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Readers Write: Demystifying Population Health

May 13, 2015 Readers Write No Comments

Demystifying Population Health
By Jeff Wu

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Population health was once again a major topic of this year’s HIMSS conference. We saw even more vendors offering products, services, and solutions aimed at helping organizations deal with the challenges population health management presents.

Unfortunately, population health is such a broad domain that no singular solution really encompasses all of it. As a result, vendor offerings tend to only address a specific challenge. The wide and varying offerings across vendors adds confusion to the topic.

Population health shouldn’t be an industry buzzword that’s approached with trepidation. Instead, we need to understand the categories of challenges we are trying to address and the process for developing interventions to solve them. Let’s start by taking a look at the three categories that population health management interventions fall into.

  • Government or mandated interventions. For many organizations, this is the primary (and perhaps only) component of their population health strategy. Some initiatives, like becoming an accountable care organization, encompass requirements that address items that will be discussed below. For many organizations, this may be enough.
  • Enterprise population health interventions. These encompass interventions that are applied to the full population of an organization’s patients. Immunization and vaccination interventions or physical activity interventions are broadly applied to an organization’s full patient population. As organizations begin to try to standardize care, interventions aimed at variation reduction are also encompassed here.
  • Cohort, group, or sub-population health interventions. This class of interventions is the most varied and covers any intervention that addresses a sub-population of patients. Some examples of interventions in this category include health maintenance for diabetes patients, preventative care efforts like breast cancer screening in women over 50, and depression/PTSD screening for military veterans.

Population health management evolves linearly in three stages that borrow some classical tools from epidemiological tracking.

  1. Passive surveillance. Passive surveillance involves the retrospective analysis of a specific issue. This is the evaluation of data that already exists. Passive surveillance addresses questions like, "How many of our diabetic patients got a glucose test in the last six months?" or, "How many of our patients got flu vaccines last month?" Most analysis starts from this level of surveillance. It’s important to note that the majority of organizations are just getting to this point in their analytical journey. Implementation of the EHR tools necessary to do this level of surveillance are finally settling and getting to a state that allows for this to happen. To date many ‘organized’ population health based initiatives focus only on this type of surveillance. CMS’s MSSP ACO initiative is a classic example of this, where an organization participating in the MSSP ACO need only report their measures for the first year to receive their financial incentive.
  2. Active surveillance. The next evolution is active surveillance. If passive surveillance identified how many patients got flu vaccines last month, active surveillance would try and answer the question how many of our patients got a flu vaccine last week or yesterday. If passive surveillance told us which of our diabetes patients got a glucose test in the last six months, active surveillance would try to address which ones are being well controlled. In the epidemiological world, passive surveillance relies on existing data, while active surveillance implies a program that generates more recent and/or new data. This could be as simple as querying the medical record or running a report more frequently for simple cases or designing a whole new workflow and data elements to monitor for more complex cases.
  3. Prescriptive intervention. Once a population or initiative is identified, prescriptive intervention is what an organization uses to address the problem. This is where the art of evidence-based medicine comes in. We now have a lot more data to develop more fine tuned and effective interventions. Things like smoking cessation no longer have to be just a pamphlet, a discussion with a provider, and then a check box in the medical record. Full care teams can be coordinated and then patients can be monitored to help them with compliance.

As the industry and technology continues to advance, so do the tools at our disposal. Sentinel surveillance and predictive analytics offer some exciting opportunities to do more earlier. Additionally, the increased volume of data allows us to start taking a more in-depth look at cost-effectiveness and variation reduction between treatments for diseases.

It’s imperative to remember that every organization’s population health strategy will necessarily be different. This is because each organization’s population of patients is different. The vendor perspective often approaches organizations with packaged solutions, when in reality, it’s almost impossible for these solutions to be “one size fits all.” Even a product geared to a specific population health goal will require nuanced configuration to be effective for an individual organization.

Here in Madison, Wisconsin, population health interventions for UW Health are drastically different than Dean St. Mary’s or Group Health Co-op. UW is an academic medical center that draws high-acuity patients from across Wisconsin, while Dean has the region’s only obstetrics practice and GHC handles only primary care needs. While these organizations may benefit from adopting collaborative population health initiatives like the MSSP ACO (which both Dean and UW are a part of), their intervention focuses differ significantly based on their unique patient populations. Seldom can a product or solution apply to both, and even more rarely will it work for both.

As the industry continues to shift care delivery to encompass a population-based perspective, we are constantly introducing changes to our workflows, our assumptions, and most importantly, our expectations. These changes introduce uncertainty and apprehension, but they are also our greatest opportunity. It’s important to realize that population health management isn’t actually anything new. We’ve been here before—we’re just upping the scale.

Jeff Wu is a population health researcher at the University of Wisconsin-Madison.

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May 13, 2015 Readers Write No Comments

Readers Write: New Discoveries in Health IT Diagnoses

May 13, 2015 Readers Write No Comments

New Discoveries in Health IT Diagnoses
By Niko Skievaski

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Over the past decade, we’ve spent billions to digitize healthcare. Health IT was to bring us the same exponential efficiency gains that computers and the Internet brought nearly every other industry. But now that rooms of paper have transitioned into rooms of servers and swarms of software vendors attempt to surf the wakes of legacy EHRs, the acute impact of this stoic transition begin to appear. Some of these newly diagnosed alignments are approaching risk of epidemic.

I am writing this to discuss our findings from a 300-vendor study attempting to understand the root causes, and most importantly, the prevention measures individuals can take when confronted with known early symptoms.

Type 1 and 2 MU (further mutations into Type 3)

An early stage MU diagnosis was a catalyst to much of the following conditions. In 2009, it first appeared in populations incentivized to spread it via certified EHR technology. If caught early, although not curable, it could have been contained and controlled. However, it soon became chronic and subsequently categorized as type 2. And it looks now as though a more progressive mutation is afoot, growing beyond incentivized  to penalized attestation.

Hyperactive Click Finger

Most commonly affecting the right index finger, hyperactive click finger (HCF) resulted from premature adoption of EHRs as spurred by type 1 MU. Market driven adoption would have controlled click counts to safe levels as sovereign end users would have chosen vendors based on efficiency gains,rather than subsidy. A regimen of optimization efforts led by EHR therapists is a potential solution that some patients have found effective. However, these therapies are usually administered at extremely high hourly costs and repeated consults are inevitable.

Acute Alert Fatigue

As MU progressed to type 2, clinical decision support combined with CPOE brought on acute alert fatigue in provider populations. This is commonly misdiagnosed as Bipolar Disorder or mild Tourette’s. Comorbidities frequently include HCF. EHR vendors have backed off heavy alerts and periphery vendors are beginning to set precedence with FDA clearance for forceful support. Additionally, alerts are normally hard-coded based on known errors and omissions, thus avoiding opportunity for proactive machine learning.

