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EPtalk by Dr. Jayne 4/20/17

April 20, 2017 Dr. Jayne 1 Comment

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The Leapfrog Group released the most recent iteration of its Hospital Safety Scores, grading over 2,600 hospitals from A to F. Transparency is a good thing, but I was surprised to see how some of my local hospitals (including a world renowned tertiary care center) fared. In going through the detail, it looks like there were several areas where they declined to report, but another is confusing. They scored low on “specially trained doctors care for ICU patients,” which is funny because they have one of the leading critical care fellowship programs and all patients are cared for by intensivists. The average patient isn’t going to be knowledgeable enough to dissect the rankings. Several smaller hospitals in town received A rankings but I still wouldn’t go there for a cardiac procedure or other specialized surgeries.

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CMS announces upcoming webinars regarding the Achievable Benchmark of Care (ABC) and five-star rating programs. The data will appear on the Physician Compare website, so clinicians should become familiar with what their patients are seeing. I have need of a new specialist, looked up the physician I am considering, and didn’t find any information that helped support (or contradict) my choice. The webinars will be hosted:

I’ve been receiving encrypted summary-of-care records from one of my local hospitals, for patients who used to be mine when I was in traditional family medicine practice. The most recent one was over 145 pages long and contained every single laboratory test performed on the patient, including bedside blood glucose testing performed four times daily. Somehow I’m still listed as the primary care physician of record for this patient, which is surprising because he lives in a group home and has to have orders reauthorized every six months, so he must be seeing someone in the community who should have received this document instead of me. A call to the hospital wasn’t helpful, and I’m planning to call the group home to try to straighten it out myself. I assume that if this data was directly imported to my EHR it would make sense, but as a 145-page PDF it’s pretty overwhelming. The best part of it was the discharge diagnosis: “Recent Acute Hospitalization.”

I recently had lunch with some of my physician colleagues and the recent approval of direct-to-consumer genetic testing was a hot topic. Since I just went through genetic counseling and testing, I decided to investigate the 23andMe process. It’s easy to order the testing package – no more challenging than ordering something on Amazon. However, I got to the “enter your payment information” screen without any mention of some of the critical things that patients should consider before they have genetic testing: Do they have adequate disability and life insurance in place, should something be found? Is there a concern regarding long-term-care insurance? Are there concerns about a specific disease process or does the patient want a “shotgun” approach? I’m not sure the average person is going to think about these things and I would have liked to have seen them at least mentioned before consumers plunk down $199 for a testing kit. I opted to proceed conservatively with my recent testing and only test for a single mutation, which ended up being present. I was able to use the results to justify why I need early screening. I wonder if insurance carriers will accept data from 23and Me to justify early intervention. The panel that they offer to consumers looks a little scattered. I’d be interested to hear from anyone who has had testing with them.

I’ve been working through some continuing education and maintenance of certification (MOC) activities over the last week and have come to the conclusion that sitting for my family medicine board exam next year is going to be more of a challenge than I thought. The MOC activities are making me crazy with their “which is the most appropriate intervention” questions when all of the choices present are appropriate interventions. The definition of appropriate can be nebulous. Which is the most appropriate from a cost/utilization perspective? From a patient satisfaction perspective? From a patient acceptance and compliance perspective? Does the patient have insurance? Are they working three jobs? Determining the appropriate intervention for a given patient takes many more factors into account than statistical minutiae. Is the difference between 28 percent and 33 percent statistically significant enough to merit spending time on analyzing what the right answer is supposed to be?

It’s also particularly challenging for those of us that no longer practice what our board certifying organization considers to be full spectrum family medicine. Although I delivered over 150 babies, the last one was more than 15 years ago, but I’ll still have to field OB questions. Even if I wanted to give up my clinical certification and keep my informatics certification, I can’t do that since informatics requires primary certification from another board. Losing board certification is the kiss of death for insurance credentialing, so if I want to play the game and keep seeing patients, or keep being a board certified clinical informaticist, I’ll need to comply.

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Wisconsin has designated this week as Healthcare Decisions Week and encourages people to complete an advance directive to document their wishes for end-of-life decision making. It’s unfortunately not enough just to have the document, but people need to talk to their loved ones about their wishes and why they have made particular decisions. We had one of these conversations at a recent family gathering and it was instructive, with revelations about what people did or did not want as far as medical treatment and funeral arrangements. As a physician, I’ve seen many arguments about care, and having both the conversation and the documentation is the best way to make sure your wishes are honored. It’s also not just for older people – there are plenty of things that go wrong with routine happenings like childbirth or small elective surgeries, so everyone should be prepared.

Email Dr. Jayne.

Morning Headlines 4/20/17

April 19, 2017 Headlines No Comments

Innovative EHR Platform Brings 11,000 True-life Cases to Med Ed

AMA introduces a web-based EHR training tool developed by Regenstrief Institute that uses records from 11,000 de-identified patients with built-in medical histories going back as far as 40 years. The EHR training platform includes functionality based on Meaningful Use Stage 2 certification criteria so that the workflows will be similar to what residents will see in a hospital setting.

Alphabet will track health data of 10,000 volunteers to ‘create a map of human health’

Alphabet’s life sciences business Verily launches its Project Baseline initiative, a 4-year project aimed at creating a database that will be used to look for early warning indicators for a variety of illnesses. The project will sequence the genomes of 10,000 volunteers and then use an activity tracker to monitor participant’s sleep, activity, heart rate, and other health metrics over the next four years.

Social networks push runners to run further and faster than their friends

A study published in Nature finds that sharing exercise activity over social networks does have a positive influence on the exercise habits of friends.

