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Health IT from the Investor’s Chair 9/17/14

September 17, 2014 Investor's Chair No Comments

Some Musings from the Chair

With summer winding down and Labor Day in the rear view mirror, it felt like a good time to write a quick Investor’s Chair post and share one or two of the more interesting things I’ve noted in the market of late.

The biggest news of the summer was clearly Cerner’s announced acquisition of Siemens’ healthcare information technology unit (or, as we old timers would say, Shared Medical Systems.) When I got a call from a reporter related to the transaction, my first reaction was a sense (as perhaps the Siemens folks would say) of schadenfreude, as this is yet another example of yet another European technology company foundering on the shores of the US healthcare IT market (think Misys).

Recall that Siemens bought SMS 15 years ago for $2.1 billion, only to sell it now for $1.3 billion. Why the decrease in value? Perhaps because in the greatest boom times our sector has ever seen (thanks in no small part to ARRA), revenues over these 15 years were astoundingly FLAT!

With this purchase, Cerner is now the clear sector leader and will enjoy mammoth cross-selling opportunities given the product fit. Cerner is a clinical leader, where Siemens (née SMS) always lagged there and was more focused on financial systems. (In fact, I recall the former CEO of SMS explaining to me that Cerner’s clinical focus was off base!)

From an investor perspective, this was a good use of both the cash hoard Cerner had built up on its balance sheet and its high-multiple stock, allowing the deal to be almost instantly accretive – especially with the $175 million in pre-tax synergies the company guided to in its press release. While the stock traded fairly flat around the release (likely because rumors had circulated for several weeks prior to the deal, causing the deal to already be priced into the stock), Cerner’s shares are up almost 10 percent as I’m writing this post, more than twice the S&P — Ms. Market seems to be more excited.

The vast majority of analyst commentary has been positive and we here at the Chair are fans of the purchase as well. The only thing that gives me pause as a long time Cerner watcher (and fan) is that the company has zero history of large-scale M&A and the sector has not been kind to such large-scale bets in the past.  What’s especially noteworthy here though is that the cultures of the two companies are literally more than an ocean apart, and in the words of famed management guru, Peter Drucker, “Culture eats strategy over breakfast”.

That said, the price Cerner paid clearly de-risks the acquisition, and Cerner is known for its strong culture (and full parking lots).

Another aspect of autumn I’m eagerly anticipating is attending the Health 2.0 Fall Conference in a few weeks. My impressions of the 2010 event can be found here. I missed it last year, so I’m really looking forward to the opportunity to see some of the new thinking and more cutting edge tech that this event usually attracts. With “digital health” so beloved of the venture world these days, I’m expecting both a fair number of cheap but cheerful innovators with apps and dreams, but also know there will be more than a few companies straight out of HBO’s show “Silicon Valley” strutting their stuff and spending their VCs’ money on booths and travel like there’s no tomorrow (and if they’re not careful, there won’t be).

Part of what I like most about this event is the great dichotomy in participants, sponsors, and attendees. I’m also particularly excited to be mentoring the HealthTraction component, Health 2.0’s Startup Championship – CEO mentoring for companies of all sizes is one of my favorite aspects of ST Advisors’ work.

As for the actual sessions, in the past they’ve varied from truly fascinating to really annoying, but that’s the beauty of industry conferences. My big complaint is that the conference moved from San Francisco to “the Valley,” but I’m keeping an open mind and will be writing a debrief post afterwards. Drop me a note if you’d like to drink some sponsor’s wine or coffee during the event.

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Ben Rooks spent a decade as an equity analyst and six years as an investment banker. Five years ago he formed ST Advisors to work with companies on issues of strategy, growth, and exit planning (among other fun topics). He lives in San Francisco with his wife and the cutest dog ever!

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September 17, 2014 Investor's Chair No Comments

HIStalk Interviews Marc Grossman, Principal, WeiserMazars

September 15, 2014 Interviews 1 Comment

Marc Grossman is principal with WeiserMazars of New York, NY.

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Tell me about yourself and the company.

I’ve been in the healthcare IT industry for 30 years. I’ve worked on the provider side as a hospital administrator and have been doing healthcare IT consulting for about 25 years.

I work for WeiserMazars. It’s an international consulting and accounting firm. I head up the healthcare national practice within the United States. Our clients are all provider-side clients in healthcare IT.

 

How are hospitals selecting and implementing systems differently now than they were five or 10 years ago?

There’s really not been that much change in how they’re selecting core systems. Hospitals typically keep systems for 10 to 20 years, which is a lot longer than most people would expect. I think it’s due to financial reasons.

We’ve gone through a lot of clinical selections recently. Our emphasis was on clinical systems due to Meaningful Use. There’s a cycle that I see the industry going through in the type of system, whether it’s financial, patient accounting, clinical lab, radiology, and so forth. But the process is basically still the same. That hasn’t changed.

 

The pendulum always swings back. People are paying more attention to revenue cycle and even talking about customer relationship management systems. What systems do you think are poised to make a comeback?

Patient accounting is going to see a big shift. That also has a lot to do with the fact that Siemens is being purchased by Cerner. Lab systems are starting to go through a cycle again.

People have in the past three or four years started looking at systems that haven’t taken off significantly yet. Systems related to population health management, data analytics, data warehousing, business intelligence. Those types of systems will cause a shift in purchases.

 

What are you seeing with lab systems? 

We’re seeing a push for an integrated approach, getting away from best of breed. You see it with Epic. You see it with Cerner. Those are probably the two biggest right now that I see people moving to. If they already have Epic, they’re moving to Epic’s lab. If they have Cerner, they’re moving to Cerner’s lab. 

We have seen that in lab systems, there seems to be a cycle about every seven years. I’d say about half of organizations are replacing. They keep it for about 14 years, typically, and about every seven years, we seem to be doing a lot more lab system selections than we have in the past. I’m talking about replacement of whatever they have — best of breed or some kind of niche vendor system.

 

How do you see Cerner’s acquisition of Siemens unfolding?

A lot of it’s going to depend on where the Siemens client is. Are they live on Soarian or in the process of implementing Soarian? Cerner has been much more successful with their patient accounting system recently. They’ve changed the name because it had such a bad reputation – they no longer call it ProFit. 

I believe Cerner is buying Siemens for intellectual property. On the patient accounting side, I think they’re also looking at the RCO base that Siemens has, which is a great revenue stream for them. 

Given Cerner’s history and the industry’s history over the last 20-30 years, Siemens Soarian and Invision product support is going to go downhill. I think they probably won’t sunset it officially for at least 10 years, just because I know Siemens does have numerous contracts which are going out 10 years. I also hear Siemens’ sales guys are really pushing to provide great deals right now, to get people to sign up or extend their contracts for 10 years. 

Like we’ve seen with many other vendors that purchased other systems, Cerner is clearly not going to put R&D money into two patient accounting systems and two clinical systems if they have an integrated system now. I just don’t see any indication that Cerner is going to continue the development of any of the Soarian or Invision products.

 

What are you seeing with population health management and analytics?

We’re seeing a lot of disappointment because the systems are so early in their life cycles. People are hearing a lot of promises from various vendors, both the major players like Cerner, Epic, and Allscripts and down the line. They have products in their infancy.

Then you have the niche players, which definitely have more mature systems, but there’s still a lot of disappointment even with those. Difficulty with interfacing issues and difficulty with the depth and breadth part of the applications.

 

Is there a mature enough process in place in hospitals that even if the systems could give them what they want, that they could follow through on the promise of either population health management or analytics?

I’ll say eventually we’ll get there. I don’t think we’re there yet.

Some of the larger academic medical centers that have large IT shops, are more sophisticated, and have a lot more money to spend have gotten their feet wet, some of them 10 years ago. But a lesson we have to learn is that vendors and consultants set false expectations. It’s a multifaceted challenge that we’re dealing with in our industry.

The biggest problem we have is that our industry is the only industry that I know of where the revenue side of the financial equation is heavily regulated, but the cost side is totally unregulated. We have a ton of regulations, a ton of incentive programs, but the money isn’t there to pay for all the wants and the needs.

We also as an industry need to accept responsibility for the fact in that we don’t have real standards when it comes to interoperability. Each hospital thinks that it’s unique. I’m not suggesting that they’re not different in some ways and some have certain specialties that others don’t. But the reality is that they’re in competition with each other, so they’re not willing to share things where they should be sharing.

The other issue is that each individual hospital’s incentives are not in sync with the government’s incentives and drive. The government can save money by having hospitals operate in a certain way. Each hospital doesn’t necessarily benefit from it. The desire of where we’re going to put our money at each hospital is not consistent.

 

Is the era of hospitals running applications from their own data centers fading as they move to the cloud?

We’re at least five to 10 years away from that. I’m hearing from a lot of our clients – they want to get out of the data center business. I don’t know if it’s going to necessarily be the cloud. There’s definitely a push to move more to RCO-RHO kind of approach like Siemens and Cerner have been doing for many years.

 

When hospitals negotiate agreements with companies to host their applications in whatever form, what’s important for them to look at contractually to protect their interest?

Service levels, to make sure that response time and downtime is going to be sufficient. Address areas related to growth and the impact on fees. Also, the whole issue of who really owns the data and how do you access that data if and when the arrangement ends. It sounds like a simple thing, but the reality is that it’s often very difficult for hospitals when they’re trying to pull out of an RCO arrangement to easily get their data.

Those are probably the biggest issues in my mind — cost, access, and availability.

 

What are the top issues that are challenging health system IT departments?

What I’m hearing from most of our clients are four or five big issues. CIOs expressing concern that they have too much on their plates, not just individually, but as an organization. They have too many high priorities and don’t have the necessary resources in most instances. ICD-10, Meaningful Use, the related offshoots from all of that, population health, changes in reimbursement, growth in terms of hospitals buying up physician practices or buying other hospitals or merging.

A second category is lack of strong IT governance. A lot of what relates to that unfortunately at many hospitals, especially at smaller hospitals, CIOs still do not have a full seat at the table. They’re often viewed as not being strategic. A lot of the hospital executives still view IT as a necessary evil rather than a strategic enabler. It becomes an uphill battle for CIOs.

There’s a lot of frustration and lack of trust among a lot of the executive leadership at many healthcare providers due to the history of false promises and expectations that were not met in the industry over the many years. Look at how many failures we’ve had with just EMRs alone and how organizations have had to replace systems.

Even in this day and age, I find a lot of executives don’t understand what systems are going to really give them and that systems are not going to solve all their problems. It’s just an enabler as opposed to the solution itself.

 

Do you have any concluding thoughts?

We’ve actually grown a lot as an industry. I think we still have a lot of growing to do.

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September 15, 2014 Interviews 1 Comment

Monday Morning Update 9/15/14

September 13, 2014 News 6 Comments

Top News

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Illinois-based Advocate Health Care and NorthShore University HealthSystem will merge to form the state’s largest health system with 16 hospitals, 45,000 employees, and $6.5 billion in annual revenue. The CEOs of both systems say more mergers or acquisitions are likely as hospital consolidation continues. They also touted the benefit of shared electronic medical records and future plans to roll out more patient-facing technologies. I would bet that NorthShore’s Epic will eventually become the new standard, replacing Advocate’s Cerner system.


Reader Comments

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From Core Consumer: “Re: Apple and Epic. Apple used Epic screen shots in their HealthKit presentation. There’s no doubt that the companies signed a partnership agreement. Just because details weren’t announced doesn’t mean it didn’t happen.”

From The PACS Designer: “Re: Office 365 Garage Series. With the focus these days on security, Microsoft in their Garage Series wants everyone to know where the Office 365 improvements will be to enhance user performance, collaboration, and connectivity.” I’m surprised Microsoft hasn’t crowed more loudly about Apple’s iCloud breach.

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From Smooth Operator: “Re: Kaiser CIO Phil Fasano. Kaiser confirms that Phil has resigned. There’s all sorts of internal discussion on who will be named interim CIO.”


HIStalk Announcements and Requests

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HIMSS and CHIME are the organizations most often joined by poll respondents. New poll to your right or here: what influence will Apple have on health and healthcare? Vote and then click the Comments link on the poll to elaborate further.


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.

We ran a couple of great, well-attended webinars in the last few days. Here’s “Meaningful Use Stage 2 Veterans Speak Out: Implementing Direct Secure Messaging for Success.”

This is last week’s “Electronic Health Record Divorce Rates on the Rise- The Four Factors that Predict Long-term Success.”


Sales

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The Amerigroup Texas Medicaid health plan will use analytics from Treo Solutions, which was recently acquired by 3M Health Information Systems.


Announcements and Implementations

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Australia’s leading interactive patient care vendor, Hills Health Solutions, will distribute patient engagement technology from Lincor Solutions. The agreement was signed during a trade mission visit to Australia by officials from Ireland, where Lincor is based. The company’s touch-screen offerings for both wall-mounted and mobile devices include clinician EMR access, audio and video patient calling, entertainment, patient education, surveys, and meal ordering.

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Visage Imaging is sponsoring the full-day New York Medical Imaging Informatics Symposium this Thursday, September 18 at New York City’s Marriott Marquis. The $70 registration fee includes a sushi lunch and up to 6 AMA PRA Category 1 credits.

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National Decision Support Company releases an Epic version of its ACR Select evidence-based imaging appropriateness module that includes not only the decision support rules, but also recording utilization data that can be reported from Clarity and Reporting Workbench.


Government and Politics

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Nevada votes to shut down its Nevada Health Link health insurance exchange and move to Healthcare.gov after a problematic rollout and the firing of contractor Xerox, who had a $75 million contract to build the site. The state announced plans in May to use Healthcare.gov for at least a year, but decided last week to make the switch permanent.


Other

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The weather this week in Verona, WI for Epic UGM attendees: highs in the mid-60s, lows in the low 40s, sunny all week other than a chance of rain Monday morning.  The local paper and TV stations are warning commuters of significant traffic delays through Thursday. The folks at Madison-based Nordic wrote up “10 ways to make the most of your 2014 Epic UGM experience.”

The Yakima, WA paper covers EMR use by doctors who aren’t thrilled by it. One is the chief medical officer of Community Health of Central Washington, who says doctors are using up to half of the already-brief patient encounter to work on the computer and complains that EHRs weren’t designed by doctors. Another doctor says EHRs can improve care and patient relationships if doctors stop their foot-dragging and give patients the benefit of real-time lab results and e-prescribing. 

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Bonds of SoutheastHEALTH (MO) are downgraded with a negative outlook after the hospital loses $39 million in 2013 because of revenue cycle problems caused by its Siemens Soarian implementation.

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”The Onion” covers telehealth.

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The Permanente Medical Group CEO Robert Pearl, MD lists five reasons healthcare IT isn’t widely embraced:

  1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
  2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
  3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
  4. EHRs provide clinical value, but slow physicians down.
  5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

My list might instead be:

  1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
  2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
  3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
  4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
  5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

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California HealthCare Foundation covers the Cerner implementation of Los Angeles County’s Department of Health Services, which will replace several siloed systems that require photocopying paper charts to transfer a patient from one of the county’s hospitals to another. Harbor-UCLA Medical Center goes live first on November 1.

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Tampa General Hospital (FL) fires an employee who it identified from audit logs as having printed the facesheets of several hundred surgery patients without authorization.

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An oral surgeon in Pennsylvania creates a public outcry when he lays off an employee of 12 years because he says her cancer (ovaries, liver, and pancreas) will leave her unable “to function in my office at the level required while battling for your life.” The doctor claims his intentions were noble: he laid her off so she could collect unemployment during treatment, he says, after which time she’s welcome to come back to work.

A hospital in England bans use of the term “computer on wheels” or “CoW,” fearing that patients might be insulted in hearing a nurse ask a colleague to “bring that CoW over here.” They like “workstation on wheels” better. A cynical employee said patients weren’t the problem, but rather hospital executives tired of hearing employees complain that the computer system is a “right cow” to use.

Here’s another example, along with bathroom scales in the homes of obese people, that having health data is not the same as using it: McDonald’s admirably posts calorie counts for every menu item and offers low-calorie choices like salads, apple slices, yogurt parfaits, and bottled water, but nobody buys the healthy items – they’re lining up for 600-calorie milkshakes masquerading as coffee and the 1,200-calorie feed trough known as the Big Breakfast. It would be interesting to calculate the annual death toll from both kinds of malnutrition – over and under.

Weird News Andy declares this story to be “efficient drug operation.” Federal agents arrest two employees of the Bronx VA hospital for using its mailroom to receive packages of cocaine mailed from Puerto Rico.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 13, 2014 News 6 Comments

News 9/12/14

September 11, 2014 News 2 Comments

Top News

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Former Allscripts CEO Glen Tullman launches Livongo Health, which will offer diabetes monitoring that includes an FDA-approved interactive glucometer and analytics. The company received a $10 million investment from General Catalyst. Its leadership team is sprinkled with former Allscripts people.


Reader Comments

From Vendor_Neutral: “Re: Apple. After months of being annoyed by misleading blog posts about Apple and Epic’s alleged partnership, I went back and watched that portion of WWDC this morning. Here is the direct quote: ‘We’re also working with leaders in health care applications like Epic Systems, now they provide the tech that enables hospitals serving over 100 million Americans, and so now with their integration with HealthKit, patients at these leading institutions will be able to get closer in sharing their information with their doctors.’ That’s all they said! NOTHING about a ‘partnership.’ They merely got early access to HealthKit. Let it be known that that is it.”

From Kaiser Roll: “Re: Phil Fasano. Resigned as CIO of Kaiser Permanente as announced in an email from CEO Bernard Tyson.” Unverified.


HIStalk Announcements and Requests

This week on HIStalk Practice: ABQ Healthcare Partners goes live on Allscripts. American College of Physicians outlines why MDs hate EHRs. Amazing Charts, athenaClinicals, and Meditouch vie for best EHR title. Research shows that primary care practices that create their own patient portal adoption strategy earn strong participation. The American Telemedicine Association grades states on telemedicine reimbursement and physician practice standards. Thanks for reading.

This week on HIStalk Connect: Apple unveils its long-awaited smartwatch, which will track activity and heart rate, but still falls short of what many were expecting for health features. The Mayo Clinic announces that it will work with IBM on a project that will use the Watson supercomputer to help analyze patient charts and match them with relevant clinical trails. Wellframe, a Boston-based startup, raises an $8.5 million Series A for its smartphone-based patient education and reminder tools.


Webinars

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

Google acquires Lift Labs, which makes a sensor-powered stabilizing spoon that helps people with tremors eat normally.

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Streamline Health Solutions announces Q2 results: revenue down 17 percent, EPS –$0.14 vs. -$0.07. Above is the one-year share price chart of STRM (blue) vs. the Nasdaq (red).

Privacy monitoring vendor FairWarning announces first-half results that include 104 percent growth in existing-customer revenue, 6,500 healthcare facilities as clients, and 64 hospitals running its SaaS-based product.


Sales

Capella Healthcare (TN) chooses Medhost’s YourCareLink to submit information to state public health reporting agencies.

