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Monday Morning Update 10/9/17

October 8, 2017 News 6 Comments

Top News

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EClinicalWorks says at its annual user conference in Grapevine, TX that it had Q3 revenue of $130 million. The company notes that its EHR is the second-most widely used in the US.

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ECW’s migration statistics for 2017 to date show that the EHRs it most often replaces are those of Greenway (by far), Allscripts, and Athenahealth.

EClinicalWorks also announces December 2017 availability of an interoperability development platform that allows developers to connect to ECW’s API-enabled EHR.

Also announced: a voice-powered Virtual Assistant called Eva, Healow Virtual Room for telemedicine, and v11 of the company’s core product.


HIStalk Announcements and Requests

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Two-thirds of poll respondents think customers that are featured in a vendor’s product sale announcement should be required to indicate whether they hold a financial interest in that vendor. The “required” part of that assertion is the problem, of course, since the obvious remaining issue is, “Required by whom?” Still, the idea that a provider’s purchase of a product wasn’t made using purely objective criteria is troubling to some since the announcement may influence others, especially in health IT-land where “I’ll have what he’s having” purchasing behavior is not uncommon.

New poll to your right or here: who among the rumored candidates would you like to see appointed HHS secretary? I can’t say I’m enthused about any of them except at least they aren’t Tom Price.

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Welcome to new HIStalk Gold Sponsor CenTrak. The Newtown, PA-based company’s real-time location system has been installed in 850 healthcare facilities, with its Clinical Grade-Visibility providing certainty-based location accuracy; rapid location and condition updates; easy installation without requiring patient rooms to be closed; and an open location platform that can be integrated with EHRs, nurse call, and other systems. Its app is available for both iOS and Android devices. CenTrak is KLAS’s 2017 Category Leader for Real-Time Location Systems, receiving the highest performance score among ranked RTLS vendors. The company offers a free Enterprise Location Services Handbook and an RTLS RFP template. Thanks to CenTrak for supporting HIStalk. 

I found this video describing how CenTrak is used at Our Lady of Lourdes Regional Medical Center (LA).

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

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Listening: the amazing alt-acoustic Jamestown Story, which I’ve mentioned before since it’s a project of independent singer-songwriter Dane Schmidt, whose dad Mark is a consultant with Navin, Haffty & Associates. Mark reports that his other son Jordan is one of the top songwriters in country music and has three songs on the charts right now. I’m also listening to former Porcupine Tree singer and guitarist Steven Wilson, justifiably recommended by a reader who also suggests Wilson’s older work with the tragically underappreciated Porcupine Tree as a “modern Pink Floyd.” I’m tracking Porcupine Tree while I’m writing HIStalk today and it is stunningly perfect, even in live recordings. Video from Wilson’s live 2013 performance gives me prog chills, to the point that I just now bought tickets for his US tour that starts in April, where I’ll be silently thanking the reader who showed great insight in recommending Wilson’s music.


This Week in Health IT History

One year ago:

  • Theranos announces that it will close all of its clinical labs and lay off half of its employees in pivoting from running labs to commercializing its MiniLab testing system.
  • ICU monitoring technology vendor Sotera Wireless files for Chapter 11 bankruptcy.
  • Xerox, preparing to split itself into two publicly traded companies, chooses Conduent as the name of the business process services segment.
  • HHS publishes the final MACRA rule.

Five years ago:

  • Allscripts offers MyWay EHR customers a free upgrade to Professional as it begins the product’s retirement.
  • Allscripts files a protest against New York City’s hospital system for choosing Epic.
  • The developer of Nashville Medical Mart shuts down the project for lack of leasing interest.

Ten years ago:

  • Misys Healthcare re-forms under new private equity owner Vista Equity Partners and returns to its old name of Sunquest Information Systems, with Richard Atkin as president and CEO.
  • Microsoft’s healthcare head predicts that the company’s HealthVault personal health record and Azyxxi data aggregation platform will generate a billion dollars in annual revenue.
  • Word leaks out that Epic is developing its own PHR called Lucy.
  • Sage fires its North American executives as the company’s US performance continues to lag.

Last Week’s Most Interesting News

  • France-based IT consulting firm Atos acquires three US EHR-focused consulting companies.
  • The US Supreme Court hears arguments on the legality of Epic’s requirement that employees agree to arbitration rather than lawsuits to settle employment issues.
  • Several names are floated as possible replacements for fired HHS Secretary Tom Price.
  • A Wisconsin court reduces the $940 million awarded to Epic in its intellectual project lawsuit against Tata Consultancy to $420 million.
  • Canada’s Alberta Health chooses Epic.

Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for informat


Acquisitions, Funding, Business, and Stock

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Medecision acquires 58 client contracts of AxisPoint Health’s retired CCMS and Vital software platforms, making it the largest independent provider of care management applications in the country. AxisPoint Health has retained its services business. 

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A fascinating profile of the richest man in Florida — an immigrant from Hungary who made his many billions from the electronic stock brokerage he created — contains his deceptively simple business strategy: “My strategy has always been to try to focus in on a product or service where you can create a dollar of value for 20 cents and sell it for 40 cents. The only way to do that is to use technology that has not been used before in producing that product or service. If I can create that dollar, then I’m already ahead 20 cents of earnings, and I’m going to keep way way way ahead.” Thomas Peterffy said when he introduced hand-held computers to Wall Street trading floors in the 1980s, “I think the way a CEO runs his company is a reflection of his background. Business is a collection of processes, and my job is to automate those processes so that they can be done with the greatest amount of efficiency.” Some other quotes that may be applicable to healthcare IT:

  • “Some traders still think that a computer could not trade as well as they can.”
  • “I always preferred computer programmers because I knew how to talk to them. I never knew how to talk to salesmen because I never believed them.”
  • “I moved to a commodity trading firm and my job was to figure out how to price options. That was a very, very interesting job because in those days people were trading options by the seat of their pants because nobody understood the mathematics. And after a very long period of ruminating and running simulations on my computer, I eventually came up with a model that is very similar to what today is known as the Black-Scholes formula. Given the fact that I was the only one at the time who had that formula, I saved my money. I bought a seat at the American Stock Exchange and I became a market maker.”
  • “Given that the market is very complex and our strategy is to give our customers an advantage over the customers of other brokers, we cannot do that with just a simple system, so unfortunately the system has to be complex. The only way we can do that is to provide a facility just like your Apple iPhone. People who only use it to make phone calls and send texts don’t know about all the other things that it can do … As to onboarding, that’s been a hassle forever … The regulators tell us that we have to know our customer rules. We have to know many things about our customers to make sure that they will not do certain trades, because even though we don’t give any recommendations, we are liable. We have to make sure that they do not do trades that they are not fit for. I don’t really know how to judge that.”

Decisions

  • Palmetto Health (SC) will switch from McKesson Star to Cerner revenue cycle management in October 2018.
  • Cape Fear Valley Health System (NC) will replace Cerner revenue cycle management with that of an undecided company.

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


People

Health Catalyst promotes Patrick Nelli to CFO. He replaces Dan Strong who, unlike his replacement, has experience taking companies public.


Announcements and Implementations

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PatientKeeper announces Charge-Note Reconciliation, which automates the reconciliation of clinical notes and inpatient charges to find the 15-20 percent of typically unsubmitted professional charges. It’s available immediately in the company’s charge capture solution.


Other

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NPR covers the three-fourths of Puerto Rico hospitals that are still running on emergency power and no air conditioning. An Arecibo hospital’s cardiac unit registered 112 degrees, requiring patients to be moved by HHS’s Disaster Medical Assistance Team to air-conditioned tents. 

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Eric Topol, MD posted this about patients owning their data.

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A terminal cancer patient expresses frustration with feel-good healthcare marketing that spreads false hope of miraculous recoveries with endless pink ribbons and catchwords like “thrive” and “smile out,” with the implication that people like herself who are dying maybe just aren’t being positive enough. Experts say that hospitals market themselves against their competitors by tugging at emotions, while drug companies are prohibited by FDA from running “this is where miracles happen” type messages that aren’t backed by rigorous studies or outcomes results.

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Arizona funeral homes are left unable to bury their customers due to problems with the state’s new death certificate processing system that went live October 2. Bodies can’t be buried or cremated until doctors have acknowledged the cause of death and many doctors didn’t sign up for the new system, requiring some funeral homes to go back to paper.

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In England, West Suffolk Hospital stops using discharge letters after doctors complain that they contain errors in medication doses, a problem the hospital blames on a Cerner software bug. One doctor says a patient collapsed after following the incorrect dose listed in the letter.

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Congratulations to the 10 people (out of 252) who scored a perfect 100 percent in Dean Sittig’s informatics terminology quiz. The mean score was 68 percent, with the most-missed terms being “structural alignment” and “syncytium.” Biomedical informatics professor Dean just published “Clinical Informatics Literacy: 5,000 Concepts That Every Informatician Should Know.”

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Bizarre in mass hysteria, sad current events sort of way, especially if you thought you were the only one sick of the fall “pumpkin everywhere” craze. A Baltimore high school is evacuated, dozens of students are triaged by Hazmat teams, and five students and adults are hospitalized for breathing problems after reports of a strange smell. Firefighters discovered the cause in a classroom – someone had plugged in a pumpkin spice air freshener.

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In England, a hospital’s power goes off during electrical system testing, leaving the delivery suite in darkness just as midwives are cutting the new mom’s umbilical cord. Her mother whips out her smartphone and turns on its light to allow the delivery to be completed. The new mom reports, “There was just no dignity because I had people pointing their phones at me. It was so surreal. I was thinking, what is my mum doing? Is she filming this?”


Sponsor Updates

  • LifeImage and National Decision Support Co., Experian Health, the SSI Group, Summit Healthcare, Surescripts, and ZirMed will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • LogicStream Health will host a reception during the Cerner Health Conference October 10 from 5:30-7:30 at Cleaver & Cork in Kansas City, MO.
  • Meditech releases a video on its Sepsis Management Toolkit featuring Capital Region Medical Center Clinical Analyst Marlene Stiefermann, RN.
  • Navicure will exhibit at the US Women’s Health Alliance October 12-14 in San Antonio.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the National Association of Neonatal Nurses October 11-13 in Providence, RI.
  • Harris Healthcare and Versus Technology will exhibit at the ANCC Magnet Conference October 11-13 in Houston.
  • Qpid Health will host “Artificial Intelligence (and More) in Healthcare” at its offices in Boston October 11.
  • Consulting Magazine includes Huron in the top 10 of its 2017 list of best firms to work for.
  • ZeOmega will exhibit at the California Association of Health Plans Annual Conference October 9-11 in Huntington Beach.

Blog Posts


Contacts

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

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Morning Headlines 10/6/17

October 5, 2017 Headlines No Comments

Atos acquires 3 key healthcare consulting companies in the US

France-based Atos acquires three US health IT consulting firms: Pursuit Healthcare Advisors, Conduent’s Healthcare Provider Consulting business, and Conduent’s Breakaway Group business.

IBM to Congress: Watson will transform health care, so keep your hands off our supercomputer

IBM is actively lobbying Congress to minimize regulatory oversight of artificial intelligence.

HCH replacing Electronic Health Records system

Hiawatha Hospital Association announces plans to migrate from McKesson Paragon to Athenahealth for its hospital EHR.

Willis-Knighton Health System statement: Board supports CEO James Elrod

Willis-Knighton Health System (LA) Chief Cardiologist Michael G. Futrell, MD resigns following a failed vote of no confidence in the hospital’s 52-years-long CEO James Elrod. The board voted to keep the embattled CEO in place, despite criticism that he has shown “resistance to changing with the times and refusal to upgrade the hospital system’s information systems.”

News 10/6/17

October 5, 2017 News 2 Comments

Top News

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France-based IT consulting firm Atos acquires three US healthcare consulting firms that focus on EHRs: Pursuit Healthcare Advisors, Conduent’s Healthcare Provider Consulting, and Conduent’s Breakaway Group.

The acquisition gives Atos 400 new consultants. The company expects its healthcare revenue to increase to $1.2 billion.

Atos acquired Anthelio Healthcare Solutions a year ago for $275 million in cash.


