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Curbside Consult with Dr. Jayne 11/9/15

November 9, 2015 Dr. Jayne 1 Comment

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My parents are quite the travelers. Although they’ve avoided most illnesses on the road, they did wind up recently at a walk-in clinic in rural Australia. The facility is staffed by a rotating slate of physicians who fly in periodically. They were eager to be seen before the doctor flew out.

Given my career with electronic health records, my father thought I’d get a kick out of his visit note. It’s a grand total of four pages (two which really matter) and features such complex notations as “unwell” and “sinusitis.”

The physician note is the haiku of clinical documentation and made me wonder what kind of job satisfaction this physician has related to topics such as “administrative simplification” and “regulatory documentation.” I think it’s pretty good since he doesn’t appear to have too concerned with gathering bullet points or capturing all the screenings that we’re required to document on patients in the US regardless of their presenting problem.

I’m betting the form was captured electronically since he was discharged with the original document. Talk about OpenNotes and transparency for patients. It reminded me of a note I saw in a chart when I first went into practice. We had purchased a retiring physician’s charts and it said simply: “Sore throat – PCN – $10.” You can bet the patient paid at the checkout desk and that the note was complete before the patient left the room. It may not be interoperable, but it certainly is elegant in its simplicity.

My mother also had a visit. Both were treated appropriately for their conditions and with low-cost generic medications. It’s interesting to hear about healthcare delivery in its purest form. Although their situations were low complexity and low risk, not every visit needs to have a full-court documentation press. There may be times where minimalist documentation is appropriate, but unfortunately our systems don’t support that. Even with the push for value-based care, I don’t see any payers loosening their documentation requirements.

It was with that situation in mind that I headed out this morning to work with a practice on a population health initiative. They’re a mid-sized primary care group that’s already running pretty lean, but they want to try to figure out how to better reach patients who need preventive services or who may have missed follow up steps on their chronic conditions.

Although it’s really a productivity and optimization project that doesn’t necessarily need clinical oversight, practices like to hire me because I’m an actual doctor. They feel like I have a better understanding of their needs because I’ve been a practice owner myself and have been in their position. Sometimes it makes things difficult, though, because I see clinical issues that are outside the scope of my current role but still need to be addressed.

Today was one of those days. While I was shadowing the triage nurse to get an idea of her workload and the flow of her day, she was interrupted by a call from a patient’s family member. Apparently the 87-year-old patient has been having low blood sugars after recently being placed on diabetes medication. Her sugar has been less than 50 several times in the last few weeks, which typically isn’t compatible with good brain function and puts her at risk of falls and other serious complications. As she was talking to the family and later the patient, I was watching over her shoulder to see the patient’s lab values.

Hemoglobin A1c is a marker of longer-term blood sugar control. Hers was barely elevated even before she was started on medications. She immediately had low sugars when starting drug therapy, so the physician had changed her dosing to three days a week and she was still having issues. I started wondering why in the world this doc had her on medication to begin with. With many diabetic patients, if you can keep them at a reasonable level with just diet and exercise, you try to avoid medications. Her near-normal value was certainly reasonable by most physician’s standards.

The whole goal of keeping people’s sugars in the normal range is to prevent the long-term complications of diabetes. I didn’t see any complicating diagnoses on the patient’s chart – no kidney disease, nerve damage, eye problems, etc. There’s plenty of literature that shows that especially in older patients, it’s more risky to try to keep blood sugar control too tight. Once the patient was scheduled for an appointment, I gently queried the nurse about the physician’s typical treatment of these kinds of patients.

She mentioned that he is “obsessed” with his performance scores and this isn’t the first time she’s dealt with this issue. Apparently he’s worried about “being dinged” in reporting and “losing his star” with a payer. It made me immediately remember the old adage from medical school about needing to “treat the patient and not the numbers,” which means to consider the person in front of you and not just their labs or the data. I asked her if they knew how to exclude these kinds of patients from clinical reporting if there were good reasons that they shouldn’t be treated in a certain way or managed to a certain level.

She hadn’t heard of the ability to do this in their EHR, so we asked a couple of other nurses and none of them knew it either. Excluding the patient from reporting on this particular parameter would prevent the physician from being penalized for less-tight blood sugar control in this patient who clearly should not be managed so aggressively. By lunch time, we were able to grab a few minutes with the physician in question and he didn’t know about the ability to exclude, either.

Although he was initially offended and felt that I was questioning his care, he realized that I was not only trying to help the patient, but to help him be able to practice in a more rational patient-centric manner without running afoul of the scorecards that we’re all slaves to now. Excluding patients such as this one may take a few more clicks, but they’re well worth it. Although Big Data can provide impressive insights and help us change how we practice, we need to make sure we’re changing in the right way and for the right reasons.

How has Big Data impacted your care delivery system? Email me.

Email Dr. Jayne.

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November 9, 2015 Dr. Jayne 1 Comment

EHR Design talk with Dr. Rick 11/9/15

November 9, 2015 Rick Weinhaus 6 Comments

The TimeBar: A Timeline-Based, Interactive Graphical User Interface for the Electronic Health Record

Dear Friends and HIStalk Readers:

Once again I can’t begin to tell you how happy I am to start blogging again and to resume sharing ideas about improving EHR User Interface design. I am very grateful to have this opportunity.

Had I been born half a century earlier, I would not be alive. As you recall from my last blog in May, I was recovering well from acute myelogenous leukemia (AML) and was just starting to resume blogging, introducing my concept of a timeline-based, interactive GUI for the EHR.

Life is never simple. Although I continue to have no evidence of recurrence of my acute myelogenous leukemia, about two weeks after my last post I developed unstable angina with dyspnea on exertion requiring urgent coronary artery bypass grafting, which went very well.

Unfortunately, immediately post-operatively I developed Acute Respiratory Distress Syndrome (ARDS – the etiology is still not entirely clear). After surgery, I was in the Beth Israel Deaconess Medical Center (BIDMC) ICU in Boston on a mechanical ventilator and heavily sedated for 48 days, followed by some improvement, a setback, and then a slow weaning from the ventilator. I am getting much better. My tracheostomy tube was removed about a month ago and I am now at home and am doing very well.

Although I had initially wanted to introduce my ideas for a timeline-based, interactive graphical user interface for the EHR in sequential order as a series of blogs, given the uncertainties of life, now more than ever I have decided to post my entire TimeBar design as it stands right now. It is a work in progress and comments and suggestions are most welcome. As I wrote before, I would love nothing more than to see some of the TimeBar concepts developed, improved, and expanded as an open source application.

Aside from being with my family and friends, nothing is more fulfilling for me than collaborating on the development of new cognitive tools to improve the usability of EHRs, especially given my medical history and seeing firsthand how much cognitive work my doctors and nurses expend on unnecessary EHR tasks.

New cognitive tools do not come automatically. Recall that true alphabetic writing only developed about four thousand years ago, after a very rocky start. The Arabic numeral system was only invented a little more than a thousand years ago. After Euclid described the mathematics of the triangle, it took two thousand years for Newton and Leibniz to do the same thing for the circle by inventing calculus. The first accurate timeline was only invented and published about 250 years ago. As Donald Norman famously wrote, “The power of the unaided mind is highly overrated.”

And now, despite being in the computer age, many of our EHR workflows and tools are still leftovers from the mechanical age – the age of the paper chart. Unfortunately, the electronic versions of paper charts tend to retain the worst aspects of the paper chart without taking advantage of new designs better suited to electronic charting. Specifically, I am interested in human-computer interaction designs which shift the balance of mental effort from cognition to perception, allowing us to use our extremely fast, high bandwidth visual processing system to perceive much of the data, sparing our working memory and capacity for abstract reasoning for actual patient care issues.

The document above describes the EHR TimeBar. Click the two-headed arrow bar icon to display it full screen since it will be hard to see otherwise. It can also be downloaded as a PDF file here.

Rick Weinhaus, MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

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November 9, 2015 Rick Weinhaus 6 Comments

Morning Headlines 11/9/15

November 9, 2015 Headlines No Comments

Quality Systems, Inc. Board of Directors Elects Jeffrey H. Margolis as Chairman of Board

Sheldon Razin, founder and board chairman at Quality Systems, Inc., retires after 41 years leading the company’s board of directors. He will be replaced by Jeffrey Margolis, a QSI board member, as well as the CEO of Welltok and founder of Trizetto.

Hartford Hospital, contractor to pay $90,000 in 2012 data theft

Hartford Hospital (CT) and its contractor, EMC, will pay the state a $90,000 settlement stemming from the 2012 theft of an EMC employees unencrypted laptop. The laptop, which was stolen from the EMC employees home,  containing PHI on 8,000 patients.

In 5 Minutes, He Lets the Blind See

The New York Times profiles Sanduk Ruit, MD, an ophthalmologist working in Nepal that has reduced the cost of a cataract replacement procedure to just $25 per patient. The American Journal of Ophthalmology published an RCT study confirming Ruit’s technique has exactly the same outcomes as modern Western techniques, both resulting in 98 percent success rates at a six-month follow-up.

Bellevue doctor sues patient who blasted him on Yelp

In Washington, a surgeon acting as his own lawyer sues a patient over a bad Yelp review, citing defamation of character and damage to his business and reputation.

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November 9, 2015 Headlines No Comments

Monday Morning Update 11/9/15

November 7, 2015 News 9 Comments

Top News

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Sheldon Razin, who founded Quality Systems, Inc. (NextGen) and has served as the company’s board chair for 41 years, retires. He will be replaced by board member Jeffrey Margolis, who is also chairman and CEO of Welltok and the founder of TriZetto.

Razin’s first QSI retirement came in 2000, when he resigned his president and CEO roles as a result of longstanding power struggle with activist shareholder Ahmed Hussein. Hussein resigned his own board position in 2013 with a parting shot in publicly announcing that Razin’s board involvement was damaging the company. QSII shares are trading at less than half their 2010 price and about the same as their value in mid-2005. Razin holds shares worth $150 million.


Reader Comments

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From PM_From_Haities: “Re: Allscripts’ quarterly results. Don’t fall for anything less than standard accounting, which shows the company lost money in Q3. See here – no one ever adjusts EPS down.” I’ve always been torn by whether to report GAAP or adjusted earnings, but leaned toward the latter only because the big investment firms seem to favor excluding supposed one-time events that are under the company’s control such as stock compensation and restructuring costs. Allscripts turned its most recent quarter’s $5 million GAAP loss into a $25 million non-GAAP gain; the company hasn’t reported a GAAP profit since September 2012. The article eloquently describes why CEOs love less-stringent accounting measures that are similar to the “our patients are sicker” excuses that hospitals embrace in explaining objectively measured but unimpressive outcomes:

Insofar as CEOs and CFOs understand their job to be upholding the fragile psychological state of their shareholders by managing earnings in an emotionally supportive way, GAAP makes their jobs harder by sometimes requiring firms to issue financial statements that are not uplifting. But companies have a response. Because GAAP rules must cover a broad variety of circumstances, firms can usually make the argument that GAAP fails to comprehend relevant complexities. Everyone is special, especially when they miss earnings estimates.