Health Insurers Make Case for Subsidies, but Get Little Assurance From Administration

At a Tuesday meeting with White House officials, health insurance lobbyists and executives seeking assurances that subsidies would continue to be paid for low-income consumers buying individual marketplace plans, a step seen as critical to stabilizing the individual markets, were given no assurances and were instead told to take the matter up with Congress.

Morning Headlines 4/19/17

April 18, 2017 Headlines No Comments

Theranos Reaches Resolution with Centers For Medicare & Medicaid Services

Theranos settles its ongoing legal battles with CMS over unsafe practices at its Newark and California labs, agreeing that it will not own or operate a clinical laboratory for the next two years in exchange for reduced monetary penalties.

Arizona Attorney General Reaches Settlement With Theranos

Theranos also settles its legal battles with Arizona Attorney General, agreeing to issue a full refund to all 175,000 Arizona residents who received Theranos blood tests.

Increasing Access to Care for Phoenix Veterans

The Phoenix VA Medical Center will partner with CVS to expand coverage locations to include local MinuteClinics.

Cardinal Health’s $6.1 billion deal for Medtronic unit ignites debt concerns

Cardinal Health announces that it will acquire Medtronic’s Patient Care, Deep Vein Thrombosis and Nutritional Insufficiency businesses for $6.1 billion in cash.

News 4/19/17

April 18, 2017 News 1 Comment

Top News

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Tail tucked between its legs, Theranos agrees to exit from the lab-testing business for two years as part of deal with CMS that will reduce its fine to $30,000 and reinstate its operating certificates. What’s left of the company’s employees are supposedly “looking forward” to helping Theranos work with regulators to commercialize its miniature lab-testing device.

Theranos also settles its legal battles with the Arizona Attorney General, agreeing to issue $4.65 million in refunds to all 175,000 Arizona residents who received Theranos blood tests over the last four years.


Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

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


Announcements and Implementations

Livongo Health will add Glytec’s EGlycemic Management System to its line of digital diabetes management tools.

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Lancashire Teaching Hospitals NHS Foundation Trust in the UK adds integrated medication management to its implementation of Harris Healthcare’s QCPR EHR. Like all NHS facilities, Lancashire Teaching Hospitals hopes to go paperless by 2020.

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Prime Healthcare ACO (CA) implements population health analytics and benchmarking from Persivia to assist its 70 practices with 2016 reporting requirements.

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Grays Harbor Community Hospital (WA) will continue its use of CipherHealth’s post-discharge patient engagement technology and protocols after a four-month pilot that saw patient satisfaction increase and hospital readmissions decrease.


Acquisitions, Funding, Business, and Stock

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HCA reports Q1 results: Revenue climbed to $10.6 billion compared to $10.2 billion in Q1 of 2016. However, net income dropped from $694 million to $659 million over the same time period; EPS $1.74 vs. $1.69. Revenue and net income missed analyst estimates, sending share prices down yesterday 3.6 percent.

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UnitedHealth reports an increase in revenue and profits after exiting from the ACA exchanges. It expects a $3 billion increase in revenue over 2016, and a net income of $2.17 billion. The company predicts EPS will increase to between $9.65 and $9.85, compared to last year’s $9.30 to $9.60.

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Mid-Columbia Medical Center (OR) attributes last week’s round of layoffs – its first in 20 years – to budgetary pressures related to its transition to Epic, as well as fewer patient visits during harsh winter months and uncertainty around Medicaid and Medicare reimbursements.


People

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Kevin Hill (Leidos) joins Orchestrate Healthcare as area VP Southeast.

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BJC HealthCare (MO) hires Jerry Fox, Jr. (Rockwell Automation) as SVP and CIO.


Sales

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Wake Forest Baptist Medical Center signs a seven-year contract with Atlanta-based NThrive for outpatient RCM services.


Government and Politics

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The VA awards Leidos company Systems Made Simple a potentially $29 million contract for IT development and support of its Repositories Program, which helps facilitate the sharing of health data between the VA, DoD, and other agencies. Leidos acquired Systems Made Simple as part of its $4.6 billion acquisition of Lockheed Martin’s IS and global services business last year.

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A Black Book report evaluating Epic, Cerner, Allscripts, Meditech, and Athenahealth says Cerner is the best EHR vendor to replace VistA within the VA. The market research firm based its findings on customer satisfaction and how well each vendor’s offerings line up with the VA’s requirements. Allscripts and Epic round out the top three choices. The DoD, as you may recall, has opted to replace its AHLTA system with Cerner’s EHR. Fairchild Air Force Base went live in February; a full roll out is expected within the next four years.

The Air Force rebrands its MiCare patient communications portal to TOL Patient Portal Secure Messaging – the same name used by Army and Navy facilities.

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The Phoenix VA Health Care System partners with CVS Health to increase access to care for veterans. Phoenix VA nurses can now refer patients to local MinuteClinics as part of the Veterans Choice Program. CVS entered into a similar arrangement with the Palo Alto VA HCS last year.


Privacy and Security

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Erie County Medical Center continues to recover from a virus that shut down its IT systems April 9 – a process that has involved returning to paper charts; scrubbing 6,000 hard drives; and enlisting the help of IT specialists from neighboring Kaleida Health and Catholic Health, its EHR vendor, Meditech, GreyCastle Security, and Microsoft. The hospital has yet to confirm it was the victim of a ransomware attack.

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From DataBreaches.net:

  • Virginia Mason Memorial (WA) notifies 419 ER patients that their medical records had been improperly accessed over a three-month period last year by 21 employees. “We believe this to be a case of snooping, or individuals who were bored,” says Chief Compliance and Privacy Officer Trent Belliston. “[There is] no evidence that the information’s being used in an improper way.”

Other

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The HHS Idea Lab previews Health Datapalooza, which will take place April 26-28 in Washington, DC, and include the launch of challenges related to patient matching and health behavior data.