Reader Comments

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From Kyle Armbrester: “Re: Givenchy’s rumor report from Tuesday. The statement that ‘about 20 hospitals are cancelling scheduled go-lives’ is false. It’s unfortunate that a few, CPSI in particular, persist in seeding and spreading misinformation about Athenahealth and our in-market momentum and success. Some facts: Earlier this year, KLAS reported that only three vendors achieved net gains in the hospital space—Cerner, Epic, and Athenahealth. Our clients are realizing improved financial and clinical results; four out of five of executives who we work with are seeing real positive impact on bottom lines (KLAS). We have plenty who would love to do a Q&A for HIStalk. We are building true partnerships across the community hospital space which are directly attributed to addressing the needs of an underserved segment. We offer low up-front costs, no maintenance fees, and aligned incentives. It’s our cloud-based, results-oriented platform model that gives us our edge and sets us apart from traditional software players that now seem to be kicking-up some in-market desperate and unsavory behavior. Givenchy, would love to talk further.” Kyle is chief product officer at Athenahealth. Givenchy also named three specific (but still unverified) hospitals that have returned to CPSI, not including Jackson Medical Center (AL), which a CPSI-issued press release says went back to Evident Thrive after its collections dropped 75 percent after a few months running Athenahealth. I’m happy to talk to folks from hospitals that have either gone live on Athenahealth in the past 6-12 months or that have returned to CPSI after trying Athenahealth, which is about as fair and direct as I can make it.

From Cheap Seater: “Re: cavorting on the UGM stage. What about so-called journalists who make the mistake of letting vendors court them at user meetings and conferences?” I think that happens only rarely since most of those folks don’t have a lot of influence to be worth courting, but I do picture most industry writers as introverted, inexperienced with frontline healthcare or IT, and easily swayed by token vendor executive attention, so I agree that their reporting might be suspect at times. It’s like reading an online review from Yelp or elsewhere – be wary of starry-eyed accounts that don’t contain at least one negative observation. I like staying anonymous because that removes even the possibility of vendors trying to apply schmooze in return for positive commentary. It’s like fake news – the problem isn’t that it exists, it’s that Facebook users aren’t smart enough to recognize it or are so anxious to validate their beliefs that they suspend whatever objectivity they once had.

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From Lazy Crazy AZ Days of Summer: “Re: Banner Health. Went big bang in replacing Epic at the former University of Arizona Health Network on October 1. A colleague says ED lab turnaround is six hours and they had to divert patients.” I reached out to Banner, whose PR contact said the hospital was briefly on diversion for some ED patients, but remained open for trauma and walk-ins. They are now off diversion.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor CarePort. The Boston-based company – acquired by Allscripts a year ago – offers a care coordination platform that bridges acute and post-acute EHRs, providing visibility into the care that patients receive across post-acute settings so that all providers and payers can efficiently and effectively coordinate patient care. Starting at discharge, CarePort Guide enables patients to choose the best next level of care based post-acute quality scores, services, and geography. Post-discharge, CarePort Connect helps the care team to track patients as they move through the continuum by pulling real-time data from acute and post-acute EHRs. Finally, CarePort Insight aggregates data across providers to deliver the insights needed to manage a high-performing post-acute network. A spokesperson from customer Cleveland Clinic says, “We are giving patients all the information they need to make an informed decision that best suits their needs and preferences.” Co-founder and CEO Lissy Hu – who earned her MD and MBA degrees from Harvard – previously worked on a Medicare demonstration project involving transitions in care for complex patients. Thanks to CarePort for supporting HIStalk. 

Listening: a new live album from The Magpie Salute, which carries some Black Crowes DNA in offering straight-ahead rock. They’ll play in Madison next week and Kansas City the week after.

Music I won’t listen to: young female singers who start every vocal phrase with a dramatically loud intake of breath even though it’s obvious they’re using vocal improvement software that could have removed even trendy extraneous bodily noises. You would not enjoy hearing most of those musically enhanced warblers on “MTV Unplugged,” which is probably why that program went away.

I know little about guns (even though I have a satisfyingly hefty .357 Magnum revolver that I used to love shooting at the range) and was curious about the inexpensive and entirely legal “bump stock” used by the Las Vegas shooter to turn a semi-automatic rifle into a poor man’s machine gun, turning up this video that illustrates a product that is either ingenious or terrifying depending on which end of it you expect to be on. I was amused only by the portion showing the product’s schematic in which the gun is throbbing in a phallic-like manner in time with heavy metal music that suggests a stereotypically swaggering target audience (notwithstanding this unfortunately accented female customer). The device is likely to be banned quickly because it’s made by a small family business (it shut down all competitors via copycat lawsuits) rather than a big gun manufacturer. The company owner should go out rich, though, since sales have gone off the charts since the massacre.

This week on HIStalk Practice: California IPAs merge as they expand Epic utilization. DuPage Medical Group fills physician pipeline with new resident incentive program. WebPT acquires Strive Labs. CareCloud launches patient intake, payment system. Practices outpacehospitals on healthcare pricing transparency. Former US Surgeon General Vivek Murthy, MD highlights loneliness epidemic. EHR investment makes up good chunk of Q3 digital health funding. MGMA President and CEO Halee Fischer-Wright, MD previews upcoming annual conference, addresses role companies outside of healthcare will play in EHR development. HIStalk’s Must-See Exhibitors Guide for MGMA 2017 goes live.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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ECG artificial intelligence analysis vendor Cardiologs raises $6.4 million in a Series A round, increasing its total to $10 million. The company’s ECG analysis platform earned FDA clearance in July 2017. Cardiologists upload a digital ECG from a Holter monitor, smart watch, or personal monitoring device and the system reviews the often-long recordings to alert the doctor if it finds one of 10 types of cardiac events, most of them related to atrial fibrillation.


Sales

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The board of Hiawatha Hospital Association (KS) approves the replacement of Allscripts/McKesson Paragon with Athenahealth.

Seven Hills Foundation (MA) chooses Netsmart as the care coordination and population health management provider for the Massachusetts Care Coordination Network.


People

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James Murray, MS (CVS/Minute Clinic) joins Culbert Healthcare Solutions as CIO.


Announcements and Implementations

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IVantage Health Analytics, part of The Chartis Group, launches Performance Manager, which allows health systems to benchmark performance, identify opportunities for improvement, manage initiatives, and share best practices in a peer-to-peer community.


Government and Politics

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Stat reports that IBM is using its lobbying clout to shield its Watson system from medical scrutiny. A former IBM executive (Janet Marchibroda) helped draft legislation that removed some kinds of health software from the FDA’s oversight; IBM hosted an event to introduce Watson to high-powered members of Congress; and the company has deployed lobbyists to argue that Watson should be exempt from medical device law. It’s an interesting piece, but it seems obvious that IBM Watson Health, like most other clinical decision support or medical knowledge systems, does not fall under FDA regulation because it is not a closed-loop system since the clinician is free to accept or reject the advice it offers. The real scrutiny should come from Watson’s customers and I’ve seen little positive commentary in that regard.

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An Oracle executive applauds the federal government’s move to the cloud, its data security efforts, and IT service consolidation in a letter to the White House’s American Technology Council and Jared Kushner, but makes these observations:

  • The federal government should emulate the best practices of Fortune 50 customers rather than Silicon Valley vendors that often fail even though they know how to deploy products at scale.
  • The government should focus on procurement and program management, not IT development, a lesson long since learned by large companies. It says that the most important CIO skills are choosing commercial products, implementing them efficiently, and maintaining those systems to prevent cyberattack.
  • The federal government should focus on open data instead of open source software development in recognizing that nothing requires the federal government to give citizens systems it builds or buys for free.
  • The most important driver of cost and complexity is customization, with code written by 18F, USDS, and other agencies creating a support tail that drives unbudgeted costs.
  • The government should modernize its processes across agencies since government-specific processes drive IT cost overruns.
  • The government is using technology preferences and vendor-favoring standards instead of competition, which “places the government at substantial risk of failing to acquire the best, most secure and cost effective technology, even if those de facto standards are proposed by well-meaning government employee who ‘came from the private sector.’”

Privacy and Security

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Brilliant satire – as usual – from The Onion. Substitute “hospital employee” for “mom.”


Innovation and Research

The NIH issues a $2.3 million grant to the chief epidemiologist at Maryland’s VA system to study why physicians overuse lab tests in believing they are more useful than evidence suggests.


Technology

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Major League Baseball – which prohibits the use of Internet-capable devices in the dugout during games because of concerns about stealing or relaying signs — launches an investigation as to why a Diamondbacks coach was captured in a photo taken during a Wednesday wild-card game wearing a smart watch.


Other

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Western Australia’s coroner blames Fiona Stanley Hospital’s lack of follow-up for the death of a 41-year-old patient who died of septic shock on March 2015 after being ordered a contraindicated drug. The patient had inflammatory bowel disease and was prescribed mercaptopurine after clinicians failed to notice a red-flag lab result on his electronic chart. The coroner noted that the hospital now watches patients who are ordered the drug more closely and has developed new requirements for reporting abnormal results, but also recommends that the hospital install better patient tracking systems and send lab results to the physicians overseeing treatment.

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The chief cardiologist of Willis-Knighton Hospital System (LA) resigns as part of a no-confidence vote in the hospital’s CEO, who has run the hospital for a record 52 years. Critics say he has been too slow in making changes and refuses to upgrade the hospital’s computer systems. The system wasn’t mentioned, but Googling suggests that the hospital has run Meditech and Siemens/Cerner Soarian in the past.

A Utah neurology clinic that was previously sued for unpaid wages and investor fraud leaves patients without access to their MRI results when it shuts down without notice. The owner blames the clinic’s closure on an electrical surge that damaged its computers, but says he sent its electronic records to Salt Lake Regional Medical Center (UT), which was able to recover those of a patient quoted in the newspaper article.

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A jury finds that a hospital’s collection agency isn’t meeting legal notification requirements when it sends a collection letter via a secure PDF email link since, unlike reliable postal mail,  there’s no strong likelihood hat the intended recipient will read the letter. The collection company’s own software proved that the intended recipient did not open the letter. The judge summarized, “She was required to open an email and then click through over the Internet to an unknown web browser inviting her to then open a ‘Secure Package’ … modern consumer practices are not conducted this way. Although a consumer may regularly open e-mails from persons and companies she knows and to which she has given her email address for communications (like a recognized email from the utility company or the bank one does business with), there is no evidence that Ms. Lavallee should have recognized as safe an email from Med-1 Solutions.”

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This is fascinating: one of 12 companies that were awarded medical marijuana growing permits by Pennsylvania’s Department of Health in June is offering the never-used permit and its 47,000 square foot cultivation facility for sale at $20 million. The company, run by a former candidate for governor, wants to obtain an even more lucrative clinical research (CR) license that would allow it to investigate the medical benefits of marijuana in partnering with a teaching hospital, which would also let it open another growing facility and to operate six storefront dispensaries. Six of the eight Pennsylvania CR permit holders have already signed research agreements with medical schools —  Penn, Drexel, Thomas Jefferson, Temple, UPMC, and Lake Erie College of Osteopathic Medicine. The company’s chief medical officer is the recently retired president of MedStar’s medical group.


Sponsor Updates

  • Influence Health announces its 2017 EHealth Excellence Award winners.
  • The Chartis Group publishes a white paper titled “Solving the IT Investment Paradox.”
  • Black Book names Nuance as the leading vendor for end-to-end healthcare coding, clinical documentation improvement, transcription, and speech recognition technology.
  • McLaren Flint (MI) implements an RTLS-smart pump interface between Versus and B. Braun, allowing clinicians to see on a real-time floor plan where pumps are located and whether they are actively infusing to improve re-distribution. 
  • A Health 2.0 conference demo shows how FDB’s Meducation solution, previously available only to providers, can now be viewed and shared by a patient-controlled app.
  • EClinicalWorks will exhibit at the Louisiana Primary Care Continuing Education Conference October 10-12 in Lake Charles.
  • FormFast and Iatric Systems will exhibit at AHIMA October 7-11 in Los Angeles.
  • Healthwise, Image Stream Medical, and Imprivata, and Intelligent Medical Objects will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • Influence Health announces its 2017 EHealth Excellence Award Winners.
  • ConnectiveRx will exhibit at the IPatientCare’s national user conference October 6-7 in New York City.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/5/17

October 5, 2017 Dr. Jayne 1 Comment

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This week is National Health IT week, with events being held across the country. The “points of engagement” for this year’s events include: supporting healthcare transformation; expanding access to high-quality care; increasing economic opportunity; and making communities healthier. I’m particularly fond of the point regarding healthcare transformation, as so much of my work revolves around helping healthcare organizations make sense of the changing delivery environment and payment models. Many organizations are transforming for the right reasons, such as patient and community health, and those efforts make me feel energized and that I’m doing valuable work.

