Recent Articles:

Cerner CEO Neal Patterson Dies of Cancer Complications

July 9, 2017 News 1 Comment

image 

Neal Patterson, co-founder, CEO, and chairman of Cerner, died Sunday of complications following a reoccurrence of cancer. He was 67.

The company announced that co-founder and vice board chair Cliff Illig will serve as chairman and interim CEO.

Illig said in a statement, “This is a profound loss. Neal and I have been partners and collaborators for nearly 40 years, and friends for longer than that. Neal loved waking up every morning at the intersection of health care and IT. His entrepreneurial passion for using IT as a lever to eliminate error, variance, delay, waste, and friction changed our industry.”

image

Cerner says its CEO selection process is nearly complete.

Morning Headlines 7/7/17

July 7, 2017 Headlines No Comments

After the Medicare breach, we should be cautious about moving our health records online

The Australian Federal Police are investigating after discovering that Medicare card details of Australians was available for purchase on the dark web.

The MeDoc Connection

An analysis of the spread of the NotPetya cyberattack concludes that a popular Ukranian accounting software hosted on compromised web servers propagated the attack.

FirstHealth completes major project

FirstHealth (NC) goes live on Epic following an 18 month implementation.

News 7/7/17

July 6, 2017 News 17 Comments

Top News

image

Patrick Soon-Shiong’s NantWorks buys a controlling interest in hedge fund-owned Verity Health, which runs six California non-profit safety net hospitals previously operated by Daughters of Charity Health System under the Integrity Healthcare name.

image

Soon-Shiong pledged in an announcement that the company will apply “the limitless powers of collaborative science and technology to transform healthcare practices and create a more efficient, more effective health system. Medical care is local and we strongly believe that community health systems should be supported with investment, technology, and science to build next generation clinically integrated networks to drive better outcomes at a lower cost.”


Reader Comments

image

image

From Pithy Aside: “Re: Cerner wins/losses.Here’s the information from the 2016 and 2017 KLAS clinical market share report.” A reader previously subsetted the KLAS data in an attempt to focus on what he or she thought would be most interesting to Wall Street analysts, but the bottom line per KLAS (as commented here previously) is, “Acute wins for 2015-2016 for Cerner: 249 (this number includes 1 Soarian add on in 2015). Total Millennium losses for 2015 and 2016: 53. Cerner’s net growth is thus 196 acute hospitals for 2015 and 2016.” Certainly further segmentation by deal count vs. hospital count, organization type, bed size, accounting for multi-hospital deals like the DoD and Emerus, net-new customers vs. footprint expansions, migrations either way due to mergers, etc. could lead to further interpretation and speculation that may or may not add value. There’s also the unusual opportunity since CERN is publicly traded to simply look at the metrics Wall Street really cares about that go far beyond hospital count – revenue, bookings, and earnings, all of which reflect Cerner’s overall activities (not all of which involve hospitals) and the efficiency with which it operates its business. For that matter, share price since January 1, 2015 is the ultimate measure of company performance vs. Street expectations and the above real-time graph as I write this shows CERN (blue, up 1.1 percent) vs. the Nasdaq (green, up 29.3 percent). The reader also noted that some Soarian sites are trying to wangle out of their contracts to switch vendors claiming poor support, but I can’t say I side with them – they signed a contract for product that remains supported, and if company change of control was important to them, they should have put that – along with service level agreements if they left those out — into their contract’s terms and conditions. Weirton Hospital has sued Cerner claiming poor support, while Cerner sued PinnacleHealth for trying to walk away from its Soarian contract after signing with Epic.

image

From Pinkeye: “Re: Epic. Hard to believe they didn’t bid on the Wisconsin DHS project if they have a viable behavioral health strategy. I’m also curious whether Allscripts/Netsmart bid.” Epic sent me a note after I mentioned that the company had chosen not to bid on the project, saying it wasn’t a big enough deal to interest Epic. I haven’t seen a list of the five bidders. Health IT websites created the self-serving notion that it’s cleverly-observed big news when a customer in Wisconsin or Missouri chooses Cerner or Epic, respectively, but that’s ridiculous.

image

From Nuance Hospital Customer: “Re: Nuance outage. Escription staging environment testing is in process, with plans to bring  the first client on board. Rebuilt speech engines. They just announced that they are in process of updating employee laptop antivirus software and installing encryption (!). Over 200K physicians are on an interim solution, but still no commitment to make clients whole — only offering clients short-term use of Dragon Medical.  I can only speak for our organization, but we have had over 10 staff working around the clock since this outage to review options and stand up outside transcription service. This is very poor remediation.” Unverified, but seemingly solid since the reader emailed from their hospital account. Nuance has issued minimal public information, instead providing status updates via customer conference calls. Some systems remain offline 10 days after the initial malware incident.

image

From NotPetya: “Re: Nuance outage. People are acting like they’re innocent victims of a cyberattack. Doesn’t this situation show what happens when you don’t upgrade your software? NotPetya exploits the same weakness as the May 4 outbreak and systems should have been patched.” I don’t think Nuance has confirmed that it was hit by NotPetya, but assuming that’s the case given the incident’s timing, it would seem that it had a PC running somewhere that didn’t have Microsoft’s Eternal Blue exploit patch from March 2017 (MS17-010) installed,  which also protects against the WannaCry strain. However, even someone as cynical as I would be hesitant to suggest that the company was negligent given the lack of facts, instead suggesting that every organization check every PC on the network to make sure they are running updated versions of Windows and antivirus.

From Crank Rod: “Re: HIT influencers. What do you think of this list that a Twitter monitoring service company assembled?” I question the premise of this list (and others like it) that assumes that hyperactive Twitter users must, by definition, be influential. I’ve never heard of most of the Twitter accounts listed, follow few if any of them, and note that their Twitter activity is often dominated by attention-seeking retweets and insight-lite comments that fail to rise above the level of social media circle-jerkery. I’ve also noticed that the real-world accomplishments of the anointed Twitterati are often much more modest than their outsized social media presence would suggest and that their self-assigned labels of “disruptor” and “innovator” sometimes ring hollow given their lack of personal success within the system they claim to be qualified to disrupt (it’s perhaps harsh to say that, “those who can’t, Tweet,” but sometimes that seems to be accurate). I’m happy for those named, especially for those whose self-validation demands it, but it’s just not something I care one iota about. I doubt many CEOs and other industry leaders are anxiously waiting for the winners to be named so they can call them up for advice.

From Money In the Banana Stand: “Re: #HIT100. Is it just me, or is this just another glad-handing campaign where the social media-verse celebrates the over-tweeters, many of whom have never even worked within a health system? While I find social media to be an effective medium to share, collaborate, inform, and educate, I am increasingly annoyed as I find folks have gotten away from why we are in this industry in the first place. In fact, I find several of these individuals exclusively making a living by talking about what the industry needs to do in social media and at conferences, but have no successful business or job within the industry. I am appreciative of those who HAVE worked in the industry who share their expertise and strategic thinking, but have had just about enough of the ‘marketers’ who are just recycling marketing and self-promotion. The tipping point for me was receiving countless messages from people ‘campaigning’ for my vote. Seriously?” I received this comment several hours after writing mine above, which was triggered by a similar but different “influencer” measure. Some of those folks don’t seem to have real jobs and are light on (a) healthcare-related education; (b) work experience; and (c) accomplishments. I apply the same standard to those who produce blogs, publication articles, or conference presentations – if you’ve never worked in a position of significant responsibility in healthcare IT, it’s hard to fathom why those who have should trust your assessment or value your opinions.

SNAGHTML3687acd1

From In the Beginning, There Were Delays: “Re: DoD’s MHS Genesis. The October 2016 military announcement said the pilot site go-lives would be delayed from December 2016 to June 2017. Should we assume they’re live but don’t want to brag about it with a press release?” Fairchild Air Force Base (WA) went live in February 2017. A tweet this week from the DOD says the the other pilot site, Naval Hospital Oak Harbor (WA), will go live “later this month.” 

From Informatics Professor: “Re: alerting privacy officers of users accessing unneeded patient information. The example of accessing records of a patient not seen in the past six months nor scheduled for an encounter implies that the only rationale for accessing a patient chart is direct treatment. There are other circumstances in which chart access is needed, such as data retrieval and quality audits.” The original poster suggested flagging such access for manual review, which would then uncover the extenuating user circumstances. The alerting could take user role into account, perhaps raising a more vigorous flag if the credentials used to look up inactive patients were those of a nurse aide rather than a quality analyst.

image

From ECW Watcher: “Re: the HIMSS-owned publication’s ‘breaking news.’ They’re a month late.” The publication ran a piece Thursday (along with breathless tweets and an email blast) indicating that CMS won’t make users of EClinicalWorks repay their incentive payments. The 12-paragraph story (nearly all background filler) contained three quoted sentences that it attributed to “a CMS spokesperson.” A competing publication ran the same information with the same quotes on June 9 (screenshot above), which also helpfully directed readers to a CMS FAQ (from months before that, but not naming ECW specifically) instead of omitting links for fear of looking less than omniscient.


HIStalk Announcements and Requests

It’s early July – do you know where your interns and first-year hospital residents are? (answer: driving your experienced doctors crazy with their inexpert questions, ordering tests and meds better suited for textbooks than a busy ED, consulting all but the most basic problems out, and requiring constant hand-holding to avoid harming patients).