Sponsor Updates

  • Besler Consulting releases a new podcast, “Episode Payment Model final rule explained.”
  • KLAS includes Casenet’s TruCare platform in “Best in KLAS for Care Management Solutions” for 2017.
  • Cumberland Consulting Group will sponsor and present at the Model N Rainmaker Conference April 24-26 in Miami.
  • ECG Management Consultants will present at The Governance Institute – Leadership Conference April 23 in Scottsdale, AZ.
  • Elsevier Clinical Solutions makes available a HIMSS presentation featuring BIDMC CIO John Halamka’s thoughts on the future of health IT.
  • EClinicalWorks will exhibit at the MPCA Spring Symposium April 19-20 in Helena, MT.
  • HCS will exhibit at the NALTH Spring Clinical Education & Annual Meeting April 20-21 in San Antonio.
  • Huntzinger Management Group’s Tanya Freeman joins the AEHIA Board of Directors.
  • Conduent’s pharmacy benefit management module, Conduent Flexible Rx System, receives federal certification in the state of Montana.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Morning Headlines 4/18/17

April 17, 2017 Headlines 2 Comments

Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Proposed Policy Changes and Fiscal Year 2018 Rates

A new rule proposed by CMS would relax CQM reporting requirements for eligible hospitals.

Cerner Tops Shortlist of Vendors to Replace VA’s Outdated EHR

A Black Book report evaluating Epic, Cerner, Allscripts, Meditech, and Athenahealth says Cerner is the best EHR vendor to replace VistA within the Department of Veterans Affairs.

HCA Previews 2017 First Quarter Results

HCA reports Q1 results: revenue climbed to $10.6 billion compared to $10.2 billion in Q1 of 2016, however net income dropped from $694 million to $659 million over the same time period, EPS $1.74 vs. $1.69. Revenue and net income missed analyst estimates, sending share prices down 3.6 percent Monday.

An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard

A JAMIA study on dashboard-based support tools aimed at reducing 30-day all-cause readmissions for heart failure finds that readmission rates were pushed downward from a 14 percent baseline to 10.1percent after the implementation of dashboards.

Curbside Consult with Dr. Jayne 4/17/17

April 17, 2017 Dr. Jayne 2 Comments

Several of my friends in medicine, engineering, and other high-tech fields participate in decidedly “traditional” craft projects in their leisure time. I’ve got a handful of friends who make soap, and many others who knit, crochet, quilt, sew, cross stitch, needlepoint or do woodworking, stained glass, or paper crafts. I see a fair amount of people at professional conferences who are knitting or crocheting during sessions. I have a lot of respect for them, because those are two skills I can’t master. My grandmother tells me I used to be a proficient knitter as a child, and even made a set of golf club covers, but based on recent attempts to master knitting I can’t imagine how the club covers came to be, despite the fact that one or two of them are still in my garage.

Except for the yarn-related projects, several of my friends use technology to augment their abilities. When you spend a good chunk of your life pursuing a professional career, there’s not a lot of time to build leisure/hobby skills. Many of us spent our teens trying to get into competitive colleges, then our college years trying to get into graduate programs, etc. If we’re physicians, we may have a three to seven year “black hole” called residency in our lives from which no free time escaped. Now that we have leisure time, we want to be able to make cool-looking projects without waiting years to hone our crafts.

Over the past year, I’ve gotten deeper into a hobby that requires a bit of computer assistance, and it’s been a great stress reliever as well as a lot of fun. I’ve met some great people, several of whom are former healthcare types who have gone into the hobby as a business in part to get away from the stress of healthcare. There are also some former teachers, who are happy to take relative youngsters under their wings and point us in the right direction. Being in a competitive “day job” world where collaboration isn’t always valued, it’s been great to have people I can call or text when I get stuck or need a few tips. Thank goodness for the night owls, who are up crafting past midnight just like I am.

Over the past month or two, though, I’ve seen several parallels to healthcare IT. The equipment I purchased to do my hobby work is from a manufacturer that dominates the market. They value their customers and understand that the work that they do is a big part of what has built their reputation as a vendor. They’re a company that started from small-town roots and grew by word of mouth and then regionally, and now have customers all over the world. They also know they have people hooked, and that the cost to change to another vendor would be significant, not only from the equipment standpoint but due to downtime, lost knowledge, etc.

Every couple of years, they issue a major software release. I came into the market in 2016 on what was then the latest and greatest software, which honestly I have very few complaints about. More than 90 percent of the time when I’ve run into trouble, it’s been due to user error or some other problem between the keyboard and the chair. Still, I am looking forward to the new software and the potential that it might bring, especially as a relative newbie to the hobby. In releasing the new package, the vendor took a couple of departures from its previous practices but that from my IT viewpoint are pretty common place. They released a list of hardware specifications required for the new software. They also distributed a beta version to the client base, along with a list of features and enhancements, and a list of known issues. They gave clear direction that formal training would not occur until general release, and set up a process for reporting defects.

As in informaticist, I followed this process closely, particularly with regard to how the end users would adapt to this. Most of the end users are in their 50s or 60s, and many began the hobby in a non-automated fashion, transitioning to automated methods when they became available. In so many ways it parallels what we see in healthcare IT. I wanted to understand how they would react to change and what similarities or differences there would be from clinical end users. I belong to a couple of independent online support groups, as well the vendor-sponsored blogosphere, so I could see the dialogue in multiple venues.

It’s been surprising how similar the user psychology is to what we see when we’re talking about an upgrade or update to an EHR system. The user community is going through the cycle of grief, lamenting the process even though they’re being allowed to stay exactly where they are, if they want, without penalty. The vendor is committed to supporting every user on every version across the globe, which is largely unheard-of in the world of certified healthcare IT. And yet, people are yelling that the sky is falling, despite the fact that they don’t even have to change at all. I’ve worked with users who have been on the same old software since 1998 and they produce beautiful work that I couldn’t even dream of creating with brand new equipment. They’re efficient, productive, and creative yet are balking at the mere idea of an upgrade that they might have to or want to consider.