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From Lawn Dart Trauma: “Re: Main Line Health. Word is they’ve chosen Epic. They’ve always been Siemens – I’m surprised Cerner wasn’t able to keep them in the fold.” Unverified.

From I’ll Show You Mine If You Show Me Yours: “Re: Epic. I’m a director at a customer hospital. Our analysts are getting calls from Epic’s support representatives asking for our hospital’s operating margin. A friend of mine at Epic told me that Judy asked employees to get this information for all Epic customers. I suspect they’re trying to assess if there’s financial trouble at other Epic sites in the way of some recent news reports. It’s frustrating since the general sense I get from colleagues is that development and service of Epic’s billing applications have atrophied greatly with the outsized focus they’ve had on clinical applications and when Epic is opaque about how it spends our money. The slow reaction times in the past few years is galling when I go to UGM and see where most of the money has been spent. I enjoy the show one day a year in Deep Space, but the quality of the other 364 days is suffering.” Unverified.


HIStalk Announcements and Requests

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It was a 60-40 split on whether customers or patients would be impressed with the respondent’s employer if they had inside information. New poll to your right or here: is the impact of private equity and venture capital firms on the health IT industry positive or negative?

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Ms. W. from Texas was so excited to hear that reader donations had funded her DonorsChoose grant request for electronic quiz tools and math activity stations that she immediately emailed, “I cannot express the excitement and happiness that has consumed me. When I saw the email that said ‘funded,’ my eyes began to water. As a classroom teacher, I saw the struggles and have come out of pocket for so many other projects. It hurt that this was something I couldn’t provide them with. Then we were blessed by you. Your generosity will help so many students better grasp the concept of math.” Meanwhile, Mrs. S in Colorado says her fifth graders vie for the chance to use the math games and materials we provided, sending the photo above.

A reader who wishes to remain anonymous donated $500 to my DonorsChoose project, asking that I fund elementary/pre-school science and math classes. I applied various sources of matching money, including from my anonymous vendor executive, to fully fund these grant requests:

  • Two Amazon Fire HD Kids Edition tablets for Ms. Torres’ pre-K class in Dallas, TX.
  • Five physics STEM kits for Ms. Owens’ elementary school class in Indianapolis, IN.
  • Math manipulatives for Mrs. Johnson’s elementary school class in Tulsa, OK.
  • Four Chromebooks for Mr. Wild’s high school math classes in Kealakekua, HI (I deviated a bit from the donor’s wishes in choosing a high school project because available matching money made the cost nearly nothing).
  • Two refurbished iPad Minis for Ms. Desai’s elementary school class in Alvin, TX.
  • Hands-on STEM learning tools for Ms. Lam’s first grade class in San Francisco, CA.

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

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Last Week’s Most Interesting News

  • MedAssets will be acquired for $2.7 billion by Pamplona Capital Management, which will divest the company’s group purchasing and consulting business and combine the revenue cycle segment with Precyse, another of its holdings.
  • Cerner’s quarterly report meets earnings expectations but falls short on revenue.
  • Meditech’s quarterly report shows the continuation of an ongoing slide in revenue and profit, with services rather than product sales making up an ever-greater percentage of total revenue.
  • Francisco Partners sells it Aesynt pharmacy robotics business to Omnicell for $275 million just two years after acquiring it from McKesson.
  • Quality Systems announces that it will acquire cloud EHR vendor HealthFusion for up to $190 million.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

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


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

  • Recurring revenue made up 75 percent of the company’s total revenue.
  • Non-GAAP earnings removed $9.9 million in expenses for severance, work on the company’s unsuccessful DoD bid, and settlement of outstanding litigation.
  • GAAP earnings were reduced by $1.4 million to account for the company’s equity investment in NantHealth.
  • The company says that inpatient EHR competitors who are leaving the market (presumably McKesson and the former Siemens) give Allscripts more opportunities.
  • President and CEO Paul Black says TouchWorks and Sunrise will begin integration with NantHealth’s protocol and algorithm work within six months.
  • The company says it has under-penetrated its client base in services sales compared to “one of our large competitors” (presumably Cerner) and hopes to improve that.

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Evolent Health announces Q3 results: adjusted revenue up 45 percent, adjusted EPS –$0.16 vs. –$0.31. Shares rose 13 percent on Friday, but are still down 20 percent from their first day of trading in June.


People

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As a reader previously reported, Graham King, former president of Shared Medical Systems and McKessonHBOC, died last week at 75.


Privacy and Security

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Hartford Hospital (CT) and EMC will pay a $90,000 settlement to the state for allowing an unencrypted laptop to be stolen in June 2012 from the home of the hospital’s contractor, EMC. Both organizations agreed to encrypt patient data and provide privacy and security training to employees.

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Police officers who wear body cameras have to remember to turn them off when entering a hospital to avoid violating patient privacy, according to the Kinston, NC police department. The department says officers will otherwise be violating HIPAA, which isn’t true because police departments aren’t covered entities and therefore have no obligation to follow HIPAA requirements.


Other

A Texas man pleads guilty to wire fraud for conspiring with others to pose as Cerner employees in order to sell hospital equipment and to defraud investors. The group registered a Cerner LLC corporate name, opened a bank account under that name, and registered Web domain CernerInc.com in selling a $1 million MRI machine to a Texas hospital, which the hospital reported to authorities when the real Cerner declined to help them install it.

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CMS reinstates Faxton St. Luke’s Healthcare (NY) after it says it fixed ED problems that allowed a violent psychiatric patient to be  released without evaluation. He killed three family members hours later. The hospital changed its order entry system to make it easier to order mental health assessments, added a hard stop so that triage nurses can’t skip documenting suicide risk assessment, and ordered physicians with illegible handwriting to use dictation software.

A judge orders Geisinger Health System to provide salaries of its executives and doctors to the family of one of its medical residents who died of a brain hemorrhage while admitted to one of its hospitals. The family is suing Geisinger and wants the salary information to determine the value of the resident’s lost life. The health system has fought the disclosure of executive salaries, arguing that the information is proprietary and strategic.

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A Bellevue, WA orthopedic surgeon sues a patient who posted an unflattering Yelp review of his work, saying she damaged his business and personal reputation. The patient’s also filed a complaint with the state medical board, but they dismissed it as lacking evidence of a violation.

The New York Times profiles a Nepal-based ophthalmologist nicknamed the “God of Sight” who developed a five-minute, $25 cataract removal procedure that he has used to restore the vision of 120,000 people. The doctor manufactures his own $3 replacement intraocular lenses to avoid the $200 cost of commercially produced ones. His success rate is the same as that of US doctors who use $1 million machines.

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The Pensacola, FL paper profiles local businessman and philanthropist Quint Studer, who worked his way up through hospital administration to become CEO of Baptist Health Care (FL), a job he left to start consulting firm Studer Healthcare Group in 1998. He sold 70 percent the company for $217 million in 2011, after which it was sold to Huron Consulting Group for $325 million in January 2015.

Johns Hopkins BSN student Stephanie Olmanni, whose background includes education and experience in music and film scoring, creates a nice parody of Adele’s “Hello” that describes her frustration trying to wade through the bureaucracy of obtaining a California RN license. 


Sponsor Updates

  • TransUnion President and CEO Jim Peck is featured on the cover of The CIO Review.
  • Valence Health and Aldera share insights on risk-based healthcare landscape.
  • Health Catalyst ranks first among healthcare technology companies on the list of Utah’s 100 Fastest Growing Companies of 2015.
  • Winthrop Resources SVP Brad Swenson will present at the Virginia Hospital and Healthcare Association Annual Meeting November 11-13.
  • Xerox Healthcare wins the Best New Venture Award as part of Market Gravity’s 2015 Corporate Entrepreneur Awards.
  • ZeOmega places twelfth on the Metroplex Technology Business Council’s 2015 Fast Tech Awards List. The company also received MTBC’s Momentum Award for placing on the list five years in a row.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 7, 2015 News 9 Comments

Morning Headlines 11/6/15

November 5, 2015 Headlines 1 Comment

Allscripts Announces Third Quarter 2015 Results

Allscripts reports Q3 results: revenue increased three percent to $355 million, adjusted EPS $0.13 vs. –$0.06.

Walgreens Healthcare Clinics to Implement Epic Electronic Health Record Platform

Walgreens will implement Epic across all of its health clinics, citing access to Epic’s Care Everywhere network as a key benefit. The rollout will begin in early 2016.

The November HIT Standards Committee

John Halamka, MD and CIO of BIDMC, recaps the November HIT Standards Committee meeting while advocating for an end to the Meaningful Use program and a consolidation of Stage 3 requirements within upcoming Merit-Based Incentive Programs.

Medivo Forms Agreement with Quest Diagnostics to Analyze Laboratory Data to Help Pharmaceutical Companies Match Caregivers with Therapies

Quest Diagnostics will begin selling de-identified lab results to Medivo, an analytics company that will use the information to help drug makers run targeted marketing campaigns aimed at individual providers.

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November 5, 2015 Headlines 1 Comment

News 11/6/15

November 5, 2015 News 1 Comment

Top News

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Allscripts announces Q3 results: revenue up 3 percent, adjusted EPS $0.13 vs. –$0.06, meeting revenue expectations and beating on earnings.


Reader Comments

From Worried: “Re: HHS and Department of Justice. Investigating [vendor name omitted] for fraud in EHR certification and safety issues.” Unverified, so I’ve left out the company’s name. Let me know if you have specific information.

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From All Hat No Cattle: “Re: KLAS’s proposed interoperability measures. These are good and will really help highlight the issues, especially those that allow users to call out issues from within their own provider organizations. Issues like opt-in/opt-out are huge. I think it will also highlight the incredible job that Epic has done in allowing its clients to share information, which is becoming the gold standard.” The draft KLAS questionnaire for providers to assess their interoperability capability and use is indeed pretty good, targeting high-value connections rather than giving credit for connections that patients and clinicians don’t really care about. My only tiny quibble is that the document defines interoperability as “the ability” to exchange and use information, while the survey far more importantly assesses whether providers are actually doing it. The downside of the provider survey approach is that those who are unwilling to share information will point fingers at everyone else, skewing the results since it’s easier to blame generic “technical barriers” than to admit that you don’t want to provide information to your competitor and vice-versa. I guarantee that if health systems and doctors were paid a per-record fee for sharing their information, they would quickly overcome every alleged barrier and would pressure their technology vendors to figure it out (see: Meaningful Use bribes). The business case for helping patients being seen elsewhere is shaky.