I14Y Virus

An infectious disease has been uncovered: I14Y Virus (interoperability influenza). Red blood cells clump together and bind the virus to infected cells, making it extremely difficult to share data between inhabitants. Additionally, the inconsistencies in data models create often insurmountable barriers for new software entrants that could otherwise bring increased efficiency and quality. New therapies, including acronyms like FHIR and SMART, are beginning to change public perception of the disease, yet it is still unclear to most of us what the heck they actually mean. Private middle layers are starting up to tackle known I14Y opportunities and a race to the cure is among us. The cure standard will be defined by what is adopted, not what is agreed upon in committees.

Hyperportalitis

Patients and providers are affected by hyperportalitis similarly. Yet it affects each population quite differently. Upon surfacing symptoms, patients simply disengage, causing aggregated MU. Affected providers, under mandate to comply, simply write usernames and passwords on sticky notes under keyboards, or in severe cases, on the frames of their computer screens. This exacerbates conditions leading to potential risk of HIPAAppendicitis.

HIPAAppendicitis

Despite repeat training videos depicting hospital elevators polluted with oral PHI leaks, we still run a high population risk of HIPAAppendicitis. This creates risk-averse symptoms of committee meeting purgatory and sluggish adoption of innovative cloud-based software therapies.

 

This is by no means a comprehensive study. I welcome review from my distinguished peers who subscribe to this journal, as well as subsequent research and inquiry. There will be an open comment period prior to the amendment of ICD-10.

Niko Skievaski is  co-founder of Redox.

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May 13, 2015 Readers Write No Comments

Morning Headlines 5/13/15

May 12, 2015 Headlines 1 Comment

Health Information Companies HealthPort and IOD Incorporated to Merge

HealthPort and IOD, both health information management vendors, will merge, creating a single company with a combined revenue of $450 million and a customer base of 18,000 health care facilities in the US.

McKesson Reports Fiscal 2015 Fourth-Quarter and Full-Year Results

McKesson reports Q4 and FY2015 year end results: full-year revenue up 30 percent  to $179 billion. Q4 revenue up 19 percent to $4 billion, adjusted Q4EPS $2.94 vs. $2.71, beating expectation on both.

New machine could one day replace anesthesiologists

The Washington Post reports on an FDA-approved anesthesia machine that can automate sedation and could one day replace the need for an anesthesiologist when performing routine procedures.  An Anesthesiologists’ fee for sedation during a colonoscopy averages $2,000, but the machine can perform the same task for just $200.

An end-to-end hybrid algorithm for automated medication discrepancy detection

A study evaluating the use of natural language processing and machine learning algorithms to support medication reconciliation processes found that by analyzing notes and prior prescription lists within the patient chart, the algorithms were able to increase accuracy and reduce manual labor.

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May 12, 2015 Headlines 1 Comment

News 5/13/15

May 12, 2015 News 1 Comment

Top News

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Health information management vendors HealthPort and IOD will merge, creating a company with $450 million in annual revenue that offers release-of-information services, audit management, coding and abstracting, and document conversion.


Reader Comments

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From Robert Lafsky, MD: “Re: typo. You could use this. I’ll take plaque instead of plague, I think.” You would need to choose dental, dermal, or arterial, of which Door #1 is the obvious preference.

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From Spaulding Smails: “Re: news items back story. Newsletters sometimes include a ‘why this is interesting’ explanation that your readers might find useful.” I did that in the snarky, weekly HIStalk Brev+IT email newsletter that I wrote 100 or so years ago. Above is a sample from those innocent, pre-HITECH days of early 2008 just in case you weren’t one of the eight people reading it back then. I added some history, perspective, and smart-alecky editorial comments to each news item. I don’t think I’d want to do that for every item I include in HIStalk (which is far more than the three items I ran in each Brev+IT), but I’m open to suggestions if anyone wants to see that commentary added. Some headlines I noticed as I reviewed them for the first time in seven years: “Is That Your iPhone In Your Pocket Or Are You Just Glad To See Me, Doctor?,” “Looking Up Britney’s Dress Was Free, But 13 Pay Dearly For Ogling Her EMR,” “Allscripts and Misys Consummate Desperate Lust: Shareholders Hose Them Down,” and “Survey: Old People Don’t Want to Pay for Health IT or Any Damned Thing Else.” Those newsletters were a lot of fun to write even though I had the equivalent of about three full-time jobs at the time.


HIStalk Announcements and Requests

Elsevier put together this video of their sponsorship of HIStalkapalooza.

It’s the annual post-HIMSS lull where I can finally catch my breath. I’m always on the lookout for brilliant guest writers and interview subjects who work for providers rather than vendors and who want to share their expertise and opinions with the industry. Let me know if that describes you.


Webinars

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

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

Here’s the video from Tuesday’s interview with Regina Holliday, which is really mostly just audio but still a good introduction to what she does and is doing.


Acquisitions, Funding, Business, and Stock

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Practo, which offers a doctor-finding website for Asia, will double its India-based headcount to 2,000 in 2015 following a $30 million investment earlier this year. The gray-on-white website theme made me think I was losing my eyesight.

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Premier announces Q3 results: revenue up 16 percent, adjusted EPS $0.38 vs. $0.34, beating expectations for both and raising guidance for the year. The company announced in the earnings call that Catholic Health Initiatives has purchased PremierConnect Enterprise. President and CEO Susan DeVore says “acquisitions play an important role in our future” and adds that IBM’s acquisition of Premier population health management partner Phytel won’t change the existing relationship with either company. The CFO says the recent TheraDoc and Aperek acquisitions are on track to meet the $20 million in annual revenue contribution that was expected. PINC shares are up 35 percent on the year and are 24 percent higher than at the September 2013 IPO. The company’s market capitalization is $1.4 billion, with Susan DeVore holding shares worth $8 million.

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PerfectServe opens an office in Knoxville, TN to handle the 50 percent headcount growth the company has experienced in the past 10 months. The new space adheres to the open floor concept and provides sit/stand desks, collaboration rooms, and a health food micro-market. The hospital I worked for had a temporary open office concept when they were ripping up carpet and had to take down the IT area’s cube walls, which I initially hated but liked at least a little bit as I got used to having everybody inadvertently making eye contact and quickly looking away from the shame of sitting in what looked like a 1950s secretarial pool. The entertainment factor was reduced as employees had to leave the area to make personal phone calls instead of being comforted by the illusion of privacy from the thin cube walls, through which everybody could clearly overhear symptomatic details of their need to schedule a doctor’s appointment and the sometimes shocking manner in which they spoke to their family members.

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McKesson announces Q4 results: revenue up 19 percent, adjusted EPS $2.94 vs. $2.71, beating expectations for both.


Sales

UC Irvine Health (CA) chooses Strata Decision’s StrataJazz for decision support, cost accounting, contract analytics, budgeting, and management reporting.

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National Institutes of Health selects Connexient’s MediNav smartphone wayfinding product for its Bethesda, MD campus.


