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Morning Headlines 7/19/16

July 18, 2016 Headlines No Comments

AMIA Sees Value, Complexity in Using EHRs for Clinical Investigations

The American Medical Informatics Association applauds the FDA’s interest in mining EHR data to advance clinical investigations, but warns “we strongly caution the FDA from assuming EHRs are readily configurable for clinical investigations, even among more advanced institutions.”

How ‘digitizing you and me’ could revolutionize medicine. At least in theory

In an interview with STAT, Eric Topol, MD discusses the administration’s Precision Medicine Initiative and the role he will play leading a $120 million project at Scripps Research Institute focused on recruiting, collecting, and analyzing health data from 350,000 volunteers.

An Insurer’s Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs

A Health Affairs study finds that a CVS Health-run care transition team offering medication reconciliation support to discharged patients reduced relative risk of readmission within 30 days of discharge by 50 percent, saving two dollars for every one dollar spent on the program.

Providence notifies 5,400 Oregon patients of records breach

Providence Health & Services (OR) notifies 5,400 patients that a former employee inappropriately accessed their medical records between 2012 and 2016. The employee has been fired, and the health system is reiterating that the employee used or shared the information.

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July 18, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 7/18/16

July 18, 2016 Dr. Jayne 6 Comments

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I recently spent a week off the grid. I have to say that it was one of the best things I’ve done with my time this year. Six nights in a tent will definitely give one a new perspective on things, especially when you’re used to being connected 24×7.

Most of my work lately involves being barraged with a continuous stream of issues that my clients feel are critical, but that often turn out to be blips in the grand scheme of things. I spend a lot of time talking people out of high-stress situations and putting together plans to mitigate potential disasters. That kind of work takes its toll on you after a while, so I was looking forward to my trip.

During my week away, the biggest plans I had to put together revolved around keeping the area clean of bear-preferred smellables and helping newbie campers get through the week. While some of my colleagues elected to do some hard-core rock climbing, trail building, and even a trip to the summit of a neighboring peak, I spent a good chunk of time watching clouds reshape as they came around the mountain and listening to the aspens quaking in the breeze.

I hiked to a couple of overlooks and just sat, doing nothing, until I was done. There was no time-boxed agenda, no deliverables, and no follow-up meeting planned. I enjoyed responding to the question of, “What did you do today?” with, “Hiked over there, then sat, then came back.”

While sitting quiet and still, I had some wild turkeys come within feet of me, pronounce me uninteresting, and go on their way. That’s definitely something to think about for those of us in high-pressure jobs who are used to being in the thick of things. Guess what? The rest of the animal universe doesn’t care who we are, what we do, or how many deals we’re closed this quarter. Nor do they care about the number of email messages accumulating back home or the number of meetings we’re missing. And maybe for our own human sanity, it would be better if we stopped caring so much too.

For the first couple of days, we had a couple of people obsessively checking their phones and trying to get a signal, hiking here and there to see if they could pick something up. None of them were trying to catch up on anything truly critical like a sick family member. They generally just couldn’t disconnect from work enough to enjoy where they were and who they were with.

I’m fortunate to have coverage I can trust when I’m out, but it takes a lot of work to get ready to leave and there’s always a mountain of work waiting when I get back. Not everyone has that level of trust with their coverage, but still, most of us would be better off if we could get back to being able to put it aside at least for a short period while we are away.

Many of the clients I work with offer to call in to meetings when they are on vacation. They’re so afraid of missing something at work that they miss the point of getting away. I’ve been known to resend invites and drop those people off so that they don’t have an excuse to put their vacation on hold. There are rarely meetings that are truly critical enough to abandon your R&R. But it’s hard to make those determinations when you don’t have perspective on what happens outside your circle of work.

Over the past year, I’ve watched my friends be laid off, reorganized, repositioned, reclassified, and generally run through the corporate wringer. I don’t think any of them wishes they’d been more loyal to their employers or that they’d have attended more meetings while they were supposed to be on vacation. Most of them wish they had worked less and had better balance, because even their best efforts didn’t make a difference in how things ended up.

It’s increasingly rare for people to spend their entire careers with a single employer, or even with two or three. As corporations churn and our industry evolves, people are constantly forced to reassess where they stand and whether they still want to be doing what they’re doing in a year, or three years, or even in a month. Being away from civilization definitely helps with that introspection, especially if you’re willing to give yourself over to the moment and watch what is happening around you.

The place where we camped had been involved in a forest fire in 2013. Since the fire hopscotched across the property, it spared certain features while destroying others. Sitting under untouched pines and looking at devastation 20 yards away reminds you that life is truly unpredictable and that if we think we have everything under control, we’re kidding ourselves. Out of the ashes of the fire, new plants are coming that haven’t been seen in years due to the overgrowth of certain species that the fire took out. It’s gratifying to see the new growth and wonder what things will look like in a decade, or two, or three.

I can’t say that my entire week was stress free. This was my first time having to deal with bear precautions, and although I was confident in my preparations, I wasn’t sure the people camping in the tents next to me were as diligent with their own. I was also keeping an eye out for altitude sickness and trying not to get sunburned while also having fun. There was a brief interlude involving a camp-style cooking contest, but if that was the most major stressor I faced, I’m good with that. And as an aside, mixed berry cobbler cooked in cast iron over charcoal doesn’t need high-altitude modifications (although the sheer amount of butter used might just have made any baking problems irrelevant).

Although it’s good to be sleeping in an actual bed again, I miss having deer surprise me on the way to get water every morning. I also miss having hummingbirds buzz me while I contemplate the mysteries of the universe. It was a great trip. We didn’t have any wildlife problems and I might have even returned home with a cooking prize.

What’s your strategy for getting off the grid? Email me.

Email Dr. Jayne.

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July 18, 2016 Dr. Jayne 6 Comments

Readers Write: ACO, Heal Thyself

July 18, 2016 Readers Write 3 Comments

ACO, Heal Thyself
By Stuart Hochron, MD, JD

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I was recently asked to comment on the success (or lack thereof) of Accountable Care Organizations (ACO) and why I thought ACOs haven’t lived up to expectations and what additional incentives will be required for them to be successful – if, indeed, they ever will be.

The questions gave me pause. Certainly ACO performance to date has left much room for improvement. According to an analysis published by the Healthcare Financial Management Association, just over a quarter of ACOs were able to generate savings in an amount sufficient to make them eligible to receive a share of those savings.

But the implication that ACOs are biding their time until new incentives or perhaps a new business model emerges is alarming. This is not a situation where good things will necessarily come to those who wait.

I work with a number of ACOs, hospitals, and physician organizations. While I am not at liberty to share their financial performance data, I’ve distilled what I believe to be the best practices employed by those that will be successful.

It takes a platform

Fundamentally, ACOs require wide-scale patient-centric collaboration – that’s what underpins the hopes of achieving more-efficient, more-effective, less-wasteful, non-redundant care. But collaboration doesn’t just happen automatically, even when everyone on the team works in the same building. And for ACOs, comprised of multiple entities that don’t necessarily have any prior joint operating experience or relationship of any kind, the challenge is greater still.

Based on extensive discussions with healthcare executives and real-world performance analysis, it is clear that successful ACOs must make an investment in robust groupware tools, the kind that professional services organizations have had in place for decades to ensure that members of a distributed workforce can collaborate and coordinate as easily as if they were in next-door offices.

In the healthcare context, these tools will facilitate everything from patient scheduling to real-time sharing of PHI to charge capture and invoicing. Far beyond secure messaging, such platforms underpin the ACO’s activities, giving providers a common workspace for all manner of collaboration and ensuring that all providers across the care continuum are aware of and working towards a single set of organizational imperatives. The ACOs that don’t invest in the transformation – that try to piggyback on existing infrastructure – will ultimately find that their people don’t make the transformation either.

Patients at the center

All healthcare systems need to become more patient-centric and this is particularly true of ACOs, whose compensation, of course, is based on how successfully they treat (and, ideally, reduce the need to treat) patients. Thus, successful ACOs will make patient-centric collaboration and communication the centerpiece of an organization-wide operating system. 

Ideally, collaboration and communication won’t stop there. ACOs will implement population health initiatives by empowering patients, giving them the ability to take a more active role in keeping themselves healthy. This will be accomplished via tools such as mobile apps that enable people to access care services before they get sick and enable ACOs to reach out to the community, helping guide patients towards good lifestyle choices and, if they have received acute treatment, helping patients follow post-discharge instructions. So that same collaboration platform that will help care professionals work together better – it will need to extend seamlessly into the community as well.

Without aligned physicians, there’s no accountability

Technically, any organization that agrees to be “accountable for the quality, cost, and overall care of Medicare beneficiaries” can qualify under the definition of an ACO. But what all successful ACOs will have in common is tight alignment of physicians and care teams. I don’t simply mean financial alignment. Theoretically, all the physicians in an ACO are financially aligned. Nor do I just mean alignment around a patient.

True alignment means the physicians who form the core of the ACO understand the goals and priorities of the organization and feel invested in its success. Physicians make dozens of care decisions every day. They need to be making those decisions against the backdrop of the stated policies of the ACO. That requires being literally as well as figuratively connected to the organization, receiving regular communications such as educational materials, opinion, and thought leadership, being part of the daily give and take.

The financial incentives and disincentives under which ACOs operate change regularly, meaning the ACO’s organizational goals are updated all the time. The challenge is for providers to understand those incentives fully and to be able to adjust their practice methodologies and for that to happen on an organization-wide basis. Achieving and maintaining alignment requires an institution-wide collaboration platform. In a distributed entity such as an ACO, there’s no physician’s lounge. But with modern groupware, we can simulate one in a virtual environment and realize the same benefits.

Networks don’t build themselves

In my work with ACOs, one hurdle encountered by all is introducing and socializing the concept that the ACO establishes a new network of providers to which to refer cases. Intellectually it isn’t that hard to grasp. But as far as changing ingrained habits, that is much more of a challenge – not least because providers have no way of knowing which other providers are also members of the ACO, nor how effective any of those providers might be as physicians contributing to the stated financial goals (savings as well as revenues) of the ACO.

The only way to keep referrals within the organization – to combat the challenge of referral leakage, which will sink an otherwise effective ACO – is the ensure that every physician in the ACO is connected to a physician referral directory that lists all providers by specialty.For good measure, it will include a rating quantifying each provider’s service.

Improving clinical documentation

In the minutely quantified world of ACO financial performance, every dollar counts. The ACO’s income is based, in part, on costs saved, along with other metrics. As is well known, incomplete clinical documentation leads to tens of billions of dollars in disallowed reimbursements every year, a situation that only grows worse in a distributed organization such as an ACO. 

While we are imagining the infrastructure of the successful ACO of the future, let’s not neglect to include capabilities for crisply identifying and documenting treatments and procedures and thus enabling the medical billing professionals – who may have no physical or organizational connection to the care delivery professionals – to complete the paperwork correctly and maximize reimbursement revenue.