This week on HIStalk Practice: Montana clinics come under fire for lack of interoperability. Hamakua-Kohala Health rolls out Medfusion patient portal. CMS develops new QPP resources for physicians in rural and/or underserved areas. This year’s digital health investments will likely make 2017 a record-breaking year. Physicians – no matter their type of employer – are still frustrated with EHRs. Carepostcard launches to help patients thank, find compassionate providers.


Webinars

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

image

Home monitoring technology vendor VRI acquires competitor Healthcom.


Sales

image

In Ireland, Saolta University Health Group chooses the Evolve clinical document management system of Northern Island-based Kainos. 

image

Dialysis clinic operator Fresenius Medical Care North America licenses Forward Health Group’s population health management system.


Announcements and Implementations

image

Patient engagement app vendor Fitango Health will use InterSystems HealthShare Connect to develop a post-discharge action plan platform.

image

Minnesota-based Treatment.com announces its Merlin artificial intelligence platform for diagnosis and treatment.

image

FirstHealth of the Carolinas (NC) goes live on Epic. CIO Dave Dillehunt is leftmost in the above photo.

image

Baylor Scott & White Health – Grapevine (TX) goes live on Pulsara, a smartphone-based app that allows first responders who are transporting potential stroke patients to coordinate with the ED on the way to the hospital.

image

Eisenhower Medical Center (CA) goes live on Epic, apparently replacing McKesson Horizon Clinicals it chose in 2007.


Government and Politics

image

Politico suggests that the VA’s abrupt announcement that it will implement Cerner under a no-bid contract was influenced by the White House’s Office of American Innovation, run by presidential son-in-law Jared Kushner. VA Secretary David Shulkin met with Kushner’s team, but says the decision was made independently.


Privacy and Security

image

In Australia, a professor says he’s not convinced the country’s health system is ready for digitization following news that the Medicare card details of all Australians are listed for sale on the Dark Web. He notes that the government’s systems use somewhat primitive security measures, as well as the fact that the information is also stored on provider systems with varying degrees of security. He’s especially worried since the government’s centralized medical record is operated under an opt-in model that will change to opt-out in 2018. The professor advocates the “100 points” identity model as used for firearm permit applicants, in which many forms of ID can be presented as long as their weighted security value adds up to at least 100.

image

In England, the Information Commissioner’s Office chastises Royal Free NHS Foundation Trust for inappropriately providing patient information to Google-owned DeepMind Health without their consent, requiring the trust to align its procedures with law, complete a privacy assessment, and commission an audit of its DeepMind trial project.

image

Speaking of DeepMind Health, the hired independent review of the company’s activities finds that “the digital revolution has largely bypassed the NHS” as doctors use Snapchat to insecurely share patient photos and NHS holds “the dubious title of being the world’s largest purchaser of fax machines.” It notes that the original, much-criticized agreement with Royal Free Hospital contained a “lack of clarity” that has since been corrected in a new agreement and recommends that DeepMind cooperate fully with the ICO’s recommendations. Panel members also voted to have DeepMind Health pay them an honorarium instead of donating their time for free.

image

A Cisco investigation finds that the Ukraine-based tax software company whose updates were used to globally propagate the recent NotPetya malware attack had not updated its servers since 2013, resulting in at least three penetrations in the past three months. Police raided the office and seized its servers, with the unintended consequence that customers who are required to use its software are now sharing older versions of it via Google Drive and Dropbox links, exposing them to potentially booby-trapped copies.


Other

image

A team from Marine Corps Base Quantico develops Infrascanner, a portable infrared device that allows detection of intracranial hematomas on the battlefield, replacing the old system of a paper-based evaluation form and potentially avoiding evacuation for unnecessary CT scans.

image

Epic’s non-marketing department is getting bolder about calling out CommonWell, I noticed, with the company noting on its website that, “Care Everywhere exchanges every 12 minutes what CommonWell exchanges in a lifetime.”

A New York Times report about low-quality nursing homes concludes that stricter oversight (fines and seldom-enacted threats to halt CMS payments) don’t seem to deter them since they just keep operating with poor metrics. The lawyer of a resident who is suing one of them says fines are just a cost of doing business for their large-corporation owners, especially since federal budget cuts allow only 88 nursing homes to be labeled as “special focus” even though regulators recommend such scrutiny for 435 facilities. 

SNAGHTML3605b6eb

I missed this originally, so maybe it’s appropriate given the pandering for social media influencer votes: a study finds that people who use Facebook more extensively feel worse about themselves. Previous studies found that excessive Facebook use detracts from face-to-face relationships, reduces meaningful engagement, and erodes self esteem, but the new study additionally found that real-world social networks were positively associated with well-being while Facebook use was associated with negative well-being, particularly in mental health. Interestingly, time on the site was more predictive of negative impact than the level of Facebook activity (liking, posting, and clicking). The authors conclude,

Exposure to the carefully curated images from others’ lives leads to negative self-comparison, and the sheer quantity of social media interaction may detract from more meaningful real-life experiences.  What seems quite clear, however, is that online social interactions are no substitute for the real thing.


Sponsor Updates

  • Aprima customer Mt. Olive Family Medicine Center wins the 2017 NCMGMA Practice of the Year Award.
  • Visage Imaging releases an update for its Ease mobile app that adds support for video and encounters-based workflow.
  • Besler Consulting releases a new podcast, “How medical scribing is utilized at the point of care.”
  • CoverMyMeds will exhibit at McKesson IdeaShare 2017 July 12-16 in New Orleans.
  • EClinicalWorks will exhibit at the 2017 FSASC Annual Conference & Trade Show July 12-13 in Orlando.
  • FormFast publishes a new case study featuring Riverside Community Hospital.
  • InterSystems will exhibit at the Population Health Exchange July 10-12 in Colorado Springs, CO.

Blog Posts


Contacts

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

125x125_2nd_Circle

EPtalk by Dr. Jayne 7/6/17

July 6, 2017 Dr. Jayne 1 Comment

clip_image002 

I’ve been watching a dialogue about medication reconciliation unfold on one of the AMIA email lists. The general consensus seems to be that medication reconciliation is a “wreck” and that there is tremendous variation in how/when organizations apply it.

In the various EHRs that I’ve used, there are many existing choices in reconciliation pick lists, and they may not always apply to a given care setting. For example, “substitute per formulary” might make sense for a hospitalized patient when they may go back on the original medication at discharge. But in the outpatient setting, if you’re doing a formulary interchange, you’re actually going to discontinue one medication and start another, which requires a different set of documentation.

There are also situations where you need to hold a medication because it’s not essential or could lead to complications (for example, oral contraceptives or daily aspirin) but still want it reflected as something that might have an ongoing influence on the patient’s current state (ongoing clotting or bleeding risk), but I have yet to see an EHR medication list that manages this well.

One respondent commented that there are options needed that don’t traditionally appear as choices during the medication reconciliation process, such as “the patient was never on this medication.” There are other choices such as, “patient’s family member says they are taking it, but patient claims they have never seen the pill,” and “patient taking every other day due to cost” that we’ll never see reflected on a reconciliation list but have to be added as a free-text or “other” type comment.

There are many patients for whom medication reconciliation is an impossibility due to dementia, psychiatric issues, or other medical conditions impairing memory and thought processes. Some of these patients have caregivers who can provide the information, but others don’t.

In the urgent care setting, we rely heavily on the medication history information available through our EHR, but unfortunately, it doesn’t always have the information for cash prescriptions since it often feeds from pharmacy benefit managers. The state prescription drug monitoring program helps fill that gap for some medications, but as a provider I often end up looking in multiple places or asking staff to call pharmacies or family members to try to get an accurate history.

For us, every patient is a transition of care for regulatory purposes as well as an opportunity for error when a medication gets lost in translation. The need for a formal reconciliation varies with the patient and their complaint. What if a visit is a transition of care but doesn’t require prescribing? Clinically a reconciliation really isn’t needed for an episodic complaint (laceration closed with glue), but there are challenges associated with saying staff can do it sometimes but not others.

The discussion brought other points about lack of functionality in EHRs in general, including the ability to trend increasing or decreasing doses over time. I know it took the better part of a decade for my previous EHR to get functionality that allowed prescriptions for different doses of the same medication to link, so that you could see the patient who started on 10mg of blood pressure medication and was gradually worked up to a higher dose. This was tricky because the system relied on NDC numbers initially, which are different not only based on dose, but also on how the medication is supplied. Personally, I don’t care whether the medication came in a blister pack or a stock bottle, but that’s how NDC worked. It was only after the system converted to RxNorm codes that things started making sense. Still, it’s hard to track things like when the patient is taking half of a 20mg tablet then starts taking a whole one, etc. That kind of documentation often winds up as unstructured data that can increase patient risk unless that unstructured data is kept attached to the medication list, which some systems don’t allow.

There were also comments about the fact that some providers don’t have any concept of ownership of the medication list. I saw this often in my past life as a primary care physician, when I would receive dictated letters from consultants that were missing most of the medications the patient was actually on. When transitioned to the EHR, these providers still didn’t feel the need to participate with the medication list, let alone try to perform a reconciliation. I saw at one hospital when they made reconciliation the job of the admitting physician of record that the procedural subspecialists (particularly orthopedic surgeons) developed a new habit of having the patients admitted under the PCP with themselves as consultants. In that case, no good policy goes unpunished.

