10 percent.
  • Allscripts, which came in at #2 most used in the 2012 survey, didn’t even place in the top five this time.
  • The top-rated EHR is the VA’s VistA, beating Epic. The lowest-rated is another government system,  the DoD’s multi-billion dollar AHLTA.
  • Hospital-based and independent practice doctors both rate NextGen as the worst system.
  • The highest-rated EHRs for satisfaction are Practice Fusion, Amazing Charts, and VistA.
  • VistA and Epic lead the pack for connectivity, while Amazing Charts, Greenway, Practice Partner, and NextGen hold the bottom four spots.
  • Half of the respondents say the EHR takes away from their face time with patients and reduces the number of patients they can see.
  • Forty-two percent of doctors say they copy and paste EHR information “often” or “always.”

Maybe some vendors are closer to becoming “the Uber of healthcare” than they think: Uber has lost at least $1.2 billion so far this year. A business professor who questions Uber’s high valuation summarizes, “You won’t find too many technology companies that could lose this much money this quickly. For a private business to raise as much capital as Uber has been able to is unprecedented.”

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A Milwaukee Brewers fan blogger proposes that Epic CEO Judy Faulkner offer to move the team’s AAA affiliate from Colorado Springs, CO to Verona, WI and building it an indoor stadium that could also be used for Epic meetings. Otherwise, the Sky Sox are headed to San Antonio in 2019 if the owner can convince city taxpayers to buy him a stadium. Cerner’s Neal Patterson has his soccer team, so it would be fun for Epic to have its own baseball team.

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This brilliant graphic tells you everything you need to know about why our absurdly high US healthcare costs involve throwing money at the wrong (but highly profitable) health determinants. That tiny patch of green on the left shows how little the delivery of healthcare services influences overall health despite what hospitals and practices would have you believe. That hugely dominant patch of aptly colored green on the right shows that, like bank robber Willie Sutton, profit-seekers have gone where the money is (hint: it’s not in prevention or teaching people better lifestyle habits). “Healthcare” is not even vaguely synonymous with “health.” You also can’t have “public health” when the public in question would rather fund hospital bills than self-examine their eating, drinking, smoking, drug-taking, and exercise habits.

In Ireland, several dozen job candidates who had been offered positions with GE Healthcare are talking to lawyers after the company rescinds all of its job offers the day before the new hires were scheduled to start work. Some of them are now unemployed since they had quit their old job. The company says its labor unions are at fault for balking at its plans to change work schedules.

Vince and Elise continue their “Rating the Ratings” series. They subjectively rank the 1-2-3 finishers among KLAS, Black Book, and Peer60 using criteria they describe.

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Weird News Andy notes the death of man whose but often-played but never-cleaned  bagpipes infect his lungs with fungi that cause hypersensitivity pneumonitis. WNA puts an upbeat spin on the story with his favorite bagpipe jokes:

  • What is perfect pitch with bagpipes? 20 yards into a lake.
  • What is the difference between bagpipes and a lawn mower? You can tune a lawnmower.
  • What is the difference between bagpipes and a trampoline? You take off your shoes to jump on a trampoline.

Sponsor Updates

  • Experian Health and The SSI Group will exhibit at CAHAM August 28-31 in La Jolla, CA.
  • Christus Trinity Mother Frances Health System CIO Mike Eckhard discusses its use of PatientSafe smart phones on the local news.
  • WRAL Tech Wire interviews PatientPay CEO Tom Furr.
  • Network World interviews Red Hat CEO Jim Whitehurst.
  • The local business paper covers GE Healthcare’s donation of medical equipment to the Olympic and Paralympic games in Rio.

Blog Posts


Contacts

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

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August 28, 2016 News 15 Comments

Morning Headlines 8/26/16

August 25, 2016 Headlines No Comments

This Princeton health economist thinks Obamacare’s marketplaces are doomed

Uwe Reinhardt, a professor and health economist from Princeton University, calls ACA public health insurance exchanges doomed because premiums continue to climb while the penalty for failing to have insurance is less than the premiums.

From health care capital to innovation hub: Positioning Nashville as a leader in health IT

A Brookings Report finds that despite its abundance of hospital management corporate headquarters, Nashville continues to falter in its effort to become a health IT hub.

JPP’s fireworks debacle could now cost ESPN millions

A Florida judge allows NFL defensive end Jason Pierre-Paul’s invasion-of-privacy lawsuit against ESPN to move forward. The case was filed after ESPN published an article about a fireworks-related hand injury that included images from Pierre-Paul’s private medical records.

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August 25, 2016 Headlines No Comments

News 8/26/16

August 25, 2016 News 8 Comments

Top News

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States begin approving insurance company rate increase requests for ACA-sold policies, with premiums of those issued by Tennessee’s largest insurer jumping an average of 62 percent. Other states are approving hikes of 20 to 43 percent.

HHS says cost-based federal subsidies will soften the blow for most consumers, with three-fourths of those who buy insurance from Healthcare.gov paying less than $75 per month. Tennessee’s insurance commissioner says she had to approve huge increases because high insurer claims cost would have forced them to pull out of the ACA market completely otherwise.

Meanwhile, Princeton economist Uwe Reinhardt says the federal insurance marketplaces have entered a premium-increase death spiral. Similar programs in other countries are run by non-profit insurers offering a standard package of benefits that carry harsh penalties for citizens who don’t sign up. He summarizes,

The natural business model of a private commercial insurer is to price on health status and have the flexibility to raise prices year after year. What we’ve tried to do, instead, is do community rating [where insurers can’t price on how sick or healthy an enrollee is] and couple it with a mandate. When you do this as the Swiss or Germans do, you brutally enforce the mandate. You make young people sign up and pay. But we are too chicken to do that, so we allow people to stay out by doing two things: We give them a mandate penalty that is lower than the premium. And we tell them, If you’re really sick, we’ll take care of you anyhow.


Reader Comments

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From FlyOnTheWall: “Re: American Well. Cut half its sales team, going from 10 to five.” Unverified.


HIStalk Announcements and Requests

I get a lot of press releases, interview offers, and sponsorship information requests from folks who work for marketing, PR, and advertising companies, but I’m embarrassed to admit that I’ve never really kept any records other than what’s in my sent emails. If you work for one of those companies and work with health IT vendor clients, enter your contact information and we’ll keep in better touch.

I was reading a Reddit about seemingly cheery pop songs that have dark lyrics about stalking, murder, and rape (both violent and statutory) that listeners fail to note. Example: Foster the People’s “Pumped Up Kicks,” to which clueless hipsters dance joyously to a whistly song about a teen planning to kill his classmates who can’t “outrun my gun.” It’s not quite as creepy as Ringo’s “Only Sixteen” or as opposite in meaning than people think about “Born in the USA,” but everybody misses it.

This week on HIStalk Practice: Dr. Gregg does the MACRA-rena. HHS awards $100 million to help health centers improve quality, HIT utilization. ONC commemorates HIPAA’s 20th anniversary. Safety Net Connect offers CCD workaround for community health centers. PMA Medical Specialists signs on with Aledade. South Carolina physicians cozy up to telemedicine. Alpine Foot & Ankle rolls out new ECW portal. Culbert Healthcare Solutions President Brad Boyd offers seven tips to help practices mitigate revenue risk during IT implementation.

This week on HIStalk Connect: Honor raises $42 million to expand its home care services from California into Texas. Big data startup Innovaccer raises a $15.6 million Series A. Smart pregnancy wearable company Bloomlife will use its latest round of funding to commercialize its first product. Accolade raises a $70 million Series E.


Webinars

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

Sensato CEO John Gomez always puts on an excellent webinar and his HIStalk-sponsored one from earlier this week was no exception. Above is the recording of “Surviving the OCR Cybersecurity & Privacy Pre-Audit.”


