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Monday Morning Update 1/19/15

January 18, 2015 News 5 Comments

Top News

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CMS Administrator Marilyn Tavenner, most known for her key role in the botched rollout of Healthcare.gov and for miscounting its enrollees to the White House’s embarrassment, resigns. Former Optum executive Andy Slavitt will take the role as interim. Trivia: Tavenner worked her way up from staff nurse at an HCA hospital to president of a 20-hospital HCA division. 


Reader Comments

From VeeDub: “Re: McKesson. Our system uses Horizon Clinicals at several of our hospitals and is just beginning the conversion to a new EMR. McKesson has told us that the last day of support for Horizon Clinicals will be March 31, 2018. I don’t know if this also applies to the rest of the Horizon product line.” Unverified, but McKesson has sent strong signals that sunset is on the Horizon.

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From Dollar Short: “Re: CIO salaries. You used to run these. Bring it back!” Since I’m a pleaser, I put together a few for you. I used to calculate the CIO’s salary vs. the non-profit organization’s revenue, but big health systems started gaming that number by setting up management corporations to hide executive salaries and reporting revenue in not very digestible ways. I chose a few big-name CIOs. Who’s up for names and pictures of the million-dollar club? (probably not members of the million-dollar club)

TX: $689,993
MA: $702,153
FL: $616,330
VA: $965,552
FL: $415,676
MA: $812,817
NY: $922,942
NY: $1,206,457
VA: $470,783
TX: $817,753
NC: $674,896
CA: $1,527,838
MA: $415,172
WI: $330,573
AZ: $1,084,140
FL: $1,091,266

From Hold the Mayo: “Re: Mayo Clinic. Will announce its EMR selection (Cerner or Epic) on Tuesday.” Unverified. One of the companies will get a lot of mileage out of that decision, and not long before the Department of Defense is making its choice besides.


HIStalk Announcements and Requests

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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My most recent poll  responses can be sliced and diced in a few ways. Forty-six percent of respondents overall will attend HIMSS15, while 22 percent who went to HIMSS14 aren’t coming this year (but those are outnumbered by readers who didn’t go last year but will this year). Based on that I would ordinarily project a slightly higher attendance for HIMSS15, but I’m not so sure the industry isn’t contracting a bit overall and attendance may not get that boost. New poll to your right or here: has technology significantly empowered patients? I would enjoy hearing your comments – click the link after voting and share your thoughts.

Listening: The Subways, a hard-rocking British three-piece band that puts on a hyper-energy live show (the bravest crowd surf ever is at 45:00 in the video). They’ll be touring to support their new album starting in a couple of weeks, but only in Europe. I’m rehearsing now for my US-based desk-drumming and air-guitaring support.


Last Week’s Most Interesting News

  • Google joins the Department of Defense EHR bid team of PwC, General Dynamics, Medsphere, and DSS.
  • A whistleblower lawsuit brought by two former NantHealth executives claims the company is “engaged in a multitude of fraudulent activities.”
  • Athenahealth acquires small hospital EHR vendor RazorInsights.
  • ONC’s numbers show that 77 percent of Meaningful Use Stage 2 eligible hospitals have attested along with 60 percent of eligible practices.

Acquisitions, Funding, Business, and Stock

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I’m fascinated by the continued share price decline of former high-flyer Castlight Health, which closed on its first day of trading last March at nearly $40, took a sharp slide immediately afterward, and now sits at less than $9, down nearly 80 percent. The company will announce full-year and Q4 results on February 18, which will be interesting.


Sales

In the UK, Sheffield Teaching Hospitals NHS Foundation Trust selects HP Enterprise Services UK to implement Orion Health’s clinical portal with Imprivata’s single sign-on.


People

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The SSI Group names Jay Colfer (Surgical Information Systems) as EVP of sales.

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Atul Butte, MD, PhD (Stanford University School of Medicine) will join UCSF to run its new Institute for Computational Health Sciences.


Announcements and Implementations

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Practice Fusion adds an online check-in module that collects patient information via practice-customizable online forms, then sends it to its EHR.

Wolters Kluwer Health enhances its Sentri7 surveillance system to support creation of antimicrobial stewardship programs.


Government and Politics

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FDA releases draft guidance for “General Wellness: Policy for Low Risk Devices.” FDA says it isn’t interested in treating low-risk wellness products as medical devices. Apps and devices are fine as long as they (a) address general wellness such as weight management, mental acuity, physical fitness, or sleep management without claiming to treat a specific disease or condition, or (b) use accepted medical knowledge to promote lifestyle management to reduce the risk of specific diseases or conditions.  


Privacy and Security

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Sensato announces its Hacking Healthcare 2015 cybersecurity conference, March 24-26, 2015 at Ocean Place Spa & Resort in Long Branch, NJ for health systems, payers, technology vendors, and physician practices. It will cover top healthcare security threats (including those involving biomedical devices), dealing with business associates, and developing strategies for addressing current threats. 

A New Jersey goes into effect that requires insurance companies to encrypt patient information on both desktops and laptops.


Innovation and Research

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Massively overexposed Mark Cuban, mostly known for being irreverently obnoxious before and after he made a ton of money, will emcee the Impact Pediatric Pitch Competition for pediatric digital technologies on March 16 at SXSW Interactive in Austin, TX. The event will be hosted by Boston Children’s, Cincinnati Children’s, Children’s Hospital of Philadelphia, and Texas Children’s.


Technology

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Fascinating: an astronaut needed a wrench, so NASA emailed up a CAD drawing and he 3D printed the tool on the International Space Station.

Samsung offers software developers and researchers a free prototype and development kit of its Simband wrist-based sensor. A tutorial steps through the writing of a heart rate variability algorithm in C, while the company also offers de-identified vital signs test data it will be collecting from research participants. 

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Berkeley, CA-based startup Eko Devices announces the $200 Core 1, which clips onto a standard stethoscope to record its sounds to any smartphone or tablet via Bluetooth, allowing doctors to share the sound file in consulting with a remote specialist.

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Stride Health launches a Healthcare.gov type medical insurance app that targets 1099 workers, claiming its app is easier to use and suggests insurance options that are more tailored to the user. The app is free since the company gets a commission on the insurance users buy. Mayo Clinic is an investor.


Other

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The Seattle paper covers what it calls the “OpenTable for medical appointments” patient scheduling apps, mentioning ZocDoc for medical appointment scheduling and InQuicker for ED scheduling. It quotes a New York dermatologist who says he couldn’t compete without ZocDoc, which sends him 15 patients per week, which seems unnecessary given the stats I’ve seen on long waits to get a new patient derm appointment, but he knows better than me. An ED patient who used InQuicker reports, “There must have been 50 people there, and they took me in 10 minutes,” which surely delighted those other folks who actually showed up and waited as the happy InQuicker user skipped the line for her “emergency.”

Speaking of EDs, Modern Healthcare reports that annual visits keep rising sharply despite the Affordable Care Act, with one ED doc saying, “We’re seeing a failure of access to care” as primary care practices close or stop accepting Medicare. Others say the newly insured just haven’t gotten used to the idea that they can be seen in places other than the ED.

Dartmouth-Hitchcock (NH) uses an EHR best practice alert to improve its blood transfusion practices, reducing the number of questionable two-unit transfusion orders from 47 percent to 15 percent.

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Harvard Medical School announces the formation of the Department of Biomedical Informatics, to be led by Isaac Kohane, MD, PhD of Boston Children’s Hospital who co-founded the predecessor organization, HMS Center for Biomedical Informatics. The department will have five core faculty members.

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Weird News Andy nominates this as his quote of the year: “Being a corpse was the most bizarre experience, but I’m so glad I managed to get out alive.” An Alabama teen with the rare mental illness Cotard’s Syndrome, in which those afflicted believe that they are literally dead, recovers three years later after psychiatric help and watching Disney movies (insert commercial skepticism or promotional opportunities here, especially since she says she and her boyfriend now want to work for Disney World). Those with the condition believe they are dead and/or immortal, that their body parts are missing or decomposed, or that they can relax only in cemeteries.


Sponsor Updates

  • Liaison Technologies CEO Bob Renner dives into five micro trends that will define big data over the coming year.
  • Versus client Dan Chambers, MBA, COE, of Key-Whitman Eye Center writes in the January issue of Ophthalmic Professional magazine about RTLS and how the technology improves patient flow.
  • Healthwise SVP Molly Mettler reflects on the opening of Healthwise 40 years ago in a new blog.
  • The local Fox News affiliate mentions Healthgrades in a story on keeping New Year’s resolutions.
  • Healthfinch makes “Another Case for Strategy, Not Just Tactics” in its latest blog.
  • Harris Corp. will exhibit at the iHT2 conference in San Diego January 20-21.
  • Impact Advisors publishes a white paper, “Optimization: The Next Frontier.”
  • Healthcare Data Solutions lists five things to love about pharmacists in celebration of National Pharmacists Day.
  • Extension Healthcare blogs about channeling change and your inner Florence Nightingale in 2015.
  • Health Care Software Inc. will exhibit at the LeadingAge California meeting in San Diego on January 23.
  • DocuSign shares tips on enhancing employee productivity in its latest blog post.
  • Hayes Management Consulting shares “Everything You’ve Wanted to Know About Keeping Employees Happy During System Implementations But Were Afraid to Ask” in a new blog.
  • SCI Solutions offers a new blog on “Eliminating the Blind Side in Care Coordination.”
  • Sagacious Consultants offers insight into improving sepsis detection using Epic in its latest blog.
  • PMD’s Siavosh Bahrami offers a new blog on “Mediums of Thought and How I Approach Problems.”
  • Phynd CEO Thomas White offers insight into the company’s ROI model in a new blog post.
  • PeriGen doubles its PeriCALM customer based in 2014, bringing total estimated number of births supported to 140,032.
  • The local paper profiles Perceptive Software’s office in a roundup of Johnson County’s coolest offices. (nice pic, too)
  • Nordic releases the third episode in its series on Epic’s Cupid application, covering differentiators and implementation stumbling blocks.
  • NVoq shares the top three providers should know about its SayIt speech-recognition technology.
  • Netsmart releases two new white papers: ”The Recovery Movement” and ”In Transition: How Electronic Data Sharing Enables Improved Health Outcomes and Reduced Costs.”
  • MEA I NEA publishes a new blog entitled, “Connected practices may be hindered by lack of a website; yes, a website.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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January 18, 2015 News 5 Comments

Reader Survey Results 2015

January 18, 2015 News 5 Comments

Thanks to everyone who completed my reader survey. Congratulations to the three winners of $50 Amazon gift cards I’ve sent (I had fun writing an Excel randomization routine to make sure I wasn’t biased in any way in choosing the winners).

I run the survey once per year. It helps me plan going forward. I always like to share some of the interesting feedback I get from it.

I’ll chime in on a few of the comments and suggestions. I should mention that the most common recommendation was, “Don’t change anything.” I appreciate that.

I have a diverse readership, and while it might seem obvious that I should make a given change, that’s from one person’s viewpoint. People have different motivations for reading HIStalk – some want just the top news boiled down, some are scouring for competitive intelligence, and many want to be entertained along with their news. I don’t want to get in the trap of writing by committee no matter how well intentioned the advice, where I please nobody in trying to please everybody. My audience is self-selecting – you either like what I write or you don’t, and I have to make you want to come back every day. It’s harder than it looks sometimes given all the distraction that’s out there.

Some major points from the survey:

  • Readers mostly work for hardware or software vendors (47 percent); hospitals, health systems, and practices (27 percent), and 68 percent have at least 11 years of experience in healthcare IT and healthcare.
  • The most common job function is IT or vendor staff or management, nine percent are clinicians, and about six percent of readers are CEOs and the same percentage are CIOs.
  • The most-appreciated elements of HIStalk are (in order) news, morning headlines, rumors, humor, and Dr. Jayne. The least-liked element is Readers Write.
  • Eight-five percent of respondents say they have a higher interest in companies when they read about them in HIStalk.
  • The most important survey result is this one: 91 percent of readers said reading HIStalk helped them perform their job better last year.
  • More than a third of readers recommended HIStalk to a peer in the past month.

Here are some of the recommendations.

Separate out Dr. Jayne’s Thursday night contribution into its own post for easier reference.

Good idea. That’s easily done. Long-time readers may remember that when Dr. Jayne started five years ago, I ran her post at the end of Tuesday night’s news. Then I had the brilliant idea (that’s not exactly true – a reader suggested it in the reader survey five years ago) of moving her post to Monday nights on its own. Dr. Jayne is a busy lady, so I’ll have to coordinate with her schedule.

Don’t write so much about startup funding.

More people said I should write more about it. I haven’t changed my threshold for what seems interesting or newsworthy about funding — there’s just more of it to cover these days as investors chum the waters. Clinical readers sometimes yawn at the business news and vice versa, but at least the business section is easily skipped (the idea of breaking out posts with subheadings also came from a long-ago reader survey, in fact).

Stop putting so much emphasis on the HIMSS conference and the events you have there.

I agree, although many readers follow that closely. I’ll try to find more substance at the conference to write about, but it seems to be in short supply.

Don’t be so snarky.

The “be more snarky” camp has you outnumbered in their responses, I’m afraid.

Stop promoting Epic so much.

I’ve analyzed my mentions of Epic and they are balanced. Most of the time I’m reporting something newsworthy or that would interest my Epic-using provider readers (of where there are many), and in those cases where I editorialized, it was a pretty even split between positive and negative. Writing about Epic is a challenge because any time I mention them, people who (a) compete with them; (b) aren’t Epic users; or (c) tried to get a job there and failed scream “favoritism.” I write about Cerner’s new campus and nobody says a word, but I mention Epic’s new campus and smoke starts coming out of the ears of some readers who react to the word “Epic” as a bull does to a matador’s red cape. If you think something I say is biased toward Epic, say so in the comments and see if others agree. I do pay attention.

Stop calling Epic’s Judy Faulkner “Judy.” It’s demeaning because you don’t do that with males.

Sure I do. I write about Neal, Farzad, Vince, Ed, and JB (for Jonathan Bush) using only their first names for the same reason – just about everybody knows who I’m talking about because their names are uncommon, unlike Paul, Robert, or John. When I hear people talking about Judy Faulkner, 90 percent of the time they just say “Judy.” I’ve never heard anyone respond with, “Judy who?”

Expand the contributor group – not everybody seeks the spotlight.

The problem is that many people shun the spotlight. I’d greatly appreciate more contributors with different viewpoints, but the single best lesson I’ve learned in 12 years of writing HIStalk is that everybody likes to read, but almost nobody likes to write. I’m always encouraging different people to write Reader’s Write articles, submit their own series of articles, or be interviewed — what you see on the page is what I get (usually vendor people interested in the exposure, which is why people don’t like Reader’s Write). Non-vendors and lesser-knowns, get in touch if you are willing and able to contribute because I’m up for it.

Start a column with new perspective from a pharmacist, lab director, nurse, and others on the front lines.

See above. I’ve asked before, especially for a nurse who writes well and has interesting points to make, but nobody has volunteered and I can’t force them to do it.

Get the contributions of government contractors since they know what’s going on.

Dim-Sum’s contributions about the Department of Defense EHR have been outstanding. I would be thrilled to run more government-oriented pieces, even anonymously, if someone is willing.

Get the contributions of patients and consumers.

I’ve tried getting people for that too with no luck, but at least I’ll have something from HIMSS since I’m providing several scholarships to patients who will attend and write about their experience on HIStalk (more details to follow).

Offer a column, interview, or other collaboration with HIMSS.

We each tend to do our own thing, but I’m willing if they are, assuming it’s interesting to my readers and not just promoting HIMSS.

Offer a column to incubators like Rock Health.

I’ve started with startup CEOs and investors and an incubator or accelerator column would be fun, limited again by the willingness of someone to actually do it. And the complaints of those HIStalk readers who say they’re tired of hearing about startups.

Put on more non-commercial webinars like the Dim-Sum and Vince ones.

The rate-limiting factor is presenter willingness, not mine. All the presenter needs is a bit of time and expertise – we lead them through the process from abstract to delivery and of course I bear the expense gladly. Dim-Sum’s webinar on the DoD EHR has had 1,531 views on YouTube and Vince’s Siemens-Cerner presentation has been viewed 1,807 times, so demand exists for webinars that are more educational than commercial, which I had in mind from the start. I have the forum and platform if you have something educational to offer readers.

Perform more analysis of informatics literature.

I love doing that myself when I have the time and have the full-text of an interesting article. I’ve asked before for an academic type to be a “literature scout” to find good journal articles and summarize them, but I haven’t had any takers. I’m feeling like a looping recording in saying repeatedly that I don’t get volunteers, but I’m just explaining why it’s not quite like the engaged community anxious to contribute that you might envision.

Stop using blue font for the reader quotes.

I’ll have to think about how to best indicate that I’m quoting a reader.

Improve the search function.

That comes up in every year’s survey, but I don’t have a solution. It’s already a Google search that works well, but what some folks want is to be able to click on a word like “Cerner” or “genomics” and have a perfectly sorted list of articles by date pop up. It just doesn’t work that way with the format I use, which is intended for an easy summary read rather than to support discrete searches. HIStalk, technologically, is just a bunch of web pages with one per post, not a massively indexed database (it’s kind of like a free-text chart entry vs. individual EHR data fields). I’m open to technology suggestions if anyone has some. Lots of  health IT vendors offer tools that convert free-text documentation to structured and searchable, so maybe this is their test case.

Spell Meditech as MEDITECH.

No. There’s just no reason to make it all capital letters. I go by the AP Stylebook, as does the Boston Globe, which spells it Meditech. Companies can go marketing crazy with cute capitalizations and symbols within their names, but that doesn’t mean publications have to buy into it. Hospitals are getting into the act, such as NewYork-Presbyterian (no space) and Partners HealthCare. Apparently spelling a word correctly following civilized rules doesn’t sizzle enough to stand out.

Stop being so picky about grammar.

No. I hate it when people make up their own rules because following society’s rules is inconvenient. Many people worked hard to teach me English, so I feel no shame in using it correctly. Americans are bizarre in passing along to their children their bemused indifference to competence in English and math, so we’ll see where that gets us in a competitive world market.

Some of the interviews feel scripted – mark those that are done live.

I do every interview live by telephone. Also, the subject hasn’t heard the questions until I ask them and doesn’t get to approve the final transcription. Two exceptions: (a) the “HIT Moment With …” where five-question interviews are done by email, and (b) a couple of times over many years, my interview subject did not speak easily understood English and I knew both the subject and I would have to work a lot harder to complete the interview, so I begrudgingly allowed email answers. I’ve done many hundreds of interviews and all but a handful were me talking on the phone asking off-the-cuff questions (I do edit out the many times the subject says, having become accustomed to low-quality reporter interviews, “What a great question …”). It would probably be fun to listen to the actual recording that gets transcribed – I interviewed Premier CEO Susan DeVore while having fajitas and a Tecate in a Mexican restaurant since I was super busy that day. I started off by telling her that she was hearing my private mariachi band serenading me in the background, which she found amusing.

Respond when someone leaves a stupid comment on a post.

I don’t want to talk over a reader who leaves a comment, even one I don’t agree with or that is factually incorrect. I let other readers correct them as they see fit. If they don’t, then I assume the comment is at least somewhat justified even if it stings a bit (my skin’s not as thick as it might seem).

I would like to have a quick way to see quickly the comments left on a post and then jump to them.

I will look into commenting options. I had a good cloud-based tool that seemed perfect, but it didn’t work for reasons I never could figure out in multiple attempts.

Send the email blast in the middle of the night instead of at around 8 p.m. EST. It creates pressure to read and I’d rather have it pop up in the morning with the other news I read.

Readers in Pacific times zones jump on HIStalk as soon as the email goes out, so I would hate to hold it until the next morning, plus some people want to see the news as soon as they can. I remember clearly when Todd Cozzens ask for a show of hands from the stage of HIStalkapalooza in Chicago how many people drop everything when the HIStalk email arrives – a frightening number of them went up.

Develop a mobile app.

I’ve been looking into that, although the existing mobile format works OK. Real-time notifications might be useful, though.

Ed Marx never did write anything about the Ebola debacle. The omission makes me think that maybe HIStalk is not as impartial as it says it is.

Let’s be realistic: would your employer give you permission to speak off the cuff to a media outlet about an issue of great human, corporate, and legal sensitivity? Or if your spouse died of Ebola, would you want to see the hospital CIO prattling on about that tiny piece of the case that he knows something about? Ed contributes articles, but he’s not free to talk casually about his employer or the patients they see, no different than when nearly got fired by my hospital when I started writing HIStalk and a loser vendor complained to my boss that I was saying bad things about them (leading to my immediate interest in anonymity).

Keep up the music recommendations.

I’m heartened by several such comments since usually someone complains about anything even slightly off topic, always in the form of, “I don’t read HIStalk for …” as though I’m an HIT-posting robot banned from going off script. Sometimes I fantasize about starting a new, unrelated site about some topic I know next to nothing about just to see if I could make it interesting while learning about the topic.

Write shorter posts or write news daily to shorten the individual posts.

Both are tough for me. I only include items I think are interesting and I cover a lot of ground succinctly, so I’d have to cut something I think is worth reading. I used to write news daily, but readers observed that HIStalk wasn’t particularly special any more when it hit their inbox every workday. Lt. Dan posts morning headlines each weekday if you just want a quick skim to see the major news items without the usual commentary and snark.

It sounds like you think you need to change something. Whatever you do, keep the news, juicy gossip, and sly, somewhat jaundiced humor.