However, I still see far too many organizations that are on the “stick” end of transformation, only changing because they feel they are being forced to. Many of these groups are fighting themselves as they move through the change, with the C-suite saying change is here while allowing some of their more vocal (and often more profitable) physicians and subspecialties to basically opt out. I watched one group mandate that primary care physicians enter all data through discrete template fields, while allowing their orthopedic surgeons to dictate because they were afraid the surgeons would leave the group. This kind of behavior doesn’t do much to engender collegiality or build professional rapport. The most successful groups I work with are transforming because they believe in their ability to deliver care more efficiently and effectively, but trying to spread that enthusiasm continues to be a challenge.

It feels like there is considerably less buzz around Health IT Week than there was even just a few years ago, let alone what it was like in the heyday of excitement around Meaningful Use. Even Google seemed a bit lackadaisical, with my “national health IT week 2017” search bringing up an article about the 2016 events as the fourth item in the search. Let’s face it, healthcare IT isn’t as sexy as it once was and there aren’t as many so-called rock stars out there doing the moving and shaking, but it’s something in which every single one of us is a stakeholder. Having gone through yet another round of medical adventures this week, I’m grateful to have care with physicians that continue to use technology to its fullest and who enable me to be a more educated and engaged patient.

Despite the relative lack of buzz, healthcare IT continues to be of interest to young physicians and those still in training who have decided that clinical medicine may not be right for them. Maybe it’s the rigors of the schedule, the stress of feeling responsible for so many outcomes, or lack of resilience to deal with the chaos that can be modern medical practice that are raising interest. I’ve been mentoring a young resident who is considering whether he should pursue a clinical informatics fellowship or give practice a try. It’s hard to watch a once-idealistic trainee talk about his level of burnout before he’s even made it out of training. Primary care salaries continue to lag behind other subspecialties and doing something other than going straight into the trenches has a certain appeal. He’d like to stay in our metropolitan area for family reasons, so I’m encouraging him to try some moonlighting shifts in the urgent care setting to see if that’s a better fit.

One of the reasons he’s so burned out is that his residency program hasn’t truly embraced the model of team-based care. The faculty physicians are still in the mold of doing things how they were trained, which means a lot of work rolls downhill to the trainees. They have to do all their own patient callbacks and aren’t allowed to leverage staff to manage routine patient requests or to do care management activities – everything must be done by the resident physicians. I don’t dispute that this gives them a lot of knowledge about managing patients, but it doesn’t teach them how to work effectively with other members of the care team or how to lead the care team. The residents don’t get assistance with chart prep or morning huddles, leaving them to try to address gaps in care as part of the routine office visit. Worst of all, when patient-facing work is delayed by other clinical rotation activities, the patients aren’t getting good care. I’m trying to help him arrange some elective work in a setting where he can see clinical transformation in play, along with a rotation with a clinical informaticist in the academic setting. He needs to see first-hand that healthcare IT isn’t all that glamorous either, and depending on where you wind up, you may not escape patient care.

I’m still waiting to see if all this talk about the shift to value-based care will increase primary care salaries, but I’m not holding my breath. I do have a number in mind for which I would hang up my frequent flyer card and go back to primary care, but it would also require some addressing of the details of physician autonomy and practice structure. The wait for a new patient appointment with a primary care physician in my community is upwards of two months if you have commercial insurance, three months for Medicare, and four to six months for Medicaid. When people complain about the potential for rationing in healthcare, they don’t understand that in all practicality, it’s already here. These issues are daunting to new physicians (and old alike) and aren’t doing much to increase enthusiasm among physicians in crisis.

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I’m always on the lookout for new vendors and found one this week in the form of CampDoc. The product is positioned as an electronic health record system for camps and they’ve been doing some epidemiologic research looking at the camp population. In addition to injuries, heat-related illness, insect bites, and allergic reactions, camp physicians also have to contend with head lice, infectious diseases, and disaster preparedness. They’ve partnered with the University of Michigan to broaden their research, which has been presented at the American Academy of Pediatrics, the Society of Academic Emergency Medicine, and other groups. Upcoming studies will focus on head injuries and concussions during summer camp activities. Interested parties can visit their website or reach out to CampDoc for more information.

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For all you IT road warriors out there, join me in saluting Southwest on their retirement of the Boeing 737-300 series planes. The last of the fleet without Wi-Fi or exit windows that open like a DeLorean vs. having to be thrown out, they officially ended service September 30. I was pleased to see that several will be turned into firefighting tankers and others are in the process of being brokered. I’ve spent many hours in its confines, usually on time. I’m looking forward to its replacement, the 737 MAX 8 ,which has enough range for destinations in South America and the South Pacific. If SWA ever heads to OGG or HNL, I’ll be cashing in my points faster than you can say humuhumunukunukuapua’a.

Email Dr. Jayne.

Morning Headlines 10/5/17

October 4, 2017 Headlines No Comments

Scott Gottlieb rocketed to the top of FDA. He may keep rising

STAT reports that FDA Commissioner Scott Gottlieb, who has earned bipartisan praise of his work thus far, may replace Tom Price as secretary of HHS.

Warren, Hatch, Whitehouse, Baldwin, Cassidy Request that GAO Consider Steps for Federal Agencies to Improve Patient Matching in Upcoming Report

Senators Elizabeth Warren (D-MA), Orrin Hatch (R-UT), Sheldon Whitehouse (D-RI), Tammy Baldwin (D-WI), and Bill Cassidy (R-LA) write a bipartisan letter to the GAO outlining topics they would like addressed in the 21st Century Cures Act-mandated report on improving patient matching.

In digital health’s biggest year of funding, women CEOs emerge as Q3 2017 winners

Rock Health publishes its Q3 2017 digital health funding report. 2017 has been a record-breaking year for startup investments, with Q3 funding raising $1.2 billion, bringing the year-to-date total to $4.7 billion.

In Puerto Rico, Health Concerns Grow Amid Lack of Clean Water, Medical Care

The Wall Street Journal covers worsening conditions in Puerto Rico as the healthcare delivery network on the island struggles to return to operations.

Readers Write: Sepsis Risk Intervention: You May Be Doing It Wrong

October 4, 2017 Readers Write No Comments

Sepsis Risk Intervention: You May Be Doing It Wrong
By Jennifer Knapp

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Jennifer Knapp is director of strategic partnerships and solutions for Vocera of San Jose, CA.

September was Sepsis Awareness Month. Many hospitals and health systems, propelled by CMS penalties for avoidable hospital-acquired infections, have made important investments in sepsis risk intervention. But these efforts have introduced new challenges.

As nurses are put on high alert for a growing number of risk factors—including falls, drug interactions, etc.—they are struggling to attend to and prioritize all of these different alerts. For long-term success against the scourge of sepsis, the health IT industry must work to mitigate and manage the negative impact of alarm fatigue on our frontline healthcare providers.

Sepsis is an important target of hospital quality and safety programs. It is a leading cause of death in the U.S., claiming 750,000 lives annually. With $24B spent annually, it is the costliest medical condition to treat in this country. Luckily, strong evidence shows that early, tailored intervention can significantly reduce the likelihood of sepsis-related complications and death.

To this end, many hospitals have deployed EHR-based pop-up advisories to identify patients at risk for sepsis. But there are three problems:

  • Nearly half of these alerts are false-positives.
  • They get mixed in with the routine pop-ups nurses have learned to quickly click through.
  • Nurses will only see these alerts if they are working in the EHR. Since nurses can walk up to five miles a day during a 12-hour shift, they are often away from the EHR.

Sepsis rates will not fall dramatically unless risk intervention alerts are accurate, reliable, and actionable. Alerts must give nurses the right information at the right time in the right way.

The algorithm used to detect sepsis must include nursing and provider documentation, in addition to data from the EHR, to improve the precision of risk determination. Alerts should only be delivered when they provide new information to the staff or when appropriate treatment steps have not been completed. Sending only actionable alerts will significantly reduce alarm fatigue.

Move sepsis alerts out of the routine flow of EHR notifications where they are likely to get lost in the shuffle. Instead, deliver them to caregivers on mobile devices at the point of care. The bottom line is that if you don’t use a mobile alert solution, you are leaving sepsis detection to chance because caregivers may not check the EHR for long periods of time.

Don’t just tell the nurse there’s a septic patient in Room 101. Provide more detailed information about the level of his or her condition (such as severe sepsis), why the alert was triggered (for example, hypotension), and what to do next. Consider functionality that would automatically alert another group, such as the rapid response team, after the alert is accepted by the frontline nurse on duty.

Hospitals are more committed than ever to reduce sepsis rates and intervene early to save lives. Health IT solutions should support, not stymie, these efforts. Deploying the right workflows and technology, driving care team engagement, and managing performance improvement against goals are keys to a successful sepsis program. Do it right and you can significantly improve patient outcomes.

Readers Write: Centralized or Decentralized Revenue Cycle After an Acquisition? Maybe There’s Another Option

October 4, 2017 Readers Write No Comments

Centralized or Decentralized Revenue Cycle After an Acquisition? Maybe There’s Another Option
By Jim Denny

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Jim Denny is founder and CEO of Navicure of Duluth, GA.

According to a recent AMA survey, for the first time, there are as many hospital-owned providers as there are physician practice owners. As this acquisition trend continues to grow, health systems are evaluating the best way to coordinate and consolidate revenue cycle management (RCM) across the entire organization. Typically, to streamline patient billing, healthcare data analytics, and reporting, organizations take one of the following approaches:

  • A centralized approach. All RCM processes are combined across all entities into a single revenue cycle with a central billing office.
  • A decentralized approach. All billing remains separate across all entities.

The path chosen often varies depending on the organization and its structure.

However, in many cases, neither option may be the perfect approach. Instead, organizations may choose to employ a customized billing approach, leaving a majority of each acquisition’s processes, technologies, and best practices separate and in place, which are evaluated over a defined time frame.

A short-term, slower, methodical approach allows the health system and acquisition time to get to know more about each other and can be much less disruptive. A slower integration, perhaps a year or year-and-a-half, allows both to understand how the other works and to work as a team to come up with a plan as how to grow together.

During this period, it is important to establish a common electronic data interchange (EDI) solution so data and reports can be standardized and summarized across all organizations. Then, the health system can review standardized performance data to better understand each acquisition’s approach to RCM, working to identify each one’s uniqueness, strengths, and challenges. From there, they can determine the best way to proceed for the long term. A customized approach is considered a hybrid because it allows the health system to decide whether centralization or decentralization is the right option, and choose from the best of existing RCM approaches, or determine that it’s time to incorporate new ones.

Here are three reasons why a customized approach can make sense for your organization following an acquisition:

This hybrid approach provides time to assess the acquired practic.e

Customized RCM can give leadership the time needed to evaluate the success of a newly acquired practice, while enabling the practice to maintain productivity and conduct business as usual. Questions to ask can include the following:

  • What’s working and what’s not?
  • Does the practice need guidance to improve their efforts? This includes looking at the statistics – days in accounts receivable (A/R), denial rate, and success in patient collections.
  • What IT systems and vendor relationships are yielding the best results across claims management, patient payments, and reporting?

A customized approach allows a health system to choose from best-in-class vendor partnerships.

It benefits both the practice and the health system by allowing practices to maintain their own systems without having to conform to a billing office’s mandate immediately, while enabling the health system time to evaluate a number of systems and vendors and then making a best practice recommendation that fits the health system’s strategic roadmap. This is the time to assess what’s involved in streamlining and integrating technology from a process, people, and data perspective, regardless of whether the organization ultimately chooses a centralized or decentralized strategy.

This method provides breathing room to evolve over time while establishing a strong foundation for future growth.

Using a hybrid model for the short term can offer an organization the opportunity to mesh with other groups in an optimal way. With this approach, health system leadership does not need to force physician practices within the system to conform to the organization’s existing processes immediately. Instead, practices are given flexibility at a critical time that can ultimately lead to a successful merger. Even more importantly, it allows for necessary breathing room for the health system so it can prepare to adapt to industry shifts – such as building a bridge to move from fee-for-service models to value-based care, or in defining the best ways to evaluate when and where to participate in taking on risk-based contracts.

Choosing a short-term hybrid approach yields the opportunity to create a transition plan based on thorough evaluation to help ensure the health system capitalizes on the right processes, technology, and vendor relationships. And while there’s no easy answer, ultimately, the decision to centralize or decentralize an organization’s revenue cycle can be made together with buy-in from each organization, which is the best way to ensure long-term success.

Readers Write: Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance

October 4, 2017 Readers Write No Comments

Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance
By Mark Crockett, MD

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Mark Crockett, MD is CEO of Verge Health of Charleston, SC.

In 2007, the Marine Corps deployed to Iraq and Afghanistan had a problem: how to identify an enemy that blended in with the population. They developed a behavioral approach to helping teams sharpen their tactical awareness skills to remain “left of bang,” or to fend off hostile actions before they culminate in the “bang” of conflict. In 2017, healthcare needs to deploy the same approach to managing risk and improving outcomes.