Acquisitions, Funding, Business, and Stock

European regulators approve creation of a joint health IT services venture between McKesson and Blackstone. I assume that’s the JV that will take over most of McKesson’s health IT business and combine it with Blackstone-owned Change Healthcare.

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McKesson will sell its San Francisco headquarters building and lease it back, freeing up capital. The value of comparable properties suggests that the building is worth around $300 million.

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Home care agency software vendor ClearCare announces a $60 million growth equity investment, increasing its total to $76 million.

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In Australia, personalized dosing software vendor DoseMe closes $2 million in Series A financing, increasing its total to $15 million. The company plans to expand to the US market and integrate its product into EHRs.

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Panama City, FL-based wait time software startup Jellyfish Health will add 100 employees over the next three years. The founder, president, and CEO is industry long-timer Dave Dyell, who founded iSirona in 2008 and sold it to NantHealth in 2014.


Sales

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Carilion Clinic (VA) chooses LogicStream Health’s clinical content optimization platform to reduce catheter-associated UTIs and venous thromboembolism by monitoring the clinical decision components that enable standardized care.

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Four-bed Southern Inyo Hospital (CA) will implement the OpenVista EHR from Medsphere, which will also manage the hospital’s IT services via the company’s Phoenix Health Systems division that it acquired in April 2015.

Receivables management vendor Specialized Healthcare Partners chooses Armor’s cloud platform to earn HITRUST certification.


People

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Pivot Point Consulting hires Brett Meyers, MD, MS (Meyers Consulting Services) as CMIO.

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MaineHealth names Marcy Dunn (Catholic Health Services of Long Island) as SVP/CIO.


Announcements and Implementations

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NVoq makes its SayIt speech recognition and work flow solutions available to healthcare customers in Canada.

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Healthwise earns Washington state certification of two of its patient decision aids as one of the first companies in the country to obtain such certification. The non-profit company offers 170 decision aids covering a variety of topics.


Privacy and Security

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A Florida judge approves the invasion of privacy lawsuit brought against ESPN and reporter Adam Schefter by professional football player Jason Pierre-Paul, whose surgery schedule was tweeted as a photo by Schefter as part of his story involving Pierre-Paul’s loss of a finger in a July 4, 2015 fireworks accident. The judge agreed with Pierre-Paul that while his injury was a public issue, his chart was not despite Shefter’s insistence that he needed the image to prove his story. Two employees of Jackson Memorial Hospital (FL) were fired over the incident.

From DataBreaches.net:

  • A stock short seller claims that medical devices made by St. Jude Medical are susceptible to cyberattacks, sending the shares he had bet against down 8 percent Thursday.
  • An Indiana clinic notifies an unstated number of patients that an upgrade to a server containing EHR data left it unprotected, a situation hackers took advantage of in breaching its systems.
  • California-based SCAN Health Plan announces that its sales contact sheets were accessed “for unauthorized purposes.”
  • Millennium Hotels & Resorts warns customers to review their credit card statements the food and beverage sales systems of 14 of its hotels were breached due to a vulnerability in the third-party system they use. That sounds similar to Banner Health’s food and beverage systems breach reported earlier this month that exposed the information of 3.7 million people.

Technology

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Fortune notes that nearly 90 percent of doctors in Brazil communicate using Facebook-owned, cross-platform consumer messaging app WhatsApp. It recently added end-to-end encryption that even many healthcare-specific, HIPAA-compliant apps don’t have (WhatsApp itself can’t read messages sent on its system). Facebook paid $14 billion for the company in 2014 and some experts think it could be worth up to $100 billion once Facebook monetizes it, which is already happening as Facebook just announced that it will use WhatsApp user information to target Facebook ads.

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Google announces Duo, a simple, cross-platform video calling app that employs end-to-end encryption and requires only a telephone number. The Android version has been downloaded 5 million times from the Google Play store.


Other

I wrote in July about the huge price increases and opportunistic marketing employed by Mylan Pharmaceuticals in increasing sales of allergy auto-injection EpiPen to $1.2 billion per year, fueled by jacking up the price of the decades-old drug by 500 percent, mandating sales of two-packs instead of single pens, lobbying to have the drug placed in all schools, and shortening its expiration date to one year. Hero-villain Martin Shkreli, who exposed drug pricing absurdities by raising the price of old but vital Turing Pharmaceuticals drug Daraprim by 5,000 percent just because he could, defends Mylan since they make only an eight percent profit overall. He says insurers should love paying the full $300 cost (without a patient co-pay) because it saves a $20,000 trip to the ED to get the same drug. Shkreli’s solution to unjustified generic drug prices – and it’s a pretty brilliant one — is for the federal government to create a generic drug company of its own and run it like a utility, leaving drug companies to sell only their patented drugs (he probably doesn’t even realize the benefit of fixing the never-ending hospital generic drug shortage problem). Shkreli is boyishly charming, shockingly outspoken, and ingeniously capitalistic, all prized characteristics except in the schizophrenic world of the business of healthcare where we don’t like being reminded of the enormous profits being made on the backs of those who are temporarily or permanently living the role of patient.

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I like this poetic discussion of the fact that 75 percent of Americans want to die at home although only 25 percent actually do so because of poor planning, written by HealthLoop founder Jordan Shlain, MD:

In contradistinction to your bed, please meet the mechanical, rigid, railing-bolstered hospital bed. Comfort be damned, it is a tool designed to protect medical vessels (a.k.a. patients) from falls, or to give nurses and doctors that ability to move you up and down like a car on a jack. In essence, it’s not really a bed. It doesn’t know you, nor does it like you. It hasn’t held you for years, it isn’t lonely without you. It sees you as a place-holding slab of flesh to be manipulated — until it meets another slab … For the foreseeable future, we cannot afford to view life as a simple game of winning or losing. Rather, it’s a process with a beginning, a middle, and an end. While some people’s ‘end’ happens in the beginning, and some in the ‘middle’, the natural end deserves, at minimum, a modicum of dignity. The last place I want to wage and lose a war in my twilight moments is in the bed(lam) of a hospital.

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A Brookings report reviews Nashville’s ambitions to become a leader in health IT. It notes that while Vanderbilt University performs a lot of health-related research, most of it occurs outside the university’s IT department, has limited IT applicability, and generates only a small number of patents given the dollars spent. The report also notes that Nashville is second to last among peer metro areas in the number of  software developers and analysts. Brookings calls Nashville’s health IT ecosystem “thin and inconsistent” with modest venture capital investment, especially in funding beyond the B round. Brookings recommends expanding the innovation infrastructure, building the health IT skills base, and fostering the health IT innovation ecosystem.

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The two big Orlando hospitals announce that they won’t charge survivors of the Pulse nightclub shootings in June for the medical services they received. It’s always interesting when hospitals decide to magnanimously write off bills for high-profile patients while aggressively chasing down money owed them by less-famous ones. Few non-profits outside of our screwy healthcare non-system bill consumers directly, but those who do don’t generally brag on allowing some of them to skip paying and leaving others to fund their expansive bottom lines and million-dollar salaries.

The Pew Charitable Trusts is looking for a health IT expert to work on safety and interoperability research that includes patient matching, data standards, a national health IT safety center, and post-implementation EHR testing.

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Weird News Andy says he hopes the cutting-edge surgery puts the end to the “sworded” affair of a man in India who swallowed 40 knives due to a “wild urge to consume metal” that he likened to alcohol or drug addiction. Surgeons removed the knives and suggested he eat spinach if he feels a need for iron. My first thought was whether the sight of the scalpel made his stomach rumble.


