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Readers Write: Patient Privacy — A New Way Forward

June 20, 2016 Readers Write No Comments

Patient Privacy — A New Way Forward
By Robert Lord

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Health data security and patient privacy are in a state of crisis. Electronic health records (EHRs) are in the process of being ubiquitously rolled out, providing access to as much patient data as possible, to as many users as possible, in as little time as possible. As a consequence, hundreds of millions of patient records have been made easily accessible to millions of health system employees and affiliates, with essentially no oversight of who is viewing what patient data in the EHR and if that access is appropriate.

However, this isn’t because of health system negligence – it’s about a collective lack of accountability among several key stakeholders. Due to the sheer volume and complexity of patient records accessed each day, it is impossible for privacy and security officers to efficiently detect breaches without new and practical solutions and standards.

Something needs to change. Despite promises of role-based access controls, training programs, and security templates, the problem just isn’t being solved, and HIPAA violations continue to affect hospitals on a daily basis. That critical human layer of access is the root of these problems, and that doesn’t have an easy solution.

A new report from the Brookings Institution details that the majority of recent healthcare data breaches are caused by theft or unauthorized access. Research also shows it takes more than 200 days to detect an insider threat, if it is detected at all. And the in-depth report from ProPublica last December helped bring into focus that small-scale violations of medical privacy — like the Walgreens pharmacist who snooped in the prescription records of her boyfriend’s ex — often cause the most harm.

We are now at an inflection point that will decide the future of patient privacy. The actions and decisions of four key stakeholders and their collective will to collaborate through an independent fifth apparatus will significantly advance or stall patient privacy protection and next-generation health data security.

Patient privacy technology vendors need to invest in their teams and products to take advantage of the significant advances made in big data analytics, clinical informatics, and cybersecurity. These advances have changed many other fields, but cybersecurity and compliance solutions built for non-healthcare industries are rarely effective in the complex and idiosyncratic healthcare environment.

Furthermore, the big data environments that define many modern hospitals also require big data solutions that are at the cutting-edge of technological possibility. Critically, vendors need to better listen to their customers to create clinically-aware, healthcare-first solutions that address patient privacy. Health systems cannot purchase what does not exist and rarely have the in-house bandwidth to create production-ready systems.

Hospitals and health systems are working hard to protect patient privacy, but their security and privacy teams are stuck in a reactive mode, having to put out fires with limited resources. It’s clear that CISOs and chief privacy officers need a seat at the boardroom table and their roles need to give them the breathing room to see into the future rather than just to react to challenges as they occur.

Furthermore, compliance and bare-minimum standards are no longer enough. To truly protect patient data, a close relationship between hospital security and privacy groups must be formed. This partnership must be augmented by the technology necessary to detect and remediate threats and their collective mission must be aligned with the board. Fundamentally, resources and C-suite support must be allocated to tackle the next generation of privacy and security challenges, as current efforts aren’t on the right trajectory.

The federal government, with privacy protection authorities like the Office of Civil Rights and standard-setting bodies like ONC, want very earnestly to protect vulnerable populations and help hospitals protect patient data, and I have always been impressed by my interactions with them. However, there is no denying that they are under-resourced and limited in the amount of time they can spend looking into better solutions that could serve as next-generation patient privacy platforms. As a result, they are not able to offer much substantive guidance on what hospitals should and shouldn’t do to keep patient data secure. While distance must be maintained between vendors and regulators, greater public-private partnerships, like those in national security, are critical.

All of us as patients are an important but (amazingly) often overlooked constituency when it comes to advancing the protection of health data. Just as we wouldn’t keep our money in a bank that didn’t use passwords for online accounts or locks on their vaults, patients should expect and ask for more details about a hospital’s security posture. When hospitals ask you to sign forms that let them use your data, we should request that our providers detail how they’re protecting our information. A basic set of criteria about data encryption, proactive patient privacy monitoring, dual-factor authentication, network security, and whether or not a CISO/CPO are part of the team can tell you a huge amount about a hospital’s stewardship of patient data. We are all patients and I’m just as guilty of signing a HIPAA release form without thinking as anyone else. But if we’re to drive change, we have to think hard about what’s truly important to us and take a stand.

Ultimately, each of the above stakeholders has its own incentives, and I would contend, its own set of responsibilities and roles with respect to bringing about a new standard of patient privacy. In addition, while industry partnerships and bodies like the NH-ISAC are steps in the right direction in unifying these stakeholders, we need collective accountability and transparency regarding insider threats and HIPAA breaches beyond HHS’s “wall of shame.” Only through creating central, practical, collaborative bodies that bring all of these stakeholders to the table will we be able to move patient privacy forward and set a new standard for protecting our patients’ data.

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

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June 20, 2016 Readers Write No Comments

Readers Write: Mapping Out a Big-Picture Strategy to Drive Smarter Healthcare Decisions

June 20, 2016 Readers Write 2 Comments

Mapping Out a Big-Picture Strategy to Drive Smarter Healthcare Decisions
By Nancy Ham

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Analytics are like a GPS navigation system for healthcare. With a full view of your route, they give you step-by-step directions for exactly where you need to go. By aggregating data from electronic medical records (EMRs), claims, health risk assessments, admission / discharge / transfer (ADT) systems, and other sources, analytics can create 360-degree views of individual patients and entire populations. This holistic approach drives smarter decisions and better outcomes.

When providers can see which patients are not following treatment guidelines, visiting out-of-network specialists, or are at risk for readmission, they can deliver more impactful interventions, close gaps in care, and improve quality. In a recent survey, 82 percent of healthcare decision makers say analytics have helped to improve patient care at their hospital or health system and 63 percent say analytics helped to reduce readmission rates.

With the right technology and strategies in place, health systems can drive change and shift value-based care initiatives into high gear.

Strategy #1: Keep patients in-network

When patient care falls outside of a health system’s network, it can lead to gaps in care, administrative referral headaches, and lost revenue opportunities. However, keeping patients in-network is a challenge, especially in today’s competitive healthcare market. Having the right data to even know who is going out of network and why compounds the problem.

Yet studies estimate that only 35-45 percent of adult inpatient care stays in network. For one accountable care organization with 27,000 lives, out-of-network services resulted in lost data, missed care coordination opportunities, and increased costs. Patients seeking treatment for hip/knee replacements saw a:

  • 10 percent increase in radiology services
  • 32 percent increase in emergency and medical visits
  • 25 percent increase in physical therapy sessions

Advanced analytics with drill-down capabilities can help. It allows users to tap into claims and clinical data so they can identify out-of-network drivers by service line and provider. These systems even allow users to see how much they are losing by diagnosis code.

From there, health systems can find ways to close gaps in services and create a strategy to keep patients in-network. For example, health systems may find opportunities to improve retention by expanding their cancer service line or adding a new service such as electrophysiology. As a result, out-of-network referrals are reduced, in-network retention improves, and the health system finds new revenue opportunities.

With this detailed level of insight, it’s also possible for health systems to pinpoint network leakage down to the provider level and use this information to educate providers about their referral patterns. When doctors and other caregivers see the impact of their referral processes on overall network performance, it’s easier to have collaborative conversations and work towards improving retention.

Strategy #2: Coordinate care to reduce readmissions

Patient data resides in a number of different sources across the continuum of care, including ambulatory EMRs, community health records, and hospital information systems. By aggregating and analyzing this data and applying predictive algorithms, it’s possible to create readmission risk scores for admitted patients so they can be proactively flagged for intervention or special consideration upon discharge.

Capabilities like these are critical for improving outcomes, particularly when it comes to managing the five percent of patients who drive more than 40 percent of our healthcare costs. When this type of information is presented as part of the clinical workflow, providers can review discharge data, anticipate potential roadblocks, take action quickly and efficiently, and reduce readmission rates.

Strategy #3: Leverage actionable intelligence and analytics

Data and analytics can help providers to gain a clearer picture of all of the populations they serve. With data from multiple sources in one central location, it’s possible to layer and visualize this information in new ways. Much like how a GPS presents directions differently based on whether you are walking, driving, or taking public transit, these tools offer users flexibility on how to view and analyze data.

By looking at clinical and claims data in a new light, providers can better understand a patient’s complete profile, including lab tests, self-reported data, health conditions, co-morbidities, lifestyle risk factors, and gaps in care. As a result, it’s possible to better stratify risk, match patients to the right interventions, and address high-risk conditions before they lead to costly treatment. Providers can then prioritize the appropriate interventions and determine a complete care plan that includes support, such as personalized patient education and coaching.

Having a comprehensive, 360-degree view of a patient or population—much like the one a GPS navigational system would provide—can ensure your journey is a successful one. With this perspective, you can reach your destination of high-quality, cost-effective care by following these key takeaways:

  • Concentrate on keeping patients in-network to improve quality care, capture vital performance metrics, and retain service revenue
  • Strengthen care coordination to reduce readmissions
  • Visualize data in new and different ways through enhanced analytic capabilities to promote better clinical and financial performance

Providers need a full picture of their patients and populations to deliver high-quality, impactful care. By harnessing a wide range of data and actionable insights, healthcare organizations can make smarter decisions that better engage patients and clinicians, reduce duplicative services, mitigate risk, and improve quality.

Nancy Ham is CEO of Medicity and VP of Healthagen Population Health Solutions, an Aetna company.