Conceptually, ACOs are the heart of the Affordable Care Act. Accountability – enforced by incentives and penalties – is central to our concept of how healthcare ought to work. If ACOs aren’t delivering on their promise, then that has ominous implications for the healthcare system overall. With the right communications infrastructure used as directed, ACOs can lead the way to the bright healthcare future we all want. Rather than stand on the sidelines as spectators, waiting for new incentives to come down from on high, ACOs can and must take action now.

Stuart Hochron, MD, JD is the chief medical officer of Uniphy Health of Minneapolis, MN.

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July 18, 2016 Readers Write 3 Comments

Morning Headlines 7/18/16

July 17, 2016 Headlines No Comments

HL7 firm hack compromised clients’ EHR records: The Dark Overlord

Hacker The Dark Overlord claims to have breached the servers of healthcare IT vendor PilotFish Technology and is selling access to the company’s database for $500,000.

Children’s hospital using ‘Pokemon Go’ to get patients out of bed

C.S. Mott Children’s Hospital (MI) is using Pokemon Go as a tool to get sick patients out of their rooms and interacting with staff members and other patients.

Jeremy Hunt remains as Health Secretary after earlier reports he’d been sacked

NHS Health Secretary Jeremy Hunt is reappointed to his position by incoming Prime Minister Theresa May.

Fancy amenities woo patients while insurers cry foul

Aetna sues 175-bed North Cypress Medical Center (TX) claiming the physician-owned hospital accepts no forms of insurance and instead charges all payers out-of-network rates while discounting the patient responsibility portion of the bill to in-network prices. A judge ultimately denied Aetna’s demand for $225 million in refunds.

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July 17, 2016 Headlines No Comments

Monday Morning Update 7/18/16

July 17, 2016 News 9 Comments

Top News

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Hacker The Dark Overlord, who has breached at least three healthcare organizations and then listed their patient data for sale when they refused to pay him, advertises for sale the digital assets of a healthcare IT vendor that appears to be PilotFish Technology, which offers integration tools and middleware to several industries that include healthcare. He’s asking $500,000 for HL7 source code, signing keys, and a licensing database. He says he stole the information by gaining full root-level access to the company’s servers. The Dark Overlord listed the information for sale after the company declined to pay him the $500,000 to keep quiet.

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The hacker says he has inserted a backdoor in PilotFish’s software that was pushed out in its most recent update and has since stolen the EHR records of all of the company’s customers.

Not only is PilotFish’s business at great risk, so is the information of its customers, among them Utah Health Information Network and the State of Connecticut. PilotFish launched its healthcare business in February 2014.

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The Dark Overlord breaches systems using Remote Desktop Protocol exploits, so I’ll recommend again that everybody either secure it or shut it down. He also seems to prefer targeting SRS EHR clients. His latest round of tweets suggests that at least one of the providers he hacked paid him to keep quiet last week.


Reader Comments

From Sharon M: “Re; LabCorp. I’m surprised HIStalk did not cover the IT crash that affected five states. Are you so biased that you only print the favorable reports about HIT?” This comment comes from a frequent anti-EHR troll who assumes multiple identities in unsuccessfully trying to avoid being called out, which even without the technical clues would be obvious since 99 percent of readers complain that I’m too critical of health IT instead of accusing me of being a cheerleader for it. I haven’t seen any mention of LabCorp problems anywhere, so given that I did not personally have tests performed recently in those five states, I have zero information about any downtime and have received nothing from users (including the phony Sharon M). In other anti-technology news, a traffic light went out for an hour recently, so it’s time to replace all of those unreliable devices with stop signs.

From Lysander: “Re: redirects. Why do you redirect the link from HIStalk.com to HIStalk2.com? I know it was originally related to a hosting switch, although if I know your style, that inside joke might be part of the fun.” It’s been nearly 10 years since I switched from a proprietary-technology web host while temporarily running both sites to prevent readers from getting lost. That change isn’t easy to undo, I’ve learned. I had my web host look into it yet again Friday night after your inquiry and they messed things up a bit temporarily, plus the change would probably screw up links to years’ worth of articles. I’ll add that to my inside joke collection (along with smoking doctor logos) and the list of things I’m too lazy to worry about.

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From Little Bit: “Re: mission and vision statements. I remember an academic medical center whose mission didn’t have one word about patients in it. There’s also an EHR vendor who talked a lot about their ‘Do Right’ principle, although I think they veered away from that one.” I’ve worked for executives who turfed off creation of mission and vision statements (they didn’t even understand the difference) to their underlings and it was a disaster. The back-stabbing, suck-up directors fought for attention in trying to distill a large, complex operation into a single overinflated, pithy sentence (it ended up with a lot of commas).  My takeaway: leaders without vision and character might as well have a crappy, eye-rolling vision statement that will be forgotten immediately because it’s not going to help anyway. My other takeaway is that committees are a poor substitute for leadership since they suck the life out of everything they do, and as such, should be limited to an advisory role to a clearly defined leader rather than to have actual power themselves. Give the buck a place to stop.


HIStalk Announcements and Requests

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Three-quarters of poll respondents don’t think levying HIPAA fines improves privacy or security. New poll to your right or here: what is your overall opinion of the Affordable Care Act? You can’t just leave us hanging by voting without explaining, so click the poll’s Comments link afterward to elucidate.

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Welcome to new HIStalk Platinum Sponsor Evariant. The Farmington, CT company offers enterprise-class CRM platforms for patients, consumers, and physicians that empower the marketing and physician relations teams of leading hospital networks. Evariant’s patient and consumer marketing CRM system drives targeted service line growth with attributable ROI, while its patient acquisition and engagement platform allows hospitals to target appropriate audiences for marketing as well as for education and wellness programs. Hospitals use its physician engagement technology to track referral patterns and physician loyalty in designing effective physician outreach activities. The company offers a free e-book titled “Creating Extended 360° Patient and Physician Views with Big Data Analytics.” Client success stories include Orlando Health, Wake Forest Baptist Health, University of Chicago Medicine, and Dignity Health. Thanks to Evariant for supporting HIStalk.

I found this Evariant client testimonial from University of Chicago Medicine on YouTube.

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Mrs. Roepke in Missouri had never had a DonorsChoose grant request fully funded until we provided her elementary school class with interactive math stations. She says her students cheered when they opened the box and saw the electronic flashcards and are using the many tools that were included in their small group work, to the point that they even refer to the game while working in other groups, which she calls “a proud teacher moment.”

I’ve realized what I hate about the phrase “pop health,” other than the fact that it’s an annoying shorthand for “population health,” which in this industry is invariably misused in describing “population health management” or “population health management technology,” which are entirely different things. Reporters and bloggers who bandy the term about from their cheap seats in their unwillingness to enunciate the daunting four syllables of “population” haven’t earned the right to lapse into jargon. Just like it’s insulting to Marines when people who have never served in the military shout out “Semper Fi.”

Listening: the almost-new album of one of my favorite bands, the highly listenable and brilliant Nada Surf, whose stock in trade is thoughtful lyrics, sweet harmonies, and ragged independence. Their catchy, sometimes jangly power-pop is hard to beat and they exhibit the maturity of a band whose lineup hasn’t changed in nearly 25 years. I’m offsetting that with the hard-rocking operatic Finnish metal of Nightwish, who I didn’t realize has commendably added the incomparable Floor Jansen (After Forever) as lead singer.


Last Week’s Most Interesting News

  • The VA takes more Congressional heat for lack of DoD interoperability and hints harder at replacing VistA with commercially available software in a Senate Appropriations Committee hearing.
  • A survey finds that most doctors haven’t heard of MACRA and hate the idea of tying their income to their quality.
  • OHSU pays $2.7 million to settle two HIPAA charges involving only 7,000 patients in incidents involving a stolen laptop and residents using Google Docs to store patient information.
  • Imprivata and Valence Health are acquired.
  • HHS issues ransomware guidance in declaring that a reportable HIPAA breach has occurred any time PHI is encrypted by malware.
  • CMS levies a death sentence on lab processor Theranos, banning Elizabeth Holmes from clinical laboratory ownership for two years and halting Medicare and Medicaid payments to the company.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

GE Healthcare’s management consulting group signs a five-year collaboration agreement with ThoughtWire, which offers machine intelligence software that GE Healthcare will roll out as real-time process alerting and decision support.


Sales

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University of Virginia Health System selects Evariant’s Physician Relationship Management and Physician Market Solver solutions for physician alignment.

The Medical Information Network – North Sound (WA) HIE adds Jiva Population Health Management to its ZeOmega rollout.


People

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Commonwealth Health (PA) names Denis Tucker (Main Line Health) as CIO.


Government and Politics

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England’s Secretary of State for Health and digital health supporter Jeremy Hunt is reappointed under new Prime Minister Theresa May.

The Defense Health Agency awards a five-year, $70 million to EHR Total Solutions. I found next to nothing about the company, which seems to exist purely to get military contracts. It previously reported $9 million in annual MHS contracts, so this will raise its total a lot.

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A US District Court orders MedSignals CEO Vesta Brue to pay $4.5 million for grant fraud. Her Lexington, KY companies received five NIH grants to develop electronic pillboxes, but she spent the money on plastic surgery, jewelry, and massages. She will also pay restitution and serve jail time for grant fraud related to Telehealth Holdings, Inc., a company operated by her partner Jerome Hahn.



Other

GE Healthcare sues 23-bed West Feliciana Parish Hospital (LA), complaining that it unfairly chose Hitachi Medical Systems to provide imaging equipment at a price below GEHC’s bid.

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I’m tiring of the Pokemon Go phenomenon as quickly as I did other pointless, imitative fads like the Ice Bucket Challenge and the phrase “threw up in my mouth a little bit,” but this is cool: C.S Mott Children’s Hospital (MI) is using the game to get hospitalized children to leave their beds and interact with employees and other patients. That won’t be offset by the hospital influx of dolts who are hurting themselves in their rare interactions with their actual physical surroundings while staring at their phones, but it’s a small plus. Speaking of which, as I predicted last week, game developer Niantic announces monetization plans in which it will offer retailers the ability to sponsor locations on a cost-per-visit basis in hopes of boosting their foot traffic. I predict the game will be a cringingly-recalled embarrassment in six months, just like Second Life and Google Glass.

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The former IT administrator of an Alaska health system faces 99 years in prison after pleading guilty to  possessing and distributing 2 million images and 13,000 videos of child pornography that obtained using the hospital’s network. He was not charged for distributing another disturbing image, the photo above from his LinkedIn profile.

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The Houston paper covers the “cost versus choice” out-of-network conundrum in describing a 175-bed, oncologist-owned hospital that brings in annual revenue of $1.5 billion despite not accepting any form of insurance. Aetna sued after finding that the hospital was reducing the patient responsibility portion of its bills to in-network levels by applying a “prompt pay discount,” but was sticking Aetna for their full part of the out-of-network charges (such as $200,000 to treat an abscess). Aetna claimed racketeering, while the hospital counter-sued for being blacklisted. The judge denied Aetna’s demand for $225 million in refunds, saying it’s up to Aetna to decide what part of medical costs it pays in applying usual and customary limits.