Sponsor Updates

  • Healthfinch asks, “Who’s Most Likely to Fix Healthcare?” in an election parody survey.
  • FDB will make its drug knowledge available to participants in the Health 2.0 SF Code-A-Thon September 24-25 in San Francisco.
  • The local paper recaps Xerox Healthcare Chief Innovation Officer Tamara StClaire’s presentation at the Health:Further conference in Nashville.
  • SyTrue’s Kyle Silvestro will serve on the Branding Panel/Entrepreneur Spotlight at the Brand Entrepreneurs 2016 Annual Business Bootcamp for Entrepreneuers – SFO Edition on September 6.

Blog Posts


Contacts

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

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August 25, 2016 News 8 Comments

EPtalk by Dr. Jayne 8/25/16

August 25, 2016 Dr. Jayne 3 Comments

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I missed the opportunity to write up the Greenway Health User Group Conference, held earlier this month in Atlanta. I was looking to find information on it when I stumbled upon the 2017 website, which is already live. In case you’re wondering, you have 377 days left to register.

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Optum Health held their user group this week, featuring keynote speaker Michael J. Fox. I’m always interested to see what kind of client events are cooked up at these events. Wednesday’s client block party was set to feature a band called Hairball performing “the greatest hits from the most popular hair bands of 80s rock.” If you have pictures, send them along and I’ll share. Some year I’d like to take the fall off and attend all the user groups that I’ve heard about for years but never made it to. Most of us only make it to a couple of vendors’ meetings in the course of a career, so it would be interesting to do the comparison. Kind of like baseball fans that spend the summer on pilgrimage to ballparks across the country, I could be a user group vagabond.

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Like millions of other people, I carry an EpiPen. I have a food allergy and thank goodness I’m an adult and can avoid eating things that might be suspect. It’s tougher on children with severe allergic reactions. I had heard a couple of months ago about dramatic price increases, but today my inbox exploded with client questions about the situation. Now that Congress is involved and calling for an investigation, the price hikes are mainstream news. My clients were mostly asking for assistance with reports to identify how many patients have been prescribed EpiPens so that they can reach out proactively to discuss the situation and make sure patients who need them are getting them. Another client asked if I could help them automate a process to generate prescription orders to substitute a similar product on affected patients. Even though the manufacturer is seemingly responding to a free market economy, it feels sleazy. I’m glad I was able to help my clients out from an IT perspective, but the situation is just sad.

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CMS posted vendor global support letters for the Comprehensive Primary Care Plus initiative. I found the formatting of the letters odd, with all vendors strung together into a single PDF. Although they are in alphabetical order, the best way to find a particular vendor is to use your browser to search. There are a couple major vendors missing – hopefully their letters are just delayed.

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It’s no secret that I’m skeptical about precision medicine and its ability to make a difference for large populations. I was pleased to see this JAMA editorial that tackles the issue. It calls out a number of important points: the presence (or absence) of disease is driven by not as much by genetics as by behavioral and social factors; the difficulty in identifying disease predictors for complex conditions; and the assumption that large groups of patients will change their behavior to modify their risk profile, when faced with the information.

We have clear and direct evidence on how to prevent many diseases and injuries (stop smoking, eat less, move more, wear your seat belt) yet it’s still difficult to move that needle. Our societal reliance on technology makes it easy to want to take a pill or use a laser or have robotic surgery, but not to do the basic preventive maintenance that the human body requires (sleep, exercise, healthy foods, etc.) The piece also mentions that the United States is lagging behind other nations in life expectancy and infant mortality, which are best addressed by broad-based rather than individual efforts. The funding of precision medicine initiatives corresponds with a decline in funding for public health efforts.

The authors go on to mention reasons why precision medicine might just be the answer: helping target resources to those who are most at risk; the economic and societal benefits of previous precision medicine initiatives (such as newborn screening for metabolic diseases); and the ability to use genomics to target infectious diseases, which have long been a part of public health efforts. The editorial concludes that although there are “clear tensions at the intersection of precision medicine and public health” there are ways to move forward. However, we might still find that old-school interventions on nutrition, poverty, healthcare access, and education may have more benefit than personalized medicine.

Although I’ve been generally skeptical, I’ve recently found myself in a place where personalized medicine may be relevant to my individual health. Although I’m waiting for results of genetic testing of affected family members, I’ve been combing through the literature trying to figure out what my options are depending on whether testing is positive or negative. Even as an educated, science-literate person, the evidence isn’t as clear as we’d like it to be and the process is frustrating. Depending on the results, I’ll likely have a consultation with someone other than the Internet, but for now that’s my approach. We’re also waiting on some copies of pathology reports from more than 20 years ago. It will be interesting if they actually show up in a timely fashion. The hospital doesn’t have anything in their electronic data repository before 1998, but hopefully we can track it down since it might make a difference.

What do you think of personalized medicine? Has it impacted your family? Email me.

Email Dr. Jayne.

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August 25, 2016 Dr. Jayne 3 Comments

Morning Headlines 8/25/16

August 24, 2016 Headlines No Comments

Draft 2017 Interoperability Standards Advisory

ONC publishes a draft version of its 2017 Interoperability Standards Advisory, which improves upon the 2016 version by establishing it as a web-based resource, rather than a text document, and embedding links to ongoing ONC Interoperability Proving Ground projects.

Tompkins v. 23andMe, Inc

A Ninth Circuit Court of Appeals judge throws out a class action suit brought against 23andMe challenging its arbitration clause.

States Start to Approve Steep Increases in Health Premiums

The White House is working to reassure consumers as states begin approving significant insurance rate increases for exchange plans, including an average 62 percent increase in prices for Tennessee plans, 43 percent average increases in Mississippi, and 23 percent increases in Kentucky.

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August 24, 2016 Headlines No Comments

Readers Write: Moving Beyond the App: How to Improve Healthcare Through Technology Partnerships

August 24, 2016 Readers Write 1 Comment

Moving Beyond the App: How to Improve Healthcare Through Technology Partnerships
By Ralph C. Derrickson

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As the pace of change in the US healthcare system increases, we are seeing inspiring progress in access and care delivery driven in part by the adoption of telemedicine and other technology-enabled care models. Health systems are embracing virtual medicine as a way to serve their patients and communities by meeting their budget and lifestyle needs. Health systems are trying to match the consumer experience of other Internet services by delivering new care models that give patients better care, save them time, are easier on their wallets, and keep them within the health systems they already know and trust.

While the prospects for technology are enormous, there are downsides that have to be avoided.

Healthcare isn’t an app. We all use apps to conduct business, purchase products, and get our entertainment fix from our favorite mobile games and streaming media services. The idea that we could put an app in a patient’s hand to diagnose or treat them is very appealing. When that app is offered as part of a comprehensive set of integrated treatment options, there are reasons to be very hopeful. But when it’s offered outside a local health system, it leads to fragmentation, excessive prescribing, and even worse, inappropriate treatment.

Simply aggregating providers using the Internet is bad medicine. App developers and their networks of doctors – who are paid on a per-visit basis – have used technology to bring out the worst of fee-for-service care. The data on telemedicine prescribing rates, visit durations, and management rates is in and it isn’t pretty. If the expectation is that the patient’s needs will be met with a telemedicine visit, it becomes a failure when the patient doesn’t get treatment or a prescription.

There’s no doubt the provider is doing their best to serve the patient, but without a place to send the patient for in-person care, they’re stuck trying their best to meet the patient’s needs. In fact, a study in JAMA Internal Medicine shows that the quality of urgent care treatment varies widely among commercial, direct-to-consumer virtual care companies. Their transactional models for medicine also offer no integrated next step for the patient and no connection to a broader spectrum of care.

Health systems need an approach that runs counter to telemedicine/app developer trends. An integrated virtual clinic enables health systems to extend the service offering in clinically appropriate situations and build on the trust they have earned from patients in years of service to their community. Payment models can come and go, but the patient’s reliance on a doctor in a time of need should never be compromised by the method of access or their payment system.