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Phoebe Putney Health System (GA) selects Harris Corporation’s FusionFX Provider Portal.

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Evans Army Community Hospital (CO) will deploy AtHoc’s emergency communication solution.

Community Health Network (IN) will link its community Epic, Cerner, and Meditech EHRs through Health Catalyst’s Late-Binding Data Warehouse and Analytics Platform.


People

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Jack Janoso is named CEO of Fairfield Medical Center (OH). He was promoted from VP/CIO to CEO at Sharon Regional Health System (PA) before taking the new job.

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Beaumont Health (MI) — formed via the merger of Beaumont Health System, Botsford Health Care, and Oakwood Healthcare – names Subra Sripada as chief transformation officer of the 10-member executive team. He was previously chief administrative and information officer at Beaumont Health System.

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David Sides (iMDsoft) joins Streamline Health Solutions as EVP/COO.

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Boston Software Systems promotes Matthew Hawkins to EVP of healthcare strategy and sales.

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Jay Anders, MD (McKesson) is named chief medical officer of Medicomp Systems.


Announcements and Implementations

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Gillette Children’s Specialty Healthcare (MN) goes live on the Versus Advantages Clinic patient flow system.

AirWatch introduces AirWatch AppShield to provide security and management capabilities.

MModal launches an outpatient medical coding service.

Elsevier chooses Clinical Architecture’s Symedical terminology management system for its InOrder order set tool.

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MetroChicago HIE goes live with 31 hospitals using technology from Sandlot Solutions.

A Health Catalyst-sponsored survey of CHIME members (70 respondents) finds that analytics is the highest-priority IT investment, followed by population health and ICD-10.


Government and Politics

ONC announces that it will make minor tweaks to its 2014 certification criteria instead of rolling out voluntary 2015 criteria as previously planned. It will also name certification criteria by their year of approval going forward and will discontinue the “Complete EHR” certification.


Technology

Samsung pokes fun at this week’s somewhat anemic (and health-free) announcements from Apple, which seems to be morphing into Microsoft as it (a) pre-announces a product that won’t be available for a long time; (b) enters an existing market (smart watches) instead of creating a new one; and (c) fails to meet expectations in not talking about its rumored Health offering, possibly because of (a) limited stage time given the urgency of discussing fashionable watches and enlarged iPhone screens; (b) the moving target nature of whatever it’s going to eventually do, or (c) poor timing given that iCloud was just hacked.

Researchers from MIT and Georgia Tech find that Google Glass can measure pulse and respiration using its built-in gyroscope, accelerometer, and camera. You could say it’s for people who wouldn’t be caught dead wearing Glass.


Other

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The American Telemedicine Association reviews the telemedicine-related physician practice and licensure standards of all 50 states. The components included physician-patient encounter (are in-person initial visits required are are more restrictive standards in place); telepresenter (does the law require someone to be physically present with the patient during the session); informed consent (is the patient required to sign off differently than for in-person visits); and licensure (does the state offer out-of-state licensure reciprocity, exemptions for physician-to-physician consultations, and conditional licensure). Twenty-three states and DC earned an A grade, 27 got a B, and one (Alabama) had the lowest composite score and a C grade.

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Billionaire doctor Patrick Soon-Shiong makes the cover of the September 29 issue of Forbes, whose reporter seems as confused as the rest of us over whether he’s a genius, a blowhard huckster, or both. It points out that despite his spending $1.3 billion of his own money to acquire a bunch of unrelated technology companies (most notable in healthcare IT: iSirona), his grand ideas for “solving” healthcare are vaporware so far even as a rollout to Providence Health & Services is planned. The article mentioned Soon-Shiong’s tendency toward wild hype and his historic, greedy shafting of business partners, investors, and family members (“more of a wheeler-dealer than a scientist.”) Forbes concludes that his Nant-related holdings (including NantHealth) are worth $7.7 billion and he will start running IPOs next year, with NantHealth being the first.

Several publications are running breathy news items that Epic has hired a lobbying firm, none of them crediting HIStalk as their source since I reported it here on August 14 as tipped of by a reader who follows federal lobbying registrations.

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Epic’s user group meeting starts Monday, with 10,000 attendees riding buses from hotels as far away as Wisconsin Dells to get to Verona. Meanwhile, the company is again named the largest employer in Dane County, WI with 7,400 FTEs.

In the UK, breast cancer screening vans are upgraded with satellite links to allow employees to enter and access patient information and to send images directly to hospitals.

The family of Joan Rivers will reportedly file a $100 million lawsuit against the for-profit endoscopy clinic where she died during a throat operation, claiming the clinic allowed one of the doctors to perform an unplanned biopsy that should have been done in a hospital instead.

Weird News Andy titles this story “Moob.” In England, a man complains of gender discrimination when NHS turns down his request for cosmetic breast surgery to correct a lopsided condition caused by gynecomastia. “Women get boob jobs on the NHS but I can’t get help,” he says, while NHS maintains that they don’t pay for surgery that has no demonstrable health benefit.


Sponsor Updates

  • MedAssets issues a call for speakers for the 2015 Healthcare Business Summit April 7-9, 2015 in Las Vegas.
  • Connance presents a video case study of the challenges and successes of Carolinas HealthCare System (NC) after implementing its revenue cycle solution.
  • Billian’s HealthDATA offers its Vitals hospital news and RFP feed free to the public.
  • Aventura will participate in the SE conference of the HIMSS Summit in Nashville September 16-17.
  • The CDC and Premier release research indicating that unnecessary hospital antibiotic use costs $163 million.
  • Chilmark Research names Wellcentive a “Standout” Vendor in Product and Market ratings in Population Health Management Analysis.
  • Health Catalyst shares the results of its recent survey of CHIME members which indicates analytics is their top priority.
  • Aspen Advisors highlights its framework and recent engagements with organizations that are realizing the full value of their EHR.
  • Frost & Sullivan recognizes GE Healthcare IT with an innovation award for Centricity Financial Risk Manager.

EPtalk by Dr. Jayne

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It’s amazing how varied my work as a CMIO can be at times. Hot on the heels of some ridiculous implementation escapades, I’ve had a week of actually enjoyable work. I started the week attending a web-based focus group for one of our vendors. They did a great job putting it on and I give them an A-plus for facilitation skills.

The task at hand was to review some mock-ups for updated Patient-Centered Medical Home workflows. Instead of just throwing us into the content, they took the time to talk with the group about our existing workflows, including the good aspects as well as the challenges. The moderator made sure everyone was participating with a good mix of calling on people and letting them volunteer.

Web meetings are always hard, especially with a group of attendees that don’t really know one another. Someone is always trying to talk over the group or failing to mute themselves while they’re banging around their office, but we didn’t have any of that.

Only after they heard our needs did we see the mock-ups. It was an effective strategy because you didn’t have people throwing out all kinds of additional needs because they hadn’t thought it through. We were validating our needs against their ideas rather than being reactive.

Additionally, their mock-ups were well done with real-world scenarios. I’ve seen samples from other vendors where it looks like they just chose random drugs from a reference book, but these were spot on. I appreciated the fact that they prepared for us rather than asking us to imagine how it would be for the scenarios we see every day.

Usually after a four-hour web meeting I’m ready to bang my head against the wall (assuming no martinis are available), but I was actually a bit sad to see this one end. We’re regrouping in a few weeks, however, so that gives me something to look forward to.

Following the focus group, I was able to use the fact that my boss is out of town and our standing one-on-one is cancelled to do some belated spring cleaning in my office. It’s amazing how much junk accumulates. I’m ashamed to say I found a bunch of marketing collateral from HIMSS that I shoved in a drawer six months ago and promptly forgot. Sorry, marketing folks, I won’t be following up. But the cool Mylar folding wine bottle drip-proofer attached to one packet was a nice find.

Today I was able to spend some time mentoring a relatively new physician champion at one of our hospitals across town. Although he has a great deal of knowledge on the inpatient side, he’s just starting to get involved in ambulatory projects. He’s also studying for the clinical informatics board exam next month, so we talked about tips and tricks.

His facility is relatively new and has always been paperless, so it will be interesting to see how he does working with physicians who are transitioning from paper to EHR at the same time they’re transitioning to being employed. I’ve shared some of my horror stories, but from the expression on his face, I’m pretty sure he thought I was making them up. I can’t wait until he has a war story of his own.

The most fun thing about working with him is showing him some of the cooler features of our EHR. I spend so much time listening to physician complaints about how bad it is and how computers are ruining the practice of medicine that it was good to get an outsider view of its capabilities. He’s had formal training from the vendor, but taking that knowledge and applying it to a real-world practice workflow when you’re being interrupted by phone calls, nurses popping their heads through the doorway, and the mounds of paper that inhabit our “paperless” offices is another thing.

The best part of the meeting was when he asked what websites I would recommend to help him learn more about the IT landscape. I get an “F” on my mentor report card because I unfortunately couldn’t tell him about HIStalk. Hopefully he’ll stumble upon it or maybe one of the other informatics staff will recommend it, but it’s always a surreal experience when my worlds almost collide.

Got an alter ego? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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September 11, 2014 News 2 Comments

Health IT from the CIO’s Chair 9/10/14

September 10, 2014 Darren Dworkin 6 Comments

Fine print: the views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

EMRs – Application or Platform?

It is hard to go very far these days with out someone looking to dismiss EMRs as “just the transactional system.” It seems every new IT innovation or idea is the next big thing that will do us the favor of connecting with our installed systems, but do so much more. Population health, analytics, mobility, and patient engagement are all the new platforms to focus on.

Wait. EMRs are depended on every minute of every day to enable care delivery through zillions of transactions and are the result of years of hard work and untold dollars. They aren’t a platform? Really?

I want to believe that our enterprise EMRs are really agile platforms on which care delivery can be transformed. They are just works in progress. Oracle, SAP, Facebook, and Salesforce.com all started as applications and grew into platforms. Some better than others, but it was a journey.

In my mind, our industry’s EMRs are on this same path. I think that the EMRs brought to us by Epic, Cerner, and Meditech (which I will refer to as the Gang of Three) all have a shot to truly be called a platform.

If the Gang of Three want to be seen as a platform and not just an application, they will need to evolve as did their big brothers in the ERP world.

Demonstrate market share dominance through rapid growth, consolidation, and the other vendors pivoting their business models in other directions as not to compete head to head. A goal here is to establish enough customer mass that effective and brilliant “group think” could take place. The market moves buyers to want enterprise all-in-one solutions instead of best-of-breed department ones.

I’m going to give the Gang of Three a grade of A on this one.

Demonstrate innovation of function, design, and features. Basically, they should be darned good — maybe even outright awesome — at transactions. Expect to see massive investments in R&D and lots of co-innovation with customers.

I’m going to give the Gang of Three” an A on this one, too.

Be regarded as having deep industry capabilities, clear and comprehensive road maps, and embedded best practices. Other software vendors from other industries would view the vertical as too complex to enter based on the learning curve.

The Gang of Three earns a split grade on this one. Deep healthcare knowledge, A. Comprehensive roadmaps, B. Embedded best practices, C.

Provide analytics. This would be translated as performance suites with end user-centric dashboards, complex and robust data integration suites, comprehensive data quality tools, and the real belief that they are enabling massive amounts of information to be transformed to competitive knowledge.

The Gang of Three gets a B+ for focus and initial efforts, but a C for execution.

Support mobility. This would be demonstrated by enabling wireless workflows across the organization. Optimized work can be done from anywhere, at any time, and on any device. Costs and tools matter in this space, so device management and security are key parts of all offered solutions.

The Gang of Three earns a C. Good progress on vision and good early applications, but with lots of work ahead.

Demonstrate reliability, flawless uptime and performance, and sub-second response times. Terabytes of data managed and delivered at the speed of thought. The paradigm of all information available in real time would be realized and would drive the enablement of new workflows never imaged before the system was installed. With the reliable availability of information, new business models to share and move data around the ecosystem would emerge.

I’m going to give the Gang of Three a B+.

Platforms are not just about function, but equally about cost. They would need to enable the shift within the IT organization of today that typically has 80 percent of costs on tactical IT delivery and 20 percent on strategic initiatives to at least a 50/50 split. IT operational costs consuming the majority of resources are lowered through hosting, cloud, and other leveraged services to allow for greater spending on innovation. Support costs are predictable and fall over time. Costs act as a consolidation driver as much or more than workflow.

This earns a B for the Gang of Three.

The toughest and probably the most important area for our gang to distinguish themselves as a platform is to create choice by building a leveraged open ecosystem. Choice would be fully realized by creating open APIs to access data models and workflows. Customers and third-party vendors would look to solve problems by building solutions within the system and innovation would be an open challenge to solve for everyone.

The Gang of Three gets a D-. This alone isn’t the definition of a platform, but it is crucial to the mix. This is the biggest area in which our gang needs to improve.

So, Gang of Three, it is time to get everyone involved to help us solve problems. Talk to your customers and third-party developers, court them, and encourage them to build their applications in such a way that they have a technology dependency on you. Risk some value you may create on your own, but balance it by figuring out how to extract value from your new workforce – your third-party developers.

It is time to enable choice!

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

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September 10, 2014 Darren Dworkin 6 Comments

HIStalk Interviews Charlie Enicks, VP/CIO, Georgia Regents University and Health System

September 1, 2014 Interviews 1 Comment

Charlie Enicks is VP/CIO of George Regents University and Health System of Augusta, GA.

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Can you describe the contract you just signed with Cerner?

Cerner has similar arrangements in a couple of places. At University of Missouri, they call it the Tiger Institute. They just recently did something at Children’s National in Washington called the Bear Institute.

They agreed to a long-term agreement that sets out a way of operating and allows us to, from a strategic standpoint, innovate with Cerner and with Cerner and Philips. We’ll have an innovation committee that has a membership from our research and clinical group, from Cerner, and from Philips to talk about what could be either three-way or two-way innovation. We’re very excited about that part. 

What it allows us to do from a strategy is accelerate the pace of implementations that we can get done here. With our current financial situation, we can’t really get capital at a fast enough pace to get done what we want to get done. This contract smooths the cost out over 14 years. The Year 1 rate is lower and in the out years, the operating side is about equal to what we’d expect and the capital side is lower because of the investment Cerner is willing to make.

That includes moving the Cerner software and data to Kansas City to their data center. It includes moving the service desk to Kansas City, where it will be open 24 hours day, seven days a week, whereas we’re operating 14 hours, five days a week, which is problematic in a clinical environment. Ten senior associates will relocate to Augusta and work here. Five of those employees will be focused on innovation and process improvement projects that we plan to undertake.

It improves our disaster recovery and security profile. We have started putting together plans to operate a warm site. We’re looking at an investment of five to 10 million dollars to do that, so we avoid that step.

 

Which employees will not move to Cerner?

I’m responsible for the university as well. The university applications, our audio-visual effects, our client services on the university side will stay with the university. I’ll have CMIO, a chief information security officer, my university operation, and the administrative. We’ll still be doing all the contracting for non-Cerner applications and hardware.

 

Are they taking over the entire operation?

They’re taking over the operation of it and they’ll make recommendations about different things, but we do the procurement. It could possibly pass through Cerner if Cerner can get a better deal for us, but it’s not a requirement.

 

Fourteen years is a pretty long contract to lock in. What led you to have the confidence in Cerner to be willing to do that?

We’ve worked with them for 12 years. The 14 years was picked because of our Philips arrangement — it started last year and was a 15-year deal. We wanted those to be concurrent. There are typical ways to get out of the contract should either party decide at earlier than 14 years that it really doesn’t make sense.

My personal experience with Cerner went back to Emory back in the early 1990s during the genesis of the Millennium software. But I had not worked with them for almost 20 years. In the last two and a half years, I’ve been very impressed with where they’re going with their company, the services that they’re offering, and the direction of software.

Our access to capital is limited. Our growth strategy as an academic medical institution is creating enough clinical work for our students and residents. We’ve got relationships all over the state.

For us, this represents a way to get done what we need to do. We don’t have the capital to switch to some other vendor. We’ve decided to become a strong partner with Cerner. We think that will get us where we need to go.

 

Do you think it will become common that hospitals will be looking for someone to do their hosting or move to a cloud-type environment?

I would absolutely agree this is a trend. You’ve got companies like Novant in North Carolina — they’re starting to do this in the Epic space — and other companies. You’re going to see more and more of it.

Cerner recognized that. I guess they started the remote hosting a little over 10 years ago. But their ITWorks component of this, and their new software like the population health management, which is a cloud-based solution — that’s really where they’re moving as well.

I agree, I think this is going to be more and more the case as this stuff gets very complex and expensive to manage. Even though Augusta is an attractive place to some people. It’s very hard to recruit senior-level Cerner folks to Augusta.

 

What other things are you struggling with?

Like everybody else, we’re struggling with getting Stage 2 Meaningful Use tested. We’re very close — we still have some transition of care. We need to get those numbers up a little bit. But we’ll get that done.

Our issue predominantly in the clinical space is that we’ve had the product for a long time. We need to optimize what we’ve got, but we also need to get in the oncology module, the anesthesia module, and the maternity module. That’s really what’s keeping me up. Before this opportunity, I really didn’t see a way out of being able to get all that done in a timeline that the clinicians needed to do their work.

For the other projects that I’m worried about it in the health system, Cerner will be responsible for managing those. We’re doing a total voice over IP replacement for the university and the health system. Cerner will be managing it. We’re doing a consolidation of our Active Directory. We will still be buying the software, hardware, or services. Cerner will be responsible for executing.

 

Do they have those resources or will they staff up to meet your needs?

They do have a fairly extensive number of resources. They’re not sitting on the bench somewhere not doing anything, but we would be the 17th or 18th client that utilizes their ITWorks service. They’ve got a pretty extensive group out of Kansas City doing this now.

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September 1, 2014 Interviews 1 Comment

News 8/29/14

August 28, 2014 News 1 Comment

Top News

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Apple updates its privacy policy to prohibit companies whose apps connect to its HealthKit platform from selling user data to marketing firms. The change comes just ahead of the expected announcement of new health-related iOS 8 capabilities, including Apple’s Health app. Deborah Peel, MD of Patient Privacy Rights reacted to the announcement by saying, “If Apple is really doing this, if they’re really saying to developers that you can only use the data for the specific purpose that app provides the user and that they can not share the data with anyone else without informed consent, that is the victory of victories. That’s what we’re seeking from all of the 100,000 of the companies that are now selling health data.”


Reader Comments

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From Aruba Layoffs: “Re: Aruba Networks. Many talented people let go as healthcare technology spending is way down.” Wireless networking vendor Aruba isn’t healthcare specific. Both its revenue and earnings announced this week beat expectations, revenue is growing at 30 percent annually, and share price matches the Nasdaq at 25 percent growth in the past year. The company is, however, laying off 65 employees and moving 75 jobs to Oregon, India, and Ireland, but it sounds like that’s related to shifting resources to less-expensive locations rather than because of financial problems.