People

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The Hospital for Sick Children (Toronto, CA) names Sarah Muttitt, MD, MBA (Alberta Health Services) as VP/CIO.

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CTG announces the resignation of SVP Ted Reynolds, who took over the company’s healthcare business and earned the SVP title six months ago.  

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TriHealth (OH) promotes John Ward to CIO. He had held the job as interim.


Announcements and Implementations

NVoq announces GA of its Code Fast service that offers real-time conversion of spoken narratives to standards such as ICD-9, ICD-10, SNOMED, and LOINC in a partnership with SyTrue.

Lexmark launches Perceptive Checklist Capture, which automates the gathering of data and documents from PCs, mobile devices, and multi-function devices into a project or case folder.

Greencastle Associates Consulting receives its fourth Pro Patria Award from the Pennsylvania Employer Support of the Guard and Reserve for supporting reservists and National Guardsmen who are called to service. Veteran-owned Greencastle, which has veterans as 96 percent of its employees, has also earned Patriotic Employer, Above and Beyond, and Seven Seals awards. The company’s management team is Senior Partner Celwyn Evans (retired US Army Ranger), Director Joe Crandall (US Naval Academy graduate and former naval special warfare officer), and Director Will Woldenberg (former Army communications officer deployed to Iraq).


Privacy and Security

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A California woman claims she was fired for uninstalling an employer-required iPhone app that tracked her location 24 hours a day. Her lawsuit claims her boss bragged to co-workers that he was monitoring her GPS location, driving speed, and time spent everywhere she went.


Innovation and Research

A Washington Post report reviews FDA-approved, software-powered, personalized anesthesia machines that may at some point replace anesthesiologists, who lobbied hard to prevent their introduction. Anesthesiologist fees for a colonoscopy sedation run up to $2,000 while the machine costs less than $200, while faster sedation and recovery allow more procedures to be performed in the same suite.

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A small Cincinnati Children’s Hospital Medical Center (OH) study finds that analyzing free-text clinical notes and discharge medication lists using machine language and natural language processing can increase accuracy with less work than manual medication reconciliation.

ONC names six winners of its HHS Competes challenge that will receive $50,000 each to fund pilot projects that begin in August:

  • ClinicalBox (Lowell General Hospital), care coordination critical task visualization.
  • CreateIT Healthcare Solutions (MHP Salud), patient engagement and messaging by SMS, email, and voice.
  • Gecko Health Innovations (Boston Children’s Hospital), respiratory disease management with medication sensors, reminders, and symptom tracking.
  • Optima Integrated Health (UCSF), real-time blood pressure monitoring.
  • PhysIQ (Henry Ford Health System), biosensors and analytical tools to monitor CHF and COPD patients.
  • Vital Care Telehealth Services (Dominican Sisters Family Health Service), telehealth care coordination.

Technology

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A clinical review of 46 insulin dosage calculators finds that only one was free of problems such as lack of edits for missing or clearly incorrect information. Two-thirds of the apps were poorly designed to the point that they gave recommendations that violated clinical assumptions, did not use their stated formulas correctly, or didn’t update properly when users changed information. I can say from experience that hospitals know you can’t let programmers develop stuff like this without a lot of oversight, including design and testing, because they just don’t see the big picture and fail to appreciate the risk of missing a corner case. App developers don’t have that level of oversight and attempt to reduce complex medical rules into a simple algorithm just because they can.

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I went to a restaurant this week that uses the NoWait iPad-powered wait list and seating tool for restaurants that don’t want to go the OpenTable route since they don’t take reservations. The hostess took my name and phone number and said I’d get a text message when the table was ready. The message also included a link to download the app, which when connected via just my phone number, showed me my place on the wait list, and gave me the option to cancel or change the size of my party. It seems something like this could be used for healthcare purposes since the patient wouldn’t have to do anything in advance. The worst waiting rooms I’ve been in were LabCorp or Quest (even worse than EDs) and most folks there are cranky walk-ins who have fasted for hours, so I’d definitely sign up to avoid being overdosed on unemployment TV while waiting for an hour to get my 60-second blood draw.


Other

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The local paper highlights the use of Nuance’s Dragon Medical speech recognition by St. Joseph Warren Hospital (OH) in a pilot project of 70 users. Doctors say Dragon is easy to use, saves them a lot of time, and “is a great way to get our true voice heard and down on paper, so to speak” (I assume the pun was unintentional).

The HIEs of Dallas and San Antonio, TX will merge.

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A KQED Science article covers patients accessing their own data, the MUS3 dial-back of view / download / transmit requirements, the cost of obtaining copies of medical information, and the lack of provider incentive to provide it. Patient advocate Regina Holliday is featured prominently.

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A survey of clinicians who participate in the Meaningful Use program and who work for practices that have earned patient-centered medical home status finds that only half of them receive timely notification of hospital discharges, a capability they believe is “very important.” One-fourth of the respondents actually worked for hospital-owned practices, so the percentage of independent practices that receive hospital discharge alerts for their patients is pretty abysmal.

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The New York Post features Brooklyn’s Brookdale Hospital as one of the worst in the country, one of only 20 US hospitals to fail Leapfrog Group’s hospital safety analysis. It recently received $68 million in taxpayer money to allow it to remain open as a safety net hospital despite the fact that locals would be better off hopping into a taxi to ambulate the few blocks to a safer hospital. The paper says that an “unholy alliance of unions, trade associations, and government officials” make excuses for dangerous hospitals like Brookdale in claiming that care is too complex to measure (note that it’s never the good hospitals that say that). We might create a better healthcare system by focusing on inter-facility transportation (instead of turfing that function off to ridiculously overpriced taxis posing as ambulance services) and moving patients to the facility best equipped to give them a good outcome rather than sticking them with whatever hospital they were closest to at their initial time of need.

I’m wary of polls that ask people what they “would” do instead of what they “actually” do or have done recently. A HIMSS Analytics nurse survey finds that 71 percent say they wouldn’t go back to paper-based medical records. My question would have been: if your employer decided to go back to paper, what hourly salary increase would keep you from leaving your job? (with “$0” being a poll choice that would have been chosen often, no doubt). The question as submitted reflects the poll sponsor’s bias, which respondents are quick to pick up on in choosing the most virtuous-sounding answer. Consumer polls always find that Americans want digital health records, smartphone access, and all kinds of nifty-sounding features they don’t really understand, but when asked if they would change doctors or pay extra to get them, they almost always say “no,” meaning their original answer was a shallow attempt to sound nobler. It’s nearly always a mistake to judge people by what they say they’ll do instead of what they’ve actually done.

Apparently salaries are discussed more openly in India than here. An “elated official” of a state-owned technical school proudly announces that two of the college’s seniors have received “plum job offers” that are the highest-paying placement packages in the school’s history, $105K annually from Epic.