Health care is challenging. I’ve referred to it as the Three Hopes: I hope it’s not serious, I hope I can see my doctor, and I hope it’s paid for. Countless studies have shown that the proven, most cost-effective health care model is to have access to primary care doctors and great doctor-patient relationships, two qualities that are part and parcel of a strong health system. However, most app-centered telemedicine companies have no connection to a patient’s primary care provider, leading to care fragmentation instead of care continuity.

Through all of this, the greatest institutions of clinical excellence – our health systems – are losing the arms race for patients, especially as the healthcare market continues to consolidate and health systems face fierce competition from their peers to attract and retain patients. Health systems simply don’t have the marketing engines of app-centered telemedicine providers and pharmacies who are fighting tooth and nail for patient acquisition.

Many health systems have yet to figure out how to adapt to a consumer-directed model while continuing to provide quality care. The same patients who want convenience first and foremost are often unable to accurately judge the quality of care received through most telemedicine methods. For health systems and patients to succeed, virtual care must be part of a broader care continuum and tightly integrated within health systems.

Keeping patients within the systems they already know and trust provides an invaluable convenience and allows opportunities to refer patients to appropriate care when an ailment cannot be treated virtually. Those referrals offer a chance to reconnect patients to health systems rather than their using a high-cost option like an emergency department or a quick fix like an app-centered retail clinic.

This is especially important as the industry shifts to fee-for-value reimbursement.

An approach that integrates virtual care within health systems ensures patients get the same quality of care that they would receive from an in-person visit. Patients have a better chance of understanding their own health, as trusted physicians give patients the information they need to become educated healthcare consumers. For health systems, integrated virtual care puts them in the driver’s seat on how care is delivered and managed, whereas an app-centered approach might not meet metrics of quality nor the needs of the patients they already serve.

App-centered telemedicine has no place in our health care system. This approach to addressing the changes in healthcare is robbing patients of the type of care they deserve.

There is no reason for the Three Hopes of healthcare to be points of uncertainty or stress for patients. I see great promise among leading hospitals and health systems who are alleviating this uncertainty with integrated virtual care. They realize they know how best to treat a patient – apps do not. Virtual care that’s integrated into a provider network is best equipped to put quality at the center of care now and in the future.

Ralph C. Derrickson is president and CEO of Carena, Inc.

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August 24, 2016 Readers Write 1 Comment

Readers Write: Moving and Sharing Clinical Information Across Boundaries

August 24, 2016 Readers Write 3 Comments

Moving and Sharing Clinical Information Across Boundaries
By Sandra Lillie

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In Gartner’s recent depiction of the Hype Cycle for Healthcare Technology, Integrating the Healthcare Enterprise (IHE) XDS has now progressed well past early adopters and rapidly toward productivity and optimization. In many regions outside the United States, it is the de facto standard for content management, and within the US, it is receiving increasing consideration for adoption in use cases supporting specialty images, standards-based image sharing and the like.

XDS is a suitable foundation for integration of clinical systems, and as noted earlier, is more widely adopted in EMEA for this purpose. It is capable of moving and sharing clinical information within and between organizations and capable of creating a patient-centric record based on multiple document (types).

XDS centralizes registration of documents, reducing the problem of deciding which system holds “the truth.” Focusing on “standardizing the standards,” XDS supports the moving and sharing of clinical information across boundaries, both within and between enterprises. This is increasingly vitally important in delivering patient-centered care across the care continuum.

Today we also have XDS-I, also referred to as XDS.b for Imaging. It is built upon the XDS.b profile with one key difference – the actual DICOM imaging study stays put in its original location until requested for presentation. This is accomplished by registering the location of the imaging study in the XDS registry while using a vendor-neutral archive that is smart enough to serve as its own XDS-I repository.

DICOM is a standard format for the storage and communication of medical images, such as x-rays. Instead of publishing the document (which would be large in imaging) to the repository, however, the imaging document source (the VNA in this case) publishes a “manifest.” This manifest contains an index of all the images within a study, coupled with a path to the VNA where they can be retrieved. This reduces the amount of data that has to move around, allowing for more efficient image sharing while minimizing the complexity and costs of image storage.

What are the implications to healthcare organizations of using XDS?

  • Documents retain their native format, allowing ready viewing by applications.
  • Standards support interoperability and sharing of both documents and enterprise image studies.
  • IHE conducts annual Connectathons in the United States and Europe to validate interoperability and enable widespread ability for vendors to act as sources and suppliers of content.

Major benefits include:

  • XDS enables movement and sharing of clinical information across boundaries, both within and between enterprises. This capability is increasingly important in delivering patient-centered care across the continuum, supporting the organization of documents across time in a patient context, allowing clinicians to realize a more complete picture of the patient.
  • XDS offers a lower-cost method for implementing care coordination through a solution that can easily respond to queries for patient-centered documents and enterprise images.
  • Use of standards simplifies healthcare IT integrations, requiring less administrative overhead.

Now is the time for US healthcare providers to seriously consider the advantages of XDS. XDS profiles provide an effective alternative for managing clinical content exported from legacy (sunsetted) systems and for supporting healthcare information sharing.

Sandra Lillie is industry manager for enterprise imaging for Lexmark Healthcare.

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August 24, 2016 Readers Write 3 Comments

Morning Headlines 8/24/16

August 23, 2016 Headlines No Comments

Loblaw makes $170-million cash bid for B.C. medical records company QHR Corp

In Canada, food and pharmacy retailer Loblaw Companies offers $132 million to acquire QHR Technologies, an EHR vendor with a 20 percent market share in Canada.

CommonWell Members Enable Patient Access to Their Health Data

CommonWell will now allow patients to self-enroll in its HIE, where they will be able to review and share their records with providers on the CommonWell network.

How Expanded Roles For Home Health Aides Can Improve The Health Of Older Americans

A pilot project in which home health aides performed medication reviews and documented visit notes in software that alerts clinical managers of concerning changes in health leads to 24 percent reduction in ED admissions.

US Residency Competitiveness, Future Salary, and Burnout in Primary Care vs Specialty Fields

A JAMA study finds an obvious correlation: lower paying medical specialties like primary care do not attract as many US medical school graduates as high paying specialties like neurosurgery.

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August 23, 2016 Headlines No Comments

News 8/24/16

August 23, 2016 News 14 Comments

Top News

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Apple quietly acquired startup Gliimpse earlier this year, Fast Company discovers. The company offers tools for consumers to collect and share their electronic medical record information in both readable and codified form. Self-funded Gliimpse reported just one investment, a February 2015 seed round of $1 million. The beta release of its software was launched in October 2015.

Founder Anil Sethi studied clinical engineering at Johns Hopkins, worked for Apple as a systems engineer in the late 1980s, founded Dakota Imaging (later sold to WebMD),  then founded Sequoia Software in 1992 that was sold to Citrix in 2001.

My take on all these recently uncovered Apple healthcare moves is that new iPhone health offerings will pressure EHR vendors to open up their systems to Apple integration. The company clearly plans to use that information in consumer-facing apps and iPhone-using patients are going to demand that their providers make it available. EHR vendors won’t be able to hide behind the lack of interest their hospital and practice customers have for interoperability once patients start complaining to those providers about their non-functional app.