Healthcare is currently focused on right of bang, or the future correction of adverse events. Too much effort is expended to react to problems that have happened, and aren’t directed to preventing failure. The military (and other industries) expect that more than 80 percent of efforts should be spent left of bang to reliably prevent failure. A shift to a balanced approach is beginning to happen in top health systems for the first time, and it’s critically important for healthcare leaders to understand the how and the why.

How we got to the current right of bang problem is pretty clear. As a physician, I see failure all the time. Kidneys fail, hearts fail, and ultimately people fail. Dealing with that compassionately and professionally is part of the territory. Financial models have not helped at all. Under straight fee-for-service medicine in the past, if I gave someone an infection, it was quite possible I could bill them for a follow-up visit and perhaps even the antibiotics. In that kind of model, preventing failure is working against your economic model, making success in prevention just that much harder.

Times are changing fast. In the last few years, an array of accrediting bodies, regulatory entities, and payment model changes have made failure punishing to a health system’s finances and reputation. It’s now possible to see quality and adverse events on a dozen web sites, and more every day. Readmission prevention, Healthcare-Acquired Conditions, MACRA, MIPS, etc. are all ways of demanding reliable and efficient care. Health systems fail to execute on quality and safety at their risk: competitors across town that are doing it well are looking to expand and acquire patients and even facilities.

For one California-based hospital system, their timeline-oriented thinking – and solutions – needed to become left of bang. One of their hospitals had implemented a Six Sigma plan to reduce central line infections. Six Sigma is a popular methodology that takes a data-driven approach to eliminate defects in any process. The approach aims for six (or fewer) standard deviations between the mean and the nearest specification limit.

Using Six Sigma, the hospital system found a catheter that was superior in their opinion and a skin sterilization technique they knew worked. That single hospital then worked through the purchasing process, the stocking of the catheter, the sterilization procedures, and finally, implemented a process that ensures no one touches the catheter until the surgeon is ready to insert it into the patient. These improvements eradicated central sepsis at that hospital for more than five years. It was an amazing feat compared to industry standard. This completely redefines the concept of “expected complication” to “zero complications,” and unequivocally saved lives.

It’s a great thing when you can eliminate sepsis in central lines. But five years later, the multiple-hospital system still had a small number of hospitals using the technique. They had no means of assessing system-wide compliance with the Six Sigma process design, which at best was being implemented inconsistently. They simply have not organized left of bang. They admitted they lacked the ability to bring about system-wide change from what was learned at one hospital.

“We know how to prevent central line infections,” said one team member. “But without strong leadership, and the technology to implement the safety procedures system-wide, we find ourselves fixing the same problem every three years. We get serious about a problem, design a solution, and implement it. Then institutional inertia takes over. Two years later we are seeing adverse events, or worse, and ask ourselves ‘Where is that folder on the way we prevent catheter infections?’ It’s just not good enough.”

Getting hospitals to look for patterns in identifying adverse events, and working to identify them before they occur, keeps clinicians and staff in perpetual left of bang mode. But process improvement through Six Sigma isn’t going to enable this essential shift to a safety-first culture. Neither will the latest software or the best management training. It’s going to take all of these approaches – and more – for healthcare to truly see the results and outcomes that payers demand from providers.

Morning Headlines 10/4/17

October 3, 2017 Headlines No Comments

Argument analysis: An epic day for employers in arbitration case?

Epic’s Supreme Court case is split over whether employers should be able to force employees to sign arbitration clauses as a condition of employment.

Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data

A Health Affairs study of EHR interoperability data from broken down into the sub-domains of finding, sending, receiving, and integrating electronic patient information, concludes that at the end of 2015 only 29.7 percent of acute care hospitals are engaged in all four domains.

2017 HIMSS Congressional Asks

HIMSS asks Congress to elevate the role of HHS CISO to that of the CIO, expand telehealth services, and increase funding needed to implement the 21st Century Cures Act.

Announcing Cityblock: Bringing a new approach to urban health, one block at a time

Alphabet’s Sidewalk Labs unveils Cityblock Health, a neighborhood-level approach to improving care coordination for Medicaid beneficiaries through technology.

News 10/4/17

October 3, 2017 News 4 Comments

Top News

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The Supreme Court in it its first day of the new 2017 term hears opening arguments over companies that require employees to sign away their right to sue them over employment issues and force them into arbitration instead. Epic was one of three companies whose attorneys argued their positions Monday.

Liberal justices expressed concern that allowing such agreements rolls back employee rights by decades and discourages expensive individual employee lawsuits, while the court’s conservative members opined that mandatory arbitration clauses are legal and that employees can as a group hire the same attorney to reduce litigation cost.

The Obama White House had initially asked the Court to hear the case in support of the NLRA, but the new administration now sides with the employers as represented in the proceedings by its Deputy Solicitor General.

The main issue is whether arbitration agreements are legal under the Nation Labor Relations Act, which gives employees the right to take collection action. The attorney representing the companies argues that the NLRA guarantees the right of employees to have a forum convened, but once that has happened, employers can present defenses that include previously signed arbitration agreements, an argument to which one justice took exception in interpreting NLRA as covering all workplace issues.

A decision in favor of the employees would invalidate the employment agreements of up to 60 million Americans. Two courts have ruled that Epic’s arbitration clauses are illegal, while another ruled that they are legal.

The court will render its decision later in the term.


Reader Comments

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From Stella Overdrive: “Re: Allscripts. Black Book’s survey finds that 96 percent of McKesson Paragon customers are optimistic that Allscripts will improve their satisfaction, but it reads like an Allscripts commercial. Similar studies by Reaction and KLAS found high levels of skepticism among Paragon customers, with KLAS reporting that only 29 percent were favorable and Reaction saying that the acquisition would actually be a deterrent to attracting new customers. Do you know if Allscripts underwrote the Black Book study, and if so, was there appropriate disclosure? Seems like it might have been commissioned as damage control given negative market reaction to the acquisition.” A Black Book spokesperson says the company did not break from its strong stance against allowing vendors to participate or influence the survey  process – no company or payment was involved in the Paragon user survey. I read the more detailed survey notes and came up with these points:

  • The survey response rate was 23 percent, with 280 respondents representing 66 facilities. I don’t know how many hospitals are running Paragon to know if that’s a significant percentage of sites.
  • Black Book wisely focused on hospital decision-makers rather than end users.
  • The survey found that none of the respondents have developed new plans to replace Paragon, although that’s not surprising since the acquisition was announced only a few weeks ago.
  • The report says that 96 percent of boards are “confidently optimistic” (I would have expected “cautiously optimistic”) that Allscripts will do a better job than McKesson, which might not be a high bar to clear. There’s also the question of how knowledgeable board members would be on IT topics.
  • Two-thirds of the hospitals say they don’t have the money to replace Paragon in the next two years and will instead focus on revenue cycle management, population health management, and analytics. That’s probably the most important finding of the survey. 
  • Eight-one percent of IT leaders representing 58 facilities say they are receptive to the Allscripts takeover.

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From Gideon: “Re: Allscripts. Layoffs in the former McKesson’s professional services area on the day the merger was finalized – PMs, tech, and interface resources. The words used in the termination letter were, ‘’Unfortunately, the new organization structure doesn’t include your position.’” Unverified, but reported by several readers. Layoffs by either company are, unfortunately, hardly newsworthy, and certainly an acquiring company will nearly always – immediately or eventually – start trimming costs involving any assumed redundancy to help pay for the acquisition’s cost.

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From Givenchy: “Re: Athenahealth. Hospitals are retreating. Following the failed implementation at Jackson Medical (AL), about 20 hospitals are cancelling scheduled go-lives. At least three have returned to their previous systems after collection and cash flow issues and clinician dissatisfaction. Veterans Memorial Hospital (Waukon, IA), Kimball Health Services (Kimball, NE), and Appleton Municipal Hospital (Appleton, MN) have returned to CPSI owned-products.” Unverified. 

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From Publius Tullius: “Re: KLAS at Epic’s UGM. In the ‘photo is worth 1,000 words’ category, KLAS’s VP in wizard garb. I can’t think of worse optics for two organizations that are already intrinsically linked amidst concerns of bias. People in the industry joke that KLAS is Epic’s marketing arm and this doesn’t help.”

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From Corny Collins: “Re: NYC H+H. NYC tax dollars hard at work as officials played dress-up with Epic employees at UGM.” I disagree. Their attendance (I’ve blurred their ID since it felt creepy otherwise) is reasonable and taxpayer accountability doesn’t require frostiness with their vendor. I agree, however, that healthcare people attend a lot of questionable conferences and thereby increase patient costs questionably, although a vendor’s user group meeting when you are spending hundreds of million dollars to implement their product doesn’t spring to mind as an obvious excess. Those of us with health system experience struggle with appeasing valuable employees whose self-worth is defined by running around like a big shot at conferences of questionable ROI, but the employer has to set the parameters and assess the value they receive in return for the cost and out-of-office time. A better target is the HIMSS conference, where people who clearly have no good reason to attend dutifully pack the exhibit hall because they like the attention and networking and can convince their employer to foot the bill. Meanwhile, NYC H+C may need some wizardry as it says it’s down to 18 days of cash on hand.

From Journomaniac: “Re: HIStalk. You must have had partnership or acquisition interest that you haven’t mentioned but should in the interest of full disclosure since you criticize other sites.” Three health IT sites (that I recall – maybe there were more over the years that I’ve forgotten — have approached me unsolicited wanting me to partner with them, sell out to them, or go to work for them. All three said they would render HIStalk obsolete because of their superior technology, deeper corporate pockets, or more insightful approach, thus leaving me no choice but to throw in with them. I dismissed their inquiries quickly because I like working alone in a way I can be proud of. All three of those sites have folded up their health IT tents while I’m still here doing what I’ve been doing since 2003. That’s all I have to disclose. I’d rather quit than let someone else tell me what to do.

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From Abraxas: “Re: VistA. The Indian Health Service uses the VA’s product at no charge. With the VA’s move to Cerner, they haven’t been told whether they will continue to get free access and they have no budget for a replacement EMR. I wonder what will happen to other VistA users once Cerner replaces it in the VA?” I would expect VistA to become an orphan product now that the VA’s attention has been diverted to the Cerner shiny, no-bid object, leaving VistA’s other users without access to the VA’s expensive development. VistA is used by hospitals all over the world as a free public domain product, although some of those are supported by third-party companies like Medsphere and WorldVistA. I invite those with more knowledge about VistA than I have to weigh in on its future outside the VA. Above is part of a 2015 slide I found from the VistA Software Alliance listing VistA’s users.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor ChartLogic, a division of Medsphere. The Salt Lake City, UT-based company, founded in 1994, offers a complete ambulatory EHR solution (EHR, PM, RCM, ERX, patient portal). Providers can create a complete patient note in less than 90 seconds, supported by intelligent voice commands, specialty-specific content (vocabularies, templates, flowsheets, and macros) and a single-page layout. Its practice management system includes a preference-based appointment scheduler, eligibility checking, an automated Collection Center, and quick claims entry and one-click payment posting that reduces claims rejections to less than 5 percent. The company’s browser-agnostic patient portal offers appointment scheduling, mobile intake forms, SMS patient reminders, and online payments to improve patient engagement and experience. ChartLogic also offers services for billing, revenue cycle management, and managed IT and service desk. The Department of Defense recognized the company a few weeks ago for its support of the National Guard and Reserve, a program led by ChartLogic EVP and former Army Ranger Chris Langehaug. Thanks to ChartLogic for supporting HIStalk. 

I found this ChartLogic EHR overview on YouTube.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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First responder software vendor ESO Solutions acquires the Firehouse emergency management software business of Conduent Government Solutions.

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Kiio — whose platform screens for low back pain, joint replacement, and rehabilitation and offers exercise guidance — raises $1 million from Wisconsin-based not-for-profit insurer WEA Trust.


Sales

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Olmsted Medical Center (MN) chooses Epic to replace the former McKesson (I think they were on Series, but I’m not positive). UPDATE: readers say Olmsted was using Cerner CommunityWorks for inpatient, with which it has reached HIMSS EMRAM Stage 6, and McKesson for ambulatory despite undated information I saw mentioning that it was running McKesson Series and McKesson-acquired MED3OOO.


People

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Robert Barras (The Advisory Board Company) rejoins CTG as VP of healthcare sales.

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Seattle Children’s (WA) hires Zafar Chaudry, MD, MSC, MIS, MBA (Cambridge University Hospitals NHS Foundation Trust)  as SVP/CIO.