Weird News Andy calls this “#2 with a Bullet.” A New Jersey criminal frequent flyer whose bathroom urges raised the suspicion of arresting officers pulls a stolen, loaded .25 caliber pistol from “between his butt cheeks” during the resulting strip search, which WNA says “is a pretty crappy holster if you ask me.”


Sponsor Updates

  • The HCI Group is named a finalist in the Entrepreneur of the Year award in the healthcare category.
  • CareSync posts a new blog about its preparations for AARP’s Life@50+ event May 14-16 in Miami.
  • ADP AdvancedMD offers a sneak peek of its solution for any browser.
  • AirWatch will exhibit at the Gartner Digital Workplace Summit May 18-19 in Orlando.
  • Impact Advisors VP Lydon Neumann will serve on the panel of “Evidence-Based Approaches and Practical Tools for the Never Ending Implementation Journey”at the AHIMA iHealth Conference May 28-29 in Boston.
  • Cumberland Consulting Group recaps its HIMSS15 experience in an interview excerpt.
  • XG Health Solutions features an interview with Janet Tomcavage, RN, SVP of Geisinger Health Plan.
  • Aventura will exhibit at the iHT2 Health IT Summit May 19-20 in Boston.
  • Besler Consulting asks, “Is it too early to prepare for Modifier -59 Billing Changes?”
  • Capsule Tech offers “Not All Superheroes Wear Capes.”
  • Medecision offers “For Population Health Tech to Work, You Need Data.”
  • CoverMyMeds offers “Electronic Prior Authorization: Sustainable Solutions and the Road Ahead.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 12, 2015 News 1 Comment

Morning Headlines 5/12/15

May 11, 2015 Headlines No Comments

Core Functionality in Pediatric Electronic Health Records

AHRQ publishes a report calling for pediatric-specific functionality to be included in EHRs, including more advanced medication ordering tools, immunization tracking systems, and data sharing between family member records.

IBM’s Watson to guide cancer therapies at 14 centers

14 cancer institutes across the US and Canada will use IBM’s Watson computer to help oncologists create cancer treatment plans based on a  tumors genetic.

US attorney subpoenas records related to Health Connector

The federal government has subpoenaed records related to the Massachusetts health insurance exchange following a failed go-live that resulted in the site being scrapped and a new site being built. Federal investigators have not yet disclosed why the records were requested or whether an investigation is underway.

Experts Criticize World Health Organization’s ‘Slow’ Ebola Outbreak Response

An independent report criticizes the WHOs response to the Ebola outbreak, saying the organization failed to seek outside support in a timely manner and claiming that there is “strong, if not complete, consensus that WHO does not have a robust emergency operations capacity or culture.”

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May 11, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 5/11/15

May 11, 2015 Dr. Jayne 7 Comments

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Jayne Becomes “Available to the Workforce”

Unfortunately, George Clooney didn’t arrive on my doorstep to give me a pink slip as his character did so many times in “Up in the Air.” Instead, resigning from my hospital position was fairly anticlimactic.

If you missed my previous post, here’s the short version. My hospital is migrating to a single platform EHR and I’ve been on the fence about taking a role on the new project vs. doing something else. I made my decision quite some time ago, but have been procrastinating actually writing about it. Readers have been asking whether I am opting for “fight or flight,” so I’m finally ready to let the cat out of the bag.

I ultimately decided not to apply for a position in the new organization, primarily because of the way the transition was being handled. Not only for leadership, but for my staff. There were so many consultants in the mix that it wasn’t clear who was making the decisions or what the eventual structure would be. I couldn’t even tell who I might report to or who my boss would be in six months.

Although it would have been tempting to jump into the fray and find something to make my own, I didn’t feel it was tenable. Apparently I wasn’t the only one thinking the same way – several of our best managers opted not to make the jump either.

I could have stayed in my old role and helped turn the lights off on the old systems. I realized quickly, though, that my team was being gutted, not only by movement of key resources to the new project, but also by the departures of those who felt sticking around would be risky. There were no guarantees of employment in 18 months after the legacy systems shut down, so people grabbed opportunities as they came by. The prospect of trying to continue to roll out new physicians and support our existing users with an inexperienced staff didn’t excite me.

Although I’ve resigned from jobs before, this was my first time resigning from one at this level. Once my decision was made, the next concern was what would happen once I handed over my letter. Would they walk me out or would I work out my notice period? I really wasn’t sure which way they would go and I wasn’t about to poll my colleagues. I’ve seen it happen both ways. On one hand, I didn’t see them with a reason to walk me out – I’ve been a loyal employee and a highly visible leader. On the other hand, I had access to all kinds of sensitive information, including upcoming physician acquisitions, strategic planning, and financial data.

I couldn’t imagine having someone else pack up my things if they did show me the door. Even in our increasingly digital world, there’s a certain amount of “stuff” that accumulates over 10 years. While I was debating my decision, I did a fair amount of multitasking as I sorted files during conference calls and took home a laptop bag full of personal belongings here and there. I couldn’t take much off the shelves, though, since I didn’t want it to be obvious what might be going on.

The weekend before I was ready to hand over the letter, I came in on Saturday and took all my personal belongings except the medical textbooks and the diplomas hanging on the wall. I figured HR could box those up and ship them, or if I had the dubious honor of doing the “pack your things while we watch” routine, there would be no question of what was mine vs. company property. It was probably an overkill approach, but you never know how it’s going to turn out when you’re dealing with a corporation.

It’s not like I was leaving to go work for a competitor. I may have been the first executive who actually resigned to “pursue other opportunities” for real rather than as a euphemism for being terminated. Still, I was pretty nervous when I headed to meet my boss for our weekly one-on-one meeting with my letter tucked in a manila envelope.

I knew he wouldn’t be surprised, but actually delivering it was another thing. He opened our meeting with his usual, “What’s on your list for today?” as expected, so I prepared to hand it over. Unfortunately, I was more nervous than I thought and my attempt to gracefully slide the letter across the table ended up being more flippant than intended. An image of an air hockey game popped into my head and I have no idea what my facial expression was, so he may have thought I’d finally gone off the deep end.

He was actually pretty cool about the whole thing since we had been talking about my need to make a decision for some time and he was aware I had decided not to move to the new system team. I sensed a little disappointment as he said he hoped I’d stay to “hold things together” but understood the decision.

The only real suspense was waiting for the answer after asking him what happens next. Apparently the topic of executive departures had been covered as part of project planning for the new system and I was on the “OK to stay” list. I have to say I was a little disappointed on some level at not being shown the door since having an extra month of paid vacation would have been nice.

I had timed my notice so that I would depart with the other team members, thinking that would minimize the disruption since there would already be activities in place to reassign work, reorganize teams, and create new reporting structures. It turned out to be a good decision since I had a natural support structure of people to talk to as we went through the process. Even when leaving is voluntary, it’s still difficult, and even more so when you don’t necessarily have something you’re headed to.

While they would be flying off to training after their last week on the team, I was headed towards a bit of a sabbatical while I burned through a decade of accumulated vacation and comp time. The last day was a bit teary all around, but overall the final month went better than expected.