Reader Comments

From Gabby Hayes: “Re: Oscar health insurance. Pulling out of Dallas and New Jersey.” Oscar is a goner given its total dependence on the exchange-sold policy market that even the big insurers haven’t figured out even though it’s just a small percentage of their business and yet all of Oscar’s. My prediction is this: only individual states can stabilize the ACA-powered market since they also regulate the non-exchange policy business. You can bet that a state like Arizona — which has seen so many insurers pull out of the exchange that one county (Pinal) has none left offering policies — will exert pressure on the companies who still want to sell in-state policies and whose rate increases it approves. That might be another reason that insurers are bailing – they can’t necessarily get state approval for the rates they require to avoid losing money. I’ve heard rational, anti-government people begrudgingly state that the only answer is a single-payer system, although that single payer in question hasn’t done so great running Medicare, Medicaid, and the VA. We may end up with a UK-like system where everybody gets coverage at a reasonable price, but a thriving market of more accessible providers would serve those who can afford their services.


HIStalk Announcements and Requests

I had a “how do I do this” question about the webinar signup software we use. The vendor replied with a screen capture video that they recorded specifically for me, with one of the support reps informally walking me through the individual steps. I wonder how often healthcare software vendors do this? An analyst could create the video in a couple of minutes, obviously faster than writing out step-by-step instructions, preparing a series of captioned screen shots, or trying to schedule a screen-sharing session.


Webinars

August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

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


Acquisitions, Funding, Business, and Stock

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In Canada, grocery store and pharmacy operator Loblaw Companies offers to buy BC-based EHR vendor QHR Technologies for $132 million in cash, although QHR is free to accept other offers until shareholders vote on the deal in October. QHR holds 20 percent of Canada’s EHR market. QHR sold its US-based clearinghouse and RCM business to MTBC in July 2015.

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Healthcare Growth Partners relocates its headquarters from Chicago to Houston.

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Premier reports Q4 results: revenue up 15 percent, adjusted EPS $0.36 vs. $0.36, beating revenue expectations but falling short on earnings.


Sales

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Union Hospital (MD) chooses Spok for enterprise communications.


People

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Patient experience vendor Docent Health, which just raised $15 million in a Series A funding round, hires Kim LaFontana (The Advisory Board Company) as chief product officer; Andrew Park (N-of-One) as CTO; Geoff McHugh (The Advisory Board Company) as VP of transformation; and Monna Nanavati (Athenahealth) as chief service delivery officer. Industry long-timer Paul Roscoe is co-founder and CEO of the company.

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Michael Zaroukian, MD, PhD, CMIO of Sparrow Health System (MI) begins his one-year term as board chair of HIMSS North America. The board has 10 members, of which five work for health systems. I didn’t realize that the vendor-heavy board of the parent organization (just plain old HIMSS global) has 13 members, of which only four work for health systems.


Announcements and Implementations

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A Huffington Post blog post by the EVP of Visiting Nurse Service of New York describes the results of a state-funded pilot project in which the role of home health aides was expanded to include medication review and updating client status on a tablet that automatically notifies a clinical manager of changes. The project reduced ED admissions by 24 percent. Patient status was documented using software from Practice Unite, the secure texting vendor that merged with physician engagement focused Uniphy Health in March 2016.

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Santa Rosa consulting offers a one-day replacement strategy workshop for McKesson Paragon users.

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In England, two London NHS trusts begin exchanging information between their Cerner-powered HIEs, allowing clinicians at each site to view patient information from the other that includes discharge summaries, diagnoses, medications, and lab results.

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CommonWell Health Alliance adds patient-facing services that will allow people to enroll themselves in CommonWell, link their own records among providers, and review information about them stored on CommonWell’s network. CommonWell members MediPortal and Integrated Data Services will add the patient capabilities to their portals by the end of the year, while Aprima, Athenahealth, Cerner, Evident, Modernizing Medicine, and RelayHealth have committed to doing so without committing to a timeline.

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Lexmark Healthcare announces new products: a zero-footprint Health Content Management Viewer for documents, medical imaging, and XDS content; a redesigned video capture device for PACSGear; and video and image enablement workflow for Epic.  

A LifeImage survey of 100 CHIME members finds that imaging responsibility has moved from the radiology department to IT; most hospitals still can’t move imaging data between applications; and one-third of CIOs worry that their organizations could be losing revenue due to lack of interoperability that could detect orders for duplicate and clinically unnecessary exams.

Nebraska Medicine takes over operation of the student health center of University of Nebraska-Lincoln and brings Epic live there.


Privacy and Security

From DataBreaches.net:

  • In Pakistan, a hospital employee steals data from its CT machine and also corrupts the machine’s software, which the hospital says it will have to repurchase for at least its original $330,000 purchase price. 
  • Orlando Health (FL) says it caught at least one of its employees reviewing the electronic medical records of survivors of the Pulse nightclub shootings in June.
  • A HIMSS survey finds that one-third of hospitals and half of non-acute providers don’t encrypt data in transit.
  • An HHS OIG report finds that the security of CMS’s wireless network has four vulnerabilities.
  • In Canada, two people behind a hospital records breach in which the information of new mothers was sold to companies selling educational savings plans get off with fines and community service. Two others had already pleaded guilty and received house arrest, probation, and community service, one of them a former OB nurse who also faces professional misconduct charges.

Technology

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Gartner releases its Hype Cycle for emerging technologies. Virtual and augmented reality are moving to the Slope of Enlightenment, but Gartner predicts that machine learning, software-defined anything, and natural language question answering have the shortest times to mainstream adoption at 2-5 years.


Other

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In Canada, a medical marijuana consultation doctor whose poor (and possibly falsified) paper recordkeeping led to his three-month suspension is ordered by the College of Physicians and Surgeons of Ontario to implement an EHR as a condition of his continued licensure.

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In Australia, Monash Health’s ED goes back to paper for two days when its Emis Health ED software goes offline, although the hospital disputes the downtime in saying that it was a planned six-hour upgrade. 

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A JAMA literature review of the high cost of drugs in the US blames “the granting of government-protected monopolies to drug manufacturers” and restrictions on drug price negotiation.

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A JAMA research letter finds that, not surprisingly, it’s harder for medical students to get into residencies for the higher-paying medical specialties. Primary care specialties have the lowest average annual salaries at around $250,000 and only around half of those residency spots are filled with US medical school graduates. On the other end of the spectrum as a huge outlier is neurosurgery, with average compensation of $750,000 and a near-100 percent fill rate of US residents. Opportunistic graduates might want to choose pathology since it’s the highest income in the least-competitive group.

Meanwhile, those high-earning diagnostic radiologists respond to the American College of Radiology’s call to action (and its suggested use of its advocacy app) in expressing outrage at the VA’s plan to allow advanced practice RNs to order and interpret MR and CT studies without physician oversight. I’m shocked that advocacy-enamored HIMSS hasn’t developed an app of its own to give members an easy way to support profitable health IT legislation.

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Here’s an interesting title for a think tank’s editorial that complains about “the federal government’s takeover of EHR.”

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A vandal (or politically paid artist, I would guess given the level of sophistication) defaces Los Angles hospital signs in preparation for Hillary Clinton’s visit, apparently spreading the unproven rumors that she is not in good health. It’s surprising to me that nobody has breached and published her records as often happens with celebrities, although perhaps people have looked and found no smoking gun to be worth their trouble. No matter how the election turns out, we’ll be left with the sobering reality that a lot of Americans of all political persuasions are angry, too partisan to carry on a civil debate, quick to resort to online harassment and bullying, and not especially bright or well informed, problems that will persist no matter who’s sitting in the Oval Office for the next four or more years. I expect hospitals to be busy the week of November 8 election dealing with the human results of unfortunate post-election events.

NYC Health + Hospitals, facing a $1.8 billion annual shortfall, tries to cut costs and diversify into new businesses without running afoul of unions and city leaders who won’t support cutbacks in staffing, which represents 70 percent of its overall costs. It’s a good example of a seldom-mentioned healthcare cost problem – bloated, inefficient health systems are often the largest employer in their communities and as such earn the unwarranted support of politicians who are more concerned about local employment and hometown prestige than national healthcare costs.