The biggest issue is the hardware requirements – the vendor is requiring that users move to a vendor-supplied PC to drive their hardware, which probably 80 percent of the customer base is already on. For those who don’t want to upgrade, they can stay right where they are and be supported, or they can buy the latest and greatest. There has been a great deal of angst among people who don’t understand the difference between Windows XP, Vista, 7, 8, and 10, and also some outright resistance to knowledgeable individuals who try to explain the difference and the various benefits of upgrading. At times, when I read the conversation threads, I feel like I’m right back in healthcare IT.

I’m not a huge fan of installing beta software, especially for a hobby at which I’m just becoming proficient. I decided to wait for the general release, until I had the opportunity to attend a class fairly close to home. One of the certified vendor trainers was going to be an hour and a half away, so I decided to go despite wanting to have my first look be a GR version. The class was an all-day affair, and again, I looked at the parallels to healthcare IT. At Big Hospital, providers balked when we asked them to be out of office for a half day to learn about a pending upgrade, even though it was going to change their workflow and they’d benefit from formal training. Many tried not to go and the decision ended up haunting them. Instead, I was surrounded by people who chose to close their businesses for a day to learn the latest and greatest, or to at least see what it had to offer them. Despite the turmoil on some of the online communities, in person people were very reasonable and willing to learn. How different would some of our EHR upgrades be if we had people willing to put in enough time to learn about software changes?

In addition to learning about the upcoming changes, one of the greatest benefits of going to training was meeting new people and creating new networking opportunities so that I can be better at what I’m trying to do. The same benefits could come from EHR training, if we could get people to acknowledge that just because it has to do with the EHR it’s not inherently undesirable. I met some serious super users who were happy to share their knowledge with a new user, and also learned some tips and tricks that I can do immediately without waiting for the upgrade. I was also gratified to learn that I must not be the only person making a mistake I make commonly, because the vendor has tweaked the software to reduce the impact of that particular workflow issue. Like many EHR vendors, they’ve also done a fair amount of usability work (some very formal, according to our instructor). Where people were surprised by the seeming blandness of the user interface, the instructor explained why they did it the way they did, and how other features were added to address users with low vision or other functional limitations.

If I wasn’t experiencing some serious déjà vu then, I really was when she mentioned that it wasn’t just an update of the workflows, that they had completely gotten off their old code base and had rewritten the program on a new platform. Then we launched into a discussion about making sure you are on the right version of the .NET framework, and I knew I had truly fallen down the rabbit hole. I did walk away from the experience with some new ideas about how to train and how to reduce anxiety for end users, which will translate nicely from the craft space to the healthcare IT space. I met several professional educators who experience similar challenges as I do, that I can stay in touch with ongoing. I got some great ideas about different ways to use my equipment, and some workarounds that I had never thought of for sticky situations.

All in all, it was a good opportunity to see that what we deal with in healthcare IT isn’t as unique as we think it is. Sure, there are some nuances, but there is a lot we can learn from other industries, processes, and people. What’s your favorite craft project? Email me.

Email Dr. Jayne.

Morning Headlines 4/17/17

April 16, 2017 Headlines No Comments

Electronic POLST Puts End-of-Life Wishes in the Patient’s Hands

In New Jersey, a program is being launched to move the documentation of end-of-life care decisions off of paper and onto a state-wide database that will integrate with EHR systems in use across the state’s hospitals.

RWJBarnabas CISO Rethinks Cybersecurity for Age of Connected Medical Devices

The Wall Street Journal profiles RWJBarnabas (NJ) CISO Hussein Syed and his approach to maintaining the network security across his organization’s 12 hospitals, 250  clinics, and 75,000 devices.

Where medical marijuana, health IT, and personalized medicine may intersect

The Advisory Board outlines the implication medical marijuana legalization is having on care delivery, and the potential role health IT will have in educating providers on the appropriate strains, dosages, and methods of ingestion.

A Boy’s Life Is Lost to Sepsis. Thousands Are Saved in His Wake

The New York Times reviews 5-year results from a program in New York State aimed at improving early detection of sepsis in hospitals. The program has resulted in a 21 percent decline in mortality among adults, but showed no decline in pediatric mortality.

Monday Morning Update 4/17/17

April 16, 2017 News No Comments

Top News

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The FDA issues a warning letter to St. Jude Medical – acquired by Abbott Laboratories in January – for failing to respond to cybersecurity vulnerabilities that could allow a hacker to control implanted devices remotely and for failing to address battery issues that have been linked with two deaths. The warning comes three months after the FDA issued a similar notice warning St. Jude of the vulnerabilities. Further inaction could result in disciplinary actions that include “seizure, injunction, and civil monetary penalties.”


Reader Comments

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From Athenahealth Spokesperson: “Re: ‘Will Athena be able to deliver, on time, for hospitals MU3?’ Athenahealth offers cloud-based revenue cycle and financial management, EHR, patient communication, and care coordination services for community hospitals. All of these services are on one platform, AthenaNet, which enables a single patient chart and a seamless Athena “look-and-feel” across the health system – inpatient, ED, outpatient, clinic, and ancillaries. The RazorInsights platform has been completely sun-setted. As of December 2016, we have over 90 contracted hospital clients, of which 35 are live on all or a portion of our AthenaOne for Hospitals & Health Systems service. These organizations are already seeing tangible results. For example, our clients saw an average of 106.5 percent of patient collections as a percentage of baseline during 2016. Stage 3 Meaningful Use is optional in 2017 and mandatory in 2018.  Currently, AthenaClinicals for Hospitals & Health Systems is a 2014 Certified EHR Technology (CHERT), which allows our clients to pursue Stage 2 Meaningful Use this year.  We plan on achieving 2015 CHERT status, which is required for Stage 3, in the second half of 2017.  Thanks to our cloud-based platform, we can deploy the Stage 3 update to our entire client base overnight. All of our Meaningful Use services – a certified platform, real-time performance insight, performance coaching, and attestation – are included in our percentage of collections pricing. Our clients don’t have to pay hefty upgrade fees or endure cumbersome upgrade rollouts. Our results prove that our model works: 95.7 percent of our hospital clients successfully attested for Stage 2 Meaningful Use in 2015.  We expect similar results for 2016, which will become available in the coming weeks.”