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From Poor Quality: “Re: University of Mississippi Medical Center. Gets an F in quality from Leapfrog, making it the worst in the state.” The hospital responds with the standard “our patients are sicker” excuse, saying other hospitals dump their problem patients on UMMC and that patients should not avoid the hospital just because it earned a failing grade. Sicker patients or not, UMMC scored horribly in all six surgical safety categories, such as leaving objects in the bodies of surgery patients. The chief medical officer says it’s not about whether the hospital earns an F or an A, it’s about improving outcomes for patients as a group, although not leaving sponges in patients might be a good start toward accomplishing both.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor LogicStream Health. The Minneapolis-based company, co-founded by a pharmacist and a physician, applies algorithms to hospital or clinic EHR data to develop clinically appropriate protocols, with one client reducing its post-surgical venous thromboembolism by 80 percent in improving outcomes and saving $1.1 million by applying individual risk assessments. The company’s platform quickly identifies clinical process problems to support data-driven adjustments that improve quality and provider satisfaction. It offers specific quality improvement modules for VTEs, catheter-associated UTIs, and central line-associated blood stream infections; cost containment solutions for high-cost labs and drugs; and the ability to measure the impact of order sets and nursing flowsheets. Co-founder Daniel Rubin, MD, MHI presented a webinar on reducing care variation that provides background. Thanks to LogicStream Health for supporting HIStalk.

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Reader donations of $150, to which I applied available matching funds via DonorsChoose, provided math activity stations and wireless quiz technology for the fourth grade class of Ms. Williams in Lancaster, TX;  a CD player, lapboards, and clipboards for small-group math instruction for the class of Ms. Penagos in Carrollton,TX; and math supplies and games for Mrs. Johnson’s kindergarten class in Silvis, IL. Meanwhile, Mr. Moore sent an update from Minnesota with the photo above of his students using the STEM materials we provided.

A brilliant Twitter enhancement request comes from @Farzad_MD as he’s getting bombarded by conference attendees (some of them reporters paid by their conference presenter employer) live-tweeting banal observations and quotes that are useless out of context (and often within context). His idea: allow Twitter muting by hashtag. That would work great for squelching dull tweetchats as well, or to allow users to create Twitter “folders” that you could follow separately to bypass their sports cheerleading and instead focus only on their work-related tweets. I might add a second variant: allow muting a Twitter account for a user-defined time out, like shushing them until the conference they’re yapping about is over. The few people I follow on Twitter are mostly insightful 95 percent of the time but some of them are insufferable when they get unduly aroused by some meeting, sporting event, or personal accomplishment.

I still haven’t heard a word from anyone who has actually seen an EHR gag clause, so I’m calling BS on the reporter who stirred up that whole issue in the first place (along with the mindless parrots who squawked about that article despite its lack of evidence and obvious confusion as to what a “gag clause” even is). My assertion is unchanged: the pressure you feel to avoid speaking up about patient-endangering software problems is far more likely to come from the executive suite of your health system, not that of your software vendor.

This week on HIStalk Practice: Healthcare.gov opens with no signs of IT trouble … yet. EClinicalWorks breaks into the UK market via a new partnership. The NC Medical Society Foundation works with Chess to transition rural practices to ACOs. Sanctus Healthcare implements CCM services from McKesson BPS. Wellero President Hanny Freiwat offers physicians advice on increasing patient payments before the end of the year. SHIN-NY targets physician practices after reaching RHIO milestone. The Toledo Clinic joins the Ohio Independent Collaborative. Culbert Healthcare Solutions Director Jaffer Traish offers best practices for streamlining the efforts of IT and operations.

This week on HIStalk Connect: Teladoc’s stock price falls 10 percent after reporting its Q3 results, which showed signs of impressive organic growth but still shows the company operating in the red after 13 years in business. Fitbit reports its Q3 results, posting better than expected earnings. The company was also named in a countersuit from rival Jawbone alleging that it has established a monopoly in the fitness tracker market. Monclarity raises $5 million to launch a "brain games" cognitive training app, despite widespread skepticism from neuroscientists over the effectiveness of such apps. Lumo raises $10 million to launch a B2B wearables platform that sets a company up with sensors, software, and an API to launch their own fitness tracking wearables powered with Lumo’s technology.


Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

November 18 (Wednesday) 2:00 ET. “Making VDI Secure and Simple for Healthcare.” Sponsored by Park Place International. Presenters: James Millington, group product line marketing manager, VMware; Erick Marshall, senior systems engineer of virtual desktop infrastructure, Park Place International. Deployment of a virtual solution can optimize the experience of clinician users. Attendees will learn how to address the evolving demands of security and mobility in clinician workflow to improve the quality of care.

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


Acquisitions, Funding, Business, and Stock

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Consulting firm The Chartis Group acquires iVantage Health Analytics.

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From the Cerner earnings call:

  • EVP/CFO Marc Naughton said the company is disappointed about missing revenue expectations by $20 million, but delivered record bookings and has a strong pipeline that includes a $13.9 billion revenue backlog. The drive is that clients are tying payments to milestones and even to specific health system performance targets.
  • The former Siemens Health Services brought in $250 million in revenue, 22 percent of Cerner’s total revenue, but was responsible for half of its $20 million revenue miss as some former Siemens clients dropped their maintenance agreements. Cerner says sales of the former Siemens products are “minimal … Siemens is negligibly impacting us” and that was the plan all along.
  • President Zane Burke says the company differentiates itself from Epic by “the ability to deliver value along with predictable costs and timelines” as opposed to “their list of clients, where the significant costs of deploying and maintaining their systems have been cited as a key reason for financial challenges is starting to impact them in the marketplace.”
  • The company says Epic-using Geisinger chose Cerner for population health management because “our capabilities could not be equaled by a competitor.”
  • The company had two displacements of an unnamed ambulatory cloud competitor (presumably Athenahealth) due to “their lack of execution, failure to meet established objectives, rising costs after teaser rates, and a realization by the client that they ended up needing similar or more staff even though they thought they had outsourced the function to our competitor because they left much of the harder work and complex work to the client.”
  • The company warns that revenue from its Department of Defense subcontracting will be slow, with the first Leidos task order representing less than 1 percent of Cerner’s quarterly bookings. That task order was valued at $98 million and 1 percent of Cerner’s quarterly bookings is $16 million, so at least for the quarter, Cerner’s cut of the DoD contract is less than 16 percent.

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Cognizant reports Q3 results: revenue up 24 percent, adjusted EPS $0.76 vs. $0.66, beating revenue expectations but falling short on earnings. The company’s healthcare segment, which includes its $2.7 billion acquisition of TriZetto last year, contributed 30 percent of Cognizant’s revenue ($939 million) in a 43 percent jump.

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Dell is rumored to be planning the sale of $10 billion worth of its non-core divisions to ease the $50 billion in debt it will take on to acquire EMC, with the former Perot Systems being one of the assets that could be placed on the block. Dell bought Perot for $3.9 billion in 2009.


Sales

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For-profit, 16-hospital Iasis Healthcare (TN) chooses Cerner for EHR and revenue cycle systems.

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San Joaquin General Hospital (CA) will implement Cerner.

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Walgreens will implement Epic’s EpicCare in its 400 retail clinics beginning early next year, replacing its proprietary EHR. I think the drug chain’s 8,200 pharmacies use Greenway’s EHR, which I would expect to be at significant risk of eventual displacement since they obviously looked elsewhere for the clinics and they are bragging on the interoperability opportunities Epic will provide. Some of the sites and fast-on-the-draw tweeters missed the fact that this announcement pertains only to the in-store clinics, not all of Walgreens (yet).

ZappRX chooses the e-prescribing state law review data set and services from Point-of-Care Partners.


People

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Rush Health (IL) hires Julie Bonello (Access Community Health Network) as CIO. I’m fascinated by her LinkedIn profile that shows she earned a BSN and then an MS in computer science, dropped out of the CIO role for several years to run the family’s chain of noodle shops as she cared for her aging parents, then jumped right back in as CIO of Cook County Health and Hospitals.

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J. P. Fingado (Francisco Partners) joins healthcare talent manager software vendor HealthcareSource as president and CEO. Francisco Partners acquired the company in May.

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Community Health Systems announces that SVP/CIO Gary Seay will retire at the end of the year.

Orion Health hires Robert Pepper (NeuroTrax) as VP of marketing for North America.


Announcements and Implementations

Influence Health announces a new version of its Connect clinical portal, which alerts physicians of frequent visitors who may be at risk for readmission and integration of DynaMed’s clinical information.

Medecision and Forward Health Group partner to provide population health management solutions to New York DSRIP participants.

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Quest Diagnostics will sell de-identified patient lab results through analytics vendor Medivo to drug companies, which will then use the information to target their marketing to individual physicians. Medivo calls their business “delivering the promise of precision medicine by providing decision support on the use of targeted therapeutics,” which is probably not what pie-in-the-sky “precision medicine” dreamers have in mind when they picture using data to treat patients rather than to sell more drugs.

Healthgrades will expand its online appointment scheduling capabilities in partnership with MyHealthDirect.

Lincoln Surgical Hospital (NE) uses Summit Scripting Toolkit to import scanned documents from clinical modalities into Meditech, requiring just eight hours of analyst time to create and test the script and move it to production.

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Durham, NC-based Touchcare, which offers a $99 per provider per month telemedicine app, adds a web-based provider dashboard and integrated billing capability.


Government and Politics

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John Halamka, MD, recapping the November HIT Standards Committee meeting, repeats his call to dissolve the Meaningful Use program and move Stage 3 requirements into CMS’s upcoming Merit-Based Incentive Programs (MIPS).


Privacy and Security

An ED study finds that 71 percent of patients who use Facebook or Twitter don’t mind doctors looking at their accounts, although I can’t imagine any ED doctor who would find that any more useful that the uneventful stream of wearables data they rightfully ignore. Maybe that would be more useful for PCPs who could possibly wade through all the inevitable junk to piece together some sort of social history that the patient could have just told them directly. Or, perhaps there’s your startup idea: a private, Facebook-like app just for the intuitive entry of health status information that you share with whomever you want (doctor, family member, etc.) Maybe you post your weight or sleep schedule and your doctor gives it a “like” or adds a slightly scolding comment.