I’ve been writing HIStalk for 12 years, so sometimes I get the urge to try something different. Occasionally I see all of the movers and shakers out there doing cool stuff (starting companies, developing products, running think tanks, etc.) and feel a pang of regret that I’m a sideline reporter rather than a full-contact participant in those high-profile or society-benefitting activities. That usually passes quickly, though, and every day when I face that blank screen yet again with excitement and hopefully some creativity, I realize I how lucky I am to be able to something I enjoy in whatever way I want. I’ve learned to be happy with my place in the world.

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January 18, 2015 News 5 Comments

CommonWell Answers HIStalk Reader Questions

January 16, 2015 News 15 Comments

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David McCallie, Jr., MD, SVP of medical informatics for Cerner and co-founder of CommonWell Health Alliance, invited HIStalk readers to submit their questions about CommonWell. He obtained answers from the most appropriate CommonWell resource. These replies were provided by David along with Dan Schipfer (VP/GM of government for Cerner and CommonWell operating committee chair); Nick Knowlton (VP of business development for Brightree and CommonWell membership chair); Bob Robke (VP for Cerner and CommonWell treasurer); and Jitin Asnaani (director for Athenahealth and CommonWell operating committee co-chair).

How do organizations like CommonWell promote interoperable transfer of health information to non-members? If our goal is a national infrastructure for transfer of PHI, don’t these aggregations of health partners create barriers to a national solution?

From a strategic point of view, CommonWell’s founders created the network because they did not believe that any of the existing approaches met the need for national-scale federated query based on robust identity management and record locator services. CommonWell’s founders believe that regional and vendor-proprietary networks won’t meet the demand for universal query connectivity. In contrast, CommonWell membership is open to all HIT suppliers and their customers, nationwide. However, if other networks emerge that cover substantial portions of consumers, CommonWell is open to creation of bridging services that could interconnect with other networks.

More tactically today, we feel that CommonWell has already promoted interoperable transfer of health information by publicly calling out the important issue of the lack of a common patient identifier in US health care. Second, to advance the state of the art, CommonWell members have designed and published specifications that address the problem of the missing patient identifier. These specifications are available for any and all (i.e. members and non-members) to evaluate, improve, implement, and use under common open source licensing. 

 

Does CommonWell have any plans for taking the initiative outside of the US?

We’re taking it one step at a time. Currently, CommonWell’s focus is to deliver real-world interoperability services across the US.

 

Why did some folks refer to CommonWell (in its early days) as the "HIE killer" and is that still a valid point? Accordingly, do entities like Aetna (who has invested in Medicity) and Optum (with their Axolotl acquisition) consider CommonWell to be a threat?

It is difficult to speculate on behalf of “some folks,” but CommonWell is not attempting to “kill” any type of exchange. CommonWell is designed to offer a national-scale service because we believe that a patient’s provider should have access to that patient’s information regardless of where the information lives. Through this approach to “universal plumbing,” members can expect an increase in the access to health information for their providers and a decrease in the cost and time for providers and their patients to gain access to their health information.

By addressing shortcomings in existing exchange models (such as imprecise standards that inhibit vendor to vendor connectivity), CommonWell is drastically reducing time and associated expense to achieving health information exchange. Furthermore, in a world driving towards the triple aim, interoperability initiatives such as CommonWell are aligned with goals common to payers, patients, provider networks, and national healthcare delivery objectives.

 

How does CommonWell relate to the Argonaut project?

There is no formal relationship. The Argonaut Project is an industry-funded initiative to accelerate the development of technical standards (FHIR and OAuth) in conjunction with HL7. On the other hand, CommonWell is a trade association that is deploying a national network. The results of the Argonaut Project should complement CommonWell’s existing use of standards, which are partially based on FHIR, as well as on standard IHE profiles like XCA (for document-based exchange). The standards work stimulated by the Argonaut Project will be important to HIT in general. CommonWell hopes to leverage these new standards to provide enhanced services as they become formalized.

 

What fees will be collected for using CommonWell’s system, who pays those fees, and where does the money go?

CommonWell is a non-profit trade association that relies on two different fee sources to operate.

One is membership dues, as are common to most not-for-profit trade associations. The dues schedule is based upon an organization’s annual US HIT revenue and provides for the organizational expenses of running the Alliance. A more detailed breakdown of the membership fees is available on our website.

The second fee, a Service Fee, covers the cost of the core services provided by CommonWell to its members to facilitate data exchange and includes the identity management and record locator services. By doing this at the vendor level, CommonWell is able to achieve unprecedented economy of scale gains for streamlining connectivity. Members who provide access to CommonWell to their customers are free to charge (or not charge) for those services as they see fit. As a non-profit trade association, CommonWell has chosen not to mark up these costs to membership.

CommonWell cannot set the fees charged by member companies to their customers. However, our expectation is that those fees will be modest compared to the value of the services delivered and will be assessed in the “commodity service” philosophy espoused in our founding principles. As noted in CommonWell Board Chairman Jeremy Delinsky’s recent blog, athenahealth’s service fee equals about one-tenth of one-percent of their annual revenue.

What’s costly for everyone is the need to build numerous point-to-point interfaces and reinvent the wheel of patient identity management for every exchange scenario. Connecting once to a nationwide network, as the health care industry has done in other instances, has proven to be a better model for widespread data exchange.

 

Will EHR vendors pay a competitor (McKesson and CommonWell’s IT provider RelayHealth) to exchange information with other systems?

CommonWell Health Alliance delivers the services to the HIT members. RelayHealth is CommonWell’s initial contracted network service provider. As with any service offering that requires hardware and software, the services fees paid by the member to the Alliance help to offset the Alliance’s network service provider investment and compensate them for the costs of providing that service.

 

I heard it costs $2 million to become a member of CommonWell. What is the ROI for those members?

As noted above, if a vendor chooses to offer CommonWell Services to its clients, the vendor is charged a Service Fee in addition to the Membership dues. The Alliance currently charges an annual Service Fee to cover the cost of the core services. The Service Fee is based upon the Member’s annual HIT revenue. This annual fee allows the Member to onboard an unlimited number of clients onto the CommonWell Network.

CommonWell plans to publically post the Service Fee schedule on our website later this year, but for the vast majority of members, the costs will be far below that amount.

 

If I’m an Epic shop, what can CommonWell do that I can’t already do through Epic? What are the cost comparisons?

CommonWell provides a national-scale identity management service, nationwide record locator service, and universal connectivity to any vendor that offers the service. A single connection to the CommonWell network will enable providers and the patients they serve to access to their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach. The identity management and record locator services reduce matching errors and make it seamless for the provider since the patient does not have to remember the places where they have records. We don’t know of any single vendor network that can enable access to a patient’s health data regardless of where they have been seen.

 

Why would providers want a few publicly traded vendors running a fee-based backbone instead of pushing the government to create freely usable standards available to all vendors?

CommonWell’s founders believed that identity management and record locator services were necessary for effective national-scale query connectivity. Those services have to be organized and paid for by someone and the existing government-related approaches were not committed to delivering those services. Additionally, the founders believed that the vendor community was in the best position to “build in” support for efficient, seamless connectivity. The standards on which CommonWell is based are indeed freely available, but the national scale services that make those standards useful require an organization and appropriate organizational governance.

 

How are health plans and payers represented in the CommonWell alliance? Medicare’s risk adjustment have always demanded better access to and merging of administrative and clinical data. Now that the ACA demands risk adjustment for commercial population the need for this marriage is even greater. The ability for health plans to better assign risk to their members and the ability for providers to help close care gaps and meet their CMS-mandated obligations for data exchange can be greatly facilitated by providing improved attribution mechanisms for identifying members, providers, and specific encounters. And there should be a common means for plans to provide care gap info.

Right now, CommonWell is made up of 17 health IT vendor organizations, but we encourage membership to any organizations, including payors, that share the association’s values and vision for interoperability. In the early days of the Alliance, we had to remain focused on designing, building, and deploying our core services. These existing services offered by the Alliance are well aligned with offering improved delivery of healthcare for the nation, and that inherently provides benefits for all stakeholders – including patients, providers, and payors.

While this is a great start, we recognize that there are other opportunities to provide value for how healthcare is delivered and CommonWell certainly has an opportunity to build upon the established model to provide additional value. The Alliance welcomes participation from and conversations with payors and other healthcare stakeholders outside of the core EHR community. We have engaged early conversations with several payors that share our vision and understand how crucial interoperability and data liquidity are to improving care.

To complement this, the Alliance has established a process for reviewing member-proposed potential service line extensions and welcomes payors to help determine if the identity management and record locator services offered could add additional value to the patient populations represented by the members in the Alliance, through examples such as care gap closure, without compromising any of our core principles.

 

What factors convinced Cerner to join the CommonWell and what is Cerner’s play after the three years of free services?

The early days of CommonWell have been focused on getting the network deployed as widely as possible to ensure that meaningful health information is delivered. We understand that the value of the network depends upon how widespread the usage is. Cerner wants to remove as many barriers as possible to help speed deployment. Removing financial barriers to early adoption was a straightforward decision for us. After the initial three years, we expect that the costs associated with the services will be in line with other EDI like transactions and will be considered minimal in comparison to the value a client receives.

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January 16, 2015 News 15 Comments

News 1/16/15

January 15, 2015 News 5 Comments

Top News

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PwC adds Google to its Department of Defense EHR bidding consortium that is pitching the VA’s VistA. Google joins, PwC, General Dynamics IT, DSS, and Medsphere. Google’s contribution would be collaboration and search tools, which seems to be more sizzle than steak as PwC tries to make VistA sound sexier to the DoD, whose contempt for that system is legendary. The group has also put up a web page to make its case.


Reader Comments

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From Weird News Andy: “Re: Iowa health insurance startup, the second-largest co-op in the country and heavily funded by the federal government, fails. The key is in this quote: ‘CoOportunity Health’s pool of people was larger than expected, was sicker than expected, so their risk became much greater than the funds that were available.’ That’s an economics lesson. Sicker people spend more and choose the one that saves them the most money, so you end up with a pool of sicker, more expensive members. If the founders of the organization did not see this going in and did not charge enough for their service, the fault is theirs. But then if they charged more, fewer people would select them and …” That’s a big problem with medical insurance. The fingers of insurance company actuaries fly over their Excel worksheets in their attempt to assemble a customer base that includes lower-risk, healthier patients to offset the expensive ones so they can bid competitively. However, individual patients sign up expecting to use more services than they’re paying for, to the point of not even buying insurance until they’ve accumulated enough problems to make it worth their while. It’s like a buffet restaurant eyeballing prospective diners at the door in trying to choose a profitable mix of picky eaters and starving chowhounds for a predetermined price, but their downfall is that few picky eaters will pay for an all-you-can-eat buffet knowing they’re subsidizing those who inhale everything in sight.

From RVA: “Re: concierge medicine. My PCP is moving to concierge practice, saying he doesn’t want to use Epic and that he can’t provide good care because his face is always in the computer ((FYI, he cashed his MU check). The concierge company touts their USB chart that allows you to take your important clinical information anywhere — apparently MyChart was not good enough (the guy sitting next to me joked that when they run out of USB drives, they’ll switch to 8-track tapes). He has approximately 1,200 patients (mostly Medicare) and a poorly-managed practice. They showed a scary video about how doctors are ‘forced’ to give up their practices and referenced the use of ‘mid-level providers’ in a negative way. A lot of people ate it up and started pulling out their checkbooks – oh, he has limited capacity, so it’s first-come, first-served at $2,500 per year. I’m worried that we’re creating a class system where those who can’t afford the fee get less than premium care.” It’s tough to ignore economics by suggesting that those who pay less should receive equally generous, excellent, and responsive healthcare services, even though we as decent people wish that were possible. All of us working in healthcare expect to be paid, so unless we turn it back over to the nuns and counties that ran hospitals as true non-profits using cheap and volunteer labor, those days are likely gone. The ED is the last foothold of healthcare democracy, where everybody is treated the same based on need, but then again, it’s a cost cesspool for that reason and hardly a poster child for open access to all. Healthcare economics is like a balloon – squeeze it in one place to cut costs and another part bulges out as providers who are understandably unwilling to reduce their personal standard of living figure out new ways to charge for their services. We’re at three tiers now: (a) those who use ED and public clinics or who don’t buy insurance because they don’t see the immediate value; (b) the large middle class who have insurance but are getting hit hard by out-of-pocket costs and sometimes facing bankruptcy because of huge and often questionable bills, with that group subsidizing the first one by paying excessive charges and taxes; and (c) those whose assets are adequate to self-insure and whose time is valuable enough to make it worth finding the best and most customer-friendly providers who don’t take insurance. It’s unrealistic to expect the care and outcomes to be identical across all three groups. It’s also reasonable to expect people in the middle group to move down rather than up, and it’s the loss of that group that threatens to implode the system. It’s just like the tax system: some percentage of people pay nothing, the wealthy pay a low overall percentage because of their small numbers and large accounting tricks, and those in the middle foot most of the bill.


HIStalk Announcements and Requests

Last year right before the HIMSS conference I supported Donors Choose by offering companies a large, short-term banner that appears beside the HIStalk title on every page, using the proceeds to fund a bunch of projects for classrooms in need. It felt good and it was fun, so I’m doing it again this year. Contact Lorre if you’d like to book the most prominent ad on the page and help needy students in the process. Like last year, I’ll write up the projects we funded and share the student comments and photos that result.

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I followed through on a reader’s suggestion of an HIStalk Book Club sort of thing where I review an HIT-related book and invite readers to share their thoughts. I reviewed Eric Topol’s “The Patient Will See You Now” and next up is “America’s Bitter Pill.” Read along, add your thoughts, and suggest what book I should read next. I have a copy of John Halamka’s “GeekDoctor: Life as a Healthcare CIO” that HIMSS sent me in return for completing a survey, so maybe that should be next.

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I’m sure we’ll see this at the HIMSS conference: every hip meeting now includes a “graphics facilitator” who documents everything on a flipboard, compelling attendees to proudly tweet out photos of the drawing afterward. I don’t want to attend a conference where a cartoonist understands the presenter better than I do.

Here’s one last appeal for you to complete my once-per-year HIStalk reader survey, which takes just a couple of minutes but helps me immensely.

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This is a fond farewell to Agilum Healthcare Intelligence, whose marketing person told us, “I’ve never even heard of HIStalk” in declining to renew their sponsorship after many years. They’ve been supporters for a long time and I appreciate it. I also appreciate the service of the marketing guy, who though he has zero health IT experience, is a former Army infantry captain who led a field artillery battery in Iraq, according to his LinkedIn profile.

This week on HIStalk Practice: Telehealth reimbursements are set to go live in New York. Tulane University Medical Group implements eCW’s CCMR. Etherapi takes advantage of the Kaiser strike in California. HHS breaks down its own silos, and enjoys flying first class. Dr. Gregg looks into the future of healthcare IT, circa 2037. Third-party patient portals go head to head with vendor-specific options. Thanks for reading.

This week on HIStalk Connect: 23andMe finds a new source of revenue as it closes a $60 million deal with Genetech in which it will use its dataset to support Parkinson’s disease research. Athenahealth acquires cloud-based inpatient EHR vendor RazorInsights, and confirms that it will move into the hospital space. Augmedix raises $16 million to scale a promising Google Glass-based telecharting business. 


Acquisitions, Funding, Business, and Stock

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Todd Cozzens of Sequoia Capital is featured on Fox Business’s “Opening Bell” live from the JPMorgan Healthcare Conference. He mentions his firm’s investment in Health Catalyst (analytics) and MedExpress (retail clinics). A Forbes profile of Sequoia Capital mentions its 40-plus year history, including its 1980 investment in Apple’s IPO (the founder thought the 22-year-old Steve Jobs “looked like Ho Chi Minh”) and its recent gains from Airbnb, Dropbox, and WhatsApp. The firm’s partners make a fortune, apparently, as the article mentions a 2003 fund that returned gains of 41 percent per year for 11 years, with the firm’s partners pocketing $1.1 billion as “Sequoia is turning its own partners into billionaires while keeping outside investors purring.”

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I mentioned that Athenahealth has acquired small-hospital EHR vendor RazorInsights for a rumored $40 million to give it an inpatient foothold. I really like what RazorInsights is doing in giving small hospitals an inexpensive, cloud-based system that covers both clinicals and financials, but I don’t see the benefit to Athenahealth in buying a four-year-old company with only a couple of dozen small customers. RazorInsights has much larger competitors (Meditech, CPSI, Medhost, NTT DATA, McKesson Paragon, etc.) with established infrastructure and most hospitals have already spent their money on a Meaningful Use dance partner, some of them even choosing to run Epic or Cerner as provided by another hospital (or to be acquired by those hospitals). Athenahealth has choked on its previous acquisition Epocrates, which is highly regarded but is stumbling even more than before under Athenahealth’s ownership. I think Athenahealth wants desperately to crack the inpatient market (after insulting that market for years), realizes it doesn’t have the expertise to build a new hospital system from scratch, and decided to spend money instead of time to get a name-plated product quickly to market and then ramp it up. The challenges are many:

  • RazorInsights is small for a reason and not being owned by Athenahealth may not be it.
  • Both product and company scalability are unknown.
  • Few big companies have low-enough overhead to profitably roll out products to cash-strapped 25-bed hospitals.
  • Expected synergies may (as they often do) prove to be elusive.
  • Companies have been historically lured into unwise acquisitions because the product aroused them technically and filled a perceived immediate need at high expense (Allscripts buying Eclipsys).

I think Jonathan Bush will talk this up as though Athenahealth is the next Epic (or Salesforce or whatever high-flying comparison comes to mind), but the acquisition is just another distraction as the company tries desperately to keep its Wall Street plates spinning in the air despite concerning profits and a year-long share price stall.

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Aetna announces that it will raise its minimum wage to $16 per hour in April and will offer an enhanced insurance plan for employees who participate in wellness programs starting in 2016.

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Two former NantHealth executives file a whisteblower lawsuit against billionaire doctor Patrick Soon-Shiong’s company, claiming that NantHealth is “engaged in a multitude of fraudulent activities,” violates HIPAA requirements, has failed mock FDA audits, and offers products that harm patients. Stephanie Davidson (former SVP of professional services) and William Lynch (former senior director of marketing) also claim that several customers were prepared to stop using the company’s Clinical Operating System, citing an internal report that characterized that product as “10 years behind in technology capability” that “runs on LUCK.” The pair claims that NantHealth’s marketing material is misleading and that Soon-Shiong’s charitable foundation defrauded Medicare by donating millions to a hospital that would then use CMS matching funds to buy NantHealth’s products. NantHealth’s responds that the employees, who are in a romantic relationship and had worked for the company for only a few months, demanded that NantHealth pay them $2 million to prevent them from launching a pre-IPO smear campaign after NantHealth fired Davidson. Perhaps it’s not a coincidence that the lawsuit was filed just as Soon-Shiong gave the company’s investor pitch at the JPMorgan Healthcare Conference.

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Craneware says second-half sales for 2014 increased 10 percent and its board is confident of meeting 2015 expectations.


Sales

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Good Shepherd Health System (TX) chooses Strata Decision’s StrataJazz for decision support and cost accounting.

Healthfirst (NY) selects InterSystems HealthShare as its HIE and clinical portal.

Providence Health & Services expands its relationship with Kyruus, which offers a doctor web search tool. That’s how I would describe their business, anyway, but if you don’t get enough buzzwords, here’s theirs: “Kyruus is an enterprise healthcare provider solutions company that helps health systems optimize their Patient Access, Referral Management and Care Coordination operations. Leveraging the cloud and a proprietary Big Data approach, the company enables the integration of massive amounts of information to create a single source of truth of providers. Kyruus helps health systems create customizable protocols for referral and scheduling across all channels of patient engagement to improve patient access and patient experience.”


People

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Ralph Keiser (Deloitte) joins Recondo Technology as chief growth officer.

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John Glaser (Siemens Healthcare) joins the board of the American Telemedicine Association.

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Hayes Management Consulting hires Gay Fright (Coastal Healthcare Consulting) as VP of strategic services.

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Huntzinger Management Group promotes David DiChiara to CFO.

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Sachin Jain, MD, MBA (Merck) joins care plan CareMore as chief medical officer. He worked for ONC for a short time a few years ago. He said in a talk last week that most health IT startups offer products that are interesting but not really useful because (a) they’re trying to make a quick buck, and (b) they are mostly run by young, prosperous, healthy people and develop products in the context of their peers rather than for the sick, expensive patients that need help. He also said HITECH came about because everybody knew EHRs were good for patients, but hospitals put the interest of their resistant doctors first because they’re the ones who admit patients.

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Ken Pool, MD, co-founder of OZ Systems and co-chair of the HL7 Public Health and Emergency Response Work Group, has died, according to a posting on the group’s listserv.


Announcements and Implementations

An article by Brad Swenson of Winthrop Resources Corporation suggests that the total cost of ownership of hospital EHRs should use a 10-year forecast rather than the more common five or seven years. It quotes The Valley Hospital (NJ) VP/CIO Eric Carey, who used a 10-year timeframe to make an upgrade-or-buy decision: “We felt no one should be replacing an EHR platform in less than 10 years unless a catastrophe happens. Also, probably the most expensive part of an EHR project is the army of consultants, staff, and project managers you need to have to pull everything together. Our implementation has involved 20 FTE over at least one year. Most organizations can’t afford to do that more than once.”

McKesson announces Paragon Community Plus, a package that includes its Paragon system, implementation, training, and remote hosting.


Government and Politics

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A House Committee on Energy and Commerce work group creates a draft policy that would require HHS to pay for telehealth services at the same rate as in-person visits within four years.