I’m not going to say how long I’ve been away from the hospital – Dr. Jayne’s timeline is fairly fluid and sometimes I don’t publish what I write until weeks or months after it happens to preserve anonymity and make sure it doesn’t come back at me. I know readers will ask what I’ve been up to. I didn’t want to relocate for another CMIO position, so it’s been an interesting combination of clinical work (both local and locum tenens) with a sprinkling of healthcare consulting. I’ve worked with nearly a dozen different EHRs, which gives me a perspective that I didn’t have before. I’ve been able to travel to cities I’d not normally visit and have had access to a stunning variety of office and health system dysfunction. Locum tenens work is not for the faint of heart – often the positions are opened to locums because they’re virtually non-fillable by traditional candidates.

My plan was to lay low for at least six months while I figured out what to do with the rest of my life, but already some opportunities are on the horizon. One came knocking after I updated my LinkedIn profile – from an organization that had been interested in me for some time but thought I would never leave Big Health System. Another is an organization that is looking to hire their first physician IT expert.

I’m not going to jump into anything just yet, but it’s nice to feel wanted. In the mean time, I’ll be adding stamps to my National Park Passport, collecting multiple state medical licenses, and seeing whether the grass is any greener on the EHRs used by other Eligible Providers. Please remember to be kind to drivers with out-of-state plates because one of them just might be me.

Have a National Park recommendation? Email me.

Email Dr. Jayne.

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May 11, 2015 Dr. Jayne 7 Comments

HIStalk Interviews Jordan Kalal, Software Engineer, Cerner

May 11, 2015 Interviews No Comments

Jordan Kalal is a software engineer with Cerner and volunteer mentor with Tech sHeroes, a program of the Kansas City Women in Technology that encourages middle school girls to explore careers in technology.

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Tell me about yourself and your job.

I came to Cerner two years ago after studying computer engineering. I work as a software engineer on a research and development team. I joined up with Tech sHeroes about a year ago and have been working with them ever since to develop a curriculum for their middle school program.

 

Why are women underrepresented in technical fields?

That’s a question that has a lot of answers. It is in part because of impostor syndrome, which is not a self-fulfilling prophecy, but it’s the condition of being underrepresented. That keeps people out. You become the representation for your gender. That’s a big role to take on and people don’t want to do it. 

A lot of it is social conditioning, which we were overcoming up until the 1980s. That’s why every other STEM field has fared a lot better than us in the technical field. As toys and movies started getting into tech and computers more, they were geared towards boys and they were geared towards a bad image. You have two factors working against you. Your male peers have been exposed more to it all throughout childhood and adolescence. Then the way it’s represented in movies and comic books and all of that — very nerdy, very loser-ish. 

It’s a lot to overcome to go into a field that you may have never been exposed to. It’s not like it’s represented in schools really at all. You know what it is to be a physics major or a math major or go into art because you’ve done all those things. Sometimes you haven’t ever written a line of code by the time you get to college, and then they say, what do you want to be?

 

Is that changing?

We are starting to see the very first bits of change, but it is highly, highly ingrained. I like to pick “Big Bang Theory” as an example because everybody knows that one. Nerd culture and computers are getting bigger exposure, but it’s still very bad. “Big Bang Theory” is just an excuse to be able to laugh at that nerd-dom and the loser vibe and all the stuff they’re interested in. It’s good that at least it’s becoming mainstream, but it’s bad that it’s still in such a negative light. 

Again, women aren’t represented there. It’s a pattern that goes across all media, whether it’s movies or shows or books like that. It’s pretty prevalent, at least in the US.

 

In the 1960s, not many women worked outside the home, but the economy’s lack of personal income growth made two-earner households common and gave women new opportunities. Looking back on that longer perspective, how do you see the trajectory in the big picture going from there to now?

That’s actually a very interesting trend to look up. There’s a wonderful graph that marks four STEM careers — I believe physics, chemistry, IT, and maybe mathematics. It shows, starting in the 1960s, the percentage of women in those fields. It starts out really low — you know, down to zero. It shows them trending up, trending up, trending up. Then while the other three careers continue trending up to the point we’re at now — we’re right about 40 to 50 percent for most of those STEM careers – computer science actually dips right at 1987, I believe, when personal computers were introduced. They were marketed and put in little boys’ rooms. It was the first time you have that disparity in exposure. 

These boys were then choosing that field, knowing something about computers. It deterred their female counterparts because they just looked at it like they were already a step behind. "I’ve never used this, I’ve never programmed before, and oh, my gosh, look at them, they have. I’m always going to be behind and I’m not ever going to be able to catch up with them."

That’s why we trended down to the point we’re at now, where from 1991 we were at 37 percent of women in computer-related fields and now we’re down to, I believe, 26 percent. If you go even farther, it’s only 12 percent of women in software engineering kind of roles. On the trend down, that’s a nine percent drop just in my lifetime. That’s a massive drop that really can’t be ignored.

 

Do you see that same gender disparity in countries like India, which was well positioned educationally and vocationally to embrace work in new technologies as an economic imperative?

I don’t have the stats outside of the US. It’s on my to-do list to investigate all those. I imagine the numbers are different just because of our cultural ecosystems that we grew up in, whether it’s how hard we push good-paying jobs and how hard we push going into a high intellectual field. Of course, our exposure to all our social media and stuff like that. I’m sure the numbers are definite and quite fascinating. I just haven’t looked into them yet.

 

What response do you get from mentoring and what results have you seen?

The response has been overwhelmingly positive and our support has just been off the charts. Schools are happy to take us in and give us the time to do this. A lot of them are backing us with their teachers, rolling it into their extracurriculars, categorizing it in the same way as like football or basketball so that teachers can come sponsor us. Even within Cerner, when I put out the call on our internal boards for mentors, it was 20 people emailing me all within 24 hours. “I want to help any way I can. If I can’t mentor, I’ll help you write the code" and stuff like that.

It’s been positive because everyone can see the inevitable fallout of not only a lack of women in engineering, but just a lack of engineers in general. I like to say I focus on a really bad problem, but there’s a bad problem looming for all of us. There’s not going to be enough engineers to even maintain the code that we have written today. It’s sad to think that we’re going to come to this weird standstill as there’s no further development because we used all of the developers to maintain.

 

What level of diversity are you seeing among your colleagues?

I don’t have the numbers on that. We obviously have quite a diverse campus here. Just because we have a fabulous reputation in the engineering world, a massive portion of our engineers are self-referrals. Someone’s here and they say, “You know, this is a great company. You should come work for Cerner.”

Specifically, getting back to women engineering, around this controversy, a lot of people are starting to look at recruiting women in the US who have dropped out of the market. I’m not sure if you’re aware of this stat, but 45 percent of women in tech fall off of the tech wagon, essentially by the age of 35. You’re talking about half your female workforce in this industry leaving for another job in a different career path. A lot of people, when they talk about the reason for the shortage or trying to vie for that, they say, why don’t we start hitting that demographic? And saying, these women aren’t staying home to become mothers — they’re leaving for a different career because they’ve been pushed out by the culture or stuff like that. We say, if we can just get them back, then it would be a massive boost in numbers without all that trouble.