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June 20, 2016 Readers Write 2 Comments

Morning Headlines 6/20/16

June 19, 2016 Headlines No Comments

Up to 20 Percent of U.S. Trauma Deaths Could Be Prevented With Better Care

A report by the National Academies of Sciences, Engineering, and Medicine on trauma-based mortality rates in the US finds that quality of care for trauma patients varies greatly depending on when and where a patient is injured, resulting in 30,000 preventable deaths per year. The report calls for a national trauma care network to establish best practices and integrate civilian and military trauma care practices.

Online Trust Audit Briefing

An independent investigation recognizes Healthcare.gov as the second-most secure consumer website, while Twitter took top honors.

Doctors’ Hand Hygiene Plummets Unless They Know They’re Being Watched, Study Finds

A new study from Santa Clara Valley Medical Center (CA) finds that hand washing compliance rates improve dramatically when health professionals know they are being watched.

LeadingAge CAST Releases New Electronic Health Record Adoption Model

LeadingAge introduces an EHR adoption model for long-term and post-acute care organizations.

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June 19, 2016 Headlines No Comments

Monday Morning Update 6/20/16

June 19, 2016 News 2 Comments

Top News

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A government report estimates that 30,000 US patients die unnecessarily from trauma each year since trauma center death rates vary widely such that “where you are injured my determine whether you survive.” It urges creation of a national trauma system driven by best practices that includes both military and civilian systems and pre-hospital providers such as ambulance services.

The leading cause of death among people under 46 years old is trauma (motor vehicle accidents, gunshots, and falls).

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The report from the National Academies of Sciences, Engineering, and Medicine recommends that trauma centers create real-time access to patient-level data that would also be used in a national quality improvement program.


Reader Comments

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From Former Westminster, CO Employee: “Re: McKesson. I worked on Horizon for 15 years. Upper management refused to listen to QA, support, implementation, and development and would demand that change requests be closed with known software bugs shipped to clients to meet project deadlines. Hospitals would then report the bug, which would be re-opened as a Hot Fix Solution as the cycle repeated. Management was more concerned about running a tight ship and laid off many critical people. Paragon will suffer the same because the management culture has not changed.” Unverified.


HIStalk Announcements and Requests

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Most poll respondents would struggle to pay an unexpected medical bill of $5,000 to $25,000, which is a lot better than the 47 percent of Americans that a federal study found would struggle to pay a $400 emergency bill. New poll to your right or here: do digital tools reduce the efficiency of care delivery as the AMA contends?

Here’s a fun enhancement idea for the new iPhone patient data EHR query: let the app automatically file an HHS data-blocking complaint for unsuccessful requests.

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Mr. Martinez is using the document camera we provided in funding his DonorsChoose grant request to record his live presentations so that students in his California high school classroom can review portions they missed or to keep up when they’re absent. He’s recording additional examples and placing them on his website so that students can follow along on their own time.

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Also checking in is Mrs. Evans from Florida, who says many of her elementary school’s students had never used a tablet until we provided six of them for her gifted class.

Listening: new from Radiohead, slower and more melodic (some might say “wimpier”) than previous masterworks like “OK Computer,” but sometimes you have to let good bands evolve and give their new stuff a multiple-play chance to grow on you.


Last Week’s Most Interesting News

  • Apple adds C-CDA records import capability to iOS 10, giving iPhone-using consumers the theoretical ability to request and capture their basic medical information from provider EHRs.
  • AMA passes a resolution supporting creation of an ONC-administered health IT safety center.
  • Doctors in Australia demand that patient update access to their own medical records be revoked, saying they can’t trust the information.
  • The AMA’s EVP/CEO lashes out at “digital snake oil,” broadly panning the health-related software that is available to doctors and consumers.

Webinars

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

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Lorre’s getting bored because of the industry slowdown that kicks in every year right about now, so ask her nicely for her “Summer Doldrums Special” that we always run through Labor Day and you’ll get a great deal.


Acquisitions, Funding, Business, and Stock

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TransUnion acquires Auditz, which offers point-of-service patient revenue products.

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Cerner shares continue their recent slide, closing at prices not seen since July 2014. Above is the one-year price chart of CERN (blue, down 22 percent) vs. the Nasdaq (red, down 6 percent).


Announcements and Implementations

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LeadingAge Center for Aging Services Technologies creates an EHR adoption model for long-term and post-acute care providers.


Government and Politics

The government of South Australia continues its years-long legal pleading to software vendor Work Systems, whose 1990s-era, DOS-based patient records system is still being used by 64 of South Australia’s health sites. The vendor demands that state government stop using its software since its license for a retired version has expired, but the government argues that forcing it to stop using the system would endanger patients. South Australia is in a bind because its Allscripts-powered EPAS project is behind schedule and over budget with only three sites live amidst widespread doctor protests that the system endangers patients.

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Karen DeSalvo, MD, MPH and her HHS team wore blue to support Men’s Health Week last week.

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An independent analysis finds Healthcare.gov to be the second-most secure consumer website.

The VA engages Underwriters Laboratories to help improve the cybersecurity of its medical devices.


Other

It’s been said that “a true test of a man’s character is what he does when no one is watching,” which is an apt summary of a new study that finds increased rates of hospital hand-washing when clinicians know they are being observed. Easy-to-spot infection prevention nurses saw a 57 percent rate of hand-washing compliance, while less-recognized volunteers saw staff washing their hands when they should only 22 percent of the time.

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An excellent analysis by Arcadia Healthcare Solutions that I hadn’t previously noticed until NPR ran a story on it finds that the cost of care provided to dying patients in their final 30 days varies widely by where they die. Patients who expire in a hospital consume $32,000 worth of services, while those who pass away in nursing homes, hospices, and at home cost $21,000, $18,000, and $5,000 respectively. Saddest of all is that 40 percent of patients died in a hospital, something that few people want. The company offers several interesting dataset visualizations on its site.

I also missed this New York Times op-ed piece from a few weeks back in which a University of Oslo professor pans the idea of a “cancer moonshot,” saying the Catch-22 of cancer is that it can’t be cured and thus keeping people alive longer means they’re more likely to get cancer again. He recalls that President Nixon called for a cancer moonshot of his own in 1971 and the National Cancer Institute has spent $90 billion since then even as cancer rates increased. He concludes that the effort wasn’t wasted, however: “We’re a lot better at fighting cancer. We just can’t cure it,” but warns of “the rhetorical spin that drives the cancer enterprise.” He urges that doctors save lives via the “boring stuff” of getting patients to stop smoking, use sunscreen, eat better, and exercise, saying that will do more good than “promising the moon.”


Sponsor Updates

  • Vital Images will exhibit at SCCT 2016 June 23-26 in Orlando.
  • Zynx Health will exhibit at AMDIS 2016 June 21-24 in Ojai, CA, as will LogicStream.
  • Integris and The Chartis Group will present “Centralized Scheduling for a Physician Enteprise” at the HFMA National Institute June 26-29 in Las Vegas.

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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June 19, 2016 News 2 Comments

Morning Headlines 6/17/16

June 16, 2016 News No Comments

Hands-on: Apple brings HL7 CCD health records to HealthKit in iOS 10

iOS 10 includes an enhancement that will let iPhone users to download and store their health records from providers capable of transmitting a CCD.

Navicure Partners with Bain Capital Private Equity to Continue Growth and Expand Healthcare Technology Platform

Navicure receives a strategic investment from Bain Capital Private Equity. Financial terms were not disclosed.

AMA Throws Support Behind Development of a National Health IT Safety Center

AMA house delegates approve a proposal formally supporting the creation of a National Health IT Safety Center.

Doctors want patient control over e-health records revoked

The Australian Medical Association argues that patients should not be able to control what is entered into their personal health records. AMA president Michael Gannon, MD explains, “If patients are able to control access to core clinical information in their electronic medical record, doctors cannot rely on it.”

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June 16, 2016 News No Comments

News 6/17/16

June 16, 2016 News 1 Comment

Top News

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Apple’s iOS 10 will allow users to request copies of their medical records from their smartphones, provided their provider’s EHR can export a Continuity of Care Document. Users can also import records from Safari and Mail. The translated medical summary can be stored directly in Health.


Reader Comments

From Meltoots: “Re: CMS and EHR vendor snake oil. MU was an unmitigated disaster for safety, security, usability, efficiency, and physician burden, yet it continues with a new name. Everyone wants to move away from fee-for-service, yet we have no idea how to attribute quality care from multiple doctors to a single patient. This is a not-so-secret CMS push to put providers into large practices so they can crank down on payments. Providers have had enough.” The other concept at work is that hospitals, which have performed so pitifully and indifferently in coordinating patient care and managing populations, are figuring out how to reap the lion’s share of the money that will be spent to improve it. It’s also interest that just as it’s hard to detect Medicare fraud because providers work under the NPI of other providers in group settings, it’s equally hard to determine using billing data which of them is individually responsible for wise or unwise care decisions.

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From Gray Sky: “Re: Medhost. Has had outages for the past two weeks for all hosted applications. Inside information points to a storage information where customer data has been erased. The company continues to investigate options to restore the data to a reasonable point in time.” I ran this rumor Tuesday with the vendor name omitted pending the company’s response, which Medhost has provided:

Medhost supports software applications in over 1,100 facilities across the United States, Canada, and Puerto Rico. Over the past several weeks we have experienced system outages impacting a total of three hosted facilities. In one instance, the outage was extended for several days. Medhost utilized both system vendors and consultants as well as its internal resources to determine the cause of these outages and to act to prevent any future outages. The extended outage was due to failure of the operating system. Medhost applications were not a contributing factor to this system outage and no customer data was lost. All customer systems have been restored and are working as designed. While we view any outage as unacceptable, we will use this as an opportunity to improve availability and resiliency of the Medhost systems. Medhost Direct historical uptime availability exceeds 99.99 percent, and no hosted facility has experienced an outage of more than 14 hours in over two years.