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Senior living community software vendor Caremerge (Merge Healthcare) hires Nancy Koenig as CEO. She replaces founder Asif Khan, who remains as board chair.

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Larry Wolf (Strategic Health Network) joins MatrixCare as chief transformation officer.

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MedeAnalytics hires Tyler Downs (TriZetto) as CTO.

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Julie Mann (Optum Analytics) joins Holon Solutions as SVP of sales.

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ViTel Net hires Richard Bakalar, MD (KPMG) as VP/chief strategy officer.


Announcements and Implementations

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A new Reaction report on telemedicine finds that physicians overwhelmingly support the use of telemedicine to replace the 20-30 percent of visits that don’t require physical examination. A surprising two-thirds of respondents either contract as a telemedicine provider or have considered such moonlighting. Hospitals are mostly using telemedicine for population management or follow-up care rather than for primary care visits as only 14 percent say such services have boosted their revenue. The biggest telemedicine platform vendor by far is “homegrown.”

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Sidewalk Labs, an urban innovation group within Google parent Alphabet, announces Cityblock, which will offer residents of low-income communities who are covered by Medicare or Medicaid a care team that provides doctors, coaches, technology tools, and a health plan. The service will launch next year.

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HIMSS Analytics adds the former CapSite vendor contracts database to its Logic platform, renaming it Logic Source.

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EClinicalWorks adds a self-service option for customers to connect with CommonWell and Carequality.

A Black Book survey finds that while hospitals and medical practices are increasing their IT outsourcing and like the prospect of increased efficiency at a lower cost, their satisfaction with outsourcing companies is decreasing. Most of that dissatisfaction involved IT managers who are forced to manage an inexperienced health IT outsourcing vendor. The top-scoring EHR vendors were Cerner, Meditech, and Allscripts.

A small Dimensional Insight hospital CIO/CMIO survey concludes that less than half of hospitals have implemented enterprise-wide data governance, causing problems with data integrity and access.

Infor launches Cloverleaf Consolidator for data aggregation and exchange in a multi-EHR environment.

JAMA will launch a broad-topic, open access journal in early 2018. 

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Fujitsu announces a new palm vein biometrics sensor for its PalmSecure F-Pro Suite authentication solution.


Government and Politics

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HIMSS asks Congress to:

  • Elevate the HHS chief information security officer role to be equivalent to its CIO and make that position responsible for creating a cybersecurity plan.
  • Pass the CONNECT act that would remove geographic restrictions for telemedicine.
  • Increase funding for rural healthcare broadband coverage discounts and adopt CDC electronic information flow for case reporting, lab reporting, disease surveillance, and death reporting.

Technology

A home care provider in Australia launches a “holographic doctor” in which physicians can participate in a home nurse consultation via mixed reality technology that uses Microsoft HoloLens. Both doctor and patient wear a virtual reality headset that allows them to see each other in real time along with the patient’s healthcare data.


Other

A Health Affairs article finds that hospital interoperability didn’t improve much from 2014 to 2015 as less than 20 percent of them reporting that they “often” use outside patient information to make clinical decisions.

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A hospital in Scotland cancels surgeries after going back to paper following flooding of its basement data center.

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Ohio National Guard Captain Michael Barnes develops a veteran suicide prevention program as part of his coursework at The Ohio State University to attain a master’s degree in nursing.


Sponsor Updates

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  • Employees of The Chartis Group held a community service event at its annual retreat in New Orleans, supporting Boys Town, Covenant House, Raintree, Salvation Army, and YMCA.
  • A Spok case study describes the use of Care Connect by Union Hospital of Cecil County (MD) to reduce communication breakdown.
  • Casenet will exhibit at the Change Healthcare Inspire Conference in Philadelphia this week.
  • Ability Network is named a finalist in the Tekne Awards that recognizes technology innovation in Minnesota.
  • Nordic posts a podcast titled “How do I plan for a successful EHR go-live?”
  • AdvancedMD will exhibit at the American Society for Dermatologic Surgery October 5-8 in Chicago.
  • Aprima will exhibit at the American Osteopathic Association Conference & Exhibition October 7-9 in Philadelphia.
  • Datica publishes a new report, “Public and Private Cloud Computing within Healthcare.”
  • Besler Consulting will exhibit at AHIMA October 7-11 in Los Angeles.
  • Carevive and Crossings Healthcare Solutions will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • CoverMyMeds will exhibit at the American Association of Medical Assistants Annual Conference October 6-9 in Cincinnati.
  • The Nashville Business Journal includes Cumberland Consulting Group on its Fast 50 list for the third consecutive year.

Blog Posts


Contacts

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

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Morning Headlines 10/3/17

October 2, 2017 Headlines No Comments

US Emergency Department Visits For Firearm-Related Injuries, 2006–14

Health Affairs publishes findings from an aptly-timed study conducted by researchers from Johns Hopkins University School of Medicine that aimed to quantify the clinical and financial burden of firearm-related injuries. Researchers concluded that in the US, firearm-related injuries claim 36,000 lives and account for a financial burden of approximately $2.8 billion, annually.

Iasis Healthcare’s sale closes, CEO Whitmer departs

Steward Health Care (MA) completes its $2 billion acquisition of 16-hospital Iasis Healthcare, expanding Steward’s network to include 36 hospitals spread across 10 states.

Three US scientists win Nobel Prize for uncovering inner workings of the biological clock

The 2017 Nobel Prize in medicine was awarded to Jeffrey Hall and Michael Rosbash, of Brandeis University, and Michael Young, of Rockefeller University, for their discoveries of the underpinnings of the circadian rhythms that help organisms adapt to our 24-hour days.

Authority of Health Care Providers To Practice Telehealth

The VA proposes a rule that would allow employed VA providers to offer telehealth services to veterans across state lines.

Curbside Consult with Dr. Jayne 10/2/17

October 2, 2017 Dr. Jayne No Comments

I saw patients this weekend and was dismayed to find a mini-release from my EHR vendor that disrupted my muscle memory. Apparently they’ve decided to create a workflow to allow documents to be uploaded to a health information exchange. However, instead of putting that feature in place to automatically send when I sign my charts, they’ve broken the signing process.

Previously, upon hitting the “signature” icon, I received a nice little pop-up where the cursor defaulted into the field where I could enter my PIN, then the pop-up closed after PIN entry. Now I get the pop-up, to which has been added a pre-populated “send to HIE” field with the cursor defaulting nowhere. Since we are not connected with a health information exchange, I have to unclick the HIE field, put my cursor in the PIN field, then key my number to sign the chart. Although technically it’s two clicks, it’s a whole lot of annoyance. I was surprised by how long it took to attempt to correct the muscle memory issues as I continued to try to go directly to PIN entry for signature. Even after 50-plus patients, I still wasn’t handling the transition smoothly all the time.

I’m often the proverbial canary in the coal mine since I work mostly weekends and our vendor likes to roll updates on Saturday nights. I talked to our EHR champion and she wasn’t aware of any way to turn off the auto-populated checkbox or to get the cursor to default to the PIN field.

By way of calculation, we can take my 50 patients, multiply it out to the 750+ patients seen daily in our practice, then times all the practices serviced by our vendor. It’s a significant amount of waste. It’s definitely enough to make one wonder whether the EHR vendor does any focus group work or user acceptance testing at all when they ship these changes to the masses. Since we’re on a Web-based product, the updates are automatic, meaning it’s impossible to pick and choose. If there were any actual improvements in the release, I’m not sure what they were since I wasn’t able to tease them out during 12 hours of patient care.

It was a rough shift overall, especially since I was working at one of our expansion locations that is still under construction. We purchased an independent urgent care facility whose owner wanted to retire, where they were seeing roughly 8-10 patients per day. Our owners figured that the low volume would allow us to do some renovation and expansion while staying open. The ongoing shortage of primary care physicians in our area has fueled a boom in our business, which we sometimes aren’t staffed to handle. Couple that with an office being in disarray due to construction and you have a recipe for a chaotic workplace.

I arrived today to find two of three bathrooms out of commission for construction, which made it tricky to handle patient needs at times. One exam room was doubling as a staff break room, with a refrigerator crammed in the corner and the microwave propped on the exam table. The dedicated laboratory area had been relocated onto one of the nursing station counters, throwing a wrench into some of the workspace efficiency.

Sometimes you forget how well your practice runs until something pushes it off kilter. Although we’ll benefit from swapping the business office and oversized lab for four new exam rooms and a right-sized lab, growing pains aren’t much fun. I was having flashbacks to the last emergency department I staffed, which completely renovated the department over an 18-month period while we continued to see steady volumes of patients and also deployed a new EHR. It was fairly traumatic for the staff, as we struggled to enter orders when we couldn’t even find supplies and were pressed into smaller quarters during the build-out. The construction chaos was bad enough, but adding in the frustration of the extra clicks in the EHR didn’t help.

The shortage of primary physicians is also causing more patients to come to the urgent care who don’t have urgent care problems. I’m glad that we’re less expensive than the emergency department and fill a vital after-hours need, but we’re not equipped to handle complex medical situations or social issues.

About 15 minutes prior to closing, a patient arrived who was seriously ill. She was in the middle oncology treatment and was afraid she had pneumonia. We made a quick decision that she needed to be transferred to the hospital, but we had the complicating factor of the minor children who were with her. We were reluctant to call for an ambulance transfer without someone to care for the children, knowing they couldn’t ride with her, but her condition was worsening. We also can’t have children in the office without a parent or guardian, especially after closing.

As we worked with her to quickly try to find someone to pick up the children, the rest of the story unfolded, revealing an even more tragic explanation for why she was caring for her grandchildren. At least if we could get her to the hospital, social workers could assist. We finally found a solution when one of our patient care techs called the ambulance district and convinced a dispatch supervisor to head over with the ambulance so he could transport the children to the hospital.

These are the situations that can’t be captured well with discrete data, and when you’re trying to problem-solve well outside the box and get the patient ready for transfer, every click counts. We have to complete our H&P documentation so it is printable for transfer and finally I gave up and just free-texted most of it. By the time our patient was stabilized and loaded, the staff was mentally and physically exhausted.

It’s important for team members who work on the IT or billing side of the house to understand the kind of situations we’re facing in patient care. I’m pretty sure I didn’t code the visit as accurately as I could have or gather as many quality measure data points as I should, which would count against a lot of physicians. I won’t take too much heat for it, but it will definitely skew my treatment cycle time metrics. As I reflected on the day overall, I started to question myself on continuing to practice clinically. Although it’s important to see patients to keep me grounded, it’s significantly more stressful than just being on the IT or consulting side and I completely understand why we can’t keep physicians in primary care practices in my community.

Hopefully my next shift will be more in the box than out, but you never know any more in healthcare.

If you’re a CMIO and don’t see patients, how do you stay grounded? Email me.

Email Dr. Jayne.

HIStalk Interviews Satish Maripuri, EVP/GM, Nuance Healthcare

October 2, 2017 Interviews No Comments

Satish Maripuri, MS is EVP/GM of the healthcare division of Nuance Communications of Burlington, MA.

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Tell me about yourself and the company.

I came to the US in 1986 as grad student and stayed. I’ve been a Boston-based executive for quite some time. I’ve dealt with a lot of global businesses. I’ve traveled quite a bit, 7 or 8 million miles around the globe. I’ve been with Nuance for six years. I’ve essentially made my career here leading the healthcare business, of which I’m very passionate about. I’m personally driven from a mission standpoint in healthcare.

What has been the business impact of the malware-caused extended system outage?

The business impact was primarily to the production days that we missed in the transcription business. For the most part, in July and early to mid-August. That was the direct impact to our direct revenue.

From an ongoing impact, we don’t have a predicted run rate tail-off from a go-forward standpoint. From our investors’ perspective,  we have this year, of which our fiscal year ended September 30. We have the fourth quarter — roughly four to six weeks’ worth, depending on which clients — of production impact downtime.

We have a few clients who have transitioned away from us during the downtime, as we had given them counsel to seek other solutions. Most of them have come back. A few have stayed with their existing temporary provider. Those we expect as clients we would lose that part of the business going into next year.

One of the things I’ve seen is that clients have been very gracious in giving us an opportunity to earn their trust back. The one thing we have focused through the entire recovery process is transparency and regaining their trust.

The downtime led me to wonder how the clinician voice dictation business is divided among front-end speech recognition, back-end speech recognition, and manual audio transcription and how that’s changed over the past few years.

We transcribe about five billion lines of transcription a year for US hospitals. That’s typically what we call the back-end transcription capabilities. The front end, which is essentially the Dragon-driven dictation, is being used by about a half a million physicians in the US.