Health management company Equity Healthcare refocuses its employee wellness services from cold-calling workers to encourage healthy lifestyles to instead use claims data to focus on those with chronic conditions who are most likely to respond.

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Weird News Andy calls this video story “She Stoops to Conquer.” He explains, “A lady gives birth on camera while her husband parks the car. Pretty amazing video with nothing that squeamish. The good stuff starts at 1:18. She just squats and there’s the baby.”


Sponsor Updates

  • Printing virtualization vendor UniPrint.net joins Imprivata’s development partner program.
  • GE Healthcare employees volunteer at Milwaukee area schools to help spruce up classrooms before students return for the new school year.
  • Besler Consulting will exhibit at the HFMA Region 8 MidAmerica Summer Institute August 24-26 in Minneapolis.
  • Boston Software Systems releases a new podcast, “CVSHealth: Best Practices for Growth with Automation.”
  • In Canada, Markham Stouffville Hospital will upgrade to Meditech 6.1.
  • CoverMyMeds will exhibit at the Ohio Ambulatory Care Summit August 26 in Columbus.
  • CTG profiles new President and CEO Arthur “Bud” Crumlish.
  • Elsevier Clinical Solutions CMIO Jonathan Teich, MD offers his predictions for addressing the social and health demands of a growing global population.
  • EClinicalWorks will exhibit at Medical Fair Asia August 31-September 2 in Singapore.
  • HCTec makes the 2016 Inc. 5000 list of fastest-growing private companies in America.
  • Healthfinch CEO Jonathan Baran will speak at the NCHICA Conference August 31 in Asheville, NC.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
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August 23, 2016 News 14 Comments

Morning Headlines 8/23/16

August 22, 2016 Headlines No Comments

Apple Acquires Personal Health Data Startup Gliimpse

Apple acquires Gliimpse, a three-year-old startup marketing PHR software to help patients collect, personalize, and share their health records with providers.

Children’s Health Dallas testing ‘digitized drugs’ with sensors inside

Digital medicine vendor Proteus Digital Health pilots its sensor-embedded pharmaceuticals within a pediatric patient population at Children’s Health Dallas, allowing clinicians to monitor medication adherence among its patients after discharge.

Digital medicine: empowering both patients and clinicians

Eric Topol, MD publishes a defense of digital health in The Lancet.

Aetna, Humana blast DOJ’s merger challenge for ignoring reality

In response to a DOJ complaint, Aetna and Humana argue that its proposed merger should be allowed to move forward, noting that other private insurers would likely preserve competition by expanding into new geographies.

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August 22, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 8/22/16

August 22, 2016 Dr. Jayne No Comments

I wrote last week about preparations for a go-live I’m supporting. My client is a hospital that has had a stalled implementation of their inpatient EHR and decided to address it by completely re-implementing the systems rather than trying to tackle adoption system by system or provider by provider. Our official go-live started at midnight, although one could argue that we’ve had a soft live that’s been going on for several years.

Monday morning can be very busy at hospitals for a variety of reasons. Often major surgeries are scheduled on Mondays so that patients can recuperate and be discharged either to home or to another facility before the end of the traditional work week. There are many more providers on the floors than the weekends, as physicians resume covering patients that may have been covered by an on-call partner over the weekend. Additionally, patients may be coming in for tests that might not be performed on the weekends or were postponed because they weren’t urgent.

Many of the hospital’s component systems were already in full use prior to this project and that definitely helped things run smoothly. Knowing that your laboratory, radiology, communications, scheduling, bed management, pharmacy, and other systems would be under control definitely reduced the stress level for providers.

In walking through the nursing stations during peak rounding hours, the most stressed group of individuals were the unit secretaries and unit clerks. Many were concerned that providers would be hostile to them as they tried to redirect the providers to enter their orders using the CPOE module rather than accepting paper orders for transcription as they had in the past. Although we had a few providers who “forgot” that it was go-live day (not sure how they could have forgotten it given the hordes of support staff in bright green shirts everywhere one looked), those few were easily redirected to the computer for 1:1 assistance. Having enough hardware available for everyone to do their work was a critical piece of our strategy, and in looking at this morning’s statistics, we only had a couple of situations where people were waiting for a computer.

Speaking of statistics, we’re aggressively monitoring the provider roster and tracking who has logged in and what they’re doing on the system. We already have a list of physicians who were strong users prior to the reimplementation and I’m not very worried about them. However, as we see new physicians access the system, round on a number of patients, and use the various modules, we move them to a “live” tracking category.

As we prepared for this, we investigated the processes that the larger medical groups use to round on their patients – whether each partner sees his or her own patients or whether they rotate by day, week, etc. We know what those schedules look like and have a hit list of providers that we will need to be targeting over the next several weeks. With that kind of data, we can adjust schedules accordingly, reaching out to providers before their next rotation on the floors to make sure we have support staff ready to meet them as they start their days. Although conventional go-live wisdom assumes that the need for support will taper over time, their first day may be several weeks out and they will still need significant support.

In addition to dedicated support team members (a mix of IT staff, clinical super users working dedicated support shifts, and contractors) we’ve also identified clinical super users who are working their normal shifts and are prepared to field questions and assist providers. I often get questions on the best way to recruit and retain super users. This hospital took my advice that they should select nurses who have been proficient users for a long time and give them extra training on the physician workflow and how to best train and support physicians. The paid training sessions that they attended counted towards their average weekly schedule requirements, so they weren’t being asked to attend training on top of their already heavy shift schedules.

Additionally, they had to demonstrate a certain level of proficiency before they received the official title. I did lobby for additional hourly payments or cash bonuses for nurses working in the super user capacity during their normal shifts at go-live, but this didn’t happen due to contractual and tax issues. Instead, we’re doing our best to reward them with gift cards and other bonuses to make sure they know we appreciate their work.

The administration also took my advice to have leadership actively participating on the floors, even if they couldn’t field questions themselves. The CMO, VP of nursing, and CIO are spending a good chunk of time this week being out with the users and assisting in whatever way they can, even if it’s just dialing the desktop support team to ask for password resets.

Speaking of password resets, we did take the hard line of resetting the password of everyone who didn’t attend training. We did this immediately prior to our midnight go-live so that if they did try to use the system, they’d have to call in first and we’d be able to dispatch a support person to their location. We can also dispatch an administrator to them, ready to help manage any unpleasantness or reluctance to accept support. We knew we only had a handful of people in this situation, but they’ve been difficult in the past so we wanted to be prepared. So far, three of them have logged in and received on-the-job training without incident.

The physician super users we had previously identified were also out with their peers, delivering pre-scheduled 1:1 support for those physicians who were most concerned about the go-live. As expected, we saw that once those physicians were able to complete documentation on several patients in a safe and supported environment, their concerns were markedly reduced. Just talking to a few of the physicians involved, it seems that simply knowing that we have physician super users that are part of the informatics team and will be looking out for physician interests going forward has been a powerful factor in bringing reluctant physicians on board.

As I suspected, even though the system has been live for a while, having a greater number of users engaged has identified some defects and some concerns with some of the order sets. Physicians who hadn’t previously participated in the creation of the defaults are now concerned with their content, so we’re documenting those concerns and will invite those physicians to participate on the committees that approve content. What we’re not going to do though is create individual order sets for the physicians who are complaining. If there is a clear and compelling reason to add a particular order, it can be added to an existing set as optional. Leadership is on board with this and having solid decision making and change control will serve them best in the long run.

As far as the defects, we’re classifying them as technical, operational/workflow, or application and are involving the appropriate groups for expedited resolution. We did engage our vendor to have a couple of application specialists available (two on site and two remote) should we need them.