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Bizarre: several doctors in India, one of them a government official, are arrested for running a child trafficking ring from their hospital, caught as they tried to sell a four-month-old. Police are also investigating whether the doctors are running their hospital legally and whether they have actual medical degrees.


Sponsor Updates

  • T-System will exhibit at the FHIMA Annual Meeting July 18-21 in Orlando.
  • Stella Technology is sponsoring and exhibiting at the Redwood Mednet conference in Santa Rosa, CA this week.
  • Datanami.com profiles TransUnion’s management and use of big data.
  • Valence Health will host its value-based industry conference, Further 2016, September 14-16 in Chicago.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

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July 17, 2016 News 9 Comments

Morning Headlines 7/15/16

July 14, 2016 Headlines 1 Comment

Hearing to Review the VA Electronic Health Record Network

Testifying before the Senate’s Committee on Appropriations, VA executives field pointed questions about the lack of interoperability between the VA and DoD, and confirm speculation that the agency will likely move to a commercial EHR system.

Health IT & Health Information Services: 2016 Mid-Year Market Review

Healthcare Growth Partners publishes its 2016 Mid-Year Market Review, a dense and informative report on M&A activity in the health IT marketplace.

Obamacare, the secret jobs program

Politico reports that the ACA was intentionally written to save healthcare jobs during the recession rather than reduce healthcare costs. While healthcare advisors lobbied for language aimed at improving care delivery efficiencies to reduce costs, more influential advisors from the job creation team successfully argued that during the recession the country needed “more middle-class jobs and the best place to create them was in health care.”

Thune Leads Senate REBOOT Members in Introducing Legislation to Improve Meaningful Use Program

Six republican senators introduce a bill that would limit the Meaningful Use reporting periods to 90-days, expand availability of hardship exemptions, and eliminate the “all-or-nothing” structure of the attestation process by allowing hospitals to satisfy MU requirements as long as they attest to 70 percent of the required metrics.

2016 Survey of US Physicians: Physician awareness, perspectives, and readiness for MACRA

A Deloitte survey measuring MACRA awareness among US physicians finds that 50 percent of non-pediatric physicians have never heard of MACRA, and 79 percent do not support tying compensation to quality.

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July 14, 2016 Headlines 1 Comment

News 7/15/16

July 14, 2016 News 5 Comments

Top News

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VA CIO LaVerne Council, testifying to the Senate’s Committee on Appropriations about the future of VistA, defends the status of interoperability with the DoD. She is grilled about why the military’s diagnostic images of newly discharged veterans can’t be viewed by the VA, forcing them to start over, and why Cerner’s suicide prevention algorithms can’t populate the Joint Legacy Viewer. She answers a pointed question about why the VA and DoD can’t use the same system by saying that no existing system can meet the needs of both. Council confirms that every VA VISN has a customized instance of VistA, meaning it’s really 130 similar but not identical systems.

VA Chief Information Strategy Officer David Waltman phrased an answer to a question as “until we move to a COTS solution on the digital health platform,” leaving little doubt that the VA hopes to buy a commercial product. Senator Bill Cassidy, MD (R-LA) was impressive in asking insightful questions about interoperability and federated data capabilities.

Council says the VA has engaged KLAS to build its business case (at a cost of $160,000, Politico reports) in reviewing products and options, hoping to give the next administration a business case by the end of the year. I’m not sure what KLAS has to offer that everybody doesn’t already know (it’s either Cerner or Epic – skip the RFI/RFP and just visit some sites, negotiate hard, and swallow the urge to rule out Cerner just because DoD chose it).


Reader Comments

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From Dr. Nicholas Van Helsing: “Re: Theranos. I posted a few weeks ago that it was clear the Emperor had no clothes. But put a mysterious woman dressed in black turtlenecks and a somewhat strange alto voice out front and people buy it. A similar image was creatively groomed 15 years or so for Kim Polese of Marimba. Every industry rag had a story about her every month, and then she complained that the press never left her alone. She hasn’t amounted to much, but at least Marimba sold for $239 million and only deal with software, not lives. Her next venture tanked – anyone know what she’s doing today? I think Liz is headed the same way. QED.” Polese made a lot of covers because of her appearance (despite holding a biophysics degree and being influential at Sun Microsystems for coming up with the name Java) and because women-led tech companies were rare back then. That was a reflection of widespread industry chauvinism more than any ego failings she might have had. Marimba created Castanet, a technology to allow fast downloads, but the company’s fame never approached her own, especially after it hired a PR firm who decided to make her the real story. You’ll be interested to know that she landed in healthcare as board chair of ClearStreet, which offers technology to help employers and employees manage their healthcare spending.

From Dilettante: “Re: HIStalk. I don’t believe that it’s just one person writing and reading every item that appears. Tell me who is on the team and where the company offices are located.” I get that a lot. I write every word of every news post myself, with the rare exception when I take a day off and Jenn covers. I don’t leave the otherwise empty spare bedroom (no schmoozing, speaking engagements, or sucking up – that’s the beauty of being anonymous) until I’ve written something that I’ll still be proud of years later, long after thousands of readers have forgotten it. Until I lose the ability or interest to continue doing that in a way that I think is better than anyone else, it’s just me alone feeling like I’m whispering in the ear of a single reader who is just like me in having a short attention span, a low threshold for BS and corporate incompetence, and a strong interest in doing the right thing for patients and those who pay their bills. Everybody has some weird, questionably useful talent (wiggling ears or solving a Rubik’s cube, for example) and this happens to be mine.


HIStalk Announcements and Requests

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We funded a significant DonorsChoose project (donating $500, which was matched by Chevron) in providing Mrs. Veltri’s Pennsylvania elementary school class with an iPad Mini and STEAM tools, books, and games. She reports, “Packages came to our door and our students could not contain their excitement. You should have seen their faces as they began to open boxes that gave them tools to explore new aspects of education. At this young age students need to explore science, technology, engineering, and mathematics to set their foundations for later on in their schooling. The blocks and tiles get them learning about these concepts at a young age and in a very exciting way!”

I asked Jenn to write an article about the return on investment vendors get for exhibiting at the HIMSS conference. Contact her if you would be willing to give some company perspective (anonymously if you would rather).

This week on HIStalk Practice: Enli Health Intelligence partners with Dell Services. Hawaii hopes to ease physician shortage with expanded access to telemedicine. Relatient partners with Uber. Flatirons Practice Management adds Mediware billing tools. HealthTap acquires Docphin. Drchrono partners with AHIMA to help HIM students. Colorado Springs Health Partners rolls out Clockwise.MD at urgent care facilities.

This week on HIStalk Connect: Involution Studios debuts digital healthcare cards. Tel Aviv University develops temporary emotion-mapping electronic tattoos. Eleven year-old helps Boston Children’s Hospital promote telemedicine legislation. Avizia and Progyny secure new funding rounds. Drones help coordinate care for wild ferrets.

Listening: new from Anderson/Stolt, a collaboration between former Yes singer Jon Anderson and former Flower Kings/Transatlantic guitarist Roine Stolt. Yes is on its sad last cash-cow legs, even more pathetic than the so-called Beach Boys with no original members left and a tribute band singer mangling its classics, so this is a pretty good substitute for the band’s prime 1970s years with Anderson / Squire/ Howe / Wakeman / White (or maybe Bruford if you’re a purist). Prog fans will be transported to the years when Yes and Genesis ruled the airwaves and concert stages. Anderson sounds great for a guy who’s 71 and who got fired from Yes in 2008 after serious lung problems kept him off the road and thus from playing the aging band’s primary keyboard instrument (the cash register). He’s also touring this fall with fellow Yes alumni Rick Wakeman and Trevor Rabin.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

Teladoc obtains a $25 million loan and $25 million line of credit.

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Care coordination software vendor Caremerge raises $14 million, increasing its total to $20 million.

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Telemedicine software and services vendor Avizia raises $11 million, increasing its total to $17 million.

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In Canada, Telus Health announces that it will acquires the Canadian EHR business of Nightingale Informatix, which is used by 4,000 physicians.

Patient experience software vendor Docent Health raises $15 million in a Series A funding round, increasing its total to $17 million.

Publicly traded Alere recalls all of its PT/INR blood coagulation testing systems as mandated by FDA, which found that the company’s software update did not fix a previously documented problem with incorrect results. Abbott had agreed to acquire the company for $5.8 billion last year but then tried to back out after Alere was investigated for foreign corruption probes, so naturally they’ll be trying even harder now. 


People

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Randy Fusco (Change Healthcare) joins patient engagement system vendor HealthGrid as EVP of product R&D.

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ID Experts hires Kimberly Holmes, JD (OneBeacon Insurance Group) as SVP and counsel for cyber insurance, liability, and emerging risks. 

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Johns Hopkins All Children’s Hospital (FL) names John McLendon (MedStar Health) as VP/CIO.

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Chris Hammack (Patientco) joins population health management consulting group Aegis Health Group as SVP of sales and business development.


Announcements and Implementations

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In Singapore, Farrer Park Hospital goes live on Meditech 6.0.

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Medecision launches Aerial for Medicaid and Medicare Advantage, a population health management system.

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Colorado Springs Health Partners (CO) goes live with online check-in by Clockwise.MD at all three of its urgent care facilities.

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PMD adds real-time discharge alerts to its software, allowing practices that participate in Medicare’s Transitional Care Management program  to be paid for performing follow-up within 48 hours of discharge. The company offers software for charge capture, secure messaging, health information exchange, and care coordination.


Government and Politics

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Six Republican Senators introduce the EHR Regulatory Relief act that would mandate a 90-day Meaningful Use reporting window in trying to “pull the electronic medical records system out of the ditch, transforming it into something that doctors and hospitals look forward to rather than dread.” The proposed legislation would also modify the all-or-nothing MU requirements and extend the availability of hardship exemptions. Senators John Thune (R-SD), Lamar Alexander (R-TN), Mike Enzi (R-WY), Pat Roberts (R-KS), Richard Burr (R-NC), and Bill Cassidy (R-LA) are members of the Senate’s working group Re-Examining the Strategies Needed to Successfully Adopt Health IT, which somehow ended up with the contrived, catchy non-acronym REBOOT.

Meanwhile, CMS Acting Administrator Andy Slavitt tells the Senate Finance Committee that CMS is open to postponing MACRA and shortening its reporting periods.