 

Is there the equivalent of refresher training to re-integrate women back into the technical workforce whose experience is a few years old?

We like to say in the programming world that it doesn’t matter which language you know. As long as you know how to code, you can code forever. Anything like that would almost be standard training, getting you up to date on which languages the company uses and what tools they use. That’s different for every company. If you were trying to re-integrate someone who has been in a different field for a while, it would just be as easy as putting them through their normal training. You’re just telling them, here are the languages, here are some online courses if you aren’t familiar with it, and here are the tools we use. That’s all standard.

 

Cerner gets a lot of press for supporting diversity and is admirably active in social causes, yet when I look at its corporate leadership team, it’s almost all white men. There are three women and no minorities out of 15 on the corporate leadership team and four women out of 16 in the executive leadership group. Do women face business barriers as well as technical barriers?

The lack of women in leadership is, of course, something that’s highly studied. Yes, it’s there across all industries. Healthcare is actually the number one industry to go upwards and try to achieve those goals, so I’m in the right place if I want to go up.

But yes, that’s a whole other set of interesting statistics and reasoning. It’s almost two different barriers — the barrier to technology and the barrier going up. It is prevalent across all industries. That’s another one where it is changing, and that one is changing rapidly due to women’s success in startups. They actually have much better statistics than men, and certain investors are starting to key into that. As the startups become not startups, it will shift. As we get this next generation of empowered women coming in, I think we’ll see a shift very rapidly in the upper ranks.

 

Companies like IBM always promoted engineers, while others rewarded experience in sales or management. That may be a barrier that isn’t gender-based, but rather that technologists might not have taken the right roles to lead a particular company. How do you see that unfolding in healthcare?

I think it’s becoming more and more appreciated to have a technical background. It’s hard to find that mesh of a people person and engineer. But more and more companies are starting to see that it’s easier to teach an engineer how to do business and be business savvy and interact with other people than it is to take a business person and try to teach them how to write code and how to make those decisions. You need someone with that technical background to make those instant choices and to make those strategic choices. You have to have someone who understands all facets of it.

That’s not to say that the business people don’t have a whole new skill set that I don’t. But it’s easier to teach them the business savvy than to teach the tech to someone else. Again, it’s a shift in the way companies are thinking and the paradigm they’re following to try to get the most. You have to be a little more agile now than you’ve ever had to have been to be on the path to be competitive.

 

What actions would you recommend for someone who is interested in getting more females and minorities into healthcare IT?

If you have a passion, it is not difficult to find others who have that same passion. My only recommendation is to choose one point and try to fix it. We talk about the pipeline of engineers – I’ll  use that as my example since I’m familiar with it. We talk about the fallout very young with gender stereotypes and then with toys. By fourth grade, half of females aren’t interested in STEM any more. Then you talk about the high schoolers trying to choose a career and they don’t go into this. Then of course, even past that, going into career, you have the fallout of women engineers from tech.

My suggestion is to try to just fix one piece. Choose one thing and do it very well. Focus on an age group and try to key into them and provide a quality experience that’s fun and that keeps them engaged. I always say that by the time people get out of Tech sHeroes, I’d love it if they can write a website and write their own code, but more importantly, I want them excited about tech. I have taken that one group and I’ve got them excited about tech. They totally know what engineering is. They totally know what computer science is. They know what code can do now. 

I’ve impacted that one group instead of trying to run five after-school programs at a bunch of different levels and having them be watered down. Choose something, be passionate about it, and greatly impact a certain group.

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May 11, 2015 Interviews No Comments

Morning Headlines 5/11/15

May 10, 2015 Headlines 2 Comments

The revolution will be digitized

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

Cerner (CERN) Q1 2015 Results – Earnings Call Transcript

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

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

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

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May 10, 2015 Headlines 2 Comments

Monday Morning Update 5/11/15

May 10, 2015 News 4 Comments

Top News

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

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

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

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


Reader Comments

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

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

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


HIStalk Announcements and Requests

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

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

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


Last Week’s Most Interesting News

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

Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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From the Allscripts earnings call:

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

People

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


Announcements and Implementations

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


Innovation and Research

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


Technology

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

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


Other

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

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

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


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 10, 2015 News 4 Comments

Morning Headlines 5/8/15

May 7, 2015 Headlines No Comments

Cerner Reports First Quarter 2015 Results

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

Allscripts Announces First Quarter 2015 Results

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

Are bungled VA claims systemic? Senators want agency review

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

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

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

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May 7, 2015 Headlines No Comments

News 5/8/15

May 7, 2015 News 8 Comments

Top News

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


Reader Comments

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

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

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


HIStalk Announcements and Requests

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

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

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

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


DonorsChoose Project Update

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

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

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


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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

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

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

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

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DrFirst raises $3.5 million in new financing.

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

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

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

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

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


Sales

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


People

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

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


Announcements and Implementations

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

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


Government and Politics

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


Privacy and Security

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

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


Innovation and Research

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

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


Other

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

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

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


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

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

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

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

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

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

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

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

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


Sponsor Updates

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

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

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May 7, 2015 News 8 Comments

EPtalk by Dr. Jayne 5/7/15

May 7, 2015 Dr. Jayne 2 Comments

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I’ve received quite a bit of reader mail this week, mostly in response to two recent pieces. One discussed people who wear the same thing to work every day. One software engineer talked about a very relaxed work environment where he wears a uniform of jeans and a collared shirt. In summer, they’re allowed to wear shorts and sandals. Although he’d prefer a t-shirt, he agrees the collared shirt is “more appropriate.”

The sandals issue is always a tricky one. I’ve been in offices where this has been allowed and have seen everything from a nicely manicured foot in a dressy sandal to platform flip flops that could cause a serious workplace injury. If you’re going to allow sandals, it’s hard to legislate what kind. Are Keen water shoes OK? What about Birkenstocks? Tevas? Flip flops? How much of the foot has to be covered? What about sandals and black dress socks like my grandfather used to wear? It’s a slippery slope for sure.

I’ve also received a significant number of emails on my recent trip to the hospital with a friend. Mr. H suggested I have my friend request a copy of her medical record to see what it costs, how long it takes to be delivered, and what it contains. It might be an interesting exercise, but I can tell you that two months later she still hasn’t received a bill from the hospital where she was initially treated. You’d think that with many of their patients being vacation-related injuries they’d be more vigilant about timely billing than say a small community hospital. I’ve also asked to take a tour of her Explanation of Benefits statements and any bills she gets since I always find them interesting. She did show me a recent statement from her PCP which actually detailed charges that were more than two years old and had been settled months ago. The current statement was for a $25 vaccine coinsurance, yet they had printed out every service and payment since 2013. The bill wasn’t even in date order. As a professional, I could barely figure it out.