HIStalk Announcements and Requests

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Just over a third of poll respondents teeter on the edge of full-blown enthusiasm for using at-home genetic testing kits to better understand their hereditary health risks. An almost even number of people are as eager to order their spit kit as are to likely not. No matter how you slice and dice the results, they are likely music to 23andMe’s ears – not to mention known competitors and those contemplating moving into it. MPW says, “I utilized their service a few years ago when some members in my family were testing positive for the same genetic abnormality, and have had no regrets. One thing to remember if you’re looking into this is that discovering a propensity for a trait does not mean it is an eventuality. For example, I’m listed as likely lactose intolerant. However, my Wisconsin roots and love for almost all things dairy says otherwise.” MineoPie explains that, “I voted ‘highly likely’ as my practical side sees the opportunity to plan appropriately whether that be treatment, an increase in health, life or long-term care insurance, or general peace of mind. There is also the potential to share these risks with my children for their own well-being. While I vacillate between this view and the one where I stick my fingers in my ears while yelling ‘la la la I can’t hear you,’ I ultimately see more benefit in having the data. Then I read the response from ‘no name’. I certainly share the concern that any negative results will not be proprietary leading to increased insurance costs and general shunning. I’m reminded of the Monty Python & The Holy Grail scene (‘I’m not dead yet, I think I’ll go for a walk’). Perhaps I’m more on the fence that I realized.” Barbara, on the other hand, thinks that “the public availability of this information will be used as a detriment in the future, i.e. insurance rates will go up, misinformation will be provided by targeting populations through Google/Facebook adds, etc. Not to mention the lack of professional interpretation resulting in self diagnosis, which could result in personal hysteria. This has already been evidenced with the advertising of medications and patients demanding of their physicians they be given this new, wonderful medication that may not be suitable for their situation. This should be done professionally where confidentiality is supported by both federal and state laws. No Name takes an even dimmer view: “I wish I trusted my government and insurers more, but don’t. I am now retired, but if I were still working, I don’t think I’d trust any employer to not use this info to possibly discriminate against employees who might prove to be high risk. Yep, that’s just the way it is.”

New poll to your right or here: Have you ever volunteered to be bumped from a flight? Share your circumstances – and the cash value you finally jumped at – by leaving a comment after voting.


This Week in Health IT History

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One year ago:

  • CMS launches the Comprehensive Primary Care Plus model, a value-based payment program that will give PCPs more financial flexibility when caring for the chronically ill.
  • Epic wins $940 million in its trade secret lawsuit against Indian IT firm Tata Consultancies.
  • VA CIO LaVerne Council says she will unveil plans for a “new digital health platform” to replace VistA.
  • Intermountain Healthcare will partner with the University of Utah and several other organizations to create a joint security center focused on thwarting cybersecurity attacks.
  • Federal regulators propose banning Elizabeth Holmes from the blood-testing business for two years after Theranos fails to correct serious problems discovered at its California lab.

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Five years ago:

  • The DoD Inspector General finds that drug abuse among Marines in the Wounded Warrior Battalion at Camp Lejeune, NC is hard to detect because of EHR shortcomings.
  • 3M acquires CodeRyte.
  • HHS proposes a one-year delay for ICD-10 compliance, pushing the deadline to October 1, 2014.
  • Verizon announces a relationship with NantWorks to create the Cancer Knowledge Action Network.

Weekly Anonymous Question

Last week, I asked readers what passion they’d pursue given enough free time and money:

  • Play music … all acoustic band.
  • Dog rescue and fostering 24/7. I would get property and have a place to foster many dogs; and would collect codified data regarding the adopters/adoptees to be able to identify traits of good dog/person pairings.
  • Ride coast to coast on a motorcycle.
  • Create a business-school partnership to encourage additional learning opportunities for math and critical thinking; incorporate local in-person and online virtual mentoring.
  • Travel the world, meeting people from all different walks of life, and seeing the beautiful landscapes of our planet. I also would love to do something to help those in need, so maybe a nonprofit that combines my dream to travel and also takes disadvantaged children on these adventures. Having fun with them and seeing their reactions to experiences like that would bring me such joy!
  • Build community gardens in areas where fresh produce is hard come by.
  • I would do more volunteer work. And make quilts – a lot of quilts.
  • Instead of having one in five kids in the US go to sleep hungry at night, I would work to drive that number to zero.
  • Roadside BBQ stand. It’s done when it’s done and it’s gone when it’s gone.
  • When I grow up, I want to be a photographer. I would love to travel the world snapping pictures of whatever comes my way.
  • Traveling to the best restaurants around the world and return to food blogging. I had to quit my blog last year (after a six-year run) due to cost and limited time.
  • Finish that novel, get it out there. Write another one.
  • Art. Art. Art. Nothing but painting, drawing, sculpting, weaving … and gardening. All things visually creative that require getting my hands dirty!
  • I’d follow my favorite bands around the world.
  • Music. That’s been the dream ever since I started playing guitar at age 12. I knew it had a chance since I can play almost every rock/blues song that I hear just by ear, but a) I never found the right band and b) my desire to secure a career somewhere besides McDonald’s led me to attend college and get a "real job" as opposed to rolling the dice and heading from the North Country out to LA a la Neil Young. That doesn’t seem to work out as well in the 21st century as it did in the mid 60’s. I still do some local gigs on occasion and play everyday; it will always be my number-one passion.
  • Photography – Weird News Andy
  • Attending as many music festivals as I could across the US and when I feel that is fairly complete, move on to Europe, Australia, etc.
  • Coaching people on living a more balanced life to have time with friends and family, and to look after emotional, physical, and spiritual needs.
  • Building and promoting a not-for-profit, nationwide health IT co-op.
  • Rock and roll guitar. What else could there be?
  • Space travel.
  • Hosting international yoga and wellness focused retreats.
  • Right now, a free weekend to relax and read a non-technical book and some time to travel and see some new places sounds pretty good, albeit mundane. The list of top 50 restaurants in the world just came out and a checking out a new one every week would be fun.
  • Cruising around the world.
  • I’d help patients learn how to be informed advocates for their own healthcare and the health of their family and friends.
  • Coding! Python, SQL, JScript and everything in between. Nothing like coding to keep your mind sharp and busy. And I do have the time and money to do it, so I do it and love every moment of it. Strongly recommended.