One of the other things we’re doing today is starting our post-mortem review of the go-live and our entire process. Even in the excitement and activity of a go-live, it’s important to start gathering that information and determining what worked and what didn’t work so that you have a jump start on the next project. One of the things that worked well here was including the business case for many features as we trained them. For example, requiring a diagnosis on every medication, not just an indication on PRN medications. Although this should be fairly straightforward, we explained exactly what the hospital was doing with that data – formulary management, pricing negotiation, patient risk stratification, and more.

We also did a lot of education around the use of discrete data and its impact on monitoring clinical quality and potentially on research projects. The majority of physicians had no idea how the data was being used beyond “because you have to” and that helped transform what might have been perceived as extra clicks into something of value. We also opened the door for physicians to receive more data about their patients and the work they were doing, including access to ad-hoc reporting on patients they are seeing in the hospital. Due to some previous physician engagement surveys conducted by the hospital, we suspected this would be a good approach.

We also did some specific pre-work to look at how providers wanted to be trained and where they wanted to be trained. We did perform some 1:1 offsite training for providers and I think that was a good way to achieve buy-in and participation. Although we weren’t resourced to do this for every provider, we did do it for those that specifically asked. During the design phase of the rollout, we also held listening sessions with providers who were concerned about the process. Many of them were under the assumption that this would create more work for them. We were able to present the actual workflows at those sessions, demonstrating that although the work would be different, it wouldn’t necessarily be more. They were able to see in person what we were planning and we believe this reduced resistance.

Although today has gone smoothly, we know this is a process and the needs will continue for the next several weeks until all of the active physician staff members have been to the hospital at least a couple of times. I anticipate some blips but think our preparations have been solid and we’ll be able to get through them.

Don’t you love it when a plan comes together? Email me.

Email Dr. Jayne.

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August 22, 2016 Dr. Jayne No Comments

Uncovering the Real Value of HIMSS Exhibition

August 22, 2016 News 2 Comments

Vendors weigh in on the real ROI behind HIMSS exhibition efforts. From “meaningful conversation” metrics to the pros and cons of in-booth entertainment and décor, most have come to realize that the conference is a can’t-miss opportunity worth the all-too-real financial risk.

By @JennHIStalk

HIStalk readers have historically not shied away from airing their HIMSS-related grievances. Whether it’s booth babe backlash, sales reps who refuse to make eye contact, or the delicate balance of staying in the good graces of HIMSS organizers, there has been ample dissection of the health IT industry’s largest tradeshow since HIStalk began covering it 13 years ago.

Yet for all the back and forth, conference attendance has grown impressively. Exhibitor numbers seem to have remained steady despite show-floor grumbling about the cost of just about everything. Atlanta, New Orleans, and San Diego have been scrubbed from the conference city rotation due to constraints in their conference hall and travel logistics and Chicago was axed because of a hotel room pricing spat, leaving Orlando and Las Vegas as the only cities capable of accommodating the massive amount of infrastructure necessary to house its sprawling square footage.

Given the double-edged sword of shelling out big bucks to exhibit with a good chance of getting lost in the crowd, HIStalk reached out to several vendors with varying levels of HIMSS exhibition tenure to gauge their return on investment assessment. From first-time exhibitors to those who’ve joined the fray for the last 20-plus years, most have come to realize that the event is a necessary evil that they will endure — some more eagerly than others — for the foreseeable future.

Setting Measurable Goals Makes the Difference

Determining ROI for an event like HIMSS can be tricky given the long sales cycle for many vendors and the hard-to-quantify benefit of relationship building. And then there are the add-ons. In addition to the standard HIMSS booth pricing — which starts in the $4,000-$5,000 range depending on HIMSS corporate membership status — there are costs associated with extras like chairs, carpet, trash cans, and power, not to mention travel and lodging, advertising and marketing, signage around the show floor, and after-hours events.

Some companies, like 20-plus year exhibitor Billian’s HealthDATA (acquired earlier this summer by Definitive Healthcare), base ROI on concrete goals such as generating a certain number of prospects and closing enough sales to cover expenses for the show.

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Others, like Stericycle Communications, lean toward the number of “meaningful” conversations conducted on the show floor. “Ahead of each HIMSS, we set a target for the number of deep, needle-moving conversations we want to have,” says Colin Hung, vice president of marketing at Stericycle, which has exhibited for the last four years. “These conversations could be with clients, prospects, potential business partners, suppliers, and even potential employees. We do look at other metrics like conversions and booth visitor sales generated,  but it’s the meaningful conversations metric that really determines whether or not the conference was successful.”

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Some exhibitors, like LogicStream Health, see ROI more in terms of generating “new opportunities and interactions with prospects currently in our pipeline, which we expect to turn into new customers and additional revenue,” according to Scott Olson, director of marketing. The company, which exhibited for the first time in 2016, is planning to exhibit again next year. Olson adds that, “Because of the effort we put in on the front end in 2016, we easily justified the expense and expect an even better return on our 2017 investment.”

The Consequences of Taking a HIMSS Break

While none of the vendors interviewed would disclose hard financial figures, all have found their presence at HIMSS to be enough of a worthwhile venture to justify exhibiting year after year. Not one company interviewed has taken a year off from exhibiting. That steadfastness may have more to do with HIMSS incentives (and disincentives) than any hard and fast financial gain directly tied to contracts signed on the show floor.

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“We do not plan to stop exhibiting at HIMSS,” says Hung, who adds that the association’s points system plays into that decision. “The points system governs how vendors select their booth space for the following year,” he explains. “Vendors earn points for various activities related to HIMSS – paying on time, booking accommodations in the hotel block, being a sponsor, booking larger booth space, etc. Points are cumulative and skipping a year cuts deeply into your accumulated points.”

Readers may remember that Cerner, which declined to comment for this story, stopped exhibiting on the main show floor for three years, citing a marketing environment that it felt was not conducive to showcasing new technologies and attracting clients. It returned in 2012 due to customer demand, occupying space on the exhibit floor that some felt was in direct correlation to the length of its hiatus.

“It is a given to exhibit at HIMSS,” reiterates one healthcare executive whose company will exhibit in 2017 for the ninth year in a row. “Clients expect to see us there. However, with our marketing budget, it’s also a trade-off. The tremendous costs equate to a significant expense, which takes away from attending other opportunities. We see HIMSS as a necessary evil. We are exhibiting at HIMSS17, but due to the exorbitant costs, we’re reducing our footprint to ramp the ROI in our favor. We may spend more relationship-building time outside of the HIMSS environment.”

The Bigger the Better?

The aforementioned executive may be the exception to the rule when it comes to downsizing exhibit space, though he does clarify that, “Regardless of size, a well-designed booth with furnishings that are comfortable yet attractive and a correct flow is equally important.” The majority of companies interviewed for this story have found value in expanding their show-floor footprint.

“Over the years, we went from a 10×10 booth to a 20×20,” says Joyce Metzer. Now retired, she managed Billian HealthDATA’s presence at the show for over two decades. “The extra space and seating allowed us to have face-to-face meetings with clients and prospects, and we were better able to accommodate attendees who wanted to see demos. Bigger booths, more seating, and more stations for doing demos is critical. Furnishings also play a big role in showing off the fact that you have money to spend on making your customers and prospects comfortable.”

LogicStream will expand its booth next year, and Olson is eager to see how much of a difference it makes. “Our booth was crowded last year because of all the traffic we drove, even being in the back corner of the main floor,” he says. “There’s a chance we missed some walk-up conversations because of the number of people we had at any given time. With a bigger presence this year, our expectation is that we’ll have more room for demonstrations of our solutions.”