Innovation and Research

Philips gives MIT researchers access to the de-identified records of 100,000 ICU patients who were monitored via its eICU program. The records, which represent about 10 percent of all US adult ICU beds, include vital signs, medication orders, lab results, and severity of illness scores.


Technology

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Google stops public sales of Google Glass and moves the product from its research lab to a separate business unit led by former fashion and eyewear designer Ivy Ross. Companies and developers will still be able to buy Glass units after the January 19 cutoff date. Google was supposed to release a new version of Glass in 2015 but hasn’t provided specifics. People seem to think this is the beginning of the end for Glass, but I’m not so sure: it desperately needed a reboot, graduation from beta status, and design help for its ugly form factor (which is true of most things Google), so perhaps this is its graduation into the real world, or even away from the consumer market and into the enterprise one.

A guest newspaper article by the CEO of a Missouri public policy organization says the state is still #49 in economic growth despite being one of nine labeled as “the corporate welfare kings of America.” He says of the Missouri’s $1.6 billion subsidy of Cerner’s $4.3 billion new campus, “If Cerner needs a corporate pleasure dome, it should pay for it on its own nickel.”

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I thought sure this was a spoof since it was heavy with Star Trek puns and one of the pictures features a nurse wearing a 1970s-style cap, but apparently the just-started IndieGoGo campaign for the $3,500 Warp 3 Medical Tricorder is for real. It’s not the X-Prize, Scanadu-type consumer Tricorder, though – this China-based one will be just for doctors and will provide vital sign, ultrasound, and EHR functions.


Other

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The local paper says that MultiCare Health System (WA) is not only represented on the advisory group IBM and Epic put together to help make their case to the Department of Defense as it selects its $11 billion EHR, but MultiCare will also serve as the pilot site should the IBM-Epic bid be chosen.

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A physician’s New York Times editorial observes that 24 of the 141 medical schools in America are now named after big donors, causing graduates to be “embarrassed that there was a rich person’s name on their diploma, with the university name tucked below in small print.” Naming rights cost from $8 million (East Carolina University’s Brody School of Medicine) to $200 million (UCLA’s David Geffen School of Medicine, above). 


Sponsor Updates

  • Imprivata integrates its Cortext secure communications platform with the Citrix XenMobile enterprise mobility management solution.
  • HealthTronics selects AirWatch for enterprise mobility for its 500 employees.
  • ZeOmega is named as one of the 100 fastest-growing Dallas companies.
  • John Stanley of Impact Advisors is quoted in a San Diego newspaper’s article on the pros and cons of EMRs.
  • Divurgent will participate in the HIMSS East Tennessee Summit in Knoxville on January 22.
  • DataMotion covers the important role e-mail plays in file sharing in its latest blog.
  • CompuGroup Medical will participate in the Critical Care Congress in Phoenix, AZ from January 17-21.
  • CommVault expands its relationship with NetApp to offer integrated data protection solutions.
  • TechGig outlines CitiusTech CEO Rizwan Koita’s predictions for 2015 healthcare technology trends.
  • CareSync publishes a new blog on the importance of taking charge of a family’s health records.
  • Dignity Health VP/CMIO David Lundquist, MD offers insight into how to keep patients in mind when discussing the future of healthcare at AirStrip’s Mobile Health Matters blog.
  • ADP AdvancedMD offers “4 surefire signs you need a new EHR for MU2 and beyond” in its latest blog.

EPtalk by Dr. Jayne

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It’s been a strange couple of weeks for me. We’re getting ready to go through some major changes at our hospital and everyone is on edge. Teams are being consolidated and it feels like the directors and VPs are playing a giant game of “Go Fish” only instead of cards, they’re playing with people. This comes right on the heels of our hospital’s push to reduce the number of accrued vacation days on the books, which had almost half of our employees taking significant time off during the last month or so.

Everyone is overworked and cranky as we try to make decisions based on forecast scenarios and half-developed plans. Sometimes we start to feel not only like the sky is falling, but that the world is burning down around us. We imagine it can’t possibly be this bad in other places. It’s difficult to reach out to colleagues at other organizations because we don’t want to admit that our own organizations are in frantic disarray.

It was in that frame of mind yesterday that I was trying to catch up on the ridiculous thing that is my inbox. I’m on staff at another hospital that’s not part of my health system. I almost got whiplash doing a double take at one of the emails I received. It was discussing the final steps of a system conversion they’ve been working on for years. They’ve been running dual platforms for the last six months during the transition and are finally pulling the plug on the legacy application.

Despite the robust features of the new system, the email wording left something to be desired. “Many fixes and enhancements have been done to NewApp to make it usable.” The email was sent out under the CMIO’s banner. Knowing him as I do, I’m pretty sure that’s not what he intended. I forwarded it to one of my colleagues – not as a way to humor ourselves at someone else’s expense, but as a confirmation that the people at our competitor across town are likely under the same pressures as we are. No matter how hard and how many long hours we work, things are falling through the cracks.

I thought about how fortunate I’ve been that during most of my time as a CMIO I’ve been surrounded by colleagues who are competent, confident, and motivated. I’ve always felt like they have my back and in turn I’ve had theirs. Over the last year and a half, however, it seems that everyone has been stretched thinner and thinner. We’re to the point where we can barely support ourselves, let alone each other. Although we’re certainly experienced in delivering the impossible, it’s become harder and harder to make it a reality.

Looking at the last few months in particular, not only has our energy been sapped, but we’ve lost some of our support structures. Our standing team meetings have been fragmented as we’re pulled in countless directions by competing demands. Those were our opportunity to update each other on our projects, potential risks, and needs. We received feedback and encouragement as well as ideas to remove blockers or handle difficult situations. Colleagues who had been in similar situations provided pointers and tips and lists of “gotchas” to look for.

I should have taken that email as a warning to stay vigilant. By the end of the day today, I watched one of my key projects go off the rails. In hindsight, I should have seen it coming, but I didn’t. Although ultimately it’s no one’s responsibility but mine, I can’t help but think that if we weren’t all so scattered and overwhelmed that someone else might have picked up on subtle signs that I missed. I spent most of the day with an impending feeling of doom and heartburn that made me want to eat a box of chalk.

I realized that given our current state of being overextended, under-resourced, and fatigued that it’s likely this isn’t going to be the last time something like this happens. This is an uncharted place that I’ve never had to operate in before. I’m officially working without a net and it doesn’t feel very good. But given the state of our industry today, I’m sure I’m not alone.

Do you have tips for how to work without backup? Email me.


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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January 15, 2015 News 5 Comments

HIStalk Interviews Peter Smith, CEO, Impact Advisors

January 14, 2015 Interviews 2 Comments

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

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Tell me about yourself and about the company.

I’m the CEO of Impact Advisors. We are a consultancy that’s dedicated to healthcare process improvement and technology consulting. That’s pretty concise, right? [laughs]

 

Many people say there’s flux in healthcare IT consulting as firms that are focused on staff augmentation and implementation work are are finding reduced demand for their services. How would you characterize the industry?

That observation is absolutely true. The market has shifted over the last year, and for reasons you don’t suspect. We went from an environment where the industry was doing large, foundational projects, particularly EMR replacements and revenue cycle replacements. The market shifted over the last year as those projects wound down. It’s now moving towards post-implementation optimization and scrappier, more nimble projects. Things like optimization, back to advisory services.

The quick answer is that observation is exactly what I think the market’s feeling. It’s hurt a lot of consulting firms.

 

What’s the future for those companies that are scrambling to find something new to keep their people busy?

Their evolution will go something like this. They’re going to try to weather this market to the best they can. They’ll probably downsize. They’re going to explore alternative channels through subcontracting relationships and things like that. They’ll try to hold on to their business as best as they can. But at the end of the day, I think it’s going to diminish for them.

The ones that can transform themselves from single, staff augmentation kinds of services into the next generation firm will survive, but it’s not going to be easy for them. I would suspect that the next year or two is going to be challenging for a lot of those firms.

 

Everyone who has been in healthcare IT for a while knows that the pendulum always swings back. Will it swing back from EHR implementation and Meaningful Use to something else?

Yes. The pendulum is definitely swinging. There will still be an EMR replacement market out there, but it’s just not going to be as robust as it was. The core business will still be there, but the market is going to shrink. There’s going to be a lot of merger and acquisition activity. 

There are replacements of a number of systems out there. The dominance of core players – Cerner, Epic, and Meditech – is fueling potentially a replacement of some other vendors. That dynamic will continue — it’s just not going to be as crazy as it’s been the last couple years. That’s one component of the market.

The other one is the shift to optimization services, although that’s a wide definition. Basically optimizing the EMRs and clinical systems already put in is going to be a continued emphasis for a lot of organizations and a continued business for a lot of consulting firms. Rev cycle replacements will be another key driver.

Those are things that will continue to fuel the consulting market. But I don’t think we’re going to see the kind of growth we have in the last couple of years. It will be slow and steady. That’s healthy for the market and for the industry. We’re looking forward to that.

 

Impact Advisors is an Epic partner. Does Epic have weaknesses it needs to fix or that other vendors can exploit?

Epic’s a really strong company. They’re doing a lot of things right, as are a number of other companies such as Cerner. I don’t see necessarily any weaknesses.

Our clients are typically concerned about Epic’s tremendous growth over the last couple of years. It’s both an asset and something to watch as you think about implementation with Epic, but they’ve been able to mitigate that risk pretty well. For the services that they typically provide and implementation, they still do a very good job.

Clients still have to be focused on their side of the work in terms of understanding the process and the operations of a hospital. Those are things that any vendor is not going to bring to the table. That’s a void that the client has to step up and fill as well as the third-party consulting marketplace, and that’s where a lot of folks have spent their time.

I don’t know if I necessarily see any weaknesses. I think you’re seeing the emergence of a couple of players in the vendor space that are going to continue to be very successful, Epic being one of them.

 

Are clients happy that they invested what it costs to implement those expensive systems from Epic and Cerner, especially with the ongoing maintenance costs?

The basic answer is yes, although it’s certainly a topic of conversation in the C-suite about the level of investment that they’ve made and the level of expense. Given the dollars and the prominence of these decisions in the executive and board level, it is clearly top of mind.

But at the end of the day, if you look at the last five years, the clients that have been through the implementations and are in steady state and now reaping the benefits of that investment are extremely happy. In fact, I think there’s even a sense of appreciation that they’ve been through it already.

It’s the clients now that are looking to just start that journey. There’s a lot of anxiety because they know they have the investment ahead of them. They know they’re getting to the tail end of the curve. Their competitors in the market have gone before them and they’re a little bit on the outside of the bell curve. That’s where the anxiety is right now, not necessarily on the people that have already done it.

 

It seemed a few years ago that we had nearly figured out interoperability, but it’s probably more contentious and more frustrating to people now than it was then. Where does it stand and where is it going?

It’s one of my personal disappointments. I had expected this industry to mature a lot faster, particularly around the technology associated with interoperability.

But at the end of the day, interoperability is a very interesting concept or philosophy because it’s not just technology. You’re getting to the core of whether organizations really want to interoperate. You get into the competitive dynamics in a marketplace. You get into what’s in the best interest of the patient. This is bigger than just technology.

By and large, the technology is starting to work. Arguably, there’s not that set of standards in the industry that’s implementable, and I would agree with that to some extent. But the ability to interoperate is technically feasible, and in some cases, organizations are doing it very well and some regions are doing it very well.

It’s bigger than just technology. It’s bigger than applications. It’s also politics. It’s a competitive aspect between providers and hospitals and having the incentives aligned to really interoperate. It’s a big one. Personally, it’s I think one of the disappointments of the industry that we haven’t been able to do a better job of doing that.

 

Given that providers have little incentive to share information with competitors and patients don’t have much of a say, should ONC be bolder about dictating interoperability standards or requiring that providers actually practice interoperability?

I generally think the market should dictate some of this more so than the government. The government can certainly give us a good head start, whether it be ONC or any other agency, and set the direction. You’ve obviously seen a lot of indirect influences and incentives by the government just through Meaningful Use and ICD-10 changes and all that that is clearly steering our industry in the right direction.

I think personally as an opinion that the market, our providers, our clients, and our consulting firms have a market-based obligation to take it to the next level. That’s getting it down to the tactics and the technology and the specifics around making it work.

The other dynamic is that patients are getting much more savvy, demanding, and customer-centric. I hope that that side of the market influence will be a catalyst to dictate some change in the industry. You’re already seeing that and it will continue to accelerate as patients are demanding more from their electronic experience with their providers. I think you’re going to continue to see it.

In essence, long-winded answer, but all the dynamics need to converge, whether it’s the government, whether it’s the market, or whether it’s patient and consumer influences that are going to take us in the right direction. The signs are there. Now we’ve just got to finish the journey.

 

Epic users in specific regions seem to talk a lot about sharing information with each other. Is it really that much different compared to, say, Cerner users?

I really don’t think there’s a difference. Just because the two vendors that you cited, Cerner and Epic, have such a large market share, you can find examples of really good interoperability between not only organizations with the same technical platform — whether it be Cerner or Epic — but even among Cerner and Epic. Just given their percentage of the market share in this country, you find good examples of both. I can’t necessarily say there’s a difference.

I know that there’s a lot of debate on that, certainly in the Epic world. But I think Epic would tell you that they interoperate better than any other vendor just based on the volume of transactions going back and forth. It’s a delicate balance, but you’ll find good examples all over the country. You’re starting to see that the influences that are going to dictate integration are probably less about technology and applications now and more about the competitive climate that you’re in.

 

Cerner has built an amazing business and is expanding into areas such as health management. The company is so big now that it has to find new ways to keep growing. Where do you see them going?

I give Cerner a tremendous amount of credit for their business strategies over the last couple of years. Not only are they tremendous competitors in their core space of EHR and now emerging revenue cycle and ambulatory products, but they also diversified their service portfolio. They got into consulting. They do a good job with their consulting environment. They also got into remote hosting and application management services. They’ve expanded internationally.

That’s an example of a company that not only is doing what they did well from a core standpoint, but also diversified their service and business model and continued to be very successful. I think you’re going to continue to see the same. I think what you’ll see with Cerner is a continued refinement of some of their core products, particularly around revenue cycle and their ambulatory and physician practice management applications, and that will be part of the next generation. 

You’ll also see a tremendous refinement of their business analytics capability. Their partnership with places like Intermountain Health will give them a tremendous opportunity to improve that side of their portfolio. I think all good things ahead for Cerner.

 

We seem to have an overwhelming number of startups, accelerators, and companies nobody’s ever heard of that suddenly claim they’ve figured something out. Where do you see them being successful in enterprises as opposed to the consumer side?

I see a lot of startups in the area of, obviously, analytics and business intelligence. You’ll see them in patient engagement. You’ll see them in products around revenue cycle. Those seem to be the cottage industries of these pop-up software and consulting firms.

This will follow the same trend as the HIS or EMR markets over the last 20 years. The market will rationalize. There will be winners. It will slowly self-select down to a set of players that will be viable market contenders.

Let’s take the business analytics space. I call that the Wild West right now because you have so many of these products out there that are generally focused on solving one component of business analytics. They might be doing Meaningful Use quality indicators or they might be doing patient engagement statistics. They all come into this space at a different place. What they’re trying to do is broaden their portfolio to be a full-service provider of business analytics and analytics capability. 

You’re starting to see some winners in that space right now. As they broaden their portfolio, as the market rationalizes, you’ll see a handful of winners in any one of these markets. That’s what I think will happen and I think that’s going to accelerate quickly. The market condensing right now is going to put a tremendous stress on the players that don’t have a viable business model or a viable product and they’ll wash out. You’ll see a rationalization of the market relatively quickly.

 

People seem less enchanted with Meaningful Use. Is ONC’s influence diminished?

Diminished is probably a strong word. They’re obviously going to be a major player in trying to not only shape policy, but the incentives and dynamics moving forward with subsequent releases of Meaningful Use. Diminished is probably the wrong word.

But market influences will accelerate. ONC’s direction, the government’s direction, and market influences are, I hope, aligned. You’re starting to see that they are aligned. Perfect storm is the wrong word, but you’re going to see a series of influences — whether it’s ONC, market forces, or consumerism — that are going to drive the industry in the same place.

So not necessarily diminished, but you’re going to see the prominence of the consumer side, particularly around employers. Employers are going to take a much bigger stance. Payers are going to take a much bigger stance in influencing the market and certainly the provider side. You’re going to see not so much a diminishing of the government influences, but an increasing of the other influences that are shaping the industry and a consistency on the other influences.

 

What do you read into the acquisition by pharma services vendor Quintiles of your consulting competitor Encore Health Resources?

It surprised us. We obviously watch the market and we watch our competitors and Encore has always been a great competitor with great leadership and great talent. So quite honestly, it was a surprise to us.

I’ve seen other of our competitors, friends, and colleagues on the consulting side that have taken different directions, which I applaud because there’s synergy in terms of some of their acquisitions and mergers. But quite honestly, the synergy of that acquisition wasn’t as apparent as others, I guess I would say. So yes, it surprised us.

 

Impact Advisors is part of the Epic-IBM bid for the DoD’s EHR contract. What effect will that project have on the overall industry?

It’s obviously a huge project, so I think it has the ability to be a very big influence.

First of all, it’s going to be a tremendous opportunity to influence healthcare in our country for the patients, the military families, and the military personnel that that system serves day in and day out. We’re excited to be a part of that bid. At the very utmost, it has the opportunity to be transformational for the healthcare service of our armed services. That’s number one.

Number two, on the industry side, I think it’s an $11 billion project, moving probably north of that over the next 10 to 15 years. As I think someone in the military told me, they said it’s going to be the largest government award that doesn’t involve steel or putting something into space. That gives you a sense of the magnitude of the project. 

We’re very excited to be part of it. I think it has the opportunity to be a major game changer, certainly for the armed services and the families that they serve. We’re proud to be part of that bid and we’re looking forward to hearing about that award.

 

What trends are you seeing from your broad exposure that might not be obvious?

The influence of the reimbursement market will have a tremendous impact on what happens in a technology space. What many of my clients call a tipping point or a pivot point is about to happen. That’s the true conversion from volume to value. You hear a lot of buzz terms around that, but basically the concept of being paid for quality rather than volume. That’s going to happen. We’ve been predicting that over the last couple of years, but we’re accelerating towards that.

When that pivot happens, it puts a tremendous premium on two things. One, provider organizational leadership. The leaders of the hospitals, IDNs, academics, and children’s hospitals are going to have to lead in a way they’ve never lead before. They’re also going to have to have a set of partners that they’ve never had before, primarily the payer side as well as other partners in their region and community. It’s going to be very interesting to see how that all manifests itself.  Not only will be an organizational change, it will be a structural change. It will require leadership change and ultimately all the way down the line to technology changes.

We’re excited about it. We think that kind of change is good for the industry, it’s good for healthcare, and ultimately it’s good for the firms that are serving that industry.

 

Do you have any final thoughts?

This is going to be a tremendously fun industry over the next couple of years. I don’t think we’re going to experience more change than we are in the next couple of years. It’s going to be fascinating and fun to be part of that. Healthcare is the most fascinating industry out there because of the dynamics and influences.

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January 14, 2015 Interviews 2 Comments

Startup CEOs and Investors: Marty Felsenthal

Startup CEOs and investors with strong writing and teaching skills are welcome to post their ongoing stories and lessons learned. Contact me if interested.

The JPMorgan Healthcare Conference
By Marty Felsenthal

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It’s bigger than the Super Bowl, the World Series, the World Cup, and the Winter and Summer Olympics. It’s more important than the BCS Championship game (particularly if you’re from Florida or Alabama) and maybe even the Famous Idaho Potato Bowl, the Scottish Highland Games, and the Cooper’s Hill Cheese Rolling and Wake Competition combined (unless you are from Idaho, Scotland, or, of course Gloucester, England).   

My name is Marty Felsenthal. I’m a middle-aged, workaholic healthcare venture capitalist with thinning hair and a thickening mid-section. Mr. HIStalk asked me to write a little bit about the JPMorgan Healthcare Conference taking place this week in San Francisco and to describe it for readers who have never attended. 

My life’s greatest joys and accomplishments are increasingly defined by (a) finding great post-holiday sales online; (b) the "sports" achievements of my nine-year-old, boy-girl twins, and occasionally, my seven-year-old daughter; and (c) by the nights my wife actually laughs at a joke I make rather than thinking I’m a workaholic, balding, overweight man who she periodically tries to pull a Chief Bromden on and pillow-suffocate for snoring in my sleep.

Since that is increasingly my life, the JPMorgan Healthcare Conference is actually a big deal for me. But it wasn’t always that way.

The conference has been taking place for decades. In fact, it used to be called the Hambrecht & Quist Healthcare Conference prior to H&Q being acquired by JPMorgan. But for decades, it was really dominated by drug companies, biotechnology companies, and medical device companies. On a relative basis, there was just less growth and innovation in healthcare services and healthcare information technology and, as a result, less investor interest.  

For clarity’s sake, I should point out that I’ve been a healthcare-focused venture capital investor for 18 years and work exclusively with what we hope are innovative healthcare services and healthcare information technology companies. This year, our firm will be hosting a reception during the conference for other venture capital firms who invest in healthcare services and healthcare information technology.  

This will be my twelfth consecutive year of co-hosting this reception. There were years when we had fewer than 30 venture capital investors show up. There was just nothing sexy about investing in venture-stage healthcare services and healthcare information technology. I was like the Kevin James of the JPMorgan Healthcare Conference.  

This year, however, we have over 150 venture capital investors attending and had to turn a number people away at the threat of the fire marshal. This year, I’m like the Kate Upton of the conference — actually, let’s say the David Beckham of the conference (and maybe with a lot of help from Photoshop, that could actually be the case). 

