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HIStalk Interviews Asif Ahmad, CEO, Anthelio Healthcare Solutions

June 3, 2015 Interviews No Comments

Asif Ahmad is CEO of Anthelio Healthcare Solutions of Dallas, TX.

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Tell me about yourself and the company. 

I was in academic medicine for 18 years. I was a CIO and head of globalization at Duke University Health System and prior to that at Ohio State. About five years ago, I moved onto the corporate side. I had done a lot of startup companies out of academics. I was at McKesson for three years. Now I’m CEO of Anthelio. I come from 23 years in healthcare, specifically in technology, with a big focus on clinical optimization and driving efficient and effective utilization of health IT.

Anthelio is the only independent, vendor-agnostic, full-breadth IT services and technology company. I thought it would be a great marriage of my background and a company with the footprint to start defining some interesting new models of service delivery and service management with what is happening since Meaningful Use.

We are privately held and the largest technology company in the pure healthcare space. We have about 2,000 employees and close to $250 million in revenue, which makes us a pretty big, mid-cap privately held company.

We provide three product lines. One is pure IT services all the way from full IT outsourcing to prioritized IT services, including EHR implementation and optimization. Then we have a second line, which is revenue cycle and health information management, from coding to revenue optimization to clinical documentation improvement. Then we have our products portfolio, which is a vendor-agnostic patient engagement product, data solution products like data warehousing and operational data store, and our analytics products. That’s what defines the company — a IT solutions group, an HIM revenue cycle solutions group, and vendor-agnostic across the board products.

 

Your background as an academic medical center CIO and a biomedical engineer makes you unusual among large-company CEOs. What was the transition like and how would you advise CIOs with similar interests?

The transition for me was really easy, because even in the academic medical center, I was really the one who was going against the norm. Things can be done faster, quicker, more efficient. Cost should be an issue, revenue, opportunity losses should be an issue, and also making a bigger footprint for your academics. When I was at Duke, for example, the three hospitals weren’t integrated a lot at all, so I was brought in to bring that together. Nobody was even thinking about outpatient care — this was pre-population health — and I, working with the chancellor, put that big footprint together. In two to three years, we had full adoption of CPOE. This was all pre-Meaningful Use. We had integrated physician-hospital billing as a single CBO. We spun a lot of companies out of there like Sentillion, a company that Microsoft bought, which was out of my department at Duke. I was always working to optimize whatever the opportunity was for the parent organization.

What I would advise for a CIO is to get yourself organized to learn the operations of healthcare. I think there’s a big movement there. The CIOs don’t really get involved in learning and being held accountable for driving the operations of healthcare. At both Duke and Ohio State, I had P&L responsibility. I was running almost a billion-dollar business for Duke. I had volunteered to run the lab and radiology business, which is a very technology-based business, and my biomedical background was in imaging. I’ve always utilized my technology background to drive operations.

You are right, you don’t see too many people like me in business. There should be more of my kind because part of the problem is that CIOs are always on one end of the board room and the CEO is on the other end calling up Deloitte or Accenture or somebody else to advise them how to use technology. There’s not really that much of a connection between the two groups. 

I have always prided myself in being that bridge, somebody who understands technology, but who wants to grow, drive, and be held accountable for managing the operations of healthcare. I always have had physicians reporting to me from a P&L perspective. At Ohio State, I was building the heart hospital with the doctors there. I was doing a lot of things that were eventually very strongly technology enabled, but we started first with, what’s wrong with the process? What’s wrong with the current way of delivering care? Then technology got introduced. But I was the one who drove both the clinical side and the technology side.

 

What is the trend for health systems to outsource infrastructure, security, or application management?

I think it’s going to start moving. There’s going to be a huge tailwind towards that. Everyone has invested a lot of money in big systems. A lot of people have bought the Epics and the Cerners and now they’re sitting with huge amounts of cost which is depreciating.

Previously most hospital CIOs were a little afraid of outsourcing because the whole idea was that you have to manage, maintain, and contain it. With cloud services and the advent of cybersecurity issues, you cannot have enough competency within your own portfolio to do it. You have to take chance of things where you think scale matters. When I look back on my days at Duke, I would never manage IT security on my own with what I know now being on the commercial side. Similarly, I built a $30 million data center. Why should you be building data centers in academic medical centers or hospitals when that’s just a huge cost sink? You should be working with somebody else to outsource.

Similarly, application management and application hosting. Why would you want to put an Epic and a Cerner or whatever else out there with the SaaS model? Take it out of your portfolio. I have to manage everything close to my chest because the whole technology evolution has told us that that’s not the way to manage in the most cost-effective or effective way because you’ll have a lot more downtime. You put all your eggs in one basket in one building and one server.

Everybody invested a lot of money, and yet the cost of IT has not borne the benefits that one was to see in how the impact of these EMRs were to be had from an outcomes perspective or what needed to happen from patient safety or better financial outcomes. People are not seeing it used for that. You’re seeing post some of these big implementations hospitals taking a hit on their credit ratings. So I think you’re going to see a lot of trends towards outsourcing. I’m able to relate to it because I was also on the other side and we work with our clients now.

But the plan is not to fully outsource everything you have. Take the pain points, take where the scale matters, and let’s take that. That’s where the idea of productized  services solutions comes in. It used to be that everything needed to be outsourced, that you would give me everything because I can’t do just parts of this business. Now we’re in an ecosystem that CIOs of the health systems can work with companies like Anthelio and we can take the headaches off you because we have the scale. Then you should focus on clinical optimization, driving changes with your physician behaviors and the patient engagement. We talk about population health, but yet a patient portfolio itself doesn’t give you that. You have to have the patients engaged in some kind of mobility solution. So focus your interests there and then companies like ours handle the back-end infrastructure. Historically, everything had to be very close to you, but now because of the cost structure and evolution of technology, people are easing up on that. I think it’s the right thing to do.

 

Is offshoring increasing or decreasing?

I’m glad you asked. Almost 30 percent of our workforce at Anthelio is based out of India. The whole trend for offshoring is different. Ours is growing because we don’t think of it as an offshore. I always tell my team that Mumbai is no different than Michigan. By the way, we have a huge delivery center in Michigan, so that’s why I use that analogy. If you align operations tightly, you don’t think of India or Philippines or wherever else you’re offshoring as some destination or location where there is a buffer and a black box. If you tie every community working from home and diffuse services, big vendors have already shown that it can be done. You don’t have to be in one location. The fact that you could have a remote workforce really changed offshoring. That’s one thing that is helping offshoring at the moment. If you align your accountability, it doesn’t matter where the employee is with the right confines in place.

The number two thing that helped us is that it’s not just a cost arbitrage to us. You look at where the best talent is, where the best access to talent is to scale, and how to drive growth from there. People used to send just the back-office jobs to India or somewhere else like that. I’m going to send my billing clerks to India, for example, with ICD-10 coming. I think that has changed. India has some really good talent. I have turned India into an innovation hub for us. We do combined product development. We do combined software delivery as well as service delivery there, not just cost arbitrage.

Offshoring done right should have never been an issue, but the problem is that it wasn’t done right. People took chunks of cost — the quarter end is coming, so let’s just thrown this out to India or wherever else and let’s drive the cost. But it’s not a cost equation. It should be a value equation. Where do you drive the most value? The way we have done offshoring is to balance that out. You can have access to some lower-cost talent in India, but what should that be, and how do you mix that talent then with the talent pool in US so it’s one combined talent pool and not just this bifurcated or trifurcated talent pool who never see each other? 

In our case, the people at all levels between our teams in India — in two locations in Mumbai and Hyderabad — and our locations here Dallas, Tennessee, Michigan, Chicago — they keep going back and forth. There’s a true sense of one combined team. Offshoring is going to continue, but in the context of where the value is driven. It’s not just a cost arbitrage, which is  bound to fail. It needs to be seen as value arbitrage.

 

What will the most important healthcare IT implications be over the next five years?

There’s been this big push to buy new integrated EMRs, and yet you don’t see an impact of it to the outcomes. I think there’s going to be a litmus test. Patients are going to push to ask for more access to their information. The traditional EMR systems can’t provide it, so I think there’s going to be a disruption.

I see in the next five years there should be a disruption in how we manage health technology in the US, which is done in vacuums and silos still. It’s gotten somewhat better, but you’re not going to get your value-based reimbursement. There’s going to be more consolidation, but at the same time, I think the patients themselves are going to push for a much more holistic kind of view. More mobility solutions are going to come forward, not just the enterprise systems that are out there.

In five years you should see a lot of non-profit and for-profit collaborations in a very meaningful way, and hopefully more transition of roles going back and forth. There’s a big vacuum in what the actual understanding of healthcare delivery is versus what the vendors perceive, both on the service and the product side. Hence, many products don’t work. The ones that do work are the ones who understand.

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June 3, 2015 Interviews No Comments

News 6/3/15

June 2, 2015 News 7 Comments

Top News

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Partners HealthCare (MA) goes live on Epic at a cost of $1.2 billion, double its original $600 million estimate, making the project the single largest investment the health system has ever made. The Boston Globe article quotes a Tufts professor and Health Policy Commission member as saying, “We will ultimately all pay for it. Will we get dividends back in terms of better care and greater efficiencies? We don’t know yet.”


Reader Comments

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From Around St. Louis: “Re: SLU Hospital. The university is buying their hospital back and conjoining with SSM to run it. SLU Hospital was the only Tenet hospital with Epic – all others are on Cerner.” The 356-bed hospital wasn’t happy that buyer Tenet, which paid $300 million for the hospital, failed to establish a regional network. The city will lose $6 million in annual tax revenue that for-profit Tenet was paying that SSM won’t, although the mayor’s office say it’s happy with the hospital providing “quality healthcare, jobs, and expansion,” thus neatly illustrating that it’s tough to control healthcare costs when everybody likes the huge employment it creates at public expense.


HIStalk Announcements and Requests

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Mr. K sent a photo of students with the Bluetooth speaker we provided to his Wisconsin PE class via DonorsChoose, which apparently was a great student motivator for our $178 donation. Mrs. F’s Ohio first graders are using their STEM kits in summer school sessions where they learn “while they think they are playing,” she reports. Meanwhile, companies donating $1,000 or more to our DonorsChoose project get mentioned and double their impact via matching funds provided by an anonymous HIT vendor executive – contact me.

I was thinking about complaints that providers don’t make EHR data available to patients vs. the tiny percentage of patients who actually request it. Someone should perform a study to determine the level of demand and the reasons people aren’t requesting their information. I haven’t seen anything to suggest that providers are denying those requests, so targeting them as the villain doesn’t make sense. Proponents should be taking their case to the public, not to providers and EHR vendors. I’ve never requested my own information or changed providers just because I couldn’t get it easily – have you?

I was also thinking that among all the unrealistic expectations placed on health IT to improve health, a big one is caused by consumers who think a huge problem is misdiagnosis. That’s a minor issue compared to lack of consistent, evidence-based treatment of easily diagnosed conditions in which the patient accepts full responsibility for their outcome. Improving outcomes and cost for obvious conditions such as COPD, diabetes, and heart disease unfortunately isn’t as sexy as uncovering a gene for an obscure disease or using Watson to suggest treatments. The transition to a public health mindset is slow and patients don’t like hearing that the answer to their problems is willpower, moderation, and acceptance rather than a decisive, inconvenience-free prescription or procedure.


Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.


Acquisitions, Funding, Business, and Stock

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Post-hospital care coordination systems vendor Careport Health closes $3.8 million in financing.

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McKesson sells its Care Management business, which offers case and disease management services to payers, to investors who will rename it AxisPoint Health.

Premier acquires CommunityFocus, a community health needs assessment management solution jointly developed by UNC-Charlotte and Premier that will be incorporated into PremierConnect.


Sales

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Kingsbrook Jewish Medical Center (NY) will use CipherHealth’s Echo to provide secure, online audio recordings of verbal discharge instructions to visually impaired patients.

Kentucky Medical Services Foundation chooses MedAptus Enroll for managing provider credentialing.


People

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Payor platform vendor Healthx names Sean Downs (Enclarity) as CEO.


Government and Politics

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Vermont Governor Peter Shumlin says a successful software upgrade to the state’s troubled health insurance exchange system this week will reduce the time required for “change in circumstance” updates, but adds that consumers will still need personal staff help until more changes are made in the fall and that warns that it will take time to catch up on the 10,000 changes that have been backlogged. Optum met the May 31 deadline for applying the update but must clear the backlog by October 1 to keep the state from considering shutting down the exchange and moving to Healthcare.gov.


Privacy and Security

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Cottage Healthcare System’s (CA) cybersecurity insurer demands that the hospital repay $4.1 million it provided in settlement costs following a 32,500-patient data breach in 2013, saying the health system lied on its application in saying that it was applying patches, performing annual audits, and verifying the security capabilities of its outsourcers. The hospital failed to update the default FTP settings of servers, allowing patient information to display on Google searches.


Other

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County-operated 439-bed Riverside County Regional Medical Center (CA) requests $53 million to convert to Loma Linda University Health’s Epic system, which I believe would replace Siemens Soarian for inpatient and NextGen for ambulatory.

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A Northwestern University study finds that 84 percent of teens have looked up health information online (mostly by Googling a topic and clicking on the first link presented) and 21 percent have download health-related mobile apps, although two-thirds of them say they didn’t change their behaviors based on health information or tools. Three-fourths of teens were at least moderately satisfied with the information they found, but a significant percentage also ran across negative information such as how to manufacture drugs, play drinking games, or create eating disorders. Only seven percent had ever used a fitness tracker. 

A New York Times analysis finds that hospitals are jacking up their list prices (paid only by uninsured and out-of-network patients) at double the rate of inflation, while their Medicare payments remain flat.

A study finds that 8.2 percent of ED patients returned within three days, with a third of them choosing a different ED and the second visit often costing a lot more than the first. The highest revisit rate involved skin infections that probably shouldn’t have required an ED visit in the first place, but of course most doctors in private practice work banker’s hours in rarely being available without an appointment and nearly never between 5 p.m. and 8 a.m., leaving the ED as the only medical “open now” sign on for well more than half the day unless you count urgent care clinics that actually expect patients to pay upfront instead of if and when they get around to it.

Your cutting edge, contemporary, and fresh HIMSS16 presentation proposal is due June 15, a mere 8.5 months before you’ll actually present it.

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AOL founder Steve Case, now an investor, says healthcare is one of the big economic sectors that will be disrupted by startups, for which he advises perseverance, partnerships, and policy. On the other hand, Steve’s one hit was dumping AOL on the clueless and Internet-terrified Time Warner in a disastrous and scandal-driven 2001 dot-bomb merger, with his follow-up Revolution Health sinking without a trace and his current healthcare IT investments being companies I’ve never heard of. He spoke at HIMSS08 back when it still looked like he might disrupt healthcare.

Weird News Andy flipped over this story that he titles “spatuvula.” A woman tries to clear her allergy-swollen throat using a foot-long kitchen spatula handle, removal of which (and part of her esophagus)required emergency surgery. WNA loves the bonus story at the end that describes a doctor removing a fish from a boy’s throat on camera, leading WNA to question whether he was paid scale.


Sponsor Updates

  • Valence Health is named as one of Chicago’s fastest-growing companies with its 50 percent annual growth rate and 800 employees.
  • Cumberland Consulting Group’s Annamarie Lee will present “Navigate Complexities of Contracting and Government Compliance” at CBI’s Medicaid and Government Pricing Congress this week in Orlando.
  • Health Catalyst is named as one of the best places for millennials to work.
  • Forward Health Group CEO Michael Barbouche is interviewed by a Madison newspaper.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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June 2, 2015 News 7 Comments

Morning Headlines 6/1/15

May 31, 2015 Headlines 23 Comments

Federal Court rules in favor of Teladoc, blocking Texas Medical Board rule and preserving telehealth in Texas

Dallas-based Teladoc wins an early victory in its anti-trust lawsuit against the Texas Medical Board, which passed a rule earlier this month requiring a face-to-face consultation before any telehealth services could be provided in the state. A US District Court has blocked the rule from going into effect until after the trial.

Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs

The American Medical Informatics Association publishes the recommendations of its EHR 2020 Task Force in a report on the status and future direction of EHRs.

Erlanger spending $91 million on major IT overhaul

Erlanger Health System approves a $91 million contract to implement Epic across its system, with an additional $97 million budgeted to maintain the system over the next 10 years. The hospital’s selection committee, made up of clinical and operational leaders, voted in favor of Epic 28 to two over Cerner.

Big Data Beats Cancer

IEEE Spectrum profiles John Halamka, MD, CIO of Beth Israel Deaconess Medical Center, who helped pioneer several big data initiatives in healthcare and in 2011 turned to big data to help create a personalized treatment plan for his wife when she was diagnosed with stage III breast cancer.

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May 31, 2015 Headlines 23 Comments

Monday Morning Update 6/1/15

May 31, 2015 News 9 Comments

Top News

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A judge approves an injunction requested by Dallas-based telemedicine provider Teladoc against the Texas Medical Board for its new rule that requires doctors to conduct a face-to-face patient visit before issuing a prescription.