At the same time this discussion was unfolding, I was contacted by a client who recently implemented functionality that allows them to electronically cancel prescriptions. Unfortunately, their local pharmacies don’t yet support this feature, which led to several days of confusion until they figured out what was going on and returned to their phone-based process. Until the pharmacies upgrade their systems, there’s little more I can recommend other than calling the pharmacies and discussing the impact and asking them to lobby their corporate bosses for an upgrade.

This has been the plight of physicians for some time now, as EHR vendors are forced to add functionality that isn’t supported in the real world. Despite electronic prescribing of controlled substances being required in several states, it’s not required in my particular locale. As a result, only a little more than half of pharmacies support the functionality. It’s kind of like being required to have LOINC codes for interfaced lab results but there not being a requirement for vendors to send the codes with the result transmissions.

I’ll be interested to see what comes of the medication reconciliation discussions and whether there is scholarly activity that might push vendors or regulators to change how they hope to steer medication reconciliation in the future. I was encouraged by the number of people willing to engage in the discussion or collaborate in future projects. A group of motivated clinical informaticists is a powerful thing indeed.

How do you feel about the current state of medication reconciliation? Email me.

Email Dr. Jayne.

Morning Headlines 7/6/17

July 5, 2017 Headlines No Comments

Heritage Valley Health System Restores Services at All Locations

Heritage Valley Health System (PA) announces that it has restored network services across all of its hospitals and clinics following a June 27 “NotPetya” cyberattack that forced operations back to paper.

What Jared’s office actually does

Poitico reports that Jared Kushner and his Office of American Innovation worked behind the scenes with VA Secretary David Shulkin and DoD Secretary James Mattis to resolve the agencies longstanding IT issues, brokering an agreement between the two to consolidate on a Cerner EHR platform and approving the VA’s request to side-step normal procurement procedures.

Million Veteran Program Surpasses 580,000 Enrollments; Faces Cut

The Million Veteran Program, a large-scale research project being launched by the VA to study how veterans’ genetic profile, medical history, and military service affect their health, has recruited 580,000 participants, but faces challenges amid cuts to the VA’s research and IT budgets.

Patrick Soon-Shiong’s NantWorks to take over St. Vincent and 5 other California hospitals

NantWorks, the health tech startup of Patrick Soon-Shiong, acquires six California hospitals, to which Soon-Shiong notes “I’ve spent the last decade of my life quietly building this infrastructure. This system will provide an experiment at scale.”

Readers Write: Moving the Adoption Needle on Electronic Prior Authorization: What Stakeholders Can Do

July 5, 2017 Readers Write No Comments

Moving the Adoption Needle on Electronic Prior Authorization: What Stakeholders Can Do
By Tony Schueth

image

Tony Schueth is CEO and managing partner of Point-of-Care Partners of Coral Springs, FL.

Prior authorization (PA) is a major pain point for both prescribers and payers (health plans and PBMs). That is because there are significant administrative costs and patient-safety issues associated with today’s antiquated paper-phone-fax PA processes. The number of PAs is increasing, causing stakeholders to look for a solution to keep ahead of the PA curve. The answer is electronic PA (ePA), which is available today. Yet, while headed in the right direction, uptake isn’t where we’d like it to be.

Manual prior authorization and utilization review create burden on providers and payers alike. According to a recent article in Health Affairs, physicians spend $37 billion annually ($83,000 per doctor) thrashing out PA and formulary issues with payers. According to another estimate, doctors spend 868.4 million hours on PA each year, not counting time devoted by other staff members. Payers incur up to costs of $25-$40 per PA, plus risk to downstream CMS rebates and medical cost savings.

Perhaps most importantly, the difficulties inherent in trying to obtain a PA significantly affect the quality of care and patient safety. According to a survey by the American Medical Association (AMA), most physicians experience a delay in excess of a week for their PA request to be processed. Some 70 percent of prescriptions rejected at the pharmacy require PA; of those, 40 percent are eventually abandoned due to the complex, paper-based PA process. The PA process impacts more than 185 million prescriptions each year and results in nearly 75 million abandoned prescriptions.  

These issues will only be exacerbated as demand for PA increases. This is due to several factors. First is the robust pipeline of new specialty medications, the majority of which require PA. Second, the demand for specialty medications is rapidly increasing because, in large part, of the rising number of chronically ill patients who rely on specialty medications.

Because of increased specialty medication utilization — coupled with the reliance on today’s antiquated paper-based processes — prescribers, pharmacies, and payers will be unable to keep pace with the anticipated flood of new specialty prescriptions and related PA requirements. Patients will have delays in obtaining needed therapies or will forego them altogether if prescriptions are abandoned due to administrative delays. Quality and patient safety are at stake.

Now that the need for process improvement and efficiencies is imperative, stakeholders are beginning to coalesce around the promise of electronic prior authorization (ePA). This solution is in keeping with the trend toward automation of healthcare and the wide-spread adoption of electronic prescribing, which is used by 75 percent of ambulatory physicians. Standards to support the ePA transaction are in place. Vendors are emerging that can handle the transaction. States are jumping on the ePA bandwagon, with several requiring use of ePA in the near future and others expected to follow suit. It won’t be long before the federal government is expected to mandate ePA as well.

That said, use of ePA is not to the point of bringing robust value for all stakeholders. Electronic health record (EHRs) can support the ePA process, but not all of them have that capability. Physicians may not know that their EHR supports ePA and it could be integrated into the workflow.

What can be done to move the ePA adoption needle? Here are some things stakeholders can do now.

Prescribers should:

  • Ask their EHR vendor about their system’s ePA functionality. If it is not available, push for it as an enhancement request.
  • If integrated ePA is available, start using it as a way to improve return on investment (ROI) in the EHR. Electronic PAs get adjudicated much more quickly than prior authorizations submitted on paper via fax. ePA also can reduce costs and improve the quality and safety of patient care. These metrics are increasingly important ingredients of value-based care, alternative payment models, and related reporting requirements.

EHR vendors should:

  • Make prescribers aware of their product’s ePA functionality and how it is used. This educational component provides value to the buyer and also could be a differentiator in the market.
  • Get ahead of regulatory mandates by either the federal government and the states. Savvy vendors will not wait for the regulatory shoes to drop and then play catch up. This can be costly and affect market share.
  • Build competitive advantage. While some of the major EHRs have incorporated ePA, many of the small and medium-sized EHRs have not. Practices and integrated delivery networks are overwhelmed by the growing number of PAs. They are demanding relief, which can only be solved through the availability of ePA. This also is an attractive selling and retention point.

Health plans and PBMs should:

  • Adopt ePA functionality that is beyond the basics. Research shows that many PBMs have minimal ePA processing capabilities. Improving ePA processes and question sets will improve efficiency, reduce costs, and add value.
  • Push prescribers to adopt and use ePA. A legitimate ROI can be demonstrated, but only if functionality is used.
  • Take full advantage of the feature set included in the NCPDP SCRIPT standard for ePA. Supporting more of the features available in the standard will reduce the need for attachments, thus reducing turnaround times and increasing efficiencies. This translate into cost savings.

Advancing ePA requires focused effort by all stakeholders, but the time is right and the technology is ready.

HIStalk Interviews Peter Smith, CEO, Impact Advisors

July 5, 2017 Interviews No Comments

image 

Peter Smith is co-founder and CEO of Impact Advisors of Naperville, IL.

Tell me about yourself and the company.

Impact Advisors is a full-service healthcare consulting firm. We specialize in strategy, process improvement, technology, and implementation. We work primarily for the healthcare provider segment, so all flavors of hospital systems as well as large providers and physician practices. I’ve been at it for about 10 years now. I’m looking forward to continuing our service to the industry.

What are the most pressing problems of health system CIOs?

There’s are a couple of things, and these are driving our business as well. If you look at the context of where people are, that will help understand where they’re going. Many of our clients have already implemented their core transactional systems, whether it’s EMRs or revenue cycle systems. Now they’re looking to harvest and move to the next generation of information. 

One of the biggest challenges is that now that the transactional systems are stabilized in many environments, how do you use all that information to create a valuable experience and valuable best practices for medicine and valuable interactions with your patients and community? Really turning that corner. You’re seeing things like analytics and business intelligence become very important. You’re seeing things like the patient /consumer experience and digital transformation driving the industry right now.

Are health systems really interested in interoperability and are they and their EHR vendors making progress to make it happen?

Interoperability is a huge hot topic in the industry. It’s critical for enabling the strategies of both health providers and beyond just the single providers in terms of creating an ecosystem of health across large communities and regions. Interoperability remains at the forefront. There has been tremendous progress. The major vendors are both adding capability and interest, and more importantly, energy to creating interoperability platforms.

As these ecosystems get larger and the need for organizations to trade information among partners — whether they’re payers, other healthcare providers, or the patient themselves — you’re seeing a real push for providing open and transparent information to a much larger community, such as healthcare partners, patients, and families.

Interoperability still remains at the forefront and there’s been tremendous progress. The industry and the environment will continue to demand it.

Have hospitals become more cautious about their technology spending as they wait to see how Affordable Care Act changes will affect them?

Everybody’s in a state of uncertainty as to what the new legislation might bring. Many of our clients in the provider segment of the industry are reacting in the exact way you described. They’re waiting to understand what it is, so there’s almost a little bit of a pause right now in terms of thinking about what the future might bring and waiting to see how this will unfold.

That being said, some of the fundamental things that need to be done in healthcare are still going to be here, independent of the legislation. Organizations continue to be conscious of cost and expense as their reimbursement models change. No matter what the legislation will bring specifically, you’ll continue to see this trend from volume to value. With that comes some significant implications to the organization. How do you deliver care in a more efficient, higher-quality manner? Those fundamental characteristics will remain important to our organizations.