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From Stephanie Reel: “Re: Star-Spangled Spectacular. I wonder if your readers would be interested in something that has everything to do with our nation, but nothing to do with our industry?” Baltimore celebrates the 200th anniversary of the National Anthem — written as Francis Scott Key observed the British bombardment of Baltimore’s Fort McHenry — with a week-long celebration September 10-16. It features visiting ships, a Blue Angels air show, a concert (Kristin Chenoweth, Melissa Etheridge, Denyce Graves-Montgomery, Kenny Rogers, Train, and the Baltimore Symphony Orchestra), festival villages, and of course fireworks. Stephanie is CIO for Johns Hopkins University and Hopkins Medicine – both campuses are worth a tour if you visit Baltimore for the celebration. You can bring the kids and take short side trips from the Inner Harbor to DC and Lancaster, PA along with seeing the Orioles play the Yankees that week.

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From Jimmy John: “Re: HIPPA. I thought you would enjoy this magazine’s misspelling.” At least they were inconsistent from one line to the next amidst the click-baiting headlines – 50 percent right is better than none. They’re owned by HIMSS (or is that HIMMS?), as is the publication devoting 12 lazy paragraphs to a wandering, not-too-interesting story with the breathy “Generalissimo Francisco Franco is still dead tonight” style headline: “New HIPAA breach details remain vague.” The “new” breach occurred in June and details are “vague” because the reporter just cobbled together the story and quotes from wire reports.


HIStalk Announcements and Requests

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School has started, so I sponsored some new DonorsChoose projects involving Teach for America teachers, doubling the impact of HIStalk readers since the Bill & Melinda Gates Foundation matched our contributions to fully fund them all. Teachers of DonorsChoose projects provide photos and updates, so I’ll have more later. What we as readers did:

  • Purchased headphones and whiteboards for Grades 3-5 of a highest-poverty school whose teacher is urging her students to take ownership of their education, accept leadership roles, and share knowledge in groups that include peer tutoring.
  • Bought 50 library books for a high-minority, high-poverty North Carolina charter school that has 100 percent college acceptance of its seniors.
  • Provided a listening center for a highest-poverty school in southern Kentucky, whose energetic English teacher is struggling with ninth graders who haven’t read a book in years, some of whom have learning limitations.
  • Bought six bilingual picture dictionaries for a middle school class of a highest-poverty school in New Orleans, whose large population of new students from Central America are working hard to learn English.

Meanwhile, I heard today from the teacher of a high school engineering class for which we bought a 3-D printer. He says he has had to redesign his lesson plans and projects for the better, the number of students in his classes has doubled, and he makes them think about, “How would you model that in the Replicator? What medium should we use?” He taught students the importance of scale and precision by having them create an iPhone case. He says, “I am overwhelmed with requests from the students about what is in the printing queue.”

This week on HIStalk Practice: Dr. Gregg shares a humorous take on voice recognition and “otto collect.” McGree Medical goes live on Epic’s Community Care EHR. HealthSpot prepares to install 100 telemedicine kiosks. Walgreens implements Greenway’s EHR in over 8,200 pharmacies. South Florida Medicine Director of PM Alyson Tiedeman shares her thoughts on managing IT across a large medical group. CarePoint Health System goes with eClinicalWorks for its medical practices. Results are in from the annual HIStalk Practice Reader’s Survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses health IT IPOs and speculates who the next batch of likely contenders might be. Peer60 analyzes the patient portal market and the varying levels of success health systems are having with each vendor’s offering. Skullcandy partners with USC to host a digital health innovation contest focused on encouraging development efforts at the cross section of health IT and music.


Webinars

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.

September 11 (Thursday) 1:00 p.m.ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

Encore did a great webinar Wednesday on “Enterprise Data – Tapping Your Most Critical Asset for Survival” that some registrants couldn’t view because of a GoToWebinar problem in its latest code update. You can watch it above or on YouTube. Jonathan Velez, MD (CMIO – Hartford HealthCare) and Randy Thomas (Encore) did a nice job and filled the 40 minutes with solid information.

Meanwhile, here’s a case study on how to be a crappy software vendor like GoToWebinar, owned by Citrix:

  • Don’t QA your new releases. Instead, outsource QA to your customers and then just roll them back to pre-broken versions when they call in problems.
  • Don’t notify customers of known problems, especially those that affect critical processes like viewing and recording webinars. Admitting failure will shake their confidence.
  • Instruct your support reps to quickly tell callers that their problem is a known issue. Everybody loves to hear it’s not just them.
  • Keep support callers on hold when they call the high-priority service number and play annoying messages throughout telling them how great support will be once they get through. This heightens their anticipation.
  • Propose illogical solutions, such as restarting a webinar already underway even though that would prevent anyone from seeing it. The support engineer will seem more skilled since no non-engineer would propose a similarly out-of-touch solution.
  • Ask customers to trust you in rolling back to old code versions, even when they have no way to verify that the change works (unless they have 100 friends willing to hop on an impromptu webinar to see if they can get in). You trust them to pay their bills, so the should trust you to release pretty good code.
  • Just give up, as did the person from Citrix who told me apologetically, “Maybe it’s time for you to find a new webinar provider.” This reverse psychology will make them want you even more.

I apologize if GTW’s bug locked you out of Wednesday’s webinar. The video above is perfect and worth watching.


Acquisitions, Funding, Business, and Stock

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Craneware acquires Scottish patient access mobile systems vendor Kestros Limited, which has been selling primarily to NHS Trusts.

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September 10 is a critical day for Castlight Health and its tanking share price: the lockup period ends and the pre-IPO shareholders will be able to sell up to 76 million shares, which closed at around $40 on IPO day in March but are now trading at less than $12. That’s a 70 percent haircut, but the company still has a $1 billion market cap on less than $30 million in annual revenue and huge losses. Maybe co-founder Todd Park can swing by on his new West Coast White House gig and apply Healthcare.gov-like CPR.


Sales

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Robert Wood Johnson Health System (NJ) expands its relationship with NTT Data in selecting its Optimum RCM suite.

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Kaweah Delta Health Care District chooses Access for electronic forms and patient signatures.

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Marshfield Clinic (WI) standardizes on Client Outlook’s eUnity university image viewer and collaboration tool for its homegrown CattailsMD EHR.

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Georgia Regents Health System (Augusta, GA-based GRHealth) signs a $400 million agreement to turn over its IT operation to Cerner, which it says will save it 15 percent of its operating costs annually and make its annual expense predictable. GRHealth operates Georgia Regents Medical Center and Children’s Hospital of Georgia. The system says all 132 employees will receive offer letters from Cerner. Cerner became interested in the arrangement last year when the system signed a $300 million clinical technology partnership agreement with Philips, indicating along with the Siemens acquisition that Cerner sees a future in merging IT systems with clinical monitoring.

Sunquest will expand its relationship with private pathology lab CellNetix to work on anatomic pathology workflow solutions.


People

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Boston Software Systems promotes Steve Cohen to COO.

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David Watson (Oracle) will be named CEO of the new California Integrated Data Exchange (Cal INDEX).


Announcements and Implementations

Walgreens completes the rollout of its Greenway Health EHR to all of its 8,200 locations, allowing its pharmacists to counsel patients and provide immunization and testing recommendations.

Aspirus Wausau Hospital (WI) announces an OR digital integration project that will feature a centralized OR hub equipped with touch-screen monitors that can display images from all devices and modalities. It will use Brainlab’s Buzz digital OR.

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Sentry Data Systems announces its 340B Technology Backbone to help pharmacies manage their 340B drug purchasing programs.


Government and Politics

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Bloomberg reports that Google executive Megan Smith is the top candidate to replace Todd Park as US CTO. Smith’s background is the Google X skunkworks lab, so unlike her predecessors Aneesh Chopra and Park, she has no healthcare experience. She is married to re/code technical reporter Kara Swisher, although they are separated.

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Meanwhile, the White House confirms that CTO Todd Park will continue working for the White House after returning home to California, recruiting technical talent for government work in a new role of technical advisor.  President Obama said in a statement, “From launching the Presidential Innovation Fellows program, to opening up troves of government data to the public, to helping spearhead the successful turnaround of HealthCare.gov, Todd has been, and will continue to be, a key member of my Administration. I thank Todd for his service as my Chief Technology Officer, and look forward to his continuing to help us deploy the best people and ideas from the tech community in service of the American people.”


Innovation and Research

XPRIZE names the 10 finalists competing for its $10 million Qualcomm Tricorder XPRIZE: Aezon (US), CloudDX (Canada), Danvantri (India), DMI (US), Dynamic Biomarkers Group (China), Final Frontier Medical Devices (US), MESI Simplifying diagnostics (Slovenia), Scanadu (US), ScaNurse (England), and zensor (Ireland.)

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President Obama will champion ElectRx, a $79 million, five-year DARPA-run project to implant computer chips in troops and veterans to promote faster healing. The program’s manager describes it as “a closed-loop system that would work in concept like a tiny, intelligent pacemaker” to assess conditions and send electrical stimulation to induce healing. A related effort will detect mood changes associated with PTSD. I don’t know how they’ll deal with FDA approval.

Speaking at the American Legion National Convention in Charlotte, NC, President Obama said,

So we’re going to keep at this until we end this backlog once and for all. And as we do, we’re going to keep working to liberate you from those mountains of paper. We’ve got to move towards a paperless system — electronic health records that our troops and veterans can keep for life, and that could cut down on some of the bureaucratic red tape so that you’re getting the benefits that you’ve earned a little bit faster. 


Technology

Korea-based medical wearables startup Ybrain raises $3.5 million in a Series A round. Its product isn’t the usual fitness tracker: the US-educated team has developed an electrical stimulation device that it says can combat the effects of Alzheimer’s when used at home for 30 minutes per day, five days per week. The company hopes to launch its service in early 2015.

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Apple co-founder Steve Wozniak says he expects the company to create a market for wearables starting with upcoming announcements on September 9 that will likely include the iWatch. He says he expects fitness monitors to be involved and maybe an EKG display at some point, but in the mean time, he’s not a fan of the category:

I feel that wearables are a hard sell. They are go-betweens for your smartphone but are an extra piece and need special advantages that the smartphone doesn’t have, in my opinion. If they are just a Bluetooth go-between then it could wind up in the category of Bluetooth headsets: Fun to wear and show off for a day.

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Discover magazine highlights three projects that owners of 3-D printers can perform to help people in need. Among them: use downloadable designs to print and assemble a prosthetic hand for someone who needs one, requiring around $50 in parts and 8-14 hours of printer time. The first e-NABLE conference will be held at The Johns Hopkins Hospital (MD) on September 28.

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More on 3-D printing: in the UK, 12 NHS trusts are using 3-D printers to test implants before surgery to reduce cost and OR time, including bones for facial reconstruction surgery, hip replacements, and forearms. In China, surgeons implant a 3-D-printed vertebra in the spine of a 12-year-old cancer patient.


Other

Sharp HealthCare (CA) becomes the tenth of the 32 Pioneer ACOs to drop out of the program, saying that local wages rose 8.2 percent in San Diego but the Pioneer model doesn’t adjust payments accordingly.

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Drug maker Bayer starts a healthcare accelerator for Europe-based companies, offering a 3.5-month program of mentoring, free office space in Berlin, and around $65,000 financial support, taking as much of 10 percent equity in return. The five startups chosen from 70 applicants are Cortrium (a device that measures temperature, activity, respiration rate, and EKG); PharmaAssistant (medication reminders via smartphone); Parica (vital signs analysis); FabUlyzer (measuring fat burned after exercise); and Cardimoni (checks heart rate and rhythm).

AMIA’s annual meeting will be held November 15-19 in Washington, DC. The early bird member registration fee of $795 ended Thursday, August 28, but it’s still discounted to $895 through October 23 (then $995). Keynotes will be Amy Abernethy, MD, PhD of Flatiron Health (I interviewed her last month) and National Coordinator Karen DeSalvo, MD, MPH, MSc. Ross Martin, MD will head up the talent show, which will provide a musically equipped stage and a house band for participants, who need only bring “additional instruments, props, and groupies.”

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Cisco CEO John Chambers says the US and other developed countries will go bankrupt if they don’t fix their healthcare systems, adding that technology has a key role (although he seems to pay little attention to the caregivers on the other end of it):

The first thing that will happen is all devices on our bodies, in hospitals and in our homes will be connected. The second technological advance is video, which is the way people will prefer to communicate in the future. Video can connect any health care professional to any patient and to any specialist, all at tremendous speeds. You’ll be able to receive medical expertise 24/7. Health care applications will combine the technologies of cloud and big data, whether in the hospital or in your home. Video allows a different level of collaboration, and it offers security and privacy from your home. This is the Internet of Everything … in a typical hospital, there are nine to 15 different applications that were never designed to share information with each other. And without a common medical record that has the appropriate security and privacy built into it, moving data from one application to another is difficult …  The end game should be connecting any patient to the best healthcare professionals in the world at any time, using video-driven, low-cost technology.

Greenway Health CEO Tee Green accepts his Ice Bucket Challenge, offering to make a donation to ALS Association for every employee who sends him a video of themselves doing the same.

Weird News Andy asks if Oompa Loompas were vegetarians because he never found them attractive: a study (of questionable scientific validity) finds that the healthy skin glow of people who eat high-carotenoid vegetables is more attractive than a suntan.


Sponsor Updates

  • Kyle Silvestro of SyTrue will participate in a panel discussion titled “How Cloud Based Solutions Allow for Improved Coordination of Care and Patient Satisfaction While Reducing Overall Costs of Billing”at the Radiology Business Management’s fall conference October 19-21 in Seattle.
  • GetWellNetwork CEO Michael O’Neil will facilitate a breakout session, “Interactive Patient Engagement and Activation Workshop: What’s in a Number?” and will present “ePatient Entrepreneur Story” at the Stanford Medicine X conference on September 4.
  • Craneware announces the appointment of Russ Rudish (Deloitte Touche Tohmatsu) to its board as non-executive director.
  • Emdeon launches its co-pay assistance program for retail pharmacies, Emdeon Easy Save.
  • AirWatch renovates and expands its former headquarters.
  • TeleTracking Technologies will launch multiple solutions at its client conference October 26-29 in Florida.
  • Sentry Data Systems shares how a Rand report clarifies the 340B program impact and provides steps to ensure its longevity.
  • NextGen announces that its ambulatory EHR V 5.8.1 has earned 2014 ONC HIT Cancer Registry Certification.

EPtalk by Dr. Jayne

Recent research at the University of Michigan finds that patients with low literacy and low comprehension of numerical concepts are less able to understand online lab results. The Internet survey of 1,800 adult patients looked at simulated diabetes results and whether patients understood if labs were within or outside of reference ranges. Less literate patients were also less able to determine when they should call their doctor, based on the data.

Researcher Brian Zikmund-Fisher is quoted as saying, “We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them.” At the other end of the spectrum, over three-quarters of patients with higher literacy skills could identify levels outside the reference range. He goes on to state the need for more research on the best ways to display lab data.

When we first started releasing lab results directly to patients, our physicians voiced concerns. Physicians wanted to hold the results until they could put a comment with them, as they had done in the paper world. Many of our physicians would mail the patient a copy of the test results with a handwritten “OK” or “great” or “double your Lipitor and see me for fasting labs in six weeks.” Our administration overruled the physicians.

Initially we received more phone calls about labs. Most physicians changed their behavior to start counseling patients about potential lab results at the time they were ordered or drawn to reduce the potential for calls.

That approach is fine when you’re counseling a patient on an existing diagnosis or if the labs in question are “maintenance” labs, although it adds a new dynamic to the visit that we don’t always have time for. Looking at other scenarios, I don’t think it’s the best approach when you’re dealing with a new diagnosis, particularly if it’s an emotionally charged one such as cancer or other potentially fatal conditions. I’d like to at least get to those patients on the phone first before they see the results on the patient portal.

Our results release in real time, so it puts the physicians in the position of “stalking” lab results in the evening and over the weekend, then frantically trying to get in touch with patients before they log on. An uncertain diagnosis is certainly stressful for the patient, but it also weighs heavily on the physician. Adding time pressure isn’t optimal for anyone, especially if the physician needs to consult with other members of the care team prior to talking with the patient.

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National Health IT Week is almost upon us again, with the goal of raising “awareness of Health Information Technology’s power to improve the health and health care of patients across the nation.” When IT solutions are used to transform care and improve quality it can be a powerful thing, but when tools are employed without goals, accountability, or governance, it doesn’t make the world a better place. There are key themes for each day of the week:

  • Patient Engagement
  • Advancing Interoperability Through Meaningful Use
  • Advancing Interoperability Across the Care Continuum – Beyond
  • Advancing Interoperability Through Standards
  • Clinical Quality & Safety

I couldn’t help but notice that quality and safety are last on the list. I’m going to give ONC the benefit of the doubt and assume that they are building the week towards the most important aspect, but if that’s true, then it puts patient engagement towards the bottom.

Why do we seem to revere the means more than the ends? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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August 28, 2014 News 1 Comment

Morning Headlines 8/26/14

August 25, 2014 Headlines No Comments

Assessing The Financial Impact Of 4.5 Million Stolen Health Records

Forbes looks back on prior data breaches to calculate the likely true cost that Community Health System will incur as a result of its recent 4.5 million-record data breach, pegging the total cost at between $75 million and $150 million.

No proof deaths caused by delay in care, VA says

After completing its assessment of scheduling improprieties at the Phoenix VA Health System, a VA inspector general’s report concludes that there is no evidence that the unethical delays in care directly contributed to preventable veterans deaths.

EMR Market Share by the Numbers: The Cerner/Siemens Acquisition, Part I

In the first of a two-part piece, KLAS covers the Cerner/Siemens acquisition and what it might mean for Cerner’s market share in the years ahead.

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August 25, 2014 Headlines No Comments

Monday Morning Update 8/25/14

August 23, 2014 News 9 Comments

Top News

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Todd Park will reportedly step down as US CTO but will remain a White House employee, moving back to the Silicon Valley to work on brokering relationships between technology companies and the federal government.


Reader Comments

From HIEway Robbery: “Re: HIEs holding registries hostage per Carl Dvorak’s testimony to ONC. Several CIOs have told me that HIEs have been allowed to use state-based immunization and public health registries to as a leverage point under Meaningful Use, forcing their health systems to join the HIE for up to several hundred thousand dollars.” Hospital IT people, please let me know if you’ve had such pressure applied. I promise to keep your details confidential, but I’d like to know the registry, state, and price quoted for HIE access. ONC needs to know that the generally noble idea of connecting to public health agencies as part of MU2 is being milked as a profit center by revenue-desperate HIEs if that’s the case. I’ve heard that one health system had to pay $700K to an HIE just to access the state’s immunization registry.