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From  Credenza Cowboy: “Re: Martha Jefferson’s errant EHR click that mistakenly labeled the patient as deceased. They aren’t live on Epic yet.” I didn’t realize that, although I attended a years-ago Cerner user meeting at which their IT director was present, so maybe they are on Cerner. Either way, it’s an interesting tip-of-the-iceberg type user error that fortunately, in this case anyway, had no clinical impact. Sentara bought the Charlottesville, VA hospital in 2010.

From Pensive Moment: “Re: digital snake oil. Do  you agree with the AMA?” Mostly no. The AMA’s solution to all problems is to put doctors in charge of everything despite their poor track record of following evidence-based guidelines, delivering whole-person health, and serving as patient advocates without bias toward their personal incomes. They have also demonstrated their own snake-oil gullibility in letting drug and medical device companies dictate their clinical behavior via shady but effective sales tactics that sometimes result in sub-optimal or even dangerous medical decisions. You will notice minimal reference to care teams in the AMA’s impassioned stand that, as usual, assumes the “Doctor as God” position in excluding all other clinicians and in pushing AMA’s commercial interests. The AMA is right that many apps (especially the consumer-facing ones) are of questionable value and that doctors have been shafted in being expected to document everything for the benefit of bureaucrats. They’re also correct that much of what doctors don’t like was handed down to them from insurance companies and the government (whose checks they don’t mind cashing, however, as evidenced by their continued participation). The AMA’s bloviating is what you get when each clinical profession has its own membership organization looking out for the interests of its dues payers while claiming to represent patients who are – along with the 80 percent or so of US doctors who aren’t AMA members, including a bunch who quit after AMA endorsed passage of the Affordable Care Act — invariably absent from its proceedings. All of the solutions offered by the AMA for “digital dystophia” involve AMA-led products and services, so from now on, let’s blame them.

From Limelight Seeker: “Re: our event. Please promote the upcoming tweetchat, webinar, or video I’m involved with.” I will say only this: quite a few overexposed pontificators — especially social media self-gratifiers and cheap-seats observers — are short on credentials to be educating the rest of us. My accomplishment-driven twit filter is powered by LinkedIn.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Catalyst Healthcare Advisors. The eight-year-old company offers consulting services in strategy, finance, operations, and technology (IT strategy, system selection, contract negotiation, and system implementation, optimization, and integration). The company led Yale-New Haven’s expense reduction project in helping the health system save $350 million annually. Among its other 200 clients are Baylor, Indiana University Health, Community Health Network, and Good Samaritan Hospital. You may know founder and CEO Steve Furry, who has been in healthcare consulting for 35 years, and senior advisor Parker Hinshaw, who founded maxIT. The company just announced the hiring of two new sales executives covering the West and Midwest. Thanks to Catalyst Healthcare Advisors for supporting HIStalk.

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Ms. Marlowe says her North Carolina kindergarten class is benefitting greatly from the Chromebook we provided in funding her DonorsChoose grant request, with the students specifically enjoying listening to stories online.

Listening: reader-recommended Richmond-based singer-songwriter Lucy Dacus, an up-and-comer who sings thoughtful and warm indie folk music that reminders the reader of the magnificent Cowboy Junkies and me of Kristin Hersh of Throwing Muses

This week on HIStalk Practice: CMS announces $10 million in grants to help practices transition to new payment models. Midwest Orthopaedic Consultants goes with care coordination tech from PinpointCare. AMA adopts long-awaited ethical guidelines for telemedicine practice. CureMD adds Izenda business intelligence tool to its PM software. Emergency Care Specialists launches joint venture with Answer Health Telemedicine. Facebook develops suicide prevention tools and protocols. Culbert Healthcare Solutions VP Randy Jones equates revenue cycle KPIs to “the ritual of the snipe hunt.”


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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As I mentioned in an update to Monday night’s post following a response to my inquiry to Navicure, Bain Capital Private Equity makes an unstated strategic investment (presumably taking a majority interest that meets the definition of an acquisition) in the company. Among the sellers is JMI Equity, which took a minority position in Navicure in 2009. JMI bears the initials of John Moores Inc., whose other accomplishments (beyond being an IBM programmer) include founding BMC Software, serving as lead financier of Peregrine Systems and ServiceNow, and formerly owning of the San Diego Padres.


Sales

The soon-to-open Sacred Oak Medical Center (TX) chooses Medsphere’s OpenVista EHR.

In Scotland, NHS Fife chooses InterSystems TrakCare, the twelfth Scottish Health Board to do so. 


People

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Clinical rules modeling vendor Applied Pathways hires Steve Lefar (Sg2) as CEO. Founder and CEO John Feldman will continue as board chair.

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Madhu Sasidhar, MD (Cleveland Clinic) joins consumer engagement platform vendor Envera Health as CMIO.


Announcements and Implementations

Congratulations to the HIStalk sponsors who took 40 spots in the 2016 HCI 100:

The local paper notes that FHN Memorial Hospital (IL) is testing Meditech 6.1 in its $8 million OurFHN project, expecting an October go-live.


Government and Politics

The American Medical Association approves a policy supporting the creating of an ONC-administered National Health IT Safety Center. The policy proposal was submitted by Matt Murray, MD, chair of the Texas Medical Association’s IT committee, driven in part by work done by Texas-based health IT researchers Dean Sittig, PhD and Hardeep Singh, MD, MPH.

The US Supreme Court rules that the VA must always give exclusive preference to veteran-owned small businesses when issuing contracts, overriding the VA’s argument that it is only required to meet specific annual contracting goals. The court says the VA must show preference to veteran-owned bidders as long as the competition meets the Rule of Two (at least two bidders are expected to submit offers and the amount of those bids is expected to be reasonable).

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New York’s attorney general forces legal website Law360 to stop requiring employees to sign non-compete agreements unless the employee has insider knowledge of trade secrets. Law360’s terms required all employees, even those fresh out of college, to sit out a year before taking another job in the same industry. The attorney general of Illinois is also upset that the non-compete clause in the employment agreement of sandwich chain Jimmy John’s prohibits employees from taking a job with another sub sandwich company for two years after quitting.


Privacy and Security

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A former IT employee sues Aspen Valley Hospital (CO) and its privacy officer, claiming that the hospital’s HR director/privacy officer disclosed the employee’s HIV status over cocktails with the hospital’s HR recruiter at a conference after noting a large medical claim for his antiviral medications. The employee filed a complaint with the hospital and then HHS as a HIPAA violation, after which he says he was disciplined, demoted, and then fired after 11 years at the hospital.


Other

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The Australian Medical Association calls for the capability of patients to manage their own medical records to be removed, saying that doctors don’t participate in the national My Health Record data-sharing program because they can’t rely on patient-provided information. The AMA wants patients locked out of making changes to core set of database elements that includes the meds list, allergies, discharge summaries, pathology and imaging results, weight, height, blood pressure, and advance directives. They also want eventual restriction of patient changes to ECG results, blood type, vaccination history, infectious disease status, surgery history, and even the patient’s chosen emergency contact. The AMA says the changes will increase trust and therefore physician usage of the system, which is nearly non-existent.

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A Nielsen survey finds that 89 percent of PCPs claim they often remind patients about preventive screenings, but only 14 percent of patients say they receive them. Only 5 percent of the two-thirds of Americans who are overweight say their doctors suggested a weight loss program. Half of patients aren’t seeing doctors who can view their history via an EHR. Only one in four patients can contact their doctor by email or patient portal question submission, with older people more likely to avoid use of available technology.

This has a small amount of health IT relevance: the mold-breaking YouTube teen vlog series “lonelygirl15” is being re-launched after 10 years by its creators, which include Miles Beckett, MD, CEO of electronic credentialing vendor Silversheet. I interviewed him in April 2016.

Theranos CEO Elizabeth Holmes will present at the American Association for Clinical Chemistry’s annual conference in August, with her submitted abstract suggesting that her talk will be long on defensive self-promotion and short on offering the definitive clinical validation data that scientists long to see. I’m not clear about why a college dropout should be presenting at a clinical conference or why the education committee would accept a presentation titled “Theranos Science & Technology: the miniaturization of lab testing,” but it will probably be an overflow session. I will be disappointed if the attendees don’t boo her off the stage.

In China, a hospital janitor is arrested hiring friends to direct out-of-towners looking for the hospital to a specific room he had rented inside it, where he delivered ineffective but expensive treatments. The health department has closed the hospital as a result. That type of scam is common in China, where hospitals routinely rent out rooms to anyone willing to pay.


Sponsor Updates

  • InstaMed releases its annual report on trends in healthcare payments.
  • InterSystems, Intelligent Medical Objects, and Meditech will exhibit at AMDIS 2016 June 21-24 in Ojai, CA.
  • Liaison Technologies wins a Stevie Award for Favorite New Product from the American Business Awards.
  • Visage Imaging validates the interoperability capabilities of its Visage 7 Enterprise Imaging Platform at the IHE Connectathon 2016 held in Bochum, Germany.
  • MedData will host a job fair June 22 in Grand Rapids, MI.
  • The HIMSS SIIM Enterprise Imagine Workgroup publishes its second white paper.
  • Validic and Omnicom Health Group will partner to counsel healthcare companies on connected health.
  • Netsmart will exhibit at the Washington Behavioral Health Conference June 22 in Yakima, WA.
  • Nordic receives RightSourcing’s Gold Supplier Award.
  • Qpid Health and Streamline Health will exhibit at AMDIS 2016 June 21-24 in Ojai, CA.
  • The latest KLAS report ranks Sagacious Consultants as the highest-rated firm for revenue-cycle optimization.