Even though there’s a slight pause in a moment of uncertainty, people are still moving ahead fairly actively with the foundational things. Process improvement and new technology solutions will continue to be important no matter what the legislation might bring. Healthcare is obviously very dependent on legislation and policy, but it’s also dependent on the fundamental undercurrents of economics — doing the right thing at a better price point and a higher quality.

Is Epic starting to look more like Cerner as it broadens scope to offer hosting and revenue cycle services?

I don’t know if their specific strategy is to look more like Cerner. It might be more happenstance of the environmental factors that are driving them. I can’t speak for Epic, but I imagine that their clients are asking them to do more given the relationships they’ve had with them historically. Hosting was a natural evolution for them. Providing some level of business process services is also an evolution for them.

My guess is that it’s being driven by a couple of factors. Obviously there’s some gaps in the industry around that and some of those services are probably ripe for the same level of aggregation, consolidation, and high-quality services that Epic has historically brought to the table, as well as Cerner. That and the fact that there’s probably client demand, and if you look at Cerner and Epic particularly, they have both been fairly consistent at the higher end of the market, the larger, more complex organizations. If they move into the middle market, combining a package of services is probably going to be important going to that segment of the industry.

It all made logical sense to us and we wish them both well. Cerner has had a long track record of being very successful and I suspect Epic will as well.

What was your reaction when the VA announced that it was going to implement Cerner before it negotiated a contract or developed a broad project plan?

I was encouraged that the VA and the DoD went in the same direction. Granted, it’s very different patient populations. We recognize that, but having some consistency in solutions across our Armed Services support environment could eventually pay some dividends. I didn’t have a dog in the fight either way, but I appreciate the consistency of having the potential for a single platform across the entire environment.

What will be the industry fallout following Nuance’s cybsersecurity-related cloud services outage?

It’s unfortunate for Nuance that they are in the news. Any vendor, particularly those providing ASP cloud services, is ripe for breaches and security issues. It’s just so prevalent right now. Our expectation is that threats will increase and get more serious, more complex, and more sophisticated. Obviously this has been a bad week for Nuance, but this could happen to almost any vendor given the scale and magnitude of what’s going on.

The event will will raise awareness and visibility. Nuance will obviously react appropriately. It’s going to hurt, but they’ll be able to survive that and learn from it and provide better, more secure solutions moving forward. The industry is going to learn from it. These high marquee visible threats and breaches will make everybody stronger. Its unfortunate that Nuance will have some significant issues as a result of this, but it will ultimately make the industry stronger.

I don’t think anybody — whether you’re a vendor or you’re a client or a provider — will be impervious to this. It’s something we have to deal with on a day-to-day basis. We work with our clients to prepare themselves, but the message is to understand that it’s not a matter of if, but rather when you get hit, unfortunately.

What are the characteristics of startups that are finding success working with health systems?

You’re going to continue to see innovation, and I hope we do. It’s an important part of the industry and an important part of the growth of the industry. Innovation around the periphery will extend and grow. 

You’ve obviously seen a lot of innovation in the BI and analytics space and a lot of vendors moved into that space. Not all of them will survive, but the good ones will. You’re seeing who can bring a better product to the market that has the opportunity to aggregate, as an example in this case. Those products will come in in a focused way and then expand based on their ability to deliver in the marketplace. It’s similar on the patient / consumer experience side.

How will the agenda of vendors and customers change in a post-Meaningful Use environment?

The vendor marketplace is seeing a stratification of vendors. A couple of vendors continue to gain market share and continue to sell. Then there’s a tier of vendors that are probably a little less dynamic, more static in terms of their market share. My guess is that their primary strategy is to preserve their existing client base and then add around the margins to that space. The strategy of the vendors that have been dominant over the last couple of years is to develop new, interesting products and extend their continuum of product and services.

There’s another factor here, too. Everyone has assumed that the EMR market has diminished. It has. It has not grown as substantially as it did in the Meaningful Use era, but there’s still a lot of work out there deploying EMRs. One of things that is driving that is all the mergers and acquisitions. You’re seeing a tremendous amount of aggregation in healthcare, both locally and regionally, and that is fueling the replacement of a number of EMRs as you move to the hosts or the acquiring provider’s platform. There’s still a lot of work out there to be done.

What trends are you and your competitors seeing that will drive the consulting business?

From a consulting standpoint, the most important thing is to continue to innovate your services as to what the market needs. Per the previous question, we’re incubating and delivering services now around things we think will be important to our clients in a year or two. We’re actively working on digital transformation, patient / consumer experience, BI, and analytics.

We still do a lot of work in EMR replacement. There won’t be as many huge implementations as there were in the Meaningful Use era. They’re more likely to be smaller or medium-sized implementations and in smaller providers, smaller community hospitals who are a little late to the game in terms of transitioning. We re-architect our services to be nimble, quick, and efficient for that market.

What trends will be the most important to follow in the next five years of healthcare IT?

The infusion of information into the healthcare delivery process is of tremendous importance. That infusion of information will come in many ways. We’re seeing the tip of the iceberg of what information can do to healthcare. You are going to see standards and best practices around treatments and delivery of care. That clinical and economic information will make a tangible difference in how you diagnose and treat patients as it works its way to the point of care. Not retrospective information, but point-of-care information based on best practices, based on very customized, personalized medicine and genomics.

Another trend is that we will see tremendous digital relationships that organizations will have with both patients and their families. We’re on the cusp of that. Not just portals and things like that, but a real relationship with the patient, and probably more importantly, their families to deliver care. Not only the information exchange, but wearables and discrete technologies that we’re going to be using. All those components of healthcare will revolutionize how we deliver care.

Those are the things I’m excited about, that we’re shaping our services around, as they will drive demand for the next couple of years.

Morning Headlines 7/5/17

July 4, 2017 Headlines No Comments

Google DeepMind trial failed to comply with data protection law

In England, the Information Commissioner’s Office concludes that Royal Free NHS Foundation Trust broke data privacy laws when it handed 1.6 million patient records over to DeepMind, a Google business unit applying AI to healthcare problems.

Chief medical officer calls for gene testing revolution

England’s Chief Medical Officer Sally Davies, MD focuses the entirety of her annual report on the potential of genetic testing, calling for an increase in the routine use of genomics testing in treatment and preventative care.

T-MSIS Data Not Yet Available for Overseeing Medicaid

An OIG report concludes that adoption of the Transformed Medicaid Statistical Information System, a database comprised of state and federally reported Medicaid data, is behind because there is no fixed deadline for when States and CMS must begin participating.

Morning Headlines 7/4/17

July 3, 2017 Headlines No Comments

Roche buys diabetes app firm in digital health push

Swiss pharmaceutical company Roche acquires mySugr, a Vienna-based diabetes management platform, to expand its patient-facing app offerings. Financial details were not disclosed.

The ice bucket challenge, made famous by ALS patient Pete Frates, raised millions. Here’s how the money was used

Pete Frates, the ALS patient behind the Ice Bucket Challenge, has been hospitalized. STAT recaps how the $115 million his idea raised was used.

Building Unity Farm Sanctuary – First Week of July 2017

John Halamka, MD and CIO of BIDMC updates readers on recent improvements he has made around his 60 acre farm.

Curbside Consult with Dr. Jayne 7/3/17

July 3, 2017 Dr. Jayne 2 Comments

No surprise here. A recent survey by the American Medical Association finds that physicians don’t feel they are prepared for quality reporting rules. The survey reached out to 1,000 practicing physicians who have been involved in discussions and decisions related to the Quality Payment Program within their practices. Nearly 90 percent of the physicians find MACRA’s requirements burdensome, with fewer than one in four feeling well prepared to meet those requirements in 2017. Specific areas cited as burdensome included the time required to report performance, understanding requirements, MIPS scoring, and the cost to capture and report data.

The AMA data notes that a little more than half (56 percent) of physicians plans to participate in the Merit-based Incentive Payment System (MIPS) with 18 percent expecting to participate in Advanced Alternative Payment Models (APMs). There were also some interesting statistics on how well physicians feel they understand MACRA and the QPP. Although 51 percent of physicians feel they are somewhat knowledgeable about the topics, only 8 percent describe themselves as deeply knowledgeable.

Although previous participation in quality programs such as PQRS and Meaningful Use seems to have helped physician readiness, only 25 percent of those with prior reporting experience feel well-prepared for the QPP. There were also concerns raised that those who may be prepared for 2017 reporting may not have the long-term financial strategies in place to succeed in 2018 and beyond. Small practices were called out as needing more assistance to be prepared, where large practices were more likely to be concerned about the organizational infrastructure needed to effectively report data.

Where the larger practices were more likely (79 percent) to have previously met Meaningful Use Stage 2, the smaller practices were mixed with 45 percent yes, 44 percent no, and 12 percent not knowing whether they had previously complied or not. Not surprisingly, primary care specialists were more likely to participate in APMs than non-primary care specialists (22 percent vs. 15 percent respectively). Multi-specialty practices seemed to be better prepared than hospital-based, solo, or single-specialty practices with greater participation in Advanced APMs and more optimism around a positive payment adjustment in coming years.

The report notes that its findings support assumptions that although some challenges are universal, small practices will need more assistance in meeting their goals. There is opportunity for CMS, medical societies, and other stakeholders to educate physicians and to help practices prepare for success.