When did it change and why? That’s easy.  2009 and 2010 when the HITECH Act and Affordable Care Act were passed. They were catalysts for innovation in "my" sectors unlike anything I’ve experienced since I first got involved in healthcare in 1992.

The conference itself is held at the Westin St. Francis on Union Square. It’s a forum for hundreds of public healthcare companies and an increasing number of not-for-profit healthcare systems and health plans with public debt to present to mutual fund and hedge fund investors. These companies include drug and biotechnology companies, diagnostic companies, medical device companies, healthcare services companies, and healthcare information technology companies.  

JPMorgan is also increasingly inviting a number of still-private companies to present. My firm is fortunate to have a few of these — Teladoc, Redbrick Health, and Vet’s First Choice. I unfortunately don’t have a chance to actually go into the conference and listen to these companies present any more. I wish I did.  

The presenting companies are among the largest and most influential players in the US healthcare ecosystem. They include UnitedHealthcare, Wellpoint, Aetna, Cigna, Centene, and all the major health plans. They include large health systems such as HCA, Tenet, Geisinger, and Banner; pharmacy chains and PBMs such as Walgreens and CVS Health; and most of the country’s most influential health information technology companies, such as Cerner and Athenahealth.  

These companies are talking about much more than their financial performance. They are talking about their strategies and how they are evolving in the face of the huge changes sweeping across our health care system. They are talking about their efforts to help reduce healthcare costs in our country, to improve quality, to improve the consumer experience, and to help lay (or take advantage of) the healthcare information technology backbone so we can transition to a more value-based environment. They understand that, in the current environment, they have to adapt and innovate to survive and thrive, and this is what some of the largest players in the US healthcare ecosystem are presenting and discussing.

Unfortunately, I don’t have time to go into the conference any more. I won’t even have a chance to see our portfolio companies present. As the customers of our portfolio companies (broadly speaking, health plans, hospital systems, pharmacy chains, HCIT companies, distributors, etc.) have started needing and demanding more innovation, more innovative companies have formed to address these needs. These companies need capital. They need investment bankers. They need management teams. They need executive recruiters.

All of these constituents — many of whom are old friends from my days as "Kevin James" and many new to the industry as we became cool — descend upon San Francisco during the conference to network, to catch up, to search for new jobs, to craft business partnerships, to look for capital. There is as much if not more action taking place outside the Westin St. Francis as there is taking place in the actual conference.

At Mr. HIStalk’s suggestion, I took a look at my calendar. This is my week. I start at 5 p.m. on a Sunday, and from there, I am booked solid every hour on the hour, breakfast through dinner, until Friday at 10 a.m. 

I am meeting with seven investment bankers. These investment bankers know and represent many wonderful entrepreneurs and companies who are in need of capital (capital that we can provide). They are also looking to represent companies we invest in when they need more capital and/or want to sell their businesses or go public.  

I am meeting with six other venture investors/firms. These are organizations that we co-invest with already or that we would like to co-invest with. We talk about opportunities to work together within our existing portfolios, companies we are currently evaluating where there might be an opportunity to invest together, and areas of innovation of mutual interest.  

We have more than 20 meetings with executives from some of the largest health plans, pharmacy chains, distributors, HCIT companies, and hospital systems in the country. We’ll talk about innovation. We’ll discuss our portfolio, trends we’re seeing in the marketplace, and interesting companies we’re seeing. 

I have meetings with three entrepreneurs who just want to network or who are looking for new opportunities. I’m getting together with Pete Hudson, the very talented founder of iTriage/Healthagen, with someone who was formerly a senior executive at McKesson, and with a former senior executive from HCSC. 

We also have an opportunity to meet with more than 10 innovative companies that are seeking capital. For obvious reasons, I can’t name them, but they are providing analytics for health systems and provider groups, and they are developing novel insurance exchange platforms. They are developing tools that deliver better provider quality information to consumers. They are helping health plans manage patients with certain types of high-cost chronic diseases (in one case we’re particularly excited about, a very large problem that no one has previously tried to target), and they are helping hospitals lower labor and equipment costs and are also facilitating better patient collection efforts.  

Unfortunately, the meetings during the conference are always too rushed, but there are two highlights of the week for me. The first is getting to sit down with these great entrepreneurs seeking capital and learning about their businesses. Occasionally this leads to an investment, as was the case with a digital pathology company called Aperio that we met with at the conference in 2007.  

The other highlight is getting together with the large healthcare companies and learning about where they are looking for innovation. One of the most satisfying aspects of our job is when we actually help young companies develop relationships with these large players. It’s a lot of fun to try to marry the young, nimble, aggressive (and sometimes naive) startups with the large, sophisticated, complex, highly influential (and sometimes slower-moving) titans of our industry.  

Unfortunately, there are also lots of people and companies I don’t get to meet with during the conference. People have started reaching out to schedule meetings during the conference as early as November now (for a conference that takes place in January). This leads to a lot of calls the first and third weeks of January with the people I couldn’t meet.  

So in short, it’s a hugely productive week of networking. We learn a lot. We get to help drive revenue to our portfolio companies on occasion. We reacquaint with old friends. We meet new friends who might someday work with our portfolio companies or partner with them. If we’re lucky, we find a new investment.

When the week is over, I go home feeling like the rock star that is David Beckham. I grab a drink. I crack a joke to my wife, I get ready for my Posh Spice, and then I usually fall asleep and start snoring, which often coincides with her trying to suffocate me.

Marty Felsenthal is a long-time venture capital investor who invests in and works with growing healthcare information technology and healthcare services companies and has been attending the JPMorgan Healthcare conference since the 1990s.

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January 12, 2015 Startup CEOs and Investors 1 Comment

Monday Morning Update 1/12/15

January 9, 2015 News 12 Comments

Top News

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HLM Venture Partners, which made several health IT investments in its first three funds, is raising up to $150 million to launch a fourth fund. Its portfolio companies include Nordic Consulting, Aventura, Medicalis, Phreesia, and Teladoc.

The investment challenge, it seems to me, is that in the frenzy to throw money at unproven healthcare IT startups, we’re well past the wheat and deep into the chaff. It’s good that demand for new technologies seems strong, but too many no-name companies confuse the market and many of them will fizzle out quickly. Companies that are thrown together purely to chase money usually don’t find it and there’s only so much proven management talent to go around. Incubators and accelerators are encouraging a lot of shaky startups that will experience the inevitable Darwinism. Still, a few of them will avoid enough minefields to get market traction or sell out to a bigger player.


Reader Comments

From Frustrated Surgeon and Developer: “Re: big health IT. Epic and Cerner are using strong-arm techniques to counter any move to interoperability. Congressman Dave Camp (MI) testified before Congress that he was being pressured by lobbyists paid for by Epic to remove interoperability from MU 2 ( and now 3) to secure their business position. Cerner said they weren’t interested in interoperating with my cloud-based system that several hospitals are using. APIs and licensing fees never came up — they just won’t do it. Cerner’s representative to ONC’s Jason Task Force is pushing hard to stop MU 3 interoperability requirements. We should not look to Epic and Cerner to open the doors. We need a HIE which Epic, Cerner, and all other permitted applications should use. It’s the data, not the application.” Unverified. I searched the Congressional Record for Epic-related comments by Dave Camp (who is now retired) but didn’t see anything relevant, although the search isn’t exactly Google quality.

From Jack Gutenberg: “Re: HIStalk book club. You should invite readers to read along and add their comments to yours.” I like the idea. I’m just starting Eric Topol’s “The Patient Will See You Now” in case anyone wants to start it along with me and then add their comments once I’ve posted mine. I’m not only interested in critiquing the book itself, but also discussing the interesting ideas inside. Books I’ve summarized here previously include “Connected for Health,” “Your Medical Mind,” “Safe Patients, Smart Hospitals,” and “Where Does It Hurt?

From The PACS Designer: “Re: Windows 10 browser. Rumors have been swirling for months about the next version of Windows 10 and its browser style since Internet Explorer and Bing have such a small market share compared to Firefox. The leaked browser is called Microsoft Spartan.”


HIStalk Announcements and Requests

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More than three-fourths of poll respondents agree with a popular stock expert’s characterization of the Athenahealth as a “bubble stock” that won’t be “the backbone of anything” rather than the company’s stated high-flying ambition to be the Salesforce of healthcare. New poll to your right or here since I ask every year: what are your HIMSS15 attendance plans compared to HIMSS14?  

Ready for your input: the HIStalk reader survey and HISsies nominations. Thanks for participating. I’ll also randomly draw three reader survey responses for a $50 Amazon gift certificate.

I was thinking about Uber’s surge pricing model, where the app tells you in real time that local demand is high and you’ll have to pay more. I’m frustrated when I get that message, but it makes perfect sense from a supply and demand point of view. When cars are in short supply, the higher price does two things: (a) it allows price-sensitive consumers to seek alternatives to Uber such as taking a cab or walking, increasing Uber car availability for those willing to pay more; and (b) it encourages more Uber drivers to get out on the road and start picking up fares. (obviously it does a third thing: it raises Uber’s profits, so you have to trust them to proclaim surge pricing only when they really are swamped). An Uber model would work in medicine if it were a pure science instead of an art and if people actually paid cash for their services – you could have doctors willing to provide telemedicine consults at a given time and price via an Uber-type service and let patients decide what it’s worth to them, with an app setting the intersection of supply and demand. That leaves those unable to pay out of the picture, but medicine is already heading toward a two-tier system where cash-paying patients have better options anyway.


Last Week’s Most Interesting News

  • IBM and Epic enhance their DoD EHR bid pitch by announcing that they’ve already installed an Epic model instance in a DoD-hardened environment for testing and also formed an advisory committee.
  • Walgreens adds health management, real-time health coaching, and wearables connectivity to its website and mobile app, offering users reward card points for using the tools to meet their health goals.
  • The AMA says EHRs, ICD-10, prior authorization, and Medicare fraud detection are barriers to care that it will target in 2015.
  • Sue Schade of University of Michigan Hospitals and Health Centers wins the Gall CIO of the Year award.
  • Analytics vendor Inovalon files for a $500 million IPO.
  • Allina Health and Health Catalyst announced an analytics technology and quality improvement partnership, explained by Allina President and CEO Penny Wheeler, MD in my interview.
  • Only 24 percent of respondents to my poll said their impression of HIMSS is positive.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.


Acquisitions, Funding, Business, and Stock

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Francisco Partners makes an unspecified investment in Olathe, KS-based revenue cycle solutions vendor eSolutions.

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The Columbus paper profiles Lyntek Medical Technologies, whose PatientStorm Tracker software provides a weather radar-like display of an inpatient’s overall condition. It’s being beta tested by OhioHealth Riverside Methodist Hospital. Founder and pulmonologist Lawrence Lynn, DO says the outdated fire alarm model of medical monitoring systems doesn’t provide useful information until vital signs hit specific limits. He adds, “You can be in the hospital dying of sepsis with a smartphone in your pocket that can detect the pattern of a song just by listening to it, but this sophisticated-looking monitor above you can’t detect a single pattern of evolving death.”


Sales

Atlantis Health Group chooses Influence Health’s Navigate population health management solution.


People

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UMass Memorial Medical Center (MA) appoints Pam Manor, RN, MSN, DNP (St. Francis Hospital) as chief nursing informatics officer. 

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William Hersh, MD (Oregon Health & Science University) is named the winner of the 2014 HIMSS Physician IT Leadership Award.

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Streamline Health promotes David Sides, who has been with the company for five months,  to president and CEO. Sides, on the left above, replaces Bob Watson, who will leave the company to become president of NantHealth but will remain on Streamline Health’s board. NantHealth announced in November that it will use Streamline Health’s analytics product in its system.


Government and Politics

The American College of Physicians urges Congress to: (a) repeal Medicare’s SGR formula; (b) continue Medicare’s 10 percent bonus for primary care; (c) restore the Medicaid program that pays primary care physicians no less than Medicare rates; and (d) provide relief from “burdensome and unrealistic” Meaningful Use requirements and “other excessive regulatory burdens.”


Other

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An opinion piece slated for publication in Academic Medicine examines whether it’s ethical for medical students to use an organization’s EHR to track their former patients so they can match outcomes to the students’ original diagnosis and treatment. The authors conclude that the benefits outweigh the harms. I couldn’t agree more – it’s hard to believe that an intelligent argument could be made otherwise. The opportunity would only arise in teaching hospitals and I see no potential ethical or HIPAA conflicts since patients understand that their treatment has an educational component. The practice should not only be allowed, it should be mandatory, and perhaps not just for medical students. Medicine (and ancillary fields) are literature-based and that always involves aggregated, de-identified research, but what could be more educational than seeing how your care decisions impacted a particular patient’s life and whether your actions were ultimately right or wrong? The patient has to live with the impact, so  why shouldn’t the professionals who made those decisions? It would also be interesting to look at a patient’s overall perception of health and well-being (perhaps via a self-survey with results trended over time) instead of just a problem list if we’re really interested in improving their lives and not just their medical conditions. We have to leave the “treat ‘em and street ‘em” mindset behind.

The Wall Street Journal runs an essay by Eric Topol, MD titled “The Future of Medicine Is In Your Smartphone” in which he again predicts that technology will alter the patient-physician relationship, reduce costs, and empower patients. He thinks that doctors will still have a role, just not as today’s paternalistic “priestly class.” He has vested interests, however, even going beyond pitching his new book: he lists consulting engagements with Google, AT&T, Walgreens, Quanttus, and Sotera Wireless. A skeptical WSJ commenter weighs in: “I am in atrial fibrillation, now what? That is the rub. All these carnival barkers for the utopian vision of the smartphone/connected world are simply exhausting. For all its many benefits, the Internet is rife with misinformation when it comes to healthcare and the burden is now shifting to the consumer to sort out what is real and what is bogus.”

Ebola vaccine researchers face a surprising challenge: a sharp drop-off in the outbreak could make it hard to find enough victims to test new vaccines.


Sponsor Updates

  • HCI Group CMIO William Bria, MD will present at IMN’s HealthIMPACT Southeast on January 23 in Tampa.
  • Passport/Experian Health will exhibit and present at the HFMA Region 11 Healthcare Symposium January 11-14 in San Diego.
  • nVoq releases a case study on the success Teleradiology Specialists (AZ) experienced with its SayIt cloud-based speech recognition technology.
  • SCI Solutions VP of Business Development Bill Reid shares his thoughts on price transparency and how to equip patients with the right tools to understand the financial consequences of care.
  • Netsmart will participate in the New York Coalition of Behavioral Health Agencies conference on January 27.
  • Patientco outlines three healthcare finance game-changers for 2015 in a new blog.
  • MedData will participate in the ACEP Reimbursement Trends and Strategies in Emergency Medicine Conference in Las Vegas from January 13-15.
  • RazorInsights will exhibit at the Texas Hospital Association Annual Convention in Austin January 22-23.
  • PMD recaps the previous week in healthcare in a new blog post.
  • Nordic Consulting offers a new white paper, “Beaker Lab: Planning for Meaningful Use Stage 3.”

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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January 9, 2015 News 12 Comments

Monday Morning Update 1/5/15

January 3, 2015 News 11 Comments

Top News

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Healthcare analytics vendor Inovalon Holdings (known until a 2012 name change as MedAssurant) files for a $500 million IPO. The CEO and board chair is cardiologist Keith Dunleavy, MD. The company’s technology is used by NextGen, Greenway, Allscripts, and Walgreens.  


Reader Comments

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From KimJongDeux: “Re: Athenahealth. Interesting that Jonathan was the much celebrated, drunk, foul-mouthed (and most un-funny) host of HIStalkapalooza for a few years and the article above seems to indicate the bloom is off the rose. Guess he’s not on the program this year? We seem to have a company run by force of personality. The quote, ‘Those naysayers don’t understand the company’s business model’ is the same cry as we hear from self-styled ‘artists’ when their works are panned and from CEOs who either get no push back from their yes-men staffs or who weeds out or banishes anyone who disagrees. The fact that their corporate meeting involves officially sanctioned heavy drinking games tells me all I need to know. And the fact that the CEO openly supports it as a good thing is troublesome. I agree that if the force of personality ever left, the company would fold like a house of cards. Being brash, loud, and verbally overpowering others can keep the airplane aloft only so long.” The company has a new logo and website, I’ve noticed, moving away from the squint-inducing yellow and green color scheme to a more serious-looking purple and green.

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From PM_from_Haities: “Re: Epic’s going public. It would have very little effect. The capital structure of a company (i.e. going from private to public) impacts who owns Epic, but it’s leadership would likely be unchanged. Given Judy has plenty of cash, it would make very little sense for her to add that kind of public scrutiny unless it helped in gaining government contracts. Epic would continue to deliver on its promises and continue to grow. If anything, Epic might get BETTER by being publicly traded as they would typically have a stronger marketing department.”


HIStalk Announcements and Requests

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One-fourth of respondents to my poll expressed a positive impression of HIMSS, with 38 percent each having neutral or negative feelings. New poll to your right or here, triggered by last week’s Fortune article: which set of quotes best describes Athenahealth, the positive ones by CEO Jonathan Bush or the negative ones from a skeptical hedge fund manager? Vote and then click the “Comments” link in the poll box to explain yourself.

Attendees of our webinars have asked about the possibility of receiving continuing education hours. I looked into this years ago and concluded that the only way to accomplish that would be to connect with a university already set up to award CEUs to physicians, nurses, and pharmacists. I’m open to suggestions.

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I registered for the HIMSS conference this weekend since the early full registration rate of $745 is good through January 27. My impressions:

  • The online registration is slow because it tries to upsell you on extra-cost events, but it’s efficient otherwise.
  • The registration policies document says that HIMSS doesn’t share attendee email addresses and to report any email received from an exhibitors. I assume that means that, as usual, registrants will receive a barrage of promotional snail mail (some of it invariably arriving after the conference has concluded).
  • The registration policy references a “use of photographic images” clause in the same document, but the only related item involves “recording any educational session content,” so apparently the widely ignored ban against taking exhibit hall photos has been eliminated.

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Divurgent, Elsevier, Falcon Consulting, Sunquest, and Thrasys have signed on as sponsors of HIStalkapalooza, which will be held Monday of the HIMSS conference week at the House of Blues Chicago. It’s an expensive event to put on — the facility, food, bar, and band add up to more than $175 per attendee — and the number and level of sponsors dictates the number of people I can invite (and thus the number I can’t invite) without going deep into the red. We still have a couple of weeks to add new sponsors – let me know if your company is interested in standing out among all the conference noise that week.


Last Week’s Most Interesting News

  • An report looking at six ONC-funded state HIEs finds that large health systems can be either supporters or competitors, HIEs are beginning to embrace Direct despite its poor EHR integration, and the HIEs are still searching for use cases that the market wants.
  • A Wall Street Journal report finds that a significant portion of Medicare fraud is perpetrated by the 45,000 newly registered providers each month that CMS says it doesn’t have the resources to review.
  • CSC pays $190 million to settle an SEC fraud case that includes its UK NPfIT contracts.
  • A Fortune profile contrasts Athenahealth’s high-flying public image with the skepticism of investment advisers and managers who say the company’s tiny market share and flattening performance suggests otherwise.

Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.


People

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OB/GYN EHR vendor DigiChart promotes Rodney Hamilton, MD to president and CEO.


Announcements and Implementations

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Terrebonne General Medical Center (LA) goes live in its admissions area on RightPatient facial recognition software from Atlanta-based M2SYS Technology.


Government and Politics

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The New York Times profiles US CTO Megan Smith, with insiders concluding that while she has a big vision and the president’s ear, she’s also in a position that comes with unclear mandates, minimal budget, and responsibility for outdated technology platforms. The article points out that the newly created United States Digital Service reports to the Office of Management and Budget instead of her office.

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A class action lawsuit filed by doctors against North Carolina’s Department of Health and Human Services over software that incorrectly paid practices Medicaid rates for services provided to Medicare patients lingers on a year later. A family practice doctor says the state owes him $100,000, adding that in his pleas to DHHS, “There was a complete lack of courtesy. Those people have no humanity.” The NCTracks system was developed by CSC at a cost of $484 million, with a significant portion copied from a similar system CSC built for New York City. The US Justice Department sued CSC and New York City in October for Medicaid fraud, claiming that the $1 billion New York system didn’t correctly bill Medicaid secondarily to private insurance. Neither system was related to CSC’s $190 million settlement with the SEC last week over accounting and fraud claims involving the company’s work on the UK’s failed NPfIT project.

Oregon’s proposed 2015-2017 budget includes $3 million for a prison system EHR, which is expected to go live in early 2016.  


Privacy and Security

The US Postal Service announces that a previously reported breach of its systems that exposed the Social Security numbers of 800,000 employees also included medical information on 485,000 current and former employees as well as retirees who had filed for worker’s compensation. The most interesting aspect to me is the huge number of injury claims filed with USPS.


Technology

I mentioned last week that John Olmstead, who runs the ED and surgery departments of The Community Hospital (IN), says in an upcoming Versus webinar that he would like to see a GPS-wayfinding type technology so that hospital visitors could navigate around campus using their smartphones. Readers sent information on two companies that offer such technology:

Connexient offers a smartphone app that provides turn-by-turn navigation to visitors at Robert Wood Johnson University Hospital and will bring six more hospitals live on it in the next few months.

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Madison, WI startup Solomo Technology is using similar technology to help conference attendees locate session rooms. It offers APIs so that developers can integrate its location and content services into their own apps.