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June 16, 2016 News 1 Comment

EPtalk by Dr. Jayne 6/16/16

June 16, 2016 Dr. Jayne 1 Comment

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It’s weeks like this that make me want to hang up my consulting shoes for sure. Storms have intermittently snarled air traffic in the Midwest, making it hard for my partner and me to get to clients. Fortunately, since we work for ourselves, we have the ultimate authority as far as rebooking and rerouting and can decide whether we want to absorb the cost of a new ticket or stick it out.

On Monday, I was surrounded by business travelers who weren’t as lucky as I overheard several frantically calling travel agencies or seeking management approval to reroute their flights. As the week progressed, I did my fair share of sitting on the tarmac and also had one round of going back to the gate. Early summer travel is always dicey (especially if you have to go through Chicago) and my plans to avoid it never seem to actually happen.

I was optimistic yesterday morning, as I found a seat on an evening flight that would allow me to avoid leaving my hotel at 4 a.m. to catch a 6 a.m. flight to the next client. The only wrinkle was that I had to arrive at a different airport than originally planned, but that seemed OK since the client is halfway between two major airports and the drive time from each is about the same. I could arrive at my destination airport at 10 p.m., hop in my rental, drive for an hour and a half, and still get a good night’s sleep. My friends at my favorite hotel chain were happy to waive any early check-out penalty because I was booking the night at another hotel in the chain.

Little did I know that the travel gods were going to make up for my seemingly good decision in a multitude of ways. I arrived at the rental car vendor to find that there were no cars. Seriously, none. The staff was kind and offered bottled water while we waited for vehicles to be brought around. There were six of us who had come off the shuttle bus from my flight, all of us had reservations, and our flight was on time, so I’m not sure why it was a problem. Since I wanted to get to my hotel to crash, I took the first car available and headed for the exit.

All was smooth until exited the airport proper and immediately got nabbed running a red light. It was a large intersection and the light turned yellow right as I entered it, but it went red while I was in the middle of it. I’d chalk it up to bad luck, but there were three other cars that also got caught so I think it’s a timing issue on the lights. Regardless, I’ll be looking forward to a ticket in the mail in a couple of weeks and really didn’t need to add that to my to-do list.

I finally made it to the highway and settled in. I knew that I was going to have to be on toll roads, so I came prepared with cash. What I didn’t know is that the toll roads were coin-only, unattended. At the first one, I didn’t have the right change but made note of the website where I can supposedly go online and pay later. At the second booth, there was an attendant, but I was so flustered by the previous incidents that I forgot to get a receipt. Depending on who you work for, there’s no reimbursement without a receipt. I’m not going to quibble about a couple of dollars, but was just annoyed at forgetting it. At the third booth, I remembered to get a receipt, so thought victory was just around the corner. Sure enough, a fourth booth (again, unattended and coin-only) loomed.

I had planned ahead at the previous attended toll booths by making sure I got my change in quarters, so I was ready. There was a car in front of me whose driver was clearly digging through the console for change. He’d come up with a coin, throw it in the basket, and start digging again. I had my window down ready to throw my quarters in when it was my turn and could hear when he started cursing and yelling. Apparently he had thrown in enough change and it still wasn’t changing his status from “Stop!” to “Thank You” and he was getting agitated. He was reaching out and punching the toll basket. The yelling was getting louder and at one point half his body was out the window. His car was shaking from side to side because he was a big guy and he was getting really, really agitated. Needless to say I put my window up – there’s nothing quite like being trapped in a line of cars with someone acting strangely near you and you know you can’t get away. Given our current times, I wasn’t sure if he was going to end up shooting the toll station or what. He finally drove through.

I confidently tossed my coins in the basket and waited for my “Thank You” and never got it either. By now it was well past midnight, I was tired and agitated, and I just drove through, thinking I’ll sort it out on the website later. Clearly the booth wasn’t functioning correctly, but what can you do at that point? I thought back to my exit from the rental car lot –  they didn’t even offer the magic toll pass option, but I promise if I ever have to rent a car in this city again, I’m definitely asking for one.

I arrived at my hotel well after midnight, but luckily check-in was uneventful. The travel gods did finally reward me, though, with the best hotel water pressure I’ve had in a long time. People without long hair don’t always appreciate the value of ridiculously high shower water pressure, and people who aren’t on the road day in and day out may not understand the value of the little things when you’re away from home. When I got to my room, I found dozens of emails waiting for me and am now addressing them intermittently while I eat breakfast and get dressed.

For those organizations who work with consultants, it’s good to understand what your hired help might have been through to get there. If they look less than rested, there’s a reasonable likelihood that they had a hard day of travel rather than staying up watching Netflix and surfing the net. (Of course I’ve had the latter kind of days too, but they’re extremely rare.) So offer them a cup of coffee and a comfortable chair (my current one at the hotel doesn’t adjust up enough to reach the desk correctly, so I’m getting tingly nerves as I type this) and let them get to work. Don’t assume their travel has been glamorous and ask them to tell you about it. You might just get more than you bargained for.

What’s your worst travel day story? Email me.

Email Dr. Jayne.

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June 16, 2016 Dr. Jayne 1 Comment

Morning Headlines 6/16/16

June 15, 2016 Headlines No Comments

Cerner chips away at building $4.5B campus

A local Kansas City newspaper reports on the progress Cerner has made on its 10-year, $4.5 billion Trails Campus construction.

Florida Blues collected $471 million profit on ACA plans in 2015

Florida Blue Cross and Blue Shield reports $471 million in profits from its insurance exchange business, unlike the massive losses reported by other major insurers like Highmark, Humana, and UnitedHealth Group.

Consumerism in focus at AHIP 2016 this week, organizers say

Former CMS Administrator and current AHIP President and CEO Marilyn Tavenner presents the keynote speech at this year’s AHIP annual conference, calling for an increase in technology as healthcare reimbursement moves away from fee-for-service payment models.

New Methodology To Examine Spending Patterns For End-Of-Life Care

According to a Health Affairs study analyzing end-of-life spending data for Medicare patients finds that costs run five times higher for patients with multiple chronic diseases during the last year of life.

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June 15, 2016 Headlines No Comments

Morning Headlines 6/15/16

June 14, 2016 Headlines 1 Comment

Why I Disagree with the Snake Oil Analogy

BIDMC CIO John Halamka, MD takes issue with the “snake oil” analogy AMA CEO James Madara, MD used to describe EHRs during a speech at the AMA Annual Meeting. Halamka acknowledges that current EHRs do not share data, engage patients, or enable population health effectively, but says “There is no snake oil.   We created the digital foundation that is a prerequisite for the next generation of tools.”

Sonoma West Medical Center chief nursing officer sues hospital, Dan Smith, after dismissal

The former CNO at Sonoma West Medical Center (CA) files a wrongful termination suit after being fired for voicing concerns that the home-grown EHR designed and implemented by a hospital board members’ startup company was unsafe.

Teladoc Secures Major Victory in Patent Dispute with American Well

A Massachusetts federal court judge dismisses a patent infringement suit filed by American Well against telehealth competitor Teladoc, concluding that American Well’s patent is invalid because major elements are “too abstract” to be patentable.

Patient wishes are tough to see in electronic health records

A Minneapolis newspaper discusses the difficulty providers have finding advance directives within EHRs, citing a recent study that found “less than one-third of ER doctors feel very confident they could locate information in the electronic record.”

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June 14, 2016 Headlines 1 Comment

News 6/15/16

June 14, 2016 News 5 Comments

Top News

American Medical Association EVP/CEO James Madara, MD, speaking at the organization’s annual meeting, lashes out at “digital snake oil” of clinically unproven software and technology products that “impede care, confuse patients, and waste our time,” adding that “interoperability remains a dream.” He says doctors – who mistakenly failed to participate in early digital health projects – need to separate the lame digital tools from the potentially magnificent ones, explaining the present state of “digital dystopia” as:

Direct-to-consumer digital health devices—which only in the fine print say ‘for entertainment purposes only’—to our clunky electronic records, to ICUs that sound like primitive swamps abuzz with a cacophony of  bells, alarms, and whistles.

However, many of the solutions that Madara offers involve products from which AMA benefits – an incubator, an innovation studio, and lobbying efforts.

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Meanwhile, John Halamka takes the counterpoint to the “digital snake oil” label, saying that more study rather than politician-like hyperbole is needed to understand that “we’ve achieved exactly the results we designed” in striving to simply replace paper charts with their electronic counterparts and to meet various government mandates. He provides examples in interoperability (e-prescribing, public health reporting, and lab reporting); population health (EHR patient panel queries); and consumer engagement (patient portals), all of which laid the foundation for the next generation of tools that will support team-based workflow, lifetime encounter records, care management workflow support, and family engagement tools. Halamka repeats the same advice he offered for Meaningful Use: focus on a small number of achievable outcomes.


Reader Comments

From Pomp and Circumstance: “Re: vendor press releases. Healthcare institutions are increasingly forbidding them to distribute press releases announcing new sales or contracts. This may distort the perception of success of companies that are compliant with the wishes of their customers.” It’s tough for a vendor to tout their successes when the client asks them not to, going beyond just not naming the client specifically, but prohibiting the sale from being mentioned at all. That practice prevents some much-need visibility into who’s buying what, but I agree that there’s no value to the new customer unless the sale can be crafted into a more self-serving announcement.