Technology

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Amazon Web Services could bring in $16 billion in annual revenue by the end of 2017, making it the company’s most valuable business at up to $160 billion.

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Researchers from Vanderbilt University School of Engineering make the hardware and software of their swallowable medical robots available via open source. The devices, also known as wireless capsule endoscopes, can be guided rather than just carried along by intestinal activity as are PillCams.

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Precision medicine is here after all: CDX develops a chemical sensor that also uses big data and machine learning to analyze a sample of marijuana and apply the experience of that strain’s users to determine whether it will deliver the desired outcome (medical or otherwise) to the app user. The company will earn revenue from displaying paid advertising of dispensaries. The company plans to expend its “electronic nose technology” into other areas, such as air and water quality. This is a brilliant business model all around.


Other

In Pakistan, Hayatabad Medical Complex, alarmed by employees and physicians moonlighting in nearby medical facilities on company time, requires them to clock in using biometric ID. Board members also mandated that all procurement be moved online.

I’m amused that the AMA’s Thursday tweetchat on digital medicine innovation was led by its CMIO – who doesn’t even have a Twitter account.

I don’t understand this at all. A DC business paper profiles ListenPort, which it contrasts to Yelp and Twitter in providing a private place to complain directly to management. I thought we had that already in products called “email” and “texting.” They offer a free basic account, so maybe I’ll try it out.

A former purchasing assistant with England-based health IT firm Ascribe is sentenced to four and a half years in prison for stealing $900,000 from the company over five years. She used the money, obtained by paying phony invoices to herself, for vacations, cars, a house, and to pay off her son’s drug debts. Ascribe hired her even though she had previously been convicted for stealing from a previous employer. Ascribe sold itself to EMIS Group in 2013 for $88 million but says it could have gotten $5 million more had the theft not reduced its profitability.

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AMIA will induct 13 new Fellows in the American College of Medical Informatics on November 15.

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An Atlantic article says programmers should stop calling themselves “engineers” since they aren’t regulated, certified, or required to take continuing education. It says the tech industry has cheapened the term “engineer” by applying it to everybody who isn’t in sales, marketing, or design.

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I haven’t watched TV for years, but this week’s episode of “CSI: Cyber” titled “Hack E.R.” (although “Hack E.D.” would have been better) apparently spins a tale of a hospital whose network was penetrated by ransom-seeking hackers through a smart TV (what the heck hospital has those?), causing the death of a patient when they disable her heart monitor. The hospital couldn’t take the network down because it would disable all their ventilators (huh?) Then a patient died when the malware-affected EHR didn’t give his doctor an allergy warning as he entered an order. The entire episode, which seems absurdly hammy and unrealistic (being TV, after all), streams here with a ton of commercials and gratuitous on-screen graphics as annoying as those “pop up” shows from years ago. I couldn’t hack (no pun intended) more than a few seconds’ worth, but I notice the series stars Ted Danson (who looks like Sam Malone’s grandfather even with his wig on) and the episode was directed by Eriq La Salle, who played Dr. Peter Benton on “ER.”


Sponsor Updates

  • A hospital group in Indonesia reports success in deploying InterSystems TrakCare.
  • A Rand Corporation study finds that Health First (FL) improved patient throughput significantly using systems from study sponsor TeleTracking Technologies to identify bottlenecks and improve processes.
  • InterSystems publishes a new white paper, “Creating Sustainable 21st Century Health Systems: EHealth and Health Information Technology.”
  • Navicure will exhibit at MGMA Mississippi November 6 in Pearl.
  • Strata Decision Technology announces highlights from its Decision Summit.
  • PeriGen will demonstrate its new PeriCALM CheckList at the Synova Associates Perinatal Leadership Forum November 11-14 in Dallas.
  • Obix will exhibit at 2015 Perinatal Leadership Forum November 11-14 in Dallas.
  • Medecision and its customer Baystate Health will present a session on population health management at the HIMSS 2015 Big Data & Healthcare Analytics Forum this week.
  • Experian Health will exhibit at the HMA CFO Forum November 11-14 in Utah.
  • Jefferson College of Public Health recognizes PatientSafe Solutions VP of PatientTouch Coordinated Care Amber Thompson as a 2015 Health Education Hero.
  • PDS CEO Asif Naseem is profiled in the local paper.
  • Validic announces client growth and enhancements that allow mobile app developers to connect to clinical devices and to Apple Health.
  • PerfectServe will exhibit at the American Association for Physician Leadership Fall Institute November 13-17 in Scottsdale, AZ.
  • Sandlot Solutions will exhibit at the HIMSS Connected Health Conference November 8-11 in National Harbor, MD.
  • The SSI Group will host a user group meeting in Nashville on November 10.
  • Streamline Health will exhibit at the HFMA Big Data Analytics Conference November 10-12 in Denver.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 5, 2015 News 1 Comment

EPtalk by Dr. Jayne 11/5/15

November 5, 2015 Dr. Jayne 2 Comments

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A shout-out to representative Steve King of Iowa for attempting to inject some Midwestern common sense into the Meaningful Use chaos. His “Putting Patients and Providers Ahead of Compressed Regulatory Timelines Act of 2015” would sunset meaningful use penalties and rebate 2015 penalties back to providers and hospitals. It doesn’t have a realistic chance of passing, but I applaud him for trying.

I mentioned last week that I’ll be attending the AMIA meeting. During my email cleanup, I happened to come across an invitation to a pre-symposium educational session and registered for it. It was lucky that I did my cleanup when I did because the session was the following morning. The late registration caused a couple of hitches in accessing the session, but the team at AMIA still got me connected in time.

I’ve attended a lot of conferences, but appreciated the ability to get some solid recommendations for first-time attendees. One of the pieces of advice that surprised me was their openness with attendees dropping in and out of sessions and following the “buzz” on social media.

One conference I attended last year required attendees to declare their intentions weeks in advance under the pretense of predicting room sizes. In reality, they were using the attendee information for target marketing in advance of the conference. They also had some pretty aggressive door-checkers who scolded attendees for leaving sessions or trying to enter ones already in progress. I understand minimizing disruptions, but I would rather people move to another session where they may learn something than to sit in a session where they don’t find value.

Now that I have more information on the meeting, I can spend my free time putting together my social schedule. There are several networking events planned, including one called WINE (Women in Informatics Networking Event). How can you go wrong with a draw like that? Unfortunately, a couple of my favorite San Francisco-area colleagues will be out of town while I’m there, but that gives me an excuse to look for new and exciting things to do in my free time.

Also in the email clean-up, I found a direct marketing piece from Pfizer about October being Gaucher Awareness Month. Although Gaucher disease only affects 50,000 – 100,000 people worldwide, it has a disproportionate impact on people of Ashkenazi Jewish heritage (one in 600) and medications are available for treatment that can make a dramatic difference for patients. Unfortunately, it’s extremely expensive (cost was $150,000 per patient per year when it first launched in 2012) despite its obvious benefit. I’ve never actually seen a patient with Gaucher Disease (treated or otherwise) as compared to other more prevalent conditions, so it seems an odd choice for a direct marketing piece.

I also found yet another email from Doximity asking me to review the residency program where I trained. I’ve been deleting these for several months. When it first launched in 2011, Doximity tried to brand itself as the LinkedIn for doctors. I’m not sure how successful they’ve been, but I suspect they’re somewhat struggling for relevancy.  I laughed, though, when I read the body of the most recent email, where they asked me to review the program because “choosing a residency program is one of the biggest decisions new physicians face in their careers” and “reviews help medical students find the right training program.” Thankfully, the program where I trained bears no resemblance to what it looked like when I was there. There have been tremendous changes to graduate medical education in the last decade and frankly anything I write would be wholly irrelevant to anyone considering the program today. I’d think that a company that is supposed to understand physicians would have a better handle on this.

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A reader contacted me about how hospitals handle Daylight Saving Time. “Our hospital claims that every hospital in the US that deals with Daylight Saving Time turns off their EHR from 1:00 to 2:00 a.m. so there are not duplicate orders, meds, notes out of order, etc. For 15 minutes prior and 15 minutes after — a total of 90 minutes — we have “Zombie Hour” every year for DST. No medical care happens in the system for one hour. Is this your experience? That if you are an unlucky soul that hits the ED from 1:00 a.m. to 2:00 a.m. on November 1 that you do not exist for 90 minutes? Isn’t there a better way? Use UTC or GMT time for meds and timestamps? I cannot imagine that EHR vendors and ONC did not think of this when it has come up before. Help me understand this.”

I was a bit puzzled by this because it hasn’t been a factor in any hospitals where I’ve worked. I double checked with one of my former hospital colleagues and our system handles timestamps in UTC but uses an adjustment for the display, whether regional standard time or regional daylight time. I polled a couple of colleagues at other systems, though, and several of them have Zombie Hour. The reader named a specific vendor in his email, which surprised me that they would not have a better solution than dropping to paper. I’d be interested to hear from vendors how they handle this issue. In the meantime, I found this NIST document on DST rules.

How does your facility handle DST? Email me.

Email Dr. Jayne.

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November 5, 2015 Dr. Jayne 2 Comments

Morning Headlines 11/5/15

November 5, 2015 Headlines 1 Comment

Cerner Reports Third Quarter 2015 Results

Cerner stock closed down 6.75 percent today after missing revenue expectations in its Q3 financial results and projecting lower Q4 earnings than analysts had forecasted. Quarterly revenue rose 34 percent to $1.1 billion, adjusted EPS $0.54 vs. $0.42.

Prestigious medical journals rejected stunning study on deaths among middle-aged whites

Two Princeton economists, one a recent Nobel Laureate, have discovered that mortality rates for whites in the US between the ages of 45 and 54 rose dramatically from 1999 to 2013. The findings, which are unseen elsewhere in the developed world, were rejected for publication by both JAMA and NEJM, before being accepted by the Proceedings of the National Academy of Sciences.

Better Together: High Tech and High Touch

A new study conducted by Nielsen Strategic Health Perspectives surveyed 5,000 patients and 630 providers on consumer attitudes toward a wide variety of technologies used in healthcare, including EHRs in the exam room, telehealth services, and text-based appointment reminders.

Many patients ok linking social media to medical records

In a study published in BMJ Quality and Safety, researchers ask adult ED patients if they would be willing to link their social media accounts to their EHR for medical research purposes, to which 71 percent of the patients agreed.

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November 5, 2015 Headlines 1 Comment

Readers Write: All Aboard the Analytics Train! Next Stop, ROI!