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This week’s question: What’s the most patient-endangering IT issue you’ve personally seen?


Last Week’s Most Interesting News

  • NextGen will acquire Entrada in a deal worth $34 million.
  • The White House finalizes its rules aimed at stabilizing the individual marketplaces.
  • Erie County Medical Center (NY) returns to paper after a virus brings down its network.
  • United Airlines suffers financial loss and extreme PR backlash after dragging a physician, later hospitalized, off a flight.
  • India-based provider appointment-scheduling vendor Practo lays off 10 percent of its workforce.

Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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


Acquisitions, Funding, Business, and Stock

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EncounterCare Solutions wraps up the sale of its telemedicine and chronic care management operations to IGambit, which plans to market the services under the HealthDatix brand.

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Salt Lake City-based Collective Medical Technologies announces plans to hire nearly 600 people over the next eight years. The company specializes in real-time care management tech for EDs.


People

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Natoshia Erickson (Washington Health Benefit Exchange) joins Royal Jay as senior manager of solution delivery.


Announcements and Implementations

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Trinity Health (MI) expands its home health telemedicine program, powered by technology from Vivify Health, to six additional states.

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Miami Children’s Health System will work with telemedicine hardware and software vendor Tyto Care to expand its MCH Anywhere virtual consult services.


Decisions

  • Indiana Regional Medical Center (PA) will switch from MEDITECH to Cerner On May 1.
  • Sierra Vista Hospital (NM) will switch from Evident (a CPSI company) to Athenahealth on July 1.
  • Van Wert County Hospital (OH) Human Resources will go live with Infor this year.
  • Cameron Memorial Community Hospital (IN) Human Resources will go live with Oracle in 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


Other

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New Jersey Hospital Association President and CEO Betsy Ryan and NJ Dept. of Health Commissioner Cathleen Bennett attempt to drum up interest in the forthcoming statewide roll out of the electronic Practitioner Orders for Life-Sustaining Treatment program. The initiative will convert the state’s paper-based, end-of-life planning documents for patients to a digital format, and give physicians access to the documents via a Web-based portal.

Here’s Part 4 of the top 10 HIS vendors report from Vince and Elise.


Sponsor Updates

  • T-System will exhibit at EDPMA 2017 Solutions Summit April 25-28 in San Diego.
  • TierPoint will host a grand unveiling of its newest Chicago data center April 27.
  • TransUnion publishes, “Revenue Cycle POS and High-Risk Patient Toolkit.”
  • ZeOmega publishes a case study highlighting how a large health system implemented Jiva HIE to connect 36 disparate EHR systems.
  • ZirMed publishes a new ebook, “3 Ways to Take Control of Your Contacts.”
  • ClinicalArchitecture makes donations to Boy Scouts of America, Casa de los Ninos, and Compassion International on behalf of HIMSS17 contest winners.
  • STAT profiles GE Healthcare CEO John Flannery.

Blog Posts


Contacts

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

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Morning Headlines 4/14/17

April 13, 2017 Headlines No Comments

NextGen Healthcare Announces Agreement to Acquire Entrada, Inc.

NextGen will acquire mobile physician documentation and communication technology vendor Entrada in a deal worth $34 million.

White House finalizes ACA rule to strengthen individual market

The White House finalizes its rules aimed at stabilizing the individual marketplaces, introducing insurer-friendly provisions that limit when consumers can gain coverage outside of open enrollment periods, while shifting authority to states to determine whether health plans have adequate provider networks, and allowing insurers to refuse to cover persons who haven’t paid their premiums.

FDA warns Abbott on heart device battery woes, cybersecurity risks

The FDA issues a warning letter to St. Jude Medical of failing to respond to cybersecurity vulnerabilities that could allow a hacker to control implanted devices remotely and for failing to address battery issues that have been linked with two deaths.

UC Berkeley challenges decision that CRISPR patents belong to Broad Institute

After winning its patent case in the EU patent courts, UC Berkeley appeals its recent CRISPR patent loss to Broad Institute of MIT and Harvard here in the US.

News 4/14/17

April 13, 2017 News No Comments

Top News

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Quality Systems subsidiary NextGen Healthcare will acquire mobile physician documentation and communication technology vendor Entrada in a deal worth $34 million. NextGen President and CEO Rusty Frantz says the company will focus on expanding Entrada’s capabilities.