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An excellent analysis of the fitness tracker market makes great points:

  • Courts are beginning to accept fitness tracker data in cases ranging from vehicular accidents to worker’s compensation, with resulting privacy concerns.
  • Wearable device manufactures use glossy marketing to position themselves as health and wellness brands instead of step counters. “You will never find a review for Jawbone or Fitbit that says ‘works as advertised’ because no one knows what they’re advertising.”
  • Trackers have penetrated only 3 percent of the market and the washout rate is high.
  • The Scanadu medical tricorder-type device holds great promise, as does senior monitoring app Lively.
  • Companies that have bought a single brand of fitness tracker for employees haven’t seen broadly successful results because people are motivated differently.
  • Users don’t want more data, they want to have devices tell them what to do and to simplify their technology interactions rather than to add new ones.

Other

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This headline from the Rome, GA newspaper succinctly describes a lot of what’s wrong with the US economy. Taxpayer-funded organizations that don’t pay taxes themselves shouldn’t be the only hope of employment growth. At least government hiring didn’t top the list.

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The Madison newspaper profiles Nordic Consulting co-founder Mark Bakken’s transition from entrepreneur to venture capitalist. He’s putting together a $10-$20 million venture fund that will invest $300,000 to $500,000 in Madison-area companies whose technologies work with Epic. He has raised $4 million so far (including $1 million of his own money) and says several Epic-using health systems have expressed interest in investing. The article mentions that he has personally invested in eight startups (Catalyze, Forward Health Group, Wellbe, Moxe Health, 100health, Quietyme, Healthfinch, and HealthMyne) and four of those have hit $1 million in annual revenue. Bakken, who stepped down from the CEO role at Nordic last month but remains board chair, says he “won the lottery with Nordic,” which had $81 million in revenue in 2013.

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A fundraising project for the children of The Johns Hopkins Hospital senior software engineer and bike shop owner Tom Palermo that included a 1,000-participant New Year’s Day ride has raised $60,000 so far, well beyond its original goal of $10,000. Palermo, 41, was killed last weekend when he was run over while bicycling by an Episcopalian bishop with a previous drunk driving arrest who fled the scene. She has been placed on administrative leave pending possible criminal charges following her admission that she hit Palermo, who leaves behind his wife, six-year-old daughter, and four-year-old son. The bishop had previously received probation for her 2010 DUI arrest (before she was hired by the diocese) in which she was driving a car with a tire shredded to the rim, told police she had drunk alcohol and smoked marijuana, and recorded a 0.27 on a blood alcohol breath test.

Five Michigan health systems receive $25 million in value-based payouts from Blue Cross Blue Shield of Michigan, which says the hospitals and physicians are communicating better because of EHRs and HIEs. The systems will also receive $500,000 each over three years to improve their IT systems and care coordination. The chief medical officer of Henry Ford Physician Network says he gets immediate notification if his patient is is seen by any provider in the network or at an area hospital that uses Epic, but otherwise he won’t know about it until he sees the patient next, so he’s looking forward to using the money to improve HIE connectivity and to improve data capture from physician practices.

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Lenox Hill Hospital (NY), embarrassed by international press coverage of a British couple unfortunate enough to have their premature baby delivered in the US at a cost of $200,000 instead of free in England, hints that it will simply write off the bill, sticking less-publicized patients with the burden of its profitability. It really annoys me that when media outlets publicize a ridiculous hospital bill involving a feel-good patient, the hospital nobly agrees to cancel the bill as though it doesn’t really need the money. The rest of us who get equally absurd hospital bills are turned over to collections for every dime. Somehow the public never sees through this PR scam to realize that we’re all paying for it. The same hospital annoyed patients and families three years ago by restricting visitor access so that Beyonce and Jay-Z could have their baby in the manner to which they have become accustomed, with the star couple adding their own private security force to guard the VIP suite (the hospital denies rumors that the couple spent $1.3 million to upgrade their room). The CEO of North Shore-LIJ Health System, which owns the hospital, was paid $4.3 million in 2013.

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The Sioux City paper describes the interoperability situation between UnityPoint Health – St. Luke’s and Mercy Medical Center, running Epic and Cerner, respectively, and still faxing scanned chart images back and forth. The hospitals are bringing up Iowa Health Information Network with hopes of electronically exchanging at least summary records.

Tennessee doctors are diagnosing and treating people with flu by telephone or telemedicine, telling them not to come to the office for fear they’ll spread the virus to other waiting patients.

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A ProPublica investigative article exposes the billing practices of the for-profit debt collection agency run by non-profit health system Mosaic Life Care (MO), which has filed 11,000 lawsuits in five years to collect money from uninsured hospital patients and to garnish their usually low wages. The part of the story that always drives me crazy: uninsured patients are sued for the full (phony) list prices hospitals make up in order to give 90 percent discounts to insurance companies, so people are losing their homes to pay for $12 Tylenols and the ever-accruing interest charges and attorney fees. It seems reasonable that hospitals be required to charge cash-paying patients their lowest prevailing contracted prices.

A JAMA opinion piece written by informatics people from Christus Health points out the rising numbers of medical scribes, the number of companies (22) offering their services, and the creation of a scribe aptitude test and a vendor-led member association. It says that overuse of scribes to make up for EHR inefficiency can lead to compliance and clinical issues, concluding:

The answer to today’s inadequate EHRs is not scribe support. Instead, physicians should demand improved products, should educate vendors to ensure that they understand how physicians think clinically, and should clarify what is needed for an intuitive, quick, and navigable user interface. If such usual market forces are vibrant, and physicians engaged robustly, EHRs will evolve rapidly. Yet even after a decade of use, some EHRs and CPOE may not compete with the speed of a paper checklist, and may never.

The New York Times notes that a doctor whose office was raided by federal agents for writing oxycodone prescriptions for $200 in cash was caught only because neighbors complained about the traffic outside his unmarked office that was guarded by an armed bouncer. The doctor made $2.6 million in cash over two years writing narcotics prescriptions to patients who then turned the drugs over to “crew chiefs” to sell on the street. The practice created false medical records that included MRI reports and urinalysis results.

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Dr. Oz makes a lot of headlines, most of them negative. His ABC TV show, “NY Med,” takes heat when a female viewer watches her husband die in an episode filmed at New York-Presbyterian Hospital without the family’s permission. Producers blurred the man’s face in the video, but the woman recognized him and heard his last words as the cameras rolled. Her son has filed complaints with the hospital, the state’s Department of Health, and HHS’s Office for Civil Rights. The hospital and ABC claim the patient isn’t identifiable, ABC says news is protected by the First Amendment, and the hospital says the man’s privacy rights ended when he died and blames the family instead for calling attention to his identity by complaining.


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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January 3, 2015 News 11 Comments

News 12/31/14

December 30, 2014 News 12 Comments

Top News

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CSC will pay $190 million and will restate previous years’ financial statements to settle a variety of SEC fraud charges that includes its participation in the UK’s NPfIT program. That’s a minor amount compared to the $2.75 billion the company already wrote off for its work on the failed NPfIT project. CSC will change its 2011 balance sheet to reflect a $1.16 billion impairment charge.


Reader Comments

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From Brandom: “Re: Barnes Jewish Christian. Rumor is it they will be installing Epic.” Unverified, but I ran a reader’s rumor saying the same thing on December 5. Often the earliest confirmation is a health system’s posting of a ton of open Epic positions, but BJC doesn’t have any of those on its recruitment site.


HIStalk Announcements and Requests

I have to disclose a brilliant idea I heard in listening to the rehearsal of the Versus webinar I mention below, which I honestly think is the most interesting webinar I’ve ever watched. John Olmstead of Community Munster captivated me all the way through on the hospital’s use of ED technology, but he really grabbed me at the end when he suggested technology tools he needs. His holy grail is a way-finding, GPS-type app that patients and visitors can use on their own devices to locate themselves precisely on a hospital floor plan, then receive directions to get them to a desired location. Example: I’m in room 4401 with my mom and I want to go to the cafeteria, then to the financial counselor, then to the gift shop, and then back to 4401, so give me turn-by-turn directions like I get with my car GPS. His take is interesting: patients will become so attached to hospitals that offer this app that they won’t consider going elsewhere, where they’ll go back to stumbling around lost or trying to follow decades-old red vs. green lines on the floor that lead to confusing elevators. Hospitals are always a poorly conceived patchwork of added-on construction that went up quickly as funding allowed, so visitors spend a lot of time wandering and wasting the time of employees who have to assist them. Turning that universally embarrassing situation into a competitive advantage is brilliant.

What’s really bugging me lately (it always has, but even more so now): companies that make portions of their name incorrectly upper or lower case, defying all of the civilized rules of spelling just because someone in marketing who’s never run a business has decided that being flagrantly incorrect is a desperate way to distinguish a company from its competitors. I’ve always refused to recognize all-caps vendor names like Meditech, Medseek, and Medhost, but I’ve also decided that I’m also no longer letting Athenahealth slide with the oh-so-cute small “a” at the beginning of the company’s name. Names in America start with a capitalized letter and then have all lower case letters following, so now I have to decide what to do with the many cutesy company names that stick capitalized letters midstream (even providers like Partners HealthCare mistakenly think that’s cool). I’ll even concede that HIStalk should really be Histalk if that will convince other companies to value conformity to accepted rules over marketing nonsense.


Webinars

January 13 (Tuesday) 1:00 ET. “The Bug Stops Here: How Our Hospital Used its EHR and RTLS Systems to Contain a Deadly New Virus.” Sponsored by Versus Technology. Presenter: John Olmstead, RN, MBA, FACHE, director of surgical and emergency services, The Community Hospital, Munster, Indiana. Community Hospital was the first US hospital to treat a patient with MERS (Middle East Respiratory Syndrome). It used clinical data from its EHR and staff contact information from a real-time locating system to provide on-site CDC staff with the information they needed to contain the virus and to study how it spreads. Employees who were identified as being exposed were quickly tested, avoiding a hospital shutdown.


Acquisitions, Funding, Business, and Stock

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Fortune describes Athenahealth’s “More Disruption Please” conference as “the Animal House of corporate gatherings,” with the company’s 387-acre Maine resort hosting drinking games and an after-party cabin for investors and corporate hangers-on led by CEO Jonathan Bush, described as a “hyperactive, no-filter goofball of a chief executive.” The article contrasts the party atmosphere to skeptical investors who believe that Athenahealth shares are massively overvalued, especially since the company just announced that revenue growth has slowed as it continues to lose money. Bush says those naysayers don’t understand the company’s business model and will miss the building of a Salesforce-like technology company that will “create and curate the healthcare Internet.” Hedge fund manager and ATHN short-seller David Einhorn isn’t buying it (literally), saying, “They’re a niche provider way out on the periphery with a tiny market share. I don’t see how they’re going to become a backbone of anything.” My take is that Athenahealth would have been an obscure, offshore-powered medical paper pusher without the cult of Bush’s personality; investors had better hope he sticks around and keeps his mojo since that’s the only way shares can continue to trade independently of tepid company performance as a self-proclaimed Internet high flyer. The money gods would lose interest quickly if recommending or owning ATHN stock no longer paid the dues for being a member of JB’s frenetic fraternity.

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Athenahealth shares (in blue above) did OK in the past year, falling a bit short of the Nasdaq’s 15.6 percent gain but 25 percent off their March 2014 highs. The company is valued at $5.6 billion on annual revenue of $711 million and a negative operating margin. Jonathan Bush hold shares worth $46 million.

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The Forbes article on Athenahealth mentions that the company’s $1.1 million investment in Castlight Health was worth $75 million at the end of Q1, allowing Athenahealth to buy a private plane it calls “the Castlight jet.” At least Athenahealth ended up with something more high flying than CSLT shares — above is the CSLT price chart since its March IPO (blue, down 71 percent) vs. the Dow (up 12 percent).

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Cincinnati-based revenue cycle management firm The Consult Inc. (TCI) will acquire RCM software and services vendor Physician Management Information Services of Denver.

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Specialty EMR vendor Modernizing Medicine acquires Aesyntix Health, which offers dermatology practice RCM, inventory management, and group purchasing services.  


Sales

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The federal government awards Accenture a five-year, $563 million contract to continue the work it started on Healthcare.gov after CGI Federal was fired.

Medical practice performance management company GloStream chooses DrFirst’s EPCS Gold 2.0 controlled drug e-prescribing system to comply with New York’s I-STOP mandatory e-prescribing requirement.


People

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Tom Palermo, a 41-year-old senior software engineer at The Johns Hopkins Hospital (MD), was killed in a bicycling accident Saturday. Memorial Mass will be celebrated Saturday in Towson, MD.


Announcements and Implementations

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Lafayette General Medical Center (LA) donates a telemedicine station to a local elementary school, allowing ill students to be evaluated by a physician without leaving school.


Government and Politics

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An ONC-commissioned report studying HIEs in six states finds that they commonly offer care summary exchange, lab results reporting and exchange, public health reporting, and ADT messaging, but otherwise their technologies and strategies vary. Lessons learned include setting attainable short-term goals to maintain stakeholder interest, recognizing that big health systems can be either supporters or competitors of grant-funded HIEs, and data standards are often voluntary but need to be standardized to achieve real interoperability. Five of the six states plan to charge subscription fees but haven’t set rates (the sixth HIE already shut down). The study found that Direct is still a confounder, with HIEs originally seeing it as a competing model but are now looking at Direct as an easier workaround to problems they found with query-based services, but Direct is still poorly integrated with EHRS (usually requiring providers to log in to a separate portal) since it wasn’t required of vendors until Meaningful Use Stage 2 and they’ve been slow to incorporate it. Wyoming’s HIE gets a special mention for shutting down immediately once its federal grant money ran out. The issue of sustainability is nicely summarized by this statement: “In the short term, grantees are trying to identify use cases that align with the market” (i.e., we built it and they didn’t come before the government money ran out, so it’s like being the owner of a tattoo shop when the local military base closes).


Technology

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Iltifat Husain, MD names his best medical apps for 2014:

  • ASCVD Risk Estimator (#1)
  • JAMA Network Medical Image Challenge
  • Medscape MedPulse
  • UMEM Pearls
  • Multiple Sclerosis @Point of Care
  • PreopEval14
  • Pediatric Quick Reference
  • Eye Emergency Manual
  • Blood Donor by American Red Cross
  • CDC Vaccine Schedules
  • Family Practice Notebook
  • Change Talk: Childhood Obesity and Motivational Interviewing

A German hacker replicates a politician’s biometric thumbprint using only a press conference photo and off-the-shelf software. The politician, ironically, was speaking at a hacker’s convention. The hacker, who’s apparently not a fan of biometric security, says he assumes that politicians will start wearing gloves when speaking in public.

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Siemens has been caught countless times over at least 100 years for bribing people to earn government bids, so this is hardly news: Israel’s securities regulator arrests six electric company employees for accepting $20 million in Siemens bribes related to a power station turbine bid.


Other

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Geisinger Health System CEO Glenn Steele, Jr., MD, PhD, who is retiring next year, comments on physician complaints about health IT in a Modern Healthcare interview:

Here’s my Jonathan Gruber statement: This is an issue of stupidity. If people believe that you can put IT in, continue working the same way you did before IT, and not get inefficiency, we are talking double-digit IQs here. What everybody’s learned over the last 15 to 20 years is if you put IT in, whether it’s hospital-based or ambulatory, you have to look at the entire workflow and use the IT implementation as an excuse for re-engineering your workflow from beginning to end. If you don’t do that, it’s going to create havoc. You’ve got to look at your patient-care processes from beginning to end and say, “How are we going to do it differently? How is this going to make it better?”

On the benefits of health IT, we couldn’t do point-of-service care innovation without having near real-time data fed back to us. You’ve got to have data both from the insurer side and the provider side to predict which patients or cohorts of patients are most likely to need the highest-intensity vigilance. If you don’t have feedback in a timely fashion, it’s not going to work.

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The president and CEO of Campbell Soup Company says she’s a fan of the quantified self movement, in which people will “[take] charge of their well-being through the use of data and digital sensors, wearable health bands, and smartphone apps that can track and quantify everything from their heart rate, blood pressure, and sleep quality to steps walked and calories consumed. The word ‘quantify’ is what’s really important because people will use the personal data and feedback from these devices to make healthier lifestyle choices and adjust the way they eat, exercise, work and rest.”

I’m not interested enough to look up the details, but somehow Cerner and Allscripts are both involved in a patent dispute with RLIS, which apparently took a stab at the EMR market in the late 1990s but then folded. I mentioned a reader’s report of the lawsuit in mid-2012, so apparently it’s still churning its way through the court system.

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CDC declares the 2014-15 flu season as an epidemic, with 22 states reporting significant influenza-like activity vs. 13 last week. Flu vaccine doesn’t seem to be working well against this year’s strain.

This is sad: a hospital Santa of 30 years hangs up her red and white suit, saying the drug test, background check, fingerprinting, and HIPAA requirements make it too much trouble to give young inpatients their December dose of Christmas cheer. At least a new Santa is happy to take over the suit, which the former Santa donated.

Only in America, home of too many lawyers trying to drum up work and too many righteously indignant people convinced that everything that happens to them is an egregious injustice wrought by deep-pockets defendants: the family of  a woman killed when a driver allegedly high on nitrous oxide rear-ends her as she slows for a traffic light sues: (a) the driver, which makes sense; (b) Toyota, because the family claimed the victim’s car was defective; (c) the driver’s sister, a doctor the family claimed helped the woman get drugs; (d) the towing company who released the driver’s car to her; and (e) a local ambulance company, who the family says caused the crash by responding to an accident with flashing lights on, causing cars to pull over right before the crash.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 30, 2014 News 12 Comments

Morning Headlines 12/29/14

December 28, 2014 Headlines No Comments

Cerner Corp (CERN): $65.71

Cerner stock closes at $65.71 Friday, an all time high for the company.

Disneyland trip, Beyonce tickets were ‘inappropriate gifts’ to official, judge rules

The government upholds a VA decision to fire the former director of the Phoenix VA Health System,  not because of the wait-time scandal that was discovered at her facility, but because she accepted “inappropriate gifts,” including an 8-night family vacation to Disneyland for herself and six of her family members, from a consulting firm whose core business is helping vendors secure lucrative government contracts from the VA.

Why It’s So Hard to Fix Medicare Fraud

The Wall Street Journal analyzes Medicare fraud detection, explaining that the problem is complicated by the fact that 45,000 new providers enroll in Medicare every month and CMS does not have the resources to verify that every one is legitimate.

Jeb Bush quits hospital chain before possible White House run

Jeb Bush resigns from his position on the board of directors at Tenet Healthcare in preparation for a widely-speculated run in the 2016 presidential elections. Tenet is a for-profit health system that has publically attributed strong financial gains to the rollout of Obamacare, legislation that Bush formally opposes.

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December 28, 2014 Headlines No Comments

Monday Morning Update 12/29/14

December 27, 2014 News 11 Comments

Top News

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Cerner shares hit a 52-week high last week, closing Friday at $65.71 and valuing the company at $22 billion. The end-of-year rise sounds impressive until you examine the one-year share price graph that shows CERN shares rising 18.2 percent (blue) vs. the Nasdaq’s 15.6 percent (red), so it barely beat the Nasdaq composite index. 


Reader Comments

From Pango: “Re:  vendor employee provider experience. My company developed a rounding program where our software developers, project managers, product managers, and QA team members spent time observing a clinician in hospital departments. It was valuable because it provided insights into workflows and usability that we could not have understood other than by on-site observation. The programs were in place at several client hospitals and we maintained an active rotation of our team members who wished to participate.”

From Patti Melt: “Re: Epic. I just spent all day interfacing it to other systems. Since Neal Patterson says it can’t be done, should I buy a lottery ticket?”

From Urban Cowboy: “Re: Madison airport. If Epic is trying to eliminate consultant advertising within 50 miles of Verona, someone should tell the airport since it’s about all they have. With fewer implementations, they need all the help they can get.” Someone mentioned previously that perhaps the airport wasn’t within Epic’s rumored no-fly-ads zone since it’s a long cab ride, but Google Maps says it’s only 21.9 miles.


HIStalk Announcements and Requests

News is predictably (and thankfully) skimpy, so the biggest takeaway from this post is that you haven’t missed anything over the post-Christmas weekend.

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Dave Miller, CIO of Optimum Healthcare IT and formerly CIO of University of Arkansas for Medical Sciences, sent out an email suggesting Christmas donations to the Salvation Army, recounting how as a child the organization got his family of seven through their temporarily homelessness. Bitdefender wouldn’t let me bring up Dave’s fundraising campaign page at OnlineRedKettle.org because of a phishing warning, but I matched Dave’s $250 donation online in honor of HIStalk’s readers. Salvation Army is my #1 overall charity choice, with DonorsChoose.org running a close second.

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I’m ecstatic to report that three-quarters of respondents to my poll say they’re happier now than they were a year ago. New poll to your right or here: what is your overall impression of HIMSS? Click the poll’s “comments” link after voting to explain.


Last Week’s Most Interesting News

  • The executive director of the Connecticut Health Policy Project observes that the state’s now-defunct HIE oversight organization spent $4.3 million in federal grant money without accomplishing anything.
  • Pennsylvania’s HIE organization asks the state for $4.7 million to keep it running now that its ONC grants have expired and its efforts to bring paying organizations online and to solicit charitable donations have failed.
  • The FDA announces plans to require drug manufacturers to publish prescribing information for professionals electronically on an FDA-maintained website, eliminating the paper versions.
  • HTC Global Services acquires CareTech Solutions.
  • Boston Children’s Hospital (MA) pays $40,000 to settle state charges over the theft of an unencrypted laptop, while Northwestern Memorial Healthcare Group notifies 3,000 people that their information has been exposed by the theft of an unencrypted laptop from an employee’s car.