November 4, 2015 Readers Write 2 Comments

All Aboard the Analytics Train! Next Stop, ROI!
By Jeff Wu

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HIStalk-ers may be familiar with Zubin Damania, MD (aka ZDoggMD), a primary care physician turned health pop star. ZDoggMD has been featured on TED and produces parody videos on YouTube of our dysfunctional healthcare system.

Dr. Damania’s videos are loaded with hilarious and witty lyrics with often deep and powerful commentary on what it’s like to practice medicine in the US. His most recent video pokes fun at EHR implementation and highlights a laundry list of relevant complaints about what EHRs have done to negatively impact many providers’ care of patients. Dr. Damania’s criticisms aren’t so outlandish as to propose going back to paper, but he does make the case that we need a new and better EHR environment.

While he makes a valid argument, we also need to consider that the greatest value that EHRs provide has barely been touched.

As of September 2015, CMS’s Meaningful Use program has doled out approximately $31.6 billion in incentive payments for the adoption of Certified Electronic Health Record Technology (CEHRT). While EHR implementations have proven valuable immediate effects — such as reduction of adverse drug events and medical errors — it would be difficult to make the case that these benefits would provide the magnitude of ROI necessary to justify their costs. CMS’s own projections and several post-MU studies have demonstrated that the types of immediate benefits achieved from CEHRT will recoup only a fraction of the MU program’s cost.

What gives? Why would CMS knowingly implement a program that they knew would not provide the immediate ROI necessary to pay for its implementation?

The intention was never to achieve ROI purely on efficiency gains, optimized billing, or reductions in medical errors. What CEHRT provides is data – to an unprecedented degree.

The real value in CEHRT is the way we are getting insights into how disease and injuries progress and react to treatments. The vast volumes of data mean that we are seeing things in novel ways for the very first time. Advances in both hardware and software means that the old days of manual chart abstraction or fragmented tables in antiquated or siloed databases are being replaced with dynamic analytical platforms that can be leveraged cheaper and more effectively.

Analytics is the way to ROI and the industry is finally moving to embrace this. Several industry reports are already seeing an influx in investments into analytics. Big tech players including Google and Microsoft predict healthcare analytics to be a key area of growth over the next few years.

This is a logical next step in healthcare’s technology maturity that we’ve been talking about a lot, even here on HIStalk. While analytics is a hot topic, who it benefits is surprisingly overlooked.

Our discussions of ROI have to be with our end users in mind. Analytics offers us an important opportunity to re-engage our disenfranchised healthcare workers. Our doctors, nurses, pharmacists, and desk staff all have contributed to the data we now have. They should be the ones to chiefly benefit from the coming data harvest. I have yet to meet a doctor or nurse who didn’t have a dozen questions they knew could be answered from data within the EMR, but did not have the tools to do so. That simple fact should be both a mark of shame and a call to action to every health IT worker.

We are on the verge of shifts in practice that can be truly groundbreaking. The information revolution started by the dot-com boom in the 1990s paved the way for companies like Amazon and Zappos to transform whole industries. These adoptions of technology and analytics are being implemented by other sectors at an even faster rate (Uber, Airbnb, Square). If we in healthcare can embrace the power of analytics and purposefully drive their output to end users, we can start tapping an endless supply of ROI.

The optimism behind analytics does not diminish the challenges the next evolution in healthcare information technology will present. All the “big data” and “data governance” buzzwords are valid, but not insurmountable, and the insights we stand to gain are priceless.

The next buzzword is already circulating—closed-loop analytics. It’s the intentional, purpose-driven effort to get analytics to end users for decision making as near to real time as possible. It’s the attempt to engage end users to a degree that the outputs of our analytics serve purposeful functions in their actual practice rather than a retrospective review of what’s happened.

This progression in healthcare technology is the necessary (and hopefully welcome) change that can make the biggest difference in rejuvenating our staff and demonstrating some much-needed value.

Jeff Wu is a population health researcher with UW Health at the University of Wisconsin-Madison.

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November 4, 2015 Readers Write 2 Comments

Health IT from the CIO’s Chair 11/4/15

November 4, 2015 Darren Dworkin 3 Comments

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

Left or Right?

I recently participated in a panel discussion on the topic of collaboration tools in healthcare. While I was probably invited to extol some wisdom as a so-called expert, I found myself instead being educated by others on the panel and the audience.

I was reminded that as EMRs get little love in a crowd of doctors, CIOs equally get little love in a mixed crowd of venture capitalists, digital health CEOs, and the usual big vendors in the “helping healthcare move from fee-for-service to value” game.

The lack of love actually extended beyond just the CIO — it was aimed at the whole IT enterprise. The words “disruption” and “innovation” were thrown around in a context that implied the establishment (enterprise IT led by a luddite CIO) just needs to get out of the way.

My first reaction was of course to minimize the feedback and chock it up to folks that don’t understand the nuance and complexities of healthcare delivery. But as the panelists spoke and the audience reacted, it was not so easy. The trouble was, these folks were making great points.

I often get asked what I do as a CIO. My well-rehearsed answer is that I manage teams that help translate workflows and build engagement to advance our organization’s use of enabling technologies. My old answer was I fix computers, so the new one is better, right?

Anyway, when I break down the work our teams do and really think about how much time we spend on change management and building engagement, I’d say that easily more than half of the time is spent around some form of convincing people to adopt technology. Contrast that with users choosing to use new technologies on their own. You start to wonder: can corporate users as consumers bring their own adoption to work alongside their BYODs?

I heard someone say a while back that we love new technologies at home and hate them at work. My fellow panelists made this same point. When technologies emerge that make your life easier, corporate users — who are consumers at home — will choose them and use them across their digital lives. I always try to remember that I used Dropbox before it was allowed by corporate policy.

Below is a chart that shows the most-blacklisted and deployed apps in the workplace. While not a perfect lineup, it is not a coincidence that the ones on the blacklist (left) are consumer driven and the ones most deployed (right) are enterprise sponsored. Again, not perfect alignment by each company listed, but I bet in a straight up poll the blacklisted would win the popularity context by a wide margin.

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I’d offer up a few observations. The first is that productivity tools are different from rich-functioning workflow applications. The list includes primarily collaboration tools — you don’t see vertical applications, line of business transaction systems, or customer-facing business apps.

The second is that “land and expand” works. If you give people what they want, they will use it, and once a tipping point is achieved, the solution morphs into an enterprise one. Let’s give Aaron Levie, CEO at Box, a ton of credit for building a really credible enterprise business from early roots of “land and expand.” I bet if you asked him, he would tell you how hard it was and how many nuanced features had to be built that not a single consumer would appreciate.

Translating this to the landscape of digital health, I think it means that enterprise IT needs to better recognize emerging tools that consumers are driving into the company and find ways to adopt them – faster! I also think it means that vendors with a “land and expand” approach need to think about how they will transition from the left side of the chart to the right. While consumers seek instant usefulness from point features, healthcare organizations — like all corporations — need a lot of integration and complete feature sets.

My advice to left-side digital health companies is to find an enterprise partner, a healthcare organization that loves the idea of your product and wants to help you learn the nuance and complexities. But most importantly, one that will help you understand how to architect for a complete feature set. It may take a while, but the hard work and the longer road taken will pay off. The overnight success healthcare software vendors I meet all tell me they became an overnight success after years of hard work building the product.

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Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on Linkedin or Follow him on Twitter.

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November 4, 2015 Darren Dworkin 3 Comments

Morning Headlines 11/4/15

November 3, 2015 Headlines No Comments

$2.7 billion MedAssets sale shakes up healthcare group-purchasing market

Private equity firm Pamplona Capital Management acquires MedAssets for $2.7 billion, absorbing its revenue cycle management business and selling its group purchasing and consulting business to the VHA-UHC Alliance.

VA team blasts Phoenix personnel office

A task force sent by the VA’s headquarters to help reform the Phoenix VA medical center, which was at the center of the patient wait-time scandal last year, was sent back to Washington DC by the hospital’s director. The team reports that the Phoenix VA is being run by “a leadership team that displayed obstructionist attitudes, and clearly lacked integrity.”

Medical Information Technology, Inc. Form 10-Q

Meditech reports Q3 results: revenue down 3.5 percent to $119 million, EPS $0.37 vs. $0.50. Net income dropped 26 percent to $13.5 million.

Teladoc Announces Third Quarter 2015 Results

Telehealth vendor Teladoc announces Q3 results: revenue is up 83 percent to $20 million, EPS –$0.37 vs. –$2.68, meeting expectations on both. The company booked a quarterly net loss of $13.2 million. Share prices fell 10 percent in trading Tuesday.

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November 3, 2015 Headlines No Comments

News 11/4/15

November 3, 2015 News 2 Comments

Top News

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Pamplona Capital Management will acquire MedAssets for $2.7 billion, announcing plans to divest the company’s group purchasing and performance improvement segments to VHA-UHC and merge its revenue cycle business with another of Pamplona’s recent acquisitions, Precyse. Pamplona says the new, privately company will be a national leader in outsourced revenue cycle, technology, and education, explaining:

Existing and prospective customers of the new, realigned company should expect a business that is dedicated to investing in integrating our technology both internally and with EMR software providers; improving the visualization and utility of our data; scaling our front, middle, and back-end services businesses; and, developing offerings in patient payments and value-based reimbursement. MedAssets and Precyse employees will be part of a growing, focused business that prioritizes long-term value creation

Pamplona will pay a 30 percent premium for shares of MedAssets. MedAssets said this summer that it was exploring strategic alternatives even as an activist investor called for it to replace some of its board members due to questionable acquisitions and undervalued shares. It also lost a key customer and and announced plans to lay off 5 percent of its workforce just a few weeks ago.

Pamplona acquired Precyse in July 2015 for an undisclosed price from Altaris Capital Partners and NewSpring Capital.


HIStalk Announcements and Requests

Want to connect with me on LinkedIn? I’m here, as is Dann’s 3,649-member HIStalk Fan Club

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Mr. Graham in Illinois sent photos of his students using the STEM materials we provided, saying, “The students have shown a great interest in science. They enjoy working with these activities and do the research that goes along with them. They have learned more from these kits than I would have ever been able to teach them using our science textbooks. It is very rewarding for me to see how much they enjoy science now and how engaged they are with these activities. We would like to thank you for supporting our grant and putting these awesome materials into our classroom.”

HIT Geek donated $100 for my DonorsChoose project, which with double matching funded $400 worth of classroom projects:

  • Eight scientific calculators for Ms. Tyler’s Algebra 2 class in La Mesa, CA.
  • Green screen broadcasting equipment for Mr. Ventura’s classes in Omaha, NE to allow students to produce morning news broadcasts and video projects.
  • A field trip to the Wildlife Science center for Ms. B’s Grade 6-8 class of emotionally disabled students in Brooklyn Park, MN.