Some of the reader comments have patient stories that are truly heart (or gut) wrenching:

A reader passes out after standing quickly at a restaurant. She is taken to a hospital while she is out, and when she realizes what is going on, starts to worry about the ramifications of her high-deductible health plan. Her workup is unremarkable. Two hours later, she is presented with a patient balance and asked how she’d like to pay it. She requests an itemized bill and copies of her records, which the hospital can’t produce unless she returns another day to request them or has a physician request them on her behalf. My favorite quote from her account: “I smile again, and I realize that I am fake-smiling so she won’t think I’m ‘that girl’… The thought that I would fake-smile at any other person in the world that just handed me a bill for $1,000 without telling me what it was for and ask me for my credit card is absurd.” My own observation is this: If a restaurant can provide an itemized point of sale bill for a party of 20, why can’t the ED give an itemization for a single patient?

An out-of-town patient visits a community hospital emergency department after his health plan triage nurse suspects kidney stones. This is confirmed via bedside ultrasound, which also finds kidney cysts. He is told to follow up with a urologist when he returns home, but forgets to ask for a copy of the ultrasound. Before flying home, he leaves a letter with a family member to take to the hospital to request the records. Radiology agrees to make a copy, but when the relative returns to pick it, up she leaves empty handed, being told that radiology doesn’t manage ED ultrasounds. Medical records doesn’t have it, either. The ED administrator doesn’t know how to get it and has to ask others, which delays the process for a day or two. The return call states that the request has to be notarized (which had not been required by radiology) but no one really knows how to copy the ultrasound or print pictures. A reply is promised, but never comes. The kicker: the hospital advertises point of care ultrasound as the first bullet point on its ED website.

A patient goes for a complex procedure that requires two different surgeons. Neither specialty uses the hospital EHR for outpatient notes. The post-op nurse provides discharge directions that conflict what the surgeons told the patient regarding home medications, requiring clarification with the physicians. The medication list includes every medication the patient has taken in the last three years and has not been reconciled despite the patient handing an updated medication list to both surgeons and multiple pre-op personnel. Discharge instructions were cut and pasted, not only from two different sets of physician instructions, but also from a previous procedure during a different hospital stay. They also contradicted each other. “At the end of the day – I was saved because I am an experienced and knowledgeable healthcare consumer. However, it takes a lot of energy, stress, and worry.”

I appreciate the reader comment that says I’m probably one of the 0.01 percent of physicians that have the interest and patience to write up the experience. He or she goes on to say, “For any hospital executive, she’s just provided a service that a consultant would charge $50K for (if you catch them on a cheap day) – lay out in plain view the issues that make modern medicine intolerable for the average consumer. And things were not that different in the pre-EHR era.” That’s more truth to that than most of us care to admit. A good percentage of EHR implementations don’t address underlying workflow issues or organizational culture. They just threw tools at it.

One reader summed it up: “We have a long way to go.” I agree completely. Some of these things are not rocket science – they’re basic processes that could be handled through checklists and protocols. However, maybe we should go to the rocket science approach. After all, if we can put a man on the moon, we should be able to figure this out.

Email Dr. Jayne.

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May 7, 2015 Dr. Jayne 2 Comments

Morning Headlines 5/7/15

May 7, 2015 Headlines No Comments

Dr. Karen DeSalvo to leave ONC if confirmed for new HHS post

Karen DeSalvo has been nominated for the permanent position of assistant secretary for health, a role she has held as interim along with her National Coordinator position since October 2014.

Dramatic results for Banner Health’s telehealth pilot

Banner Health announces that it has reduced its hospitalizations by 45 percent, and its cost of care by 27 percent through its new telehealth pilot with Intensive Ambulatory Care pilot program.

Lack of Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke

A study published in the Journal of the American College of Cardiology designed to measure any correlation between improved ischemic stroke outcomes and the use of EHRs finds no such correlation.

FDA launches UDI database website

Three years after Congress called for medical devices to be tracked with unique identifiers, the FDA has launched a website where consumers can look up information on devices sold in the US by its unique ID.

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May 7, 2015 Headlines No Comments

Readers Write: Is Health IT Guilty of Being a Worm in Horseradish?

Is Health IT Guilty of Being a Worm in Horseradish?
By Nick van Terheyden, MD

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A survey conducted at HIMSS15 found that patient satisfaction and patient engagement rank among the top priorities for CIOs. In fact, they rank above improving care coordination, streamlining operational efficiencies, and achieving Meaningful Use.

The tides are clearly changing. We’ve all been talking about what the shift to a value-based care model means for healthcare organizations. What we haven’t been talking about is how this shift is transforming our patients into “prosumers.”

There’s a saying, “To a worm in horseradish, the world is horseradish,” meaning we are predominantly aware of that which we are surrounded by on a daily basis. Health IT, in all its intricacies and expansiveness, has become hyper focused on making sense of its nebulous infrastructures, working hard to prepare healthcare organizations for next new wave of regulations. Our world, while not horseradish, is composed of goals and milestones that are 100 percent contingent upon these systems.

But, as yet one more unintended consequence of this pursuit, we have become myopic. The business of healthcare is no longer simply confined to a hospital or an IDN site map.

Patients are reaching for their phones, not to call their doctors, but to research their symptoms. They’re educated buyers, looking up reviews before seeing a new specialist, just as they would before buying the latest gadget on Amazon. And, as we enter the era of the Internet of Everything (IoE), they want their wearable devices to meaningfully connect as simply as when they use their phones to play songs from the playlist on their laptop.

It becomes a challenge of sustaining the momentum of the moment. As the wearable trend continues to grow, it is not merely enough to count steps or measure the amount of UV rays absorbed. That won’t keep patients engaged. We need statistics and personal health trends that can be used to foster a richer, ongoing dialogue between patients and their physicians.

Consider the positive health implications for patient who receives a treatment plan from her doctor, which is entered into the EMR during the visit and connected to a three-question daily check-in for three months via a mobile device. The patient could provide a thumbs-up, thumbs-down, or neutral rating (think Pandora playlist) on how the treatment is working, with perhaps an option to enter free text should she choose to expound upon her responses. These daily reports could be aggregated into trends and reviewed by a clinician to make adjustments to the treatment plan as needed, extending patient care beyond confines of the four walls and the 12 minutes of an office visit.

Connectivity and personalization is the zeitgeist. CIOs know this. We are all unique snowflakes, and as more and more people submit their genes for analysis and mapping, we’re proving the increased drive for individuality. While the industry is pushing for population health (a laudable vision indeed), patients are looking not to be considered in aggregate, but to be treated with the same personalized attention they experience when they go to a favorite restaurant where the wait staff recalls their usual order or when they go to a website that remembers all their previous preferences. It’s about not starting from square one every time.