Reader Comments

From Bob Oakley: “Re: Allscripts dbMotion. I no longer have a horse in this race, but feel compelled to write as I weathered the introduction of CareInMotion – including being miscategorized by KLAS. Setting expectations – this will hit about three or four of your bad branding hot buttons. You indicated that it was part of the Care Management population health platform, when it should have been identified as the CareInMotion population health platform. The confusion is not surprising, as CareInMotion (egregious capitalization not withstanding) is trying to corral several disparate applications under one brand, while working to create the common backbone necessary for it to be the platform it’s purported to be. Contributing to that is that the word Care prepends several legacy applications under the brand, including Care Management (the legacy ECIN utilization management, discharge planning, and referral management application). It is definitely confusing. I wish it weren’t, but its use is only a little over a year old and the dbMotion Azure announcement is heartening that the platform is being realized.”

From HIT User: “Re: Athenahealth. Athena seems to be making a lot of traction in the acute care space. This seems to mostly be to the attractiveness of their percentage of collections model for smaller hospitals that cannot afford most EHR price tags. What offering are they really providing to hospitals? Is it fully vetted or half-baked with RazorInsights hodgepodged with their ambulatory system? I see they are just now certifying this for Stage 2 per the CHPL site. Will they be ready by Stage 3 with all of the customers they are trying to reign in? I heard of one site – Cottage – that was delayed over a year from original anticipated go live (into the middle of 2018) for an install. Will Athena be able to deliver, on time, for hospitals MU3?”


Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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


HIStalk Announcements and Requests

This week on HIStalk Practice: CMS awards United Way of Greater Cleveland a $4.51 million grant to help it create an Accountable Health Communities Model. Thirteen people from three clinics are busted for their roles in a $24 million multi-clinic pill mill and fraudulent billing conspiracy. Physicians seem to favor faxes and phones over e-prescribing tech. Researchers determine community physicians are less likely to order unnecessary tests than their hospital-based counterparts. Dean Dorton acquires Metro Medical Solutions. Craft Behavioral Health Practice Manager Cara Farooque shares the challenges her practice faces in vetting technology for security and privacy controls. CareSync goes after customers for back payments. OCR gives Metro Community Provider Network a $400,000 slap on the wrist. ChenMed’s Jessica Chen, MD and Denise Hatzidakis offer insight into building and using IT for value-based primary care for seniors. Sign up for physician practice news here.


Acquisitions, Funding, Business, and Stock

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Caradigm announces that it will reduce its workforce as part of a reorganization that it hopes will streamline operations. “GE Healthcare is committed to supporting the Caradigm team as they continue to evolve, positioning themselves to develop digital solutions for better outcomes in population health,” says Charles Koontz, chief digital officer, GE Healthcare. The company went through similar motions last fall, reorganizing product teams and its Services organization.

Sansoro Health raises $5.2 million in a Series A funding round led by Bain Capital Ventures. The Minneapolis-based company, which has raised $6.4 million so far, has developed a data integration tool for digital health apps and EHRs. It won the Venture+ Forum startup contest at HIMSS16.

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Austin, TX-based healthcare cloud vendor ClearData raises $12 million, bringing its total funding to $55 million since launching in 2011.


Announcements and Implementations

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Freeman Health System (MO) implements Access e-form and electronic signature software.

Kroger pharmacies connect to the Michigan Automated Prescription System with help from Appriss Health, which is helping the state develop and launch a new prescription drug monitoring system. Kroger expects to start sharing PDMP data between Michigan, Indiana, and Ohio within the next several weeks.


People

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Verscend Technologies hires Chris Coloian (Welltok) as SVP of revenue and growth, and Michael Kapp (WellPoint) as SVP of government services.

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Former State of Minnesota CIO Scott Peterson joins Avalere as VP of data architecture.


Technology

AMD Global Telemedicine updates its Agnes Interactive software to offer improved EHR integration.

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Iron Bridge develops a portal to help providers query and submit data to public health registries.

Intermedix adds Web and mobile form configuration and management capabilities to its EMS patient-tracking software.


Sales

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McPherson Hospital (KS) will implement EHR and RCM software and services from CPSI subsidiaries Evident and TruBridge.


Innovation and Research

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Final Frontier Medical Devices wins a $2.6 million Qualcomm Tricorder XPrize for its efforts to develop a diagnostic device for multiple ailments akin to the one used in Star Trek. Runner-up Dynamical Biomarkers Group will take home $1 million for its attempt at developing a lightweight tool that can diagnose 13 ailments and measure five vital signs at the same time. XPrize organizers will use what’s left of the original $10 million purse to help both teams develop their devices. The Roddenberry Foundation, organized by Star Trek creator Gene Roddenberry’s son, has pledged an additional $1.6 million to the effort.


Government and Politics

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The VA launches a website aimed at helping bring transparency to access and quality across its facilities. Patients can look up same-day availability, average appointment wait times, satisfaction scores based on those times, and hospital and outpatient compare data.

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CMS issues a final insurance market stabilization rule. The 139-page rule, set to take effect next year, will, among other things, cut the enrollment period in half, allow lower minimum coverage requirements, and put health plan physician networks in the hands of the states rather than the federal government. CMS Administrator Seema Verma admits that, “While these steps will help stabilize the individual and small group markets, they are not a long-term cure for the problems that the Affordable Care Act has created in our healthcare system.”

Meanwhile, in an effort to draw Democrats to the healthcare policy negotiation table, President Trump threatens to withhold payments to insurers meant to cover discounts for low-income consumers, explaining, “I don’t want people to get hurt. What I think should happen—and will happen—is the Democrats will start calling me and negotiating.”

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The VistA replacement saga continues as the VA issues a request for information on a commercial, SaaS-based replacement that would enable – eventually – easy updating across the entire system. Vendors have until April 26 to submit their proposals for streamlining the 130 variations of the system and migrating them to the cloud.