People

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Oneview Healthcare names Samir Batra (CareInSync) as VP of patient engagement.


Announcements and Implementations

TEDMED is offering a $1,000 discount for registrations completed by December 31 for next fall’s event, dropping the cost of the refundable, transferrable delegate pass to $3,950. This year’s event was split between San Francisco and Washington, DC and connected by video. No way I’m paying thousands of dollars to watch a big screen meeting from the other side of the country, but to each his own. The only names I immediately recognized from last year’s speaker list were swimmer Diana Nyad and Theranos CEO Elizabeth Holmes, neither of which would cause my hand to move toward my wallet.


Government and Politics

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Jeb Bush will resign from the board of for-profit hospital operator Tenet Healthcare as he explores a 2016 Presidential run. He made $300,000 from that gig last year. Tenet is worth $5 billion, with CEO Trevor Fetter holding shares worth $42 million.

A Wall Street Journal report says that Medicare is hard to fix because the agency doesn’t want to restrict care, adding that new providers aren’t vetted and inspectors never visit provider locations to see if they are real. The article points out that 45,000 new providers sign up to deliver Medicare services every month and CMS doesn’t have the resources to vet them.


Technology

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My most-used iPhone app is the outstanding, 99-cent MotionX GPS Drive navigation system. I just noticed that the company offers the also-99 cent MotionX 24/7, which includes a sleep tracker, step counter, heart rate monitor, and wake-up alarm, all integrated with Apple Health. I didn’t realize until I looked up their site that the company’s emphasis is on and quantified self rather than GPS navigation. It holds dozens of patents and licenses its technology to wearables vendors such as Nike. MotionX’s CEO and co-founder is Philippe Kahn, who invented the phone camera, founded the powerhouse 1980s software vendor Borland (Turbo Pascal, Quattro, TopSpeed/Clarion, dBase, Delphi, and Paradox), and earned simultaneous master’s degrees in mathematics and classical flute. I’m installing MotionX 24/7 now and will report back, but I can already see that it’s as well designed as I expected.

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Since I mentioned my most-used iPhone app, here’s another highly used one on the phone, desktop, and laptop: the LastPass password manager and single sign-on utility, which allows me to log on to a single Web page and have instant auto log-in to everything I use online (and to easily and centrally maintain complex and mandatory-change passwords) from any device. It’s free for personal desktop use, or an extra $12 per year to run it from mobile devices.

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This should annoy everyone smart enough to use their phone as a personal hotspot instead of paying $15 for crappy hotel Internet access: Marriott and its hotel lobbying group ask the FCC for permission to block tethering, using the extraordinarily stupid and self-serving excuse that guests might use their personal Wi-Fi connections to attack the hotel’s network, steal information from other online guests, or slow down the hotel’s Wi-Fi (all of which are arguments hotels should make for NOT using their own in-house networks, other than the fact that they profit handsomely from it). Microsoft and Google are urging the FCC to deny Marriott’s lame idea. Somehow cheap roadside hotels can offer free parking, Internet, and breakfast but the snootier, big-city ones milk their business travelers hard. Marriott’s Springhill Suites is still my favorite chain, though.


Other

The board of Massena Memorial Hospital (NY) approves spending $49,000 for a Medhost upgrade and $29,000 for a Meditech/LSS purchase. The CEO explained that the Medhost upgrade is required for complying with New York’s I-STOP mandatory electronic prescribing law, adding, “The last thing we want to do is end up sideways with the state and DEA. That would be extremely unpleasant.” 

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Eric Topol, MD tweeted this graphic of his medical smartphone concept from his new book, “The Patient Will See You Now.” Amazon’s “look inside” preview contains generous sections of the book’s content – it looks good.

This YouTube video of Derby the dog running for the first time after being fitted for 3D-printed prosthetics has received 6.8 million views for its producer, 3D Systems. The company, based in Rock Hill, SC , is traded on the New York Stock Exchange and is valued at almost $4 billion even after shares dropped 64 percent in the past year.

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The children of “American Top 40” host Casey Kasem, who died of dementia last June at 82, will share his hospital records with his widow, who is suing the hospital that cared for him. Kasem’s widow is the former Jean Thompson, who played Nick Tortelli’s curvaceous wife Loretta (with the “I Dream of Jeannie” hairdo) on “Cheers.”

The federal government upholds the firing of the head of the Phoenix VA, not because of the wait times scandal that erupted there, but because she accepted gifts from a consultant that included a family trip to Disneyland and Beyonce concert tickets.

‘Tis the season for intolerant lunatics: American Airlines removes a disruptive La Guardia passenger who was loudly berating the flight attendants and crew who had wished him “Merry Christmas.” The man, who wouldn’t calm down, said nobody should ever say Merry Christmas because not everyone celebrates it. His fellow passengers cheered when he was escorted off the plane.
 
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UPMC’s Magee –Women’s Hospital (PA) gives keepsake Christmas stockings and caps knitted by volunteers to the parents of newborns who are in the hospital over the holiday.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 27, 2014 News 11 Comments

News 12/24/14

December 23, 2014 News 4 Comments

Top News

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Healthcare workforce services vendor AMN Healthcare acquires Avantas, saying its clients need staffing forecasting analytics.


Reader Comments

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From Sonoran Dog: “Re: Maricopa Integrated Health System. Veiled rumors from administration suggest it will have to shut down in July 2015 due to lack of funds after receiving a large bond in the November elections. Any truth to the rumors? A lot of us medical personnel are working hard to comply with every cost-cutting feature we can come up with to help.” Voters overwhelmingly approved a $935 million bond to upgrade the facilities of the 515-bed public health system that includes Maricopa Medical Center, the Arizona Burn Center, and the Level One trauma center. The CEOs of the four largest private hospitals in Phoenix (Abrazo, Banner, Dignity, and Scottsdale Lincoln) say the huge construction expense is unnecessary given the sufficient bed capacity already in place (theirs, of course.) Readers comments are welcome. Surely there’s little chance of MIHS shutting down given public support, but some sort of public-private partnership with the those other Phoenix systems would make sense.

From Czarina: “Re: vendor-provider contact. What do HIStalk readers suggest for giving vendor employees exposure to the clinical workflow and technical challenges that providers face? We want every one of our people to get out in the field, but just taking a hospital tour doesn’t seem to have much value. We’re considering encouraging volunteering, attending a local or national conference, or taking a clinician to lunch.” I should note that this isn’t a huge company, so their employees won’t overwhelm the local health systems. Ideas? I’ll be honest that in my health system IT experience, I wouldn’t see the benefit to my department in having vendor people underfoot so they could learn on my dime, so I would be somewhat resistant to committing. I like the idea of setting up a volunteer program specific to the IT department if the hospital is willing to support it – our desk-bound IT department people learned a lot just going out with the field services techs or sitting with the help desk people.

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From HITPro: “Re: cyberdefense training system. Can’t mimic real-world health system security because it is virtually non-existent.” CyberCity, created to train federal government employees to defend against cyberattacks, had to artificially boost the security capabilities of its prototype hospital because it otherwise would have been “too trivial to hack.”


HIStalk Announcements and Requests

I’ll probably slack off a bit over the next week by posting less frequently. Merry Christmas, Happy Hanukkah, and Habara Gani (and if you don’t celebrate any of these holidays, those of us who do thank you in advance for respectfully tolerating that fact).


Acquisitions, Funding, Business, and Stock

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Provider secure messaging app vendor GroupMD renames itself Flow Health, or at least that’s what I infer from the maddeningly vague company blog post announcing a change without really describing it. I probably shouldn’t be surprised given that Flow Health’s “About Us” page on its we’re-so-hip, scroll-happy website doesn’t list its founders, physical location, or history.


Sales

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Porter Medical Center (VT) chooses Summit Healthcare’s data exchange platform to meet Meaningful Use Stage 2 Direct messaging requirements.


People

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Explorys hires Greg Yarrington (Truven Health Analytics) as VP of operations and Patrick Wells (Deloitte) as VP of solutions.

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Home medical equipment manufacturer Invacare appoints Cleveland Clinic CIO Martin Harris, MD as interim board chair following the retirement of Mal Mixon. The publicly traded Ohio-based company has 5,200 employees and a market value of $533 million, with Harris holding shares worth $327,000. The company’s share price has dropped 28 percent in the past year.

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J. Robert Beyster, PhD, founder of SAIC and Leidos, died Monday at 90. He left his job working on nuclear submarines for Westinghouse in 1969 and founded SAIC at age 45.


Announcements and Implementations

The Cal INDEX HIE connects to Blue Shield of California via Orion Health.

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India’s state of Telangana rolls out the country’s first healthcare app.

Sagacious Consultants announces an Epic report-writing annual subscription that provides a fixed number of hours each month with discounts of up to $50 per hour.


Government and Politics

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The executive director of the Connecticut Health Policy Project says the now-defunct state HIE oversight organization (Health Information Technology Exchange of Connecticut, or HITE-CT) was shut down “after wasting $4.3 million in federal grants and four years without accomplishing anything.” She references a state auditor’s report that concluded that the organization was slow to react, couldn’t figure out how to fund itself, and failed to renegotiate a bad vendor contract it had signed with Axway and GE Healthcare. At its peak expense year of 2013, the organization paid $343,000 in salaries. Auditors also noted that some of the 20 members of its board often missed meetings, vacant board positions weren’t filled, and with zero revenue the organization couldn’t pay the paltry matching funds required by the federal government ($1 for each $10 in federal grant money received). The editorial’s author is correct: the only accomplishment of the group was to squander federal money.

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Acting HHS Assistant Secretary Karen DeSalvo, MD writes a Huffington Post blog post welcoming home the US Public Health Service officers who returned from fighting Ebola in Liberia this past Saturday.

The FDA issues a proposed rule that would require drug manufacturers to provide prescribing information for professionals in electronic form, which would then be posted on an FDA reference site. Paper versions would no longer be allowed since they can’t be updated with new information, but manufacturers would be required to staff a telephone service that would send paper copies on request.


Privacy and Security

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Mercy Medical Center  (CA) announces that a third-party transcription vendor unintentionally opened up its server to the Internet for several weeks, making the physician notes of 620 oncology patients visible in web searches. The hospital has apparently fired the responsible contractor.

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The Michigan appeals court dismisses a privacy brought by 159 people whose medical records were unintentionally made available online by a contractor for Henry Ford Health System (MI). The three-judge panel ruled that an invasion of privacy claim isn’t valid unless the plaintiff’s actions are intentional.


Other

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Time magazine profiles Qliance, a Washington-based nationally expanding concierge primary care practice that has lowered its cost to the point that it covers entire businesses (Expedia and Comcast) and even Medicaid groups for a flat monthly per-patient fee based on age. Billionaire investors include Amazon’s Jeff Bezos and Michael Dell. I really like this snip:

At the tangled heart of this dysfunction is Medicare, which by its sheer size sets the standards for insurance reimbursements. Specialists dominate the panel that sets its payment rates. Thus the system values surgeries, scans and other procedures more than it values checkups and management of existing conditions. West, a primary-care doc, explains it this way: “If I put in an hour with a patient, I will be reimbursed for one exam–the same payment I would get for seeing that patient for 11 minutes. Meanwhile, an ophthalmologist might perform three cataract surgeries in that same hour, and each surgery might be reimbursed at twice the rate of my exam. So that doctor is making six times as much money.”

And if the eye patient has questions after the surgery about her medicine or her recovery, the specialist’s office is likely to suggest that she consult with her primary caregiver. After all, neither doctor gets reimbursed for answering questions on the phone, so the chore is often traded like a hot potato. “We say primary care is critical to a healthier future,” West says, “but in every way we show value, it is at the lowest level.”

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Doctors without Borders is using donated advertising on free medical imaging social network Figure 1 (“Instagram for doctors”) to recruit Ebola volunteers. The app automatically detects faces in submitted photos and blocks them for privacy and allows users to manually block other identifying features. Images are also moderated before posting to make sure they have been de-identified. The Toronto-based company has raised $6 million in funding and was founded by (a) a professor and writer with a JD and Columbia MBA; (b) an internist who describes himself as having an “above-average sense of humor and below-average physical fitness”; and (c) an iOS app developer.

A Harvard Business Review article called “The Antidote to Fragmented Health Care” contains as  one of its recommendations universal EHRs. It doesn’t define exactly what that means, but references the VA’s VistA, Kaiser’s HealthConnect, and the OpenNotes initiative. Looking back at all the money (taxpayer and otherwise) spent on EHRs and HIEs, maybe the better and cheaper alternative would have been to buy or create a nationalized EHR. Or, as I proposed years ago, mandate use of a standardize EHR database structure with rule-defined fields and let vendors compete based on the user interfaces and add-on capabilities they sell beyond the basic database-populating parts of the EHR.

Trustees of Regional Medical Center (SC) approve an extra $500,000 to implement Cerner’s document imaging system, with its president explaining that the hospital had underestimated the number of departments that would use the system and the volume of documents to be converted.

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The annual report of the Pennsylvania eHealth Partnership Authority says its biggest challenge is funding (duh) after its ONC grant ran out earlier this year, when it asked for $1.85 million in state support. Now it wants $4.7 million for the next fiscal year, explaining that it failed to generate the charitable donations it expected, user fees that were supposed to start kicking in earlier in 2014 won’t start until mid-2015, and even then those fees “will not reach levels that contribute significantly to Authority sustainability until most HIOs are onboarded to the P3N in 2016.” Translation: we don’t don’t know how to run a business, every one of our plans and projections were wrong and have been scrapped, and it’s highly doubtful anyone will ever pay us for the services we may eventually offer. Therefore, taxpayers should provide a never-ending flow of money so a poorly conceived, ever-changing, and incompetently executed idea can be pushed onto a market that doesn’t want it.

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An apparently serious study finds that the 30-day mortality rate of high-risk heart failure and cardiac arrest patients admitted to teaching hospitals is lower when cardiologists leave to attend national conferences. I remember reading years ago that death rates dropped when hospitals were closed due to strikes.


Sponsor Updates

  • Greenway Health releases version 3.1 of PrimeMOBILE.
  • EDCO Health Information Solutions posts two new case studies involving its Solarity medical records scanning and indexing solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

Get HIStalk updates.
Contact us online.

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December 23, 2014 News 4 Comments

News 12/17/14

December 16, 2014 News 4 Comments

Top News

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The massive Sony Pictures data breach forces the company to warn employees that hackers have their personal information (including Social Security numbers, government identifiers, and compensation information) as well as HIPAA-protected health information collected by the company’s health plans. Celebrity PHI was among the information downloaded, which should provide interesting gossip when it inevitably leaks out. A worksheet listing the company’s highest-cost health plan patients (above) was one of the documents hackers posted to the Internet as a warning. Sony Pictures hires a law firm to threaten newspapers and websites that might otherwise post embarrassing hacker-released information, a tactic that legal experts say probably won’t work since the publications would be obtaining the information legally.

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Meanwhile, the movie that apparently stoked the ire of the North Korea-based hackers premiered in LA Thursday night, with early mediocre reviews of “The Interview” raising the question of whether it was worth it, especially since the breach exposed emails in which a Sony Pictures executive griped to peers that the film is “desperately unfunny.” At least the movie will get curiosity box office revenue. Perhaps as the ultimate closing of the loop, Sony Pictures can make a movie about its own breach, featuring the “minimally talented spoiled brat” Angelina Jolie. After all, she starred in 1995’s “Hackers” before donning jewelry containing Billy Bob Thornton’s blood and then finally rebranding herself into a pouty-lipped Mother Teresa. Sony Pictures could use the ticket sales to help pay for the fines, privacy lawsuits, loss of business from exposure of its trade secrets and intellectual property, and general damage caused by incriminating emails. If they survive, that is, which should be in serious doubt at this point. The job you should be glad you don’t have is that of David Buckholtz, SVP of corporate IT at Sony Pictures Entertainment, who will never work in that town again.


Reader Comments

From Shag Dancer: “Re: HIStalk. How long does it take you to write it?” I spend at least eight hours on Tuesdays and Thursdays, sometimes more and sometimes less on the Monday Morning Update, since I research and write every word. That’s only for the heads-down writing and not all the stuff in between … I’m a fast writer, but it takes forever to wade through all the meaningless junk that I don’t mention and to make sense of the sometimes poorly presented information that I do. My job as I see it is to make it look easy and to disguise a lot of work into a quick and entertaining read.


HIStalk Announcements and Requests

I decided to add a new subcategory called “Privacy and Security” to each post since breach and threat news is frequent. I’ve placed it below the “Government and Politics” section below.

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I’m running an end-of-year special on promoted and produced webinars for those signed by December 31, so it’s a great time to contact Lorre to book a slot before the HIMSS conference.

Some company tossed a telephone book in my driveway this morning, reminding me that they still exist even though I haven’t opened one for at least five years (and when I did, I was only seeking pizza coupons). It reminded me of my first cell phone, which was not only large and sporting a walkie talkie type antenna, but also came with an downsized phone book for stashing in the glove box (where, curiously, no gloves have ever been placed).

Listening: new soulful and honest R&B crooning from K. Michelle. I listened unaware that she’s been in some trashy reality TV shows, thankfully, since the music soars despite her iffy career and lifestyle decisions.

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I’m a recent coffee convert after years of making fun of Starbucks lines and bizarre morning rituals, so I need to know whether I’ve found belated enlightenment or whether I’ve instead crossed over to the dark side. Take my poll here – what do you enjoy drinking most at work? I usually hit all the hydration checkboxes with coffee, water, and soda in the mornings and I’d still find it hard to choose a favorite, although there’s nothing like coffee to get me going (and it’s not just the caffeine – there’s something about the warmth that just works). I’m not a snob about it, though – the giant $1 cup at McDonald’s is fine.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.

December 18 (Thursday) 1:00 ET. Virtual book launch for “Extraordinary Tales from a Rather Ordinary Guy,” a new book by “CIO Unplugged” contributor Ed Marx. Ed will go over the principles contained in the book, read a couple of tales that haven’t been shared until now, and accept live questions. Attendees who use the webinar’s interactive features will be eligible to win free copies of the book as well as a Kindle.


Acquisitions, Funding, Business, and Stock

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Google’s venture capital fund is moving its investments from consumer Internet startups  to healthcare and life sciences, with a special interest in companies that focus on health data.

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Orion Health completes its New Zealand IPO, raising $97 million.

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Neos Technologies acquires wearables monitoring vendor AFrame Digital. I don’t know anything about the former except that it writes a bad press release, including misspelling its own name. I’ve only heard of AFrame when it received a 2011 NIH grant to study falls in the elderly. Its “About” page obscures whoever is involved with the company, so my initial “who cares” reaction is that two unsuccessful companies are trying (against all odds) to merge into one better one. I lose nearly all interest in a company whose website fails to (a) list its executives; (b) indicate the location of its headquarters; (c) showcase recent announcements; or (d) make it clear on the home page exactly what it does in a succinct, buzzword-free tagline or paragraph. If they can’t accomplish those trivial tasks, why would I want to buy anything from them?

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Lightbeam Health receives an unspecified capital investment from former Allscripts executives Glen Tullman and Lee Shapiro.

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A report published by Good Jobs First names Cerner as #3 on the list of companies linked to the Forbes 400 list of richest Americans (Neal Patterson at $1.55 billion) that have received more than $1 billion in subsidies from state and local governments trying to boost economic development. Cerner at $1.7 billion worth of taxpayer gifts trails only Intel ($5.9 billion) and Nike ($2 billion). I say blame politicians rather than the companies that were voluntarily offered taxpayer money for reasons that may or may not make good fiscal sense.

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Singapore- based RingMD, which offers consumers live video access to a global network of doctors, will establish its North American headquarters in Charleston, SC in preparation for an expanded US presence. Former programmer and founder Justin Fulcher, who is 24, started the company with the financial support of the Singapore government.  


Sales

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Massachusetts Eye and Ear (MA) chooses Medarchon’s Quarc for secure messaging.

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Hunterdon Healthcare (NJ) will use secure communications from Practice Unite.

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Genesys Health System (MI) signs up with PerfectServe for clinician communication.


People

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Mary Jahrsdoerfer, PhD, RN (Philips Healthcare) joins Extension Healthcare as chief nursing officer.

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Remote monitoring vendor Sentrian hires Lance Myers, PhD (Vivonoetics) as CTO.


Announcements and Implementations

The non-profit American Telemedicine Association launches an accreditation program for providers offering direct-to-consumer consultations, with the cost and requirements of the three-year certification disclosed only after submitting an application. Part of the package includes being able to use ATA’s accreditation seal and being listed in its consumer guide.

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Allscripts certifies the Patient Engagement Solution of non-profit Healthwise for integration with its TouchWorks EHR.

Kaiser Permanente Hawaii launches a teledermatology service in which primary care physicians can send patient photos to dermatologists for diagnosis. 

The 300th hospital goes live on Medhost’s YourCareCommunity vendor-agnostic patient portal.

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The folks at Forward Health Group got permission for me to use the above summary graphic from KLAS’s just-released “Population Health Performance” report in which Forward Health Group scored at the top of several categories and #2 overall. Phytel, Forward Health Group, and i2i Systems led the pack, while eClinicalWorks and McKesson were the only two vendors in the low-performing category.

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Wellcentive joins the CommonWell Health Alliance.


Government and Politics

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The Senate finally confirms Vivek Murthy, MD, MBA as surgeon general, filling a position that has been vacant for 17 months. President Obama nominated him in November 2013, but his statements labeling guns as a public health hazard drew opposition from the influential National Rifle Association, which ended up on the rare wrong side of a political decision.