From Surveyor: “Re: Modern Healthcare’s top employers and Inc. 5000. These lists are a joke and your running the results is questionable.” I only mentioned in the Sponsor Updates which sponsors won. I don’t think the lists are a joke, but publications give awards to sell magazines and generate ad revenue, no different than those full-page airline magazine ads for “best steakhouses” or “best plastic surgeons.” Which means: don’t take them too seriously either as a reader or a winner. Let’s take a look at those two awards based on what I could find online. Readers with more information are welcome to chime in.

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Modern Healthcare’s Best Places to Work

  • Participation is free, but companies are offered a detailed employee feedback report that isn’t (the price, however, is modest).
  • Information is self reported and not verified by the magazine.
  • The survey asks for the voluntary employee turnover percentage, but it’s not clear how that number fits into the rankings even though it’s arguably the best way to assess employee satisfaction.
  • A random number of company employees are surveyed directly using an adequate sample size from the entire employee database. The survey company was created specifically to conduct “Best Places to Work” programs across all industries and is a division of a publishing company.
  • My grade of the methodology: B+. The employee survey portion seems sound and is of sufficient depth, but online survey of company programs and benefits is self reported and apparently unaudited (but the company HR people who respond aren’t likely to game the system to win). I’d like to see the voluntary turnover number reported in the profile of the winners. I think the winners are probably doing a good job in how they manage their employees, but it’s easy to forget that most companies don’t participate. It’s not quite perfect, but as good as can be expected from a voluntary survey type program designed to simultaneously stroke the egos of winners and the magazine.

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Inc. 500/5000 list of fastest-growing private companies

  • Information is self reported and not verified by the magazine.
  • Companies send in 2013 gross revenue vs. 2010 gross revenue and basic demographic information only.
  • Applicants have their short entry form signed by any CPA, financial analyst, or attorney. No proof of the claimed revenue numbers is required.
  • Companies could be losing a ton of money and still make the list as long as their gross revenue increased in the previous three years. Privately held companies aren’t going to disclose profits, so the magazine has to go with revenue alone.
  • Companies have to pay $150 to submit their information. The magazine pitches the exposure they’ll get as a result. They don’t indicate the number of applications received, but the 5,000 winners alone would generate 5,000 x $150 = $750,000 for very little work on Inc.’s part since they don’t verify the submitted information – they basically plug it into an Excel worksheet, sort by revenue growth percentage, filter by industry and a few other factors, and call it done.
  • My grade of the methodology: F. The entire premise of the award – that revenue growth is the single best measure of company success – is suspect enough, but choosing winners from fee-based unaudited company submissions is lazy. Winners aren’t necessarily even the fastest growing companies – only the fastest growing of those that dash off the quick information form and mail in their $150. I wouldn’t dock a company points for trying to generate some easy PR in return for an investment of $150 and the five minutes it takes to complete the application form, but I also wouldn’t necessarily think more highly of the winners, especially noticing that some of the highly-ranked companies have only an employee or two. I like seeing fast-growing companies, but I wouldn’t buy shares of a publicly traded company’s stock based on a one-time snapshot of unaudited revenue growth. 

 

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From The PACS Designer: “Re: iPad vs. Android L. The iPad monopoly may start to start to shrink with the Android L, scheduled for release in late October with a true 64-bit system.” I would argue that the iPad doesn’t have a monopoly even now, representing less than a third of tablets sold in Q1 2014. Samsung is gaining ground quickly and Lenovo is coming on strong in the past year, although tablet sales seem to be hitting the wall anyway since there’s not much incentive for people to trade up.


HIStalk Announcements and Requests

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Nearly two-thirds of poll respondents thing Cerner is getting a good deal in buying the Siemens healthcare IT business for $1.3 billion. New poll to your right or here, for health system IT employees: is your organization taking new security steps in reaction to the Community Health Systems breach? I would be interested in hearing more … click the Comments link after voting.

Listening: new from SOJA (Soldiers of Jah Army), an eight-piece DC-based reggae band.  It’s not my favorite genre, but I like this since it sounds more like decent pop music instead of formulaic noodling by ganja-stupefied Rastafarians.


Last Week’s Most Interesting News

  • Chinese hackers steal the data of 4.5 million Community Health Systems patients, most likely enabled by outdated network software as vendors responded slowly to address the Heartbleed exploit after it was announced in late spring.
  • Oracle’s lawsuit against the state of Oregon says state officials should have hired a systems integrator to oversee the creation of its failed health insurance exchange, comparing Oregon’s project to an inexperienced company deciding to build a skyscraper without hiring an architect. The failed rollout of Healthcare.gov has been similarly attributed to CMS’s attempt to serve as its own project overseer.
  • CMS statistics show that few providers (and thus few vendors) are clearing the Meaningful Use Stage 2 hurdle, with the early trend suggesting that practice-based users appear to be moving from smaller vendors to Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
  • A New York Times article says CMS’s Medicare fraud prevention efforts are expensive and ineffective due to its poor management of private recovery audit contractors and the bogged down provider appeals process.
  • The private equity owners of revenue cycle vendor TriZetto are rumored to be shopping the company at a price of $3 billion.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  

September 11 (Thursday) 1:00 p.m.ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.


Announcements and Implementations

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The Albuquerque business paper profiles Seamless Medical Systems, which will release SNAP Express RX on Monday. It’s an iPad-based patient self-history system for pharmacies (vaccines, immunizations, and medications). The company also says its SNAP Practice check-in system will be piloted at Houston Methodist Hospital starting in October.


Government and Politics

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The state of Oregon finally files the lawsuit it has been threatening against Oracle, saying it paid Oracle $240 million to build the dysfunctional Cover Oregon health insurance exchange site. The Associated Press named the spectacular failure of Cover Oregon, which will be shut down, as the state’s top news story in 2013:

Once considered a national healthcare leader, Oregon produced the worst rollout in the nation of the new national health insurance program. While the crippled federal website eventually got up and walked, Oregon’s remained comatose, unable to enroll a single person online. The state had to resort to hiring 400 people to process paper applications. Officials lay much of the blame on the primary information technology contractor, Oracle Corp., and withheld some $20 million in payments. But state officials’ own actions played a role, too. In the face of disaster, they insisted on doing things The Oregon Way, clinging to a grandiose vision of creating a grand health IT system that would not only enroll new people in the national health insurance program, but also provide other vital services.

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The personal information of 25,000 Homeland Security employees is compromised when hackers penetrate the systems of a federal contractor that performs security clearance. The contractor, USIS, says the cyberattack appears to be the work of an unnamed country’s government.

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For-profit hospital operator Steward Health Care System (owned by a private equity firm) and The Boston Globe engage in legal wrangling over the hospital’s use of a patient’s medical records. The newspaper is running an in-depth feature about the man’s experience with the mental health system that Steward expects to be uncomplimentary to its hospitals, so it filed a lawsuit asking to be able to publicize the man’s records to tell its side of the story. The court said no. All of this happened before the article ran in Sunday morning’s paper and it appears that Steward’s heavy-handed actions were premature – the article touches little on the patient’s experiences at the chain’s Quincy Medical Center and Norwood Hospital and focuses more on the challenge of fitting mentally ill people into society so they can’t harm themselves and others.


Innovation and Research

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Wired profiles Enlitic, a just-announced startup that will use deep learning algorithms to diagnose medical conditions. Data scientist founder Jeremy Howard says the company’s approach is different from that of IBM, which tries to teach Watson by feeding it textbooks that contain information that doctors already know vs. giving the computer raw data and letting it figure out the patterns that represent new knowledge. I’m not sure doctors need as much help diagnosing patients as computer people tend to think, but at least a small percentage of patient conditions are baffling.


Other

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Cedars-Sinai Medical Center (CA) reports exposure of the information of at least 500 patients following the theft of a laptop from an employee’s home. The hospital says the device was not encrypted per hospital policy because of an installation mistake. The description of the employee’s job suggests that he or she has IT responsibilities since it includes “troubleshooting software used for clinical laboratory reporting” and requiring off-hours availability.

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A peer60 report on patient portals finds that the most implemented are from Cerner and Epic, while those most often being considered by the 10 percent of providers who don’t have one are Cerner, Medfusion, Meditech, Epic, eClinicalWorks, and Medhost. Generally deficient functionality includes meeting the needs of specialists, EHR integration, appointment scheduling, streamlined enrollment, bill pay, and  managing the information of patients under 18. It concludes that health systems can hit the 10 percent engagement threshold required by Meaningful Use Stage 2.

Jonathan Bush’s 1990s business idea as described in his book finally happens: EMTs are providing primary care services in the home instead of just giving 911 callers expensive rides to the ED for non-emergent issues. It’s a smart idea: the supply of relatively easily trained EMTs and paramedics exceeds the available jobs (often in fire departments) and most people would prefer being evaluated and treated at home, especially if the EMR/paramedic was in touch with a doctor via telemedicine as needed.

A University of Pennsylvania Health System study finds that urinary catheters were removed more promptly (presumably reducing the chance of urinary tract infections) when EHR provider reminders were replaced with an integrated homegrown alert that required fewer clicks to generate the DC order.

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Interesting: improved guidelines and more widespread use of less invasive surgical procedures have reduced blood transfusions by a third and blood profits by 70 percent in the last five years. The Red Cross takes in nearly $2 billion of its $3 billion annual budget from selling blood and employs 17,000 of its 26,500 employees in its blood program, requiring layoffs and expense cutting. People don’t realize that their thoughtful blood donations are sold to hospitals for hundreds of dollars per unit, sometimes by for-profit blood centers that don’t exactly broadcast that fact, one more aspect of healthcare that doesn’t seem like it should be a business but very much is one.

An investigation of the corporate support services department of Health and Hospitals Corporation of New York finds that officials contracted with friends and neighbors for no-work temporary jobs and hired unqualified but connected employees. In one case, a supervisor who was also a minister performed a wedding in his office during work hours.


Memorial Hermann Southeast (TX) fires an employee after someone complains to it about a racist comment she posted on her personal Facebook, on which she doesn’t identify herself as a hospital employee. The hospital announced the employee’s firing on Twitter, ironically. According to a legal analyst, “People have the right of free speech, but employers can fire you for whatever they want in the state of Texas.”


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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August 23, 2014 News 9 Comments

News 8/22/14

August 21, 2014 News 10 Comments

Top News

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The China-based hackers who stole the information of 4.5 million patients of Community Health Systems used the Heartbleed exploit for access, the first major cyberattack to do so since Heartbleed received major world attention in April 2014.  Community Health Systems provides employee VPN access using networking equipment from Juniper Networks, which along with other networking vendors was slow to update its products in response to Heartbleed. The hackers were able to log in as employees in the weeks after Heartbleed was announced and before vendors updated their software. There’s a lesson to be learned: watch for unusual behavior from user accounts and certainly for huge data files being sent outbound. Meanwhile, the FBI issues a flash alert to healthcare firms, warning that that they’re being targeted by hackers.


Reader Comments

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From Former SMSer: “Re: former Shared Medical Systems employees. A members-only Facebook group was started on August 15 and has 1,200 members. It is special to have so many warm personal connections 14 years after the Siemens acquisition.”

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From Eek How? “Re: Ekahau. Let its president go and the VP of marketing walked out. The company has gone from 119 employees to fewer than 45 in the past year. WiFi-based RTLS still disappoints hospitals.” Unverified, but former CEO Mark Norris has updated his LinkedIn profile to indicate his immediate availability.


HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi digs deep into data on the EHR replacement market. Industry representatives weigh in on Walmart’s foray into primary care. Newt Gingrich makes the case for integrating mobile health tools into care for veterans. Greenway Health and Apple are granted patents, though for decidedly different innovations. A physician in Alaska gets creative when attempting to opt out of Meaningful Use. Azalea Health CEO Baha Zeiden dishes on the simplifyMD acquisition and the role of telemedicine in rural communities like his. Thanks for reading.

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I talked today with the brilliant and articulate Dim-Sum,  who knows everything about the Department of Defense and its impending choice of EHR vendors for its $11 billion EHR project. He graciously agreed (probably while grimacing at the arm-twisting Lorre and I were applying) to host one or more webinars on the topic. Mark your calendar for September 18 at mid-day for the first one, in which Dim-Sum will describe the DoD’s healthcare reach, current systems, relationships with contractors and other government agencies, and selection process. The webinars will be fun, slightly cynical, and highly educational to those of us who don’t really understand military health, as well as crucial to those with a vested interest in what will be one of the largest and most expensive government IT projects in the world.

Also in September: the virtual launch of Ed Marx’s upcoming book, “Extraordinary Tales of a Rather Ordinary Life.”

I’m always interested in hearing from providers who would like to be interviewed, write guest articles, or otherwise participate in HIStalk. Let me know if you are willing. I get plenty of volunteerism from vendor people, but not much from those working on the provider side. 


Upcoming Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.

September 4 (Thursday) 2:00 p.m. ET. MU2 Veterans Speak Out: Implementing Direct Secure Messaging for Success. Presented by DataMotion. Moderator: Mr. HIStalk. Panelists: Darby Buroker, executive director of health information exchange, Steward Health Care; Anne Lara, EdD, RN, CIO, Union Hospital of Cecil County, MD; Andy Nieto, health IT strategist, DataMotion; Mat Osmanski, senior application analyst, Steward Health Care; Bill Winn, PhD, Meaningful Use service line executive, Navin, Haffty & Associates. Panelists will discuss the strategy and tactics of meeting the transitions of care requirements for MU2, including assembling the team, implementing Direct Secure Messaging, getting providers on board, and reporting results.  


Acquisitions, Funding, Business, and Stock

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HealthPrize Technologies, which offers a medication adherence app, raises $3 million in its first institutional financing. Co-founder Tom Kottler’s first startup was MedAptus.  

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HealthQuest Capital raises a $110 million fund to invest in medical devices, diagnostics, and healthcare IT.

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Aging services technology vendor Healthsense, which offers a remote monitoring system for chronic diseases, adds a $10 million funding round.

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Vocera shares touched a 52-week low this week, closing Thursday at $8.48 and valuing the company at $216 million. Above is the one-year price of VCRA shares (blue) and the Dow (blue).


Sales

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Saint Agnes Hospital (MD) chooses clinical alerting and secure texting solutions from Spok, also upgrading its hospital call center suite.

Baylor Scott & White Health chooses the Allscripts dbMotion HIE platform.

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Baystate Health (MA) selects Premier’s PremierConnect Enterprise to support development of solutions within its Health Informatics & Technology Innovation Center, a co-working space and late-stage accelerator.

The Froedtert & Medical College of Wisconsin network chooses the analytics platform of Explorys.

Atlanta Gastroenterology Associates chooses Greenway PrimeSUITE EHR/PM.


People

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Surescripts names Tom Skelton (Foundation Radiology Group) CEO.


Announcements and Implementations

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PerfectServe opens an Atlanta office.

Forbes names Cerner to its list of the world’s most innovative large, publicly traded companies. Salesforce.com came in #1, and other familiar companies joining Cerner in the top 30 are Amazon, VMware, Red Hat, Stericycle, and Express Scripts. The ranking is derived from the somewhat questionable metric “Innovation Premium,” representing the degree that share price exceeds current business value.

SAS and 39-hospital Dignity Health (CA) will create a big data platform to reduce readmissions, create best practices for CHF and sepsis, and manage drug costs.

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Greenway Health receives a patent for the function of automatically aligning billing codes with payer- and location-specific fee schedules.

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AliveCor receives FDA clearance for its atrial fibrillation detection app that monitors ECG in real time and allows the user to email, print, and analyze their single-channel ECG records. The app is free, but the monitoring hardware costs $199.

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UltraLinq’s cloud-based image management solutions will be available through athenahealth’s No More Disruption Please program.


Government and Politics

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Oracle, in its lawsuit against the state of Oregon for not paying the company for its work on the state’s failed healthcare insurance exchange, says the state should have hired a systems integrator instead of trying to run the project itself. CMS made the mistake in trying to run the Healthcare.gov project without outside help.

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CMS Administrator Marilyn Tavenner didn’t just accidentally delete Healthcare.gov-related internal emails as she claimed, although this request pertains to a largely dull conversation about training telephone reps handling manual insurance sign-ups after Healthcare.gov failed. 

The FDA releases an API to allow programmers to access its MAUDE medical device problem database.


Other

Cerner CEO Neal Patterson not only dumps ice water over his head, he issues an Ice Bucket Challenge of his own to John Glaser, CEO of the Siemens health IT business that Cerner is acquiring. Glaser accepted the challenge.

As simultaneously cute and annoying as the virally spread ice bucket challenge videos are, this one is worth watching if you really want to understand the non-entertaining aspects of the disease as one of its sufferers takes the challenge and then explains how ALS affects him.

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Jamie Stockton of Wells Fargo Securities provides updated slicing and dicing of CMS hospital attestation data through June 30. The significant Stage 1 vendors are (in order) Meditech, Epic, Cerner, CPSI, McKesson, and Medhost. Of the 10 hospitals that have attested for Stage 2, Cerner has four, Meditech and CPSI have two each, and Medhost and Allscripts have one each. Top vendors of the EHRs used by the 977 physicians who have attested for Stage 2 are, in order, athenahealth, Epic, and Practice Fusion, who have 97 percent of the Stage 2 attestations among them.

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Economist Uwe Reinhardt writes a brilliant and remarkably compact criticism of the bizarre payment system of US healthcare. A tiny sample:

For starters, we allow our providers of health care – doctors, hospitals, pharmaceutical companies and other providers—to use classic price discrimination in the markets for their products and services. That tactic helps sellers to extract from buyers with different abilities or willingness to pay as much total revenue as can possibly be extracted from the buyers collectively … Altogether, the highly complicated cash flow resulting from this strange system of financing, flowing through so a myriad of capillaries, makes it almost impossible to hold any providers formally accountable for all of the moneys they receive. Somehow this rickety Rube Goldberg contraption of financing health care has worked in some fashion in this country, for over half a century. Many hospitals have thrived financially under it, while hospitals located in mainly low-income areas have struggled or gone under. And as a series of journalists—most recently Steve Brill in “The Bitter Pill”—have reported, this system also has put brutal financial stress on the budgets of many American households.

Aaron Carroll, MD, MS, a medical school professor and contributor to “The Incidental Economist,” explains why doctors have plenty of data problems without having to deal with patients sending them their fitness tracker information.

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The Columbus business paper profiles CoverMyMeds, which is doubling in size every year while remaining profitable as a bootstrapped company.


Apple CEO Tim Cook visited the VA hospital in Palo Alto, CA, tweeting a photo from the facility that is using iPads.

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Massachusetts eHealth Collaborative President and CEO Micky Tripathi examines the EHR replacement market in an HIStalk Practice post:

  • The number of EHRs used to attest has dropped considerably from MU Stage 1 to Stage 2.
  • Customers are switching from smaller vendors to the benefit of Epic, Cerner, athenahealth, eClinicalWorks, and Aprima.
  • Athenahealth and eClinicalWorks are losing customers to Epic.
  • Allscripts lost more customers than anyone, most likely because of its retirement of MyWay, which boosted Aprima’s customer base.
  • Epic, Greenway, and athenahealth are the EHR vendors most acceptable both to larger practices as well as hospitals given their maturity,support, and product stability.