From Sticky Wicket: “Re: innovation award winners. You didn’t list those from the attached announcement.” I don’t consider press releases of these types worth mentioning since the average health system CIO would have minimal interest in companies whose enterprise readiness is years away at best even if they manage to avoid being among the 95 percent that will never be successful. Thus I’ve stopped running announcements of the following types, preferring to wait for actual customer success:

  • Company funding under $1 million.
  • New accelerators forming or companies joining an accelerator.
  • Tiny companies winning an app contest or submitting an innovative idea.
  • Startups offering a new consumer-facing health app whose outcomes have not been studied.

From Duluth: “Re: Navicure. Sold to Bain.” Unverified. I’ve reached out to the company for a response but haven’t heard back. UPDATE: Navicure confirms that it will receive an undisclosed strategic investment from Bain Capital Private Equity. Founder and CEO Jim Denny and the executive team will remain with the company.

From Gray Sky: “Re: [vendor name omitted]. Has had outages for the past two weeks for all hosted applications. Inside information points to a storage information where customer data has been erased. The company continues to investigate options to restore the data to a reasonable point in time.” Unverified. A company spokesperson responded quickly after hours and is trying to reach one of its executives for a response, so I offered to withhold the company’s name until my next post, which will also include any response the company provides.

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From DOSsier: “Re: US Department of State. Issued an RFI for an off-the-shelf EHR for diplomatic missions.” The RFI is here, but note that it covers EHR implementation project management services only – it’s not a RFI for an actual EHR. The original plan was for the Department of State to share the Coast Guard’s Epic system, but the Coast Guard has backed away from that project. Before that, the DoS was planning to roll out the DoD’s AHLTA, so perhaps this RFI involves the DoD’s Cerner rollout. I don’t know the source of the DoS’s existing eMED system. The RFI was posted June 3 with a two-week response date.

From Pickle Entry: “Re: ACA insurance. UnitedHealth Group is pulling out of the exchange in my state. I’ve had to change insurance companies every year since Obamacare was rolled out, paying multiples of the premium prices I paid before the ACA.” The administration touts decreasing levels of uninsured citizens. That’s good, but those newly insured people are spending a lot of insurance company money catching up on their deferred health needs while young, healthy citizens are going without insurance because they are unlikely to get a payback. You can’t blame insurance companies who are stuck with a money-losing risk pool of self-selected patients when they stem their financial bleeding by exercising the only option the government gives them – shutting down their exchange plans. You are fine if you have employer-provided insurance, have a low enough income to qualify for endless government insurance subsidies, are old enough for Medicare, have few assets and therefore little financial exposure to expensive uninsured services, or are rich enough to not care. Otherwise, you’re paying more to keep the insurance-funded profits flowing to providers, drug companies, and the endless bureaucracy of middlemen who make up most of the US healthcare non-system and who are happy that ACA gave them newly insured patients to bill without touching the real problems of unjustified prices, fraud, and the financial incentive to create overutilization.

From Dan Blocker: “Re: data blocking. John Halamka says he’s never seen it. I say he needs to look harder.” Lots of people (including ONC) claim  that providers and EHR vendors intentionally block the flow of patient information, but nobody is serving up real-life examples instead of poorly sourced anecdotes. Such proof can only come from patient complaints and those are rare because: (a) patients don’t know that their interoperability expectations should be higher; (b) the moment of need is when they are unwell; and (c) they don’t have the information or incentive to figure out who to complain to. I bet that if you asked 100 people who were in the process of being seen as inpatients or outpatients to ask those providers to retrieve their history from other providers, nearly all of them would be unsuccessful, but turning that into a data blocking complaint against either of the providers or their respective EHR vendors would require a lot of investigatory legwork. Most of what’s wrong with healthcare is due to indifference or ineptitude, not carefully planned evildoing.


HIStalk Announcements and Requests

Listening: reader-recommended Fantastic Negrito, raw Delta blues from the Oakland,CA solo artist who describes his music as “uncut realness and zero concern for pop anything” and whose background is uplifting. Mark my words: all things (especially musical ones) must pass and eventually audiences will tire of shimmery musical junk food crafted by false-prophet celebrity musicians who possess no life experience and whose primary musical instrument is Auto-Tune. 

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Ms. Westover says students in her inaugural high school microbiology course in Georgia are making good use of the lab supplies we provided in funding her DonorsChoose grant request, examining bacteria and analyzing water samples in discovering “a whole new microscopic world.” 


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Hearst acquires a majority stake in MedHOK, which offers health plan software including case management, utilization management, and medication management. MedHOK will be incorporated into Hearst Health, which includes First Databank, Zynx Health, MCG, and Homecare Homebase.

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A federal court dismisses the patent infringement lawsuit brought by telehealth provider American Well against competitor Teladoc, with the court finding that American Well’s patent is too abstract to be enforceable. Teladoc asked the patent office to invalidate American Well’s patients in 2015, after which American Well sued Teladoc just before Teladoc’s IPO. American Well will of course appeal. TDOC shares have dropped 33 percent in the year since its IPO.

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Hospital medical device spend management software vendor Procured Health raises $10 million in new funding. The Chicago-based company had raised $5.1 million, with its most recent round being completed in March 2014 with little news since. 

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Sunquest acquires patient flow technology from The Royal Liverpool and Broadgreen University Hospitals NHS Trust, which it will market to customers of its Integrated Clinical Environment. 

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Patient access and RCM services vendor MedData will acquire RCM services vendor Cardon Outreach for $400 million.

Microsoft inexplicably pays $26.2 billion to buy LinkedIn in its biggest acquisition ever. Microsoft always seems desperate to grab onto whatever is trendy at the moment, wildly overpaying to acquire companies with higher growth potential that it then runs into the ground in repeated and easily predicted examples of failed synergy. MSFT is paying a 50 percent premium to the share price of LinkedIn, whose luster has faded as its revenue stalled and the platform keeps finding new ways to annoy its users in between their rare bursts of job-seeking and self-promotional activities.


Sales

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Manati Medical Center (PR) and Mayaguez Medical Center (PR) choose Meditech 6.1, raising the company’s Puerto Rico hospital count to 21. 

Tampa General Hospital (FL) selects records aggregation and referrals management tools from EHealth Technologies.

Mainstreet Health will implement the HealthMedx Vision EHR for its transitional care facilities.


People

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Justin Barnes (Justin Barnes Advisors) is named partner and chief growth officer of IHealth.

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Extension Healthcare hires Ben Kanter, MD (Sotera Wireless) as CMIO.

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Eric Kretzer (Strata Decision Technology) joins SA Ignite as SVP of products.


Announcements and Implementations

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Boone Hospital Center (MO) lays off 26 transcriptionists following the decision by parent company BJC HealthCare to outsource transcription services to Madison, WI-based Amphion Medical Solutions, which was acquired by Atlanta-based IMedX in January 2016. 

The American Medical Association adopts ethical standards for telehealth and telemedicine at its annual meeting, noting that technology doesn’t change the ethical requirements for physicians to place the patient’s interests first. The guidelines also urges physicians to be cautious in making treatment decisions based on the limited information available in a telemedicine session and suggests that care coordination is essential.


Government and Politics

The SEIU healthcare employee union tries again to convince California to cap total hospital CEO compensation at $450,000, the same salary earned by the President.


Technology

Microsoft’s new XBox console eliminates the dedicated port for its Kinect motion-based controller, leading to speculation that Kinect is being phased out. Kinect is used by several innovative healthcare applications for pain assessment, physical rehabilitation, and patient-provider communication. My speculation would be that Kinect turned out to be less interesting (and less profitable) for consumer use but it will continue with a non-gamer focus.


Other

The former chief nursing officer of Sonoma West Medical Center (CA) sues the hospital and one of its board members, claiming she was fired after raising concerns about problems with the hospital’s new clinical software that was developed by the board member’s company. She says the hospital allowed the board member to use its patients as his EHR guinea pigs because he has donated $9 million to keep the previously closed hospital afloat, with the resulting buggy product mixing up patient records, providing incorrect medication information, and failing to display the code status of patients. The software in question appears to be from E-Health Records International, which claims that its tablet-based HarmoniMD hospital EHR can be brought live in single day. Its only users appear to be Sonoma West and a single hospital in Africa.

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A Commonwealth Fund-sponsored study finds that only 30 percent of behavioral health providers use EHRs, recommending that SNOMED and LOINC terminology be enhanced to address behavioral needs, incorporating IT costs in setting bundled payment policies, adding behavioral-specific clinical decision support and interoperability capabilities to existing EHRs, and requiring EHR vendors to beef up their security capabilities.

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A Peer60 report on payers finds that BCBS and Medicare are the ambulatory provider favorites by far, with UnitedHealthcare trailing the pack. Providers like payers that get them paid more quickly with minimal staff involvement, while their least-favorite attributes are time-wasting practices, denials, and poor customer service.