Privacy and Security

An interesting study seems to suggest that patients think the specific use of their health information is more important than whether their consent was given in advance. That’s surprising given that our entire desired state is is driven by opt in/opt out via consent signatures. Respondents said research use is OK in most cases, but using their information for marketing (even with their consent) is not OK.

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Clay County Hospital (IL) calls the FBI after receiving an extortion email demanding cash to prevent stolen patient information from being disclosed (of which a sample was included as proof of possession). The 22-bed hospital says its servers haven’t been hacked, which would suggest that responsibility rests, as it often does, with an employee.

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Virginia Commonwealth University Health System (VA) notifies patients that the used CDs donated by one of its employees to a children’s art project contained PHI, including full clinical records and Social Security numbers. 

In Canada, Ontario’s privacy commissioner orders Rouge Valley Hospital to upgrade its computer systems, appalled that a year after several employees were found selling patient information, hospital still can’t review access records going back further than two weeks. A fun tidbit from the article: one of the employees who was selling information to Registered Education Savings Plans (RESPs) changed jobs and lost his access to the computer, after which he pulled the brilliant move of sending a formal request to IT asking to have his access restored so he could look up patient phone numbers to “sell them to RESPs in the course of his part-time employment.”


Innovation and Research

A tongue-in-cheek observational study finds that physician waiting rooms contain old, boring magazines because patients steal the others, especially newer celebrity gossip magazines. A couple of years ago I picked up a new-looking travel magazine in the lobby waiting room of one of our hospitals while waiting for a co-worker. I wondered why it featured now-defunct countries and photos of vintage automobiles until I checked the cover date, which was 1995. If only it could talk.

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”Which surgeon you get matters – a lot,” says a profile of surgical outcomes software Amplio, developed by Memorial Sloan Kettering Cancer Center. The system combines post-op patient feedback with EHR information to tell surgeons how they’re doing, which they rarely know since they assume all similarly trained surgeons have similar outcomes with any variation explainable by how sick their patients are. The article references an earlier study in which it observers could easily and accurately determine who was the better surgeon by simply watching videos of their procedures. It also cites the startling results of a 2007 study: cancer returned in 10 percent of patients whose prostate was removed by inexperienced surgeons vs. in only 1 percent of those operated on by experienced surgeons. A snip from the brilliantly written article:

There’s something powerful about having outcomes graphed so starkly. Vickers says that there was a surgeon who saw that they were so far into the wrong corner of that plot — patients weren’t recovering well, and the cancer was coming back — that they decided to stop doing the procedure. The men spared poor outcomes by this decision will never know that Amplio saved them.
 
It’s like an analytics dashboard, or a leaderboard, or a report card, or… well, it’s like a lot of things that have existed in a lot of other fields for a long time. And it kind of makes you wonder, why has it taken so long for a tool like this to come to surgeons?
 
The answer is that Amplio has cleverly avoided the pitfalls of some previous efforts. For instance, in 1989, New York state began publicly reporting the mortality rates of cardiovascular surgeons. Because the data was “risk-adjusted”—an unfavorable outcome would be considered less bad, or not counted at all, if the patient was at risk to begin with — surgeons started pretending their patients were a lot worse off than they were. In some cases, they avoided patients who looked like goners. “The sickest patients weren’t being treated,” Vickers says. One investigation into why mortality in New York had dropped for a certain procedure, the coronary artery bypass graft, concluded that it was just because New York hospitals were sending the highest-risk patients to Ohio.


Technology

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The CEO of Withings apologizes to purchasers of its Aura sleep device, acknowledging that in its rush to get the product on the market, the company left out important features such as heart rate tracking and the ability to view results immediately. They’re trying to fix some of the problems with updates.


Other

The Portland, OR newspaper covers the failure of a local interoperability project that started eight years ago, concluding that it didn’t work even though most hospitals are on Epic because: (a) hospitals bear the cost while insurance companies reap the benefit; (b) hospitals get paid for the procedures they perform rather than those whose duplication they avoid; (c) even information that is successfully exchanged doesn’t always make sense to the recipient. Thus reads the boilerplate RHIO epitaph.

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A new Consumer Reports survey of recently hospitalized patients finds that those who didn’t feel respected by staff during their stay were 2.5 times more likely to experience a medical error, with an alarming 30 percent of those surveyed saying they actually did. A third of respondents say they weren’t treated like responsible adults, while 40 percent report that doctors and nurses interrupted them instead of listening. The article, which will appear in the February 2015 issue, suggests that patients choose a hospital carefully, invite doctors to sit down and talk, write things down, and bring along a trusted ally to help. I asked Consumer Reports about the survey’s methodology, with the positives being that it was a national representative sample with a high confidence level. The negatives that I can determine (without seeing the actual survey instrument that I asked for) are that patients self-reported whether an error occurred and nothing was mentioned about error significance (getting a daily aspirin an hour late might be reported as a medical error by some patients). Interesting but not surprising to me is that all of the lowest-safety, lowest-respect hospitals (listed above) are in big metro areas, with a heavy Chicago representation. As I always say, go to a big academic medical center if you require tricky diagnosis or surgery; otherwise, a mid-sized community hospital that does a lot of whatever you need is your best bet.

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The latest article in the New York Times series “Paying Till It Hurts” reviews the cost of diagnostic tests, which it describes as “what liquor is to the hospitality industry: a profit center with large and often arbitrary markups.” Example: an outpatient EKG done by a community hospital’s technician took 30 minutes and was billed at $5,500, while the same test performed by a Harvard hospital and cardiologist over 1.5 hours was billed at only $1,400 (the article should have mentioned what the graph shows, that Medicare didn’t pay the funny money in either case, instead reimbursing around $400 for each). Eric Topol, MD summarizes the economic incentive as, “At many hospitals, the threshold for ordering an echocardiogram is the presence of a heart.”

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The bonds of 109-bed Mayers Memorial Hospital District (CA) are downgraded, primarily because of EHR-related capital expenses and resulting lower cash collections. The hospital, which implemented McKesson Paragon, is down to 3.5 days of cash on hand.

A New Zealand coroner warns doctors to pay attention to the clinical warnings generated by their EHRs after ruling that a patient died after his doctor prescribed quinine inappropriately. The coroner also noted that hospital records aren’t available to physician practices.

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In England, a lead nurse in an endoscopy unit hangs himself after expressing concerns about staff shortages and the introduction of a new hospital computer system that was causing a patient backlog, forcing him to work 80 hours per week.

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Also in England, doctors at Royal Free Hospital warn that patients are being endangered by its implementation of the OpenText document management system that has created scanning backlog, causing patients to arrive for new visits while their paper records are still piled up in a scanning contractor’s warehouse. The hospital was bragging just a few months ago about the problems that OpenText solved in sending scanned records to its Cerner EPR system.

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Duke University Health System (NC) hospitalist Ricky Bloomfield, MD provides the remote chronic monitoring billing codes he mentioned at his mHealth Summit session on Apple HealthKit: the new E&M 99490 for  monthly chronic care management ($42.60 per month) that could be combined with CPT 99090 or 99091 to yield $99.52 per month. He warns that nobody has actually tried billing Medicare or any other insurer using these codes yet, so it’s a work in progress.

Only in America: the family of an Ohio inmate who raped and killed a woman who was 30 weeks pregnant sues just about everybody for his painful execution that was performed using the untested two-drug combination of midazolam and hydromorphone. Named in the lawsuit are the manufacturer of the drugs (Hospira) and their distributor (McKesson), companies the family says should have known would cause suffering. In an interesting twist, a prison guard says the inmate told him before he died that his attorney urged him to feign suffocation with a prearranged “thumbs up” signal as the injections were started in the hopes that the governor would stop the execution.

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Weird News Andy says, “They really do have skin in the game.” Scientists develop artificial skin for prosthetics that can feel warmth and other attributes. Or as WNA adds, “for Terminator v0.1.”


Sponsor Updates

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I invited sponsors to send photos of their holiday activities since I like to put faces with company names. The folks from Direct Consulting Associates providing shots of their company gathering.

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Employees of PerfectServe collected donations for the Florence Crittenton Agency in Tennessee, donating clothing and 10 suitcases for the agency’s “Wheels of Hope” campaign that allows children who arrive carrying their belongings in a trash bag to leave with their own suitcase.

  • Visage Imaging posts its “RSNA 2014: Visage’s Top Five.”
  • RazorInsights doubled its client base, increased revenue by 200 percent, and hired 80 new employees during 2014.
  • GetWellNetwork Ambulatory earns ONC-ACB 2014 Edition Modular EHR Certification. The company also announces that CEO Michael O’Neil will present at the 2014 HIMSS Middle East Integrated Health Innovations Conference this week. 
  • Nuance announces that KLAS rated it #1 for regulatory reporting in “Quality Management 2014: The Race Gets Closer.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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Contact us online.

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December 16, 2014 News 4 Comments

News 12/5/14

December 4, 2014 News 10 Comments

Top News

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HL7 launches the Argonaut Project to address the standards recommendations of the federal government’s JASON group, including HL7’s FHIR (fast healthcare interoperability resources). Working with HL7 will be athenahealth, Beth Israel Deaconess Medical Center, Cerner, Epic, Intermountain, Mayo, Meditech, McKesson, Partners HealthCare, SMART from Boston Children’s, and The Advisory Board Company. HL7 says the group will create FHIR-based EHR data sharing API specification by the spring of 2015. The big news here: (a) the second JASON report called for a big vendor to propose an open API standard instead of waiting around for the government to do it; (b) FHIR and APIs are a heck of a lot better than today’s document-based interoperability standards and probably better than the customized jungle that the HL7 standard has become; and (c) getting Epic, Cerner, Meditech, and McKesson together at the same table covers nearly all of the hospital EHR market and Epic, particularly, is a key member given its non-participation in CommonWell (and Epic and Cerner already have customers using APIs).

I asked an expert who shall remain unnamed to summarize Project Argonaut:

Project Argonaut is beginning the hard work of not only formalizing the API calling sequence (the easy part and something most vendors already do), but to formalize a set of vocabulary objects – Problems, Allergies, Notes, etc. with controlled vocabularies and predictability. To make FHIR really work, both must be done well. If FHIR succeeds, it will allow third parties to create an “app” and be able to run it in any FHIR-compatible system without the meet and map exercise with each implementation. What we’ll need to do with FHIR is to ensure people don’t get ahead of themselves and customize the “resources,” otherwise we’ll be back in the same boat as HL7 v2. FHIR is at the peak of inflated expectations. It will be great as a minor plug-in where there’s a UI or visualization, but not so great for machine-to-machine communication where one of the endpoints might not always be reliable for high-volume transfers at scale – some of the simpler web service configurations can be horribly inefficient, like making separate grocery store trips for each item on your list. There may be audit and security issues as well.

I asked another expert how the Argonaut Project might relate to CommonWell:

There is no immediate connection, but over time, CommonWell could add services that are based on the FHIR standard that the Argonauts are trying to speed up. For example, CommonWell today uses XCA to move CDA documents around, but that can be cumbersome if all the doctor wants is to get a list of known allergies from some other site. FHIR makes the later query much easier than using XCA to move a "fake" document that contains only allergies. So, CommonWell will benefit from the success of the Argonaut work (assuming it’s successful!) But otherwise, there is no direct connection, though some of the same people are involved with both.


Reader Comments

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From Ken L. Ration: “Re: HIMSS. Our designer got a good laugh from this HIMSS15 promotional graphic. One thought it was an attempt to be edgy, but the general consensus is that it’s a marketing fail.” I think it’s an insightful graphic: those benzene ring-shaped items are probably snowflakes burying HIMSS attendees who would much rather be almost anywhere else — Chicago came in seventh of 11 desired HIMSS cities last time I surveyed, with the clear winners being San Diego, Las Vegas, and Orlando.

From Roy G. Biv: “Re: physician billing services. Do health systems keep using them after implementing Epic? Could you ask your readers if, for instance, the keep using athenahealth’s PM and billing service post-Epic?” Readers have been duly notified – responses are welcome.

From HIT5982: “Re: Medhost. Let 71 people go Wednesday all at once. HR cleaned out their desks while they were being told. I was one of them – I worked in the department division (EDIS, Patient Flow, perioperative) and was told the emphasis will shift to Enterprise (clinicals, financials, patient access, revenue cycle). Departmental sales were down this year.” Reported by two readers. I reached out to the company for a response but didn’t receive one. Nothing says Christmas like being laid off.

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I shall digress and pontificate on the topic of layoffs. I’ve seen both sides over the years: (a) I was literally on my way out the door before getting a last-minute reprieve in my one and only vendor job many years ago, where layoffs every quarter were a given as executive bonuses became threatened by poor financial numbers mostly due to their own poor decisions; and (b) I have personally marched at least 20 people out of the hospital IT department through a gauntlet of their peers as I served as judge, jury, and executioner for high-level decisions that I neither made nor agreed with. Both situations were largely created by clueless, spreadsheet-circulating executives who were shockingly indifferent to the havoc they were wreaking on the lives of people and their families. While some of the folks who get axed deserved it and should have been canned a lot sooner, many of them had been given perfectly fine performance evaluations but were singled out for factors beyond their control: changing organizational strategy, their own demographics, higher salaries that they had been voluntarily offered to them, and doing their jobs every day instead of kissing executive butt and backstabbing their co-workers. Readers regularly send me personal stories about being cut loose and I always provide the same response: you’ll be better off in the long term because who wants to work for a company that lays people off? To people all over the industry who have to face the holidays (and their families) with uncertainty, fear, and feelings of personal inadequacy for whatever reason, I am truly sorry. It will get better.

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From Pierre Dukane: “Re: slimy companies. This site [URL omitted] charges consultants $300 per quarter to be on the ‘elite’ list for go-live job notifications, using information it gathers from other members and online job postings (duh). The ‘About’ page doesn’t say who runs it and the domain registration information is blocked. I can’t believe people pay for this garbage. Also, an HIT consulting firm’s recruiter is sending emails offering entry into a gift certification drawing if they ‘forward any email you receive from another recruiter or company regarding current opportunities or referral incentives.’ What happened to working the old-fashioned, honest way? No wonder clients and consultants feel so negatively about consulting firms.” It wasn’t hard for me to track down the operator of site you mentioned, which doesn’t seem to be offering much for $1,200 per year. But hey, it’s a free country, and he’ll either get business or he won’t depending on the value he provides. I’ve had both good and bad experiences with recruiters that I’ve either hired or been placed by, but I agree that quite a few questionably motivated people see it as nothing more than making easy money by matching Resume A to Job Posting B. Nearly everything in life can be explained by supply vs. demand.

From Elsa: “Re: BJC’s core clinicals replacement. Vendors were to have been notified Friday. I was shocked that it wasn’t Cerner – my source says it’s Epic. Not sure how they’ll justify the cost when they laid off staff, cut charity care, and froze raises.” Unverified.

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From Not Quite: “Re: JASON report. ONC is putting a lot of stock in it, but it’s a fake that is partially plagiarized from Wikipedia. The report lists many references, but fails to list Wikipedia, from which many things were copied. ONC should ask for our money back!” No report should ever reference Wikipedia since it’s not a vetted reference, but hopefully the JASON folks cited their primary references properly, at least where a source contained something that isn’t common knowledge.


HIStalk Announcements and Requests

Voting for the US capital of healthcare IT has been heavy, with Madison leading the pack and Nashville and Boston pulling up as a distant second and third. Voting ends this weekend – my poll is here.

This week on HIStalk Connect: Data scientists with athenahealth are monitoring the onset of the 2014-2015 flu season and note an early uptick in flu-related visits. Google is said to be revamping the internal components of Google Glass in an effort to boost battery life. Personal genome testing startup 23andMe will begin selling genetic tests in Canada and the UK after a year of trying and failing to secure FDA approval for US sales. 

This week on HIStalk Practice: Payers in Colorado build online claims data-sharing tool for physicians. HIPAA compliance at physician practices is found to be woefully lacking. Gila River Health Care goes with NextGen, while Advocate Community Partners selects eClinicalWorks. Practice Fusion VP argues for net neutrality, while Amazon takes advantage of lightning-fast consumer Internet connections. AMA winner Nancy Adams asks, “Interoperability? How about achieving operability first?” Thanks for reading.


Webinars

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Integrated payments network vendor InstaMed raises $17 million in a private placement, $2 million more than it was seeking.


Sales

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Rio Grande Valley Health Alliance (TX) and Lakewood Health System (MN) choose Lightbeam Health Solutions for population health management. I interviewed CEO Pat Cline a few months ago. 

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Western New York’s HEALTHeLINK HIE chooses Stella Technology’s clinical data access technology for analytics and reporting.

Children’s Hospitals and Clinics of Minnesota chooses Strata Decision’s StrataJazz for decision support and cost accounting.

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Granite Health Network (NH) selects athenahealth’s athenaCoordinator Enterprise Population Manager.

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The Medical Center at Bowling Green (KY) chooses ProVation Medical for its cardiac cath lab.


People

CompuGroup Medical US promotes Navid Asgari to VP of service and support for its ambulatory information services division.


Announcements and Implementations

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Lehigh Valley Health Network (PA) announces that its physician group will move to Epic.

Levi, Ray & Shoup announces release of a new user interface for Epic users of its VPSX output management solution.

Imprivata announces OneSign 5.0, a new version of its authentication and access management product.

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Children’s National Health System (DC) opens an Innovation and Learning Center to house Bear Institute, its partnership with Cerner. The announcement is confusing, but I think it’s just a new physical space to house the existing project, which was announced just over a year ago.

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CareSync launches its Chronic Care Management service that allows providers to earn Medicare’s monthly CCM payments.

Perceptive Software launches Perceptive Interact for Google Apps, which allows users to integrate Gmail content into Perceptive Content for review, routing, and collaboration.


Government and Politics

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ONC names Jon White, MD from AHRQ as acting deputy national coordinator and acting chief medical officer, taking over for the recently departed Jacob Reider, MD.

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Someone tweeted out this fascinating article from March called “Sinkhole of Bureacuracy,” which describes the 600 federal government employees who push paper in the abandoned limestone mine run by Iron Mountain in the middle of nowhere in Pennsylvania at a cost of $56 million per year. Previous federal government automation efforts of the government’s retirement program failed despite spending well over $100 million. A former employee described the manual process as, “I used to chase people for months — literally — for one signature on one piece of paper. You want to talk about an egregious waste of taxpayer money? … On a daily basis, we would get from five to 50 e-mails, asking everybody to take time out of their day to search their desks for case files.” The article says the old mine is legend in the federal government, quoting former CTO Aneesh Chopra as calling it “that crazy cave.”

Massachusetts says it has repaid most of the $2.1 million in Medicaid EHR incentives that were incorrectly given to 19 hospitals that were identified by the HHS OIG. The state blamed requirements that are hard to understand and hospitals that reported incorrect data to the federal government.


Innovation and Research

A small study finds that a computerized symptom questionnaire that was turned into a History of Present Illness narrative using computer algorithms created a better HPI than physicians doing it themselves.


Other

Hospitalists at two Oregon hospitals form a union, hoping to remain as hospital employees rather than being outsourced to a national firm.

A review of a tiny sample of the 100TB (!!) of data hackers took from Sony finds medical information, in the form of doctor letters for medical leaves of absence. The responsible hacker group, possibly from North Korea, has posted some of the information publicly, including salaries, scripts, and video files of unreleased Sony movies. The hackers also released a Word document titled “Passwords” that some idiot Sony executive had used to store all of his computer passwords and credit card information. Sony was burned by hackers in 2011 who stole credit card numbers and took down its PlayStation network for weeks. 

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New York police arrest radiologist James Kessler, MD, MPH for copying the information of 97,000 patients of his former employer onto a portable hard drive with intention of starting a competing business.

Singer and cancer survivor Melissa Etheridge, just announced as a keynote speaker for GE Healthcare’s Centricity Live user conference, creates a line of prescription-only “cannabis-infused fine wines” that provide “a delicious full body buzz.”


Sponsor Updates


  • An Imprivata video provides an overview of electronic prescribing of controlled substances.
  • HCS provided 50 tickets to the Los Angeles screening of the overwhelmingly positively reviewed Glen Campbell documentary “I’ll Be Me” in support of Alzheimer’s awareness. The company will be contributing to the Salvation Army through the holidays on behalf of its clients.
  • DataMotion earns accreditation as a Certification Authority and Registration Authority from DirectTrust.org and EHNAC, allowing it to issue and manage digital certificates in addition to its role as an accredited Health Information Service Provider.

EPtalk by Dr. Jayne

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ONC will hold its annual meeting February 2-3, 2015. The email announcement caught my eye in mentioning that “the two-day meeting will gather over 1,200 health IT fans,” but on the registration website, it had been toned down to “health IT partners.” The event includes “an exciting panel of ONC’s former National Coordinators,” according to the email. I’m not sure if that’s enough of a draw to convince me to head to Washington in February. If you’re planning to attend, keep us in mind for rumors and newsy tidbits.

GE Healthcare announces its Centricity Live 2015 meeting April 29-May 2, 2015 at the Walt Disney World Dolphin Resort. Keynote speakers include Atul Gawande, Melissa Etheridge, and LeVar Burton. That lineup looks pretty good compared to some I’ve seen. I stayed at the Dolphin a couple of nights before HIMSS and it’s in a minimally mousey part of the Disney compound. Given the recent weather in my neck of the woods, I’m sure by April I’ll have a complete deficiency of Vitamin D, so if anyone wants a sassy traveling companion, let me know.