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Burke Mamlin, MD of Regenstrief Institute pens a letter in response to the Indianapolis newspaper’s article on medical scribes, recommending caution since physicians don’t always review scribe EHR entries until after the fact, they don’t see clinical decision support recommendations, and they become dependent on the scribe. The letter describes Regenstrief’s vision:

Rather than using a scribe to reduce the computer’s role in the exam room, we envision the medical scribe’s role to increase the computer’s role. By using the scribe as a “Wizard of Oz” replacement for the keyboard and mouse, the computer can become an intelligent, anticipatory and active participant in the conversation between patient and physician. Physicians can become super-users as they learn from watching the scribe, there is less chance for errors when the physician is actively monitoring input, and benefits of real-time decision support will not be lost.

Weird News Andy finds this article interesting in that not only have an estimated 90 percent of hospitals and clinics lost patient data, the black market pays $50 per stolen medical record vs. just $1 for credit card information.


Sponsor Updates

  • Craneware will hold its first Revenue Integrity Summit October 14-16 in Las Vegas.
  • HCS participates in LeadingAge Center for Aging Services Technologies (CAST) EHR 2014 Selection Portfolio.
  • Ingenious Med employees complete their third annual 100-day team-centric Thrive Challenge.
  • Andrew Borland, Wellcentive’s director of architecture and research, is interviewed on Atlanta Business Radio.
  • The SSI Group adds contract management to its RCM offerings.
  • Aspen Advisors, Clinovations, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Encore Health Resources, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, Intelligent InSites, Nordic, Santa Rosa Consulting, and The Advisory Board Company are named on Modern Healthcare’s 2014 Best Places to Work in Healthcare list.
  • Besler Consulting, Clinovations, CompuGroup Technologies, Cornerstone Advisors, CoverMyMeds, CSI, Cumberland Consulting Group, Divurgent, eClinicalWorks, ESD, Etransmedia Technology, Forward Health Group, GetWellNetwork, Health Catalyst, Health Care Software, Healthcare Data Solutions, Impact Advisors, Imprivata, Informatica, Ingenious Med, Patientco, pMD, Santa Rosa Consulting, SRSsoft, Strata Decision Technology, HCI Group, and Wellcentive are named on the Inc. 5000 Fast Growing-Growing Companies 2014 list.

EPtalk by Dr. Jayne

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One of my CMIO duties is to periodically review the patient care protocols in our EHR and recommend updates and additions. Evidence-based guidelines have been a part of our organization for almost two decades, but they’re constantly evolving. I like to do a comprehensive review every year, but there are always guidelines that change on the fly.

Occasionally, it seems like every day brings a new recommendation for screening or treatment. Some of the updates are relatively straightforward, but others can be quite controversial.

This year my review process took a twist. Our organization wants to start building financial information into our care protocols, including the cost and accessibility of various services according to the patient’s insurance coverage. Most payers are fairly transparent about what they do or don’t cover. Sometimes, however, the nuances between different plans offered by a given payer tends to make me a little crazy.

In addition, our state legislature has mandated coverage for certain services, but most of the laws were written to apply when patients enroll in a plan after the law goes into effect. For patients who are on older or existing plans, they may not be covered for the services until they change jobs or their employer changes plans or payers. We have some large regional employers who self-insure and somehow they seem to skirt some of the payment requirements as well.

Medicare has always been the steady player as far as knowing what will be covered and how. The payment guidelines are transparent and usually follow along with other federal guidelines. This year we have a bit of a wrinkle since the Medicare Evidence Development and Coverage Advisory Committee has decided not to cover CT screening for lung cancer, which is a “B” grade recommendation by the US Preventive Services Task Force. I read the commentary from their meeting and they cite the American Academy of Family Physicians, which feels the evidence is insufficient to recommend for or against the test.

This is where it gets really fun. In accordance with the Patient Protection and Affordable Care Act, marketplace insurance plans and many private plans are required to cover the screening with no out-of-pocket costs to the member. However, the law does not specifically state that Medicare is required to pay the full cost to Medicare beneficiaries. Instead of being able to do some relatively clean development around the USTSPF “A and B Recommendations” list,  we have to continue with the patchwork approach.

Quite a few guidelines have been revised for 2014 and more are under revision, so this project is definitely the gift that keeps on giving. I’ll be taking my recommendations to our clinical quality committee in the next week or so and then the development team can get to work. I’ll also be giving a report of my findings to our managed care negotiation team so we can try to leverage better coverage for the services we find most clinically appropriate.

Got guidelines? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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August 21, 2014 News 10 Comments

Morning Headlines 8/21/14

August 20, 2014 News No Comments

US hospital hack ‘exploited Heartbleed flaw’

A cybersecurity firm claims that the theft of information on 4.5 million patients of Community Health Systems was performed using the Heartbleed exploit. The firm says CHS used network equipment from Juniper, which was slow to correct software vulnerabilities.

Cerner lands on Forbes’ most innovative companies list

Forbes names Cerner #22 on its list of large, publicly traded companies that invest in innovation.

SAS to build cloud-based big data analytics platform for Dignity Health

Analytics software vendor SAS will create a big data platform for Dignity Health to support care planning, value-based reimbursement, and outcomes and value performance analysis.

Wearable Intelligence is raising $8.4M for Google Glass for doctors

San Francisco-based Wearable Intelligence has raised $7.9 million of its goal of $8.4 million from investors that include Google Ventures and Andreessen Horowitz. Its Google Glass technology displays information from EHRs,clinical alerts, and real-time information from patient monitors.

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August 20, 2014 News No Comments

Monday Morning Update 8/18/14

August 16, 2014 News 9 Comments

Top News

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Epic President Carl Dvorak testifies at an ONC HIT Policy Committee interoperability governance subgroup hearing. Some of his points:

  • Epic’s Care Everywhere exchanges 4.6 million C-CDA documents each month with 26 non-Epic vendor systems, 21 HIEs, 29 HISPs, and 28 government agencies. Its connections to other organizations carry 20 billion transactions annually to 88 public health agencies, 18 research societies, 51 immunization registries, and 17 research registries. This, Dvorak says, portrays a broader definition of interoperability than just exchanging patient summary documents.
  • Dvorak said providers who receive Meaningful Use money should be required to participate in a national list of exchange-ready participants.
  • Epic recommends that Meaningful Use Stage 3 add eHealth Exchange standards for unplanned transitions of care.
  • Epic suggests allowing multiple trust verification services since DirectTrust is too expensive for some organizations.
  • Dvorak says data exchange should be simplified for data used only for patient treatment and not for the “payment and operations” part of HIPAA where information is often sold or redistributed to business associates.
  • Epic says ONC should give patients control of information sharing with a simple opt-in/opt-out option and let patients who want finer control to use their own personal health record instead.
  • Epic customers are reporting that state and local HIEs are demanding payments that exceed their connectivity value and that some are trying to pass laws requiring providers to pay their full fee just to access state immunization registries. Epic says immunization and public health reporting should be free to users and paid for by the states, and providers in states that refuse to do so should get an exemption from those Meaningful Use requirements.
  • Epic urges ONC to be wary of “political agendas and commercial competition” in assessing interoperability, adding that if ONC wants to get a true picture, they should encourage health care systems to voluntarily report their interoperability statistics directly to ONC. 

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Also testifying at the subgroup meeting, CORHIO Executive Director Morgan Honea said one practice was quoted $50,000 to connect to its network. He also said independent providers and small health systems should get Meaningful Use money for connecting to HIEs since they have little incentive otherwise.

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Tim Burdick, MD, CMIO of OCHIN, said that data are tethered to one EHR and one patient portal, giving an example of a cancer patient who has to log into the patient portals of six organizations to see her information, then send messages to the other five asking them to update their EHRs. He says that most of the 22 states in which OCHIN operates have their own technical standards and they are often outdated, vague, or impractical (example: data standards for immunization registries required 15 different interfaces.) He said that his organization struggles with connecting to specialized registries as MUS2 requires because not only is every state different, some registries are run by drug and device companies and require each participating doctor to pay a monthly fee or make them agree that the patient data they submit can be sold or used for any purpose. He says it’s hard to match Direct addresses to specific providers because some of them work for multiple organizations and it’s not clear whether each role has its own Direct address or what happens when that doctor stops working at that location. He finished by suggesting that ONC rate organizations that are using HIE best practices, which he calls “Yelp for HIE vendors.”


Reader Comments

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From HIErarchical: “Re: new insurance company-sponsored HIE in California. This has CalRHIO 3.0 written all over it. The program came from the president of UCLA, where former CalRHIO head Molly Coye, MD is chief innovation officer. She has surfaced to restart what was thrown out in 2010.” CalRHIO’s ambitious California-wide RHIO plans were thwarted in early 2010 when the state created a new entity that paired CalRHIO with a competitor with whom it had fought over HITECH money. CalRHIO, like former National Coordinator David Brailer’s Santa Barbara project, talked a lot but accomplished little – it brought one county’s EDs online. The chair of the newly created Cal Index HIE, which is funded with $80 million from Blue Shield of California and WellPoint’s Anthem Blue Cross, is the president of UCLA’s health system.  

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From Information Governor: “Re: information governance. I’m curious whether organizations have an information governance policy as described by a recent AHIMA white paper.” AHIMA recommends that hospitals define information as a critical business asset that is managed using published standards and the appropriate resources. Two-thirds of survey respondents said their organizations haven’t developed that kind of strategy. The most interesting part to me was the information life cycle management of electronic information, including accuracy, access, protection against loss, preservation for legal holds, managing data deletion, and plan for technology obsolescence. Actually, maybe even more interesting was the section on information controls: documentation requirements, downtime planning, data definitions, software testing, how information is corrected, and how data quality is measured. The survey went out only to AHIMA members, which may have skewed the results. Leave a comment if you’d like to describe your organization’s efforts.

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From Lodi: “Re: EMRs and quality improvements. You are a hospital IT person. Why do you always question study results proving that EMRs improve care?” Because the studies prove no such thing. It’s appalling to me that the people who conduct those studies, many of whom have a vested interested in being EMR cheerleaders, misstate their results as proving causation rather than correlation. Clueless reporters then add another layer of obfuscation by writing punchy but flat-out wrong headlines. I believe that hospitals using EMRs have better outcomes. I also believe that hospitals that have bigger profits, prettier buildings, cafeteria sushi bars, and showcase helicopters also have better outcomes. I’m throwing down a challenge to anyone who claims EMRs improve outcomes: show me your data.


HIStalk Announcements and Requests

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Cerner handily won the vote of which EHR vendor is best equipped to support population health management, although the IP addresses of respondents suggest that a huge percentage of the nearly 1,500 votes it received came from inside the company. Cerner contacted me to say they didn’t encourage ballot box stuffing, but non-Cerner voters nonetheless left scathing poll comments upon seeing the results, one of whom suggested giving the win to Epic by default (who also had some homers clicking away, with 62 of its 216 votes.) Let’s move on to a new poll to your right or here: is it a good deal for Cerner to buy the Siemens HIT business for $1.3 billion? Vote and then click the Comments link to expound further. Add some insightful comments and I bet some healthcare publications will use the results for further articles since information is otherwise scarce.

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I asked readers whether their employer requires them to share hotel rooms for group travel. The results: only 12 percent of respondents said yes, which is about the same percentage as reported in other national surveys. The numbers were the same for both vendor and provider employees. My thoughts:

  • Vendors theoretically save their customers money by forcing the rank and file to share rooms, but the frugality often ends when executives are involved as the lavish salaries and stock options dwarf the cost of a few hotel nights. Customer costs never go down, and it’s likely that customers of the room-sharing vendors pay just as much.
  • I would bet anything that company executives don’t share rooms. I’m not a fan of policies that only apply to people in the trenches.
  • A better option would be to book single rooms in cheaper hotels and provide group transportation to the event’s location.
  • The “two same-sex people should be comfortable and safe as roommates” idea is a dated concept that makes incorrect and stereotypical assumptions about sexuality and body image.
  • A shared employer isn’t enough reason for me to be comfortable with forced cohabitation with someone I barely know.
  • I’m a big fan of asking employees if they will share rooms instead of insisting they have to. That gives people who are uncomfortable with the idea for any reason a discrete way to opt out.
  • Lawyers would salivate at the chance to represent someone exposed to sexual harassment or violence because of employer-mandated room sharing.

Last Week’s Most Interesting News

  • Epic hires a lobbying firm, breaking from its long-held claim of having nobody assigned to sales, marketing, and government relations roles.
  • Free EMR vendor Practice Fusion raised the ire of practice customers and hopefully the awareness of other cloud-based system users in reminding those customers to insist on access to local copies of their data for downtime situations.
  • A survey of ACOs finds that most have only basic IT systems.
  • Massachusetts says it will spend more money to fix its struggling health insurance exchange website rather than move to Healthcare.gov.

Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.


Acquisitions, Funding, Business, and Stock

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Cerner shares (blue) are up nearly 12 percent since the company announced that it will acquire the healthcare IT business of Siemens on August 5, but they still lag the Nasdaq (red) over the past year.


People

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MModal announces that CEO Duncan James will resign from the company, which exited Chapter 11 bankruptcy two weeks ago. MModal has also brought in a new board.


Government and Politics

The New York Times reviews the government’s Medicare fraud efforts that cost $600 million per year, concluding that the 90 percent of fraud isn’t caught because HHS doesn’t manage the private recovery audit contractors it uses very well. The article says hospital pushbacks and extensive appeals have nearly completely shut down recovery efforts and cases can take up two years to get in front of a judge. It also notes that RAC bounties are so high that the companies paying fraudulent claims are sometimes the same companies paid to investigate them.


Other

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I missed this: Health Information Technology Exchange of Connecticut died a quiet death on July 1, 2014 when a new state budget bill repealed the creation of several quasi-public agencies, of which HITE-CT was one. Nobody seemed to notice or care, so that probably says it all.

In Canada, B.C. Emergency Health Services drops its $2.8 million ambulance electronic patient care record a year after it was supposed to go live, saying that, ”the vendor was unable to meet our business requirements.” The vendor was Interdev Technology.

A study of 2011 California data finds that hospitals charged between $10 and $10,169 for the same lipid panel lab test. The same author previously found that the list price for an uncomplicated appendectomy prices ranged from $1,500 to $187,000. Nobody pays list prices except the uninsured, who obviously wouldn’t be able to afford the ridiculous prices even if they wanted to pay. Healthcare prices are even more irrelevant than the inflated nightly rates listed on the back of hotel room doors.

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In a relevant story, a man who went to the ED of for-profit Bayonne Medical Center (NJ) to have them look at a finger he had cut days before is billed $9,000 for a tetanus shot and a bandage. The hospital’s CEO says it went out-of-network for the insurance company because of low payments and that it needs high ED charges to survive. The insurance company says the CarePoint Health-owned hospital is deliberately gouging consumers by dropping out of networks since New Jersey law requires the insurance company to pay for ED services anyway. The insurance company settled with the hospital for $6,640, and after the local TV station picked up the story, the hospital wrote off the balance owed by the patient. It’s ridiculous to put in-network verification responsibility in the hands (no pun intended) of a patient seeking emergency treatment, or to ask every employee who walks in the door whether they are in-network since hospitals always have private doctors and contractors running around who issue their own bills.

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The top 10 executives at the non-profit Blue Cross and Blue Shield of Alabama made more than $1 million each in 2013, doubling their 2011 pay. The president and CEO made nearly $5 million.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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August 16, 2014 News 9 Comments

News 8/15/14

August 14, 2014 News 18 Comments

Top News

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A survey of 62 ACOs finds that many lack tools for risk management and patient engagement and haven’t made much IT progress in the last year. Every respondent said they have problems getting data from external organizations as they struggle with interoperability, workflow integration, and infrastructure maintenance. Few of them use secure messaging, referral management tools, self-scheduling, remote monitoring, smartphone apps, or telemedicine. Most do not coordinate care via an HIE.


Reader Comments

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From Bucolic Splendor: “Re: Practice Fusion. Was down most of the day Wednesday, a major catastrophe for practices all over the country. Nobody really believes their explanation.” Practice Fusion blames its multi-day downtime on unnamed third parties, their data center partner, and a “global Internet brown-out.” Strangely, some users could access the system on their phones only, others could get on with the Safari browser but not Chrome, while some users said they could get partial access by turning off Shockwave. Users ripped the company in Facebook messages for not answering the support line and failing to provide updates as their practices sent patients home without treatment. The bottom line: get SLAs from your cloud-based vendors (so the burden of reviewing their infrastructure is theirs, not yours) and make sure you have a local information retrieval option since even Internet connectivity itself isn’t guaranteed. The cloud is great except when it isn’t and then you’d give anything to have that under-the-desk server back. Some user comments:

  • “I just had a consultation with a patient I only see once monthly and I had no idea what we talked about last time.”
  • “Don’t care about your acquisition since I can’t see my patient charts!”
  • “Practice Fusion deleting comments & removing unfavorable forum threads is a BAD IDEA. One step away from charging for negative reviews. Spend more time on keeping the system up, and less time combing your social rep.”
  • “It is amazing how many people there are out there who is getting a superb free handout and then bite the hand that feeds them. And you are supposed to be professionals. Give me a break. Go out and actually pay for another premium service. Then you will have every right to bitch when things go wrong.”
  • “I see lots of photos of team-building games and fun … and bravo for that … but it appears there is less emphasis, as David Stewart suggested, on building infrastructure and contingency plans. Your suggestions to have a backup server and hub do us no good when the problem in on your end.”
  • “We may be looking for another EMR system. I’ve been relatively happy with the program when it functions, but the lack of adequate support has challenged our practice more than once.
  • “Although it is free to medical provider, some huge advertisers are paying big dollars and are the ones allowing it free for us. I hope they are aware of this inconvenience.”
  • “For everyone that is frustrated, how long have you been with PF? How many times has it gone down? I’ve been with them for 3 1/2 years and had a total of 4 hours of unplanned down time.”
  • “I am OK with a Day or 2 of outages, but this is a wake up call to how much we rely on you. Next time it might be a security issue and we are helpless to do anything about it. I would feel better knowing that if there is a catastrophe, I at least have a backup that I can use to go forward with. Maybe even a paid option – like $50 a month to be able to do a daily backup to my local computer.”

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From Reluctant Epic User: “Re: new Epic patent. I’m surprised the patent examiner thought that was novel for a Level of Service user interface.”

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From Details … Details: “Re: Habersham Medical Center. With Meditech’s industry-leading 800+ attestations, it would seem that there might be some missing information here.” I don’t doubt that a bit – it was the client that said it was a software problem. However, they also fired the IT director, so that plus Meditech’s lack of attestation problems elsewhere seems to put the blame on the hospital.