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A Politico article calls the Affordable Care Act “the secret jobs program” in which the administration–  facing a tanking economy and the loss of millions of jobs — chose preserving healthcare employment over controlling healthcare costs in deciding not to cap healthcare spending or address provider efficiency. Healthcare employment has grown 23 percent since 2005 vs. just 6 percent in non-healthcare jobs. The excellent article notes that the “poison pill” that’s included with all those jobs is ever-growing healthcare costs (healthcare creates its own demand) footed by employers, patients, and taxpayers, noting that doctors are outnumbered by non-doctors by 16 to 1, with nine of those being paper-pushers. Experts say the investment is a poor one if health doesn’t improve. Legislators have declined to face the issue because “every job is a good job” and all of them have big-employer hospitals in their districts, with healthcare and social assistance providing the highest employment in 56 percent of Congressional districts.

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HHS lists a position for an IT security specialist, which contains mostly unsurprising duties except for the last two that cover prosecution and corrective action.

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A Deloitte survey of physicians finds that only 50 percent of the non-pediatricians have heard of MACRA, with 32 percent of them saying they’ve heard of it but don’t actually know what it is (maybe CMS should hire drug salespeople to spread the word since they seem to get doctors to pay attention, at least when they bring lunch). Nearly 80 percent of respondents say they would rather be paid under fee-for-service or salary arrangements instead of value-based payments. Three-quarters think performance reporting is burdensome and 79 percent don’t like the idea of tying their incomes to quality (that might be the scariest number of all).

An HHS report says national health spending will hit the $10,000 per person mark for the first time this year and will continue to grow at around 6 percent annually through 2025 as the economy improves, healthcare prices rise, and baby boomers get older. It predicts that spending may be moderated by higher out-of-pocket costs and says insurers will increasingly narrow their networks in trying to avoid price increases.


Privacy and Security

Oregon Health & Science University will pay $2.7 million to settle charges stemming from two 2013 data breaches involving 7,000 patients, one the theft of a surgeon’s unencrypted laptop from his vacation home and the other caused by medical residents who stored patient information in cloud-based Google Docs. That’s a big penalty considering there’s no proof anyone actually saw or used the patient information.


Other

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Healthcare Growth Partners publishes its mid-year health IT market review, which always dazzles me with its insight and brilliant writing. It notes the change since 2005 in which “solvers” (companies that do the right thing in generating profits while maximizing returns for many) now outnumber the previously dominant “exploiters” (companies that exploit inefficiencies to maximize returns for a select few), as the fee-for-service model rewards exploiters and value-based care rewards solvers. It notes that companies with just $10 million in revenue have a wide variety of investors to choose from in the immature health IT market. Respondents were mixed on whether an health IT investment bubble exists, but those who think it does point mostly at early-stage companies. There’s too much information to summarize adequately, so take a look – unless you are already an M&A expert, you’ll learn a lot by reading the report.

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Greater Baltimore Medical Center (MD) celebrates its EHR go-live with what it calls a company barbeque (which it wasn’t – it was a cookout with no low and slow smoking involved). I assume it was Epic ambulatory that went live.

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A funny spoof from the Gomerbloggers.

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Weird News Andy helpfully provides ICD-10 code Y93.C2 (activity, hand held electronic device) for treating the idiots who are harming themselves by ignoring the real world in favor of the Pokemon Go variety. He provides examples: (a) two men fall off a San Diego cliff after cutting through a protective fence in their pursuit of a character; (b) a guy crashes his car and tears up a woman’s yard while driving and chasing an imaginary monster; and (c) a 21-year-old generously absolves the game’s maker for falling off his skateboard while hunting characters, saying, “I don’t think the company is really at fault.” Meanwhile, officials at the United States Holocaust Museum, Arlington National Cemetery, and Poland’s Auschwitz Memorial ask the game’s vendor to take their sites off its monster-hunting list to keep them from being overrun by disrespectful players. The CEO of the company that developed Pokemon Go says his goals were to get people to exercise, to encourage them to explore their neighborhoods, and to serve as an icebreaker in getting strangers together, all of which could allow the game to meet the definition of a health app except that people actually use it.


Sponsor Updates

  • Ingenious Med Chief Innovation and Product Officer Todd Charest speaks at the Gwinnett Chamber of Commerce’s Wearable Technology Forum.
  • InstaMed is featured in the Deloitte Health Care Current.
  • Fifty-nine Meditech customers achieve the “Most Wired” distinction for 2016.
  • Netsmart will exhibit at the ASU Annual Summer Institute July 19 in Sedona, AZ.
  • Experian Health will host its Northeast Regional User Conference July 19 in Philadelphia.
  • Following up on an Earth Day-related pledge, PatientPay donates to The Nature Conservancy for the restoration of longleaf pine forests in the North Carolina Sandhills.
  • Teknovation.biz interviews PerfectServe CEO Terry Edwards.
  • Sunquest Information Systems will host its 35th Annual User Group Conference through July 15 in Tucson, AZ.

Blog Posts

HIStalk sponsors named among the 100 winners of Modern Healthcare’s “Best Places to Work in Healthcare 2016” are:


Contacts

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July 14, 2016 News 5 Comments

EPtalk by Dr. Jayne 7/14/16

July 14, 2016 Dr. Jayne 1 Comment

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HIMSS has started planning for National Health IT Week, to be held September 26-30. Events include a “Virtual March” to allow participants to reach out to their representatives to discuss the benefits of health IT in advancing medicine. The “Activities & Agenda” section of the website still lists the 2015 content, so we’ll have to wait to see exactly what is on tap for this year.

A good friend shared a link to Stop Meeting Like This. which has some eye-catching headlines. My favorite was the link to the flow chart that answers the perennial question, “Are you about to have a crappy meeting?” Although it’s largely tongue in cheek, it made me smile. The fact that other people think about how soul-sucking meetings can be reminds me that I’m not alone.

Other topics include strategies for making sure 24-hour access doesn’t interfere with work-life balance and the “dark side” of collaboration. I’ve got some colleagues who could definitely benefit from the latter piece. I love the last line of the piece: “Make sure that the collaboration in your organization isn’t just a smokescreen allowing many to coast on the efforts of others.”

Another friend clued me in to Athenahealth’s take on “If You Give a Mouse a Cookie,” which appeared just a couple of days after my own mention of the classic tale. They did a really good job with it, ultimately calling on CMS to “avoid ending this sordid tale exactly where we started” and saying “it may be too late at this point to take back the cookie from CMS, but it’s not too late to push back on the milk.”

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The AMIA 2016 Annual Symposium “early bird” registration deadline is approaching. It’s closer to home for me this year, but I’m not sure I’m going to make it. It’s nearly back-to-back with another conference I’m already committed to attend and even the early bird registration rate is nearly $1,000. Add in hotel, meals, and travel and it’s a good chunk of change.

I do enjoy going, though, and getting together with colleagues who work in different spaces within the clinical informatics universe. It’s good to be able to commiserate about some of the things we see in the field, but now that I have more responsibility with my practice, it’s harder to get away.

I’m also interested in attending the NCQA Patient Centered Medical Home Congress in October (and also in Chicago). Moving forward with PCMH efforts will clearly benefit physicians and practices as we move towards value-based care. However, NCQA is planning to update its recognition program, “planning an ambitious full redesign.” Public comments on the proposed redesign close Friday, so I hope people have been able to submit their thoughts.

Recently I came across a physician who wants me to come up with a strategy to “de-spam” his Direct interoperability solution. He’s in a part of the country where secure communications between providers is really taking off, but he’s not happy that pharmacy benefits managers and other organizations have started sending patient-related communications. He wants to restrict use of messaging to only physicians, which flies in the face of the idea of team-based and collaborative care. He also wants to figure out a way to make his address “unlisted” so that people can only reach him when he wants them to reach him. I’m not sure what to tell him, but I’m betting my informatics colleagues will have some ideas.

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It’s not health IT-related, but it did make my day. The Apollo Guidance Computer code is making the rounds on the internet. There’s some pretty humorous bits and also a little Shakespeare included for good measure. The article is worth the read if you’re looking for a little distraction.

Email Dr. Jayne.

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July 14, 2016 Dr. Jayne 1 Comment

HIStalk Interviews Howard Messing, President and CEO, Meditech

July 14, 2016 Interviews 6 Comments

Howard Messing is president and CEO of Meditech of Westwood, MA.

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Tell me about yourself and the company.

I’m CEO of Meditech, one of the founders of the EHR industry. I’ve been here for almost the entire history of Meditech. I have a very strong technical background. I think if you looked in the dictionary under “computer nerd,” you’d see my picture there. I’ve been here since 1974.

Combined with my computer nerd background, I’ve also dedicated my life to the healthcare industry and making sure that we can proceed and use our systems and electronic health records — although we didn’t call them that back in the early 1970s — to improve care, improve productivity, and hopefully control costs, though we know that’s been a continuing challenge for the entire industry.

I always like looking at those black and white 1960s pictures on your site, like seeing Neil Pappalardo up to his waist in water trying to save the data center.

Believe it or not, that was actually in Phoenix. People don’t think of floods in Phoenix, but that was a water main break.

How many hospitals run full-blown Meditech hospital-wide?

We actually have very few customers any more who have just one or two products. The vast majority of our customers are dedicated to our entire portfolio. We have somewhere around 2,300 or 2,400 hospital sites worldwide running our systems.

When we last spoke a few years ago, you priority was to move customers off older product versions like Magic. How is that progressing?

That was the priority then, and to be honest, it’s still a priority. The staying power of our older platform has surprised us. We still have approximately 800 customers on our oldest Magic platform and a similar number, perhaps even a few, more on our Client/Server platform. We have close to 600 on our 6.x platform.

We have a brand new platform. 6.x is the underlying technology, but we’ve redone the entire front end of our products to be Web- and mobile-based for the ambulatory solution and for the clinicians on the inpatient side. It’s really quite a brand new system.

Unfortunately, when many people think of Meditech, they think of our systems that were introduced 20 or 30 years ago because that’s still the bulk of our customers. Keep watching us, because we’re introducing brand new products that are quite different than the rest of the marketplace.

Do you still have to make the argument that customers should value the benefits of software rather than having the latest, coolest underlying technology?

I agree with that in general. One of the main issues right now in EHR, maybe the main issue, is while keeping patients safe, we want to make sure that clinician productivity is not hurt. For the last 10 or 15 years, the entire industry has been saying, “Go to our systems and you won’t lose any productivity.”

We think that’s the wrong message.  We want to say, “Go to our systems and we’ll improve productivity.” We think by adopting modern user interfaces — we’ve achieved that and have some numbers to back it up — that’s going to differentiate us moving forward as these products get adopted.

Articles that blame EHRs for physician dissatisfaction usually fail to differentiate between community-based providers who have occasional interaction with one or more hospitals and those physicians who work full time in a hospital. How did your studies measure productivity?

I’ll first add that the other issue we see with physician dissatisfaction is the change in what is required of physicians over the same period of time that we’ve been adopting EHRs over the last five to 10 years. It’s sometimes difficult for physicians — and it’s difficult for us — to understand how much of their dissatisfaction is due to poor implementations of software from vendors and how much of it is due to the fact that they are required to document more, provide more statistics, and do more inspection of data. Maybe some will view that as an excuse, and perhaps it has been.