Although the report doesn’t mention them specifically, some of those other stakeholders include vendors and consultants. I’ve seen a pretty significant uptick in messaging from the latter, although nearly all the emails I receive seem to be for clients on Epic. The vendor emails I receive are mostly targeted towards smaller practices who may not be on an EHR or who are looking to switch. These communications make everything look pretty rosy as far as ability to report on their platforms, but neglect to mention the amount of work needed to complete a conversion or bring a practice live on EHR in the first place.

My vendor is actually pretty good at providing information around the various quality and regulatory programs out there, even though it’s a niche specialty vendor and many of its clients have opted out of Meaningful Use in the past and plan to opt out of quality programs in the future. Whether your practice has opted out or not, there needs to be an ongoing dialogue and analysis to make sure that their plan still makes sense. Payer mixes can shift over time, especially with an aging population, and what may have made sense a couple of years ago may not make sense moving forward.

For independent practices, ongoing dialogue is also needed with local health systems or hospitals to determine how their strategy for value-based care will impact everyone else. There are several major players in my area, and none of them seem particularly interested in sharing data with the little guys, especially when smaller groups are potential competitors for procedural volume. It still seems to be less about the patient or controlling costs than it is about market share. I have yet to see any medical staff meetings devoted to helping admitting physicians stay in business by learning how to handle Meaningful Use or MIPS. I do see a lot of attempts to purchase practices, however.

CMS does seem to be trying to do its part to educate physicians, and recently released some new resources on its Quality Payment Program website to try to help us through the maze. At least two of the new resources – MIPS Measures for Cardiologists and Advancing Care Information Measure Specifications/Transition Measure Specifications – are updated versions of previous documentation. This highlights the difficulty in staying up on everything, and the fact that even when you think you have the game figured out and have put processes in place, the game can change. Other resources include vendor lists for Qualified Clinical Data Registries (QCDRs) and Consumer Assessment of Healthcare Providers & Systems (CAHPS) for MIPS. This highlights the complexity of the program, where many participants need to work with multiple vendors to even have a chance of doing it right. The list of new documents is rounded out with an Introduction to Group Participation in 2017 MIPS and a MIPS Measures Guide for Primary Care Clinicians.

I was a little disappointed in the primary care document, which seemed to be overly general and was described as a “non-exhaustive sample of measures that may apply to primary care.” It seemed to be more of a filler to point physicians to the main QPP.CMS.GOV site for more information. Even for those of us who have been steeped in the content, requirements are pretty complex and implementing them is daunting if you haven’t done the pre-work to get all your clinicians on the same page and operating as a cohesive organization. The majority of the consulting work I’m doing these days seems to be in the change management / change leadership space, where I spend a fair amount of time trying to convince reluctant providers that having standardized care plans and office processes really is a good idea and not an infringement on their individuality.

Regardless of our feelings about it, MIPS, the QPP, and Meaningful Use (Medicaid-style, at least) are not going away. It will be interesting to see how physicians feel about their level of understanding a year or two from now.

Are you ready for MIPS? If not, why? Email me.

Email Dr. Jayne.

Morning Headlines 7/3/17

July 2, 2017 Headlines 1 Comment

Nuance Healthcare: Impacted Customer Update

In Nuance’s most recent cyberattack update, the company says that its Emdat eScription RH service is being brought back online.

Department of Veterans Affairs IT Project In Danger of ‘Catastrophic Failure’

A $543 million project to implement real-time location service tracking software across VA medical facilities to help track medical equipment has been setback by a slew of previously undisclosed problems, including failed operational tests and questions over whether VA WiFi networks can adequately support the new tracking equipment.

Day 4: Princeton Community Hospital diligently rebuilds network after cyberattack

Princeton Community Hospital (WV) continues to manually rebuild its network following a cyberattack that forced clinicians back to paper. The hospital’s  IT department is installing new hard drives across all of its computer and reports that “fifty-three new computers have been installed throughout the hospital offering clean access to Meditech.”

Patients are losing patience, and they’re speaking out

The Boston Globe reports on patient satisfaction amid the tendency of practices to double book provider schedules, sometimes leaving patients waiting an hour past their scheduled appointment.

Monday Morning Update 7/3/17

July 2, 2017 News 3 Comments

Top News

image

Nuance’s post-malware update says the company is bringing Emdat (aka eScription RH) clients and MTSO partners back online, but eScription Large Hospital remains down. 

Nuance advises transcription customers that use BeyondText or iChart Hosted Solutions to have their physicians re-dictate their documents going back to 48 hours before the incident that occurred this past Tuesday, June 27. 


Reader Comments

image

From Judy Fake-ner: “Re: Hoag Health (CA). Will be leaving Allscripts Sunrise to join Providence-St. Joseph Health’s Epic system. Heritage Medical group is also transitioning from Epic to Allscripts.” JF sent over an internal Hoag memo from February 2017 that explained why it’s moving away from Allscripts.

From Amphibious Assault: “Re: [company name omitted]. I asked the CEO what publications his team reads. He said that everybody just reads HIStalk.” Thanks. We have that in common, then.

From Gitche Gumee: “Re: EHR access rules. Why can’t EHRs include an alert notifying the privacy offer if staff look at information without need, such as someone accessing records from a patient last treated six months ago with no treatments scheduled? There’s a legal case pending where we found 252 breaches in confidentiality on 12 patients over a 12-month period, where we can’t determine why someone would need to access their clinical information.” 

From EMRDoc: “Re: Nuance outage. It is interesting and somewhat ironic how providers who were not previously interested in templates, smarttext, autotext, etc. are suddenly hungry for education about those tools for creation of documentation. This outage may be the best thing yet for user adoption! We also appreciate Nuance’s action to make voice recognition licenses and microphones available to assist with the outage. Ironically, this outage may inadvertently result in a decrease of our overall transcription volume in favor of front end voice recognition.”

From EHR Datahacking MIPS Solutions: “Re: MIPS data submission. Is it ethical to skim EHR database schema? This is being offered as a service and professional societies are lapping it up since it is cost effective (offshored). The database design allows intelligent guessing of which data fields house the patient-specific data needed for MIPS/PQRS quality submission, which appears unethical. Only Epic is smart enough to have controls in place to ward off unauthorized use of its databases. The accuracy of the data extracted and submitted to CMS is a different can of worms.”


HIStalk Announcements and Requests

image

One-fourth of poll respondents say they’ve lost an IT job due to a new system’s implementation. Just a Nurse Analyst says she walked away from her job (and her five Epic certifications) after seeing the “creepy” situation in which Epic was directing hospital staffing decisions and pushing the CIO with threats to go to the CEO. Furydelabongo experienced poorly executed layoffs at a previous health system employer that was desperate to find operating dollars to support “an Epic project run amok with consultants” once requesting more capital dollars became distasteful. Greek CIO says he/she was displaced when Eclipsys convinced hospital management to outsource all of IT to the company at a 300 percent increase in staffing cost.

New poll to your right or here: For Nuance users: how much business will you give the company following its cloud services outage?

My “summer doldrums” special deal on newly booked webinars and sponsorships is winding down after a few companies jumped on board. Contact Lorre.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

image
image
image
image
image
image
image
SNAGHTML22774468
image
image
image
image
image
image
image
SNAGHTML226df25c
image
image
image
image
image
image
image
image
image

Listening: new from Iowa’s Stone Sour, moving away from their last couple of progressive-type albums to pure alternative metal that invites vigorous, four-limbed desk-drumming (as I can attest). Also: Diablo Blvd, catchy hard rock from Belgium with a singer who – no joke – is a stand-up comedian. 


This Week in Health IT History

image

One year ago:

  • Allscripts sues former chief marketing and strategy officer Dan Michelson and his new employer, Strata Decision Technology, claiming that Michelson and the company used confidential information to displace Allscripts as the top-ranked product in KLAS’s “Decision Support – Business” category.
  • McKesson announces that it will spin off its Technology Solutions business into a new company that it will co-own with Change Healthcare.
  • Definitive Healthcare acquires Billian’s HealthData.
  • A study finds that PCs and servers that control hospital medical equipment are often running old versions of operating systems that make them vulnerable to malware attacks.

image

Five years ago:

  • MModal announces that it will be acquired by a private equity firm for $1.1 billion in cash.
  • The Supreme Court upholds the legality of the Affordable Care Act, including its requirement that every American carry medical insurance or pay a fine.
  • In England, Cerner complains to Cambridge University Hospitals Foundation Trust that its EHR bidding process was a sham and that it had already settled on Epic before launching it.
  • The government of Australia admits that the signup function of its just-launched personally controlled record system had to be taken offline when it was found to not support hyphenated patient names, with Accenture getting the blame.

image

Ten years ago:

  • Francisco Partners acquires Dairyland Healthcare Solutions.
  • Mediware President and CEO James Burgess announces his resignation.
  • PSS World acquires a 5 percent stake in Athenahealth for $22.5 million.
  • Apple provides developer information for the just-released iPhone.