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From ShoezyQ: “Re: sharing hotel rooms. At the Allscripts user group meeting and annual sales meeting, the company requires employees to share hotel rooms. Maybe they should just send fewer people if they can’t afford the rooms. Can you ask your readers? I would never share a room with a colleague.” I’m with you. I bet Paul Black isn’t bunking up with Jim Hewitt at a Motel 6 and coordinating bathroom times, apologizing for snoring, and agreeing on the TV channel, so the policy is just for the “little people” who weren’t born with a suit on. It’s a pretty cheap company that requires employees to work a company event (which probably also means putting in a ton of excess unpaid hours away from home) and then forces them into steerage to save a few bucks. Maybe the peons could cook ramen noodles in their room’s microwave to save even more money. My strategy would be: (a) ask if you can apply your half-room cost to a single room and pay the difference for your privacy; (b) say you have sleep apnea and use a very loud CPAP machine that will keep your roomie up all night; or (c) find a new employer who values your dignity over their dollars. Meanwhile, I will ask readers as you requested: take the poll here and feel free to explain your employer’s policy via a comment.

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From John Britton: “Re: Cerner acquires Siemens. I am the CIO at a medical center that uses Cerner as our primary EMR as well as their Smart Room technology. We also use Siemens MedSeries4 for General Financials (AP, MM, GL). In 2010 we became one of the first Cerner ‘smart’ hospitals when we went live with this technology in 2010. Since then, I’ve had a front-row seat to the work Cerner has done to connect medical devices to the EHR through their CareAware ecosystem. Avoiding duplicative data entry and preventing errors are some of the biggest benefits of this approach. I think Cerner’s acquisition of Siemens will only accelerate their work to connect different data sources to the EHR. It might also help get closer to realizing more comprehensive interoperability and data sharing models between disparate information platforms using initiatives currently underway like the CommonWell Health Alliance.” John is CIO of Fisher-Titus Medical Center in Norwalk, OH.


HIStalk Announcements and Requests

This week on HIStalk Practice: HHS spends precious man hours (and taxpayer money) attempting to find emails related to the Healthcare.gov rollout. ONC launches a website to collect feedback on its interoperability roadmap. HIPAA worries cause OBs to remove baby pictures from their office walls. Dr. Gregg explains how HIT leads to HID. The Healthcare Administrative Technology Association opens for business. Investors outline their attraction to healthcare IT firms in Nashville. Square’s new appointment-booking feature poses potential HIPAA concerns for small practices. Thanks for reading.

This Week on HIStalk Connect: HealthMap, a Boston Children’s Hospital and Harvard Medical School collaboration, combines public health data, Twitter data, and Google news alerts to track the recent Ebola outbreak with greater accuracy than the World Health Organization. Apple is reportedly in discussions with Allscripts, Johns Hopkins, Cleveland Clinic, and Mount Sinai to generate support for its HealthKit rollout. Validic raises a $5 million Series A round that it will use to expand its digital health integration engine and grow its customer base.

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The first book written by ”CIO Unplugged” Ed Marx of Texas Health Resources will be released in late September. Watch for details of the upcoming virtual book launch for “Extraordinary Tales of a Rather Ordinary Life: How Applying Common, Everyday Principles Can Lead to Uncommon Results” on HIStalk.

Listening: new from The Gaslight Anthem, a hard-rocking New Jersey working class band that sounds like Springsteen backed by the Ramones. Also: new hard rock from the latest of several incarnations of Fuel from Henderson, TN – none of the 16 people who have played in the four-piece band’s 21-year history were in it continuously, but they always sounded good. 

I had a cool customer support experience today with one of our webinar tools. I had opened a ticket since the company basically rewrote the web-based software without instructions or updates to the knowledgebase. The support rep emailed me a screen capture movie showing how to do what I needed to do, even having a little one-way chat with me as he stepped through it. It would have taken him three times as long to write out the steps instead of just turning on Camtasia or whatever capture software he used to dash off a quick video.  That was both brilliant and personal, exactly what you want from a support tech.


BOSS Award Winner – Riton Khan

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Several people nominated Riton Khan for the HIStalk Beacon of Selfless Service (BOSS) Award. Riton is an HISP/iNexx deployment engineer with Medicity.

Adam Rossback of the Ohio Health Information Partnership said in his nomination, “Riton spent countless hours working with me to establish HISP integration with our organization to allow 30+ hospitals to attest for July MU2 attestation.” Donna Maxey of Healthcare Access San Antonio says Riton went above and beyond his job description by working through EMR integration issues with her clients, adding, “Whenever I felt my client was stuck, no matter what the issue was, I asked for a meeting and Riton would send me a screen shot of his calendar. He allowed me to pick any open day/time that the client’s vendor was available. I have yet to work with any vendor employee that is that transparent so that my clients could get the project done on time.” Several other of Riton’s customers added their accolades.

Congratulations to Riton for his excellent work, which makes him entirely deserving of both the thanks of his customers and the BOSS Award. 

You are welcome to nominate a non-management individual for BOSS Award recognition.


Webinars

August 27 (Wednesday) 1:00 p.m. ET. Enterprise Data – Tapping Your Most Critical Asset for Survival. Presented by Encore, A Quintiles Company. Presenters: Jonathan Velez, MD, FACEP, CMIO, Hartford Healthcare; Randy Thomas, Associate Partner, Encore, A Quintiles Company. This first of a webinar series called “It’s All About the Data” will describe the capabilities provider organizations need to become data driven. The presenters will provide an overview of the critical role of an enterprise data strategy, creating the right data from source systems beginning with implementation, real-world data governance, how to avoid “boiling the ocean” with an enterprise data warehouse, and the role of performance feedback to transform analytics insights into improved outcomes and efficiencies.


Acquisitions, Funding, Business, and Stock

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MedAssets will acquire consulting firm Sg2 for $142 million in cash.

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Private equity firm GTCR will invest up to $200 million Cedar Gate Technologies, which it will form with former Medco CEO David Snow, who will add $20 million of his own money and serve as CEO. The company plans to “build a transformative company in the healthcare information technology industry by acquiring outstanding healthcare data and analytics businesses and accelerating their growth.” Snow is hardly an entrepreneur – he’s worked his whole career running giant insurance companies, although he’s on the board of a couple of startups.

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Geneva Healthcare, which offers a pacemaker data management platform that also integrates with other medical devices, raises $1.8 million in financing.


Sales

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Princeton HealthCare System (NJ) selects Premier’s integrated supply chain, performance, and technology services.

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In England, West Suffolk NHS Foundation Trust signs for Cerner Millennium. I think they went live a few years ago on iSoft’s Lorenzo (now owned by CSC) as part of the now-dead NPfIT. You may infer from the hospital photo that despite having the superior healthcare system, NHS doesn’t suffer from the Edifice Complex of aggressively billing Medicare and using the otherwise restricted profits to erect huge, artistically stunning buildings whose exteriors can’t be viewed by the sick people inside their walls but that stroke the egos of the proud community and the executives in charge.

Azalea Health signs up the physician groups of two Georgia hospitals for its EHR and RCM systems, Dorminy Medical Center and Irwin County Hospital.

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Wake Forest Baptist Medical Center (NC) chooses Tonic Health’s patient survey system.

National physician specialty services company Sheridan Healthcare chooses VitalWare’s iDocuMint ICD-10 code assignment and bill preparation tool for its 2,800 providers.

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Basset Healthcare (NY) chooses Strata Decision’s StrataJazz as its complete financial platform.

Urology Centers of Alabama adds Greenway’s PrimeRCM revenue cycle solution, joining its PrimeSUITE EHR/PM system.


People

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Louis Leibhaber (Fundamental Succcess LLC) joins WeiserMazars as director of the healthcare group.

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Asif Ahmad, CEO of Anthelio Healthcare Solutions, is appointed to the board of orthotics vendor Hanger, Inc.

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People Magazine profiles the family of MedAptus employee Jennifer Crowley, whose six-year-old son Padraig has been diagnosed with stage 4 neuroblastoma, the same rare childhood cancer that killed her infant son in 2006. Friends have started a fundraising page to help cover the family’s medical bills. Padraig was started immediately on chemotherapy and will have a long stay at Memorial Sloan Kettering.  

Larry Covington, former CEO of Unibased System Architecture, died earlier this week at 75. Services will be next Friday, August 22, in St. Louis. 


Announcements and Implementations

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Allscripts will integrate Clinical Architecture’s terminology management system, Symedical, with dbMotion.

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Two Texas hospitals are using Holon’s CollaborNet HIE platform in a state-developed pilot project to refer smokers to a free telephone-based smoking cessation program. Annual referrals jumped from seven to 1,254 after the single-click electronic system was put in place.

4medica announces the release of the first laboratory PHR licensed by MMRGlobal, which is curious in that paying off a patent troll is bragworthy.

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The non-profit Healthcare Administrative Technology Association launches to provide advocacy and member education to practice management system stakeholders.

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Impact Advisors joins the Epic-IBM team in pursuing the Department of Defense’s EHR bid.

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Allscripts and Netsmart will partner to co-develop solutions for their acute care and behavioral health EHRs, respectively.

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Nordic announces that it has worked with 100 Epic-using organizations, about a third of all Epic clients. That’s double the company’s 2012 total.


Government and Politics

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HIMSS EHR Association responds to a request from the Senate Finance Committee asking for comments about the availability of patient data vs. the need for patient privacy. The association says the biggest barrier to using existing data effectively is lack of a patient matching strategy, although it stopped just short of suggesting implementation of a national patient identifier.

CMS reactivates its Open Payments system for reporting drug and device company payments to doctors 11 days after taking it offline. Data problems had misattributed some of the physician payments.

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HHS says CMS Administrator Marilyn Tavenner inadvertently deleted emails related to the failed rollout of Healthcare.gov, explaining that she receives so many emails that she regularly hits her Outlook inbox limit and has to clear space. They added that she is supposed to forward or copy the emails for retention as the law requires before deleting emails, but she sometimes forgets. The National Archives and Record Administration says they can probably recover most of the internal emails since they would have been saved by their recipients, but those going to outside addresses may be gone for good. HHS has spent 23,000 staff hours so far trying to retrieve the emails in response subpoenas from Rep. Darrell Issa (R-CA), chair of the House Oversight Committee, so that’s a million-dollar plus delete key.


Innovation and Research

A HIMSS Analytics telemedicine study finds that … well, we don’t know what it finds since they provided a six-page teaser that only included the table of contents. That’s probably enough since the response rate was only 2.7 percent, so any generalization would be suspect.  

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Speaking of HIMSS Analytics, they should know better than to make this speculative leap even though clueless reporters do it constantly. They did the usual lazy test of mashing up some clinical quality data with their own EMR Adoption Medical scores and found that mortality was generally better in EMR-using hospitals. What the study couldn’t find – despite the headline stating otherwise – is that the EMR cause the improved outcomes. Why couldn’t they use the same detailed Healthgrades data and compare it to each hospital’s EMR go-live date from the HIMSS Analytics database and see if mortality improved afterward? It’s just absurd to try to claim that because EMR-using hospitals have better outcomes that the EMR should get all the credit. The same study found that sepsis mortality rates were higher in EMR-using hospitals, so if you feel an infection coming on and you believe this report, you should seek out any randomly chosen hospital that still uses paper charts.

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It was love at first sight between Gartner’s Hype Cycle and me years ago. Here’s a current version, which says mobile health monitoring is about to start moving up the Slope of Enlightenment. Big data and Internet of Things are still years away from matching their hype.

The Michael J. Fox Foundation and Intel announce their collaboration to objectively analyze data created from wearable devices to determine the progression of Parkinson’s Disease.


Technology

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Apple quietly adds another healthcare expert to its payroll: Divya Nag, founder of StartX Med, an accelerator to commercialize Stanford research. The beta version of iOS 8, released last week, includes support for spirometry data, an option to display medical ID on the lock screen, and health privacy options.


Other

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Epic officially breaks from its long-held “no marketing or government relations” position by engaging lobbying firm Card & Associates, run by the brother of the former White House chief of staff under President George W. Bush, as it seeks the DoD’s EHR bid.  

Beth Israel Deaconness CIO John Halamka says the hospital is almost ready for Meaningful Use Stage 2’s September 30 deadline, but is struggling with the 10 percent transitions of care threshold since few other providers, especially small physician practices, are capable of receiving the hospital’s information electronically. He adds, “On some days it feels that we have the only fax machine in town and thus it’s hard to fax.” That’s going to be everybody’s problem — so few providers are ready for Stage 2 that the go-getters don’t have anyone to exchange information with.

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Former Allscripts CEO Glen Tullman says patients don’t want more engagement with their chronic diseases – they want less engagement so they can get on with their lives. He says that pushing patient engagement is a patronizing approach that will kill off all the technology startups that haven’t made a dent in managing illness anyway. He adds that words such as “tracking,” “monitoring,” and “intervention” are disempowering because they suggest a loss of independence and that nobody’s going to analyze their own data or look up ways to be healthier. Not everything Glen said when he was at Allscripts made sense, but this does.

An article in The Atlantic says that big data from expectant women is being used for both good and bad: good for analyzing fetal DNA to uncover genetic problems, bad because marketers are using it to find purchasers of pregnancy tests and other products so they can launch aggressive marketing campaigns that hope to turn their offspring into long-term customers. Crafty data brokers use browser cookies, page view histories, Facebook posts, and online purchasing histories to build marketing profiles that are sold to any willing buyer. An example is the father who complained to Target that sending coupons for maternity clothing to his daughter encouraged teen pregnancy, only to find that Target knew something he didn’t: she was already pregnant.

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Torrance Memorial Physician Networks blames its EMR for allowing one of its doctors to code “homosexual behavior” in a male patient’s problem list. The patient, who is suing the doctor and practice for emotional distress and libel after seeing the entry in his chart after the hospital said they would remove it, says the doctor argued that the medical community is still not sure whether or not homosexuality is a disease. The man’s chart was coded with ICD-9 code 302.0, “ego-dystonic sexual orientation,” a code that was retired in 1987 to describe someone who’s unhappy with their sexuality. According to a spokesperson, “Due to the highly complex software used in creating an electronic medical record, the incorrect code continued to exist in an electronic table only. As a result, this incorrect diagnosis code was included on a paper copy of the record, which was provided only to the patient.”

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It’s surprising how much technology is being developed around the medical marijuana industry, but then again the financial alignment is clear. A radiologist and clinical owner develops CannaScan, a real-time, cloud-based validation system that allows Massachusetts police departments to verify that people found with marijuana have been issued a valid prescription. Massachusetts doctors were previously charging patients for ID cards, which the Department of Health found unethical, leading to CannaScan’s claim that it allows the “Good Guys to Weed Out the Bad.” The doctor says the software allows better care coordination and real-time patient management since it supports videoconferencing, scheduling, and notifications, or as he calls it, “A Clinic in the Clouds.”

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Weird News Andy utters one of my favorite Monty Python lines in titling this article “I’m not dead yet.” A hospital in Australia apologizes for faxing death notices for 200 still-breathing patients to their family doctors, saying someone accidentally changed the templates involved. At least it’s not just the US healthcare system that’s keeping long-abandoned technology such as pagers and fax machines alive.

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WNA also likes a story he calls “a knife on his mind.” A man in China taking a stroll feels pressure in his head, not realizing the cause until a shopkeeper points silently at the five-inch kitchen knife protruding from his skull. It had fallen from the balcony of a high-rise. He’s OK.


Sponsor Updates

  • NextGen describes the three tiers of the Patient Centered Medical Home.
  • The Meditech Solutions Group within Dell adds DataMotion Direct secure messaging to its portfolio of services.
  • CompuGroup Medical US and Teche Action Clinic (LA) team up to celebrate the 2014 National Health Center Week.
  • Levi Ray & Shoup announces the release of its Virtual Session Printer Agent.

EPtalk by Dr. Jayne

I attended a CME seminar this week which was actually pretty fun. It was good to get away from the grind of the IT world and remind myself why I became a physician in the first place.

Although most of us continue to have grumbles about payers, conflicting recommendations, and of course EHRs, we also have great stories about our patients and what it means to care for them. The course was on delivery of culturally competent care, which is pretty far away from what we usually deal with in the IT trenches.

Several of the physicians I met were interested in the fact that I gave up a busy solo practice to go into the world of IT. Many were from cities of a size that they may not have dedicated physician IT resources and were interested in how they could get more involved in the decisions that impact their practices and how they care for patients. Most were employed, although there were a few solo holdouts.

A couple are in direct-pay practice situations which I think is a very interesting solution to many healthcare issues. The patient sees the doctor, a fee is assigned, and the patient pays. If the patient wants to submit to insurance, they are given information about the visit so they can self-file. Although one uses EHR, the others don’t. All of them have opted out of Medicare and Medicaid. At least for now, all are happy.

It was strange to talk to physicians who aren’t dealing with MU attestation or the risk of audits. That’s become so much of our world lately. It was invigorating to see whether the grass is greener on the other side or not. I’m not interested in hanging up my IT hat, but I certainly would consider that model if I went back into a continuity-type primary care practice. It reminds me of the physician I saw when I was a kid.

Of course not being connected has its disadvantages. I don’t think I’d take it that far. I like the benefits of EHR too much to go back entirely.

Speaking of e-prescribing, I mentioned that I enrolled in the free Allscripts eRx product through the National ePrescribing Patient Safety initiative. Although the registration process was easy, I still am not set up to e-prescribe. Apparently they need to verify my NPI number. First they asked me to fax proof of my NPI, which I don’t have – I don’t have the original enumeration letter from way back when. I also don’t have a fax machine.

I asked if I could email it. They said yes, but again I need to provide proof. They helpfully directed me to a website where I could look myself up and find my NPI number, which I already knew and submitted to them. I’m not sure why they couldn’t go to that website and verify that the number I provided matches my name, but instead sent me 12 emails and called the office multiple times to tell me to go take a screenshot of a public website and email it to them.

I was finally able to find time to do that and sent it off, so hopefully they’ll get me set up soon. In the meantime, the system isn’t that useful since we don’t have a demographic interface to it and everything has to be manually keyed. Looks like I’ll be going back out to look for other vendors regardless of the outcome with the NPI.

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From The Grey Goose: “Re: Allscripts user group meeting in Chicago. My kind of town! Check out this view from my hotel room.” I wasn’t sure initially if this picture was real or from a postcard, but I can only hope I have such a great view when I’m in town for HIMSS. This will be an interesting HIMSS for me since we’re in the middle of consolidating our systems. By the time it rolls around, we’re likely to be under contract with a new vendor. That will put a whole new spin on things.

The Allscripts user group meeting is in full swing and purports to have a Thursday night client event with bands Styx and The Gin Blossoms performing. Sounds like a great time and I hope some of the attendees share pictures. I’m off to the airport now. It will be good to sleep in my own bed before handling the torrent of emails that flooded in while I was away.

What’s your favorite vendor user group client event? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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August 14, 2014 News 18 Comments

Morning Headlines 8/13/14

August 12, 2014 Headlines No Comments

Dallas County gets futuristic general hospital

A local paper highlights some of the technology being installed at Dallas-based Parkland Memorial Hospital, a $1.3 billion “digital hospital” set to open in May 2015.