Reader Comments

From Talking About BS: “Re: Athenahealth. Has spent almost $1 million on lobbying so far in 2014-15 and VP Dan Haley is listed in OpenSecrets.org as a ‘revolving door’ lobbyist, described as federal employees turned lobbyists and vice versa. Athena’s cloud vapor simply isn’t selling to real customers and instead is being sold to Wall Street and Congress. Einhorn has this company pegged.”

From Travlinman: “Re: Epic. Guarantees ongoing interoperability with TeleTracking. Are they going to start playing nice with other vendors?”


HIStalk Announcements and Requests

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More than half of poll respondents think Cerner is the HIT stock to buy. New poll to your right or here: who is most to blame for lack of patient data sharing among providers? Vote and then click the poll’s comments link to make your case.

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I have no idea what a Rekenrek is, but Ms. S says her Indiana first graders are using the ones we bought via our DonorsChoose project daily for Math Warm-Up, adding that, “We had been using Rekenreks that we made on our own that are falling apart, so to see professionally made ones is wonderful!”

I seem to be especially cranky about grammar these days, so add these to my already long list: (a) starting sentences with the word “So” like a drunken bar patron launching into a long, dull anecdote; (b) sloppy use of geographic terms such as “a German doctor” that could mean a doctor from Germany, a doctor in Germany, or both; (c) using “less” rather than “fewer” in describing a collection of individual items, as in erroneously stating, “The event had less people than before”; (d) confusing “I” with “me” as in incorrectly proclaiming, “My brother came to visit Mary and I.” There, now I feel better.

I’m also annoyed by the expression “EHR mandates.” Nobody requires doctors to use EHRs except perhaps their employers – they just pay them extra if they do.


Last Week’s Most Interesting News

  • HHS names Susannah Fox as its new CTO.
  • Two entrepreneurs who sold DiagnosisOne to Alere in 2012 buy back the business – now known as Alere Analyics – to form Persivia. 
  • Athenahealth VP of Government and Regulatory Affairs Dan Haley said in a New York Times article titled “Tech Rivalries Impede Digital Medical Record Sharing” that customers typically pay EHR vendors $1 million upfront, $500,000 per year, and $2 per patient record to exchange information with other systems.
  • Forbes names Epic CEO Judy Faulkner as the wealthiest women in all of technology with an estimated $2.6 billion net worth.
  • Cerner told shareholders that it recorded $4.25 billion in sales for 2014.

Webinars

June 9 (Tuesday) 11:30 ET. “Successful HIEs DO Exist: Best Practices for Care Coordination.” Sponsored by Medicity. Presenters: Dan Paoletti, CEO, Ohio Health Information Partnership; Brian Ahier, director of standards and government affairs, Medicity. Not all HIEs are dead – some, like Ohio’s CliniSync HIE, are evolving and forging a new path to successful care coordination. Brian Ahier will explain how HIEs can help providers move to value-based care models, emphasizing Meaningful Use Stage 3 and FHIR. Dan Paoletti will provide best practices in describing CliniSync’s journey to success in serving 6,000 primary care physicians, 141 hospitals, and and 290 long-term and post-acute care facilities. Attendees will learn how to use a phased approach, establish client champions, help providers meet MU Stage 2, create a provider email directory, deliver care coordination tools, and drive continued ROI.


People

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Tim Theriault, global CIO of Walgreens Boots Alliance (the former Walgreen), resigns for personal reasons. He will be replaced by Anthony Roberts, SVP/international CIO. Roberts came on board with the December 2014 Boots acquisition.

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Former Meriter CIO Peter Strombom died May 18 at his home in Costa Rica. He was 75.

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Jeremy Delinsky, chief product officer at Athenahealth, resigns after five months in the position to take a CTO position with an online furniture company. ATHN shares dropped more than 5 percent Friday following the announcement.  His interim replacement will be VP Kyle Armbrester. ATHN shares are down 20 percent so far in 2015.


Announcements and Implementations

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Athenahealth offers athenaCommunicator Enterprise to new customers who participate in an ACO for a flat 10 percent of their MSSP shared savings payouts.


Government and Politics

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Florida Governor Rick Scott, former CEO of for-profit and fraud-admitting Columbia/HCA, wants to hold the state’s non-profit hospitals more accountable for their huge profits, topped by Lee Memorial Health System’s $230 million.


Technology

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Ashish Jha of Harvard tweeted out rave comments about Doc Stats, an app that shows the approximate number of procedures a doctor performs as derived from CMS data.

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A Bay Area recycling firm is looking for a woman who dropped off garage junk following her husband’s death that included an Apple I computer, one of only 200 that were hand built by Steve Jobs and Steve Wozniak in 1976. The company wants to give the woman $100,000, her half of the amount a private collector paid to buy it from them.


Other

AMIA’s EHR 2020 task force publishes its recommendations. Many of them are observations of the current state or non-specific ideas about long-term changes that I didn’t find especially compelling or novel, but a few actionable items are:

  • Use natural language processing to convert free text notes to discrete data and reduce reliance on documentation templates.
  • Spend government money to study data entry methods and encourage the use of those that improve provider efficiency.
  • Slow down or freeze the Meaningful Use and certification requirements.
  • Eliminate requirements for providers to enter EHR information that isn’t used for direct patient benefit.
  • Eliminate E&M codes and checkbox-driven data entry that fails to capture the patient’s voice.
  • Allow vendors to meet MU certification with less-prescriptive methods and require them to post video recordings of their system so that EHR purchasers can see how they work.
  • Create the national Health IT Safety Center.
  • Require vendors to offer APIs to earn certification.

The board of Erlanger Health System (TN) approves its $91 million Epic contract, which will also require $97 million in maintenance costs over the next 10 years. The CFO says Epic beat Cerner on price and the selection committee preferred Epic 28 votes to two.

The Indianapolis business paper profiles ICUcare, which puzzling offers both a smartcard-based PHR (the company owner says he spent $25 million to develop it) and a telemedicine platform. The owner says the company has 12 employees and $3.5 million in revenue, some of which should probably be directed to updating the website, whish announces plans to release new technology in June 2010 and that lists Windows Vista as the required operating system (those are just the tip of the “ice-burg,” it says).

A Florida hospital tests the Internet lag time in performing telesurgery using the da Vinci surgical robot, finding that surgeons can’t tell the difference whether they are a few feet or a few states away from the patient.

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Influential healthcare IT expert Jess Jacobs of Aetna’s Innovation Labs recounts her recent and current experiences (with photos) as an inpatient of a hospital that can’t do anything right – a bathroom sink clogged for three days with her roommate’s bloody vomit, having to use her own cellphone to coordinate the work of several attending doctors who hadn’t talked to each other, mixing up mouthwash with handwash, a nurse call system that didn’t work, the nursing staff’s disregard of her roommates sickle cell crisis pain, and the barring of her patient advocate (who is a medical student at the same organization) from participating in her care. She complained to hospital administration after an earlier visit and received a halfhearted apology blaming her being housed in a treatment room as due to unplanned admissions, an acknowledgment that it was “unfortunate” that the hospital didn’t allow her friend to serve as her patient advocate (without offering an explanation as to why), and defense of her roommate’s pain management as being appropriate based on medical evidence. She’s back in as an inpatient for intractable vomiting and says nothing has improved – the hospital missed her abnormal lab results, security guards confiscated her prescribed drugs and supplies and threatened to arrest her for objecting, and the hospital assigned a “sitter” who sleeps, talks loudly in the hall, and eats bacon in her room. The scary thing about her story is that it’s not unusual from my experience – everybody who lives through an inpatient stay can relate equally horrifying stories about the incompetence and indifference they encountered.

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A good article in IEEE Spectrum describes how BIDMC CIO (and gentleman farmer) John Halamka, MD helped develop early big data platforms I2B2 and SHRINE that later may have saved his wife’s life as he researched the best treatment options for her newly diagnosed cancer based on historical outcomes. He adds in describing future innovation, “All these big companies are fine, but do we really think the next cool innovation is going to come out of an 8,000-person company? No. It’s probably a two-person garage operation.”

Another interesting IEEE Spectrum article addresses the healthcare uses of IBM’s Watson, which it concludes isn’t ready for prime time and may not be for some time because: (a) it not only has to find existing answers in existing content but also has be trained to think like a doctor; (b) journal articles Watson uses as source material aren’t always current or based on actual medical practice; (c) EHR databases are full of errors and focus more on billing rather than clinical usefulness. The article mentions other companies working on medical artificial intelligence such as QPID, DXplain, and CancerLinQ.

A small study of Facebook users finds that those with low self-esteem post often about their romantic partners, while those who brag about diet, exercise, and achievements are often narcissists who crave “likes” and positive comments from annoyed “friends” just trying to be nice.


Sponsor Updates

  • Medicity posts “ICD-10: Are We There Yet?”
  • MedData will exhibit at the Coastal Emergency Medicine Conference June 5-6 in South Carolina.
  • First Databank customer Joshua Schmees, PharmD of Hospital Sisters Health System describes the organization’s success in reducing alert fatigue by using FDB’s AlertSpace.
  • Quest Diagnostics employees raise over $11,000 in the American Cancer Society’s Relay for Life.
  • WeiserMazars posts pictures from its nationwide community service day.
  • NTT Data offers “Predictive Intelligence Brings Increased Value to Data.”
  • Versus Technology will exhibit at AAMI 2015 June 5-8 in Denver.
  • Truven Health Analytics posts “Understanding Your Exchange Population: Are You Asking the Right Questions?”
  • Microsoft summarizes the origins of Oneview Healthcare as part of its Customer Stories series.
  • Orion Health and Passport Health will exhibit at AHIP Institute 2015 June 3-5 in Nashville.
  • Patientco offers “Out-of-Pocket Costs are Increasing Faster Than Expected.”
  • PatientPay Founder and CEO Tom Furr asks “What Would Steve Jobs Say?”
  • ZirMed posts “Leveraging Data Analytics, Keeping Up with Value-Based Care, and Rev Cycle Success at Stanford Children’s Health.”
  • PMD offers “Reusing Code to Improve Care Coordination.”
  • Wide River will host an educational event, Health IT: Compliance & Innovation, June 4 in Lincoln, NE.
  • Sagacious Consultants posts “What You Don’t Know Can Hurt You: the Importance of Measuring Productivity.”
  • Huron Consulting will sponsor the 2015 Aria Health Golf Classic June 1 in support of Philadelphia-based Aria Health’s ICU renovations.
  • The Nashville Business Journal features Shareable Ink CEO Hal Andrews in its “The Boss” video series.
  • Streamline Health will exhibit at the 2015 CHIA Convention & Exhibit June 8-10 in Palm Springs, CA.
  • T-System will exhibit at NYHIMA’s 2015 Annual Conference June 7-10 in Syracuse, NY.
  • TeleTracking offers “Making Interoperability a Commonplace.”
  • Valence Health Project Manager Jacob Krive will present a session on big data and population health at the University of Illinois College of Medicine Chicago June 3.
  • Verisk Health, West Corp., and ZeOmega will exhibit at the AHIP 2015 Institute June 3-5 in Nashville.
  • Voalte offers a new blog showcasing the successful deployment of its smartphone solution at Massachusetts General Hospital.
  • Winthrop Resources will exhibit at the NY Tech Summit June 4-5 in Verona.
  • Xerox offers “The Best Kept Secret in Healthcare.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 31, 2015 News 9 Comments

Morning Headlines 5/25/15

May 24, 2015 Headlines No Comments

Patterson: No intersection has ‘more potential than what we’re at’ — health care, IT

Cerner booked $4.25 billion in new sales in 2014, beating its previous record of $3.8 billion. The company also reports that it expects its Siemens acquisition to return $1 billion in revenue in 2015.

Thompson and Rangel Introduce Veterans E-Health & Telemedicine Support Act of 2015

Representatives Glenn Thompson (R- PA) and Charles Rangel (D-NY) introduce H.R. 2516, the Veterans E-Health and Telemedicine Support Act of 2015, which would expand access to telehealth services for veterans by authorizing VA clinicians to practice medicine across state lines without running afoul of state or local regulations.

Connecticut Senate adopts major health care changes

Connecticut’s state Senate has passed a bipartisan bill that funds the development of a health information exchange for the state, replacing its failed $4.3 million first attempt.

eQHealth Solutions Selected by Colorado Department of Health Care Policy and Financing to Provide Medical Management Services

Colorado selects non-profit population health vendor eQHealth Solutions to provide solutions for Colorado’s Medicaid program.

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May 24, 2015 Headlines No Comments

Monday Morning Update 5/25/15

May 24, 2015 News 1 Comment

Top News

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Cerner tops its 2013 $3.8 billion new contract sales record with $4.25 billion in new sales in 2014, according to figures released during the company’s annual shareholders meeting. The company expects $1 billion in 2015 revenue to come from its Siemens acquisition. Cerner saw new business growth with state, specialty, regional, and community hospitals, and record contract sales in the physician market. CEO Neal Patterson focused on the need to look beyond EHRs to keep the company’s fiscal success going: "It’s up to us as leaders to continue the growth. You couldn’t find an intersection that has got more potential than what we’re at.”


HIStalk Announcements and Requests

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Check out Jenn’s weekly wrap up of population health management news.


Last Week’s Most Interesting News

  • Allscripts lays off 250 employees across its service, support, solutions management, sales, and G&A departments as part of a wider “rebalancing” effort.
  • The House Energy and Commerce Committee unanimously approves the 21st Century Cures Act, sending the legislation to the House floor for a vote.
  • Lahey Health (MA) lays off 130 people due to the unusually brutal winter in New England this year and its $160 million Epic implementation, which together resulted in a $21 million operating loss for the first six months of 2015.
  • CareFirst BlueCross BlueShield announces a June 2014 data breach affecting 1.1 million members in Maryland and Washington, D.C.
  • The battle of the ICD-10 bills heats up: Rep. Diane Black (R-TN) introduces the ICD-TEN Act, a bill that would introduce an 18-month period during which providers could submit claims in either ICD-9 or ICD-10 format, while the AHA proclaims its support for Rep. Ted Poe’s (R-TX) Cutting Costly Codes Act of 2015, which would cancel the migration to ICD-10 completely.

Webinars

May 27 (Wednesday) 1:00 ET. “Introducing Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement.” Sponsored by Health Catalyst. Presenters: Tommy Prewitt, MD, director, Healthcare Delivery Institute at Horne LLP; Bryan Oshiro, MD, SVP and chief medical officer, Health Catalyst.  The presenters, who are graduates of Intermountain’s Advanced Training Program, will introduce the Health Catalyst Academy’s Accelerated Practices program, a unique learning experience that provides the tools and knowledge for participants to improve quality, lower cost, accelerate improvement, and sustain gains.


Announcements and Implementations

The Colorado Dept. of Health Care Policy and Financing selects nonprofit population health management technology company eQHealth Solutions to manage its ColoradoPAR utilization management program for Medicaid patients.

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Visage Imaging receives FDA clearance for the use of its Visage Ease Pro app, part of its enterprise imaging platform, for mobile diagnostic interpretation of all imaging studies except mammography.


Government and Politics

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Rep. Glenn Thompson (R-PA) and Rep. Charles Rangel (D-NY) introduce H.R. 2516, the Veterans E-Health and Telemedicine Support Act of 2015. The bipartisan legislation would enable VA health professionals to practice telemedicine across state lines if they are qualified, and practice within the scope of their authorized federal duties. It would also enable veterans to receive telemedicine treatment from anywhere, including their home or a community center, rather than solely at a federally owned facility. 

The Connecticut Senate passes a bill that includes provision for a new state HIE. This would mark the second time the state has attempted to stand up a HIE. The first one, HITE-CT, was shuttered last July after burning through $4.3 millions in four years with no discernible progress made. (Former HITE-CT Board Member Ellen Andrews paints a pretty scathing picture of the ineptitudes that led to the HIE’s failure.) Legislators intend to put out out a RFP to contract with an existing system or come up with an alternative plan.

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Agriculture Secretary Tom Vilsack announces that the USDA is accepting applications for its Distance Learning and Telemedicine grant program, which provides increased access to education, training, and healthcare resources in rural areas.


Sales

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Auburn Community Hospital (NY) selects revenue cycle software solutions from Mediscribes venture ezDI, including clinical documentation improvement and compliance auditing modules, analytics tools and dashboards, and computer-assisted coding.


Technology

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Oculus Health launches a chronic care management and coordination platform with remote monitoring capabilities.


People

Ram Udupa (QIM Analytics) joins Paragon Development Systems (PDS) as vice president of product management.

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Saint Francis Medical Center (MO) promotes Gene Magnus to director of IS.


Other

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Forbes profiles Gaumard Scientific, a family business that has developed and manufactured robotic patients for over 60 years. Patriarch and founder George Baine, a physician with the British army during World War II, founded the company in 1946 and now counts Cedars-Sinai Medical Center, John Hopkins Hospital, and George Washington University Medical School among the clients that helps it generate more than $60 million in revenue annually.

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Vancouver high school student Raymond Wang wins $75,000 in the Intel International Science and Engineering Fair for his design of an air inlet system for planes that can reduce disease transmission by up to 55 times, and improve fresh airflow by almost 200 percent. The system can be installed in a plane in just one night for the price of a single passenger’s airline ticket. Wang is pursuing a patent for his design.