HIT Geek likes reading about my funding choices. For others who would like to donate, here’s how to do it:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

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


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: revenue up 34 percent, adjusted EPS $0.54 vs. $0.42, meeting earnings estimates but falling short on revenue expectations. The company projects Q4 revenue and earnings lower than consensus, sending shares down 9 percent in after-hours trading following the announcement.

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EClinicalWorks announces the opening of a London office and the signing of its first UK customer, the 1,700-store Specsavers optical chain. ECW says it booked $100 million in international business in the past year.

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Teladoc reports Q3 results: revenue up 83 percent, EPS –$0.37 vs. –$2.68, with its loss meeting expectations and its $20 million in revenue beating slightly. From the earnings call:

  • The company touted future potential given its 60 percent telehealth market share in a market that’s only 1 percent penetrated.
  • Subscription fees made up 85 percent of the quarter’s revenue, with the remaining $3 million coming from telehealth visits.
  • The company will raise its visit fee from $40 to $45 on January 1.
  • Teladoc spent $1.6 million in the quarter on its legal fight with the Texas Medical Board and expects to spend up to $750K more in Q4.
  • The company emphasizes that customers get what they pay for, with some lower-priced offerings failing to deliver value.
  • The company says health systems are using its product to acquire patients, while health plans are using it for population health and care management.
  • Teladoc believes CMS will allow fee-for-service telehealth payments via Medicare and Medicaid.
  • The company is working with health systems to design a post-discharge program.

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Two co-founders and a former executive of travel and expense management system vendor Concur (sold to AP last year for $8.3 billion) join Accolade. The Plymouth Meeting, PA company offer Health Assistants who work with technology and analytics to  engage with consumers to reduce utilization and costs. The company claims a 98 percent user satisfaction rate, contacting healthy members an average of five times annually and reaching out to the least-healthy ones 24 times per year.

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Referral and access management technology vendor SCI Solutions acquires Clarity Health, which offers authorization and referral management services.

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Meditech announces Q3 results: revenue down 3.5 percent, EPS $0.37 vs. $0.50 as product revenue dropped 16 percent year over year due to lower sales. Nine-month net income slid to $51 million vs. $104 million in 2014. Here’s the five-year change:

Product revenue: $60,102,900 (2010) vs. $37,004,099 (2015) – down 38 percent
Service revenue: $58,368,348 (2010) vs.$82,102,999 (2015) – up 41 percent
Total revenue: $118,471,248 (2010) vs. $119,107,098 (2015) – flat
Net income: $31,957,358 (2010) vs. $13,591,077 (2015) – down 57 percent
Earnings per share: $0.89 (2010) vs. $0.37 (2015) – down 58 percent
Shareholder equity: $408,525,252 (2010) vs. $529,738,300 (up 30 percent)


People

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Best Doctors names Peter McClennen (Allscripts) as CEO.

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HealthMedx founder Charlie Daniels (CS Funding) will return to the company as COO.

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Sam Miller, former CIO at Massachusetts General Hospital and University Medical Center (AZ), died last month in Canada. He was 77.

A reader reports that Graham King, former president of Shared Medical Systems and McKessonHBOC’s IT business, passed away this week.


Announcements and Implementations

A two-year Geisinger study finds that patients given online access to their clinical documentation via OpenNotes have a slightly higher rate of adhering to their medication regimens. It’s an unimpressive finding, but perhaps asked the wrong question in the first place since the two observations don’t seem to have much intuitive correlation. 

Wheaton Franciscan Healthcare’s southeastern Wisconsin operations will join Ascension Health, which already had 150,000 employees and 131 hospitals. Ascension pays big salaries: the CEO made $8.5 million, the CFO $4 million, the chief medical officer $2.7 million, and quite a few executives at $1.5 million and up.

In England, Addenbrooke’s Hospital is testing an online tool that allows prostate cancer patients to set PSA testing reminders and to track their own PSA levels.

A small study of outpatient diabetic patients finds that use of Glytec’s Glucommander insulin management software reduced the average A1C level from 10.4 percent to 7.4 percent within 30 days.

Middle Park Medical Center (CO) will implement Epic via Centura Health, replacing Healthland.


Government and Politics

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The just-announced 2016 work plan for HHS’s Office of the Inspector General includes examining the effectiveness of the FDA’s oversight of medical device security to determine if it adequately protects patients.

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The FDA seeks input on how technologies such as apps, telemedicine, and biomedical sensors might be used in performing clinical trials for drugs. FDA wants to know what technologies are being used, how FDA can encourage their use, and what challenges need to be overcome, especially regarding the use of patient-owned devices.

I’m bored with taxpayer trough-lappers biting the hand that feeds them, including the AMA, which announces that the Meaningful Use program is “doomed” unless Congress lowers the bar. It says the market needs new EHRs to support the way doctors practice, not mentioning how many of its members bought whatever a salesperson stuck in front of them in their zeal to pocket a seemingly easy $44,000 taxpayer bribe. AMA blames Meaningful Use for physician data entry time, the requirement to collect pointless information, and for creating interoperability barriers. AMA concludes that physicians embrace new technology, but are stymied by bureaucracy. I hope they are right, actually – it would be just fine with me if Meaningful Use went away.

Medicare will eliminate higher payments for medical practices acquired by hospitals starting in 2017, lowering their payments to be the same as for non-hospital owned practices and saving $9 billion per year. However, the change isn’t retroactive, so it effects only newly acquired practices, meaning hospitals may buy practices even more aggressively to lock in their high Medicare rates. The AHA is predictably lobbying against the change, saying it will reduce access to care. The change may have limited impact anyway depending on how far value-based care has progressed by the time the change kicks in.

Two senators are investigating why 12 of 23 non-profit state co-op insurers funded by $2.3 billion in ACA loans have failed. The senators also express concerns that the surviving co-ops may be using “creative accounting” that may lead to even more failures. A report from a few weeks ago found that all but one co-op is struggling financially, with some of their leaders blaming Republican-led funding cuts. Observers say the co-ops set their premiums too low and had to use their federal loans to pay medical claims.

A national human resources team sent by the VA’s national headquarters to help fix widespread problems (including extended wait times) and massive employee shortages at the Phoenix VA hospital was sent home by the hospital’s acting director, who told them that he “calls the shots.” The team says hospital management was “obstructionist” and “clearly lacked integrity.” The Phoenix VA’s HR department uses paper-based systems with no tracking capability, hampering its hiring efforts. The team observed chronic abseentism that left clueless people in charge and noted that several HR employees refused to learn new IT systems because they would then be held accountable for completing tasks.


Privacy and Security

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An unnamed hacker earns a $1 million prize for creating a Web-based exploit for iOS 9, which is mostly interesting because company that sponsored the challenge sells hacks non-exclusively to the highest-bidding world governments and to the NSA. An ACLU technologist referred the earlier company as a “merchant of death” that sold “the bullets for cyberwar.” The new company, Zerodium, will undoubtedly sell the hack many times for far more than $1 million to governments interested in performing electronic surveillance.


Innovation and Research

The Birmingham business paper covers Alabama Eye Bank’s self-development of a FileMaker iPad app for collecting information from cornea donors. The CIO likes that developers only need to learn one tool to deploy to both mobile and to the Web.


Technology

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The Glow fertility app comes under scrutiny after the company presents data that claims women who use it to track their fertility cycles are 40 percent more likely to conceive. Researchers immediately pounced on that assertion since the analysis proved correlation but not causation. The study also didn’t control for important variables such as prior fertility treatments. An expert says the results most likely reflect selection bias rather than an app-inspired change in behavior.


Other

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The Boise newspaper digs up old news from 2012 saying that the implementation of Epic at St. Luke’s caused provider productivity problems. It appears that the reporter was just playing in some legal databases and decided to throw some factoids together to create a non-story.

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Here’s an infuriatingly stupid and insulting comment from an oncology site that also declared the ICD-10 switch to be “much ado about almost nothing.” I suppose the next time an oncology intervention saves someone from dying of cancer we should just say the tumor “blew over” instead of thanking the oncology team for saving them.

A small survey finds that people prefer receiving their lab results via a patient portal rather than by email, traditional mail, or voice mail.

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In England, NHS launches its digital maturity self-assessment that trusts are required to complete. NHS England created its own assessment in which trusts will rate themselves on how well they use their systems. NHS declined to use the HIMSS EMR Adoption Model, saying it measures use only within a given organization and NHS wants to focus on interoperability.

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A New York business paper delves into the expensive and not universally loved “rebranding” of North-Shore LIJ Health System to Northwell Health, chosen because it’s a neutral name that won’t limit the system as it expands. The system rejected similarly dull, feel-good names such as Laudica Health, Dedication Health, and Northstar. It will spend $20 million to roll out the new name.

Experts debate whether surgeries should be recorded on video as a “surgical black box” that could be used for learning or to defend malpractice lawsuits. Naysayers don’t like the possibility that recordings could be used to prove malpractice, would increase costs, and would expose the sometimes secretive goings-on of a typical OR.

Weirton Medical Center (WV) protests the $1.5 million an arbitrator awarded to a management company the hospital hired to turn its finances around, saying the company miscalculated payment rates and failed to prepare it to earn $1.8 million in Meaningful Use money.

Weird News Andy leans on the bar and starts his story with, “A deer walks into an ER …” An injured deer walks through the automatic doors of Strong Memorial Hospital’s ED and wanders down the corridor. Unlike other ED patients, the deer was taken out to the parking lot, where animal control officers killed it. 


Sponsor Updates

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  • Medicity celebrated Halloween with an ICD-10 graveyard titled “You Don’t Want to Die on This Hill.”
  • Fox Business profiles AirStrip’s integration with Apple Watch and its use at Montefiore Medical Center.
  • Wellcentive wins the “Emerging Company of the Year” award presented by the Metro Atlanta Chamber of Commerce.
  • Aprima will exhibit at the American College of Rheumatology Annual Meeting November 8-10 in San Francisco.
  • Awarepoint will exhibit at the iHT2 Health IT Summit November 3-4 in Beverly Hills, CA.
  • Bernoulli will exhibit at the American Association for Respiratory Care Congress November 7-9 in Tampa, FL.
  • Besler Consulting wins a 2015 Bright Bulb B2B Marketing Award for best small team in-house campaign.
  • CenterX will exhibit at the NCPDP Workgroup Meeting November 4-6 in St. Louis.
  • Sunquest will exhibit with GeneInsight at AMP 2015 November 5-7 in Austin, TX.
  • Nordic releases a video titled “After ICD-10: Minimizing pain, increasing gain.”
  • Direct Consulting Associates sponsors the HIMSS North Ohio Chapter Conference November 5 in Akron.
  • Connected for Care introduces its telemedicine solution and integrate it with HealthMedx’s LTPAC EHR.
  • Divurgent will exhibit at the Virginia HIMSS Fall Conference November 5-6 in Williamsburg.
  • EClinicalWorks and Healthwise will exhibit at the mHealth Summit November 5-6 in National Harbor, MD.
  • FormFast helps hospitals move away from paper documentation.
  • The Colorado Technology Association nominates Healthgrades EVP/CIO Douglas Walton for Apex CIO of the Year.