When we look at productivity, what we look at is the very standard kinds of measures. How long does it take a physician or clinician to get through an encounter? One good measure of that is clicks or taps. We have a customer who has done a study looking at the older systems and then looking at our new Web-based product. They found there’s about half the number of taps or swipes than there were with the older systems’ clicks. The amount of time it takes them to get through an encounter is approximately half.

We don’t have the firm data to back it up yet because it’s a new system for us. We only have four or five Web-based ambulatory systems up and running. Our Web-based acute care system is actually just being delivered this summer. We’re pretty excited about the implications that will have for productivity of clinicians, of course while maintaining safety of the patients and providing the best possible care. Maybe as importantly, keeping costs within a reasonable realm.

How well is Meditech competing with Cerner and Epic in getting new customers and keeping existing ones?

We’re certainly keeping our old customers pretty well. We have a lot of old customers. Our maintenance revenue keeps going up.

We have seen a little bit of a pause over the last couple years in acquiring new customers as people wait for these newer user interfaces to be delivered. We’ve still managed to convince a fair number of our existing customers and a handful of new customers to join us in pursuit of this new product. We think that will pick up next year.

How do approach the market knowing that you have to displace someone else’s product?

That’s a challenge. It is very much not a new market, it’s a replacement market. We go in making the case that both our products can help increase provider productivity.

Then we also make the cost-based argument. We think that we are far and away the most reasonable total cost of ownership vendor of the three major vendors. It’s a little bit obscene the amount of money that some of the healthcare industry is spending on some of these systems. We can make a good dollars-and-cents argument that going with Meditech will save them money. Particularly when you consider that no matter who gets elected in the next election, nobody’s expecting our government or payers to be paying more for healthcare episodes and for healthcare in the future. As we move to population health, that’s a way of achieving better health, but also controlling costs.

In general, there needs to be some ceiling placed on what is spent on electronic health records. We think we have the right answer with that and that’s the major argument we make. You can get a new, modern system; a system that will increase your physicians’ productivity; and you can do it for less cost than with the other vendors.

Is it hard to get someone who spent dozens or hundreds of millions of dollars to implement Epic or Cerner to admit that they made a financial mistake and go back and replace it with Meditech?

If they’ve just spent the money, it’s hard. We have to make the argument as these systems age, although we have had some success with people who have made that commitment and then realized what they’ve gotten themselves into.

The company’s product revenue has dropped by around half since 2013, which directly hit net income. What’s the cause and how do you fix it?

Net income is down. On the other hand, we are still strongly profitable, still paying a dividend, and still giving our employees raises and bonuses. We have a very strong balance sheet.

A lot of this was anticipated as we moved towards the new user interface that we’ve provided for our products. We’ve seen a lot of people waiting to buy that. We also have lost a handful of customers to consolidation, where people are acquired. There’s not much we can do if they’ve decided on going with another vendor’s system. We’ve seen a slowdown in that loss. 

This year, we’re doing relatively well. We expect that to turn around over the next 12-18 months as people start to see the effects of our new products.

Some of the market change involves hosting of client systems, which Cerner has built into a big business as Epic cautiously tests the waters. What does Meditech offer customers who want to turn over EHR system operations to their vendor?

We’ve actually offered, through third parties, the ability to do that for quite a while. There are a fair number of our customers who already are hosted by a third party, just not by Meditech. We’re also looking at whether we ourselves want to brand the entire system and provide it. We’re looking at some efforts, particularly at the smaller hospitals, and introducing that over the course of the next 6-12 months.

How do you see the potential change of ownership of McKesson’s Paragon product line changing the market?

I’m not sure it changes the market. I think everybody has been anticipating that McKesson was not very interested in pursuing their product line over the last 12 or 18 months. If this new arrangement involves a significant investment in R&D, perhaps they’ll be able to turn that around and become a significant force in the marketplace again. If they don’t do that, then I’m sure it will just be a winding down over time. I have no idea and am not privy to their deal to know what’s involved.

To be honest, we haven’t seen them as a very strong competitive force for two or three or four years. It’s very much a three-horse race on the acute care side among Epic, Cerner, and ourselves. Perhaps if you throw in the ambulatory side, there’s another couple of vendors that are strong and that we know are trying to get into the acute care space. The future clearly is in being able to provide services to the entire spectrum of healthcare — acute care, ambulatory, mental health, long-term care, urgent care, wherever healthcare is being provided. Particularly as population health begins to assert itself over the next few years.

Ambulatory was a perceived weakness of Meditech compared to Epic and Cerner. Is that changing?

Absolutely. I agree — we stayed away from the ambulatory sphere probably for too long. Then about 4-5 years ago, we acquired a long-term partner of ours, LSS Software, with the expectation that that might fill the gap for us. But we quickly began to realize that there were some issues with having a separate system. We bit the bullet, so to speak, and three years ago started developing our own ambulatory system and chose that as the testing ground of our new mobile and Web-based technology.

We’re happy to report that that product is now out in the marketplace. It’s live at four or five sites. We have orders for approximately 15 or 20 more of these systems. We see it as a big improvement on what our competitors offer, both in the functionality it offers specifically in the ambulatory space and also in the ability to integrate completely with the total healthcare enterprise.

Your Boston neighbors Athenahealth and EClinicalWorks are trying to push their way into inpatient from the ambulatory side. How do you see that developing?

Those were the two I was specifically thinking of when I said there are a couple of vendors trying to get into the acute care space. We’ll see what happens. They’re both good companies, both run by able leaders. We’ll see if they’re successful in getting into the marketplace.

Just as we’ve been learning about ambulatory and what it takes to provide an ambulatory system — and honestly there’s more to it than it seems when you first look at it –  we think they’ll have the same kinds of experience as they push into acute care and learn that there’s a whole lot to it. We’re welcome to take them on competitively.

Some people think inpatient systems are just EHRs, but Meditech offers complete departmental automation rather than just maintaining a patient record. Will companies like EClinicalWorks and Athenahealth need to get out into the hospital department operations to be successful?

They really have to get out into the departmental operations. They will discover that those are pretty complex and difficult to do.

To be honest, in the future, I believe that with the rise of FHIR and other API technologies, that might not be as important. Certainly as a technologist, I think that eventually that’s the right way to go. I still think we’re several years, if not the better part of a decade, from actually having that kind of capability as standard in the healthcare industry.

When that happens, perhaps it will be easier to provide an EHR that doesn’t also provide departmental systems. For right now, those particular integrations — particularly between pharmacy and the rest of the EHR — are very tightly coupled. It’s difficult to see how you can provide that without going into the departments as well.

How would you assess the interoperability capabilities of Meditech and its two significant competitors and their progress toward offering APIs as ONC is emphasizing?

I don’t like to comment negatively about my competition, so I’ll just say that you couldn’t be more dedicated to interoperability than we are. We’re involved in all the major industry efforts to do that. We are one of the founding members of the FHIR effort.

We currently do, I think, as much if not more interoperability than anyone else. There are hundreds of billions of data transactions a year going through Meditech’s systems interoperably. I think the last time we looked it was 300 billion, with 200,000 different interfaces. We’re well on our way to already supporting interoperability, both because it’s required and actually because it’s the right thing to do.

The CIO of one of your highest-profile clients told me he was shocked at how easy it was to turn on interoperability with Meditech compared to the systems of a couple of your competitors that his health system also uses. Would that surprise people?

I don’t know if that would surprise people. It doesn’t surprise me, although I’d like to know who that is [laughs].

We have from the get-go always had an interest in interoperability. I used to give a talk maybe 10 years ago about how in “Star Trek” they get your medical records on the other side of the galaxy. If we’re going to be able to do that in 200 years, we have to get started now. We’ve been pushing for that. 

It’s very pleasing to see that we’ve gotten as far as we have, particularly because the healthcare industry still doesn’t have, from my point of view, the right incentives in place to encourage people to interoperate. For the most part, it’s being done because it’s required as part of government programs. I think that that will change over time.

You mentioned the demand from customers for population health management and analytics. That market is pretty frothy, with a lot of companies popping up out of nowhere. How would you characterize the market for population health management and analytics and Meditech’s place in it?

I’m glad you asked that because we think we are a little bit different in our approach to population health.

First of all, it’s obviously currently one of the big buzzwords in our industry. It’s a clear trend to a way to manage patient population-based health. It’s going to become more and more important as our population ages and has multiple conditions and multiple chronic diseases. We think it’s an important thing.

On the other hand, there’s a lot of people playing on the fears of our customers and of the healthcare industry that if they don’t jump on the bandwagon right now with this particular model of population health, they’ll be left behind. We think population health needs to be a lot more integrated with the care delivery system than some of our competitors. Our approach is embedded in everything that we do. We’re taking a holistic approach to it, making sure that our customers can define and then manipulate and understand the various populations, no matter what their definitions are, as they practice their healthcare.

With the newly-announced MACRA regulations, it’s not even obvious that a physician can always tell which patients are in the population they’re responsible for and counting towards their statistics versus which ones are outliers that they are not responsible for. Our point of view is to give them that knowledge at the point of care, not on some separate list that someone has to compile and deal with on a different basis. We’re doing that by embedding that in their system. We have patient registries. We have a newly introduced analytics product that enables them to slice and dice the data about populations, but then build that into case management capabilities, build that into their revenue cycle issues, and maybe as importantly also relate to patient portal so that the patient can get involved.

One of the things about population health is figuring out how to get patients much more involved in their care. That’s been a Holy Grail. Nobody’s really achieved it very well yet. We want to make sure that we have all the tools in place to allow our customers to do that as we figure out how to get patients responsible for their own health.

Meditech’s executives all grew up within the company. How is their lack of industry experience outside of Meditech a strength when it comes to innovation?

It’s true that our most senior staff are from within the company, but we certainly do hire a lot of people who have not worked here before. We have a lot of smart people. There’s certainly no lack of outside ideas and influences.

In particular, over the last four or five years, we’ve hired a number of physicians into relatively senior positions here at Meditech. They certainly bring a lot of very interesting perspectives and ideas to us. We think that’s made a very big difference in the way that we approach development, implementation, and ongoing support. It’s been a bit of an eye-opener for a lot of us. That’s been a major factor in doing that.

There are both advantages and disadvantages to having long-term senior staff. We’re quite aware of that and try to capitalize on the advantages and make sure that we don’t get complacent about the things that are disadvantages.

How do you prepare for having executives and board members who have been with the company for 40 or 50 years turning it over to the next generation?

Obviously that’s one of the biggest discussions that our board has. We just appointed a new female board member. I wouldn’t be surprised if there were other board changes over time, looking for other people. We also just recently announced a new chief operating officer at the company, Michelle O’Connor, who is quite a bit younger than me and has not been here quite as long as I’ve been here.