We see usage of front-end speech continue to grow and the back-end dictation continue to erode due to phenomena that the industry is already aware of. I don’t see that trend reversing. In fact, in the last year or year and a half, we’ve seen the front-end speech capabilities accelerate in adoption. We have, in fact, been a big part of that adoption by driving front-end speech into the cloud. Dragon is now, for the most part, in the cloud. With that, our physicians get ubiquitous access no matter which setting — at home, in the car, in the clinic, and in the inpatient setting — with a single profile that is always available in the cloud.

Even through the downtime we had, it’s the transcription part of the business that was down, but the front end-speech Dragon capability was up and secure.

That’s where we see the adoption going. In the last three or four months, we’ve added something like 25,000 to 30,000 physicians moving into the cloud-based capabilities. We only see that accelerating.

Speech recognition has reached consumer appliance status, with the Amazon Echo, Apple Siri, and other products moving conversational user interfaces to the mainstream. How do you see that changing?

If you wouldn’t mind, if you would indulge me a little bit in where we see the vision and the next-generational landscape going in clinical documentation, that might just be a little bit of context that’s going to clarify a bit of your question.

We see a world where a clinician is having a conversation with a patient. The two of them conversing is automatically generating clinical documentation that is also annotated and improved on the inside. Then as it goes into the final resting place of the EMR with the capability of being transcribed, being converted to medication lists and into other lab reports, etc. We truly see an ambient clinical documentation world coming to fruition.

Intersect that today with today’s burden of the clinician. Roughly 43 percent of an average clinician’s time today is being spent in front of a computer, dictating and documenting things. You intersect these two and an ongoing increased demand in knowing multiple things to improve clinical documentation. You only see this leading to one thing, which is the more we can take off their plate and the ability to make their life a little bit easier by dealing with the patients — which is what they took the oath for — the better it is for them.

That’s essentially our mission. That’s what we at Nuance Healthcare are putting all our investments into. Every step we’ve taken in speech NLP and now the capability of conversational AI that we’re bringing to the table is geared toward that next step. We have effectively delivered a highly scalable, secure Dragon Medical speech solution. The next frontier for us in that step is to bring Dragon Medical Virtual Assistant to the table.

Our view is that the next paradigm shift in this Virtual Assistant is the ability to have navigational access and conversational interactions with the EMRs in the multi-modality setting. Then of course the question becomes, how do you actually intersect that with the actual device and the form factor? We believe that the complexity of clinical documentation use cases that are in today’s physician’s setting require a level of capabilities that require a unique device to solve that problem. Hence the prototype of an innovation that we announced around the smart speaker as well that goes along with our Virtual Assistant that addresses these needs.

You may already be aware that Nuance as a company has addressed several Virtual Assistant use cases already. Our Virtual Assistant platform is being used at Audi, American Airlines, BMW and I can keep going in both the automotive and the consumer sector. We’re bringing this capability to the clinical documentation problem, as we just announced, by taking all that Virtual Assistant capability and IP and specializing that for healthcare, just like we did for Dragon Medical in the cloud. We think that is much needed.

We’ve had a prototype out there for about two and a half, three years now. Our providers have given us really solid feedback on that. We’re now going to that next level of actually launching that, integrating with the EMRs, and taking some of the early adopters to market.

Now, your question specifically on consumer entrants. They’re not to be ignored. In healthcare in general, there are a couple of different use cases. There are patient-driven use cases and there are physician-driven use cases. Eventually those might blend, but we think that today, there’s a natural extension of the consumer devices into the patient-centric use cases. They may be in an outpatient setting or an inpatient setting, but there’s a big barrier from that point to cross over to clinical documentation and actually being the Virtual Assistant for a physician. That’s the setting in which we have years of experience and that what we are driving to at this point as well.

How will you get clinicians to try something new with the Virtual Assistant and how will you develop and maintain its EHR integration?

You touched on a couple of things that we believe are critical. In terms of the physician adoption question, we can automate tasks that are repetitive and mundane in a very conversational sense. That would be a huge win, because today they go out of their way to document by doing something unnatural — speaking into certain boxes and into certain dialogue frames to be able to capture documentation. If you can eliminate those and make those navigational style control-and-command — open Tim’s record, dictate all of these labs, all the medications, prescribe this, check that — these are all things that are natural command-and-control navigational style. That’s a huge step for us in getting that addressed for our clinicians.

Initial indications from our pioneering clients who have been at the leading edge of technology over the years is that this would go a long way if you make it natural, navigational command-and-control style. That’s what we’re shooting for.

We have to work closely with our EMR partners. Epic, Cerner, Meditech, and others have expressed varying degrees of interest over the years in trying to solve this problem. We now have the enabling technology and we need to work with them for tighter integration. I think you’ll see that every single one of them is interested in aligning and making the physician’s life better. If this leverages a Virtual Assistant that allows the physicians to make their day a bit better, EMR interests are aligned. We understand how to work with the EMR partners very well and that’s a big benefit for us.

As far as your question on adoption of physicians, they’ve been asking for something like this. Ease of use. Take the burden of click-and-dictate — I have to go through five unnatural steps before I can even dictate something into text. Once we take that out of the way, that becomes natural adoption. That’s not to say we shouldn’t go through the training. This year’s next technology razor blade — am I really ready for that? There is a little bit of that curve that happens with any new technology. But I think once the early adopters start to see this, it will be a natural next step.

The other thing is that most of the physicians have some level of consumer devices at home. The early adopters are starting to say, why can’t I do the same thing at the physician’s desk? They are already asking for this. I believe that barrier will be broken provided we make our navigational access and Virtual Assistant easy to use. That’s what we’re focused on right now.

I was with a client on Monday. They’ve even gone to the extent of looking at the overview video and saying, it would be tremendous if I could take the investment in the thousands of TVs that we’ve already put in our hospitals, and beyond just showing movies to our patients, if a physician could walk in and through a Virtual Assistant that’s connected to the TV, they could see the medical record on screen. It’s a bit of a Star Trek look and feel, but that’s not too far away by leveraging existing investments. They’re very creative about this.

It would seem a natural fit that hospitals could be your partners since they often impose the EHR burden on clinicians who are affiliated with them or employed by them, giving those hospitals a competitive advantage in encouraging adoption of a Virtual Assistant that could improve physician satisfaction and alignment.

You’ve hit the nail on the head. Often you worry about, is there a market there if you build the technology? In this case, it’s the large institutions and the hospitals that for the most part have already gotten to the point of, “How can we make this better?” The adoption of speech itself is a good indication of that. This takes it a whole other level. They’re already asking for something like this.I can probably name a dozen institutions that have actually said, “If only this had existed.”

You’re spot on. This would catch on pretty quickly if it was available with a tight integration and with the accuracy they would demand.

Five years ago, we would have been talking about speech recognition accuracy wondering if it would ever be good enough. What will change over the next five years?

For us, it’s been a continuum. You touched on a couple of aspects of that.

Going back to five years ago, we would have been talking about 95 to 98 percent speech accuracy. Would that be a reality? We’ve proven that it absolutely is possible. Now it’s leveraged in the cloud with ubiquitous access at multiple settings with different form factors at a level of accuracy that we wouldn’t have guessed five to seven years ago. That has come to fruition and we’ll continue to innovate on that. We have speaker-independent models, where training is not needed. The level of innovation and applying artificial intelligence into just the speech innovation has been tremendous and I think we’ll continue to stay ahead of that.

The next thing is, how do you make that available through an easy access Virtual Assistant capability, hardware device or not? We’ve demonstrated that in multiple areas around consumer speech and automotive. Now we are bringing that into healthcare. I see that in not more than three years, let alone five years, I’ll walk in as a patient in a physician’s office and I will see a Virtual Assistant. The physician walks in, has a conversation with me, and uses a good amount of command-and-control navigational access. With the Virtual Assistant in the room, the documentation is taking place in either a semi-automated, or for the most part, an automated clinical documentation fashion. I don’t think that’s too far away.

You’ve seen speech accuracy get to a certain level. You’ll see a level of Virtual Assistant use case become mainstream. Then the question is, what do you do to intersect clinical intelligence into that scenario and setting? By that, I mean a level of clinical decision support, a level of knowledge, a level of improving the clinical documentation that’s being captured for a couple of different purposes.

Today’s accuracy and the improvement of documentation that’s being captured is a big part of what we do for our clients. We often refer to that as clinical documentation improvement, or CDI. We’ll see more technologies that improve the accuracy of what’s being captured to accurately represent severity of illness, risk of mortality, etc. because that directly impacts the quality of documentation that eventually drives downstream reimbursement models.

I see a level of intelligence being built on top of what’s being captured. We refer to that as clinical intelligence that’s being introduced in front of the physician and the other parts of the care team, whether it be radiologists, whether it’s part of the CDS specialists, etc. It’s speech, but it’s in the cloud, it ubiquitous, with a Virtual Assistant capability on top of that, and that’s the starting point. It’s already happening today where a level of clinical intelligence is being brought to the care team, especially the physician. With artificial intelligence and the level of deep learning capabilities that are available today, we know that that’s not out of the realm of reality for us within three years. A good portion of that exists today.

Do you have any final thoughts?

Economics don’t quite scale to the level at which the healthcare spend is going. The space is ripe for disruption. I’m extremely confident that enabling technologies, whatever those might be and a few of which we’ve just covered, are going to enable that massive disruption. It’s coming and it’s actually happening. We are at a point where we, through some of our larger partners, are enabling some of that disruption. We’re very excited about that. The healthcare industry will see the benefit of a lot of that disruption coming.

On a personal note, given what we’ve gone through — both in my own personal life as well as the incident recently — I’m really proud of the teams and the way that the company and the teams handled one singular focus of customer focus and doing right by the customer with a set of core values. The operative word there is resilience. Both personally as well as from a team perspective, we are committed to driving what’s right for the clients and driving that through a level of resilience. We’ve come out stronger as a business through that whole experience while it didn’t seem like that in that six-week period.We’re really proud of that.

Morning Headlines 10/2/17

October 1, 2017 Headlines No Comments

Trump’s breaking point with Price

HHS Secretary Tom Price, MD resigns amid public outrage over his use of taxpayer funded private jets for personal travel.  Don Wright, MD and assistant secretary for HHS, will serve as acting secretary until a permanent replacement is named.

VA close to awarding Cerner contract for new EHR

VA Secretary David Shulkin notifies Congress of his intent to award a no-bid contract to Cerner within 30 days as part of the VA’s modernization roadmap.

US jury cuts damages in TCS-Epic trade secrets lawsuit

A Wisconsin court cuts the damages awarded to Epic in its trade secrets suit against India-based Tata Consultancy Services rom $940 million to $420 million, citing a Wisconsin law limiting punitive damages to twice the compensatory damages.

Temple University Health System: Financial Summary

Temple University Health System (PA) reports a $22 million year-over-year decline in net income, despite recording a $68 million increase in net patient services revenue over the same period. Temple attributes the decline in net income to its Epic implementation at Temple University Hospital.

Monday Morning Update 10/2/17

October 1, 2017 News 3 Comments

Top News

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President Trump fires HHS Secretary Tom Price – not for his questionably legal stock trades, for serving as a political lapdog in trying but failing to torpedo the laws he swore to uphold, or even for squandering hundreds of taxpayer dollars on unnecessary charter and military flights — but rather for embarrassing the President in the press coverage about the flights, admitting his wrongdoing, and offering only partial taxpayer reimbursement.

The only regret the former Tea Party member expressed in his resignation letter is that he “created a distraction.”

Price also didn’t mention the $19 million Republicans spent to keep his former seat in the most expensive House race in history. A Republican PAC executive director obviously wasn’t thrilled with Price’s short stay in Washington: “While it was certainly fun destroying [Democratic nominee] Jon Ossoff and attacking Nancy Pelosi for three months, I am hopeful Dr. Price will use his newfound fame and leisure time to jet around the country and help make up for some of the $7 million we spent on the Georgia special election.”

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Appointed as interim HHS secretary is Deputy Assistant Secretary for Health Don Wright, MD, MPH, an HHS long-timer who replaced Karen DeSalvo, MD, MPH in the January 2017 administration change. The permanent replacement will almost assuredly, like Price, have credentials that are more political than clinical.

Politico’s list of rumored candidates includes some current and former members of Congress, Dr. Oz, CMS Administrator Seema Verma, Florida Governor Rick Scott, the VA’s David Shulkin, FDA Commissioner Scott Gottlieb, former Louisiana governor Bobby Jindal, HUD Secretary Ben Carson, and Don Wright himself.