Blog Posts


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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November 3, 2015 News 2 Comments

Morning Headlines 11/3/15

November 2, 2015 Headlines No Comments

Geisinger study: Access to doctors’ notes increases med adherence

Researchers working with the Open Notes project at Geisinger Health System report a small improvement in medication adherence among patients with access to their doctors notes. Lead investigator Eric Wright, PharmD and MPH, explains “Providing patients access to their doctors’ notes and reminding them to read them before visiting their doctor is key to reinforcing the doctors’ rationale for prescribing specific medications and dosage."

Combining Search, Social Media, and Traditional Data Sources to Improve Influenza Surveillance

Researchers from Boston Children’s Hospital and Harvard University have combined data from Twitter, Google, Athenahealth, and Boston Children’s Hospital’s HealthMap project to create a machine learning algorithm capable of tracking national flu trends with a 90 percent accuracy compared to CDC reports of actual flu activity.

Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule

CMS released its final Physician Fee Schedule rule, which adds several new telehealth billing codes and limits CQM performance data from being published to the Physician Compare website until each metric is proven to be reliable and appropriately risk adjusted.

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November 2, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 11/2/15

November 2, 2015 Dr. Jayne 1 Comment

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I attended a continuing education seminar the other day. It was a rare treat since I’m usually on the speaking side of continuing education engagements. I get most of my continuing education from online sources, reading my specialty society’s journal, and answering continuing ed quiz questions.

The seminar I attended was put on by one of the local hospitals. It targeted physicians who have been using their EHR for some time, but who need tips and tricks to make documentation faster.

A friend of mine was teaching the class and invited me to attend. She is relatively new to being a clinical informatics administrator, although she’s been an end user for a very long time. This was her first time teaching a “techy” class and she was looking for feedback on her delivery. She also wanted my opinion on whether she had prepared a good blend of clinically relevant information and technical suggestions.

I’m not on staff at her hospital, but wanted to help her out. Not to mention it was an easy way to get CME while getting a sneak peek at their state of the art (aka “hundreds of millions of dollars”) system and hear feedback from users of a system I don’t usually work with.

Physicians tend to think the grass is always greener on the other side of the fence. Being able to peek under the hood of another system usually shows that although the grass may be different, it’s not always greener. Many of the physician comments made during this class were the same ones I hear when working with users of other systems: not enough user-level configurability, alert fatigue, too many clicks, etc. Half the physicians in the room might love a particular features while the other half hate it.

This group was no different. Some of the lines of disagreement split as anticipated, whether specialists vs. generalists or procedural specialties vs. cognitive specialties.

My friend did a great job covering some of the nuances of the EHR. Whenever she covered an area where physicians were particularly struggling, she was not only able to show the best practice workflows, but often provided commentary on why the system was set up in a particular way or why a feature might or might not be enabled. Many of the attendees were in agreement that understanding the “why” behind a given feature can make it seem less clunky if it’s clear the benefits outweigh the annoyances of the workflow.

This allowed for a lot of dialogue among the end users, the IT department, and the administrators. Usually I don’t see IT or administration attending sessions like this and it went a long way towards convincing the providers that their organization really does care what they think about the EHR and that they are committed to making the workflows as good as they can possibly be. It also allowed them to hear directly from the physicians without the help desk or a physician services liaison trying to translate or summarize the concerns.

My friend did a fantastic job with her training. After the initial lecture portion of the class (which granted continuing education hours), there was a 45-minute lab time where trainers were available to work with attendees on particular workflows or sticking points. That way, any outstanding questions could be addressed immediately and the learners could also practice and solidify the new workflows they had used in class. She also incorporated hot button clinical issues into her examples, leading several of the providers to go in and update their order sets or modify their preferences accordingly.

Having immediate lab time after the formal lecture is something that many workflow classes lack. Attendees are often excited about learning, but then have to go back to their department or patient care area and have difficulty finding the time needed to try new workflows in a protected environment or to update system configuration. It was also great having trainers to work one on one with attendees so that those who might have been struggling or had more questions knew that they would be able to get help and didn’t derail the rest of the class with questions.

I met with my friend after and gave her a couple of ideas for changes to her presentation style as well as a heads-up about some speech habits that might be distracting to learners. As a clinician who was thrown into the administrative and training realm without a lot of formal support, I know that kind of feedback can be valuable. I have a mentor who sits in on some of my presentations from time to time and does the same thing for me and the advice I’ve received has been extremely valuable.

Depending on the medical school and residency training program a physician attends, there may be solid presentation skills training or none at all. I remember my first presentation as a student, using overhead projector transparencies and a carousel projector. I may be dating myself, but that required a lot more advanced preparation to get slides organized and transparencies created. I definitely appreciate being able to throw together a presentation on the fly, but sometimes we lose the formality we had when we were lower tech.

Hospitals that don’t offer this kind of ongoing EHR training and optimization sessions are short-changing their end users. They don’t always have to be this formal and with this many resources involved, but having them available to users on an ongoing basis (whether live or recorded) is critical to long-term success and user satisfaction.

Does your hospital offer ongoing EHR training? Email me.

Email Dr. Jayne.

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November 2, 2015 Dr. Jayne 1 Comment

Readers Write: Financial Health of Patients Is an Afterthought

November 2, 2015 Readers Write No Comments

Financial Health of Patients Is an Afterthought
By Jonathan Wiik

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Most healthcare providers offer exceptional levels of care to their patients. After all, we patients expect it. But what most patients don’t expect is the rising cost of healthcare, and unfortunately, financial health is often an afterthought for both parties.

The average deductible for a single person enrolled in an employer-sponsored health plan reached $1,217 in 2014, just under a 7 percent increase over the previous year, says a 2014 study published in JAMA. What’s more, the Affordable Care Act (ACA) Bronze Plan—the new 2015 HDHP (high-deductible health plan) entry plan for patients—establishes its average annual deductible at $5,203.

By 2019, providers could see a 50 percent increase in the amount of revenue requiring a collection from patients. Of that amount, 30 percent (as much as $200 billion) will be written off as uncollectable, according to estimates from Citi Retail Services, a division of Citigroup. Among households with incomes over 400 percent of the poverty line, almost half cannot afford the higher deductible amounts.

For these reasons, many healthcare consumers are reluctant to pursue adequate and timely medical care. The fact is, they simply cannot afford it.

Consider these facts:

  • A recent report issued by the Consumer Financial Protection Bureau (CFPB) found that medical debts account for a majority of debt-collections actions appearing on consumer credit reports.
  • An earlier Kaiser Family Foundation report found that one in three Americans struggle to pay medical bills, in spite of 70 percent of them being insured.
  • Unpaid medical bills are the highest cause of bankruptcy filings, outranking both credit card and mortgage debt.
  • Once in debt, many people may delay or forego other needed care to avoid incurring further unaffordable medical bills.

The number one complaint from patients typically concerns confusion with their medical bills, an issue that could be alleviated with proactive, data-rich discussions on the front end of the cycle. Accordingly, financial clearance—an industry term—is gaining momentum. Screening patients for eligibility under their insurance plan, confirming benefits are payable for the services they are about to receive, and ensuring they can afford to fund their out-of-pocket costs are paramount processes that should occur as early as possible.

Similarly, 501(r), a component of the IRS tax code covering not-for-profits, is garnering a lot of attention. The rule, which takes effect in January 2016, requires that not-for-profit hospitals demonstrate the effectiveness of their financial screening for charity programs, among other initiatives.

Additionally, under certain provisions in the law, providers must offer charity care to qualified patients and refrain from pursuing aggressive collection actions for those who would have otherwise been eligible. Documentation of charity assistance, processing, discounting, and collections must all occur prior to billing.

From a high level, financial clearance helps ensure three important things:

  1. That patients are paying within their financial means and are receiving financial assistance where possible.
  2. That providers and government programs are maximizing their scarce resources for charity and other programs.
  3. That bad debt, bankruptcy, and collection issues are reduced for provider and patient alike.

A patient’s financial health is becoming increasingly important in healthcare. Providers, for their part, must ensure that they have sophisticated tools and workflows to put both parties on the same page from the start.

Jonathan Wiik is principal consultant at TransUnion Healthcare.

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November 2, 2015 Readers Write No Comments

Morning Headlines 11/2/15

November 1, 2015 Headlines No Comments

Francisco Partners to Sell Medication Management Company Aesynt to Omnicell

Omnicell acquires Aesynt, a company making medication robots and pharmacy automation systems, for $275 million.

CPSI Announces Third Quarter 2015 Results

CPS reports Q3 results: revenue is down 16 percent at $44.6 million, EPS $0.31 vs. $0.83. Stock prices fell 15 percent after the results were published.

Quality Systems, Inc. Announces Agreement to Acquire HealthFusion Holdings, Inc.

Quality Systems, which sold off its NextGen hospital EHR business last week, will acquire the cloud-based HealthFusion EHR for up to $190 million.

Healthcare IT Trends in England | 2015

Peer60 publishes a report on the UK EHR market, finding that Epic, Cerner, and Allscripts have replacement vendor mindshare among hospital executives, with Epic leading among the three. Epic’s only live customer in the UK is Cambridge University Hospital, where its $300 million implementation resulted in the resignation of the hospital’s CEO and CFO, and an investigation from the NHS Monitor.

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November 1, 2015 Headlines No Comments

Monday Morning Update 11/2/15

November 1, 2015 News 8 Comments

Top News

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Medication management technology vendor Omnicell will acquire Aesynt, which offers pharmacy robotics, for $275 million. As reader WhoKnows points out, McKesson bought the former Automated Healthcare in 1996 for $65 million and then sold it in late 2013 to Francisco Partners for a rumored $52 million. That’s either horrible McKesson mismanagement or a truly spectacular performance by Francisco Partners, which gets a five-bagger in just two years. The only acquisition I recall Aesynt having made was Italy-based Health Robotics, which was having limited success with its IV room robotics technology. FP didn’t even change the CEO when it bought the company – Kraig McEwen came on board in November 2011 and remains to this day.