We do talk about succession and the next generation. I’m not quite ready to retire. I don’t know that I’ll ever retire, but I certainly like to surround myself with a bunch of, I’ll say, younger people with good ideas. Talk about the future and make sure that the company traditions that are good are maintained and that the traditions that are not good are not maintained. Always ask the question when we do something. If somebody ever answers to me, “Because we’ve always done it that way,” I get very upset. We want to make sure that we’re justifying anything that we do and it’s not simply based on rote repetition of the past.

There’s quite a bit of overlap in the histories of Meditech and Epic, with one factor being that both companies have steered clear of the limelight with little interest in interacting with anyone other than customers and no real marketing or press presence. Epic seems to be opening up a bit. Is Meditech doing the same?

Absolutely. It’s one of the biggest things I’ve wanted to change in the five or six years I’ve been CEO. We’ve been working hard on it.

You touched on it yourself earlier when you pointed out that it’s a replacement market today, that it’s much more difficult to acquire customers. It’s also that the world in general is a much more marketing-oriented world. To be perfectly honest, we were founded by a bunch of MIT engineers, of which I’m one. I was here from the early days and we used to have the old mentality of, “If you build it, they will come.” Clearly that doesn’t work in the modern world, so we want to get our message out there.

Combine that with what I said early in the interview that we have a lot of older customers that we continue to support, but that means that many people continue to associate Meditech with our 20- and 30-year-old systems. We feel the imperative to get the word out that if you’re buying something new from us today, it is new. You’re not buying that 30-year-old Magic system.

All that has led us to believe we need to spend more time and more money on marketing. Hopefully, though, we’ll still be the relatively laid back, not overly slick vendor in providing that kind of information to the marketplace so they can make their decisions based on functionality and cost.

Where do you see the company going in the next five years?

In some ways, we’ll be doing the same things we do today. We’re dedicated to the healthcare market. We want to provide a complete, sophisticated solution for all the modalities of care.

There’s going to be a lot of challenges in healthcare no matter which direction our government takes. There’s going to be many challenges over the next few years. We want to make sure that our existing and prospective customers are prepared to handle that.

We need to polish off the new systems we have, extend those, then make sure that ancillary markets are also well served. In addition, I’d personally like to see our international share grow. We have close to half of the English-speaking market in Canada. The rest of the world is ripe to see the same kind of advances that we’ve had here in EHRs.

Do you have any final thoughts?

It will be interesting to see how the healthcare marketplace develops. We certainly intend to be a major player in how that transpires.

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July 14, 2016 Interviews 6 Comments

The War on Wearables

July 14, 2016 News 1 Comment

HIStalk looks at the bad rap wearables have been getting lately. From class action lawsuits against Fitbit to digital health snake oil comments, wearables have major ground to cover when it comes to winning over providers as medically reputable devices.
By @JennHIStalk

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Industry headlines would have you believe that it’s not the most opportune time to be in wearables. The consumer-friendly devices, most of them of the fitness-tracking variety, face abandonment rates of between 33 and 50 percent after the first six months of use, not to mention increasing scrutiny as to the accuracy of their measurements.

And then there’s the comment heard ‘round the health IT world: “From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality. This is the digital snake oil of the 21st century.”

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The comments of AMA CEO James Madara, MD during the association’s annual meeting last month was provocative to many. Although it did have a certain clickbait ring to it, his stance was born out of an underlying concern by many in the medical field that digital health tools — of which wearables take up an increasing percentage — have yet to be fully accepted by physicians. Whether it’s accuracy, usefulness, easy integration with EHRs, or reimbursement for time spent sifting through all that data, wearables haven’t achieved the panacea status many entrepreneurs would have providers and consumers believe they’re capable of.

The Physician’s Perspective

And yet there seems to be no going back. Companies continue to work wearables into their product roadmaps, even in the face of questionable data accuracy. Elmurst, IL-based Power2Practice, for example, announced Fitbit integration with its EHR for integrative medicine last month. UK-based personal health record company Medelinked has announced a similar arrangement with Jawbone.

Clinical researchers don’t seem deterred, either. The Dana-Farber Cancer Institute’s new breast cancer weight loss study has equipped all of its participants with Fitbits to track activity and weight. The examples of academic and corporate enthusiasm for wearables could — and likely will — go on, suggesting that, like the ancient medicinal properties of snake oil, there is a grain of truth to their purported value.

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Danny Sands, MD, a practicing physician at Beth Israel Deaconess Medical Center (MA), co-founder of the Society for Participatory Medicine, and chief medical officer at several healthcare companies admits to wearing a Fitbit because he likes receiving reminders that he needs to pick up the pace on a daily basis.

“I think that’s a positive step in the right direction, if you’ll excuse the play on words,” he jokes. “We have to remember that these are consumer devices. They’re not accurate clinical devices. For some people, having the Fitbit on is a motivator. I have seen firsthand how my encouragement to get a Fitbit helped one of my patients get moving and make profound changes in his life. Unfortunately, the vast majority of people who use these tracking devices don’t need to. They’re being used by the young, healthy, and wealthy, not by my patient with three chronic conditions who really should be wearing one.”

“As a primary care doctor,” Sands explains, “one of the things that is so hard and so frustrating is this issue of behavior change – how to motivate patients. If this is one more tool we can use to help motivate our patients, then I figure there’s something to it.” He adds, however, that not all physicians are comfortable recommending wearables and apps, either because they’re not familiar with what’s on the market or have no interest in diving into the back-end issues of receiving that deluge of data.

“You have to ask yourself, as a physician, is this data useful to me,” Sands says. “There it gets a little more complicated, because, first of all, there’s the issue of accuracy. Second, there’s the issue of integration with my workflow/EHR. Third, and perhaps most importantly, it’s about the volume of data that these things generate. This is only going to be useful to me in my practice if it’s information I want to see on a patient that I want to keep track of. Perhaps I’m in some sort of value-based payment contract where I have an incentive to try and keep my patients healthy. I need to figure out how to separate the signal from the noise. I need a system that’s going to show me just the data that’s important to me.”

Sands obviously isn’t convinced by the snake oil rhetoric. “Time and time again we’ve seen that a computer program in the absence of human beings providing something as well is not going to make a big difference in people’s lives. You need systems in place. You need some interface with the healthcare system. If you want to show measurable benefits, then you really have to have human beings there – some touchpoint with the healthcare system.”

The Quality vs. Quantity Conundrum

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ACT | The App Association, the Washington, DC-based nonprofit that represents software companies in the mobile app community, has been keeping a close eye on the evolution of wearables in the healthcare space. “Connected devices that we think of as wearables are undergoing a significant transition,” says Executive Director Morgan Reed. “As sensors and technology improve, these devices are rapidly blurring the line separating highly accurate medical devices and something you might pick up at an airport kiosk.”

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“The struggle,” he adds, echoing Sands’ comments, “will be taking all of that accurate information and presenting it to a care provider in a meaningful way. This is a place where the balance between quality versus quantity comes into play on the physician side. EHRs – loved or loathed – aren’t so much barriers, but instead have created a new paradigm in which medical apps and connected device makers must create technology that integrates seamlessly with those systems. An ideal interoperable system gives care providers access to a lot of data, but instead of just dumping it into one place, the system highlights the data that the physician needs the most, and makes it available in a usable format. Open APIs are a big part of the solution. The tech industry, regulators, and physicians need to work together to determine how best to create and implement these APIs and related standards.”

Workflow Integration will be Key

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Companies like Validic are helping physicians navigate the still-murky waters of wearables integration. The Durham, NC-based company recently partnered with SAP to enable its enterprise healthcare clients to easily access patient data from wearables, clinical devices, and consumer health apps using Validic’s digital health connectivity tools. Co-founder and CTO Drew Schiller believes partnerships like these will help wearables move past the early days phase they seem to be stuck in.

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“Consumer wearables as a market is still maturing, with only one IPO and a couple of exits,” Schiller explains. “We are still in the early phases of using these devices in healthcare. Given this, it’s unsurprising that there have been challenges getting adoption from providers. The ‘time to drawer’ is a concern, indicating that these devices may not have yet reached full utility.”

“The biggest barriers today have to do with presenting meaningful information in existing workflows,” he adds. “One barrier is that we are still working to understand the applications and necessary reporting mechanisms for healthcare. There are dozens of ongoing pilots, projects, and grant-funded studies looking to address these needs, and organizations like Node Health are working to bring these disparate efforts together in one place and disseminate learnings.”

“I wouldn’t say that categorically certain wearables are more conducive to integration,” Schiller points out. “However, having a single point of entry for all wearable data certainly makes things easier. Additionally, if an endpoint from the wearable already has a classification and a place in workflow, that makes the logistics of implementation much easier.”

The Biggest Impact

Despite their current shortcomings, wearables seem poised for improvement in terms of provider acceptance, ease of use and integration, overall sophistication, and, most importantly, impact on patient care.

“In the immediate term, wearables enable people to take a more active role in their health,” says Reed. “This represents a shift toward prevention instead of treatment once someone is sick. In the longer term, insights powered by mission-specific wearables and apps will be huge for physicians and patients. Patients can use connected devices to help manage chronic conditions like diabetes or complete post-operative physical therapy, all while physicians monitor progress and identify potential risks.”

Moore adds that one of the most critical issues facing the healthcare system is that of the rapidly aging US population. “By 2050, there will be 83.7 million Americans over the age of 65 – that’s more than double the number just four years ago,” he points out. “Eighty percent of them will have at least one chronic condition, and a large portion will live in rural areas far from family members that could offer support. Wearables and apps are key to empowering this population, helping them to live healthier – and independently – for much longer.”

“Looking forward,” he adds, “advanced personal emergency response systems will be wearables packed with sensors and enabled by mobile apps that can track blood sugar, blood pressure, heart rate, biomarkers for medication adherence, and geofencing for Alzheimer’s patients. The sensors in these devices will then connect to a loved one’s phone, a physician’s tablet, and a medical record system. This increasingly connected approach to healthcare will lower costs and empower aging populations to live at home longer.”

Schiller concurs that wearables will be key to helping care for an increasingly elderly population. He also points out that the devices will help make up for the physician shortage we’ve all heard so much about. “We face a generation of physicians preparing for retirement and a dearth of PCP replacements. We simply won’t have the skilled workforce to maintain business-as-usual practices in healthcare. We must better leverage technology to scale reduced healthcare resources with an eye toward preventing sickness before it becomes chronic. Wearables will play a central role in this revolution.”

Present Benefits are Possible

While the revolution is in the works, wearables, for all their documented shortcomings, are capable of offering near-term benefits to physicians and patients. “Those benefits will depend on the supporting infrastructure and tools the health system and/or EHR vendor has put in place,” Schiller says. “For example, Cerner and Meditech have built smart alerting and dashboarding into their patient portals leveraging a growing list of patient-generated data from remote monitoring devices, including wearables. Health systems such as Sutter Health have realized tremendous success with wearables in comprehensive remote patient monitoring programs for chronic diseases like hypertension. Programs like these will help a physician better treat patients by knowing precisely how well or how poorly a patient is progressing in their care.“

“Long term,” he adds, “physicians will benefit from a shift toward preventative and monitoring measures. This will enable PCPs to know how their patients are doing without physically seeing them, allowing them to spend more time with patients who need care the most.”