CMS Acting Administrator Andy Slavitt commits at the AMA conference that CMS will simplify its processes, involve physicians in decisions that affect them, focus on patients, support small physician practices, and make “healthcare technology a tool, not an industry.” Some snippets:

Off-the-shelf tools like Certified EHRs and clinical data registries can provide complete capabilities [for quality reporting], but other options exist as well, including most types of reporting that a physician is doing today. If CMS can get data automatically or through another source, we will do so … [CMS will focus on] putting more pressure on technology vendors and less burden on physicians, so physicians can do simple things like track referrals when a patient sees another specialist or visits a hospital … It’s also time to ask a lot more of the technology and technology vendors. This is particularly true in the area of what many call interoperability … the burden needs to be on the technology, not the user. EHR vendors and hospitals that use them will now be required to open their APIs so data can move in and out of an application safely and securely. This will also serve to help eliminate the ‘desktop lock’ that occurred based on early EHR decisions by allowing technology to more easily plug and play. Today’s data silos are more a function of business practices than technology capability and we cannot tolerate it any longer.

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Here’s a textbook example of how to write a bad press release. The boring headline contains glaring spelling and capitalization errors, oddly uses the past tense, and reeks of company self-importance in providing a “news item” that would interest no one except the unfortunate author who was charged with getting some company buzz out there despite a lack of buzzworthy events. It randomly capitalizes job titles and other words that are not proper nouns (“EHR Systems”) and uses awkward phrasing that suggests it was crafted by someone whose mother tongue is not English. My mom’s advice remains valid: if you don’t have anything good to say, don’t say anything.

A Virginia hospital blames a misplaced EHR click for sending a sympathy card to the family of a patient who was in fact still alive. Sentara Martha Jefferson Hospital says someone clicked “deceased” instead of “discharged to home” in Epic, triggering the obviously automated condolences. At least the errant checkbox entry didn’t create a medical error that actually killed the patient.

Athenahealth’s Jonathan Bush provides an impassioned video reaction to news that TV host John Oliver formed a fake debt collection company, bought $15 million in overdue medical accounts receivable for $60,000 cash, and then told those patients that he was forgiving their debt. I assume that buying debt at less than a penny on the dollar means it was uncollectible anyway, so it wasn’t really much of a gift.

The Minneapolis newspaper covers the problem in which patient advance directives are not easily located in EHRs. It cites a study in which less than one-third of ED doctors were confident that they could find patient preferences for resuscitation, feeding tubes, or ventilators.

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Eastern Maine Healthcare System (ME) offers voluntary early retirement to 43 of the 300 employees in its IT department, which is running $3 million over budget.

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The American Diabetes Association is embarrassed when it allows a drug company to present new, sensitive research data to thousands of doctors attending one of its conferences, warning them to hold the information for one hour until the public announcement and the inevitable stock market reaction. The itchy Twitter finger doctors were already blasting out photos of the presentation’s title slide even before the presentation began, after which they tweeted out the presentation’s data slides and charts despite pleas from the ADA to remove them. Novo Nordisk shares dropped 5.6 percent on the modestly positive news.

Here’s the final physician practice vendor overview from Vince and Elise, which includes tips for product selection.

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Weird News Andy loves good customer support even if it comes from sophisticated ransomware hackers who now provide live-chat operators to walk victims through the payment process in an effort to differentiate themselves professionally by improving usability. WNA suggests the hacker’s customer support agent be prepared to answer questions such as:

  • How do I buy bitcoins?
  • How do I know you will actually unlock all our data?
  • Do you provide training on how not to click suspicious links?
  • How’s the weather in Romania?

Sponsor Updates

  • Impact Advisors is named as  one of the 500 largest technology integrators in North America.
  • AirWatch announces updates to AirWatch 8.4.
  • Bernoulli CNO Jeanne Venella is featured on RN FM Radio.
  • Carevive Systems will host a tweet chat on the oncology care model on June 21.
  • Cumberland Consulting Group will exhibit at AHIP June 15-17 in Las Vegas.
  • Fast Company features CTG Technical Recruiter Kate Orngard in an article on recruiters.
  • Extension Healthcare will exhibit at the ONL Annual Conference June 16-17 in Newport, RI.
  • FormFast publishes an infographic on the real cost of paper-based informed consent processes.
  • Healthfinch will exhibit at the AMDIS Annual Physician Symposium June 21 in Ojai, CA.

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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June 14, 2016 News 5 Comments

Curbside Consult with Dr. Jayne 6/13/16

June 13, 2016 News 4 Comments

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I spent 38 of the last 72 hours seeing patients. Even the full-time physicians in my practice don’t usually work that much in a short stretch, so I’m not surprised that I found it exhausting. Normally, I find our EHR tolerable, but there were times in the last several days where it was unbearable. I experienced instability like I haven’t experienced since being a beta client for another vendor several years ago. I seemed to find more errors in the physician workflow than my co-workers found in the support staff workflows, and I could feel my attention drifting because I was becoming increasingly annoyed.

At one point, I was managing multiple high-acuity patients when I encountered a string of error messages. The one above nearly put me over the edge. End users should never see error messages like the one above. It’s insulting to the users and, although I’m sure it might mean something to a developer, it doesn’t mean anything to a customer who is trying to care for patients. It’s enough to make one want to wish for even more federal regulations – but only if they require vendors to provide mechanisms for graceful error handling.

As an EHR user, I sometimes feel like I’m a research subject in an experiment that hasn’t been approved by any kind of institutional review board. Everyone thinks that Certified EHR Technology is going to make our world a better place but the jury is still out on whether it’s going to truly be effective. And while we as physicians are having to cope with arduous workflows as a result of the regulations, there are advancements that would really benefit us that remain unaddressed.

Over the last decade, I’ve accumulated a wish list of product “enhancements” that would benefit the people in the trenches. Years later, though, they’re mostly unaddressed:

  • The NCPDP standard for electronic prescribing limits the “SIG” or prescription instructions field to 140 characters. I’ve been told for years that this will be addressed in a future version of the SCRIPT standard, but it remains unaddressed in any production system I’ve ever used. Physicians who have tried to prescribe triptans or other medications that require unstructured SIGs know exactly what I’m talking about. I bet 140 characters made sense at some point, but it’s time for a change. If we can regulate the picklist selections available for marital status, certainly we can regulate this.
  • Standardized lab ordering mechanisms are lacking. One major national reference lab supports electronic directory of services (eDOS) formatting but another doesn’t. This leads to a hodge-podge of strategies for EHR vendors who are trying to manage multiple lab compendia. Some use third parties to try to keep it straight, and others push the work onto the clients. This can result in thousands of physician offices trying to stay in sync with their reference labs, often with a lot of manual work. If we can regulate the use of CPT for lab charges, certainly we can regulate this. (I have to admit that I got a kick out of this reference on eDOS that mentioned that “MU3 proposed rules are anticipated to be published in January 2014 with final rule anticipated to be published in summer 2014.)
  • Requirements for lab vendors and the way they deliver results is lacking. Although physicians are required to use LOINC codes for results to meet various quality measures requirements, there is no requirement that lab vendors send LOINC codes with their results. I’m working with a handful of clients right now who are having to do manual recoding to attach LOINC codes to their results, so that they don’t get dinged on their quality reports. If we can regulate the use of SNOMED, certainly we can regulate this.
  • Interoperability remains elusive. Even when systems communicate, the mechanisms used to reconcile data from disparate systems can be clunky at best and downright unsafe in certain situations. Although some vendors have robust algorithms to identify potential matches and bring data seamlessly into the patient chart, others deliver a greater cognitive load than I experienced in my third semester calculus class. If we can regulative giving lip service to usability through user-centered design, certainly we can make it a reality.

Unfortunately, my list is growing longer rather than getting shorter. We’re forced to gather loads of information that could be put to good use but isn’t. For example, we collect information on race, ethnicity, religious preference, language preference, sexual orientation, and more. In many cases, it’s not used to further clinical care. It would have been great to have a prompt to ask about religious fasting the other night when I was treating a patient with profound dehydration. Although it occurred to me to ask, it didn’t occur to my patient care technician or to the resident I was supervising.

My state doesn’t have a usable database for identifying potential abuse of controlled substances. That’s not a vendor problem but a failure by our legislators to ensure that what they legislated was actually delivered as promised. It’s sad, because I could benefit from that kind of technology every single day. Other states have had it for years but here I am, calling around to try to confirm my suspicions when I’m concerned about a patient.

I know the industry is going through growing pains. There is a tremendous amount of external pressure and we’re trying to use technology to solve the broader healthcare problem rather than addressing the root causes. We can’t expect that to be easy, and I’m hoping we’ll look back on these times someday and chuckle at our relative naivety. Of course, there’s always the chance we’ll look back on these times fondly, because things will have gotten worse. Let’s hope that doesn’t come to pass.

For now, I’d settle for some friendlier error messages. I’d take “I’m sorry Doctor, I’m afraid I can’t do that” rather than hearing about unhandled exceptions or missing widgets. What’s your most annoying error message? Email me.

Email Dr. Jayne

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June 13, 2016 News 4 Comments

Morning Headlines 6/14/16

June 13, 2016 Headlines No Comments

Digital Dystopia

American Medical Association CEO James Madara, MD speaks at the AMA Annual Meeting about the state of technology in healthcare, saying, w“e’re seeing digital tools in medicine that, unlike digital tools in other industries, make the provision of care less, not more, efficient.”

Walgreens formally cuts ties with Theranos

Walgreens ends its relationship with Theranos, effective immediately, citing bad test results and ongoing federal investigations.

ONC Publishes New Reports on Health IT Safety

ONC publishes two health IT safety reports: Report of the Evidence on Health IT Safety and Interventions, and Goals and Priorities for Health Care Organizations to Improve Safety Using Health IT. The reports were drafted eternally with ONC support as part of ONC’s Health IT Safety and Surveillance Plan.