The new No. 1 private-sector employer

Cerner has grown to become the top private sector employer in Kansas City, driven by a hiring spree that added 1,500 new hires in the past year.

Apple prepares Healthkit rollout amid tangled regulatory web

Apple is reportedly in discussions with Allscripts, Johns Hopkins, Mount Sinai, and Cleveland Clinic as it continues recruiting new digital health partners ahead of its upcoming HealthKit rollout.

Telemedicine could yield $6B per year in savings

A new study claims that adopting telemedicine as the primary means of treating certain non-urgent conditions could theoretically save US employers $6 billion annually.

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August 12, 2014 Headlines No Comments

News 8/13/14

August 12, 2014 News 3 Comments

Top News

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The White House creates the US Digital Service, a new program that will recruit the “country’s brightest digital talent” to provide strategic guidance on major IT projects like Healthcare.gov and iEHR. Mikey Dickerson, an ex-Google engineer credited with saving Healthcare.gov, has been tapped to run the service. As a deputy federal CIO, he will work with similarly titled Lisa Schlosser in her role of policy, agency oversight, and accountability. The new service will ultimately consist of 25 experts brought in on two- to four-year term appointments to help agencies plan, improve, and fix IT programs. It will be financed with existing funds in 2014, and scale in 2015 as outlined in the President’s FY 2015 budget.


Acquisitions, Funding, Business, and Stock

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Cerner jumps to the top spot of the Kansas City Business Journal‘s Top Private-Sector Employers List due in large part to the addition of 1,550 local employees in the past year. That’s not counting the 16,000 it will need to hire to fill its planned $4.5 billion Three Trails Campus, or the unknown number it may create in the coming years as a result of the Siemens acquisition.

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National staffing company Jackson Healthcare acquires Sullivan Healthcare Consulting, which focuses on improving the performance of the hospital perioperative suite through surgery benchmarking, scheduling, staffing, sterile processing, and surgery IT implementation. SHC will serve as a complementary service line to Jackson Healthcare operating companies Premier Anesthesia and Jackson Surgical Assistants.

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Hospital administrators at Emerson Hospital (MA) attribute the facility’s operation-margin gains and service-line upticks to an increase in outpatient services. Though IT upgrades in the mammography department have led to the need for fewer patient visits, referrals from other places for Emerson’s new, higher-quality mammographies have made up for the decline.

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Healthcare IT firm Priority Consult acquires business intelligence and analytics software developer Balanced Insights to form Cordata Healthcare Innovations. The new company will use Balanced Insight’s technology as a starting point for a new generation of patient navigation and tracking applications. Priority Consult president and CEO Gary Winzenread will serve as Cordata’s president and CEO, while Balanced Insight founder and CEO Tom Hammergren will serve as CTO.

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Population health and workflow technology company Acupera secures $4 million in financing from Lightspeed Venture Partners. It will use the Series A funding to scale its product development team and add to its customer implementation group.


People

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Travis Crenshaw (United Surgical Partners International) joins Foundation Healthcare Inc. (OK) as CIO.


Announcements and Implementations

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University of Colorado Health selects Zix Email Encryption to provide consolidated, secure email to 18,000 users across its system, which includes University of Colorado Hospital, Memorial Health System, and Poudre Valley Health System.

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Allegheny Valley Hospital (PA) becomes the first in the state to equip its paramedic team with iPads. The pilot project has so far enabled AVH ER physicians to observe 12 patients on their way to the hospital. The hospital paramedic team will present the results of the project to the Pennsylvania Department of Health, which is considering rolling out similar programs across the state.

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Providence Medical Center (KS) selects the GroupOne Health Source One Rate platform of medical billing and EHR implementation services for 40 of its providers. PMC will use the OneRate platform to facilitate integration of physician practices into its multi-specialty network across the greater Kansas City area.

UnityPoint-Allen Hospital and Black Hawk-Grundy Mental Health Center in Iowa announce they will begin electronically sharing patient records early next year.

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St. Joseph Mercy Health System launches a telemedicine service from MDLive that provides real-time physician appointments 24 hours a day, seven days a week via video, phone, or app. Patients are connected with a SJMHS or MDLive physician who can offer treatment evaluation and advice, and e-prescriptions.

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Halifax Regional (NC) launches the HalifaxHealthLink patient portal, which follows the successful rollout of the FollowMyHealth portal for patients of Roanoke Clinic, Roanoke Valley Internal Medicine, and Halifax Regional Cardiology.

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The Willis-Knighton Physician Network (LA) selects InteliChart’s Enterprise Patient Portal to serve as a single portal solution for its system of network clinics. Physician Network Administrator Greg Gavin noted that “[a] vendor-neutral patient portal that provides a single source solution for our patients as well as a consistent brand across the entire Willis-Knighton System were top priorities in selecting a solution” to improve communication, coordinate care, and facilitate patient healthcare goals.


Government and Politics

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ONC launches a website designed to collect feedback on its proposed interoperability roadmap. Stakeholders have until September 12 to provide their thoughts and comments, after which ONC will present aggregated feedback to the Federal Advisory Committee for its input and recommendations. An updated version of the roadmap will be posted for public comment early next year.


Research and Innovation

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Creative England announces a £1m fund for small and medium enterprises in the North, Midlands, and Southwest regions designed to stimulate creative and digital innovation in UK healthcare. Four new programs will open as part of the fund. The first is the West Midlands Interactive Healthcare Fund, which will offer five £50,000 investments to support projects that focus on improving quality of care, caring for people with dementia, supporting people with long-term conditions, and data visualization. Applications will be assessed on a rolling basis and the fund will close on Oct. 31, 2014.

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A new report finds that using a touchscreen EHR to support and monitor a national antiretroviral therapy program in Malawi faced challenges similar to that of EHR adoption in the U.S.:

  • Implementing a point-of-care EHR has been more challenging than initially anticipated.
  • The success of a POC system ultimately depends as much on a commitment from system users as on the technologies employed.
  • Poor adherence to system use will result in incomplete data.
  • Health workers will not adopt a system if they do not find sufficient value in it. Consequently, the primary challenge is to identify and address the value proposition for the user. This is an iterative process that requires a commitment to regular and ongoing dialog with the users if this paradigm shift to POC system use is to be sustainable.

Technology

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Reports surface that Apple is in HealthKit development talks with providers at Mount Sinai, Johns Hopkins, and the Cleveland Clinic, as well as with Allscripts. Cleveland Clinic CIO William Morris says the clinical solutions team is experimenting with HealthKit’s beta and is providing feedback to Apple. Representatives from the other three organizations have not yet chimed in.

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Simple Medical Software Inc. releases the SimpleRounds app to help providers better communicate and collaborate on patient care. Developed by SMS founder Rubén Zamorano and Manuel Martinez, MD the app features secure text messaging, billing manager, physician directory, rounds manager, patient census, and sign-out manager.


Other

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The local paper highlights the new $1.3 billion Parkland Memorial Hospital, one of the first “digital hospitals” in the U.S. The hospital, set to open in May 2015, will feature $80 million worth of digital technology including touch-screen way finding kiosks, smart beds, baby tracking devices, and hand-held communication devices for nurses, as well as an integrated digital system controlling nearly every aspect of its operations. CIO Fernando Martinez points out the hospital will be similar to a smart home: “All the digital devices in a smart home can talk to each other because they’re connected to a common hub. That’s not unlike what we do, only we’re much bigger.”

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Irish health service officials find that the number of patients waiting more than a year for hospital treatment surged 600 percent between December 2013 and May 2014. They have not formally addressed the spike, but have noted they are addressing the issue “in the face of significant financial challenges.”

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Jersey City Medical Center (NJ) reveals that a computer disk containing 2011 Medicaid patient information was lost in June when a package sent via UPS failed to arrive. The unencrypted disk contained an undisclosed number of patients’ names, and many of their Social Security numbers and birth dates.

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This article highlights the success of the Maryland Chesapeake Regional Information System for our Patients (CRISP) HIE, which has seen patient searches by providers jump from under 10,000 in late 2012 to nearly 55,000 as of last month.


Sponsor Updates
  • Capsule discusses why timing is everything with vital signs.
  • Rochester Regional Health Information Organization (NY) and HealtheConnections RHIO of Central New York are live on eHealth Technologies’ Image-Enabled Results Delivery.
  • The Advisory Board Company offers its ready-to-present slides on the surgical services market trends for 2014.
  • OhioHealth upgrades its Infor Cloverleaf solution to V6.0.
  • Aventura client Hunterdon Healthcare System’s Greg Melitski will explain how they met their ED workflow challenges at the Optum Client Forum in Chicago, August 18-21.
  • Streamline Health is participating in the Allscripts ACE 2014 Conference, which kicks off today.
  • Wolters Kluwer ProVation offers a white paper entitled “ICD-10: The Gift of Time.”
  • Black Book names Allscripts “Best of the Best” Ambulatory EHR vendor for interoperability.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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August 12, 2014 News 3 Comments

Monday Morning Update 8/11/14

August 9, 2014 News 5 Comments

Top News

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Massachusetts will upgrade Massachusetts Health Connector instead of piggybacking on Healthcare.gov, officials decide. The state will replace fired contractor CGI, to which it has paid $52 million, and replace it with Optum. The struggling site has cost $108 million so far.


Reader Comments

From Chris: “Re: jaded by the industry. We vendors are jaded too because it is a very difficult industry to serve. Fat cat EMR vendors have stolen from hospitals for years for very little value or improved outcomes. Then ACA just dumps millions into the hands of the same vendors, starving those innovating and trying to change a culture from the ‘80s. We have to deal with absurdities like IE7 (and IE8, 9, 10, and 11) while we push boundaries with iPad. There is so much apathy and very little standardization and consistency from one hospital to the next. You have to laugh at the amount of money that’s being spent to convert to electronic medical records and protect privacy. Paper wasn’t so bad after all and it was certainly cheaper. Until human behavior changes and the FDA starts protecting our food supply, we’re just fooling ourselves about improving healthcare.”

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From Sticky Clicky: “Re: Habersham Medical Center. Which EHR forced them to return their Meaningful Use payments due to lack of capability?” They’ve been running Meditech forever, I believe. The hospital spent $3 million on software upgrades and attested for Stage 1, but later found that “a statement we made to CMS that it would work was in error” so they returned the $1.5 million in incentive money.

From Equitable: “Re: a recent vendor raising debt funding. I’m guessing it’s because they failed to raise equity after hiring Blair to try. Investors were concerned about the viability of an e-prescribing vendor at this point in the market.”

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From Certified: “Re: LabCorp. Nationwide systems down as of noon Friday. Radio silence from corporate. Why aren’t they at Starbucks informing customers by Gmail? They can afford elite collection agencies, but their IT systems are primitive.” Even LabCorp.com is down as I write this Saturday evening and their portal log-in page returns an internal server error. That’s some major downtime.


HIStalk Announcements and Requests

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Two-thirds of poll respondents think the federal government should develop EHR interoperability standards and make them mandatory. New poll to your right (or here):  which EHR vendor is best positioned to support population health management?

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

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Last Week’s Most Interesting News

  • Cerner announces that it will acquire the healthcare IT business of Siemens for $1.3 billion in cash as Siemens finally unloads the business it bought in 2000 for $2 billion, making Cerner the biggest vendor in the industry in terms of revenue. Cerner’s interest is buying a captive audience for conversion to Millennium, incorporating patient data from the legacy systems of Siemens into a population health management system, and using R&D to blur the line between diagnostic and therapeutic equipment and IT systems in a post-EMR world.
  • Six Wisconsin health systems announced their affiliation to manage populations and earn business, including sharing patient information from the Epic system used by all six to deliver care and manage patients across institutions.
  • The annual EHR report by the Robert Wood Johnson Foundation finds that HITECH-incented hospitals and practices have rapidly implemented basic EHRs, but few are using them comprehensively and only a tiny percentage of users are ready for Meaningful Use Stage 2.
  • HHS OIG released a report that said ONC’s certification program doesn’t focus enough security issues ,such as enforcing password complexity and managing user privileges.
  • The State of Vermont ends its $83 million health insurance exchange contract with CGI, saying the site still isn’t fully functional.
  • Allscripts announces Q2 results that meet analyst expectations.

Acquisitions, Funding, Business, and Stock

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Voalte will open Voalte Labs, an independent research center, in its home town of Sarasota, FL. It will be run by Don Fletcher, PhD, the company’s chief scientist.

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From the Allscripts earnings call:

  • President and CEO Paul Black says the company will benefit “as clients look for solutions that are both interoperable and fully integrated, something Allscripts’ open platform is uniquely positioned to provide.”
  • The company’s one Sunrise hospital sale in the quarter was to a 78-bed hospital.
  • Black says the company’s new “fusion” technology will integrate parts of dbMotion, Sunrise, TouchWorks, and Pro.
  • The company blames reduced revenue vs. 2013 on “a continued shift toward subscription software arrangements.”
  • Maintenance revenue dropped as customers moved off MyWay.
  • The company blames flat transaction revenue on Medfusion, which cancelled its agreement with Allscripts claiming it wasn’t getting paid and that Allscripts was urging its portal users to switch to Allscripts acquisition Jardogs, now called FollowMyHealth.
  • The company is targeting Siemens customers now that its business will be acquired by Cerner.
  • Allscript expects international business to double as a percentage of total revenue, from 5 percent to 10 percent.

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The CEO of Siemens Healthcare, quoted in the announcement that it will sell its health IT business to Cerner, said:

We have continuously invested in our HS-portfolio and achieved significant progress on the technology side. At the same time, we realized that business success of our hospital information systems could not always keep pace with our competition. Additionally an increasing number of country-specific requirements, such as resulting from US healthcare reform, make it increasingly challenging to achieve sufficient scale effects. Going forward we will focus on the development of information systems that support our businesses in laboratory diagnostics as well as imaging and therapy.


People

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Patient data monitoring app vendor Conversa Health appoints Peter Levin, PhD (US Department of Veterans Affairs) to its board.


Announcements and Implementations

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Google announces availability of preview version of its Google Fit software development kit. It allows programmers to access a user’s fitness history as recorded on Android-powered apps and sensors. Google Fit is scheduled for a fall release.


Government and Politics 

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Oracle sues the state of Oregon, claiming that the Cover Oregon health insurance exchange owes it $23 million for using its software. This follows the state’s announced intentions to sue Oracle for the $134 million it paid it to develop the site, which never went live because of problems. According to a state spokesperson, “The state fully expected to end up in litigation over Oracle’s failure to deliver." Oracle says the state failed to define system requirements, focused on the site’s appearance instead of its functionality, and failed to hire a systems integrator. Oracle adds that state officials went on a 60-day day retreat to define specifications but “returned empty-handed.” Legal experts say the state probably won’t win its lawsuit against Oracle because of the state’s weak contracting practices and the fact that its actual contract is with Dell, which paid Oracle time and materials as a subcontractor. Meanwhile, the state is planning to dump Cover Oregon and use Healthcare.gov after spending $250 million in federal taxpayer money on the failed website.


Innovation and Research

Here’s how surgeons use TedCas’s Microsoft Kinect-powered user interface in the OR.


Texas Health Resources / CVS MinuteClinic Affiliation

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CVS Caremark and Texas Health Resources announced an affiliation three weeks ago to provide convenient primary care services such as medication counseling, chronic disease monitoring, and wellness programs at CVS/pharmacy stores and MinuteClinic locations. The organizations hope to keep people healthier and out of the hospital and ED. I spoke to Barbara Adams, VP of Innovative Technology Services for Texas Health Physicians Group / Texas Health Resources about the relationship.

She says the driver for THR was to increase its access points. She said, “We have 250 clinics in DFW. We wanted to be able to refer after-hours patients so they don’t have to go to the emergency room. Many of the THR ED patients don’t have primary care doctors.”

Minute Clinic is staffed by nurse practitioners. Texas law requires physician supervision in the form of a review of 10 percent of charts. CVS will pay THR’s physicians for providing that supervision. THR also may gain referrals if patients choose them from the list MinuteClinic provides.

CVS is using a homegrown EMR but is moving to Epic, which THPG already uses. For now, the organizations will exchange information using Surescripts. The NP can push a message into THPG’s Epic system and the organizations can exchange CCDs over the HISP. Once CVS goes live on Epic next year, message exchange will be directional using Epic’s Care Everywhere.


Other

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TechCrunch profiles five-employee PicnicHealth, which offers a $39 per month personal health record that is populated from information the company obtains by performing manual records requests for a person’s encounters. The fee also includes ongoing digitization of new records, synching with patient portals, and unlimited records delivery to doctors. The company’s official address is a San Francisco apartment.

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HIPAA worries are causing obstetricians to remove “baby boards” that feature photos of babies they’ve delivered from their office walls. An OCR representative confirms that the practice is illegal even if the family sends the picture for that purpose since “implied consent” doesn’t count.

A new regulation in India requires doctors to write prescription in all capital letters to avoid sloppy cursive handwriting that was causing medication errors.

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A California pathologist is charged with embezzling $500,000 from the pathology company that promoted her to CFO, with one of her first accomplishments being to give herself a raise from $226,000 to $739,000.

Weird News Andy says this story involves a million-dollar typo. A family who purchased  health insurance through Nevada’s health insurance exchange finds themselves on the hook for $1.2 million in medical bills related to premature birth of their daughter because of an incorrectly entered date of birth. The state has already fired Nevada Health Link’s contractor Xerox, who says the only way to add a newborn is to cancel the family’s policy and start over.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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August 9, 2014 News 5 Comments

News 8/8/14

August 7, 2014 News 16 Comments

Top News

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Six Wisconsin health systems that cover 90 percent of the state create a network to share resources, manage populations, and attract the business of employers, insurance companies, and individual insurance holders. All of the 44 hospitals owned by the unnamed network’s members use Epic and will share their Epic EHR information to manage populations and deliver care across facilities. The systems are Aspirus, Aurora, Bellin Health, Gundersen, ThedaCare, and UW Health. The board chair of the network says the members chose a virtual affiliation because working out the financial and administrative details of a merger would have taken too long.


Reader Comments

From Pink Slip: “Re: hospital IT department layoffs. Do  you agree that the number seems to be increasing, or am I just noticing the announcements more?” That’s a good question to pose to readers, who are welcome to provide their thoughts. I asked the Advisory Panel about layoffs recently and few reported any, so I’m skewing toward it being perception more than reality.