Reader Comments

From The Basics: “Re: SSN. Yesterday I visited my local hospital to review a bill. I was shocked to see my whole Social Security number on an employee’s computer screen. She said she didn’t know why it was there since she doesn’t use it. It only takes one dishonest person to steal the identity of patients.”


HIStalk Announcements and Requests

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A bunch of us have had our information exposed in Equifax’s breach, although nearly as many of poll respondents have lost interest reading about the breach du jour. Some respondents expressed optimism that “the big one” may force companies to get their security act together, while several others said they’ve placed an indefinite freeze on their credit accounts with the belief that the hassle of unfreezing them as needed is still better than cleaning up the post-breach mess.

New poll to your right or here: should a vendor’s newly announced customer be required to attest that they hold no financial interest in the company?


This Week in Health IT History

One year ago:

  • PeriGen acquires Hill-Rom’s WatchChild fetal monitoring system.
  • The local paper spotlights the refusal of the Texas Department of State Health Services to release pregnancy and maternal death statistics to reporters interested in why death rates doubled in one year.
  • PE firm Warburg Pincus announces plans to acquire Intelligent Medical Objects.
  • Former President Bill Clinton, stumping for his wife’s presidential campaign, calls the Affordable Care Act “the craziest thing in the world” because of risk pool limitations.

Five years ago:

  • The UK’s Department of Health admits that its contract with CSC requires it to turn custom-developed NHS software back to the company after NPfIT was shut down.
  • McKesson announces that it will acquire MED3OOO.
  • HIMSS acquires CapSite.
  • Patrick Soon-Shiong’s NantHealth announces that the company will work on personalized medicine with Blue Shield of California and St. John’s Health Center. 

Ten years ago:

  • A KLAS report on how well clinical systems work for nurses gives all vendors a grade of ‘D’ or below.
  • Quovadx acquires Healthvision.
  • Microsoft announces its HealthVault PHR.
  • MD Anderson redesigns its ClinicStation EMR and CIO Lynn Vogel joins Partners (John Glaser) Vanderbilt (Bill Stead), and Marshfield Clinic (Justin Starren) in an AMIA conference session on homegrown development.
  • CMS awards AHIMA a $10 million contract to evaluate the possible change from ICD-9 to ICD-10.

Last Week’s Most Interesting News

  • Epic opens the first group of App Orchard products to public access.
  • A VA OIG report finds that the DoD is not sharing attempted suicide information with the VA despite a 2014 federal mandate.
  • The American College of Radiology and SIIM hold a session and a conference, respectively, on use of artificial intelligence in medical imaging.
  • Senate Republicans fail to bring the Graham-Cassidy bill to a vote.
  • FDA chooses the digital health software vendors that will participate in its software precertification program.

Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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Medication risk management technology vendor Tabula Rasa HealthCare acquires University of Arizona medication therapy management spinoff SinfoniaRx for $35 million in cash.

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A Wisconsin court reduces the $940 million awarded to Epic in its intellectual property lawsuit against Tata Consultancy Services to $420 million. The original judgment violated Wisconsin law, which limits punitive damages to twice the compensatory damages, causing Epic to suggest a lower figure of $720 million. Epic says Tata employees working as Kaiser Permanente consultants stole thousands of company documents to help Tata create a competing system, but Tata says its lawyers believe the award can be set aside completely on appeal since Tata did not benefit from the information.


Sales

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In Canada, Alberta Health Services signs a $368 million contract to implement Epic. It will replace 1,300 systems that it claims will cover most of the project’s overall $1.2 billion cost, although the province’s auditor is skeptical.

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Methodist Le Bonheur Healthcare (TN) will implement the PatientTouch communication and clinical workflow platform from PatientSafe Solutions.


Decisions

  • Mammoth Hospital (CA) will go live on Cerner Millennium in October 2017.
  • Osceola Medical Center (WI) will switch from Evident to Athenahealth in January 2018.
  • Jersey Shore Hospital (NJ) will replace Meditech with Epic in April 2018.
  • Memorial Hospital (IL) will switch from Evident to Epic in November 2017.
  • St. Francis Memorial (NE) Hospital will replace McKesson with Cerner in 2018.

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


People

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Don Woodlock (GE Healthcare) joins InterSystems as VP of HealthShare.

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OurHealth hires Brian Norris, MBA, RN (Aledade) as VP of analytics.


Announcements and Implementations

Black Book names its 50 health IT disrupters and challengers.

UMass Memorial Health Care was scheduled to go live on its $700 million Epic project this past weekend, replacing Siemes/Cerner Soarian. 


Government and Politics

The VA gives Congress the required notice that it plans to sign a no-bid contract with Cerner within the next 30 days. Secretary David Shulkin also announces that the VA will end work on 240 of its 299 open software projects, many of them floundering, to shift resources to the Cerner implementation. Shulkin urged private sector employees to join the VA’s Cerner implementation “because we need the A team on this.”

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Meanwhile, the VA’s Shulkin has his own Tom Price-like problems to deal with as the Washington Post discovers that a taxpayer-paid trip to Europe included, in addition to discussions with officials in Denmark and England initiated by the VA, attendance at the Wimbledon championship and a cruise on the Thames that also included his wife, four other travelers, and six-person security detail. He took the trip, about half of which didn’t involve government business, less than two weeks after demanding that VA executives approve only essential travel.

The US Supreme Court will hear arguments Monday in a federal labor case that involves Epic and two other companies, a key issue being Epic’s requirement that employees sign away their rights to sue the company over labor issues and instead submit to arbitration.


Other

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Performer Cher sues Patrick Soon-Shiong for stock sale fraud, claiming that a drug company convinced her to sell back her shares cheaply and then sold the company for a higher per-share price to Soon-Shiong’s NantCell. The suit says Soon-Shiong paid $15 million for the company that is now worth $1 billion.

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Temple University Health System (PA) attributes its $23 million budget shortfall primarily on the implementation of Epic, mostly due to high-than-expected staffing costs and its impact on operations improvement goals.

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The president of Erlanger Health System (TN) says its 67 percent drop in net income from operations in the fiscal year is mostly due to its Epic implementation costs, as the health system paid Epic $33 million this year. However, revenue exceeded budget, also due to Epic.

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Dean Sittig, PhD, biomedical informatics and bioengineering professor at The University of Texas Health Science Center at Houston, just published a new book on informatics terms. Not sure if you need it? Take this 10-question multiple choice informatics terminology quiz that Dean created at my suggestion, check your score at the end, and then let Dean help you do better if needed. 

Here’s Vince’s latest 30-year look-back on the health IT industry, which addresses the DoD’s 1987 EHR bid and the birth of HL7.

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Weird News Andy calls this DWI – driving while immature. Rady Children’s Hospital rolls out (no pun intended) little cars that peds patients can “drive” (they’re actually controlled remotely) to the OR to help them relax before their procedure. The kids – like their surgeons with their larger equivalents – can choose from among a BMW, Mercedes, or Lamborghini.


Sponsor Updates

  • QuadraMed, a Harris Healthcare company, and T-System will exhibit at AHIMA October 7-11 in Los Angeles.
  • Salesforce announces $50 million donation and 1 million volunteer hours to further computer science education.
  • The SSI Group will exhibit at the NJ HFMA Annual Institute October 4 in Atlantic City.
  • Surescripts will exhibit at the EClinicalWorks 2017 National Conference October 6-9 in Grapevine, TX.
  • Versus Technology will exhibit at MD Expo October 5-7 in Orlando.
  • Boston Magazine includes ZappRx CEO Zoe Barry on its list of Bright Young Things.
  • ZeOmega will exhibit at Change Healthcare’s Inspire Change Healthcare Solutions Conference October 2-5 in Philadelphia.
  • Lightbeam Health Solutions and Experian Health will exhibit at the NAACOS Fall Conference October 4-6 in Washington, DC.
  • Logicworks earns PCI DSS Level 1 Certification for the sixth straight year.
  • Navicure will exhibit at the EClinicalWorks National Conference October 6-9 in Grapevine, TX.
  • Netsmart will exhibit at the CBHC Annual Behavioral Health Conference October 4 in Breckenridge, CO.
  • Clinical Computer Systems, developer of the Obix Perinatal Data system, will exhibit at the University of Iowa Health Care Children’s & Women’s Services Fall Nursing Conference October 2-3 in Coralville.
  • PatientSafe Solutions will exhibit at the 2017 IntegraTe 2017 South Florida HIMSS event October 4 in Davie, FL.
  • The Metro Atlanta Chamber selects Patientco as one of seven companies to join its first cohort of Backed by ATL businesses.
  • PokitDok will present at Health 2.0 October 3 in Santa Clara, CA.

Blog Posts


Contacts

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

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Morning Headlines 9/29/17

September 28, 2017 Headlines No Comments

Epic advances its health-centric app store

Years in the making, Epic launches its App Orchard app store, where customers can shop for third-party apps that integrate with Epic’s EHR.

#BeThere: What More Can Be Done To Prevent Veteran Suicide

A VA OIG report on preventing veteran suicides finds that the DoD is still not sharing attempted suicide information on service members transitioning out of the armed services with the VA from its DOD Suicide Event Report system, despite a 2014 federal mandate that it do so.

Certified Health IT Developers and Editions Reported by Hospitals Participating in the Medicare EHR Incentive Program

CMS releases the latest MU attestation numbers by vendor, showing that Epic has edged ahead of Cerner, with Meditech trailing closely behind the two.

U.S. brings new charges over Tenet Healthcare fraud scheme

Two former Tenet executives are facing conspiracy and wire fraud charges in Georgia. The indictment says that from 2000 to 2013, the executives engaged in a scheme to pay over $12 million in bribes to clinics in Georgia and South Carolina so that providers there would refer pregnant patients to Tenet hospitals to deliver their babies. Tenet billed $400 million to the Georgia and South Carolina Medicaid programs as a result of these referrals.

News 9/29/17

September 28, 2017 News 8 Comments

Top News

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Epic announces at UGM go-live of its App Orchard, offering software from:

  • American Joint Committee on Cancer (cancer staging forms)
  • Aunt Bertha (connecting patients to social services)
  • Cedars-Sinai Health System (personal device data flowsheets)
  • DocASAP (patient scheduling)
  • Doctella (patient education)
  • HealthDecision (shared decision-making)
  • Healthfinch (patient visit planning, prescription refill processing)
  • ImageMoverMD (EHR image integration)
  • Impathiq (chest pain protocols)
  • Northwestern University (patient outcomes monitoring)
  • Parachute Health (durable medical equipment ordering)
  • PeraHealth (at-risk patient identification)
  • StayWell (patient education)
  • Tissue Analytics (wound documentation)

Epic actually rolled out the App Orchard site early this year, but this is the first public access to the apps it contains.

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Epic’s 1.5-day App Orchard Conference will be held November 9-10 at its Verona, WI campus.


Reader Comments

From Kim Wisconsin: “Re: Epic UGM. Clients watched KLAS VP Taylor Davis and Judy Faulkner prance together in wizard costumes on stage. Needless spending on top of what it cost Epic to attain Best in KLAS?” Unverified. Epic’s UGM involves a lot of voluntary whimsy and I’m OK with that, but I’m always skeptical of KLAS’s objectivity and having one of its executive participate in a vendor’s user group meeting skit does little to allay my concerns. Imagine a Consumer Reports editor cavorting on stage at a Ford PR event, although that’s unfair since KLAS is light-years away from the objectivity and science behind Consumer Reports despite the inevitable industry comparisons. Still, customers of both Epic and KLAS make their own informed decisions, so they know what they’re buying and it’s nobody else’s business.

From George St. Short: “Re: executive attributes. What is your observation about strengths and weaknesses and how it affects companies?” That’s a broad topic, but I will summarize thusly. Most of us know our strengths. We don’t, however, know our weaknesses, and that’s where we stumble. Just ask the people you work with to list what you’re bad at. Try to improve, get someone else to handle that function, or both.

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From The PACS Designer: “Re: digital pathology. The era of digital pathology is upon us and can be seen through this digital pathology sample. You will see the digital pathology records in your EHR when vendors begin to add them to their EHR systems in the years to come.”

From OnlyForGiggles: “Re: national EHR procurement in Singapore. It’s been four years in the running and Allscripts and Epic are the finalists. Cerner didn’t even bother showing up at this month’s HIMSS Asia. Accenture is running the procurement with Oracle as a partner and only Allscripts runs Oracle. The Ministry of Health CIO is a former Accenture partner and has now installed himself also as CEO of the IT arm of the Ministry of Health. He is partial to awarding contracts to his former employer, so both companies would do well to sidle up to Accenture. We see this kind of drama in the US and UK and Singapore, alas, is no exception.”