Sponsor Updates

  • Navicure asks, “Are You on a ‘Need to Know’ Basis with Value-Based Reimbursement?” in a new blog.
  • The Netsmart Technologies men’s volleyball team wins bronze at the Kansas City Corporate Challenge.
  • The New York eHealth Collaborative will exhibit at the d.health summit May 29 in New York City.
  • Nordic offers the latest edition of its HIT Breakdown video series, focusing on engagement in population health.
  • Orion Health offers a new blog entitled, “The IT Inclusion Paradox.”
  • PDS offers a new blog entitled, “Software-Defined Data Center: A Long and Winding Road.”
  • PMD offers a new blog entitled, “Health Exchange Video: The Art of Narration.”
  • Sagacious Consultants offers a new blog entitled, “5 Things that Might not be Working in Your IT Department.
  • SCI Solutions offers a new blog entitled, “Five Top Revenue Generation Strategies for CFOs.”
  • The SSI Group will exhibit at the South Carolina HFMA Annual Institute 2015 May 26-29 in Myrtle Beach.
  • TeleTracking announces that Scott Halford will keynote its user conference October 25-28 in Las Vegas.
  • Truven Health Analytics will exhibit at the American Society of Clinical Oncology annual meeting May 29 in Chicago.
  • Valence Health opens registration for its Further 2015 client conference September 30-October 2 in Chicago.
  • Versus Technology offers a new blog recapping client Community Hospital’s presentation at HIMSS15 on technology’s role in containing MERS.
  • Voalte offers a new blog entitled, “Off the Cuff.”
  • Huron Consulting will sponsor Father of the Year Awards May 27 in Riverside, CA in support of the American Diabetes Association and the Father’s Day Council.
  • ZirMed is honored by Louisville Central Community Centers Inc. with its 2014 Corporate Community Service Award.
  • Several HIStalk sponsors will exhibit at the 2015 International MUSE Conference May 26-29 in Nashville, including Park Place International, Passport Health, PatientSafe Solutions, PatientKeeper, Sandlot Solutions, Summit Healthcare, Surgical Information Systems, T-System, Winthrop Resources, and Zynx Health.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 24, 2015 News 1 Comment

Monday Morning Update 5/18/15

May 17, 2015 News 5 Comments

Top News

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The AMA writes a letter to Rep. Ted Poe to support his bill that would delay ICD-10. The AMA says ICD-10 should be skipped in favor of ICD-11, the first draft of which isn’t due until 2017, explaining that EHR implementation work and introduction of new payment models make 2015 a bad time (hint: it’s never a good time). Failing getting ICD-10 overturned, incoming President Steven Stack says providers should be “held harmless,” presumably meaning getting paid by Medicare no matter what they’ve done in failing to prepare themselves despite years of advance notice. Doctors are vendors and I can’t imagine any other vendor angrily telling its customer how it demands to be paid. That’s like telling your employer it’s their problem to pay you correctly even if you refuse to turn in your timesheet or fill it out incorrectly. Or, me calling up the IRS and making snooty demands about my refund check. On the other hand, CMS and both state and federal governments have proven themselves to be predictably inept at health IT and claims payment rollouts, so I’d be worried too. I’m surprised an insurance company hasn’t offered ICD-10 interruption insurance to practices, although that might indicate that the risk is too high for underwriting.


Reader Comments

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From Faraway: “Re: Allscripts layoffs. Two since the first of the year. On May 15, they started tapping people on the shoulder, with 40 well-seasoned support analysts terminated from the US help desk. The heck with quality service to the thousands of customers who pay software maintenance every month – they will have to fend for themselves and deal with the language barriers that come with offshore support. Many employees feel other departments will be hit Monday morning.” Several folks have emailed about Allscripts layoffs last week, with the number most often mentioned being 250 people. Regular Reader says it was mostly Touchworks people but also some working on Sunrise. The writing was on the wall given last week’s executive comments during the quarterly earnings call, in which professional services revenue was announced as down and not expected to fully recover anytime soon, the company sold only two new Sunrise accounts and those were 50-bed hospitals, and stock analysts were told that the $6 million in Q1 severance payments won’t end there. You made a big mistake if you bought MDRX shares five years ago – they’ve dropped 27 percent while the Nasdaq was jumping 127 percent. A $10,000 investment in MDRX shares in May 2010 would be worth $7,342 today while the same money spent on Cerner shares would have yielded $32,173.

From Make: “Re: Weird News Andy’s snippets. Am I the only one who wonders whether Andy has a real job or how he finds time to track down these crazy nuggets? Keep ‘em coming, Andy — the news links and your color commentary always make my day!!” WNA’s stories and pithy commentary are a highlight for me, too. He’s been sending them in for years without recognition or reward of any kind. Every year I suggest that he take a bow at HIStalkapalooza and he always declines.


HIStalk Announcements and Requests

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Quite a few provider readers work for employers who don’t impress them too much with their service delivery, with half of poll respondents giving them an A or B and the rest going with lower grades. At least there weren’t too many F scores given. New poll to your right or here: which company’s shares would you buy?

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We had all better be interested in population health management, so that being the case, check out Jenn’s weekly wrap-up that runs every Friday. You’ll be up to speed in just a handful of minutes each week.

April 2015 appears to have been the busiest HIStalk month ever because of the HIMSS conference, with 220,000 page views from around 30,000 unique readers in 42,000 unique visits. I don’t check numbers often, but I’m always happy to see that I’m not just talking to myself like I was in those first HIStalk days of June 2003.

Here’s DrFirst’s video of HIStalkapalooza. They got a lot of good crowd shots, so you might see yourself if you were there.

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Our DonorsChoose project bought a Surface Pro for math practice by deaf middle schoolers in Washington. Mrs. Burns sent over a photo, adding that our contribution as an “anonymous donor” gave the students new vocabulary words to review as they  “get to imagine our mysterious benefactor.” Every time I get photos like these I remember my early education in a very poor school and wonder which of these kids will, 30 years from now, still remember the excitement of opening that box or using a new tool that got them engaged in a subject that lit the path to their adult lives. I guarantee it will happen.


Last Week’s Most Interesting News

  • Publicly traded medical group Mednax acquires radiology services vendor Virtual Radiologic for $500 million.
  • McKesson’s Technology Services business reports lower hospital sales, declining revenue, and the upcoming divestiture of an unspecified product line.
  • Cerner says in its earnings call that its acquired Siemens Health Services business had minimal sales and lower revenue than expected for the quarter, adding that Cerner has set aside $35 million for Q2 voluntary separations that involve 2 percent of its workforce.
  • Allscripts attributed its lackluster quarterly performance to lower professional services revenue, a trend it expects to continue, and says it expects to make additional severance payments in Q2.

Webinars

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making

May 27 (Wednesday) 1:00 ET. “Introducing Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement.” Sponsored by Health Catalyst. Presenters: Tommy Prewitt, MD, director, Healthcare Delivery Institute at Horne LLP; Bryan Oshiro, MD, SVP and chief medical officer, Health Catalyst.  The presenters, who are graduates of Intermountain’s Advanced Training Program, will introduce the Health Catalyst Academy’s Accelerated Practices program, a unique learning experience that provides the tools and knowledge for participants to improve quality, lower cost, accelerate improvement, and sustain gains.


Acquisitions, Funding, Business, and Stock

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Paragon Development Systems (PDS) will consolidate two offices into a newly named headquarters location in Brookfield, WI. Its offices in Madison, WI; Minneapolis, MN; and Wichita, KS won’t be affected.

Optum, which in 2013 rescued Healthcare.gov from the mess CMS created with the help of contractor CGI, won’t bid to continue the $40 million per year contract. The company says its job is done and that the experience it gained will “leverage our ability to develop and operate large transactional systems that advance healthcare.”

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Shareable Ink raises $3 million and plans to bring in another $1 million in funding.

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Private equity investor Thoma Bravo will sell Mediware Information Systems, according to a financial report that says the company has engaged William Blair to seek a buyer. The author tossed out a rough price of $400 million. Thoma Bravo’s other healthcare IT-related holdings are Hyland Software and SRSsoft.


Government and Politics

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Hillary Clinton’s financial disclosure forms filed Friday show that she was paid $225,500 to deliver her HIMSS14 speech. Quite a few healthcare and drug companies retained her pricey oratorical services as well, with the Clintons banking $30 million in just over a year in total income from speeches and books.

Connecticut legislators express interest in developing a state HIE that would replace the work of HITE-CT, which burned through $4.3 million in federal money before it was put out of its misery in 2014 having accomplished basically nothing.

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Hawaii state officials say speculation that its  $205 million health insurance exchange will shut down in the next few months is premature, although they admit having to make “hard choices” since the site is losing money, CMS audit problems the found IT and sustainability problems have restricted its federal grant money and state lawmakers gave it only $2 million of the $10 million it requested. Like other states that stubbornly built their own insurance exchanges that have since failed, Hawaii is considering shutting down Hawaii Health Connector and instead piggybacking on Healthcare.gov.


Technology

It’s a shameless marketing gimmick that is delivering the obligatory YouTube viral response in pitching a questionably cost-effective healthcare product, but this video of a da Vinci surgical robot suturing the skin back onto a grape while chipper music plays in the background is pretty cute.


Other

Doctors in India question why medical school education doesn’t cover telemedicine even as the country sets up telemedicine centers for rural medicine. A medical school physician says it’s tough to remove the inertia and create telemedicine champions when students haven’t been exposed to it, while a private physician says, “We have an ethnographer who observes doctors and the way they deal with patients in terms of technologies and otherwise. Sometimes, even after training for two weeks, it is so hard to sensitize doctors and make them get used to technologies.”

Newly released tax documents reveal that UPMC paid CEO Jeffrey Romoff $6.4 million in 2013, one of 31 UPMC executives who made more than $1 million. CIO Dan Drawnbaugh, who left in September 2014, made $1.6 million.

I bet Weird News Andy would make a pun about “piece of mind.” A patient sues Norton Cancer Institute (KY), claiming that a surgeon extracted tissue from his brain for an experimental cancer treatment but then lost it.


Sponsor Updates

  • Verisk Health takes a cue from HIStalkapalooza and holds a pie-in-the-face event, giving employees the chance to throw pies at their managers.
  • Huron Consulting partners with 60 charitable and nonprofit organizations during its fourth Annual Day of Service.
  • Patientco offers “Thoughts on PwC’s Patient Payments Report.”
  • TeleTracking client Royal Wolverhampton Hospitals NHS Trust reports that monitoring of hand hygiene increased by 1,000 percent in a single month.
  • Qpid Health offers “Clinical Registries Still the ‘Wild West.’”
  • Oneview Healthcare outlines the “Eight Principles of Patient-Centered Care.”
  • The SSI Group will exhibit at the HFMA Region 1 Annual Conference May 20-21 in Uncasville, CT.
  • NVoq offers a new blog focusing on industry response to its new SayIt Code Fast service.
  • MedData offers “Our People Make the Difference.”
  • ZeOmega posts the final installment of “The Five Pillars of Population Health Management.”
  • Imprivata wins a strategy and delivery award for its customer experience accomplishments.
  • Netsmart will exhibit at the Ohio Public Health Combined Conference May 19 in Columbus.
  • Nordic offers a new edition of its HIT Breakdown podcast, focusing on new revenue opportunities via the CCM CPT code.
  • Orion Health explains why nurses are a healthy population’s biggest ally.
  • PatientSafe Solutions offers insight into “Easing Cognitive Workload for Clinicians.”
  • PMD outlines “The Cloud Confusion.”
  • Sandlot Solutions outlines its support for the Institute of Medicine’s proposed streamlined set of standardized measures and recommendations for their application.
  • Clinical support expert Deon Melton, RN shares how he got into healthcare in the latest T-System blog.
  • Valence Health introduces the results of its pediatric care reimbursement model survey.
  • Voalte offers “Nurses Taking Care of Nurses.”
  • ZirMed offers “Patient Portal A/B Testing.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 17, 2015 News 5 Comments

HIStalk Interviews Beau Raymond, MD, CMIO, East Jefferson General Hospital

May 15, 2015 Interviews 3 Comments

Sidney “Beau” Raymond, MD is VP/CMIO at East Jefferson General Hospital of Metairie, LA.

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Tell me about yourself and your job.

I’m internal medicine trained. I did LSU for my medical residency. I initially went to a multi-specialty clinic that went bankrupt because they didn’t know how to transition from capitated payments to fee-for-service. I went out on my own, was independent for a while, another physician joined me, and then I was recruited by the hospital here to become employed and become medical director for the employed positions. With that role, I became more involved with the IT aspect of things as well as other tasks and items and got more and more involved in the administration side, became CMIO, and now I am almost fully administration, but still doing some clinic work.

 

What are the major systems used at East Jefferson?

We use Cerner for inpatient. We were using the same platform in the ambulatory setting as well. Due to some difficulties in getting some information out of the system for quality reporting to outside payers, we felt the need to change to a different system in the ambulatory setting, so we just recently switched to GE Centricity. We’re in our second week of go-live. Being on the same platform had benefits as well as some problems, and some of our problems were getting really good information out of the system.

 

I haven’t heard of many health systems that had the same systems for both inpatient and outpatient and then replaced the ambulatory one. What was it about Centricity that was appealing?

One of the problems that we had with Cerner is when we initially had it – which we’ve had it for a while — is that you had the customization. You were given lots of choices as to where you wanted to go and how you wanted to do things. Because of that, some choices were made at that time which then affected things later on because it wasn’t standardized back then. They now have become more standardized with fewer options. We were part of that learning process.

Flaws that were made way back when – that’s why we had to make some adjustments. That was the drive. GE has a very standardized database, which allows us to get information out of it to outside payers and outside resources that we need to get that information to in an easily standardized fashion.

 

You mentioned that your previous practice had challenges trying to survive in a value-based payment model. Will having two systems present a challenge in that kind of world?

Let me clarify. The group that I was with before was in a highly capitated system. When I joined them, which was 15 years ago, it switched from that capitated system of the HMO world to fee-for-service. They were so entrenched on how to manage capitated care, which they were doing well with, they couldn’t make the switch to fee-for-service. That was a little bit different than what we’re doing.

 

It’s interesting that they failed in trying to move from value-based care to fee-for-service. 

Yes, that was 15 years ago, but now the pendulum has swung back around and we’re back into value-based care. Our thing is that we want to be sure that we get the information out there as to what we’re doing and make sure that that information gets there. Because some of the problems we’re having when we deal with the Humanas and Blue Crosses out there, they look at our information, they’re not able to get all the data that’s really there. For us to be scored properly and reimbursed properly, we need to make sure they’re getting the information correctly.

 

You probably answered my question by saying you just went live on ambulatory with Centricity, but what projects are taking up most of your time?

That’s in the past two weeks. Actually more recently than that, inside the hospital, we went live on Dynamic Documentation from Cerner. We switched from paper progress notes to electronic progress notes. A lot of the other stuff was already being done via dictation anyway. People could still write a consult if they wanted to, but most people were dictating them. We made that switch to Dynamic Doc, which went extremely well. We had postponed it for nearly a year because of some issues that we were finding regarding how Nuance interacted with the system and with Citrix and all sorts of other interactions that were going on.

Once we got all those things to the level that they needed to be, it was working very smoothly. The first weekend of go-live, I was here walking around campus over and over and over again and was very pleasantly surprised as how well it went. Did the same thing for the two weeks, just constantly walking around talking to physicians, and they were very happy with the system. It was a very smooth transition to a fully electronic documentation.

 

What are you doing with population health management, patient portals, and patient-facing technologies?

We are engaged with a company that was Medseek that is now Influence Health. We’re going to have a portal that has information from both the Centricity side and from the Cerner side, all in one area. The patient can access all that information at one spot. That hasn’t actually gone completely live yet. It’s finishing up development right now because they needed Centricity to be up and running more. That should be going live soon as a single portal for both sides, ambulatory and inpatient.

On that note, that is going to be a way for us to do outreach regarding patient engagement as well as scheduling that they’ll be able to do directly inside the portal. Also possibly doing population management using that tool as well – possibly. We’re evaluating that now. We also have a clinical integration network called Gulf South Quality Network, which also is engaged in population management, especially with Blue Cross at this time. We have a new tool we’re implementing with them as well regarding trying to get that information. But linking to numerous EMRs is difficult, so it’s taking a little bit longer than we’d like it to.

 

The direction is value-based care, yet most organizations still get most of their revenue from traditional fee-for-service. Are you finding it difficult to try to straddle those two worlds with your technology?

Yes, well, I will tell you that we have a significant amount of fee-for-service. Actually here at East Jefferson, we have a significant Medicare population around here, but we have a Blue Cross contract which has a shared savings component to it. We think we’re doing well according to the reports that we have. That final analysis, I believe, is in August, so we’ll see where those numbers are. But what we’ve found so far is that we’re doing pretty well with that. We’re heading in the right direction.

It is very difficult because of the fact that it is only one real contract that is value based. We have some others regarding Humana and some others that have some aspect to it, but not nearly to the extent as the Blue Cross one. Technology-wise, as well as contracting-wise with physicians and compensation for physicians for those that are employed, it’s just a difficult transition because you can’t go too far too fast. When you’re stuck in the middle, it tends to be problematic, which is where I feel like we’re a little bit there now. I would love for the rest of the payers to switch to value-based all at once. It would make my life a whole lot easier.