Reader Comments

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From All Hat No Cattle: “Re: John Glaser. I noticed his CV lists his HIStalk Lifetime Achievement Award from 2011. I wonder if any of the other HIStalk award winners list theirs?” Probably not, but someone new will have that chance in around four months when we do it again. 

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From Over Easy: “Re: Hoag Hospital in Orange County. Rumor is another senior IT leader was released or resigned, which makes the third in the last four months. The hospital has implemented drastic budget cuts in IT and overall in the past two years.” Unverified. I don’t think I know anyone there.

From Wayne Tracy: “Re: VA-DoD interoperability. As a retired Naval Officer having commanded a field hospital (Fleet Hospital 13B) I have come to the conclusion that until Congress holds the Surgeon Generals of the Army, Air Force, and Navy as well as the head of the VA personally responsible, nothing is going to change. Give them a two-year deadline and withhold all medical computer budget funds until they are fully interoperable in real time (say, using HL7’s FHIR) or the budget goes away. It seemed to work when the railway system was not going to meat the end-of-year (2015) deadline — the New York to Washington line miraculously got done in two weeks. Somebody with big brass ones needs to be put in charge. Congressional oversight hasn’t worked to date,  just more deadline extensions. Congress, grow some!”

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From Wealthy and Wise “Re: Highmark. As patients grovel for care and medications, these guys are raking it in. No wonder they are struggling financially and cutting care and services. Shameful and despicable.” It’s big money in Pittsburgh healthcare, where Highmark Health’s former CEO earned $10 million in 2014 having worked there less than two years before he was paid to go away. Highmark paid its human resources chief $2.7 million and its treasurer $3.3 million. The CEO of arch-rival UPMC made $6.4 million.

From Purple Hay: “Re: UnityPoint Health System, Iowa. VP/CIO Joy Grosser is gone.” Unverified. Her LinkedIn profile is unchanged, but her patch of real estate on the health system’s executive page is now vacant. I searched their site for information and found only that she was paid $591K last year, with other fun information from their Form 990 being that their largest-expense contractors were all IT related: Epic ($7.8 million), McKesson ($4.7 million), and IBM ($4.5 million). Fifth-highest was a “branding agency” that earned $4 million for doing whatever vital, patient care-focused work that branding agencies are known for doing.

From Maven PR: “Re: headlines. You need sexier ones to bring more attention to what you write. I can help you.” I won’t stoop to the level that many or most sites do in shamelessly fooling readers into clicking over to crap stories by using CNN-type click-bait headlines, mind-numbing slide shows, pointless stock photos, and “listicle” articles that start with a number (in the form of “6 Tricks You Won’t Believe that Lame HIT Sites Use to Suck In Readers.”) I would hope that health IT people and advertisers are smart enough to realize that the steak they hear sizzling is usually just cotton candy, but regardless, I would rather have 100 smart, influential, engaged readers than 1,000 who mindlessly click on whatever shiny object is thrust in their face without recognizing that they’ve been had.

From Atom Heart CIO: “Re: DonorsChoose. I think your legacy will be more about the charitable work you have done than with HIStalk, which is amazing given how successful HIStalk has become.” I don’t seek or expect a legacy either way, but it’s exciting thinking about how the donations readers make to DonorsChoose might, through some unlikely chain of events, help some kid become a legacy themselves. One of these days I’ll either decide to quit writing HIStalk or just die in the saddle, in which case I’ll fade away with my planned or unplanned final post being the only artifact of my anonymous existence (and leaving Weird News Andy homeless).

From The PACS Designer: “Re: ICD. With our first month under ICD-10-CM with no major issues, it’s time to focus on the next aspect, ICD-10-PCS (Procedure Codes). Since it will be done first here in the US, it gives us the opportunity to choose where we do it initially. TPD proposes that we do it with the VA and DoD so that a breakdown occurs to the barriers each of them currently have against each other working together to improve healthcare for our military and veterans.”


HIStalk Announcements and Requests

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Poll respondents were evenly split on whether they’d want Theranos running their lab tests. I agree with Don, who said that using the company’s services has nothing to do with a pinprick blood sample and everything to do with convenience and pricing. I enjoy visiting LabCorp and Quest about as much dealing with the people at the driver’s license office. New poll to your right or here: if your customers (or patients) knew what you know about your employer, would they be more impressed or less impressed?

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Mrs. G sent photos of the printer supplies, reading games, and early literacy books we provided to her Los Angeles pre-kindergarten class via her DonorsChoose grant request, adding, “There are no words to describe the impact this has had on my life. My students and I feel so blessed for your kind donations.”  Ms. G from Oklahoma sent photos of her students using the earbuds we provided to her elementary school class for online math intervention work.

I thought sure Facebook would collapse this weekend under the weight of every single parent in America posting pictures of their costumed children. Speaking of which, I was also thinking that people seem to like spending Halloween prowling around old buildings where people have died, making any former hospital an ideal choice since the number of deaths inside any of them must be huge.


Last Week’s Most Interesting News

  • A diverse group of lawmakers slams the VA and Department of Defense for their expensive and stubborn failure to integrate their electronic medical records systems.
  • Theranos restructures its board and takes another hit when the FDA labels its proprietary Nanotainer blood draw system as an uncleared medical device.
  • CMS reports a quiet, non-eventful October following the ICD-10 switchover.
  • The AMA and MedStar Health rank EHRs on user-centered design without actually doing any research or measuring usability.
  • Xerox and Lexmark announce poor quarterly results and announce plans to review and possibly restructure their operations.
  • Athenahealth shares jump sharply after beating quarterly expectations, while those of Huron Consulting tank on lowered guidance due to delays in two academic medical center projects.

Webinars

November 11 (Wednesday) 2:00 ET. “Trouble Upstream: The Underinsured and Cash Flow Challenges.” Sponsored by TransUnion. Presenter: Jonathan Wiik, principal consultant, TransUnion Healthcare. The average person spends nearly $15,000 per year on healthcare as deductibles keep rising. Providers must educate their patients on plan costs and benefits while controlling their own collection costs by using estimation tools, propensity-to-pay analytics, and point-of-sale collections. This webinar will highlight industry trends in managing underinsured patients and will describe ways to match patients to appropriate funding.

November 12 (Thursday) 1 :00 ET. “Top Predictions for Population Health Management in 2016 and Beyond.” Sponsored by Medecision. Presenters: Tobias C. Samo, MD, FACP, FHIMSS, CMIO, Medecision; Laura Kanov, BS, RRT, MBA, SVP of care delivery organization solutions, Medecision. With all the noise and hype around population health management, the presenters will share their predictions for 2016 and their insight into meeting the mounting pressures of value-based reimbursement and the tools and technology needed to manage care delivery.

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


Acquisitions, Funding, Business, and Stock

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Quality Systems Inc. will acquire cloud EHR vendor HealthFusion for up to $190 million. QSI announced just over a week ago that it sold its NextGen hospital business to QuadraMed.

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CPSI announces Q3 results: revenue down 16 percent, EPS $0.31 vs. $0.83. Shares took a 15 percent dive Friday on the news. The company seems to be struggling now that HITECH-fueled hospital EHR sales are drying up, leaving it to hope that a replacement market emerges. Above is the one-year share price chart of CPSI (blue, down 39 percent) vs. the Nasdaq (up 9 percent).


People

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Sarika Aggarwal, MD, MHCM (Fallon Health) joins XG Health Solutions as SVP of population health and chief medical officer.

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LifeImage names Matthew Michela (Healthways) as president and CEO. He replaces co-founder Hamid Tabatabaie, who will move to EVP and remain on the board.

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Former Siemens Healthcare North America President and CEO Gregory Sorenson, MD takes a minority interest in Deerfield Imaging, which offers image guiding technology, and will become its executive chairman.

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Jim Macaleer, co-founder, chairman, and CEO of Shared Medical Systems until he sold the company to Siemens in 2000, died last Thursday.


Announcements and Implementations

Fitch Ratings holds its rating of MetroHealth’s bonds as stable, concluding that the Ohio health system “has demonstrated the ability to be profitable with its challenging payor mix due to its longstanding electronic medical record (Epic), closed medical staff, and care management processes.”


Other

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Peer60 publishes “Healthcare IT Trends in England.” NHS hospital executives say their top challenges are physician and nurse shortages, care coordination, and managing and analyzing data. Allscripts, Cerner, and Epic hold high mind share in both EPR (above) and PAS, suggesting they are well positioned to gain business in both clinical and administrative areas.

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Greencastle Associates Consulting is named as one of three finalists for the US Chamber of Commerce Foundation’s “Hiring Our Heroes” award for hiring veterans and military spouses. Malvern, PA-based Greencastle was founded by Army Rangers and its three primary executives are all veterans.

Struggling Kinston Hospital (NC) ends its shared services agreement with Novant Health — which included IT improvements — after less than a year,

In Northern Island, Belfast NHS Trust underpays 1,500 employees due to a software error. The union declares the situation to be “totally unacceptable,” apparently finding it even worse than just “unacceptable.”

A healthcare IT entrepreneur says entrenched software vendors are stifling innovation by refusing to open up their systems to startups, causing new companies to burn through their seed rounds without sales to sustain them. He concludes that patients are harmed because “interoperability into the legacy systems of their customers still remains a primary roadblock.” To which I would offer a counterpoint: rightly or wrongly, we’ve defined healthcare (and therefore healthcare IT) as a business. As with any business, it’s irrational to expect competitors to behave in any way that isn’t self-serving, as much as we like to pretend that everybody’s primary motivation is altruistic patient care. Provider or vendor, you are naive and likely to be insolvent if your business plan assumes that your computers will voluntarily lower your barrier to entry.

I asked Vince Ciotti if he would write something about Jim Macaleer in way of tribute for the folks who knew him and who may not have heard that he passed away.


Sponsor Updates

  • DataMotion publishes an infographic titled “A Brief History of Data Breaches and Security Regulations in Healthcare.”
  • Ear, Nose and Throat Associates of Texas describes its easy implementation of Talksoft’s RemindMe application.
  • Vital Images will exhibit at HIMSS Latin America November 4-5 in São Paolo, Brazil.
  • VitalWare SVP of Operations Doug Picatti is featured in a CNBC report on key issues in the presidential debate.
  • Huron Consulting Group releases the latest edition of its clinical research management briefing.
  • ZeOmega will exhibit at the TAHP Managed Care Conference & Trade Show November 2-3 in San Antonio, TX.
  • Zynx Health will exhibit at the Meditech Physician and CIO Forum November 5-6 in Foxborough, MA.

Blog Posts


Contacts

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

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