Time – and the Market – will Tell

“We are currently witnessing Moore’s Law as applied to wearable devices,” Schiller concludes. “Wearables on the market 18 months ago are significantly inferior to the capabilities of those on the market today, and we expect to see another jump in functionality and sophistication within the next six to 12 months. I could make some specific predictions, but it makes sense to instead state more generally that the consumer technology industry will rise above these challenges to make useful, compelling, and practical devices.”

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July 14, 2016 News 1 Comment

Morning Headlines 7/14/16

July 13, 2016 Headlines No Comments

Imprivata Agrees to Be Acquired by Thoma Bravo

Private equity firm Thoma Bravo acquires Imprivata for $544 million, a 33 percent premium over the company’s closing stock price Tuesday.

Evolent Health to Acquire Valence Health, Extending Breadth and Depth of Value-Based Care Offering

Evolent Health will acquire Valence Health for $145 million in cash and stock.

CMS Opens Door to Possible Delay of MACRA Implementation

During testimony before the Senate Finance Committee, CMS Administrator Andy Slavitt says that he is open to postponing the implementation of MACRA to ensure that providers have enough time to prepare.

Healthcare spending growth rate rises again in 2015

Healthcare spending climbed 5.5 percent in 2015 to $3.2 trillion, an increase over last year’s 5.3 percent growth and on par with economist projections.

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July 13, 2016 Headlines No Comments

Evolent Health Will Acquire Valence Health for $145 Million

July 13, 2016 News 1 Comment

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Evolent Health will acquire the majority of Valence Health for $145 million, the companies have announced. The deal, which involves $35 million in cash and the remainder in Evolent shares, excludes Valence’s state insurance cooperative contracts, which will continue to operate under a newly created entity.

Evolent CEO Frank Williams said in a statement, “The addition of the Valence Health business will provide increased scale and client diversification, and we expect it to accelerate our target timeline to Adjusted EBITDA break-even in 2017 by one to two quarters. We believe this transaction will strengthen our business strategically and financially and position it for continued growth well into the future."

Chicago-based Valence Health offers technology and consulting services to providers moving to value-based care. The company last year hired as its CEO Andy Eckert, who had previously served as CEO of Eclipsys, TriZetto, and CRC Health as well as currently serving as board chair of Varian Medical Systems.

Evolent Health, which also offers integrated solutions that help providers shift to value-based care, was formed in 2011 with The Advisory Board Company and UPMC and went public in June 2015. It has a $1.2 billion market cap as share price has risen 3 percent in the year since its IPO.

I interviewed Evolent President and Co-Founder Seth Blackley in August 2015 and interviewed Valence Health then-CEO Phil Kamp (now chief strategy officer) in March 2015.

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July 13, 2016 News 1 Comment

Thoma Bravo To Acquire Imprivata for $544 Million

July 13, 2016 News No Comments

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Imprivata will be taken private by an affiliate of private equity firm Thoma Bravo for $544 million in cash, giving shareholders a 33 percent premium to the last closing stock price.

Imprivata President and CEO Omar Hussain was quoted in a statement as saying, “We’re tremendously excited about Thoma Bravo’s investment in our company and believe this transaction represents a great outcome for our current shareholders. Given Thoma Bravo’s successful track record in both security and healthcare IT, today’s partnership is an endorsement of Imprivata’s corporate vision and our relentless focus on the customer experience — a value which has established us as the vendor of choice in healthcare IT security. We are now in a stronger position to pursue market opportunities through innovating and expanding the products and services we offer.”

Thoma Bravo’s other active healthcare IT investments include Global Healthcare Exchange, Hyland Software, Mediware, and SRS Software. It also owns Bomgar Corporation, which offers remote support and identity management solutions. 

Imprivata offers single sign-on, secure virtual desktop access, patient IT, secure messaging, and two-factor authentication. The company went public in June 2014. Share price has decreased 11 percent since.

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July 13, 2016 News No Comments

Morning Headlines 7/13/16

July 12, 2016 Headlines 1 Comment

Fact Sheet: Ransomware and HIPAA

HHS issues ransomware guidance, clarifying that successful attacks do constitute a reportable HIPAA breach.

United States Health Care Reform Progress to Date and Next Steps

President Obama publishes a data-based JAMA article outlining the impact ACA has had thus far and calling for continued reform efforts to curb costs and improve outcomes.

Dutch hospital’s appeal: No more Pokemon hunting!

The Academic Medical Centre in Amsterdam issued a plea to Pokemon Go players to please stop hunting for the characters within the hospital, a spokesman for the hospital explains “Since yesterday we’ve noticed young people walking around the building with mobile phones into places they’re not supposed to be.”

Quebecers Ahead of Rest of Canada in Use of Digital Health Technology; Still Craving More Solutions

In Quebec, a survey finds that 85 percent of the local population believes that digital health technology will lead to better care, but just 21 percent actually use any digital health solutions.

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News 7/13/16

July 12, 2016 News 2 Comments

Top News

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HHS issues HIPAA guidance for ransomware attacks, saying that a reportable HIPAA breach has occurred if the malware encrypts PHI. The only exception is if the covered entity or business associate can demonstrate that the risk of PHI compromise is low, which would be difficult to accomplish in a ransomware attack.

HHS says a breach has not occurred if the user’s data was encrypted, but with a big exception –  users who are logged into a PC have made the information on their hard drive available during their session, so if that user clicks on a phishing link or opens an infected web page that triggers ransomware encryption, impermissible disclosure has occurred.


Reader Comments

From Geno Petralli: “Re: Xcite Health. A client says they’ve been bought by Athenahealth and the EncounterPro/Xcite Health program will be sunsetted and everyone moved to Athena by 1/10/17.” Here’s Athenahealth’s official response (from the head PR person) to my inquiry about this reader’s rumor:

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A few hours later, I received this “partnership” announcement from Xcite Health, confirming the reader’s statement that EHR/PM vendor Xcite Health is shutting down as of January 10, 2017 and is suggesting that its now-orphaned clients switch to Athenahealth.

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From Roll Liftface: “Re: HIT100 winners. This guy doesn’t appear to have a job beyond self-promotion. Next year you should mock the process by getting your readers to nominate Carrot Top or Prince.” I haven’t heard of at least half of the tweet-happy winners, who seem to participate in a lot of mutual back-scratching among the Twitterati. Twitter isn’t the real world and the job titles of some suggest more success in the former than the latter. I’m sure part of the motivation beyond self-validation is employment, but I think companies would be wary of hiring someone who spends that much time and energy tweeting.


HIStalk Announcements and Requests

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Elementary school librarian Ms. H in Texas created a maker space that we stocked with programmable robots and other technology kits in funding her DonorsChoose grant request. She reports, “The younger students were in awe of this technology! I had a few even say ‘It’s Magic’ and I had to respond ‘No, it’s science!’ I had first graders screaming with joy when they got their Ozobot to follow the path they had created for it.”


Webinars

July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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The Wall Street Journal publishes fascinating factoids about Theranos CEO Elizabeth Holmes, including that her admiration for Steve Jobs (as evidenced by her black turtlenecks) led her to maintain an Apple-like secrecy about company news until the “one more thing” type public reveal. She also hired an Academy Award-winning director to film videos of herself. She is also escorted everywhere by an earpiece-wearing security detail that refers to her as Eagle 1. The article notes that her presentation to the American Association for Clinical Chemistry next month won’t include the information she originally intended since FDA said she couldn’t, so she’s going to instead focus her talk on Theranos company history (yawn). WSJ’s readers always provide insightful comments:

  • Hey, investors in Eagle 1–do you guys really know what you’re doing? Heaven forbid that you actually consult with someone who actually KNOWS SOMETHING about diagnostics.
  • I just hope that this story helps to shed light on the loophole in the law that allowed Theranos to promote tests that were not scientifically validated or to bring a spotlight to the many start-ups that continue to raise funds on the basis of hype and revenue growth, but without any real business plan or hope of profit.
  • This is what the VC’s seemed to really lust after, the idea that Theranos was going to move the bulk of blood testing out of doctor’s offices disrupt LabCorp and Quest as if they were stodgy old taxi companies. Theranos was really an "Uber for _____" and a data hoovering company. How many more clinically relevant (but smaller and less sexy) medical companies could have been funded with the money that was wasted on this?
  • I hesitate to draw any parallels between Holmes and Jobs because Jobs actually built products that worked as advertised.
  • I know a former employee of Theranos. This person got out when they realized this company was all smoke and mirrors. Also, this person told me that the whole Elizabeth Holmes story is all PR driven fluff (boldly dropping out of Stanford, starting the company on her own, etc.). Holmes actually has a lot of political connections in DC and is related to the Fleischmann Yeast fortune. Why are there so many politicians on the Theranos board and very few MDs?
  • It is possible that the famous Reality Distortion Field attributed to Mr. Steve Jobs might have been taken one step too far in this one case.
  • She is working in that exciting grey area between novel scientific breakthrough and scam.
  • Seems "Fake it ’til you make it" doesn’t work with medical technology.

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Protesters picket Washington State clinic operator Zoom because it doesn’t accept Medicare or Medicaid, which the company logically replies is exactly its business model in offering quick, technology-powered local care for which Medicare pays poorly if at all. Protesters, many of them representing unions and those who want universal healthcare, issued a statement saying that population segmentation causes inefficient, lower-quality healthcare. Zoom’s CEO responds, “Don’t think that we have to be all things to all people.”

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Stella Technology acquires Zigron Healthcare to expands its web and mobile app development, ETL, BI, QA, and user experience design services.

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ECG Management Consultants acquires the healthcare consulting division of Kurt Salmon US.

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Emergency medical services software vendor ESO Solutions – which offers an EHR and healthcare data exchange platform — receives a growth equity investment from Accel-KKR.

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I missed this from a couple of weeks ago: investors including Blue Shield of California buy out MeYou Health, which offers behavior modification and social tools for health plan members. The new CEO is Rick Lee, co-founder of the acquired and then failed Healthrageous. MeYou Health company was previously owned by Healthways.

Aprima will consolidate its North Texas offices and 250 employees in Richardson, TX.


Sales

In the UK, Pennine Care NHS Foundation Trust chooses FormFast for its paperless health initiatives.

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Rady Children’s Hospital – San Diego (CA) selects Strata Decision Technology’s StrataJazz for decision support, cost accounting, and contract analytics.

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East Texas Medical Center Regional Healthcare System (TX) chooses Orion Health’s Rhapsody Integration Engine.