Weekly Anonymous Reader Question

image

Responses to last week’s question:

  • 50 hours, six days per month on the road.
  • I’m a woman who just hit child-rearing years, so now I’m down from 75 percent max to just above 0 percent. I like having a husband!
  • 45 hours, not counting time I spend reading industry, technology, or professional development articles and books. Travel approximately 5 percent or about 2.5 weeks a year
  • Work hours should be held around 50. As for travel maximum, it should be 1 1/2 weeks per month.
  • 45 hours and 10 percent travel.
  • 40-45 hours per week and 20 percent travel.
  • Work hours including time in the air? Does this include the number of days that require me to leave my family on a Sunday afternoon? Work hours range from 50-75 depending on where I am traveling. I typically travel 50-60 percent of the days during a month.
  • Three days, three nights. What’s that saying? “Fish and company start to stink after three days.”
  • 9-5, work from home option. 10 percent travel requirements.
  • After years of 80 hours per week and 75 percent travel, I’ve found balance and what’s important in my life. At this point, I wouldn’t do more than 50 hours per week and 25 percent travel.
  • 45 hours of work, per week. 10-15 percent travel (1x/month ish).
  • 40-45, one week up to a couple times a year.
  • In my line of work (consulting), job opening are pretty thin right now so my expectations have changed a bit. I would hope to limit travel to three days a week, and a corporate mindset that if travel isn’t necessary to move the project forward, we don’t travel. I’d hope to find a culture where weekend hours are not the norm.
  • About 45 hours per week. Special projects may require more occasionally, but if you need me more than that, then you have an issue with resource allocation. For a position which requires travel, every hour, from the arrival at the originating airport to the destination, should be counted as a work hour, especially since I am expected to be on calls or work while in transit. So, roughly the same hours, with some exceptions. And if traveling on a weekend or holiday—comp time.
  • Don’t recall going at it with that focus in mind. However, now that I’m away from the the travel jobs and requirements, I can share that, yes, it’s typically the case that you arrive at client’s site around 7:30-8:00 a.m., usually work through “breaks” and lunch so you can “answer client questions,” you leave around 5:30-6:00 p.m. (maybe later if you need to meet with the doctors after their workday is done). After grabbing some dinner back at the hotel, you go back to your room and start making edits to a template, writing up a report, answering emails, etc. and finally call it a day around midnight. And that is just the M-F schedule, not the catch-up on the weekend. If I added up all the hours, I’m guessing I earned $2.75/hour! I don’t honestly know how I would have limited the weekly work hours and travels requirements and still kept my job. Can’t say I miss it! Not that part anyway!
  • 50 percent.
  • 50 percent, less than 10 nights out per month.
  • 60 hours per week, no more than 75 percent travel.
  • Realistic expectation based on 25+ years in travel roles: M-F belongs to your work life. You’ll work as many hours as needed for whatever phase of the project, and travel however many hours are required to get to/from the client site(s) for the week of work. If you are lucky there will be slow-ish weeks where you can get out in the evening and sample the local culture. Be sure to protect your weekends/holidays else the lines will start to blur and you’ll find that your work IS your life.
  • 70 hours. What a blessing that would be after working conference meetings while carrying on numerous marketing functions, launching new campaigns, presenting annual budgets with their justification, training sales, producing new materials, securing new clients, and creating new products. During my 25+ years in the healthcare business, I’ve slept possibly three hours a night, missed my child growing up, and have lost more relationships than I can count – never mind the issues this took upon my health. I’m happy to travel at any level and take certain conference calls while on the road. However, when I am on the road and taking two conference calls in each ear while being asked to speak with a prospect or answer sales questions is unreasonable. I travel typically during the evening on my own time. However with time changes, conventions, conferences, prospect and customer meetings, as well as bosses’ schedules, the calls tend to eat up valuable face time with clients and prospects. Working from 5:00 a.m. to 2:00 a.m. simply to meet expectations is unreasonable, then add the travel to that schedule is not an acceptable demand. I don’t mind working a 70 hour week, but 126 hours a week is a two-person job. 70 hours per week, excluding evening travel, seems much more reasonable than 126.
  • A limit of 200 work hours per month and 15 days of travel, with the hours spent in transit counting against the work hours limit. If either limit is exceeded, travel in business or first class would be required. Expense limits on hotels, meals, and incidental expenses need to be realistic for the locations visited.
  • 50 hours, 50 percent.
  • Particularly in light of the efficiencies of teleconferencing , my limits would be no more than 50 hours weekly and 10 days of travel per month. Average should be 40 hours with seven or less days of travel.
  • 50 hours per week and travel only seven days out of the month.

image

This week’s question: for those who are allowed to work from home for at least one day per week, what restrictions or requirements does your employer impose? It would probably be informative to describe (in high-level terms) what your job involves since it’s likely to be a lot different for a software developer than an implementation consultant.


Last Week’s Most Interesting News

  • An apparent ransomware attack takes some of Nuance’s cloud-based services offline.
  • CMS cancels its scheduled release of Medicare Advantage data to researchers at the last minute, citing data quality concerns.
  • The chairs of the Senate Veterans Affairs and Armed Services committees urge the VA to seek the DoD’s advice in its Cerner contract negotiation and implementation.
  • Google offers consumers the ability to request that their exposed medical information be filtered from its search results.
  • Anthem agrees to pay $115 million to settle a class action lawsuit involving its 2016 hacker breach of 78 million records.

Webinars

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Sales

Wisconsin’s Department of Health chooses Cerner for its seven care and treatment centers in a 10-year, $33 million contract. In-state competitor Epic did not submit a proposal for the project, which drew five bidders.


Decisions

image

  • Cedar County Memorial Hospital (MO) will replace NextGen Healthcare with Meditech in 2018.
  • Rankin County Hospital District (TX) will go live on Cerner by November 2017.
  • Christus Mother Frances Hospital – Sulphur Springs (TX) will replace Meditech with Epic in October 2017.
  • Teton Valley Hospital (ID) will move from Healthland to Athenahealth in September 2017.
  • Liberty – Dayton Community Hospital (TX) will go live on Cerner in March 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

SNAGHTML22cfc4b8

Sandy Rosenbaum, SVP of contracts at Iatric Systems, died June 21, 2017. The Alzheimer’s Association fundraiser launched in her honor by her husband — Iatric founder and CEO Joel Berman — has raised $223,000 vs. his goal of $10,000.

image

The family of former Sutter health CIO John Hummel launches a fundraiser looking for help covering his rehabilitation costs following a fall-related head injury that has depleted his insurance benefits and personal funds. His LinkedIn profile says he’s now director of IS at Taos Health System (NM).


Announcements and Implementations

image

Learn on Demand Systems adds an API-accessible instant notification engine to its training management and lab-on-demand learning systems, allowing instructors to send tips to particular students or to send commands that the student can play back in their lab console.

image

The patent office issues five new patent allowances to Glytec for its diabetes therapy management software, raising the company’s allowed/issued patent total for EGlycemic Management System to 11, with another 50 pending.

image

T-System integrates EBroselow’s SafeDose and SafeDose Scan medication calculations functionality into its T-System EV EDIS.

image

Sphere3 releases Aperum Enterprise, which allows health systems to analyze nurse call light data and patient feedback to set patient experience benchmarks.


Government and Politics

image

image

Austin, TX-based VA officials warn that the department’s $543 million real-time location (RTLS) system is in danger of “catastrophic failure” as the overdue system has failed operational tests and may not work on the the VA’s WiFi network. The VA pitched the system as the solution for managing inventory and ensuring equipment sterilization, but a DC hospital site visit found that the lack of a functional system has caused supply crises that have required cancelling surgeries and using expired surgical equipment. A VA employee’s email referred to the former HP Enterprise Services (now DXC Technology) as “nitwits” and refused to give the company access to its backup systems, while the company blamed VA incompetence. The company’s RTLS subcontractor is Intelligent InSites. Employees at the same DC medical center are refusing to use Catamaran, a $275 million predictive analytics supply chain system whose contract has since been terminated.


Privacy and Security

image

Princeton Community Hospital (WV) remains down as its IT department continues to “build an entirely new computer network and install new hard drives on all devices throughout the system” following last Tuesday’s ransomware attack. The hospital lost access to all systems, email, and the Internet but has since installed 53 new computers to provide access to Meditech.

A Connecticut hospital warns local residents that scammers are spoofing its caller ID to demand that they send payment for medical services.


Other

image

A West Virginia community college hosts a week-long Drone Camp for high school students, with funding for the 12 drones provided by Cabell Huntington Hospital (WV) via VP/CIO Dennis Lee, pictured above with the participants. 

The Boston Globe says consumers are losing patience with waiting room delays caused by intentional provider overbooking to maximize profit. The article observes that many hospitals don’t even monitor delays, possibly because despite alleged consumerism, their waiting rooms remain full. Possible solutions include hiring a patient flow coordinator to monitor delays, giving patients pagers so they aren’t tied to their chair waiting for their name to be called, posting notices on the board when doctors are running late, and tracking patient flow by RTLS.

image

An Oregon trauma surgeon designs and creates a $50 3D-printed hand and forearm for a six-year-old.


Sponsor Updates

  • ZirMed receives HFMA Peer Review Designation for its charge integrity and claims management solutions and also announces that its charge integrity solution has identified $7.5 million in recoverable net revenue for Novant Health.

Blog Posts


Contacts

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

125x125_2nd_Circle

Morning Headlines 6/30/17

June 29, 2017 Headlines 2 Comments

Nuance Healthcare: Impacted Customer Update

Nuance launches a webpage to keep customers informed of its progress restoring services following a cyberattack that took down its hosted services.

Petya.2017 is a wiper not a ransomware

A blogpost on Petya explains that its not technically ransomware because it does not attempt to solicit money from victims and offers no options for reversing the damage it causes.

Medicare Halts Release of Much-Anticipated Data

CMS cancels the highly anticipated planned release of Medicare Advantage data to researchers, which was scheduled to be released at the annual research meeting of AcademyHealth.