Patients aren’t going to tolerate the disconnect in healthcare forever. And as digital natives, some generations won’t tolerate it at all. The day is coming where a patient will ask her doctor, “Did you notice that that my headaches seemed to lessen on those days I go to the gym? I’m wondering if there’s a connection?” If her physician isn’t paying attention to her, she will find a physician, or perhaps even an intelligent medical assistant, who will.

Nick van Terheyden, MD is CMIO at Nuance Communications.

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May 6, 2015 Readers Write No Comments

Readers Write: Big Data, Small Data, Meta Data, See Ya Latah

Big Data, Small Data, Meta Data, See Ya Latah
By Jim Fitzgerald

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It’s the RESTful, object store, file and block make me snore, it’s still bits and bytes to me……(sorry, Billy)

I just got back from HIMSS. Big data, like savoir faire, is everywhere. The cynical side of me says that technology vendors just want to sell more disk or flash drives. The analytical technical businessperson somewhere inside me says that the real play for the people trying to sell you and me on big data is in the tool suites for managing, monitoring, sorting, searching, and processing big data. We will be lured in with open source tools like Hadoop, and then when the hook is deep enough, the vendor community will point out to us why we need their quasi-proprietary toolkit to enhance the “limited feature set” and “programmer required” aspects of Hadoop.

Don’t read me wrong. I think I am a fan of this. Why the qualification? Big data, taken to its logical extreme and paired with some artificial intelligence, can help my doctor process all the environmental, social, and lifestyle data related to me and correlate it with the highly structured “small data” in my electronic health record to zero in on, and advise on, the real underlying issues behind my health that go well beyond the “sick care symptom” I am presenting that day.

The vague and slowly clarifying healthcare zeitgeist around population health and “well care” probably won’t be realized without employing big data management techniques as an everyday tool. This apparent service to humankind will be aided and abetted by small and large chunks of data streaming up to the cloud from the “personal Internet of things” that I already own and the things I am considering, like Apple Watch.

The cautionary note comes from my informed-paranoid fear of Big Brother. I have Orwellian visions of the healthcare police showing up at my house and herding me into the quarantine van for a stint of “voluntary rehab” after some warehouse full of seemingly disconnected Facebook posts, Yelp reviews, sensor numbers, and Whole Foods Market receipts mistakenly puts me on a high-risk list for the next pandemic. I won’t even go off into the potential side rant on all my voluntary and involuntary surrenders of my privacy rights along the way, although I do think the court system should brace itself for the onslaught.

Let’s hope my paranoia amounts to nothing more than the receptionist not being a bit surprised that I showed up in the doctor’s office that day because the data-lake-fed-AI predicted I would and had already authorized my insurance and sucked all the available fresh data on me into a useful visualization for my clinicians.

What’s the difference between big data and small data? The short version is that big data is generally considered to be an unstructured collection of data objects. Unstructured in this usage implies that there is no classic structured database format imposed on the data. The unstructured data could be a song captured as MP3 or AAC, a simple list of my last 20 temperatures stored in my Apple Watch, or a photo just taken in the ED of the festering wound on my right leg.

Big data is generally big because it is a vast collection of objects. Sometimes big data is big because the individual objects are prodigious on their own, and are also known as BLOBs or binary large objects – for example, your favorite “Breaking Bad” episodes that are still sitting on your iPad. It could really be anything, including a file that has a structure and order of its own, but is being considered as part of a greater set of data molecules in a “data lake.”

Storing data as objects, most commonly done on the Internet with RESTful storage protocols, is an increasingly normal trick in the world of data storage and management. When we store data as objects, we don’t care all that much about structure, or about the nature of the data, or about its accessibility by a particular file system or operating system. That problem is shifted from its traditional place in the OS or the storage array and is moved to the app. (notice I did not say “application.”)

To the extent that we care about the objects in an object store (an allegedly safe place to put objects) we may tag them as they go in with meta data, which everyone who has followed the Edward Snowden story knows is “data about the data.” In fact, the object might get multiple tags. One might be a lookup address or unique ID in the object store and one or more others might be some common descriptor of what is in the object itself. Hence the chaos of unstructured data may in fact, have some external structure imposed on it by some rules-based system ingesting the data objects.

In truth, small data is still where the rubber meets the road in today’s healthcare information systems. The organization or structure of that data by the HCIS in a pre-defined database provides the accuracy and confidence clinicians need to treat me and administrators need to bill me. It generates the endless arguments and the grossly inefficient cottage industry that has sprung up around HIEs. (do we really need to argue on what the “first name” field means?)

Big data can provide inferential context for small data, but it cannot supplant the precise articulation or definitive metrics collected and presented, in context, to help treat me. Small data is so important that we protect it not only in context of its integral structure in a database, but also in some cases at the file system, operating system, and storage subsystem levels. In many cases via RAID technology, backups, and replicas we have so many copies of the same small data that it is really not very small at all; but hey, in the days of petabyte and zettabyte data lakes, a few terabytes looks more like a data puddle.

There is, however, an economic force in play here. Depending on whose numbers you believe, big data on object stores is four to 20 times cheaper to manage than an equivalent amount of small data being managed by a production application in a Tier 1 SAN. The “apps” which are slowly arriving in healthcare (and may continue to arrive) may be happy just to slam a bunch of tags on an object and call it a day. Then we will have “tag oceans” and “tag bagging” toolsets with cute animal logos, and the circle of data will continue to self-perpetuate.

Jim Fitzgerald is technology strategist and EVP at Park Place International.

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May 6, 2015 Readers Write 2 Comments

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

May 6, 2015 Interviews No Comments

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

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Tell me about yourself and what you do.

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

 

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

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

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

 

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

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

 

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

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

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

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

 

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

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

 

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

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

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

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

 

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

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

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

Do you have any concluding thoughts?

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

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May 6, 2015 Interviews No Comments

Morning Headlines 5/6/15

May 5, 2015 Headlines No Comments

Cognizant Earnings Top, Fueled By TriZetto Buy

Cognizant reports Q1 results: revenue up 20 percent to $2.9 billion, EPS $0.62 vs. $0.57, beating analyst estimates on both. The company’s stock price climbed 10.8 percent, to a record high $65.55, following the results.

Imprivata Achieves Revenue Growth of 32% for the First Quarter of 2015 and Raises Annual Guidance

Imprivata reports Q1 results: revenue up 32 percent to $25 million but still resulted in an overall net loss of $6.7 million, EPS –$0.28 vs. –$2.29, beating expectations for both.

Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

In a New Yorker piece, Atul Gawande, MD discusses the tendency to overtreat patients in the US, citing a study suggesting that, every year, at least 25 percent of Medicare patients receive high-cost tests that are well known to be wasteful.

Apple Has Plans for Your DNA

Apple will begin offering DNA testing to some iPhone owners to support current and future ResearchKit initiatives. UCSF and Mount Sinai Hospital are planning ResearchKit-based studies that involve DNA testing.

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May 5, 2015 Headlines No Comments

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