Americans’ Experiences with ACA Marketplace and Medicaid Coverage: Access to Care and Satisfaction

The Commonwealth Fund publishes survey results measuring the impact marketplace insurance coverage has had on consumers. The survey found that over 80 percent of consumers were satisfied or very satisfied with the insurance they purchased, while just over 70 percent report that coverage options are good, very good, or excellent.

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Morning Headlines 6/13/16

June 12, 2016 Headlines No Comments

Privacy Concerns Halt UCSD’s Posting Of Patients’ Physician Critiques

UC San Diego Medical Center suspends its plan to publish physician ratings on its website after realizing that it solicited reviews from patients without informing them that the responses would be used in a public forum.

SA Health is offering $90,000 for a spin doctor to sell its EPAS electronic patient record project

South Australia is looking for a spokesperson to reassure the public that its over budget, behind schedule 80-hospital Allscripts EHR implementation is still a worthwhile investment.

70% of Consumers Still Don’t Price Shop for Healthcare Services: HealthMine Wellness Survey

A survey of 750 consumers enrolled in wellness programs finds that 70 percent do not compare prices before seeking medical services or pharmaceutical drugs, while only 29 percent of health plans offer online tools that would help consumers price shop.

Man lives for over a year without a heart in his body

CNET profiles the SynCardia Freedom Portable Driver, a 13 pound machine that fits in a backpack and uses compressed air to keep blood pumping through the body. A Michigan man has been using one for more than a year while waiting on the transplant list for a new heart.

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Monday Morning Update 6/13/16

June 12, 2016 News No Comments

Top News

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In light of voided test results and potential CMS sanctions, Walgreens ends its relationship with Theranos, closing all 40 of its Theranos Wellness Centers in Arizona. Walgreens will redirect lab testing to third-party companies or to the certified Theranos lab in Phoenix.


Webinar

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

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


Last Week’s Most Interesting News

  • McKesson may sell its health IT business unit to focus efforts on its core drug distribution business.
  • Vice President Biden announces formation of the Genomic Data Commons, an open-access cancer database that will help researchers collaborate and share information, as part of the administration’s Cancer Moonshot.
  • Theranos says that less than one percent of its blood test results have been voided or corrected, a clarification on earlier reports that it would need to cancel or amend tens of thousands of results.
  • Practice Fusion settles FTC charges that it misled consumers by soliciting reviews for their doctors without disclosing that the information would be publicly posted on the Internet, leading to patients unknowingly publishing their own sensitive patient information.
  • The House passes the Helping Hospitals Improve Patient Care Act, exempting ambulatory surgical centers from MU and MIPS penalties.

Privacy and Security

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UC San Diego (CA) halts plans to post physician reviews and star ratings on its website after realizing the surveys it sent to patients didn’t disclose that their comments could go public, potentially revealing their identities. The two-hospital system has postponed launching the reviews to redistribute surveys with appropriate disclosure language. While one healthcare executive believes the decision is based on physician pushback in the face of potentially damaging reviews, Practice Fusion’s recent settlement with the FTC over a similar situation lends UCSD’s decision some merit.

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Twitter locks accounts and issues password resets after reports surface that 32 million passwords were leaked on the dark web. The company denies that its servers were hacked, instead attributing the leak to “combining information from other recent breaches, malware on victim machines that are stealing passwords for all sites, or a combination of both.”


People

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The University of Iowa Health Alliance promotes Jennifer Vermeer to CEO.


Innovation and Research

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A survey of 750 insured consumers reveals that they aren’t shopping around for healthcare services as much as industry insiders seem to hope they will. Just 30 percent of health plan members comparison shop, and only 30 percent of plans offer comparison-shopping tools. While 42 percent of those surveyed ranked such tools as “very important,” it’s hard to believe that importance would translate to more savvy shopping when a similar percentage believe the "cost is covered by my health plan, so it doesn’t matter."

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NewYork-Presbyterian Hospital concludes its 10-week long InnovateNYP Pediatric App Challenge, awarding $40,000 to three finalists:

  • FhirStarters pediatric medication administration app, developed by Riley McKenna and Anees Merzi.
  • Teen Screen mental health screening and resource app, developed by Vikas Mandadi.
  • NYP Care Companion patient engagement app, developed by Ekaterina Chernetsova, Roman Makhnenko, Andrew Gluschenko, Dan Piekarz, Alexander Demura, Margarita Olshanskaya, Egor Kobelev, and Allan Wellenstein.

Government and Politics

Illinois-based Boyd Memorial Hospital, HSHS Holy Family Hospital, and Hillsboro Area Hospital will share a $155,000 USDA Learning and Telemedicine grant to expand stroke treatment, neonatal, and pediatric telemedicine programs.


Other

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Stan Larkin lives for 17 months without a heart by wearing a SynCardia Freedom Portable Driver. Powered by compressed air and worn in a backpack, the artificial heart allowed the 25 year-old – the first patient in Michigan to use the device – to live until he received a successful heart transplant in May.

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South Australia Health hopes to hire a spin doctor for a six-month stint to convince the public that its highly criticized Enterprise Patient Administration System is worthwhile. The electronic records system is years behind schedule and over budget by over $200 million. Hospital physicians have formally complained that the system cut clinical activity by 50 percent, and have written a letter listing 37 major flaws and pleading for it to be shut down. SA Health named Allscripts as vendor of choice for the 80-hospital, $225 million project in November 2010 and signed the contract a year later.

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The local paper looks at the hard time physicians often having locating end-of-life directives within EHRs, attributing the problem to a lack of training and/or intuitive field within the EHR. It holds up Gundersen Lutheran Medical Center (WI) as a forward-thinking organization when it comes to advance care planning documents. The hospital made digitizing such documents a priority when it implemented Epic in 2008.


Sponsor Updates

  • Valence Health makes the top 20 of Fastest Growing Companies in 2016 by Crain’s Chicago Business.
  • Verisk Health and ZeOmega will exhibit at AHIP June 15-17 in Las Vegas.
  • Huron Consulting Group will exhibit at Vital 2016 June 15-17 in Boston.
  • Zynx Health will exhibit at the Nurse and Home Care Forum June 15-17 in Foxborough, MA.
  • Black Book names E-MDs the top ambulatory EHR for thoracic and vascular surgery specialties.
  • The Chartis Group Director Jody Cervenak co-authors a chapter in the new second edition of the Oxford Textbook of Critical Care.
  • PokitDok attains Microsoft certification and is inducted into the Microsoft Azure Marketplace.

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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June 12, 2016 News No Comments

Morning Headlines 6/10/16

June 9, 2016 Headlines 12 Comments

Electronic Health Records Company Settles FTC Charges It Deceived Consumers About Privacy of Doctor Reviews

Practice Fusion settles FTC charges that it misled consumers by soliciting reviews for their doctors without disclosing that the information would be publicly posted on the Internet, leading to patients unknowingly publishing their own sensitive patient information.

The Helping Hospitals Improve Patient Care Act of 2016

The House passes the Helping Hospitals Improve Patient Care Act, exempting ambulatory surgical centers from MU and MIPS penalties.

Southcoast Health’s implementation of new electronic health record boosts South Coast region’s economy with an estimated $3 million in local spending

Southcoast Health (MA) says that its $100 million Epic implementation resulted in $3 million going back to the local economy in the form of hotel room, auto rental, gas, and dining costs for the Epic staff and consultants that helped manage the implementation.

Shkreli taunts feds, pleads not guilty to new charge

Martin Shkreli pleads not guilty to an updated indictment that added a new conspiracy charge to the list of criminal allegations against him.

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June 9, 2016 Headlines 12 Comments

News 6/10/16

June 9, 2016 News No Comments

Top News

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Practice Fusion settles with the FTC over charges that it misled consumers by asking for reviews of their physicians without adequately disclosing that those reviews would be posted publicly online. The reviews were published in 2012 as part of the company’s efforts to develop a public-facing healthcare provider directory. “Practice Fusion’s actions led consumers to share incredibly sensitive health information without realizing it would be made public,” says FTC Bureau of Consumer Protection Director Jessica Rich. “Companies that collect personal health information must be clear about how they will use it – especially before posting such information publicly on the Internet.” The settlement, which seems to carry no fine, prompted the FTC to publish six privacy pointers, with perhaps the most relevant being, “Disclosures should reach out and grab consumers,” and “Don’t bury key facts in a hard-to-understand privacy policy.”


Reader Comments

From EMR Expert: “Re: Financial trouble in the Middle East. Like many other vendors in various sectors, Cerner, Epic and InterSystems are having tough times collecting their money from existing clients. One of the executives of those companies stated that their Accounts Receivables of the value of more than $15 million is overdue by more than six months. Support contracts are not being renewed and payments for implementation are not honored. It is a catch 22 situation when all their clients were oil rich and now cash strapped governments/government entities.”


HIStalk Announcements and Requests

This week on HIStalk Practice: AMN Healthcare acquires Peak Health Solutions. CancerLinq announces new collaboration and practice sign-up milestones. North Carolina Medicaid reform will include the development of a statewide HIE. South Carolina lawmakers pass telemedicine-friendly legislation. SingleCare partners with American Well. Closed-door meetings in Texas could lead to more telemedicine-friendly legislation. Medfx and Falcon Physician develop software for nephrology practices. FastMed Urgent Care rolls out TouchCare telemedicine services at 57 clinics. Tandigm Health Medical Director Leslie Saltzman, DO shares the hurdles physician groups face when implementing telemedicine tech.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Xerox launches Virtual Health Solutions, a new service line that will offer providers telemedicine consulting, interface design and development, and virtual clinic services.