 

What are you doing with MedCPU?

MedCPU is a rather neat program as to how it works. It looks at all the data within Cerner historically on a patient, has all that information, gets it processed on the back end. It takes that information, sends it over to their processors, and depending on what it finds, it sends us information back if it falls within a certain algorithm. We’ve already gone live with them on VTE as well as stroke.

Our VTE numbers, when we looked at them, were not nearly where we wanted them to be. That’s why we got engaged with MedCPU. We thought it would be an innovative way to deal with that. It has helped us tremendously. We went from some of the measures being in the 60 percent, 70 percent, up into the upper 90s now.  We’re not quite to 100 percent, but that is our goal. We’re heading in the right direction regarding that. It has been rather dramatic as to how well it’s worked for us.

For stroke, our numbers have been very good. We’re stroke certified, so that’s been working well for us. We are piloting with them a product that Merck developed with MedCPU which looks at sepsis, UTI, and pneumonia. Basically it gives you an alert when somebody hits SIRS criteria – systemic inflammatory response syndrome — and lets you know that there are certain tests you may want to order. So far in this first few weeks, it’s averaging about six alerts a day. Most of them are pretty valid and are acted upon appropriately. Some have had to be tweaked a little bit.

It’s going to be interesting to see what tweaks need to be done going forward, because if you think about it, SIRS criteria was probably created with someone looking back at a chart over a time frame rather than having real-time information, which is what we have now. We may be acting a little bit earlier than we really need to sometimes.

There have been episodes where it’s a post-surgical patient and they had a mild fever, which triggered them to get into the right criteria. They had all their factors, of course, to actually hit SIRS criteria, but with that, the physician said, let’s give it a moment and see what the next temperature is. The next temperature came back fine, so the patient was no longer SIRS criteria. It’s one of the things where I think we may have to tweak it somewhat. Right now we’re following SIRS criteria pretty strictly, but we may have to tweak it somewhat and say that they have to have it for maybe four hours or something along those lines, but we’ll see where that goes. It’s a pretty effective tool so far as what we’ve seen, but it’s in the beginning stages.

 

Is MedCPU’s technology good enough to trust to accurately create discrete data from free text using your rules?

Yes. It’s looking at numbers that are discrete data from lab results, from vitals that are entered, as well as from looking at information that is entered by the physicians and nursing regarding the documentation. For pneumonia, for example, if the radiology reports mentions consolidation, it’s going to trigger and say, "Does this patient have pneumonia?" It’s going to ask you. It’s pretty active and pretty accurate. For VTE, for example, it knows whether you documented that the patient is ambulating and therefore doesn’t meet criteria for VTE. You say that in your note and it doesn’t fire. It’s pretty remarkable as to how it works now.

 

Will you use it more broadly going forward?

We’re piloting the ones involving SIRS, bacteremia, UTI, and sepsis. We’re piloting that now and that seems to be going well. We’ve had conversations with them about some other products that they already have. One is regarding radiology — appropriateness of ordering the right test. We’re looking at that as a possibility. They’ve already done that elsewhere, so that would be implementing something that they already have. There’s also a pretty good OB product that they have, so we may take components of that and implement it over time as well.

The beauty of it — and to be honest, the thing that’s been most beneficial to us — is that the tweaks that they’re making to the program are happening on the back end. It’s not happening on our servers. It’s not interacting with what we do. It doesn’t affect speed or anything else regarding how you document or view your information. It’s just pulling that information and sending it back to their processor and sending information back across. It’s not running on your own servers, slowing their progress as well. It’s nice because you just add something and it really is kind of seamless. They monitor to make sure it’s not affecting the Citrix servers, and if there’s an issue, then they stop it and re-calibrate whatever they need to do and turn it back on and go from there.

 

What will the most important IT-related priorities be at the hospital?

It’s going to be population health. That’s everybody’s answer, I’m sure. It’s just trying to get that information, trying to figure out a way to manage it to continue to do value-based care, and do so with getting compensated for keeping people out of the hospital, which is the trick that we have now.

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May 15, 2015 Interviews 3 Comments

Morning Headlines 5/11/15

May 10, 2015 Headlines 2 Comments

The revolution will be digitized

The Washington Post analyzes the emerging wearables market, the data-tracking consumers driving the increased demand, and the critics that say the “worried well generation” is collecting data that is not necessarily useful or accurate, and that over-monitoring introduces a host of new problems.

Cerner (CERN) Q1 2015 Results – Earnings Call Transcript

Cerner shares drop 4.5 percent on Friday after reporting lower than forecasted Q1 earnings and reducing Q2 expectations. On its earnings call, Cerner CFO Marc Naughton explains that the $50 million shortfall on projected revenue was a result of missed targets within both the Cerner and Siemens business lines.

Allscripts Healthcare Solutions (MDRX) Paul M. Black on Q1 2015 Results – Earnings Call Transcript

Allscripts hosts its Q1 earnings call, in which CFO Richard Poulton explains that the company missed both revenue and EPS projections for the quarter in part because its professional services bookings were down and client service margins were down because anticipated work to support New York’s eRx initiative never materialized.

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May 10, 2015 Headlines 2 Comments

Monday Morning Update 5/11/15

May 10, 2015 News 4 Comments

Top News

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Cerner shares fell 4.5 percent Friday after the company reported lower-than-expected revenue for the quarter and also warned of slightly reduced revenue expectations for full-year 2015. From the earnings call, the acquired Siemens Health Services business contributed $176 million in the quarter of the company’s overall revenue, about 18 percent of the total, with “minimal bookings contribution from Health Services” and minimal sales expected for the year. HS is now on track for $1 billion in annual revenue vs. the originally expected $1.1 billion, but Cerner wants to stop talking about that business separately since it now isn’t.

Cerner has set aside $35 million in Q2 for a voluntary separation program that will affect 2 percent of the workforce, which works out to around 400-500 people from both the Cerner and Siemens sides. Cerner also called out its Business Office Services for physician practices, which the company says can display an unnamed cloud-based competitor (presumably Athenahealth) because Cerner’s lower staffing requirements cost 20 percent less and “many of these larger and more sophisticated clients are facing several challenges with our competitor’s solution, such as having 50 to 60 percent of the claims requiring manual intervention because they don’t fit the cloud configuration.” Cerner says three former Siemens clients committed to Millennium in Q1, although it admits that those decisions had probably already been made before the acquisition announcement just sped them up.

Speaking of the Cerner earnings call, a Morgan Stanley stock analyst set a world record by sprinkling the maddeningly meaningless “kind of like” liberally throughout questions that were buried somewhere under an avalanche of verbal crutchery:

You talk about the contract with Intermountain and really kind of like a new way of doing business , so when you think about kind of like other health system that are similar in size, can you just kind of like share with us how kind of like that pipeline is looking and do you need to kind of like first implement all the 22 hospitals of Intermountain or should we expect to see a deal, kind of like that looks at that type of intelligent systems before that? … When we look at kind of like your new contracts, what percent of your new contracts have kind of like a Population Health feature to them? And how should we think about kind of like what is an average Population Health deal in terms of revenue contribution?


Reader Comments

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From Interesting: “Re: John Hammergren. He gets a lot of negative press, but this story (which doesn’t identify Kayla Hammergren as his daughter) gives a different perspective on the family life of America’s highest-paid CEO.” A Boston College newspaper article notes the meeting of senior Kayla Hammergren with the four-year-old boy to whom she donated bone marrow in 2013 after she signed up for a donor registry at a campus recruitment drive. Her donation of bone marrow (and later blood) led to the boy’s being declared free of leukemia a year later.

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From Greg Marmalard: “Re: Castlight Health. Our company just rolled it out to employees this week. I searched on a common surgery for glaucoma and it came up empty. Then I searched just on glaucoma and got information on eyeglass exams, low back pain, acne surgery, culture bacteria, and vaccines. A teammate looked up follow-up visit costs for PCPs in his area (including his own) and there was some range shown although it wasn’t large. Then he checked out hip replacement surgery and it came back with over 50 hospitals and surgical centers in a 25-mile radius showing the same cost for all of them. It asked for my email address so they can send me endless emails, so I unsubscribed.”

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From Barb Dwyer: “Re: MyChart on Apple Watch. Photos attached.”


HIStalk Announcements and Requests

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Forty percent of poll respondents say a medical bill has caused them financial hardship within the past two years. Two readers (one Canadian, one on Medicare) said no, while two others said that high-deductible plans put them much more at risk than before. New poll to your right or here, for those who work for a health system: how would you grade your most recent encounter with your employer’s service offerings? I would, of course, love to get more details if you’d leave a comment after voting.

Listening: new from Mikal Cronin, summery but sometimes growly power pop on the trustworthy Merge Records label. Also: addictive melodic ballads from James Blunt, a former British Army captain and current Doctors Without Borders supporter who cranks out pretty amazing music.  One more from a reader: jangly, tied-dyed psychedelic prog from Temples, young English guys who sound like like old English guys did in 1972.

I was thinking about how consumers created a huge but questionable market for herbal and vitamin products whose manufacturers make medical claims without FDA oversight. That happened largely because doctors ignored the demand and refused to educate themselves and their patients about those products, so consumers sensed that traditional medicine was stonewalling them and bypassed the medical system entirely in favor of “alternative medicine” (some of which actually works) and created a great business for chiropractors and other non-physicians who jumped all over the new income source. The same thing happened with weight loss, sexually related products, acupuncture, etc. My conclusion: clinicians need to educate themselves on wearables and health apps because consumers will just sidestep them if they don’t. Unfortunately, short and brusque PCP encounters don’t leave much time for discussions about general health and doctors are often ill prepared to participate in those discussions anyway since their focus is often myopic, standardized, and focused on symptom alleviation via drugs or procedures. For me at least, the ideal team would be a generalist health coach (whose knowledge is broad but not necessarily deep) who is supported when needed by a physician. Many patients don’t believe doctors have the time, objectivity, or economic incentive to serve as their ongoing health partner.


Last Week’s Most Interesting News

  • Cerner and Allscripts turn in unimpressive quarterly results.
  • President Obama nominates National Coordinator Karen DeSalvo, MD to the post of HHS assistant secretary for health, in which she has served in an interim capacity for several months.
  • Harris Corporation restructuring suggests that the company may be planning to divest its healthcare business.
  • Cognizant reports impressive quarterly financial results that were significantly driven by the former TriZetto business it acquired in November 2014 for $2.7 billion.

Webinars

May 12 (Tuesday) 1:00 ET. “HIStalk Interviews Regina Holliday.” Catch up with Regina Holliday and her recent patient advocacy efforts as she chats with HIStalk’s Lorre and Jenn about the HIMSS conference, The Walking Gallery, her upcoming advocacy events, and her new book. Regina will talk about how providers and vendors are working to make the patient voice heard.

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

  • The company added 200 clients even as revenue declined due to lower professional services sales, a trend the company expects to continue given the lack of new government mandates.
  • Gross margin was “disappointing” because of the decline in client services margin, some of that due to the one-year delay in New York’s mandatory e-prescribing program.
  • The company sold two new Sunrise clients: 51-bed Palo Verde Hospital (CA) and 53-bed Grand Lake Health System (OH).
  • No new international sales were made in the quarter.
  • The company reported severance payments of $6 million during the quarter and told analysts to expect more severance payouts in Q2.
  • The company hopes to have one or two referenceable clients running the full suite of Allscripts products, including Sunrise Financial Manager, by the end of the year.
  • On the possibility of acquiring population health management companies, CFO Richard Poulton said, “That’s definitely an area that is high on our list of areas to invest in. Whether it’s purely an acquisition, though, is a different question. I don’t have to tell you that some of the companies that are out there, fairly immature companies, are with advertised capabilities are trading at crazy valuations. We’ve looked at a bunch and we’ll continue to look at a bunch, but right now, we have a pretty good plan that is not heavily dependent on acquisitions.”

People

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Vince Roach, founder of Technology Management, Inc. and later an executive with Daou Systems, died May 8 in Indianapolis. He was 71.


Announcements and Implementations

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A Web petition at GetMyHealthData.org urges politicians, providers, and insurance companies to ensure that patients have access to their own health data.


Innovation and Research

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India-based Tata Memorial Hospital works with a for-profit company to offer free, evidence-based online second opinions for cancer treatments. Patients submit their medical records online and receive expert opinions within a few days. Commercial partner Navya offers a patented “analysis engine” that reviews best practices, expert opinion, and patient preferences to provide treatment options. Navya co-founder Naresh Ramarajan, MD has a Harvard undergrad, Stanford MD with community health emphasis, and is completing a critical care and pulmonology fellowship at UCLA along with a PhD in medical informatics.


Technology

An in-depth Washington Post piece says wearables have become big business, but questions the value of the data they create, especially by “life loggers” who obsessively try to quantify their every move in a quest for “self-perfectability” in the “narcissism of the technological age.” A professor says it’s a lot easier to collect information than to do something useful with it, while the article also points out possible privacy concerns, such as in 2011 when Fitbit users realized that their publicly shared data made it easy to determine the frequency, duration, and vigor of their sexual activity. My most recent pet peeve is people who have their fitness apps set to proudly tweet out their latest run or bike ride, which I can personally guarantee no fellow earthling cares about.

An Esquire writer who tried the Apple Watch says it “seems to be designed to be a thing you can’t get overly excited about” and is mostly useful for ignoring unimportant text messages and for the all-important fanboy bragging rights, adding that the watch itself  has decent battery life but it sucks the iPhone battery dry quickly since it’s conversing via Bluetooth. It will, he says in stating the obvious, become obsolete quickly and will require buying it all over again, also stating the obvious that Apple zealots never seem to mind.


Other

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Half the ophthalmologists working for Indiana University School of Medicine have quit since construction of a $30 million eye institute began in 2008, with key issues apparently being a forced practice integration, disputes over their share of the $12 million the eye clinical brings in each year, and aggressive fundraising in which doctors were sent lists of their upcoming appointments by the fundraising director (who is also the wife of the department chair) who flagged high net worth people so they could be given extra attention and hit up for donations. One of the doctors filed a HIPAA complaint over that practice, which the medical school says it has since fixed.

Idiotic lawsuit: a Raleigh, NC police officer who spilled his coffee in his lap is suing Starbucks for the maximum allowed $750,000, saying the emotional damage aggravated his Crohn’s disease and that he was served a large cup without an insulating sleeve as required by the chain’s policy. He told the jury that he really should get $10 million. He didn’t even pay for the coffee since officers in uniform aren’t charged, a benefit he had taken advantage of 50 times in two months. The officer admitted under questioning that after the spill, he went back to the police station to get his truck, drove home, had his wife take pictures of his burn, and finally sought medical attention 2.5 hours later. He says, “I knew it was hot, but not that hot,” indicating his prime candidacy for a Frappucino.

Weird News Andy calls this story “Doctors Acting Badly.” In England, an OB-GYN and his RN wife are charged with slavery after a Nigerian man claims the couple hired him 24 years ago at age 12, but then altered his passport so he couldn’t leave and then forced him to be their unpaid and beaten babysitter and butler.


Sponsor Updates

  • Medicity’s Brian Ahier contributes “5 things we have to do to make health IT work.”
  • Nordic focuses on pharmacy in the sixth installment of its “Making the Cut” video series on Epic conversion planning.
  • MedData offers “Go All In on Early Out.”
  • Versus Technology offers “Nursing’s Impact on Patient Care Transcends the Bedside.”
  • West Corp. offers a Storify tweet recap of its time at ATA 2015.
  • PMD outlines the benefits of “The Developer Carpool.”
  • Netsmart wins the Smile for Team Spirit Award as part of its annual Kansas City Corporate Challenge.
  • Voalte offers “Have faith in nurses.”
  • New York eHealth Collaborative’s Anuj Desai and David Jacobowitz contribute to the third edition of “Medical Informatics: An Executive Primer” from HIMSS.
  • Orion Health offers “The Importance of Chronic Care Management (CCM).”
  • PeriGen offers an interactive history of labor and delivery nursing in honor of National Nurses Week.
  • QPID Health offers “3 Key Insights From Dr. Robert Wachter, Author of ‘The Digital Doctor.”
  • Sandlot Solutions will exhibit at the SoCal HIMSS 7th Annual Clinical Informatics Summit May 15 in Irvine, CA.
  • Shareable Ink and The SSI Group will exhibit at the Ambulatory Surgery Center Association Annual Meeting May 13-16 in Orlando.
  • TeleTracking offers a new blog on “National Nurses Week 2015.”
  • TransUnion hosts Philippine President Benigno Aquino III at its corporate headquarters.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 10, 2015 News 4 Comments

Morning Headlines 5/8/15

May 7, 2015 Headlines No Comments

Cerner Reports First Quarter 2015 Results

Cerner reports Q1 results: revenue climbed 27 percent to $784 million, adjusted EPS $0.45 vs. $0.37. Revenue came in below Cerner’s Q1 forecast, due to lower than expected revenue across both its existing business and its new Siemens business.

Allscripts Announces First Quarter 2015 Results

Allscripts reports Q1 results: revenue was down two percent, at $335 million, adjusted EPS $0.08 vs. $0.07, missing expectations on both.