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From Frazzled CIO: “Re: Cerner. Our hospital announced the same day of the Cerner-Siemens announcement that we’re in discussions to acquire another hospital. We’re Cerner and they are Siemens. The announcement may have sent me over the edge if I hadn’t already been alerted through HIStalk of the potential deal and pondered the potential impacts ahead of time. Awesome work and thank you.” I will pass those thanks along to the readers who alerted me months before it happened and then provided thoughtful analysis Tuesday when it was announced. The “analysis” run by other sites was generally lame and dull, showing a remarkable lack of insight in gravely pontificating that Cerner should keep Millennium as its showcase platform (were they seriously thinking that Cerner would be tempted to lead with Soarian?) or that Cerner paid too much (they bought the Siemens IT business at the fire sale price of one year’s revenue, most of it probably recurring since Siemens isn’t selling much, and those customers can’t bolt short term.) The financial risk to Cerner is low as long as they don’t let the Siemens mess distract them.

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The Siemens business needed to be bought because they had trashed it in the 10 years they owned it, as is often the case when a big company jumps into healthcare IT because it seems like easy money and because it makes their executives fell Silicon Valley-ish. I will repeat my mantra: only three companies (Epic, Cerner, and Meditech, although CPSI might logically be included) are serious competitors in the hospital core systems market and all three (a) built most or all of their products on a single platform; (b) sell and support one core system; (c) rarely acquire companies; and (d) haven’t themselves been acquired. Cerner breaks what would have been my fifth rule since they aren’t privately held, and now that they are buying the Siemens business, they will violate my third rule as well and we’ll see how that goes. Siemens was waiting to fall – events of similar importance that may happen one of these days that would put the industry into a similar frenzy are (a) Judy Faulkner retires and hands off Epic to her successors; (b) the retirement-age owners of Meditech decide to sell it given lagging market performance and the chance to cash out at the top; (c) Allscripts throws in the Sunrise towel because of infrequent sales, poor ambulatory integration, and a missed DoD contract if that happens; and (d) DoD’s selection makes Cerner, Epic, or Allscripts a household word but threatens to suck the energy out of them with endless government bureaucracy and implementation challenges.  

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From Brian Yeaman, MD: “Re: Cerner acquires Siemens. In my longstanding history with Cerner as a major client in interoperability and around HIE an population health for nearly a decade, we’ve seen Cerner commit and engage deeply around interoperability. We’ve had great success with Cerner native solutions as well as acquired solutions and their ability to support all platforms while integrating the best of both worlds regarding the front and and back end for HIE, Long Term Care, reporting, Direct and other EHR integration have empowered tremendous success in our efforts in Oklahoma. I’m very confident that this will be a big win for existing and new Cerner clients via Siemens alike. Cerner’s efforts to enhance interoperability and the entire care continuum and care regions like Coordinated Care Oklahoma just took a quantum leap, in my opinion, to the good.” Brian is chief administrative officer of Coordinated Care Oklahoma. I think it’s a good deal all around. Siemens was not that great of a vendor, hoarding its legacy system recurring revenue and pretending the world hadn’t changed since the swinging SMS 1980s. Its customers would have been faced with abandoning the company’s antiquated core systems at some point anyway since Siemens did little beyond half-heartedly dangling the unattractive Soarian bait in front of them with no bites. Cerner will force Siemens customers to finally make a long-term choice, hopefully soothing the pain of the ripped-off Band-Aid with attractive Millennium pricing and conversion assistance.

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From Holly Mathews: “Re: Epic. Putting the health back in healthcare—that’s been a big initiative of mine at Epic for the past three years. It finally seems like preventative care is coming to the forefront of EMR attention or at least it’s slowly being pieced together. There is absolutely more emphasis on what folks are to doing to maintain a healthy lifestyle. To a new Epic customer today I responded, ‘Yes, we do integrate with Fitbit.’ There is a genuine desire to promote and manage not just the patients who are sick. I work at Epic as a project manager, but I also race bikes on a professional cycling team. Last week I won a stage at the Prairie State Cycling Series in Chicago. I thought it was pretty cool. :) Epic will ultimately help drive the shift of medical practice paradigms to focus on and manage active lifestyle choices.” My favorite part of Epic is the youthful, idealistic enthusiasm of its mostly 20-something very smart employees with no pre-Epic healthcare experience who jump in with both feet, have fun, and work hard. My stock in trade is jaded, world-weary cynicism formed by many years of being ground down by clueless executives, dysfunctional vendors, and healthcare decisions made by everybody except patients and clinicians, so it’s fun to see new optimistic new blood who think they can change the world and who in fact just might, no matter who they work for.

From OGMD: “Re: Practice Fusion. Don’t even mention their name on HIStalk – cover them on HIStalk Practice. The only docs I know that use it are one-doc practices too cheap to purchase a best-of-breed EMR. They still use paper charts because Practice Fusion comes with no training and is not robust enough to go entirely paperless.”  

From LFI Masuka: “Re: patient portals. The government mandates them, but patients will go online when it’s convenient or necessary. Kaiser’s success didn’t come from government mandate – they have things set up where it’s a bigger hassle to not use the portal than to use it. Most healthcare organizations don’t have such comprehensive control of the patient experience. My PCP is on Centricity, my specialist in the same clinic is on paper, and the local hospital is on an old version of Meditech. There’s a rudimentary RHIO trying to aggregate everything. As a patient, what compelling reason do I have to use a portal on any of these systems? I might trend some vitals or use it more if I had emergent health issues, but that won’t push the mandated numbers. We are throwing millions of dollars at technology in search of a problem.”

From Curious and Curiouser: “Re: patient portal opt-in. People are building the field to plug into the CCD format, but not actually placing the question anywhere it can be answered, essentially making every patient opt-in. What is your readers’ experience with opting in/out of portals? Are they asking the question or just opting everybody in to meet their numbers? It bothers me that the patients’ wishes aren’t being taken into consideration.”

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From The PACS Designer: “Re: Apple. Reports suggest that the iPhone 6 could be announced on September 9.” 


HIStalk Announcements and Requests

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This week on HIStalk Practice: Dr. Andy rants about the review of systems and checklist solutions. Telemedicine’s future in small practices comes into question. Big-box retailers continue to encroach on the business of primary care. Patients go the Priceline route for non-emergency care. Over 100 medical groups call for delay of the Open Payments system. Physician and EP Stage 2 MU attestations continue to underwhelm. Mark Gettleman, MD leaves brick and mortar for mobile and online at Goofy Gettwell Pediatrics.

This week on HIStalk Connect: Dr. Travis discusses the overlooked direct primary care segment of digital health and why he’s excited to see what new technologies it spawns. The FDA publishes draft guidance reducing its regulatory oversight on a large segment of Class I and II medical devices. Doctors On Demand raises a $21 million Series A to expand its national telehealth platform. Researchers at the Medical College of Wisconsin link text message-based reminders with improved preoperative instruction adherence. 

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I almost never look at HIStalk readership stats, but May always starts the summer slowdown that runs through September. Surprisingly, the numbers jumped sharply up this past May despite mostly routine news and the rise has continued through June and July to record levels. Tuesday’s Cerner-Siemens announcement drove record single-day traffic with 10,600 visits from 7,800 unique people – I run HIStalk on a high-powered dedicated, rack-mounted server (geek alert: Xeon E3 four-core CPU, dual 7,200 RPM primary disks, 120GB SSD for MySQL databases, 16GB DDR3 memory, CentOS 64-bit Linux) and the page still took forever to load on Tuesday afternoon when the site was slammed. Visits in the past 30 days exceeded 150,000 and the number of unique people reading is 38,000, more than double the July 2013 total. I get an amazing amount of support from readers, sponsors, and contributors and I’m glad to see the numbers reflect that.

Listening: new from Mary Lambert, an eloquent and empowering 25-year-old Seattle singer-songwriter with a heartbreaking history of sexual abuse, body image problems, and bipolar disorder whose dark and emotional live performances often elicit tears from her audience. Lyrics: “Girls like us are hardly ever wanted, you know. We’re used up and we’re sad and drunk and perpetually waiting by the phone for someone to pick up and tell us that we did good. Well, you did good. I know I am because I said I am. My body is home.” If that’s not your thing, the new Godsmack rocks – my hand is tired but happy from desk-drumming.


Acquisitions, Funding, Business, and Stock

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Allscripts announces Q2 results: revenue up 2 percent, adjusted EPS $0.09 vs. $0.05, meeting analyst expectations for both.

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Practice Fusion acquires Ringadoc, which it calls a “telemedicine platform” and “next generation patient-doctor communication tools” vs. Ringadoc’s self-description as “medical answering service software.” The appeal to Practice Fusion — other than the fact that its CEO is an investor and mentor to the now-acquired company — is that Ringadoc is testing a doctor consultation service for consumers, although it seems to be phone-based rather than online.

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The private equity firm that has owned healthcare product research vendor MD Buyline since 2011 sells the company to contract management solutions vendor TractManager.

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Valence Health says its first-half revenues are up 51 percent year over year and it has added 10 clients so far in 2014. Headcount has risen 150 percent in three years to 470 and the company just leased 125,000 square feet of new office space in Chicago.

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Walgreens announces that it will spend $15 billion to complete its acquisition of a European pharmacy and beauty company, but will surprisingly decline the resulting opportunity to declare its headquarters offshore to save a fortune in US taxes because of expected protracted IRS challenges and consumer backlash. The stock market’s reaction: shares dropped 14 percent. Meanwhile, the CIO of Walgreens hopes to leverage IT to meet the company’s goal of cutting operating expenses by $1 billion annually as it expects annual revenue to jump to $130 billion in the next two years.

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Doctor on Demand, which offers $40 video visits, raises $21 million in a Series A round, with Sir Richard Branson as one of its investors. The company is recruiting doctors to staff its service, touting flexible shifts, $200K income for full-time work, no overhead, malpractice coverage, the ability to work from anywhere with Internet access, and easy-to-use paperless technology that is “more like applications they use personally than traditional medical software.” Sounds like the job-frustrated Dr. Jayne should work some shifts and report back.

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Optum-owned QSSI, which was called in to save Healthcare.gov, will be the lead office tenant at a new Columbia, MD downtown office project scheduled for completion in July 2016.

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CoverMyMeds will lease 64,000 square feet of office space in Columbus, OH to handle its expected growth from 70 to 180 employees in the next few years.

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DrFirst secures $10 million in debt financing, which it will use to expand its development resources and prepare for international expansion.


People

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Peter Csapo (VHA Inc. and McKesson before that) joins Accretive Health as SVP/CFO as the struggling company prepares to restate its financials.

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CompuGroup Medical US promotes Werner Rodorff as CEO/SVP, replacing Norbert Fischl.


Announcements and Implementations

MModal joins athenahealth’s More Disruption Please program, adding its Fluency Direct and Fluency Flex mobile solutions to the MDP Marketplace.

Medicity and athenahealth will improve interoperability between their systems.

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T-System donates T Sheets to QuestCare Clinic, a Dallas-area non-profit urgent care clinic. It is operated in partnership with Watermark Community Church and sees patients without requiring ID, insurance, or appointment, asking only for a $10 donation.

Children’s National Health System (DC) goes live on MedAptus’ dual-code ICD-10 solution for 600 physicians and 400 nurses.


Government and Politics

A VA hospital social worker and union president who claimed in May that her hospital was keeping secret patient waiting lists says the hospital harassed her after she met with a White House representative in July by taking her desktop PC away for a week to encrypt it.

A review of 2013 AHA hospital survey data finds that only six percent of hospitals met Meaningful Use Stage 2 criteria. The actual number is probably even lower because the authors looked only at EHR capabilities, not actual usage in tricky areas such as sending summaries of care and allowing patients to access their own information. The study also did not take into account where hospitals stood with regard to 2014 Edition criteria.


Other

A former Epic employee posts details of the company’s “cryptic raise/bonus black box,” explaining that the normalized results from ranking each employee against co-workers in the same role are sent to the compensation team that assigns raises. This person was hired right out of college at $60K and earned bonuses of $16K and year-end raises of 18 percent and 10 percent. The annual salary of the employee, who was probably 24 when he or she left Epic two years later, was $84K. 

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Can Sanjay Gupta, MD please get back to his medical practice and ask CNN to return to its regularly scheduled programming of cute cat videos and celebrity gossip?

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An internist writes in a NEJM article what it’s like coordinating the ambulatory care of a newly diagnosed cancer patient. In the 80 days from the time the internist told the patient about a liver mass until the day it was removed, the patient saw 11 other clinicians, had 11 office visits other than with the internist, and underwent five procedures. The internist communicated with those other clinicians via 32 emails and eight telephone calls, adding another 12 calls with the patient or the patient’s wife. He concludes that such coordination is essential for patient safety, but is difficult since it involves distributed teams of people who don’t know each other and the healthcare system was not designed to support collaboration. The internist was modest enough to not point out that neither he nor his employer (Weill Cornell Medical Center) were paid a penny for all of his efforts.

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The annual Robert Wood Johnson Foundation report on EHRs finds that:

  • Two-thirds of hospitals have received HITECH money, but few of them can meet Meaningful Use Stage 2 criteria.
  • 59 percent of hospitals are using at least a basic EHR, quadruple the percentage of just four years ago, but only 26 percent have a comprehensive EHR and that number has increased only 3.6 percent since 2010.
  • Of the physician practices that received a Medicare EHR incentive check in 2011, 12 percent didn’t get one in 2012.
  • Of the physician practices earned a Medicaid EHR incentive payment in 2011, 61 percent did not in 2012.
  • The only hospitals that fell on the wrong side of the “digital divide” are critical access and small rural hospitals.
  • Health information exchange is still in its infancy, with barriers being privacy and security, competition concerns, and lack of physician demand.
  • Most hospitals use their EHR to create organizational performance dashboards, but only about half use them to identify care gaps and allow doctors to query their data directly. The key barrier is lack of EHR dashboard and query functionality.

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Weird News Andy speculates that patent trolls are getting bolder given this newly issued patent for this innovative process: (a) a patient calls a doctor’s office; (b) the receptionist records their information and asks the doctor if they want to talk to the patient; (c) if so, the receptionist calls the patient back, transfers the call to the doctor, and adds the recording of the call to the patient’s file. The article points out the infamous MMRGlobal/MyMedicalRecords, which sent threatening letters to practices who dared speak to their patients by telephone without paying it a license fee.


Sponsor Updates

  • Aperek posts highlights of its attendance at the AHRMM conference.
  • Blanchard Valley Health System extends its Wellcentive PHM initiative by instituting a Nurse Care Navigation program that nets significant ROI.
  • Boston Software Systems publishes a white paper on avoiding five myths of EHR migration and eliminating the chaos.
  • MEA|NEA uses the importance of a good website as an example of the importance of technology to growing a business in a recent blog post.
  • PerfectServe posts an article titled “The Changing Role of the Physician.”
  • Aprima kicks off its user conference in Dallas.
  • ADP AdvancedMD spotlights three smaller private practices using its cloud solution to stay clinically and fiscally efficient.
  • Kareo suggests six steps to take in hiring the right staff for a medical practice.
  • NextGen Healthcare announces a new name for its November user group meeting, NextGen One.
  • Premier Health (OH) discusses how it solved the challenges and complexities of payer pre-certification by deploying Passport Health’s OrderRite.
  • SRSsoft will participate in the American Society for Surgery of the Hand conference September 18-20 in Boston.
  • Allscripts shares what “Open” means for healthcare and why it’s so important.
  • IHT2 offers an infographic, “Analytics: The Nervous System of IT-Enabled Healthcare.”
  • Susan Niemeier questions whether the new cool thing is always the smart choice when it comes to technology on Capsule’s blog.

EPtalk by Dr. Jayne

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Of course the big news around the IT corridors today was the announcement of Cerner’s purchase of the Siemens Healthcare IT business. We are using solutions from both parties in at least some fashion. I’m not going to say exactly which ones (or respond to a reader comment asking specifically what systems I use) because I’d like to keep my day job. Let’s just say we have multiple hospitals that we’ve acquired over time and thus have a variety of systems in play.

We’re consolidating, which made the announcement more interesting although it’s not clear at this point how the marriage will impact us. If we decide to chuck everything and move to a different vendor entirely (always possible, but I’m not sure we can scrape up that much cash) it might be a moot point. Unfortunately, so many of our users have grown accustomed leveraging multiple systems to get the work done that the idea of a single vendor isn’t as sexy as it once was.

There was exactly zero discussion of the merger in the physician lounge, which didn’t surprise me. Unless they have stock in a given vendor or were involved in a selection process, some of our providers are oblivious to what system they’re actually using. We’re one of those cutesy organizations that gives every system an acronym used in a branding campaign to assist with user buy-in. I once had a user tell an auditor that our vendor was “SMILE” because we had used that acronym for a go-live.

Coupled with the fact that some of our systems are from vendors that acquired other products that we already owned and morphed them into a suite of quasi-connected pieces under a single name, it’s a wonder we can keep track of everything that’s in place.

For those users who do care that we use multiple systems, one benefit of consolidating our vendors would be a more consistent user experience. We already do a fairly good job of interfacing the data from system to system so that users don’t have to duplicate data entry, but it would be nice to have a more uniform look and feel. I’ve been through several product demos as part of the consolidation effort and have to say that even among vendors purporting to be single system, the look and feel can vary dramatically depending on whether they purchased components or built the system from scratch.

In the same set of comments, Brian Too asked how physicians want technology to reconcile the “tactical” needs of point of care IT support with the “strategic” needs of population health and statistical capabilities. “How do you make the physician interactions with an EMR low-friction while still gathering enough information, of sufficient quality, to support the strategic imperatives?” The answer is a difficult one. The key is in finding an easy way to enter discrete data that physicians don’t perceive as “clicky” or overwhelming.

I’m personally holding out hope for voice-to-data in which narrative can be parsed to identify discrete elements. Physician notes could appear like the dictations they’re accustomed to, but the data could sit underneath, ready for the picking. Technologies are getting closer and closer, but we’re still not to the point where we can pull it off in the way physicians expect.

Even with the slickest user interface, most of our providers still perceive data entry as being something they shouldn’t have to do (even though they did it in the paper world, only with a pen). I think it’s a factor of the volume of data they have to enter now compared to the pre-MU, pre-ACO era.

He also asks: “How much of current physician griping is more about having lost a certain amount of workplace control versus serious mismatches between software capabilities and real workflow needs?” Particularly among ambulatory physicians (and especially among those whose practices have been acquired by a hospital or health system) loss of autonomy may be the majority of the problem. Many organizations do not do a great job with the change management piece of the EHR transition. I see them doing a similarly bad job in transitioning purchased practices from independent to employed models, especially when the organization desires to standardize workflows or centralize certain practice functions.

When we hire new physicians coming out of training, I don’t hear anywhere near the level of complaining that we do when we acquire practices. Most new physicians have used EHRs during training and they’re used to the limitations, so whether they’re using one system or another it doesn’t seem to be as much of a big deal. You’d think we get more complaining from our most tenured physicians, but we actually don’t. The most vocal and unhappy of our providers are in the 45- to 55-year-old range. They’re generally proficient users, but they also have the highest expectations for what the system should be able to do and don’t like it when it doesn’t deliver.

At this point my perspective is so warped, I’m not sure what an ideal EHR would look like. For more and more physicians, the ideal EHR looks like a scribe.

What is in your ideal EHR? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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