Connecture, a technology company that builds online health insurance marketplaces, acquires ConnectedHealth, a benefits technology platform that helps employers chose health plans. Financial terms were not disclosed.

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Southcoast Health (MA) reports that its $100 million Epic implementation boosted the local economy by $3 million, mainly through hotel room costs, car rentals, gas, and dining. Nearly a third of the health system’s budget for the project went to costs associated with expenses for Epic staff and consultants.

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Martin Shkreli jeeringly pleads not guilty to an updated indictment – one that adds a new conspiracy charge to original December allegations that he illegally took stock from a biotechnology firm he launched in 2011 and was fired from three years later. Not surprisingly, the “habitually unavoidable-for-comment Shkreli unloaded as he spoke to customers at a Manhattan Dunkin’ Donuts outlet while live-streaming on Periscope.” In related (and absurd) news, Shkreli blocks presumably reputable reporters from his Twitter stream, and lauds an upcoming satirical musical about his purchase of a $2 million single-copy Wu-Tang Clan album. It will no doubt give Hamilton a run for its money.


Announcements and Implementations

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Radiology Associates of Macon (GA) extends its RCM agreement with Zotec Partners.

Meditech develops a sepsis management toolkit for select EHR customers.

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St. Vincent’s Medical Center (CT) rolls out telemedicine services from Zipnosis.

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The Guam Dept. of Public Health and Social Services partners with Good Samaritan Hospital in Los Angeles to roll out a specialty care telemedicine program for island residents.


Sales

Houston Methodist (TX), Meadows Regional Medical Center (GA), and Shore Medical Center (NJ) sign on for Unified Provider Management software from Phynd Technologies.


People

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North Mississippi Medical Center promotes Shannon Fryery to director of telehealth for North Mississippi Health Services.

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Callie Shaver (Greenville Regional Hospital) joins Jersey Community Hospital as HIM director.

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Ed Mercado joins Crux Quality Solutions as CEO.


Government and Politics

The VA fires three more administrators within the Phoenix VA Health Care System. Lance Robinson, assistant director at the Carl Hayden VA Medical Center; Brad Curry, chief of health administration service; and Darren Deering, DO the hospital’s chief of staff; were all terminated for “negligent performance of duties and failure to provide effective oversight.” The terminations come more than two years after the exposure of the cover up of a huge backlog in medical appointments that severely impacted veteran care.

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The House passes the Helping Hospitals Improve Patient Care Act, excluding ambulatory surgical centers from Meaningful Use and MIPS penalties.


Innovation and Research

Cerner launches a one-year pilot study that will help determine whether patient’s genetic data can play a motivating role in promoting behavior change.

A Health Affairs study correlates the use of prescription drug monitoring programs with a 30 percent reduction in the rate of prescribing Schedule II opioids, a change that continued in the second and third years following the launch of the program.

A small Health Catalyst survey of hospital executives finds that 62 percent have between zero and 10 percent of their care tied to the value-based contracts CMS hopes to have hospitals converted to by 2018. Just 3 percent meet the CMS goal of 50 percent value-based reimbursement today, and only 23 percent expect to meet it by 2019.


Technology

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Avizia adds the patient-facing MyCare app to its AviziaOne telemedicine and secure messaging solution.

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Experian Health’s Coverage Discovery uncompensated-care alert tool can now integrate with Epic’s EHR.

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Influence Health develops new digital presence management technologies that include directory listings, reputation, and online provider review ratings tools.


Other

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Jennifer Lawrence signs on to play Theranos founder Elizabeth Holmes in an Adam McKay-directed drama about the now-infamous blood-testing startup.

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A mother in Australia uses Siri to call emergency services when she discovers that her sleeping baby had stopped breathing. While the digital assistant may have contributed to saving the girl’s life, it likely had more to do with the mom’s administration of CPR, given that the ambulance took 20 minutes to arrive.


Sponsor Updates

  • Impact Advisors achieves top overall performance score in the KLAS Healthcare IT Advisory Report.
  • InterSystems and PDR will exhibit at AHIP June 15-17 in Las Vegas.
  • LiveProcess will exhibit at the SC Hospital Association Hospital Preparedness Summit June 8 in Columbia, SC.
  • MedData will exhibit at the Southern Coastal Emergency Medicine Conference June 10-11 in Kiawah Island, SC.
  • Medecision signs on as a founding member of the Accountable Care Learning Collaborative.
  • Navicure will exhibit at the Arizona NextGen UGM June 10 in Phoenix.
  • Nordic and Stella Technology will exhibit at the HIMSS New York State meeting June 16 in the Bronx.
  • Millward Brown names NTT Data to its 2016 Brandz Top 100 Most Valuable Global Brands.
  • Obix Perinatal Data System will exhibit at the 2016 AWHONN National Convention June 11-15 in Grapevine, TX.
  • Experian Health will exhibit at the Georgia Society for Managed Care meeting June 12-14 in Jekyll Island.
  • PatientMatters will exhibit at the Ohio Hospital Association Annual Meeting June 13-15 in Columbus.
  • The SSI Group will exhibit at the Gulf States ASC Conference June 15-16 in New Orleans.
  • Catalyze achieves a second HITRUST CSF Certification.

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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June 9, 2016 News No Comments

EPtalk by Dr. Jayne 6/9/16

June 9, 2016 News No Comments

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Thanks to everyone who sent well-wishes about my recent hand injury. I’m happy to report that I’m recovering and have traded out the giant dressing for something more sleek – today I sported a Mickey Mouse themed bandage. I’m seeing patients tomorrow and am a bit nervous about hand hygiene, but our infection control nurse is on board with a plan. I’ll also be running with a scribe, so that will help. Laughter is good medicine and I appreciated one reader’s comment that at least I wouldn’t need to buy a foam finger to cheer my team at the ballpark.

From Florida Orange: “I was reading your post and this sentence jumped out at me: “I know my practice leans heavily towards patient satisfaction scores for determining provider compensation, and the idea that giving patients what they need (rather than what they want) can impact me negatively is always a consideration.” How is satisfaction calculated? HCAHPS scores? Press Ganey? Or Yelp reviews? And what factors make up patient satisfaction?” The methods used vary depending on whether an organization is a hospital or ambulatory group. I’ve actually seen groups use all of the above to assess patient satisfaction, plus other strategies such as anonymous waiting room surveys, online surveys, and more.

In my largely ambulatory world, the factors that come into play include: satisfaction with contacting the office (which may include appointment scheduling and availability); wait time in the office; friendliness and helpfulness of staff; whether patients felt their diagnosis and treatment was explained to their satisfaction; willingness to recommend the office to other patients; and more. My practice uses a third-party survey service that emails a link to the patient and we can see responses via a practice dashboard. They’re not anonymous and we contact anyone who doesn’t give us at least four out of five stars overall or offers narrative comments that are concerning.

Everyone likes getting good reviews, and the percentage of four- and five-star reviews impacts our bonus calculation, as does our ability to care for patients in a timely manner when they arrive. As a member of the executive team, I get an email notification when a patient activates the survey link. Sometimes this happens when I know the patient has to be driving home from the visit, which is amusing. All of our patients are emailed the survey at the time of check-out, even those that we know had less than optimal experiences. The times when we didn’t’ do well are the most important for learning and we really need that feedback.

Different organizations weigh the impact of their results in different ways. I worked with an organization a few years ago that lived and died by their Press Ganey statistics, even when the results didn’t make sense as far as supporting the organization’s overall goals. As organizations evolve along with our changing healthcare system, it’s going to be increasingly important for groups to evaluate their survey strategies on a regular basis. If processes have been improved and responses are flat, maybe it’s time to measure different elements.

Patient engagement is an increasing part of patient satisfaction, and at last week’s ONC Annual Meeting they launched a Patient Engagement Playbook. It’s designed to help organizations improve patient engagement via patient portal usage. The first phase encourages clients through the critical steps of making enrollment easy; activating features that patients want; allowing proxy access for caregivers; and integrating patient-generated health data. Physicians often resist the last item, so if you work with those who might fall into that category, a quick read might be in order.

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From Jimmy the Greek: “OK, Dr. Jayne, tell me why this patient portal view of lab results is useless. That’s right, campers, there’s no ‘normal range’ displayed.  Just how the hell is a non-clinician supposed to interpret these values?  Should I turn to Dr. Google?  Should I make a follow-up appointment with my doc to talk through the results?  Should I expect a phone call to discuss them? I have loads of data, but no way to turn the data points into useful information.” This goes right along with my recent post about trends in organizational patient portal release policies. The mere fact of releasing labs to patients doesn’t necessarily empower them, and without the right supporting information can lead to patient frustration or worry. I don’t immediately recognize this vendor, so I can’t tell whether there are other features that would help the patient understand their results such as hovering over them, but from other correspondence, Jimmy seems to be a pretty astute IT guy and would likely have picked up on something like that.

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Aprima is hosting its annual User Conference at the Omni Dallas Hotel August 5-7th. A piece on their blog caught my eye, since it quoted a client from a practice named “Serenity Now Psychiatric and Counseling Services.” That’s probably one of the best practice names I’ve seen in a long time. The write up also caught my eye since they’re offering a service project where attendees can assist with making blankets, gift bags, and other items for patients at Children’s Medical Center in Dallas. I love seeing companies help the community.

Are you a vendor who gives back? Email me.

Email Dr. Jayne

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June 9, 2016 News No Comments

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Reader Comments

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