Are bungled VA claims systemic? Senators want agency review

The VA’s notorious claims processing system is back in the headlines. The VA reports that the claims backlog currently stands at 161,00, down from its peak of 611,000 in March 2013, but a VA inspector general review uncovered doctored data at five of the 10 worst performing claims processing centers. Now, a bipartisan group of senators is calling for a wide-scale, GAO-led review of all 56 regional VA claims processing offices.

Meaningful Use Stage 2 E-Prescribing Threshold and Adverse Drug Events in the Medicare Part D Population with Diabetes

A study published in the Journal of the American Medical Informatics Association compares medication error rates between handwritten and electronically generated prescriptions and finds that e-prescribing was associated with fewer adverse drug events. The study also found that e-prescribing increased the number of prescriptions that make it to the pharmacy by 12%, and increased the number of prescriptions picked up by the patients by 10%.

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May 7, 2015 Headlines No Comments

News 5/8/15

May 7, 2015 News 8 Comments

Top News

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President Obama nominates National Coordinator Karen DeSalvo, MD to become HHS assistant secretary for health, a role she has held as interim (in addition to her ONC duties) since last year. The appointed position, which involves Senate confirmation and a four-year term, is the nation’s highest-ranking public health officer. Howard Koh, MD, the previous assistant secretary, resigned in July 2014 to rejoin the Harvard School of Public Health. DeSalvo will leave ONC if confirmed, which is nearly certain since both she and her HHS boss Sylvia Burwell have widespread political support that crosses party lines. Her nomination was entirely predictable from the moment she was named as interim.


Reader Comments

From Code Jockey: “Re: Siemens. As a Siemens/Cerner HS employee I’d like to gauge the community’s thoughts. Unofficially, 200-300 people took the voluntary separation package, so where does that leave the rest? Should they look elsewhere given the probably layoffs or stick it out?” I’ll open the floor, but if it were me, I’d stick it out. Layoffs are certain but strategic, so the first wave will be in areas of obvious generic corporate redundancy such as marketing, finance, sales, and HR. Second-worst is if you work on a clearly doomed product line but even then someone has to keep the lights on until customers are prodded to move elsewhere. Otherwise, the need for technical experts for existing Siemens products isn’t just going to go away overnight. You’re working for a much more successful and US-based, healthcare-focused company now, and while I would always be keeping my ear to the ground for new opportunities as a general policy, I wouldn’t assume the worst.  Speaking of Siemens, I hadn’t checked lately, but our November 2014 webinar, “Cerner Takeover of Siemens: Are You Ready?” with Vince Ciotti and Frank Poggio has been viewed over 4,000 times on YouTube.

From Ex-McK: “Re: layoffs. Heard more layoffs at McKesson and RelayHealth. How many employees are left on the technology side? Someone told me as many as 500 were let go last week. It’s definitely not the company when Pam was running the company.” Unverified. Another reader reported hearing that 300 were laid off, but I haven’t heard from any of them directly.

From Rumor Mill: “Re: MUS2 attestation date. I’m hearing it may be moved to January 2017. Any idea if this is true?”


HIStalk Announcements and Requests

This week on HIStalk Connect: Apple, in collaboration with UCSF and Mount Sinai, will update ResearchKit to support genome data collection, storage, and sharing. American Well launches a new telehealth app designed to let practices offer remote consultations to their patients. Stanford University researchers have improved on recently developed retinal implant technology and are developing a new prototype that should provide some blind patients with 20/250 restored sight. Online glasses retailer Warby Parker raises a $100 million Series D to expand its physical footprint and to develop an online eye exam that its ophthalmologists can use to prescribe lenses.

This week on HIStalk Practice: Harrington Family Health Center goes live on Athenahealth. AHRQ recommends several areas where pediatric EHRs can improve. HHS announces $101 million in funding for health centers, and prepares for artists and health data activists to converge at its headquarters. CareMore Medical Group goes with Allscripts, while Tandigm Health opts for NaviNet referral tool. Harbin Clinic welcomes a new CIO. Apple Watch users bring new meaning to the phrase "lonely hearts club." Calypso, cowbell, and Jonathan Bush converge. Dr. Gregg shares the HIT challenges of being independent (i.e., non-Borgian).

A reader asks if I listen to any Icelandic music. I do sometimes: Sigur Ros, Of Monsters and Men, and of course Bjork. The reader likes indie pop band Seabear, and having checked them out, so do I. A lot of good music comes out of a country whose population is just 300,000.

It occurred to me that just about everybody who’s salivating at the prospect of never-ending streams of real-time, sensor-powered patient data are businesspeople and technologists rather than hands-on doctors and nurses. The diagnostic value of the information is questionable, the cost of follow-up is significant, and the effect on outcomes and cost is unknown. You often can’t even get an appointment when calling in with an acute condition, so who’s going to jump on an unusual iPhone heart rate sensor value? It makes me uneasy to see the further polarization of healthcare haves and have-nots since it’s already easy to find previously undiagnosed and untreated people without using apps – it’s just that their demographics make them unprofitable and our healthcare delivery system doesn’t get excited about unprofitable public health.


DonorsChoose Project Update

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I fully funded these DonorsChoose projects from the generous donations of Cerner and Epic, which I’m listing here so those companies (and Centura SVP/CIO Dana Moore since it was his idea and effort) know where their money went:

  • Books and math flash cards for fourth grade classes in Indianapolis, IN.
  • An iPad Mini for literacy and math stations for an elementary school class in Baltimore, MD.
  • A Common Core math manipulatives set for grades 3-5 in Baltimore, MD.
  • A laptop computer for programming Lego EV3 robots for grades 6-8 in Hartford, KY.
  • Two programmable rover robots for a fifth grade class in Clarendon, TX.
  • Six Makey Makey computer invention kits for K-5 classes in Hull, GA.
  • A Lego EV3 programmable robot and reference books for a middle school robotics competition team in New York, NY.
  • A STEM bundle, three STEM kits, and four engineering centers for first grade recess learning at a bilingual learning school in Columbus, OH.
  • A portable air conditioner for an elementary school classroom in Paterson, NJ.
  • Two iPad Minis for a third grade technology workstation in Tulsa, OK.
  • A math manipulatives library for grades 3-5 in King City, CA.
  • Two Kindle Fires for technology learning for a kindergarten class in Indianapolis, IN.
  • 25 scientific calculators and clipboards for a high school chemistry class in Indianapolis, IN.
  • An iPad Air for reading and math practice for an elementary school in Henderson, NV.
  • Summer school supplies for an elementary school in Norfolk, VA.
  • Educational computer games for a class of pre-K through second grade students with autism in Indianapolis, IN.
  • A library of math books for an elementary school class in Indianapolis, IN.
  • A STEM bundle for grades 4-5 at an elementary school in Fairfield, CA.
  • Two STEM bundles for an elementary school class in Tulsa, OK.
  • An iPad Mini, case, and earphones for a kindergarten class in Aloha, OR.
  • A set of Rekenreks math learning tools for an elementary school class in Indianapolis, IN.
  • Interactive math tools for an elementary school class in Wilder, ID.
  • Math games for first graders at a Spanish immersion school in Minneapolis, MN.
  • Macbook accessories for programming courses at a college prep school in Chicago, IL.
  • Four Kindle Fires for a grade 5-6 math classroom in New York, NY
  • A STEM bundle for a second grade class in Fort Walton Beach, FL.
  • A listening center for grades 3-5 at a Bureau of Indian Affairs school in Hayward, WI.
  • A Bluetooth speaker to play music during gym class at a middle school in Milwaukee, WI.
  • A Samsung tablet and case for reading work at an elementary school in Middleton, WI.
  • Scientific calculators and learning supplies for an at-risk middle school class in Cottage Grove, WI.
  • 20 STEM professional resource books and an iPad Mini for an elementary school teacher in Green Bay, WI

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Mrs. Anderson from Colorado sent over photos of the TV and flash drive paid for by our donations. She placed it in the library as the first thing students see when entering or leaving as it runs new book advertisements and school announcements. She reports that students gave it a lot of “oohs and ahhhs” and checked out three new books the first day by 10:30 a.m. even though the books had been sitting untouched on the new book display for the three weeks before the TV went up. Meanwhile, Mrs. McDermott of Brooklyn sent a note about the four Kindle Fires for her math class: “Thank you so much for your incredibly generous donation. I can’t even believe it! I’m currently on Spring Break, and I woke up thinking of all the things I need to do in order to prepare for when the kids come back, and then I see this wonderful email! I appreciate it from the bottom of my heart! Thank you, thank you, thank you! These Kindles are going to be so helpful in my classroom, and the kids are going to be so excited to have some technology JUST for math class. You are an AMAZING human being!” (it’s actually amazing companies donating, so I’ll accept on their behalf).


Webinars

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May 12 (Tuesday) 1:00 ET. “HIStalk Interviews Regina Holliday.” Catch up with Regina Holliday and her recent patient advocacy efforts as she chats with HIStalk’s Lorre and Jenn about the HIMSS conference, The Walking Gallery, her upcoming advocacy events, and her new book. Regina will talk about how providers and vendors are working to make the patient voice heard.

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making.


Acquisitions, Funding, Business, and Stock

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Harris Corp. eliminates the headquarters function of its Herndon, VA-based Integrated Network Solutions business, which includes Healthcare Solutions, as it plans for the integration of defense contractor Excelis, which Harris is acquiring for $4.5 billion. SEC filings suggest that the company may be considering divesting the INS businesses, which in addition to healthcare, include IT services and telecommunications. Harris Healthcare Solutions offers the FusionFX care collaboration suite, FusionIQ analytics, and FusionOS middleware, acquired with its $155 million acquisition of Carefx in 2011.

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IMS Health acquires England-based Dataline Software, which offers healthcare cost analytics and develops custom hospital software.

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Castlight Heath reports Q1 results: revenue up 90 percent, adjusted EPS –$0.17 vs. –$0.72, beating expectations for both. Shares jumped on the news but are still down 31 percent on the year, valuing the company at $739 million.

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The Advisory Board Company announces Q4 results: revenue up 30 percent, adjusted EPS $0.31 vs. $0.34, missing expectations for both. ABCO acquired educational enrollment vendor Royall & Company for $850 million in December 2014 and most of the analyst questions in the earnings call involved that topic.

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DrFirst raises $3.5 million in new financing.

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Cerner reports Q1 results: revenue up 27 percent, adjusted EPS $0.45 vs. $0.37, falling short of revenue expectations due to “a combination of lower-than-expected revenue from the recently closed acquisition of Siemens Health Services and lower revenue in our existing business.” It’s a rare and somewhat shocking miss for CERN.

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Allscripts announces Q1 results: revenue down 2 percent, adjusted EPS $0.08 vs. $0.07, falling short of expectations for both by quite a bit.

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Fitbit earns $142 million profit on $745 million in revenue in 2014 and announces plans to IPO after raising $100 million, having valued itself previously at $1.2 billion.  The company also disclosed that its product recall in response to consumer complaints about band-induced rashes cost it $107 million plus settlements for lawsuits both settled and open. Fitbit says less than half of the total devices it has sold are being actively used.

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Private equity firm ABRY Partners will acquire pharmacy 340B systems vendor Sentry Data Systems, with an unannounced price that one banker says is more than $200 million.

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Population health management vendor Evolent Health files for a $100 million IPO.


Sales

England-based urgent care provider Coordinate My care selects InterSystems for care coordination.


People

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Andrew Rhinehart, MD (Johnston Memorial Center for Comprehensive Wound Care) joins Glytec as chief medical officer.

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Harbin Clinic (GA) names Andrew Goodwin (Georgia Hospital Association) as CIO.


Announcements and Implementations

Zynx Health announces the annual Clinical Improvement Through Evidence (CITE) Award for nurses leading a clinical decision support team. Nominations are due June 15.

The Indiana Rural Health Association announces that the tobacco referral application by Holon Solutions is being used by 11 clinics and three hospitals, replacing faxed referrals with one-click electronic access.


Government and Politics

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The fired head of the Phoenix VA hospital that falsified wait times sues to get her job back, saying she was a scapegoat. In response, Rep. Kyrsten Sinema (D-AZ, above), annoyed that the VA pays terminated employees for months to years of appeals and that it lied about the number of employees it fired related to the scandal, has introduced legislation to hold the VA and its employees more accountable, explaining, “It’s now been over a year and these two are on paid administrative leave. That’s ridiculous. They’ve been sitting at home eating bonbons getting paid and they’ve done jack. Every time I talk to the secretary, I’m like, ‘Why have you not fired more people?’ And the secretary says, ‘Well, the process is very long and there’s due process, there’s all these steps, blah, blah, blah’… This is precisely the type of situation that makes the average citizen lose faith in their government.” The Congresswoman’s bio is fascinating.


Privacy and Security

A Ponemon Institute report (which you ironically can’t read without divulging private information) finds that the number one cause of healthcare data breaches is now criminal attacks, with a 125 percent uptick over five years.

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Two unnamed hospitals will test PowerGuard, a medical device malware detection system that looks for unusual power consumption without touching the underlying FDA-regulated hardware and software. The PhDs that started the company found that they could recognize when a computer accessed a particularly website by analyzing its power frequency footprints.


Innovation and Research

Brigham and Women’s Hospital (MA) will validate the offerings of startups in which Rock Health invests.

A UC Berkeley engineering team develops CellScope, a smartphone video blood microscope that can diagnose parasitic worm diseases that are common in Africa. Their work was funded by the Bill and Melinda Gates Foundation.


Other

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Here’s a reader-sent photo of folks representing most of the lab middleware vendors (including Liaison Healthcare Informatics, Lifepoint, CareEvolve, and Atlas Healthcare) taken at a recent conference. They talked about issues of mutual concern, including how to get more value from conferences and trade shows.

An employee of the Broward County, FL sheriff’s office faces 15 years in prison for attempting to extort $7,000 from a doctor she met on “married but dating” site AshleyMadison.com.

Weird News Andy titles this, “Not Exactly Wearable.” University students design seat-based airplane heart rate sensors that could allow flight attendants to identify passengers who are anxious or ill.  


Report from the American Telemedicine Association Conference
By Bill Rieger, CIO, Flagler Hospital

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The ATA conference, held this week in Los Angeles, was the largest in the 20-year history of the association. What is the ATA? American Telemedicine Association, of course. Did you know that association existed? Sadly, until last year, I wasn’t aware of it. Historically, unless you were dealing with the challenges of rural healthcare, you may not have had the desire or need to think about telemedicine. A couple of industry dynamics are changing that.

First, some definitions for those of you like me who are just awakening to the world of telemedicine. Telemedicine refers to the use of video or telephone technology used to reach those who would not normally have easy access to healthcare. Telehealth, a newer term that is more personal, is the use of technology to deliver healthcare. This can be wearables, remote monitoring, or even going to Dr. Oz’s website to get health tips that can impact your life. The terms are not really interchangeable, although they are commonly used that way. The conference was full of education and vendor booths that supported both concepts.

I went this year because we are trying to leverage both telehealth and telemedicine within the construct of our ACO. We have plans to use telemedicine to both reduce readmission rates and provide additional benefits to employers as we look to contract directly with them in our community. This is now common in most cities as the use of clinically integrated networks grows . In addition to ACOs driving use of telemedicine, the change in technology itself makes a case for increased use. Remote monitoring of patients in the least-expensive setting of care is just plain smart. Monitoring at home was a huge focus at the conference and the technology used to do this is exploding.

There were two main issues discussed in the keynote panel discussion and they were both excellent topics. The first one was interoperability. That’s right, that $10 word thrown around at HIMSS for the last few years. Well, that word did not even make  it to the showroom floor at ATA. When I walked around and talked to vendors, their technology was great, but the data resided in their individual cloud servers that could only be accessed through their proprietary Web-based or mobile application. Ugh!

Frustration filtered through me as I walked around and heard this repeatedly. Some of them mumbled something about HL7, but it clearly wasn’t a focus or priority. This is problematic for the industry as we look to consolidate data through the increasing use of private and public HIE strategies. It will be left to the health systems leveraging these technologies to assimilate the data into their EMR and HIE systems.

The other issue debated was standards of care. I was happy to hear about the new partnership between the ATA and the AMA. The AMA is starting to understand the potential of telemedicine and has determined that they needed to partner with this rapidly growing initiative and ensure there is a focus on patient safety, quality, and coordination of care. I look forward to seeing this relationship grow.

Eventually, I anticipate Joint Commission-like standards being put in place for the use of telemedicine. That will have to be done for the physician office and the hospital. Sprinkle some MU-like regulations for vendors that focus on interoperability and you will have just what we need — more innovation stifled by bureaucracy. Personal feelings aside, it seems too loose and Wild West right now, especially in the telehealth arena. Maybe I have been a part of the establishment too long to recognize the strength in loosely managed innovation. At the end of the day, a patient is involved, so no matter how cool or innovative, patient safety, quality, and coordinated care has to be addressed in some fashion.

The trip was well worth it. The conference was well run, although there were some minor hotel issues. There were minimal booth babes there, mostly telemedicine techno geeks that loved to talk. I learned a lot about telemedicine and telehealth and how different organizations are leveraging these technologies across the globe to improve access of care. I definitely recommend attending next year in Minnesota.