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My good friend Anjali called last week asking for a favor. The annual Christmas Party at her hospital (it’s a faith-based institution, hence the name) was looming. Her husband had to travel and she didn’t want to go alone. She’s run three half marathons with me and has had my back in countless clinical situations, so how could I say no? She works at a hospital across town where I only know a handful of medical staff members, so I was looking forward to a holiday party where I could have a couple of glasses of wine without being interrogated about our EHR.

We were a little late heading out. She had picked up a dose of flu vaccine from the local retail pharmacy and was planning to vaccinate her daughter. The pediatrician’s office was already out of vaccine and the pharmacy won’t vaccinate children under 8 even with a physician’s order, so she decided to get creative. Unfortunately, she’s a surgeon with few pediatric vaccine skills, so I was persuaded to step in.

It’s a sad commentary when you have to work the system to vaccinate your child. Most parents don’t have that option, but I was happy to help. Needless to say, that vaccine won’t be making it into the state immunization registry, but I did email her the Vaccine Information Statement so I don’t run afoul of the feds.

The tables were packed when we arrived. We grabbed the first open space we found. We were next to a husband/wife physician couple – she’s a radiologist on staff and he’s an internal medicine physician elsewhere in town. The odds of a physician conversation (regardless of setting) eventually turning to EHRs and healthcare IT is nearly 100 percent if you talk long enough, and tonight didn’t disappoint.

The radiologist is pretty happy with the hospital’s system. She appreciates being able to view the entire patient chart when there are questions about what an ordering provider hopes to achieve with a diagnostic test. She also enjoys not having to help the radiology staff decipher cryptic physician handwriting.

Anjali told them she preferred handling patient messages from home after her daughter goes to bed rather than having to stay in the office. A couple of other people chimed in and I thought for a brief moment that the EHR love fest might continue in the spirit of holiday togetherness.

The bubble was burst when the internal medicine physician started complaining about his EHR. He complained of the burden of data entry with little return. He said he didn’t understand why there wasn’t any data exchange with other practices or hospitals or why he doesn’t have access to reports on his patients’ health status.

I asked a couple of questions about his practice and his system and was able to deduce that he is actually on my hospital’s platform, through our affiliate subsidy program. Anj picked up on this as well and gave me a little eyebrow raise. She knows I led deployment of our private HIE more than six years ago and that our users regularly exchange data between owned and affiliate practices as well as our multiple hospitals.

She’s also on the same ambulatory EHR although on a different platform, so was able to provide some positive counterpoints to keep him from going too far. I didn’t want to reveal myself as the owner of the platform due to the potential for turning a holiday gathering into a debate, so I excused myself for another glass of wine.

Most of our providers are satisfied with our system and are seeing the benefits of our patient registries, actionable reports, and interoperability. I’m going to need to get to the bottom of why his practice isn’t having a good experience and figure out what we need to do to get them to the same level satisfaction. I’ve reached out to our affiliate program manager so that I can review his implementation documentation and support tickets to try to identify what might have gone awry. I just wish I had heard about it through or formal processes rather than as an aside at a party.

Anj has never seen me in full Administralian mode and told me she was impressed at how I kept my cool while the physician was ripping apart the system I’ve spent the better part of a decade implementing, optimizing, and personally ensuring that practices receive value for their efforts. I must say I haven’t always been unflappable in these situations, but they have become easier over time. I’ve learned to pick my battles and not let situations get out of control.

We did enjoy some seafood and a nice string quartet, as well as good conversation with other physicians.

Have any strategies for enjoying the company holiday party? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 4, 2014 News 10 Comments

Morning Headlines 12/3/14

December 2, 2014 News No Comments

Health Data Outside the Doctor’s Office

National Coordinator Karen DeSalvo, MD publishes a blog post touting a JASON report that HHS commissioned to explore “how to create a health information system that focuses on the health of individuals, not just the care they receive.”

Electronic patient records systems not ‘good enough’, says NHS CIO

In England, David Walliker, CIO of Liverpool Women’s NHS Foundation Trust says that he will pursue an electronic document management solution, rather than upgrading to a modern EHR, because the current systems available from CSC, Cerner, and Meditech are not yet viable options for the hospitals specialists.

Epic Systems backs down on noncompete clause

Epic backs down from an earlier decision to up its non-complete cause from one year to two for any recently departed employees that were trying to join Vonlay, a local health IT consulting firm. The employees in question had already left Epic and had only signed a one-year non-compete when they were hired.

Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care

The Bipartisan Policy Center will live stream a six-hour meeting on Wednesday called “An Oversight Framework for Assuring Patient Safety in Health Information Technology.” Speakers include National Coordinator Karen DeSalvo, MD, and McKesson CEO John Hammergren.

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December 2, 2014 News No Comments

News 12/3/14

December 2, 2014 News 13 Comments

Top News

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An ONC blog post by Karen DeSalvo, MD called “Health Data Outside the Doctor’s Officer” references a new JASON report titled “Data for Individual Health” (JASON is a highly regarded independent science advisory group run by DoD contractor MITRE Corporation). The report addresses the steps needed to move to “a system focused on health of individuals rather than care of individuals” in creating a learning health system. Some of its recommendations:

  • HHS: take action on previously created reports and measure progress.
  • HHS: adopt interoperability standards and incentives.
  • HHS: support open API standards and pay providers more (the report suggests a 0.25 percent bonus in CMS’s Hospital Value-Based Purchasing Program) for using “ecosystem-friendly EHRs” that follow those standards.
  • HHS: encourage non-profits (such as disease-specific advocacy groups) to mark consumer apps with their stamp of approval to increase their adoption.
  • Joint Commission and professional schools: add informatics training requirements.
  • FDA: loosen control of product services that could be construed as practicing medicine, for example, allowing apps to report their information to both provider and consumer as a risk mitigation strategy.

With regard to interoperability, JASON says the market is moving in the right direction and specifically notes that Epic (which the report says is regarded as “among the most closed systems”) has announced that it will develop APIs to allow external programs to interact with its systems. However, it says that initiatives are not complete because systems sometimes only export entire documents, omit patient information, or provide APIs whose use is contractually limited to customers rather than entrepreneurs. The new report suggests that the government encourage “an incumbent vendor with significant market share” to propose an open API standard to encourage the market leaders to step forward rather than being forced to follow a competitor-proposed standard. It also says FHIR is a significant improvement over CDA document-based exchange.


Reader Comments

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From Enumerator of Legumes: “Re: Laurens Albada. You mentioned that he appears to have left as CFO of Greenway Health. He’s now managing director of financial services with the consulting group of Vista Equity Partners, Greenway’s owner.” Verified, according to his LinkedIn profile. That’s a nice move up.


HIStalk Announcements and Requests

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Reminder: I’m collecting questions for CommonWell. If you want more information about its interoperability technology or strategy, send me yours

“Utilize” has been at the top of my “most annoying words” list for a long time since it is just a needlessly complicated way to say “use.” However, its top position has been recently threatened by “leverage,” which in a remarkable coincidence is yet another pompously pointless way to say “use.” Give marketing people their way and system users will be renamed “leveragees.”

Listening: Green River, an obscure mid-1980s hard-rocking Seattle band that arguably created what would later be known as grunge. They’re angry and armed with loud guitars that require me to provide air drums accompaniment. Two of the members later formed the similarly intense Mudhoney. I’m also enjoying the amazing Dinosaur Jr., late 1980s indie rock that remains fresh (and loud).


Webinar

December 17 (Wednesday) 1:00 ET. There Is A 90% Probability That Your Son Is Pregnant: Predicting the Future of Predictive Analytics in Healthcare. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Predictive analytics is more than simple risk stratification. Once you identify an individual’s risk, what are the odds that you can change their behavior and what will it cost to do so? This presentation, geared towards managers and executives, addresses scenarios in which predictive models may or not be effective given that 80 percent of outcomes are driven by socioeconomic factors rather than healthcare delivery.


Acquisitions, Funding, Business, and Stock

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Microsoft acquires 18-month-old, 20-employee Accompli — which developed a slick, free, Exchange-enabled smartphone email management app — for $200 million. I’ve tried it with my Gmail accounts and it has some nice features, such as smart messaging organization, easy calendar access, Dropbox enablement, and one-swipe conversion of an incoming email to a calendar event. I don’t know how Accompli planned to make money other than by being acquired, so maybe it cleverly noticed Microsoft’s mobile email weakness and figured MSFT would eventually wave money in its direction with hopes of renaming it Outlook Mobile. Accompli had raised only $7 million of VC money in its short history, so that’s quite a score.

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Madison’s alternative weekly newspaper says that Epic has backed down from its plan to extend its non-compete term from one year to two for employees who quit to join consulting firm Vonlay after its acquisition by Huron Consulting Group. The paper says that Epic got involved with the acquisition at the last minute by insisting that Huron not hire any Epic employees within two years of their resignation from Epic, meaning Epic would be enforcing a requirement to which its employees hadn’t agreed. The article says local speculation is that Epic is beginning to fear being held liable for violating antitrust laws, especially after Silicon Valley software engineers filed a successful class action against big-name tech companies for conspiring to not poach each other’s employees. According to the paper, Epic has also warned consulting firms that they can’t put up Madison area billboards or advertise within 50 miles of its Verona no-fly zone, also extending its workforce control by giving hospital clients maintenance fee discounts for honoring Epic’s non-compete agreement. Epic’s only official response to the non-compete issue was, “This is being reverted to a one-year term. We’d rather not comment on the policy as a whole.”


Sales

Gila River Health Care (AZ) chooses NextGen’s ambulatory PM/EHR.

Advocate Community Providers (NY) chooses eClinicalWorks for population health management and interoperability to support its Delivery System Reform Incentive Payment program for 437,000 patients.

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Grand View Health (PA) chooses Cornerstone Advisors Group to upgrade its Meditech Client/Server 5.6 system to 6.1 and to support its early adoption of Meditech’s web-based ambulatory product.


People

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Anthelio Healthcare Solutions names Gary Trickett (Allscripts) as SVP of IT services.

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Anthony Caponi is named VP of healthcare IT at Direct Consulting Associates.

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Allana Cummings (Northeast Georgia Health System) joins Children’s Healthcare of Atlanta as CIO.

Payer software vendor Healthx names Sal Gentile (TriZetto) as CEO.


Announcements and Implementations

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MedAssets will use Procured Health’s data intelligence and workflow solution in its product value analysis services.

Jackson General Hospital (WV) goes live with CrossChx’s SafeChx biometric patient identification solution in its registration area.

NextGen connects its Share platform with Merge Healthcare’s iConnect Network to allow NextGen Share users to send orders to Merge systems and receive images back.

The American College of Radiology and Massachusetts General Hospital (MA) will use Nuance’s PowerShare Network to present clinical guidelines in radiologist workflow and to automate PQRS data collection.

Ricoh will offer Levi, Ray & Shoup’s VPSX software to its healthcare enterprise output management customers.

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Hosted infrastructure vendor SingleHop had me all impressed with their announcement that they would sign Business Associate Agreements with healthcare customers, at least until I hit the part of their press release that said HIPAA is “also known as the HITECH act.” Close enough for government work, I suppose, and it is kind of confusing.

EHR vendor CureMD chooses DrFirst’s EPCS Gold to add e-prescribing of controlled substances (EPCS) to its system. DrFirst reports that EPCS volumes jumped by 200 percent in the most recent three-month period, likely boosted by New York’s I-STOP mandatory e-prescribing requirement for all drugs beginning March 27, 2015.

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Lawrence Memorial Hospital (AR) goes live with electronic forms from Access.

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PeriGen is awarded a patent for its software that assesses fetal descent in helping OB-GYNs determine when it’s appropriate to perform a C-section delivery. I really like the company’s laser-sharp focus on fetal monitoring and the innovations it has introduced there. One of my favorite interviews was with CEO Matt Sappern a couple of years ago, when he succinctly explained the company’s products as, “Our ability to apply technology to what has been a subjective part of labor and delivery is important. Probably 80 percent of medical malpractice comes back to bad interpretation of the fetal monitoring strip. We’ve figured out a way to apply technology to help interpret that strip. ” 

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Boston-area Gillette Stadium, home of the New England Patriots, announces plans for an upscale, expensive, members-only end zone suite that will be called Optum Field Lounge, named for the healthcare IT division of UnitedHealth Group that’s sponsoring it.


Government and Politics

The Bipartisan Policy Center will live stream a six-hour meeting Wednesday titled “Promoting Innovation; Protecting Patient Safety: Advancing Use of Technology in Health Care” with participants that include Karen DeSalvo from HHS and McKesson’s John Hammergren. The former is not surprising; the latter, a bit so.


Technology

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Google Glass is a consumer bust that hasn’t even made it out of beta status, but it appears that Intel will get involved in selling it to enterprises, according to a Wall Street Journal report. A new Intel-powered version of Glass will be released next year and Intel will promote it to workplaces that include health systems. The new Glass is expected to have a longer battery life because of Intel’s power-conserving chips.

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Victoria’s Secret launches a sports bra that includes hidden heart rate monitor sensors.

Dropbox will launch its business API on Wednesday, which will allow third-party developers to create enterprise applications on top of the storage service using their own rules for security, compliance, and workload integration.

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An investigation by cybersecurity firm FireEye finds that an apparently US-based hacker group called FIN4 is using email phishing (without the usual obvious mistakes made by non-native speakers) to obtain insider information from 100 publicly traded companies, two-thirds of them in healthcare and pharma, that it then uses to play the stock market. Two of the identified targets are unnamed healthcare providers. The hackers embed VBA code in a copied document that mimics the Windows authentication prompt, leading the user to think they’ve lost their network connection and need to log on again. Those credentials are then used to probe the victim’s email for useful information and then to use that account to send compromised documents to colleagues at other firms. They even create Outlook rules to delete incoming emails containing words like “hacked” or “malware” that might have been sent as warnings from associates or IT departments. Recommended security actions include disabling Office VBA macros, blocking specific domains the group uses, and checking OWA logins from known Tor exit nodes since real users don’t use Tor (an anonymity network) to read email.


Other

USC cardiologist Leslie Saxon, MD provides some fascinating quotes in discussing her rather startling recommendation that patient biometric data should be placed on Facebook for doctors to review and share.

Oftentimes, you’ll see a patient and they have a vague symptom. You see them for 0.00001 percent of their life and you have to contextualize, use your experience, do some guesswork and diagnostics to understand what’s going on. Your car has over 100 sensors. They’re wireless, it’s continuously monitoring itself and telling you when it’s going to get sick, providing you with this A.I. so people’s cars don’t break down as often any more. One of the things that’s really interesting about digital health and sensors is that we haven’t seen a lot of the data that’s being captured before, so we’re not sure how to contextualize it. I’ve been doing cardio electrophysiology for over 25 years. Now that I’m monitoring some of my patients all the time, I don’t know what some of this stuff means. We’re going to have to build these data sets, track clinical events, then go back and contextualize it—say, oh, okay that was a sign of that.

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In England, the CIO of Meditech client Liverpool Women’s NHS Foundation Trust says EHRs from CSC, Cerner, and Meditech can’t handle hospital specialty areas such as neonatology and OB-GYN and he’s putting efforts instead into implementing the open source Alfresco electronic document management system. He says, “As long as you’re seeing all the information pertaining to a patient, why should I put it in a single box and sacrifice the good things on the specialist systems so it’s all in one place? I think I could do a lot more good for patients with the money it would cost.” Once Alfresco is live, Microsoft Sharepoint will get the boot because he says it’s too expensive. Alfresco is available as a free online trial or download.

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In Australia, Royal Children’s Hospital, which will go live on a $41 million Epic implementation in 2016, is looking for a medical device integration vendor.

The Russian economy continues to tank (no pun intended) beyond mass doctor layoffs and hospital closures as sagging oil prices and Western sanctions apply a double chokehold, with Apple raising prices up to 25 percent to offset the devalued ruble, which dropped 6 percent against the dollar on Monday alone and 42 percent in the past year. That puts the ruble as the world’s worst-performing currency behind only the subject of its aggression, Ukraine. Food prices are skyrocketing and banks have restricted the swap of rubles for other currencies. Up to 10,000 healthcare reform protesters took to the Moscow streets Sunday morning, carrying signs saying “Save money on war, not doctors” and demanding that the city official in charge be fired.

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Highland-Cashiers Hospital (NC) mails letters to 25,000 patients explaining that its HIM contractor TruBridge made a configuration mistake that opened up some of their information to the Internet.

A literature review finds that while HIE usage probably has reduced ED visits and cost in some cases, no studies have been conducted that prove any particular benefit even though the government has subsidized their operation with $600 million in taxpayer money.

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Several children’s hospitals will offer their patients televisits with Santa in the eighth year of the Cisco Santa Connection program that uses the company’s Telepresence system.

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Bizarre: a corporate guy buys a USB-chargeable e-cigarette from an eBay user in China. He plugs it in and the cigarette phones home and plants malware.


Sponsor Updates

  • TeraRecon offers an upgrade program for its enterprise imaging customers.
  • Perceptive Software is demonstrating new features of its Acuo Vendor Neutral Archive and the newly announced Clinical Archive this week at RSNA. 
  • University of Arkansas for Medical Sciences reports significant nurse time savings from using Capsule’s SmartLinx to send medical device data to Epic.
  • PerfectServe posts a blog entry titled “Evolving Healthcare: Six New Realities for the C-Suite.”
  • Extension Healthcare CEO Todd Plesko will present a session on alarm management at the mHealth Summit in National Harbor, MD December 7-11.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

 

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December 2, 2014 News 13 Comments

Advisory Panel: Favorite Vendor

November 24, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: Who is your favorite healthcare IT-specific vendor (product or services) right now and why?


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IMO, Intelligent Medical Objects. They have a team that we’ve seen be proactive in finding ways to help ease our physicians’ jobs. Their products are cost effective, especially when we point to amount of provider happiness they return. We’ve partnered with them for at least one beta partnership and are currently considering another, in part because of how easy they are to work with.


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I’m pretty happy with Allscripts right now. It’s a completely different company under Paul Black vs. Glen Tullman. Now that I’ve said that out loud, I’ve probably jinxed the relationship. 


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Epic delivers an adequate documentation system that automates workflow, can be integrated with other clinical and administrative systems, and scales to our very large care delivery system.

Epic. Sorry, that might not be the politically popular answer. But they are continuously focused on making their products better and making their customers successful. And the idea that they are trying to block interoperability in some way is frankly nuts. The recent back-and-forth in the press on interoperability and who is the best or the most committed is mostly posturing in advance of the impending DoD contract. Could Epic do better in this area? Absolutely. Could Cerner and the rest of “CommonWell?” Absolutely. We need a common standard.

Epic. They are the most focused on healthcare reform and the most ready to adopt and support the changes.


I don’t have a favorite company right now as I am dealing with too many that I would like to get rid of.


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Favorite is Wairever. They offer Plexina, which is a content management tool that we use for developing and managing order sets. The tools they provide are fantastic and their responsiveness has been great.


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Fortified Health Solutions. They partner (and I do mean partner) with us to provide security monitoring and consulting. We’re much safer than we were a year ago because of their recommendations and guidance.


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My favorite vendors lately are Vocera and small nurse call vendor called Critical Alert Systems. They have been extremely engaging and get it – they both have engaged individually and collaboratively to figure out how we achieve our desired result. They have been candid, direct, and honest. I wish larger vendors would get off their high horse and act like they did when they were half their size. Every CEO should ask themselves: how did we act when we had half the customers and market share? My favorite services company lately is Beacon Partners. Ralph is easy to do business with, easy to interact, with and hasn’t let me down yet!


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Cerner is my favorite vendor as they are rescuing Siemens from the mud.  (I am a Siemens customer.)


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EClinicalWorks. They have many shortcomings, but are delivering a usable ambulatory EMR at a decent ROI. Their support folks respond and often can help solve problems.


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I am absolutely overwhelmingly impressed with Salesforce.com. They are not an HIT vendor, but they have shown me an ability to provide a malleable platform along with a team of leaders who really get it.


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Meditech. Provides the best level of support, especially with their task management system. Meditech has also become more proactive and letting clients know about software issues and severity of the issues. The stability of the system is still topnotch, with no unplanned downtime in our environment in over two years. Meditech also has a lower maintenance cost then many of our other vendors. Not that you asked, but the vendor that we struggle with the most is eClinicalWorks. Communication with eCW is very, very difficult and they don’t use their task management system very well.


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Microsoft Azure and Office 365. Removes a heavy load of keeping the lights on. CommVault — best solution to backup to Azure and have the ability to preform legal/investigative searches.


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There are two I would highlight. The first is the best staffing firm in the world, iMethods Inc out of Jacksonville, FL. They are the only firm I have worked with that realize that is a person with a resume versus a resume that happens to come with a person. The other company is dbMotion. We are working on a project with them right now where we will connect all of our community data and make it actionable at the point of care, where it is needed most. Great stuff there that will put our community in a great position for the future.


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November 24, 2014 Advisory Panel 1 Comment

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Reader Comments

  • Federalist: The not-so-veiled allegation from Publius that Leidos sabotaged Epic seems ludicrous. Why would they do something to hur...
  • PM_From_Haities: At some level, it would be nice to see a "complexity reduction" initiative. It's hard to fathom the US Constitution is ...
  • R Newsome: As an EHR vendor for surgical specialists, we have always designed our solution to deliver an optimal clinical documenta...
  • meltoots: I wanted to add my 2 cents to your great post. I read through the relevant parts of the 980 page rule. As a front lin...
  • SumOfParts: @PM_From_Haities: Touché. It's a pretty superficial review - not only there's no mention of debt, there's also no conce...

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