Former DoD acquisition chief Kendall joins Leidos board

Frank Kendall, the former DoD undersecretary for acquisition, technology and logistics, joins the board of directors at Leidos, effective immediately.

News 6/30/17

June 29, 2017 News 5 Comments

Top News

SNAGHTML8093226

Nuance’s most recent update from Wednesday afternoon says it is still recovering servers following Tuesday’s malware attack. The company has not provided an estimated time to resolution.

Affected cloud services include transcription, radiology critical test results, Assure, Dragon Medical Advisor, Cerner DQR, Computer-Assisted Coding, Computer-Assisted CDI, CLU software development kit, and all Quality Solutions products.

Nuance recommends that cloud transcription users move to Dragon Medical or use an alternative dictation service, which suggests lack of confidence that the systems will be restored soon. A few customers say they’ve been told not to expect restoration of services until next week or even longer, but I can’t verify that.

Patient care is surely being affected as hospitals and practices try to implement minimally-tested downtime procedures or switch to backup transcription providers with the inevitable delays in patient information flow.

image

It will be interesting to see, once the smoke clears, how Nuance handles the HIPAA implications of the malware attack given its massive healthcare presence. HHS has advised that a ransomware attack is by definition a breach since an unauthorized party has acquired PHI, but adds that if the business associate (in this case since Nuance isn’t a covered entity) can argue that it is unlikely that the information was compromised, then breach notification is not required. The Petya malware – which arguably isn’t ransomware — does not send data anywhere but instead permanently encrypts it (in essence, destroying it), so assuming Nuance can restore the PHI from backups, it may be able to successfully argue that the information was never exposed or threatened.

NUAN share price has declined just 5 percent since its systems went down Tuesday.

image

Nuance seems to be understandably struggling with its public communication, same as any of us who would rather be fixing the problem than explaining it individually to every user affected by it. Some customers say the company is doing a great job of keeping them in the loop, which probably means that it’s doing the best it can given potentially outdated or incorrect contact information. The company:

  • Launched a communications page that was quickly taken down.
  • Announced in a press release that updates would be provided on a different page and via a Twitter account, neither of which contain any updates.
  • Hastily put up still another page (I’m inferring “hastily” given spelling and punctuation errors) and went silent on Twitter except for a single link to the newly created page.
  • Is taking heat from its transcriptionists who are questioning in the absence of definitive updates from Nuance whether they’ll be paid for being unable to work during the several days’ of downtime. However, a Nuance email to employees says they will be paid their normal rate for their scheduled hours and will be offered incentive pay to help clear the post-resolution reports backlog.

Reader Comments

image

From Gordon Gecko: “Re: my KLAS-corrected comments about Cerner. My math is right. I included ‘new’ customers, which are of more interest to the Street, and excluded add-on sales to existing customers. I also said ‘if you take away DoD and the 30 micro-hospitals,’ 85 total. I included all Cerner losses. Maybe the most relevant takeaway is that there have been more Millennium defections in the last two years than Soarian defections. Looks like for every Weirton and Pinnacle that sues Cerner to escape Soarian, there are dozens who don’t dare.”

image

From Yuge Surprise: “Re: DoD. The swam is not draining, but swirling.” Frank Kendall — the Pentagon’s recently retired undersecretary of acquisition, technology, and logistics — joins the board of Leidos. Kendall presided over the DoD’s selection of Leidos for its $4.3 billion EHR project.


HIStalk Announcements and Requests

image

HIStalk had 12,114 page views Wednesday, which I assume can be attributed to ransomware interest and the fact that – because of reader tips — I reported Nuance’s incident many hours before anyone else. It was the fourth-busiest day since I started the site in 2003.

This week on HIStalk Practice: HHS announces $195 million in HIT-related community health center funding. BCBS of Nebraska takes over Think Whole Person Healthcare. Rhode Island providers protest PDMP legislation.Independent Health forms Evolve Practice Partners. Physicians show a decided lack of interest in MACRA prep. PatientPoint raises $140 million.


Webinars

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

image

Cincinnati-based physician office marketing technology vendor PatientPoint raises $140 million in financing from private investment firms.

image

Anti-trust concerns cause Walgreens and Rite Aid to cancel their planned $9.4 billion merger and instead strike a deal in which Walgreens will buy half of Rite Aid’s drugstores for $5.18 billion in cash. In other news, Walgreens apparently puts its much-regretted experience with Theranos behind it in announcing that LabCorp will offer specimen collection services in some of its stores.

image

Diabetes management app and data analytics vendor Glooko raises $35 million in a Series C round, increasing its total to $71 million.


Sales

SNAGHTML113220d3

Henry County Health Center (IA) chooses FormFast’s FastPrint and FormFast Capture.


People

image

MedeAnalytics hires Paul Kaiser (TriZetto Provider Solutions) as CEO.

image

Anna Clark (Truven Health Analytics/IBM Watson Health) joins Medecision as SVP/chief revenue officer.

image

Greg Chittim (Arcadia Healthcare Solutions) joins Health Advances as VP/healthcare IT practice leader. 


Announcements and Implementations

SNAGHTML119acaf3

Ability Network adds physician scheduling to its ShiftHound workforce management product.

Novant Health (NC) and Carolinas HealthCare System (NC) begin exchanging patient information via an HIE.


Government and Politics

SNAGHTML112aee6a

An HHS/ONC bulletin warns of the most recent ransomware threat and provides recommended actions for affected sites.

image

CMS halts its planned release of Medicare Advantage of claims data at the last minute, cancelling a conference presentation at which it was to have been unveiled. CMS blames unresolved issues with the quality of the information, which immediately raises questions: (a) if CMS is using the information to pay providers, why isn’t it good enough for research purposes?, and (b) given lack of commitment to an updated release date, will the data ever see the light of day? 

The Senate considers legislation that would ban the Department of Defense from doing business with antivirus software firm Kaspersky Lab, citing intelligence agency concerns about the company’s close ties to the Kremlin. 

image

This headline and the threat it references say a lot.


Privacy and Security

image image

Heritage Valley Health System (PA) has brought its hospitals back online following its ransomware attack Tuesday, although its community locations remain closed. Princeton Community Hospital (WV) says it will “rebuild its computer network from scratch” following its Tuesday infection and it remains on diversion. 

SNAGHTML1176c6cc

An interesting analysis of the Petya malware concludes that it’s not technically ransomware since it has no ability to actually recover the drives it encrypts even if the victim pays. The author says Petya is instead a nation-state authored “wiper” that is intended to destroy systems, disguised as ransomware to influence media reports. The intended target may have been institutions in the Ukraine, with the malware’s global spread possibly being unintended. That would make Russia the obvious suspect.

In a bizarre incident highlighted by DataBreaches.net, a federal judge chastises California’s attorney general for harassing movie site IMDb.com, the subject of a California law that requires the site to remove the factual age of celebrities who want that information hidden. The Screen Actors Guild backed the law – now blocked by injunction — by saying it would reduce Hollywood age discrimination.


Other

image

A BCBS analysis of insurance claims finds that opioid addiction diagnoses have increased 500 percent in the past seven years. Twenty-one percent of patients whose claims were reviewed filled at least one opioid prescription in 2015, while the study also found that short-term, high-dose therapy increases the chance of addiction by 40 times compared to lower doses. 

In Kenya, three men are charged with stealing the body of a four-year-old from a hospital morgue, apparently with the intention of burying it. The hospital wouldn’t release the body because his family hadn’t paid his bill.

image image

I love dogs, but this is as ridiculous as people scamming airlines into providing free main-cabin rides for their “emotional support animals.” A woman brags on Twitter that she snuck her grandmother’s dog into the hospital to see her, swaddling it to look like a baby. A fellow smuggler voiced support in providing a photo of the dog he brought in (or rode in) as a visitor. Apparently many folks believe that rules apply to them only when convenient.


Sponsor Updates

  • IDC Health Insights recognizes NTT Data as a Top 25 Enterprise.
  • Reaction Data publishes an industry brief on the Lexmark/Hyland acquisition.
  • Optimum Healthcare IT posts a video of the recent presentation of Dan Critchley, CEO of managed services, at UK eHealth Week.
  • ECG Management Consultants releases a new white paper, “ASCs at a Tipping Point: The New Reality of Surgical Services for Health Systems.”
  • Glytec publishes a new case study, “With Glytec, Hospital Moves to Basal-Bolus Insulin, Saves $9.7 Million.”
  • Imprivata will exhibit at the Patient Safety Congress July 4-5 in Manchester, England.
  • Twenty-seven Influence Health customers upgrade to its new Web CMS.

Blog Posts


Contacts

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

125x125_2nd_Circle

EPtalk by Dr. Jayne 6/29/17

June 29, 2017 Dr. Jayne 1 Comment

Several readers who have ties to consulting or staffing firms have reached out to me regarding my recent Curbside Consult that covered a friend’s layoff following her employer’s migration to a new EHR platform. I am very appreciative of the gesture and it sounds like she has some promising leads.

The piece had several reader comments, with one calling me out for using a full consulting schedule as an excuse to not do business with her former employer rather than telling them I didn’t want to work with them because of how they treated their people.

Like so many large organizations, I suspect here that the proverbial right hand doesn’t know what the left hand is doing, and there is going to be some reorganization that takes place. Eventually someone with their head on straight will be in control and they’re going to need qualified help.