Sponsor Updates

  • DocuSign will exhibit at Microsoft Ignite through May 8 in Chicago.
  • Extension Healthcare celebrates National Nurses week with a #NursesRock Twitter contest.
  • ZirMed’s ZUG 15 user conference will be held August 17-18 in Chicago.
  • Galen Healthcare offers “eRX Refills – Just Click the Button, Right?”
  • Hayes Management Consulting offers five things to know after EHR implementation.
  • SyTrue CEO Kyle Silvestro is quoted in an article titled “Unlocking Unstructured, Qualitative Data Is Key to Analytics.”
  • HealthMEDX will host its user group meeting May 12-14 in St. Louis.
  • Healthwise offers “Apps and APIs: A Positive Step for Patients.”
  • Access customer Hilo Medical Center says the company’s electronic patient signature helped it attain HIMSS EMRAM Stage 7 and saved it $200,000 annually on consent forms.
  • Holon Solutions will exhibit at the New England Regional MGMA Meeting May 13-15 in Rockport, ME.
  • Impact Advisors offers “Revenue Cycle Management – What Does it Encompass?”
  • Aspen Advisors publishes “Transforming Care Delivery: The Power of Clinical Variation Management.”
  • Ivenix offers a new white paper entitled, “Improving Intravenous Therapy: Opportunities for Designing the Next Generation Infusion System, Part 1: Supporting Medication Safety.”
  • Logicworks publishes “Managing Hybrid Clouds: What Team Do IT Leaders Need?”
  • Medecision’s Aerial InCircle mobile application is named a finalist for Dorland Health’s 6th Annual Case in Point Platinum Awards in the patient engagement category.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 7, 2015 News 8 Comments

HIStalk Interviews Susan Newbold, PhD, RN, Owner, Nursing Informatics Boot Camp

May 6, 2015 Interviews No Comments

Susan Newbold, PhD, RN-BC is the owner and a faculty member of Nursing Informatics Boot Camp.

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Tell me about yourself and what you do.

I am a PhD prepared informatics nurse. I’ve been in the field for many, many years, since the early 1980s. I conduct something I call the Nursing Informatics Boot Camp. It’s a two-day course. I travel around the country and the world giving that course, mostly for nurses, but for other clinicians as well. I’ve pretty much always been an educator. It’s my goal to teach every nurse about informatics.

 

Are the educational and experiential expectations changing to be able to call yourself an informatics nurse?

It is changing. When I started, I was self-taught. There are still people now that are self-taught. I’m still finding that.

People don’t have traditional coursework in informatics, so that’s why the boot camp that I do is valuable in one respect, because sometimes it pulls it together for the nurses that have been in the field without the education. It makes them realize that they are an informatics nurse. According to the American Nurses Association, you can only call yourself an Informatics Nurse Specialist if you have a degree and everybody else can be an informatics nurse.

 

Training options include your boot camp, 10×10, certificate programs, and graduate programs. If I’m a BSN working in informatics, what education might I pursue?

If one has a bachelor’s degree already, they could pursue a master’s degree specifically in nursing informatics. There are at least 43 programs available, many or most of them online. There are many, many options for education. Also, health informatics, because they’re not just restricted to nursing informatics. They could go into more of healthcare informatics, which is broader.

 

As an informatics nurse, what organizations and publications do you find most relevant?

I like CIN, which used to be called Computers, Informatics, and Nursing. It’s available in hard copy and online. I have had the privilege of being able to be part of many books related to informatics. In fact, two of them just came out at HIMSS. One of them is a HIMSS book called, “An Introduction to Nursing Informatics: Evolution & Innovation.” That’s new, hot off the press. That’s for people that may be nurses and wonder what informatics is all about, so it really is a good intro. I think people in the field can benefit from it as well.

I was also privileged to be a part of the newest edition of Saba and McCormick’s “Essentials of Nursing Informatics, 6th Edition.” I always think when a book is in a later edition, it always gets better, and this one is better. It’s one of the newest and latest books out there. I was privileged to edit the international chapters, so it’s not just a US perspective, it’s international as well.

And of course, HIMSS. Everybody has to be a member of HIMSS. Some people that are in academic medical centers may go toward AMIA, which used to be the American Medical Informatics Association.

 

Speaking of the HIMSS conference, how were informatics nurses represented there compared to previous conferences?

We are lucky in that there’s a one-day symposium on nursing informatics. If you want to be drawn toward nursing informatics topics, then be with a network and have education surrounding nursing informatics, we do have that one-day symposium. That’s excellent. Otherwise, the topics are very broad, and I know — well, that’s probably the wrong word — not very nursing focused. But that’s OK. We can pick and choose and find topics that are of relevance to us as nurses and clinicians.

 

Do you think there’s any movement to make the HIMSS conference more relevant to nurses?

I can speak from a chapter level. When I first moved to Tennessee, I said, hey, you guys are all consultants talking to vendors. That seemed to be what Tennessee HIMSS was. They said, well, Dr. Newbold, you can change that, and we will make you vice-president of professional development for Tennessee HIMSS. Because of that, I had the opportunity to bring in more clinical aspects of our programming.

I think we have that opportunity within HIMSS. I really think that HIMSS is us. HIMSS is me. I have that opportunity to make suggestions and have things more nursing focused.

But of course, we just don’t look at nurses. We focus on the patient, so all things clinical are of interest to us. I recommend that every nurse who’s interested in informatics joins HIMSS because there is plenty for nurses. The online drills, the webinars. I’m doing a webinar during Nurses Week on the pioneers in nursing informatics. We have plenty of opportunities.

 

Do you see vendors paying more attention to what happens to their products when they’re put out in the field for nurses to use or getting input on product design from nurses?

I think vendors are getting better. I did work for a couple vendors along the way. The smarter vendors now have things like usability labs and have nurses that are employed by them. Vendors like Cerner have hired me to see that they can get their nurses are certified in nursing informatics. That’s a huge gold star for that vendor. They see the importance of nurses and have hired hundreds of nurses. That’s a big thing.

We still have a long way to go as far as usability is concerned, but some of the vendors are getting it and starting to hire nurses and utilize nurses and focus groups, usability labs. We’re getting better. It is a little bit frustrating that it’s taken so long. You know, I’ve been in the business for over 30 years. When are we going to get products that accurately reflect our workflow?

But then part of the problem is nurses. We don’t all do things the same way, even two units in a hospital. “Oh, we do things differently because we’re special.”

 

It sometimes seems that the attributes that make a good nurse doesn’t necessarily make a good technologist. Do you see that changing with the educational requirements?

I think it is changing. Most nursing programs are now required to include nursing informatics. That’s a good thing. We’re using more technology in our everyday life. Even the smartphone is technology that we didn’t have a few years ago. We’re using it, we’re integrating it into our everyday life, it’s there in our organizations. There are nurses now who have always documented using electronic means.

 

Do you see more opportunities for nurses to take leadership roles within health systems and informatics?

Oh, definitely. The only thing that’s holding us back is ourselves. We can be chief nursing informatics or information officers. We can be CIOs.

 

When you say nurses are holding themselves back, what should they do differently if they aspire to those leadership roles?

If we want to be a CIO, we can figure out what the path is to get there. I don’t really see that there’s a glass ceiling that doesn’t allow us to get there. Most of the people in healthcare IT these days are men, definitely, but that doesn’t mean we’re held back from getting those CIO top-level jobs.

 

What would be the ideal background for a nurse to get into that CIO-type position?

I always think it’s easier to take a nurse and teach them the technical aspects than to take a technical person and teach them the healthcare aspects. So the first thing is being a nurse. Then there are plenty of degree programs so you can get more of that technical aspect. We do, as nurses, need to know more about technology than we do. I think we need to be a little bit more technical ourselves and not leave that up to somebody else on the team.

 

Are nurses actively involved in patient engagement enough to make a difference?

I think we’re trying to figure it out. It’s funny. When I do my boot camps, I say, “OK, how many people have patient portals?” and they may have it, but they don’t use it. We should be the role models — the nurses. Every nurse should be engaged personally in a patient portal so then we can encourage patients to be part of the patient portal.

 

Do you have any concluding thoughts?

Besides education, one of my issues with nursing informatics is that it may be hard for us to define who we are and tell others who we are because we have so many titles. As in hundreds of titles, not just a dozen or so. We have hundreds of titles, so it’s hard to say who we are as informatics nurses. I think that’s one thing we have to work on — to try to get it down to manageable numbers so we can convey to others outside of nursing who we are and what we do.

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May 6, 2015 Interviews No Comments

News 5/6/15

May 5, 2015 News 3 Comments

Top News

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Cognizant reports Q1 results: revenue up 20 percent, EPS $0.62 vs. $0.57, beating expectations for both and boosting the stock to a record high Monday. The company’s healthcare unit, which includes its November 2014 TriZetto acquisition for which it paid $2.7 billion, increased revenue by 43 percent year over year. CTSH shares are up 32 percent in the past year. Cognizant says it has added 500 consultants and 300 developers to the former TriZetto business and was selected for $200 million worth of synergy deals, which it says proves its expectations of $1.5 billion in post-acquisition revenue synergies. TriZetto had closed 2014 at $729 million in revenue with single-digit growth rates before the acquisition. Cognizant CEO Frank D’Souza added that while the TriZetto integration continues, the company would consider another acquisition of similar size.


Reader Comments

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From Compadre: “Re: Athenahealth. Its core offering is data entry, not software. They have thousands of people scanning, typing, and following up on claims. The actual software is just a Web front end that drives little profit margin. Let’s do some math. One MD internist collects $25K per month. Athena charges 7 percent ($1,750) to perform billing services, allowing it to book annual revenue of $1,750 x 12 months so the top line revenue looks like it’s growing. However, the cost is $1,500, leaving $250 per month for busy work. That’s not cloud computing. The street has caught on to this and it’s starting to show in investor sentiment. Finance rule 101: not all revenue is created equal.” A Forbes analysis says Athenahealth, like Allscripts, is facing low and declining ambulatory EHR margins compared to Cerner and says ATHN struggles with “evaporating profits, competitive struggles, and fading tailwinds” even as its share price climbs, making it ripe for implosion.

From BestBets33: “Re: Dr. Jayne’s report on her friend’s hospitalization. I often wonder why discharge planning and education is so disorganized. They do these things every single day, yet everywhere I’ve been it is such a cluster. Think about confused patients and nurses chasing things that should have been taken care of with a short checklist.” It is ridiculous that award-bragging hospitals can’t drive their policies and technologies down to frontline staff, meaning patients are at the mercy of whatever the individual nurse or doctor decides to do given their other priorities. Any other high-volume, high-revenue business would collapse from the lack of standardization and consistency – can you imagine shopping at a Walmart or eating at a McDonald’s that is run like a hospital? I suggested to Dr. Jayne that she ask her friend to request a copy of her medical record to see how closely it matches reality, not to mention finding out the cost and time required to get it. The hospital has a $200 million EHR, but from Dr. Jayne’s account, they’re using it poorly. Here’s my theory: hospital executives all over the country have fooled themselves into thinking they offer great care because they’ve walled themselves off from reality. They don’t eat their own dog food — when they themselves are forced into the patient role, they either go elsewhere due to privacy concerns or they get the swanky suite treatment far away from the huddled masses who pay their huge salaries. I would bet that every one of us who has been hospitalized was appalled at the inefficiency, clinical errors, and lack of consistent humanity. We ought to be embarrassed as an industry at what we’ve let ourselves become while pretending otherwise, but on the other hand, just acknowledging the opportunity for improvement is the first step.

From Picky Eater: “Re: Jeremy Bikman’s comments about KLAS. One report I saw recently costs $16,000 and it surveyed only a few dozen people. That’s not sustainable, especially considering that its methods are not statistically valid.” KLAS’s business model is brilliant – by ranking vendors, it creates a profitable maelstrom as the higher-ranked ones pay it fees to brag on their accomplishment (no matter what its statistical validity) and the lower-ranked ones pay the company for whatever insight it can offer to help them move up the food chain. I contributed to KLAS as a provider almost from the day they opened and my summary is that I rarely quibble at their best- and worst-ranked vendors – it’s the ones in between that are always duking it out. It was most useful when I was looking at a product I knew nothing about because otherwise the reports only validated what I already knew. I wasn’t as interested in the rankings or even the scores as much as I wanted to read customer comments, but even then you can’t put too much stock in them since you don’t know either the organization or the background of the commenter.

From Sam: “Re: Ed Marx. I like reading his submissions because he seems like a CIO with a philosophy. I’m curious if he resigned to work for a new organization and which one it might be.” I’ve heard indirectly that he has a new job, but I’ll leave it up to him to announce it when he’s ready.


HIStalk Announcements and Requests

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This is Ms. Sheppard’s Texas third-grade class using the drawing tablet, response buzzers, and iPad projector adapter bought with our DonorsChoose donation. She says the students now want to do all of their work using the response system since they enjoy competing. Maybe the buzzers should be used at some of the HIMSS snoozer sessions, or perhaps at executive meetings after being wired to provide an electrical shock to the presenter if the majority of attendees are bored.

I also got a fun thank-you card from a high school student who is happy with the algebra calculators we purchased for the class. It reads, “You’re my hero. You’re like the Superman of my math class today. For years now my brain has had one thought … I hate math. But now it is a lot easier for me to do basic and hard math because of the technology you have donated. I still don’t like math, but it’s not the worst thing in the world.” It apparently isn’t, because the student ended with a PS that included a complicated math problem and the challenge, “See if you can solve this.” It’s great seeing the benefit of donations firsthand, knowing that the impact wasn’t diluted by middlemen salaries and wasteful corporate overhead (which is why I would never donate to a hospital).

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Meanwhile, Epic has generously donated $4,500 towards our classroom projects, so I’ll be funding quite a few new ones this week. I have to look at our total donated, but I think it’s $20,500, and that funds a lot of important activities. Thanks to Epic for helping a bunch of kids  – I will make it a point to look for Wisconsin teachers in need.

Listening: reader-recommended Tame Impala, a one-man band from Australia that sounds like Sergeant Pepper-era John Lennon jamming with the children of Pink Floyd at the home of Tears for Fears.

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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Webinars

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making.


Acquisitions, Funding, Business, and Stock

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Imprivata announces Q1 results: revenue up 32 percent, EPS –$0.28 vs. –$2.29, beating expectations for both.


Sales

Visiting Nurse Service of New York chooses Cureatr for secure messaging and care coordination.

CareMore Medical Group of Nevada signs up for the chronic care management program of Allscripts.

Grady Health System (GA) selects Strata Decision’s StrataJazz Continuous Cost Improvement.


People

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Penny Wheeler, MD, president and CEO of Allina Health, joins the board of Health Catalyst, replacing Larry Grandia.

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Kathleen Brenk (Trust Company of America) joins Recondo Technology as chief human resources officer.

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Former HHS Innovation Fellow Zac Jiwa joins healthcare API vendor MI7 as CEO. He had been an advisor to the company.


Announcements and Implementations

Raintree Systems will offer its customers patient billing solutions from PatientPay.

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Telehealth service vendor American Well releases a telehealth app for providers who want to see non-urgent patients via high definition video visits and Apple HealthKit connectivity. It also allows patients to choose a particular doctor or to take first-available and for doctors to invite their patients to a telehealth visit.

IBM, Epic, and Mayo Clinic will collaborate in using IBM’s Watson to analyze EHR information.

CompuGroup Medical announces CGM Analytics, a data aggregation and analytics solution.


Government and Politics

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Rep. Ted Poe (R-TX) introduces a bill that would prohibit HHS from implementing ICD-10. He’s been a hater from the beginning (mostly of anything Democrats favor), but his previous legislative attempts to stop ICD-10 haven’t gained traction and probably won’t this time either since he doesn’t have much Congressional clout. At least he’s apparently given up on his repeated attempts to prove that President Obama isn’t a US citizen.


Other

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Beth Israel Deaconess Hospital – Plymouth (MA) declares “Email Free Fridays,” urging employees to stop emailing each other for a least one day per week, get out from behind their desks, do real work, and communicate with co-workers face to face.

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Atul Gawande says in a New Yorker article that performing unnecessary tests and procedures is expensive and risky to patients, but it’s hard hit the sweet spot between doing too little and doing too much, especially in an environment that pays doctors for unnecessary care and penalizes them (via satisfaction scores and lawsuits) for lapsing into inadequate care territory. My interest is something he doesn’t emphasize much – what voice does the patient have in those decisions? We always assume patients want their doctors and hospitals to be aggressive with their procedures and prescriptions, but I suspect doctors aren’t always good at explaining the long-term benefit or recommending only those treatments that they themselves would choose.

A three-hospital study finds that while physicians often blame demanding patients for running up healthcare costs, less than 9 percent of oncology patients ask for specific tests or treatments, nearly all of those are clinically appropriate, and physicians very rarely comply with the inappropriate ones.

An MIT Technology Review article says Apple will recommend genetic testing to certain iPhone users, arrange for the tests to be run by academic partners, and then allow people to share their results with each other or with researchers via ResearchKit. UCSF and Mount Sinai Hospital are planning studies that will involve DNA collection.

The family of deceased Ebola patient Thomas Duncan says the donation of $125,000 by Texas Health Resources as part of its settlement with the family is “not nearly enough,” expressing shock that THR didn’t provide the $5 million the family asked for to build a hospital in Liberia.