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Some exhibitors, however, just don’t see the value in the extra square footage. “Granted, you don’t want to be too small such that no one can find you,” says Greg Chittim, vice president of strategic marketing at Arcadia Healthcare Solutions, which has been a HIMSS exhibitor for 10 years. “But I think our customers would rather we spend our money on our products and their experience versus a second floor to our booth. That being said, we try to draw people in with eye-catching visuals that are light on the latest buzzwords and stock photos of happy doctors and friendly experts who actually execute our programs rather than people who just sell them.”

Hung, who has been to HIMSS 10 times, agrees – somewhat. “I honestly don’t think there is any difference between a 10×10 versus a 10×30,” he says. “When you are in a booth that small, you won’t be able to cut through the noise. When you get to a 20×20, that’s when you’ll get a little bit of attention, but you still have to work hard to get business. It’s not until you cross 2,500 square feet that the size of the booth suddenly makes a difference. When you have a space that size, people notice. If you aren’t able to afford 2,500 square feet, I think you’re better off going with a smaller booth and investing your dollars in other aspects of HIMSS.”

It’s What’s in Them That Matters

No matter how big the booth may be, it’s what’s in them that counts in terms of attracting passers-by and making invited guests feel comfortable. Depending on the service or technology offered, many vendors have taken to offering the aforementioned demos and in-booth presentations featuring high-profile customers.

“Presentations can be effective if you have a lot of clients or partners who attend, and if you’re willing to make the effort to market them consistently in the four weeks leading up to the show,” Hung explains. “If, however, you are counting on people just stopping in, I think you’ll be in for a very lonely HIMSS experience.”

Chittim believes that offering something compelling at the booth will help to keep the crickets from chirping. “Bringing something interesting absolutely makes a difference,” he says. “We focus on really compelling data visualizations presented like an art gallery, which does an amazing job of drawing folks from all backgrounds in for a second or third look. Entertainment that has nothing to do with healthcare or our core business is useless from my point of view.”

Hung is of the same mindset and believes that the days of having entertainers such as magicians, jugglers, and game show hosts at HIMSS are long past. “These types of entertainers attract and repel an equal number of booth visitors, in my opinion, and are thus a waste of money. I never find I have time enough at HIMSS to stand and watch a magician perform. I’m always rushing off to the next meeting. I know many fellow HIMSS attendees have similarly packed schedules.

“Having a good-looking model, male or female, in your booth is a complete turn-off,” Hung adds. “I honestly can’t understand why a company would hire a non-employee just to stand in the booth to look good. Not only is it incredibly sexist, but it insults the intelligence of attendees. This form of in-booth entertainment definitely has an impact and it’s completely negative.”

In-booth entertainment, good or bad, can often add up to one thing – noise. “Due to the nature of our business, we don’t have experience with presentations or in-booth entertainment,” the anonymous executive explains. “What we do have unfortunate experience with is the noise level at HIMSS due to the over-crowding of exhibitors in the given space. Our neighbors on multiple occasions have repetitively exceeded the decibel level specified by HIMSS, resulting in less-than-optimal business environments for us. Although HIMSS attempts to monitor and discipline offenders, this challenge is a reality on the show floor.”

Reeling the Right People In

Aside from the challenges of noisy neighbors, exhibitors have over the years defined what works for them and what doesn’t in terms of attracting qualified decision makers to their booths.

Some avoid giveaways and the “goody grubbers” that go after them altogether. The Arcadia team, for example, has found that giveaways tend to draw in only folks who aren’t decision makers, or even employees of potential customers. “The most successful thing at our booth is showing live demos by real experts – our product team, our technical leaders, and clinicians that have really used the product.”

The LogicStream team has had a similar experience. “We had a drawing for a hoverboard in 2016,” recounts Olson, “but didn’t get much traffic from people just dropping off business cards or stopping simply to get their badge scanned. We haven’t decided if we’ll do a larger giveaway in 2017. Attendees that we talked to were more interested in what we could offer their health system and how we could improve care delivery for their patients and providers.”

While tchotchkes may not work, food and beverage seem to be a no-brainer. “Giving away quality food or beverages is always a hit,” says Hung. “Whether it’s coffee, desserts, candies, mini tacos … attendees always appreciate food, especially when the alternative is a $9 cup of dark water that only looks like coffee.

“It’s really challenging to come up with a giveaway that’s unique these days,” he explains, though he adds that he did notice a lot of buzz around HIMSS16 booths featuring a custom T-shirt station and miniature obstacle course. “Everyone has access to similar tchotchke vendors, and every year those vendors follow the same trends. My suggestion is to avoid grab-and-go giveaways like pens and notepads … anything that someone can just grab from your booth without stopping. Instead, plow your money into a good food giveaway that forces the person to pause at your booth, like coffee or ice cream.”

Metzer has also found food and beverage to be the quickest way to the hearts of attendees. “Any kind of food or drawing for a gift will definitely increase traffic,” she says. “We discovered that having a cocktail hour with a drawing at the end of show hours brought in a lot of customers and prospects. The customers would tell the prospects how our product helped them do their jobs, and how easy it was to use the product.”

Due Diligence for Decision Makers

Marketing initiatives, whether they be focused on scavenger hunts, giveaways, baristas, or bartenders, are all designed to do one thing – get decision makers into booths and keep them there. As anyone who’s ever attended HIMSS knows, getting the attention of the C-suite can be challenging without the proper due diligence.

“They key to HIMSS is to invest the time and effort ahead of the conference to book meetings rather than expect walk-ins,” says Hung. Such due diligence is what helped keep the Billian’s HealthDATA booth humming year over year. Metzer says that, on average, 25 percent of booth visits were made by decision-makers, a figure driven by the sales and marketing team’s pre-HIMSS push. Olson recounts that about half of LogicStream’s drop-in visitors were of the decision-making caliber, with the rest being students, vendors, investors, lower-level health system employees, and media.

“Too often,” adds Chittim, “the real decision makers are hounded as they walk the show floor, so are understandably protective of their time and attention. Based on the fact that we’re showing something that is detailed and real versus things that appear to be vaporware, we often have a junior person come first, but they typically bring a real decision maker back with them.”

Time to Sign on the Dotted Line

The health IT sales cycle is not a quick one, and while vendors may use the HIMSS conference as a means to amplify news of a recently signed contract, it is not the type of event that lends itself to initial meetings one day and contractual agreements the next.

“HIMSS is definitely a long-term investment,” says Hung, adding that Stericycle can trace almost 80 percent of its technology partnerships back to a meeting or discussion at the show. “It’s very rare that we meet someone at HIMSS for the first time who buys in the same year. It usually takes two or three HIMSS meetings along with other touch points before a business relationship is cemented.”

Metzer puts the Billian’s HIMSS sales cycle at less than two years, while Chittim says Arcadia’s is six months or less, with 5 percent of total sales being traced directly back to the conference. The variety of times and percentages certainly seems to add to the complexity of attempting to define HIMSS ROI.

Getting Ready for Orlando

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Despite the opaque accounting, vendors are already getting their ducks in a row for HIMSS17. “Between the follow-up work and evaluating the 2016 experience, and then looking at increasing our 2017 presence, it’s quite a task to manage and prepare for,” admits Olson. “Next year, we’ll bring a larger team and have a larger booth. Along with that comes bigger goals and a higher expectation of return from the conference.”

Stericycle is also planning to put more of its team members on the show floor. “It’s so valuable for our product team to see what’s happening in the industry and for them to interact with clients and prospects directly,” says Hung. “There’s no better place for that than HIMSS.”

Chittim is on the same page as his exhibitor peers, adding that, “We try to be as conservative as possible with our marketing dollars, but it’s hard to pass up an opportunity to go big in a time and place that has all of our competitors and many potential customers in one place. We’ll be right by the HIMSS17 front door with a new data gallery, new product demos, and a number of clients presenting at our booth and at HIMSS broadly. We’re already looking forward to the week even though it’s six months away.”

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August 22, 2016 News 2 Comments

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