I recall a similar situation with another employer who downsized a division in a way that strongly smelled of age discrimination. Several team members took early retirement. One of the analysts had the last laugh when she came back as a consultant making double her salary while also collecting her pension. She continued working there for another four years. Had her new employer refused to work with them on principle, she might not have had that opportunity for payback.

It’s human to want to sock it to bad people on the way out, but it seldom works out well. I recently coached a former colleague on how to write his resignation letter. He wanted to tell the truth about how the employer was abusive, negligent, and reckless, spurring his decision to leave. I counseled that the standard “This letter serves as my notice, my last day of work will be X” approach would be a much better way to go. He went with the emotional response and ended up being perp-walked through the office without even a chance to pack his cardboard box of personal belongs. His former boss also immediately started attempts to sully his reputation. It’s not to say that the boss might have acted that way regardless, but I don’t think my friend having his say helped the situation.

Even when you’re leaving a job voluntarily, it’s often difficult. Depending on your role and the amount of privileged information you have access to, there are concerns as to whether your resignation will simply be accepted or whether you will be escorted from the premises.

When I left one hospital position, I was fairly confident they were going to do the latter since I had access to their recruiting and acquisition strategies and was going to a relative competitor. I prepared for the resignation for several weeks, slowly moving things out of my office, but keeping enough personal items for it to not appear suspicious. On the day I was planning to deliver my resignation letter, the file cabinets were empty and the medical texts in the book case had been replaced by random binders, coding books, and training manuals.

I had gotten myself to a place where I was mentally ready to be walked out, so it was surprising when they asked me to work through my entire four-week notice period. Several days later they told me that they were going to use my resignation as an opportunity to change the role to a part-time position that would only cover about 20 percent of my job duties. They didn’t plan to continue the kind of change leadership and process improvement work I had spent most of my time doing. They didn’t expect me to perform any knowledge transfer since they hadn’t identified anyone to take the remaining portion of the role.

I spent three weeks doing little to nothing, attending meetings like the walking dead just to have something to do. Finally, they identified someone to take the remaining part of the role and we had three days of frantic hand-offs and a request to extend my employment.

Now that I’m in consulting, I’m constantly in a state of either starting a new job or leaving one. When I really connect with a client, it’s hard to leave, even if we’ve accomplished the goals we set out to meet together. Sometimes, however, the leaving is pretty easy, as it was this week with a client I can only describe as extremely challenging.

They brought me in to do a stakeholder assessment and to look at why they are still struggling with EHR adoption six years after go-live. They’ve got some serious leadership deficits and don’t seem too keen on doing the work needed to move to a place where the physicians have buy-in on what the parent company wants them to do.

Even though I was supposed to be winding things down this week, they spent my last day on site arguing with me about when the physicians should complete their documentation. They allow 10 days for the physicians to finish ambulatory visit notes, which is absurd. They have all kinds of reasons why the physicians can’t complete their notes in a timely fashion and aren’t interested in learning strategies to remediate the situation.

It was like dealing with an argumentative teenager. I think they actually believed I would change my opinion if they continued to badger me. They never seemed to understand that it’s not my opinion that counts — it’s that of CMS, auditors, and their medical liability carrier. I wish them luck defending their policies when an audit or subpoena reveals charts completed more than a week after the fact.

image

We talk quite a bit about healthcare technology, but sometimes it’s the low-tech solutions that really matter to physicians. I experienced this first hand over the weekend when my stethoscope gave up the ghost. I should have known it was coming since I already had to replace the ear tips and diaphragm. Although I had some spare parts at home, I didn’t have the diaphragm retainer ring that had failed. According to the websites that usually carry spare parts, mine was so old they didn’t stock replacement kits.

I started to despair. I own half a dozen stethoscopes, some of them special purpose (from those neonatal ICU and pediatric rotations) and others that I’ve bought to have a spare or a less-expensive version to take on volunteer trips. But I’ve always been partial to my first stethoscope, my constant companion since the beginning of clinical rotations.

I made a last-ditch effort by emailing 3M about options and was pleasantly surprised to find out that a certain model repair kit would do the trick even though it isn’t officially listed as being compatible. They also sent the handy Amazon link to buy it, so I should be back in business in a couple of days.

What’s your favorite piece of healthcare technology, IT-wise or other? Email me.

Email Dr. Jayne.

Morning Headlines 6/29/17

June 28, 2017 Headlines No Comments

Cyberattack Causes Surgeons to Cancel Some Operations

The Wall Street Journal covers the global Petya ransomware attack that forced a Pennsylvania-based, two-hospital health system (PA) back to paper.

Merck hit by new global ransomware attack

Pharmaceutical giant Merck’s network is taken offline, a victim of the global Petya ransomware attack.

Survey Finds Doctors Don’t Feel Prepared for Quality Reporting Rules

A survey of 1,000 practice-based physicians involved in MACRA planning finds that fewer than one-in-four feel well prepared to meet its requirements in 2017.

Fast, Precise Cancer Care Is Coming To a Hospital Near You

Wired profiles a recently FDA approved tumor sequencing test from Thermo Fisher Scientific that will tell doctors which treatments will work best to tackle lung cancers.

Readers Write: Why Daily Clinical Analysis May Be A Game-changer In Patient Outcomes

June 28, 2017 Readers Write 3 Comments

Why Daily Clinical Analysis May Be A Game-changer In Patient Outcomes
By Benjamin Yu, MD, PhD

 image

Benjamin Yu, MD, PhD is vice president of medical informatics and genomics at Interpreta of San Diego, CA.

A missing piece in population health is real-time data and its real-time and continuous analysis. It’s a key ingredient that can help streamline health delivery, improve outcomes, and manage a dynamic patient population. Real-time interpretation is a keystone in many service industries, especially finance and e-commerce. However, its value is often overlooked in healthcare.

Instead, the health industry typically relies on monthly or quarterly business reports to spotlight health needs (e.g., gaps in care, medication management, etc.) and to find regional deficiencies. Using this information, groups plan and carry out campaigns to target and improve care through a variety of outreach mechanisms such as care managers, call centers, and provider network contacts.

However, during the laborious process of assessing static reports, millions of conditions change. It’s analogous to using turn-by-turn instructions for driving based on outdated information. Normally, turn-by-turn directions help the driver navigate through unknown roads and emerging traffic conditions in real time. However, if the system is not current, it might alert the driver long after he/she has missed a turn.

Similarly, in healthcare, by the time an outreach takes place, the member’s medications may have changed, a new refill may have been missed, a vaccine or screening may have been completed without the knowledge of the campaign, or a patient could have become ill or hospitalized before discovery of his/her risk. Thus, in addition to being expensive, the discover-and-campaign approach can be disjointed and too slow to adapt to the ever-changing landscape of a patient population.

Despite their potential benefits, real-time clinical solutions have been hampered in population health for several reasons. Many groups fear that real-time clinical data means too many alerts. While this may be true of some clinical information systems, it is not inherently true. In fact, the opposite may be true in that one of the major efficiencies provided by real-time data is reduced noise.

Because data is up to date, resolved issues should quickly disappear from the clinical workflow. For example, when a health plan calls a patient, instead of reviewing a long list of care initiatives — many of which are already complete — the clinician or plan can focus on future needs that are of the highest priority. Using up-to-date information ultimately can reduce alert fatigue and provide a more satisfying and impactful patient experience. In summary, real-time analysis is a noise reducer.

Indeed, the fear of ‘too much information’ often stems from the design of current health information systems, which rely heavily on clinicians and staff to sort through printouts, inboxes, notifications, and data reports to resolve issues in the clinic. Notably, real-time data should not be considered synonymous with an increase in graphs and decisions. Using the driving analogy, data is constantly changing in a turn-by-turn application. However, these applications natively interpret incoming data and only alert the user with upcoming turns or changes to the route. With respect to healthcare, real-time systems also need to be designed to interpret real-time data with actions and prioritizations of the clinician in mind.

The value of real-time data is underestimated. While some inherently accept that real-time clinical information is better than outdated information, real-time data and its immediate interpretation impacts far more than today’s era of business reports. Real-time data and analysis enables feedback interactions and behavioral modifications that cannot be derived from periodic reports.

In the consumer market, real-time responses enable end-to-end services such as ride share, routing, and many financial transactions. In healthcare, real-time clinical information enables better predictive technology and thus an ability to identify trends much earlier. In an increasingly connected world, new clinical services and technologies require instantaneous feedback and timely actions for members and users, enabled by real-time clinical information. If the rapid growth of consumer health devices like wearable monitors is an indicator of upcoming trends, real-time clinical data in population health is just around the corner. Leading healthcare institutions and technology providers need to make sure they don’t miss the turn.

Subscribe to Updates

Search


Loading

Text Ads


Report News and Rumors

No title

Anonymous online form
E-mail
Rumor line: 801.HIT.NEWS

Tweets

Archives

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reader Comments

  • In Poor Taste: Loading up on wine futures? Really??...
  • Just a Reader: How can premiums skyrocket when Obamacare is enacted AND when it is repealed? Seems like the insurance companies are...
  • Brian Too: Ever notice how Presidential candidates hate Executive Orders and decry the previous President's use of them? Then the ...
  • Associate CIO: Re: Desperado I am going to say false on that statement that Zane is the new CEO. Now, that doesn't mean it cannot h...
  • AynRandWasDumb: Be honest. The most economically efficient way to distribute insurance costs equitably is to include everyone in the sam...

Sponsor Quick Links