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Legacy Health System (OR) goes to an emergency operations plan when an apparent power surge takes its systems down for 12 hours.

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A New York Times article covers the rise of air ambulance services that are raising their rates dramatically and pressing harder for patient payment even as insurance companies reduce coverage. A glut of medical helicopters has caused usage to drop and an industry trade group is trying to convince the federal government to increase their Medicare payments, warning that “it’s about access to healthcare.” Billion-dollar operator Air Methods, which operates 450 helicopters and airplanes in 300 locations, charges an average of $40,000 per flight. It’s another of those healthcare things that sounds like a fairly good idea to doctors and patients until everybody finally realizes what it costs.

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Weird News Andy offers a thumbs-up on the just-published “The Thrilling Adventures of Lovelace and Babbage: The (Mostly) True Story of the First Computer,” which he describes as “fun, smart, and very entertaining / informative.” It’s a mix of fact and fiction for “the whimsical intelligentsia,” a group to which we all surely aspire to belong.


Sponsor Updates

  • Extension Healthcare wins the Health Tech Award from Indiana’s TechPoint.
  • A team from Nordic will ride in the Madison Tour de Cure benefit for the American Diabetes Association on May 16.
  • PatientSafe Solutions CEO Joe Condurso is interviewed by The Wall Street Journal about health app development.
  • Ingenious Med is named as one of Atlanta’s 100 fastest-growing companies.
  • Medecision asks, “Who is Responsible for Patient Engagement?”
  • Cumberland Consulting Group Managing Partner Jeff Lee is featured in a PharmaVoice article on technology.
  • Culbert Healthcare Solutions offers “3 Strategies for Retaining and Attracting Top-Notch Physicians.”
  • Capsule Tech offers “Are your medical devices configured to reduce alarm fatigue?”
  • ADP AdvancedMD offers “Spring Cleaning for ICD-10” tips.
  • TransUnion Healthcare President Gerry McCarthy is quoted in an article that addresses uncompensated care.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 5, 2015 News 3 Comments

HIStalk Interviews Jeremy Bikman, CEO, Peer60

May 4, 2015 Interviews 3 Comments

Jeremy Bikman is founder and CEO of Peer60 of American Fork, UT.

10-14-2011 7-27-00 PM

Tell me about yourself and the company.

I used to be at KLAS, running research sales strategy for seven years. Now I am in my apology tour, doing atonement to the industry with Peer60.

Our whole goal with Peer60 is to enable companies to get whatever data they need from customers and the market directly, with no one in between besides the platform. This lets them get tons of data a lot faster and hopefully have all the control they want from the information.

 

Why can’t vendor executives talk to their customer counterparts directly instead of hiring somebody else to do it for them?

I was talking with someone at my company yesterday about the management consulting thing. The cliché is, "All they do is interview people at the company that they consult with, then just repackage the answers." When I used to do some consulting, I would think the same thing. I would go, geez, all of the strategy for what this company should do is already contained in the minds of its own people, so why don’t they just go talk to the people?

I always wonder if it’s simply because it’s almost like in a war — everyone is in a foxhole and bullets are going overhead, so they can’t really step back and think strategically. Is that part of it? Is that just what happens? Do you need a third-party consulting firm or just a different set of eyes to look at it? Is it a case of “measure twice, cut once?”

That may be the reason why there are so many research firms out there. Maybe they have the connections. The companies don’t have the expertise themselves, or  the time or the know-how to actually go do it, so they turn to that.

Is it a case of everybody loves being ranked? People obsess about, "Where I fit in comparison to everyone else?" I think everyone does that in life — we are always comparing ourselves to each other. Is that natural thing now happening and the research companies just leverage that to pump up a lot of interest to be able to sell? I know when I was at KLAS I took that angle. You’d say, "Here is where you are and here is where your competitors are, and hospitals are using it for this." It would generate a fervor that would build on itself. That’s how I would sell in some cases. Some of that still permeates.

 

Along those lines, are companies just looking for a customer-friendly "you’re doing a great job" validation or are they really looking for things they need to improve?

It depends on who you are looking at. Typically when you are talking to people who are in sales — and I’m a former salesperson, so I’m indicting myself in some aspects with this statement — those people are usually pretty tactical, where I’m thinking in the moment, "How can I get something done?" and I run off.

You have some exceptions out there. Some of the salespeople at Epic are exceptionally aggressive. I think Judy’s mandate was, "Just don’t lose a deal." They really get into it and they think strategically. There are obviously some other salespeople that think like that.

Within the organization, there are some people who care about the data, who care about the feedback. A lot of them also say, "I just care where we rank. I don’t care how truly accurate this information is. Is this statistically significant? I don’t care. I don’t care what this company’s research methodology is — look where we sit." Of course they take it and market it like crazy.

Is that accurate? No, but people are acting on it. My grandpa used to say, "Never confuse what should be done with what, frankly, is being done."

 

Do KLAS rankings and awards mean anything?

I think they do. KLAS does their best. Their data is not remotely statistically significant. When you go out and you’re talking to 15, 20, or 30 of someone’s customers over a 12-month period, that’s not relevant, but it is the voice of the customer. That is one thing that they are gathering. Those 30 or 40 hospitals they talk to for GE or Allscripts or anybody else — that is legitimate information, but is it a highly accurate rank about what is actually happening? Not necessarily.

It’s not just KLAS – it’s Black Book or anybody else who comes out with it. They are asking questions to CMIOs that CMIOs don’t know, such as work flow, and lower-level IT where their IT analysts can’t answer it. They’re also asking CMIOs some hardcore interoperability questions and maybe security that they may know in a secondary and a cursory way, but not primary themselves. A lot of its “opinuendo,” but it’s not just KLAS — it’s pretty much every research firm out there. That’s how they do it.

 

The most important information that you don’t see is who they’re talking to. If I want product-specific information, I’d want to talk to the person who works with it every day. But if I want to know from a marketing standpoint, “Is my customer going to fire me?” I’d want to talk to the person who has the clout to make that decision. Do they talk to the right people?

It’s obviously too much of a mix. Again, I just need to make clear that it’s every research firm. I haven’t come across a research firm that really does it right. But it’s part of the model, too. If KLAS, Black Book, MD Buyline, or anyone else were to say, "We have to segment our questions. Operational finance questions go just to people who are in operations and finance, IT questions go only to IT people and clinical workflow questions go just to those clinicians." They would have to do so much research that their cost would go through the roof.

People complain about how much KLAS costs right now. That’s nothing if they had to get a lot of data per user per that specific context that you really should be talking about. Like I said, operations questions to operations people, just limit it to that. It would be very, very difficult.

If you look in the fine print with KLAS, it says, “This is overall just the voice of customer.” They have little things in there, like confidence level isn’t with a C, it’s with a K. If you read the fine print — and they’ll admit it — this is voice of the customer. For the most part, the KLAS rankings do a pretty good job. Is it perfect? It is completely accurate? No way. No research I’ve seen out there is. It’s one the reasons why we started this platform.

If a company wants to go out and get feedback from the customers or the market in Europe and North America, they’re getting hundreds and sometimes thousands of responses within a week or two. In that, stats mean something. The questions get very specific. IT to IT people. Operations to operations people. Finance to finance. Of course, this is their data, it’s not going in the market.

We’re producing these free reports just because it’s so easy for us to get the data. We did this clinical purchasing report. We got 25 percent of the hospitals in the US in three weeks. It’s very fast and easy for us to get the data. You’ve seen our reports. They’re pretty basic. Just, “Here’s the data.” We don’t really do much analysis. We’re not into the vendor rankings. Just, “Here’s interesting information.”

Our customers use that to get far more information far faster. Then they can do whatever they want at that point. We hope that they do it to improve, but we’re never going to rank vendors. That’s not who we are.

 

The source that I liked most, at least of those who provided their information without requiring payment, was CapSite.  HIMSS Analytics bought them. How do you see HIMSS Analytics fitting into the market research world?

You know what I always wanted someone to do? I talked to HIMSS a couple years ago. They’re just too big. They can’t get out of their own way. Their data is pretty reasonably accurate to some extent. We buy it sometimes to make sure we have demographics for hospitals. Definitive’s doing a good job there, too.

I always thought some of these guys should go out and do what’s called an "ideal fit." You have a report come out that bashes Meditech from somebody, but Meditech is still selling. What about those smaller hospitals that don’t have very sophisticated IT environments? They don’t have much budget. They’re not going to sell out to one of the big IDNs or to a health plan or something like that. Meditech is a really good fit for them, but you don’t get that in “one size fits all” research. I remember telling HIMSS, "I know you guys are really trying to get more into this primary research, more away from just demographic information. Why don’t you go that direction?”

I hope someone does it. That would be way better for the market to rank vendors on where they actually play well. Why in the world are we comparing Meditech to Epic in a large hospitals? That doesn’t even make sense. That’s not where they play. They get crammed in and it does a big disservice to the market.

 

It would be like Consumer Reports saying that the best car is Rolls Royce and just leaving it at that. Healthcare has a list of best products and another list of all the types of hospitals — maybe the job of consultants is to arbitrage the information by matching them up.

That’s very good way to put it, actually. There are some consultants that can do that, real domain experts. They’ll take available data that’s out there. They’ll get a KLAS report, MD Buyline, whatever. Then they need to do primary research themselves. The hospital does, too. No hospital will go, "Oh, they rank #2 in this report – done. We’ll do it." They’re going to do site visits and they’re going to do calls. They have to go through their normal decision-making process. Money still means something. How much money do we have? Our internal capabilities still mean something from an IT and informatics perspective, biomed. These things mean things, so they will factor that into it. The “one size fits all” report does not do that. It lumps everybody together.

Just because of my background in working for a major research firm, every meeting I had at HIMSS, and I probably had 50 meetings, every person would go, "I hate this report. What do you think about this report?" I said, “I don’t really work there any more and I don’t really know that other research firm, but you have to quit trying to take these reports” … everyone is coming at it the wrong way. They anticipate that this should be an apples-to-apples comparison. They’re not apples-to-apples comparisons. You have to get that out of your head. The lens through which you view this has to be that there are both fruits or vegetables. It’s an apple to a kumquat or it’s like a fruit salad. That’s really what these reports are. Obviously there needs to be way more analysis that’s done and it’s probably like you said — that’s probably a time where some consultants need to step in and they can probably add real value.

 

f you’re talking to someone on the provider side who doesn’t really understand the vendor world, how would you describe what market research means to a typical healthcare IT software vendor?

It’s a crutch. Buying reports is a crutch. It’s an easy way out. Is that inflammatory enough? [laughs]

 

If you’re a vendor trying to formulate a market strategy, how important is market research? What else goes into that mix of saying, "What do we do for the next five years?"

Market research is great, but you need to it yourself. It needs to be primary. You don’t want it filtered.

There’s a saying that I’ve heard before. "If you drink from a stream, get as close to the source as possible." When you’re getting it filtered through a research firm and it’s anonymous, you have no idea who said what or anything like that. You’re getting an inherent bias coming from the research firm. No matter what they try to do — and you can read all the philosophy of Immanuel Kant and those other ones out there that talk about this, those German philosophers — there can’t be anything truly objective.

It becomes far less objective when it’s filtered through somebody else. Someone else made the calls. Someone else is now analyzing the information. They’re trying to keep it as pure as possible, but they’ll see some phrases and the natural tendency is to try to clean it up. It’s like the Bible. the Bible has been translated how many different times? From Aramaic into Greek, into Latin, into German, into whatever. How much stuff gets lost in that translation? Same thing happens.

Market research is absolutely critical. Research and getting data from the customers is critical. But get it directly from them and get a lot of it. Get it repeatedly. Make it easy for them. That’s the reason I say market research reports are a crutch. Hiring a research firm to do custom research for you is a little bit better than that, but still you are ceding control to somebody else.

It’s as if you hired someone else to do this interview and they didn’t give you a direct transcript. They’re going to change it. That’s the way research works. You get it and go, "This is interesting," but you can tell it’s bland. You can tell something’s have been changed rather than getting it unfiltered.

 

You talked about Epic’s sales and marketing. They claim they don’t do marketing and they don’t ever talk about their sales. Does Epic do sales and marketing?

Oh, my gosh, they are the best in healthcare. It’s brilliant.

Have you seen the show “Usual Suspects?”  It’s a brilliant show. There is a guy Verbal Kint played by Kevin Spacey. The main villain is this guy named Keyser Soze, this super evil global Mafioso boss who no one has ever seen. Verbal says, "The greatest trick the Devil ever pulled was convincing the world he did not exist.”

It’s brilliant, that line. Every time someone says Epic doesn’t sell or market, I laugh about it. They are brilliant at it. By virtue of saying they don’t market, that is different. It sets them apart. What is that? That is marketing. You just established a brand.

They’re not traditional though. They’re very thoughtful. They’re very extremely aggressive, but they do it in a very calculated way that’s not offensive and doesn’t feel like sales is coming across. They’ve earned a lot of it, too.

I want to preface that out front. When you have companies like KLAS ranking them constantly and other publications are constantly publishing the rankings, you are using that to your advantage. When other people market for you, that is way better than when you’re doing it yourself. 

Epic absolutely markets. They just do it in the early Silicon Valley way. The rest of healthcare needs to catch up, which is have other people market, be almost counterculture. That is really Epic. They are just brilliant at it. Absolutely brilliant at it.

 

Epic somehow always seems to slide across from being on the other side of the table to their customer’s side. The customer feels that Epic is their partner and defends them. How would you create something like, that where both contractually and morally, the customer feels the imperative to be their vendor’s advocate?

You see that in Silicon Valley. Look at Apple. I like Apple just because it’s stable so I don’t really care, but people are violently defensive of Apple. Epic does the same thing. It’s not about the solution. 

When I was at KLAS, people would complain, "Epic can’t get this — they have older technology." I would say, “Yes they do — it’s not about the technology.” As long as the technology is stable and does the basics, it’s all about the people. It’s the the relationship and the feeling. My dad used to say, "Son, you only sell two things in life — solutions and good feelings.”

That’s correct. Epic solves a problem. Companies solve problems and how you feel about that. Epic is really good, like you said, at getting themselves on that same side of the table. They don’t talk about their tech a lot — they talk about the problems they are solving and the benefits they are providing. Apple did that. Steve Jobs always talked about “why we do what we do,” not all the features. Those will come later. They would build this whole culture. That is really what Epic has done.

Can another company do it? I don’t think they can if they don’t start out that way. You’d have to do a scorched earth. Before Siemens got bought out by Cerner, to turn it around, John Glaser would have to come in and say, "I’ve got to fire everybody. Anyone that’s been hired here previous to two years that doesn’t have a lot of neural plasticity, doesn’t have a lot of bad habits — we’re just going to get rid of everybody. We’re going to start from the ground up.“

I don’t know how a company pivots. I haven’t seen a company pivot like that. Maybe you have, I just haven’t seen someone. You have to start out like that. You can obviously improve, but you also need to be yourself. Epic is Epic because of Judy and Carl. You don’t have to be like that. Cerner is highly successful and you wouldn’t really say their culture is very similar to Epic.

 

What are the most interesting trends you took away from the HIMSS conference?

The most interesting trend that I’ve seen — this is a bit tongue in cheek — is how fast marketing moves. Products move at glacial speed in comparison to marketing. I am absolutely blown away that pretty much every company out there can do accountable care, care coordination, population health management, patient engagement, and data analytics. It’s amazing. It was like a forest just crept up over the last two years.

I may be underselling everybody, but their marketing departments are in full bloom. I’m not sure the R&D is there. I spent so much time just meeting with people. It was hard. That was just one of my takeaways, "Wow, everybody does everything and nobody is standing out because of it."

 

In our 2011 interview, you predicted that Epic and Cerner would lose some dominance, best-of-breed would make a comeback of sorts, and smaller vendors would upset the apple cart. Do you still think that will happen?

Because the government is in, no, I don’t. I was wrong.

The big are going to get stronger because what the government has done is going to enable it. It makes it tougher. When you have government-required mandates that somehow map well to the “one size fits all” big integrated vendors, how do you fight that?

Imagine if you are in Silicon Valley and all these B2C companies. The government came in and said, "Here are all the different mandates you have to do." How many new startups could crop up and really be successful? 

I underestimated the impact and the staying power of what was enacted through HITECH legislation. When it comes to enterprise, maybe in 10, 15, or 20 years, but nothing soon. The governments has enabled this to happen and smart vendors like Epic and Cerner absolutely jumped on it and have done exceptionally well. It’s not like they haven’t done a good job anyway, but there is no doubt it certainly helped.

 

In that regard, is there irrational exuberance with mobile health and the unprecedented amounts of money being invested in innovative companies?

I love the energy. When you have a lot of companies coming in and competing, hopefully you can get to something that is really usable, specifically for patients, that really engage them without having hospitals having to do the heavy lifting, which is happening now. What if the government steps in there and starts putting all these mandates around that? It is just going to empower the incumbents. That still isn’t good for innovation or for patients. I hope that it stays the Wild West for a while.

 

What will the health IT market look like over the next five years?