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From The Mechanic: “Re: Athenahealth. One of its 35-bed inpatient sites is already leaving them and returning to CPSI.” Jackson Medical Center (AL) says collections dropped 75 percent after they implemented Athenahealth, so they’ve gone back to the Thrive EHR solution offered by CPSI subsidiary Evident in what they call a fairly easy transition. 

From Super Bee: “Re: EClinicalWorks. Cold call emails cite an ‘AmericanEHR’ survey that finds EHR tops at many categories. It would be more impactful if they actually provided the study, but in addition, ECW isn’t on any of that site’s Top 10 lists.” That site doesn’t inspire a lot of confidence with outdated information and no recent news items. It was developed by the American College of Physicians to sell reports and to charge EHR vendors to create profiles on its site or to run ads. Its top five EHRs by user satisfaction are CattailsMD (which I thought was long gone or at least renamed, but maybe not), Praxis, Waiting Room Solutions, ABELMed, and Sevocity.

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From Beefy Goodness: “Re: ONC’s inpatient EHR certification stats. Epic has overtaken Cerner for the #1 spot in data updated through July.” The chart is above, although it also list hospitals using Siemens Medical Solutions that might be reasonably added to Cerner’s total to keep it on top. Epic is the only vendor that has customers using 2015 certified technology. Also note that while the data source was updated in July 2017, the graphic depicts only participation through the 2016 program year.

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From Spacemen Collection: “Re: Sunquest. President Matt Hawkins is leaving, to be replaced by Mike Epplen, who has been president of fellow Roper acquisitions Data Innovations and Atlas Medical.” Unverified, although the non-anonymous source is solid. UPDATE: Hawkins will become CEO of the combined Navicure-ZirMed when that merger is completed in early November.

From Frank Sumatra: “Re: MyWay. Physicians are telling me that Allscripts will shut off the hosted version within five weeks, but can’t get them their data for 12 weeks. Practices will also have to pay $5,000.” Unverified. I invited the Allscripts media contact to comment but haven’t heard back. MyWay was retired several years ago as I recall to avoid adding ICD-10 support, so practices have had five years to seek an alternative. MyWay is disproportionately represented among the many embarrassing points in the company’s history (search HIStalk for a fond look back).


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Vocera. The San Jose, CA-based company offers the leading platform for clinical communication and workflow, with 1,400 hospital and health system customers around the world using smartphone-based secure texting or making hands-free calls using the Vocera Badge. Vocera interoperates with 120 clinical systems to reduce alarm fatigue, reduces staff response time, and improves patient care, safety, and experience. Vocera ensures that critical information reaches the right person at the right time on the right device, or as Halifax Health VP/CIO Tom Stafford says, “There is no other communication solution I’m aware of that can send a notification as closely and instantly to a nurse than the Vocera system.” Hospitals use the system to increase ED and OR throughput, prioritize clinical alerts, optimize patient placement, improve collaboration, strengthen patient communication, and reduce care team burnout. Halifax Health just implemented a real-time sepsis surveillance program by integrating Wolters Kluwer Health’s POC Advisor with its Vocera technology to quickly alert clinicians of a potential sepsis case, while Dayton Children’s Hospital (OH) connects pediatric patients to nurses by connecting Hill-Rom’s nurse call system with :Star Trek”-like Vocera badges to alert them when the child presses buttons for “pain” or “potty.” Gartner’s Hype Cycle report names Vocera as an example of a technology vendor with offerings in several categories of the real-time health system. Thanks to Vocera for supporting HIStalk.

I found this new YouTube video that describes Halifax Health’s use of Vocera in its ED.

This week on HIStalk Practice: Volunteers in Medicine Clinic Executive Director Raymond Cox, MD discusses the role data access plays in caring for the underserved. PeakMed Direct Primary Care founder and CMO Mark Tomasulo, DO shares his thoughts on the ways attempts at health insurance reform are driving the DPC business model. Deadline extended: HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide over at HIStalk Practice.


Webinars

October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRX. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Physicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Associates automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester: What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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Leerink Transformation Partners forms its first healthcare IT growth equity fund with $313 million in assets under management, led by managing partners Todd Cozzens (Marquette Medical, Picis, Optum) and Jared Kesselheim, MD, MBA, both previously with Sequoia Capital and Bain Capital Ventures. The fund’s initial investments are Outcome Health, Scientist.com, Vera Whole Health, PatientPing, Health Catalyst, and Kyruus. 

IBM, which has laid off a significant part of its US workforce, now employs more people in India than in the USA, supporting the theory that low-cost overseas labor moves up the food chain from hardware assemblers to knowledge workers. 


Sales

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Emory Healthcare (GA) chooses Kyruus’s provider data management and patient access solutions.

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South Africa’s Areta Health will implement Medsphere’s subscription-licensed, cloud-hosted healthcare IT solutions in its Specialist Day Hospital system.


People

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UW Medicine (WA) hires Joy Grosser (University Hospitals) as CIO. She had been CIO of University Hospitals for just over a year.

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Ed Gaudet (Iboss Cybersecurity) joins Censio as CEO.

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CheckedUp hires Jim Decker (AMD Group) as VP.

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Seattle Children’s (WA) promotes Eric Tham, MD, MS to VP and associate CIO over research IT, clinical applications, and analytics.


Announcements and Implementations

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The American College of Radiology’s newly formed Data Science Institute hosts its first meeting in its Reston, VA headquarters, convening an international group of artificial intelligence experts, device vendors, and physicians to discuss the use of algorithms in clinical workflows. ACR DSI is building consensus around a vendor-neutral framework to apply AI to patient care that will include developing imaging use cases, setting interoperability standards, testing algorithms, and addressing regulatory issues. 

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Society for Imaging Informatics in Medicine holds its second conference on using machine intelligence in medical imaging (SIIM C-MIMI) at Johns Hopkins Medicine, with keynotes offered by presenters from Google Cloud and the FDA.

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Allscripts will integrate medical reference and patient education information from Merck Manuals into its EHRs via an HL7-compliant Infobutton.

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Nuance releases Dragon Medical Virtual Assistant, which applies voice biometrics and text-to-speech via a smart speaker conversational user interface to automate high-value EHR clinical workflows.

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Lightbeam Health Solutions will integrate AI technology from DocSynk into its population health management platform to improve identification and targeting of patient groups.

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Ability Network announces the Ability Insight Medicare revenue cycle analytics and benchmarking application for SNFs, home health agencies, and other LTPAC organizations.

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Talent management solutions vendor HealthcareSource launches a healthcare job search site that is integrated with its Position Manager applicant tracking system. The company’s CEO is industry long-timer J.P. Fingado (API Healthcare, Cerner, Dynamic Healthcare Technologies). HealthcareSource says it has 3,000 healthcare customers of its Quality Talent Suite.

Healthcare Growth Partners posts the first in a six-part series on due diligence in health IT transactions, this installment covering accounting and tax considerations.


Government and Politics

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The Department of Justice charges several executives of for-profit hospital operator Tenet Healthcare with Medicaid fraud, claiming that some of its Atlanta-based facilities paid $12 million in kickbacks to a medical clinic that serves pregnant women who are in the US illegally, steering them to Tenet hospitals for their deliveries that were then billed to Medicaid for $400 million.

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A report on veteran suicide by the VA OIG finds that despite federal mandates going back to 2014, the Department of Defense still does not share attempted suicide information from its DOD Suicide Event Report system with the VA. The report also notes that 11 percent of the patients identified by the VA as being high risk for suicide did not have a suicide prevention safety plan in their EHR record and that the VA’s use of EHR suicide risk flags could be improved. A previous report found that veterans have a 21 percent higher suicide risk compared to civilians, with 20 of them killing themselves each day, 30 percent of those after recent VA visits.

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Former HHS CIO Frank Baitman says he doesn’t understand why Healthcare.gov needs to go offline for 12 hours every Sunday (including the first day of open enrollment period) as announced by HHS. The system was down less than 1 percent in previous years vs. a scheduled 6.6 percent this year, triggering several letters from senators to CMS Administrator Seema Verma questioning whether the impetus is political rather than technical. The open enrollment period has already been reduced from 12 weeks to six and outreach programs for signups have been cut almost entirely.

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HHS Secretary Tom Price apologizes for the $400,000 worth of chartered plane flights he has taken – some for questionable purposes and five in a single week —  in the past few months in potential violations of federal travel laws, declaring that he won’t take any more charters and that “taxpayers won’t pay a dime for my seat on those planes.” He will repay the $52,000 portion represented by his own seat, but taxpayers remain on the hook for the additional $350,000 Price spent to bring HHS employees along for the ride. Meanwhile, a Politico investigation finds that fiscal hawk Price and his wife also took global trips on military aircraft that raises his total since May to more than $1 million, but HHS says Price reimbursed the government for his wife’s travel. Price, his wife, and eight HHS employees took a private jet from Berlin to Geneva at a cost of $16,000 for the flight offered by several commercial airlines for between $60 and $260. Price railed about Democrats flying charters when he was a Congressman, citing “fiscal irresponsibility run amok in Congress.”


Technology

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Fujitsu develops a wearable, hands-free speech translation device that can identify the voices of two speakers and translate their speech into the other’s language. The company claims 95 percent accuracy in a typical hospital setting. It was developed to help hospitals in Japan converse with their patients who don’t speak Japanese.


Other

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From Epic’s user group meeting:

  • CEO Judy Faulkner talks up Epic’s new Share Everywhere, which allows any provider (even those who don’t use an EHR) to view a patient’s records via C-CDA.
  • Faulkner advocates eliminated the term “electronic medical record” in favor of the “comprehensive medical record,” which of course why the term “electronic health record” was created to describe systems that manage information extending beyond the four walls (at least for that term’s first five minutes of life, after which overzealous and often crappy EHR vendors misappropriated the term to describe their unchanged systems to sound sexier).
  • Epic demonstrated the use of consumer technology such as Google Home and Amazon Echo that can allow patients to connect to MyChart to request prescription refills.
  • The company announced Payment Guardian for reimbursement.
  • Epic is working on using artificial intelligence to assist clinician users, with Epic being noted this week in Microsoft’s Ignite Vision keynote speech by CEO Satya Nadella as an AI-first healthcare leader.

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CVS joins the opioid abuse fight in a puzzling manner, limiting new opiate patients who are covered by insurance to a seven-day prescription supply, limiting the number of doses its pharmacists will dispense based on product strength, and declining to dispense extended-release opiates until immediate-release products have been tried. It’s interesting that a drugstore chain – which has limited access to a patient’s medical history – feels it needs to override physician prescriptions, although certainly state medical boards, pharmacy boards, and other overseers haven’t made much of a dent in questionable opiate prescribing.

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This might be a good early warning. Doctors performing a bronchoscopy on a long-term smoker find that his lung mass isn’t cancer, but instead is an easily removed plastic play set traffic cone he swallowed as a child, which caused no symptoms until 40 years later.


Sponsor Updates

  • Boston Software System publishes “Simplifying Legacy System Decommissioning.”
  • Parallon Technology Solutions publishes a white paper for CIOs and chief medical officers titled “Upgrading to Integrated Meditech 6.16.”
  • Robert Lord, co-founder and president of Protenus, is chosen as a New America Cybersecurity Policy Fellow, where he will focus on defining the program’s next-generation healthcare cybersecurity efforts.
  • Datica CEO Travis Good, MD will moderate a panel event at the Health 2.0 conference next week titled “What does the success of digital health look like?”
  • Lightbeam Health Solutions publishes a case study describing Princeton HealthCare System’s 15 percent reduction in inpatient admissions after implementing the company’s population health management platform.
  • The Chartis Group publishes a white paper titled “The Shift to Value: Understanding Market Dynamics to Inform Your Strategic Course.”
  • Meditech AVP Cathy Turner, MBA, RN will serve on a panel at Northeastern University’s Nurse Innovation and Entrepreneurship Summit this week.
  • EClinicalWorks will exhibit at Health 2.0 October 1-4 in Santa Clara, CA.
  • Iatric Systems will exhibit at the HCCA Regional Conference September 29 in Indianapolis.
  • Boston Voyager profiles Image Stream Medical CEO Eddie Mitchell.
  • InterSystems will exhibit at the CompuGroup Medical User Conference October 3-5 in Las Vegas.
  • Intelligent Medical Objects Senior Software Engineer Yunwei Wang becomes the first to successfully complete the Health Level Seven International inaugural HL7 Proficiency Exam.
  • Kyruus will exhibit at the Boston Bar Association’s Life Sciences Conference October 3 in Cambridge, MA.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
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