People

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Jennifer Karstens (Encore Health Resources) joins Orchestrate Healthcare as area VP.


Announcements and Implementations

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The American Heart Association’s Institute for Precision Cardiovascular Medicine will award 14 data-related grants in the next year and will provide winners access to Amazon Web Services to analyze and share their information. The grants will cover data mining, data methods validation, development of data analysis tools, and fellowships for scientists interested in computational biology training.

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NCQA awards Premier its first Electronic Clinical Quality Measures Certification, verifying its ability to report clinical data for HEDIS and CMS EHR inventive measures.


Government and Politics

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President Obama writes a JAMA paper (bylined as “Barack Obama, JD”) describing the impact of the Affordable Care Act. He describes the decrease in uninsured citizens and the elimination of cost-sharing for preventive services and lifetime coverage limits. He says reform needs to continue via CMMI, ACOs, MACRA, precision medicine, and the Cancer Moonshot. He asks Congress to revisit his original proposal to offer a Medicare-like public plan that would add competition in areas served by a small number of insurers. He also wants Congress to force drug companies to disclose their actual production costs and to give CMS the authority to negotiate prices for expensive drugs. The President warns of the influence of special interest groups:

The second lesson is that special interests pose a continued obstacle to change. We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits. We need to continue to tackle special interest dollars in politics. But we also need to reinforce the sense of mission in health care that brought us an affordable polio vaccine and widely available penicillin.

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CMS announces that the median deductible on marketplace-issued health insurance policies is $850, down from $900 last year, when the subsidies the federal government gave to 60 percent of those policy-holders is figured in. The announcement glosses over the 40 percent of people who bought insurance from Healthcare.gov and state exchanges without federal handouts for their premiums and deductibles, the latter of which for silver-level plans are often the maximum allowed $6,800 for single coverage. As is nearly always the case in the US, the rich and the poor do well at the expense of the middle class.

The Congressional Budget Office calculates that the national debt will rise to 141 percent of the economy’s size within 20 years, eclipsing the previous high of 106 percent that followed World War II. Entitlement programs such as Medicare and Social Security are mostly responsible, along with interest payments on the ever-increasing US red ink.


Privacy and Security

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A hospital in China apologizes to the parents of 6,000 newborns whose nursery videos were stolen by hackers and posted on the Internet. Experts say many website developers in China lack even basic security knowledge, adding that the hackers were probably just practicing their skills since the videos have no value otherwise.

A secretary fired by Jackson Health System (FL) for giving ESPN a photo showing the surgery schedule of football player Jason Pierre-Paul, whose finger was amputated following a fireworks accident last July 4, sues the hospital, claiming she’s had nightmares and headaches following what she says were false accusations. The hospital stands by its decision, saying they have electronic proof that she looked at Pierre-Paul’s chart at least four times and left work early the day the information was leaked. 


Other

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A hospital in the Netherlands asks players of the wildly popular week-old, GPS-powered virtual reality Pokemon Go smartphone game to stop hunting the game’s imaginary monsters on its campus after several of them wander into its restricted areas. AMC’s tweet above translates to, “There is a sick Pokemon in AMC – we will take care of him. We would appreciate your not visiting.” Other businesses are facing similar headaches: a woman demands that a music festival let her daughter on its private property to play, a cafe bans the game because customers were taking up space for hours, and officials expect game-players to be injured or killed by wandering into roadways or onto railroad tracks while absorbed in gameplay. Players have run across dead bodies, been mugged in sketchy areas in the middle of the night, and admitted playing while driving. At least people who usually sit and stare at their phones all day long will finally get some exercise. I’m sure Nintendo / Niantic are quickly plotting ways to monetize their surprise hit, such as charging businesses to host destinations or to allow users to sell accomplishments back and forth, but it will probably be killed off by the next shiny object (a la Words with Friends and Second Life) before they roll something out.

I received an email touting a healthcare IT job site’s newly published “Health IT Stress Report,” which despite being overloaded with cute infographics and lofty yet lame conclusions, is based on only 470 survey respondents whose method of selection and response rate were unstated. That usually means someone stuck a survey on their website and harvested any willing, self-selected, statistically unrepresentative people who felt like filling it out.

In Canada, a survey of unstated methodology finds that only 21 percent of Quebec residents have used online health tools, causing the cheerleading digital health company authors to incorrectly conclude, “leaving 79 percent of Quebecans wanting digital tools that would allow them to take control of their personal health” (apparently the authors reckon that every single Quebec resident wants digital health tools even though they didn’t ask them.) Respondents were a lot more interested in online banking and social media even though they obligingly answered the leading questions offered about interoperability, electronic prescribing, and EHRs.

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Weird News Andy labels this plastic surgeon as “selfieish.” The Ukraine doctor, whose motto is “Love is free, medicine is not,” specializes in breast augmentation and posting selfies and videos taken with his unconscious naked patients on social media. The shameless self-promotion is working – he has a year-long backlog of patients. 


Sponsor Updates

  • Edward-Elmhurst Health (IL) says its physicians are saving two hours per shift by using Nuance’s Dragon Medical One cloud-based clinical speech recognition.
  • Besler Consulting releases a new podcast on the comprehensive Care for Joint Replacement appeals process.
  • ECG Management Consultants will present at the HFMA Region 7 Conference July 18 in Lake Geneva, WI.
  • PMD CEO Philippe d’Offay is spotlighted in a Q&A about secure messaging for providers.
  • Forward Health Group will participate in the National Governors Association Summer Meeting 2016 July 14-17 in Des Moines, IA.
  • Impact Advisors will participate in the “Run to Home Base” fundraiser for veterans on July 25 at Fenway Park in Boston.
  • Glytec CMO Andrew Rhinehart, MD offers an overview of DPP-4 inhibitors.
  • HCS will exhibit at the Health Forum/AHA Leadership Summit July 17-19 in San Diego.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
Contact us.

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July 12, 2016 News 2 Comments

Morning Headlines 7/12/16

July 11, 2016 Headlines No Comments

Impact of computerized provider order entry (CPOE) on length of stay and mortality

A JAMIA study finds a statistically significant correlation between the use of CPOE and a reduction in length of stay and mortality rates.

Under Fire, Theranos CEO Stifled Bad News

The Wall Street Journal reports that Theranos CEO Elizabeth Holmes had planned to present clinical data validating the company’s technology during her upcoming presentation at the American Association for Clinical Chemistry’s annual meeting, but because the necessary studies were not completed in time, she will present a slide deck recapping the company’s 13 year history.

Congress Shouldn’t Pass The 21st Century Cures Act In A Summer Rush

A Health Affairs article calls for the Senate to delay a vote on the 21st Century Cures Act until after its extended election-year summer recess.

The American Heart Association Announces Strategic Collaboration with Amazon Web Services to Advance Precision Cardiovascular Medicine with AWS Cloud

The American Heart Association’s Institute for Precision Cardiovascular Medicine partners with Amazon Web Services to provide cardiovascular researchers with a cloud-based infrastructure to store and share data.

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July 11, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 7/11/16

July 11, 2016 Dr. Jayne 6 Comments

I read with interest the recent alternative certification proposal from John Halamka.

I have a couple of vendor friends who work on the certification process for their respective organizations. They both describe the process as cumbersome and tedious. One of them is a nurse and says she detests the entire process since it forces adherence to rigid scripts rather than testing the actual workflows users are going to need. Those of us who have spent a bit of time implementing systems know there is a significant difference between vendor QA testing (where vendors see if the code that was produced meets the build specifications) and true user acceptance testing, where we see if the code that was produced actually meets the needs of those using the system.

Whenever I assist with running user testing events, I make sure we test features and functionality using a dual approach. Some users will be given turn-by-turn test scripts that target a new workflow component in the context of the larger existing workflow, to ensure that the new pieces don’t adversely impact any other parts of the workflow. We all know about releases that fix one thing and break another, and this seems to be the best way for many clients to catch those kinds of issues.

Another group of users will be given test scripts that are a bit more nonspecific, such as, “Prescribe these three medications, then schedule an appointment for an office visit and send a referral for a mammogram through the portal.” This approach allows us to test new features against the way users actually use the system rather than against a rigid test script.

Users are generally creative. If there’s a work-around to be found or an alternate way to do something, they’ll unearth it. Sometimes those workflows are legitimate – the vendor offers three or four different ways to do something. However, some work-arounds may take advantage of unintended functionality or existing defects, so that that when those seemingly-unrelated defects are fixed, it causes issues with other workflows. You’re generally not going to find those with rigid test scripts since you may not have any way of knowing how creative your users have gotten or what workflows they have come up with.

Of course, testing those kinds of scenarios is far beyond certification, and with as tedious as certification already is, I’m certainly not advocating expanding it. It’s just a shame though that vendors are spending time certifying their products against criteria that have little impact on the actual use of their product.

At the same time, we seem to be lacking in actual usability testing. Although vendors are being pushed to include user-centric design principles in their processes, the outcomes still vary widely. The recent dust-up with Athenahealth’s Streamlined upgrade seems to illustrate this. Judging from the comments I’ve seen and heard, it feels like there may not have been enough user acceptance testing to identify workflow problems that are causing significant issues for a good number of their clients.

Although the comments should be taken with a grain of salt (since it’s difficult to know whether clients attended training, performed testing, whether they were following best-practice workflows previously, etc.) there is always a kernel of truth to be found. I’ve been on the receiving end of enough poorly-conceived or poorly-executed vendor “enhancements” to know that they seem to make it out the door more often than they should.

Sometimes they are the product of good ideas. but the technology doesn’t really make them executable. Sometimes they are enhancements that were created for a single client as a result of a contractual obligation even though they have zero utility for the rest of the vendor’s customer base. Other times they are enhancements that were created for sales purposes, to allow for a glitzy demo that looks good yet doesn’t meet the needs of actual physicians or clinical users. Not only are they unhelpful, but a couple I’ve seen recently are downright insulting to the good sense of the average doc.

In his comments, Dr. Halamka discusses how certification has negatively impacted the industry: “Overly zealous regulatory ambition resulted in a Rule that has basically stopped industry innovation for 24-36 months.” Clients who have waited patiently for their vendors to implement basic usability enhancements know exactly what he’s talking about. Rather than improving the user experience, scarce development dollars were spent meeting the letter of the law for requirements that may never be used. He closes with some profound thoughts that made my day:

If Brexit taught us anything, it’s that over regulation leads to a demand for relief.
Pythagoras’ Theorem has 24 words
Archimedes’ Principle has 67 words
The Ten Commandments has 179 words
The US Declaration of Independence has 1,300 words
The EU regulation on the sale of cabbages has 26,911 words.
As a comparison, the 2015 Certification Rule document has 166,733 words.

Good food for thought for the governmental bodies, agencies, payers, and others whose rules define how we deliver healthcare in the US.

What do you think about excessive rulemaking? Email me.

Email Dr. Jayne.

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July 11, 2016 Dr. Jayne 6 Comments

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