Big getting bigger. You are going to see a lot more consolidation. There are some pretty cool startups and a lot of cool companies. You are going to see a lot more consolidation. I don’t think that Athena and some other guys are even close to being done, snapping up different companies and rounding things out. Salesforce is coming in in a big, big way. Amazon is coming in. I just got an email from a guy at a major IDN saying, "Hey, you’ve got watch out for Amazon — they’re doing some amazing things. They are moving stuff to the cloud and are starting to bring all these different apps no one is even talking about.”

I kind of love that, but I don’t know if they are going to stick around. We’ve seen the hokey pokey dance go on in healthcare for decades, where guys jump in and jump out. I’m sure hoping that a lot of these guys will stick in – Salesforce, etc. — and really help out. An argument could be made that guys like Salesforce need to be in there. If you are really going to engage patients and you’re really going to manage populations, CRM-like technology may be absolutely critical. Can the big incumbents in healthcare really develop a CRM? I don’t know. I don’t think so, but they certainly could.

 

Did the FDA really come look at your fake crack booth giveaway at HIMSS?

They did. Did I tell you my marketing guys didn’t take a picture of it? They did a great job. I said, I’d have given you an A+ because it was such an awesome event, the booth, everything, the traffic, but the FDA came by after hearing, "What’s this? You guys are giving away dime bags?" Do you really think we are giving away illegal substances at a trade show? Besides, it would be cheaper for us to give away iPads. We should have gotten a picture.

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May 4, 2015 Interviews 3 Comments

Morning Headlines 5/4/15

May 3, 2015 Headlines No Comments

Former HealthCare.gov IT program manager Chao retires from CMS

Henry Chao, CMS deputy director of the Office of Information Services and program manager of the troubled Healthcare.gov rollout, retires after 21 years of government service.

Almost half of Obamacare exchanges face financial struggles in the future

The Washington Post reports that nearly half of the 17 state-run health insurance exchanges are struggling financially. Some are considering increasing fees imposed on insurers, while others looking into cost sharing arrangements with other states or shutting down completely and migrating exchange services to Healthcare.gov.

athenahealth’s (ATHN) CEO Jonathan Bush on Q1 2015 Results – Earnings Call Transcript

Athenahealth hosts its Q1 earnings call, with CEO Jonathan Bush providing his own style of commentary on the company’s recent performance and projects. This quarter the company added 2,300 providers, and sold a number of new inpatient systems through its recently acquired EHR RazorInsights.

Erlanger Chooses Epic Software For New $100 Million Electronic Medical Records System; CEO Judy Faulkner To Visit Chattanooga

Erlanger Health System chooses Epic as its next EHR vendor, beating out Cerner as the other finalist. The system will be implemented over a two-year period and will cost $100 million.

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May 3, 2015 Headlines No Comments

Monday Morning Update 5/4/15

May 3, 2015 News 3 Comments

Top News

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Henry Chao, the CMS CIO and deputy director who led the rollout of Healthcare.gov, has retired. He was little noticed until a September 2014 House report on the site’s failure, which quoted emails from former HHS CTO Bryan Sivak that characterized Chao as being in way over his head to the point that HHS plotted to hijack the project to try to salvage it. Chao reported to CMS CIO Tony Trenkle, who hightailed it for an IBM federal IT executive job just a handful of weeks after the site went down in flames (of taxpayer money).


Reader Comments

From Not So Lucky: “Re: McKesson EIS division. Big layoffs Friday.” Unverified.


HIStalk Announcements and Requests

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Around 17 percent of poll respondents think that HIT vendors intentionally stack the executive deck against women and unstated minorities, but most of them feel that companies have simply chosen the best people for the job and possibly only need ongoing reminders of the desirability of diversity. Some readers commented that perhaps companies can’t even see the benefit of executive diversity because they’ve never practiced it, while others commented that the “mommy track” may present a more attractive option for women who aren’t very interested in the never-ending hours, travel, and relocation required to move up the executive ladder. Cerner Europe GM Emil Peters referenced the poll on Twitter, saying, “Personally I think it’s a travesty. And I’m going to do what I can to fix it. However, I don’t think it’s by design.” New poll to your right or here: within the past two years, have you had to pay a medically related bill that created at least a modest degree of personal financial hardship?

Here another poll that interests me since I see a lot of people playing around with media in ways I don’t quite get: which would be the most attractive way to catch up on a weekly health IT news summary? I personally have never listened to a podcast and don’t anticipate a time that I ever will, so the results will help me figure out if I’m in the Bell curve hinterlands.

Check HIStalk Practice for the Population Health Management Weekly Roundup.

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I bought Regina Holliday’s brand new book “The Writing on the Wall” from Amazon and became so engrossed that I read it nearly straight through this weekend. My expectations are modest for healthcare IT-related books given some fairly lame ones, but this one is among the most moving things I’ve ever read, more of a story about love and family, overcoming adversity, and standing up for what’s right than the usual preachy, recycled facts about technology coming from someone who thinks of patients as people and/or customers different from themselves (the big secret: we’re all frightened, marginalized patients at one time or another). If your blood runs above room temperature, I predict you’ll laugh, cry, and get fighting mad at the very system you work within as you read about her life and the untimely death of her husband, but you’ll also find it uplifting and empowering. It would be a great read even without the IT connection. I’ll most likely write a full review shortly since to do less would be a disservice to people who either want or need to peruse it, but here are some excerpts that got me as I learned that Regina’s art is not limited to the visual variety:

We come into this world screaming and owning nothing. We grow and change. The years pass by and we fill with life experience as our homes fill with possessions. Time rolls on and on, but for all of us there is an end. Some will meet their end on highways and some in hospitals, but for most of us the end is the same. We are patients in the end. We pluck at cloth hospital gowns, left with only a few possessions: our watches, rings, and wallets … Hospitals can deconstruct a person as assuredly as I could lay bare a jewelry box. Take any professional adult and remove their clothes and their accessories. Dress them in a threadbare gown that is faded by thousands of wash cycles. Give them a number rather than a name. Confuse them with jargon while applying copious amounts of medication. Then watch them try to navigate the maze of care … I felt like a bright blue inconsequential bird in my Easter dress as I fluttered among the forests of polo shirts, hoodies, and business suits. Conference attendees in the world of medicine have a uniform look. You were welcomed if you wore a suit, tolerated if you wore a hoodie, and ostracized in a church dress. I was not wearing the correct uniform, but I took a deep breath and introduced myself. I would say, “Hello, my name is Regina Holliday. I want to paint about healthcare to improve health policy for patients.” I’d then say that I was inspired to paint by my late husband who very recently died of kidney cancer. I would give them my slip of paper masquerading as a business card. Then tell them to reach out to me via social media or email. Then I’d share the horrific things we had experienced during my husband’s 11-week hospitalization at five different facilities. I would see them step back from me with a brief condolence. A nervous half-laugh would often escape their lips. I was a widow fresh from the graveside asking questions that affect the lives of us all. I was not supposed to be there. They were having a ball and I was death walking among them.

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I’ll have more DonorsChoose project updates later, but here’s a photo from Ms. Classen’s intervention algebra class using the calculators we provided. She says, “What we’re able to do now with these calculators is amazing. Many more students are going to get the practice they need to graduate high school and learn to solve difficult problems thanks to you all.” 

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Here’s a photo of Mrs. Rowe’s third graders using the six iPad Minis we bought them for math study.

I was thinking about how hospital patient rooms often resemble hotel rooms in being littered with previously popular but now-useless technology components, which in the hotel’s case often includes iPod docking stations and dial-up ports that get used rarely and never, respectively.


Last Week’s Most Interesting News

  • CMS releases a gigantic Medicare Part D prescribing database for 2013 that includes details on $103 billion of drug spending.
  • Teladoc announces IPO plans and files an antitrust lawsuit against the medical board of its home state of Texas for requiring prescribers to see a patient at least once in person before issuing a prescription.
  • Anthem books $865 million in Q1 profit, up 25 percent despite its massive data breach during the quarter.
  • Imprivata acquires palm vein scanning biometric vendor HT Systems.
  • The chair and ranking member of the Senate’s HELP committee follow through on HHS Secretary Sylvia Burwell’s request for help identifying pressing but easily solved EHR-related issues.
  • A Brookings Institution report questions why patients are charged significant and inconsistent prices to receive copies of their own electronic medical records from providers.
  • CareCloud announces $15 million in additional funding and a new CEO.
  • Validic receives another $12.5 million in funding.
  • Vanderbilt University Medical Center announces that it will replace McKesson Horizon, some of which was developed internally by Vanderbilt, with either Cerner or Epic.

Webinars

None scheduled soon. Contact Lorre for information about webinar services.


Acquisitions, Funding, Business, and Stock

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Startup MORE Health receives $3 million in Series A funding for its multi-language EHR that connects doctors and patients in China with US specialists.

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From the Athenahealth earnings call, which followed Friday’s expectations-beating earnings report that for some reason triggered a 7.4 percent share price drop:

  • The company added 2,300 providers in the quarter, raising its total to 64,000.
  • The RazorInsights team has been moved into the Atlanta office and the company has made RazorInsights sales, cross-sold AthenaOne to a RazorInsights client, and sold both products to a new client.
  • Jonathan Bush says the urgent and convenient care market is the most important to him because it’s growing fast and is managing “worried well” lives.
  • Bush says of big, non-academic health systems buying Athenahealth, “These guys have done their homework, gotten out their protractors and done the math on the arc of their flight, and they see it not clearing the tree tops. Not clearing the tree tops due to lack of profit is a great way to make you for-profit … They know that they can’t put the kind of obscene amounts of capital against or manage internal IT systems in the way that the fancy pants universities can afford to do and they’re slowly coming around to us and it’s exciting.”
  • The company says it won’t talk about individual hospitals or sales of RazorInsights, but “When we look at our growth, first of all, we’re starting with a very new company with a small base, so it’s relatively easier to grow a lot on the small base. We don’t intend to talk specifically about the number of individual Razor deals or that sort of thing. We really bought RazorInsights as a strategic asset along with WebOMR to build out our full inpatient solution over time.” Bush added that RazorInsights got its clients to Meaningful Use but “the billing needs a lot of work, like a lot” and says by year-end Athenahealth will offer a full-service revenue cycle program to RazorInsights users.
  • In justifying the $40 million paid for RazorInsights, Bush says Athenahealth got the best deal it could since the VCs who owned the company were either going to re-fund it or step out, so he sees it as an “acqui-hire” play in buying a product, a founding team, and brave early customers, adding that he’d like to do more of that.
  • Bush responded to an analyst who asked how bookings revenue drove operating income improvement, “If you’ve been following us for a while, you’re following a caterpillar, right? There’s sometimes where the nose of the caterpillar doesn’t appear to be moving at all, but back in the ass, it’s building up potential energy which will turn into a great nose stretch. ”
  • Bush said of ICD-10, “Never has a Bush felt so longing for more federal mandates as I have felt since the dying down of Meaningful Use and ICD-10 and PQR and ABC and do-re-mi. It is so easy when some fearful group of federal apparatchik are going to come for your prospect if they don’t buy. We are currently in a period where there are no apparatchiks coming … if ICD-10 tightens up and actually looks real later in the year it will help our close rate. I will feel sheepish about it because it seems a silly reason to make a free market move. But it’s true that right now our close rates are lower and that the specific reason we can attributed to it is no urgent federal mandate to buy.”
  • Bush said that Athenahealth’s connection to CommonWell is in beta and that he’s OK with making EHRs interoperable via other methods because “otherwise we’re all going to be on some federally mandated ridiculous EHR.” He adds, “CommonWell could have been perceived as sort of a PR smite against Epic, which I assure you I would never want … I want to be anything that Epic’s in as well, even if we have to double pay. This is not the solution for interoperability by any stretch. This is just a service so that a patient can get their freaking chart and have the same patient match to all the different systems that their chart is in. So I don’t think you guys should think of CommonWell as some sort of silver bullet that fixes everything … I don’t think it’s a solution to the real challenge, which is the B2B interoperability … that’s kind of the new frontier that we’re doing most of our work on.”

Sales

Erlanger Health System (TN) chooses Epic in what the local paper says is a $100 million deal.

CoverMyMeds will use state-specific electronic prior authorization requirements information from Point-of-Care Partners.


People

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Valence Health hires Michael McMillan (Cleveland Clinic) as SVP of strategic solutions.


Announcements and Implementations

CVS says in its earnings call that its Epic rollout is on schedule and will be completed by mid-year.


Government and Politics

A Washington Post review finds that nearly half of the 17 health insurance exchanges created as alternatives to Healthcare.gov are struggling with high technology and call center costs along with less-than-expected enrollment numbers. They’re considering raising fees charged to insurance companies, sharing costs with other states, asking for state money, or shutting down and using Healthcare.gov instead.


Technology

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Consumer personal health record vendor LMG 3 Marketing and Development Corp. sues Apple, claiming that its Health and HealthKit apps violate its patents for technologies that it claims to have licensed to retailers such as Target. I found the original 2012 patent, which is a vague and seemingly unrelated description of a personal health record on a thumb drive. The primary inventor is Mike Lubell of Raleigh, NC, who developed MyPMR in 2000 while creating an EMR/PM business unit  for Canon Business Solutions. LMG 3 apparently still offers MyPMR for $34.95.


Other

Former National Coordinator David Brailer, MD, PhD says in a Wall Street Journal opinion piece titled “They’re Your Vital Signs, Not Your Medical Records” that Congress should ensure that individuals have unqualified ownership of their health information and be given legal control over who sees it. He adds that patients should be allowed to designate an “infomediary” who can manage their information on their behalf. He warns that EHR vendors and providers block interoperability to gain a competitive edge and because “whoever controls health information will dominate the healthcare marketplace and its vast profit pool.”

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Intermountain Healthcare CHIO Sameer Badlani, MD lists his favorite apps for reference guides (DynaMed, UpToDate, ACP Smart Medicine); drug reference (Epocrates, Lexicomp, and one listed as Medimex that I assume is supposed to be Micromedex); clinical calculators (MediMath, MDCalc, and one I haven’t heard of, OxCalc); and antibiotic guides (Johns Hopkins Antibiotics Guide, Sanford Guide).

UnitedHealthcare will offer 24×7 video-based virtual physician visits to members enrolled in self-funded employer health plans, expanding availability to employer-sponsored and individual plan participants in 2016. It’s working with Doctor On Demand, Optum’s NowClinic, and American Well, with access through its Health4Me app. 

A Phoenix TV station profiles the local neurosurgeon who in 2008 developed The Medical Memory, which provides doctors with video recording equipment for recording patient encounters and posting them securely online for reference and sharing. I checked out the video link from the site showing his overview, but was kind of turned off that he got rather curt with whoever was running his slides (he’s a neurosurgeon, after all). It’s fascinating to me that on at least half a dozen occasions recently, I’ve had email or telephone conversations with healthcare IT people who came across as rude and clueless, leading me to question: could they possibly be that unlikeable in real life, or do they just come across poorly online without realizing it?

I’ll go out on a limb with this story: a Florida man sues a hospital for discarding his amputated leg in the trash, which he discovered when homicide detectives knocked on his door to inquire about what it was doing there.


Sponsor Updates

  • The SSI Group will exhibit at the Louisiana HFMA meeting May 3-5 in Lafayette.
  • Streamline Health will host the 2015 NEXT Summit Client Conference May 3-5 in Atlantic Beach, FL.
  • VitalWare shares “Five More Facts about ICD-10.”
  • Versus Technology recaps its HIMSS15 presentation on “Transforming Process Improvement through RTLS Data.”
  • Huron Consulting Group will sponsor the 2015 Cristo Rey Viva Event on May 7 to support the students of Cristo Rey Jesuit High School in Chicago.
  • Verisk Health offers“How Dollars Flow to Fight Medicaid Fraud.”
  • Sunquest Information Systems will exhibit at the Pathology Informatics Summit May 5-8 in Pittsburgh.
  • T-System President and CEO Roger Davis weighs in on EHR interoperability.
  • Team Hackasaurus Rex wins TransUnion’s first Hackathon, held at California Polytechnic State University.
  • Truven Health Analytics will host its Advantage Conference May 4-7 in Boca Raton, FL.
  • Valence Health will exhibit at Becker’s Review and Annual Meeting May 7-9 in Chicago.
  • ZirMed CEO Tom Butts shares his thoughts on IT trends and challenges, hospital CFOs on preventing claim denials before they happen, and ICD-10.
  • MedData exhibits at the MGMA Anesthesia Administration Assembly through May 1 in Chicago.
  • MediQuant President Tony Paparella is interviewed as part of the #TalkHITwithCTG podcast series.
  • Navicure exhibits at Centricity Live through May 2 in Orlando.
  • New York eHealth Collaborative will exhibit at the Crain’s Health Care Summit May 5 in New York City.
  • Nordic Consulting releases the fifth episode of its “Making the Cut” video series on Epic conversion planning.
  • NTT Data offers “It’s Beginning to Look a Lot Like Christmas … Thoughts on the Apple Watch.”
  • Oneview Healthcare will exhibit at Digital Health Live 2015 May 5-7 in Dubai, UAE.
  • Orion Health, Patientco, and PDS reflect on their HIMSS15 experiences.
  • PMD offers “There’s More to Health Than Being Happy: What a Patient Satisfaction Score Really Means.”
  • Qpid Health will exhibit at the Medical Informatics World Conference May 5 in Boston.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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