The Vancouver Island Health Authority decides against suspending the CPOE feature of its IHealth EHR as originally announced in February. Government officials claim the $174 million Cerner system, which has earned a fair amount of media coverage based on end-user concerns with patient safety risks and documentation quality, is too intertwined with other systems and workflows to be taken offline, even temporarily. This may be a decision that pushes some nurses over the edge: A British Columbia Nurses Union survey found that 32 percent of RNs had seriously considered leaving or retiring because of the software.


Privacy and Security

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Erie County Medical Center (NY) returns to paper after a virus brings down its network early Sunday morning. A hospital spokesman refused to comment on speculation that the virus was actually a ransomware attack, and if it had been contacted by hackers or asked for payments to restore access. ECMC hopes to have patient data available today and its IT systems fully restored by Saturday.


Other

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The Leapfrog Group launches a calculator designed to illuminate the impact medical errors have on an employer’s covered population. The calculator estimates the number of avoidable deaths among covered lives, how much employers spend annually due to medical errors within general acute care hospitals, and how much of their total health care spend goes to these medical mistakes.

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A local media outlet publishes a nicely written profile of Epic founder Judy Faulkner. Some HIStalk readers may not know that Faulkner’s mother Del, who graduated high school at the age of 15, received a Nobel Peace Prize in 1985 for her work as director of the Oregon Physicians for Social Responsibility – an affiliate of International Physicians for the Prevention of Nuclear War. Those who have been in the industry since the company’s early days will appreciate the accompanying photos.


Sponsor Updates

  • Everest Group recognizes Conduent Health in two reports, “Healthcare Payer BPO – Service Provider Landscape with PEAK Matrix Assessment 2016” and “Contact Center Outsourcing Marketing for Healthcare Industry – Service Provider Landscape with PEAK Matrix Assessment 2017.”
  • Netsmart will exhibit at the VNAA National Leadership Conference April 19 in San Diego.
  • NVoq will exhibit at the TORCH Annual Conference & Tradeshow April 18-20 in Dallas.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at Symposia Medicus April 18-20 in Las Vegas.
  • Experian Health will exhibit at HFMA Hawaii April 20-21 in Honolulu.
  • The SSI Group will exhibit at the Alabama HIMSS chapter Spring Conference April 19 in Huntsville.
  • Sunquest Information Systems publishes a new white paper, “Build or Buy: Optimizing Informatics for Genetic Testing.”
  • The FutureTech Podcast features Sytrue’s Kyle Silvestro.
  • Solutionreach becomes a preferred partner of Crystal PM for optometrists.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 4/13/17

April 13, 2017 Dr. Jayne No Comments

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I unfortunately had to spend some non-quality time this week at the Microsoft Store. The pen for my Surface Pro tablet has been acting up over the last month and all troubleshooting maneuvers have failed. Since I’ve been on the road a lot, I’ve spent more time than I care to admit perusing various support articles, blogs, and commentaries on how to get it back up and running. Although the button was working, the business-end was not, and then the tip started to actually disintegrate. I had to wait until I was in a city that actually has a Microsoft store, and until I had free time during normal store hours to address it.

The staff at the store was eager to greet me, but then when they found out I was (gasp!) an individual consumer and not a corporate or enterprise customer, it started going downhill. The fact that I bought my device at Costco rather than directly from Microsoft was clearly an issue for them, and they made a big deal about not being able to locate the purchase in their system and having to use another system to find me (which they did, in about 20 seconds, so I’m not sure why we needed the drama). They then informed me that I was out of warranty on the pen. Apparently it’s not hard to be out of warranty when the warranty is only 90 days, which is pretty short in my opinion.

The rep did all the troubleshooting I had already done, then replaced the tip, which didn’t make a difference. He then proceeded to tell me he’d have to make me a tech appointment, but didn’t explain what that meant or what the timeframe might be. I was treated like a child when I asked, as if I should know intrinsically what a “Microsoft store tech appointment” expectation might be. As a consultant, I’m sensitive to my hourly rate and how much time and money I’m burning with exercises like this. Knowing the pen was about $50 and that I had been down for weeks and getting to the store when it was open was an ordeal, I asked if I could just buy a new pen and be done with it. He acted like that was the strangest thing he ever heard, then disappeared “to see if there is anything else we can do.”

I appreciate the fact that he was trying to save me money and resolve my issue, but it felt like an odd piece of “service recovery” after the initial stumbles over being an individual consumer and having purchased from a reseller. Ultimately they agreed to warranty the pen and swap it out, which took an additional 15 minutes of paperwork and back and forth. Counting the drive, the trek through the mall, and the troubleshooting, then getting home and back to work, I spent an hour and a half getting a new pen. Adding in the hours of troubleshooting that I did before even going to the store, you can bet that if this one malfunctions in the least I’m going straight to an online order for a new one.

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I mentioned a couple of weeks ago that I was working with a clinical informaticist that was learning the ropes of actually managing a team – dealing with expense reports, vacation approvals, and the other managerial functions that we don’t learn much about in medical school. This week we waded into the minefield that is the annual performance evaluation. I’m a firm believer in the concept that the annual performance review should never be a surprise. It’s important for managers to incorporate the concepts they’ve been discussing with the employee for the last year, and to make overall comments on progress (or lack thereof) but nothing should be a revelation. When there is a transition in managers or a change in job role, this is particularly tricky because one needs to incorporate any available feedback from the previous manager or role.

The good thing is that the time frame for the review process is usually clear, and shouldn’t be a last-minute exercise. Of course there are exceptions to that, such as when my previous employer decided to move everyone from “review on your anniversary date” to “review the entire company all at the same time, STAT,” which was a horrendous exercise I never want to repeat. But in this case, my managerial trainee had well over a month to track down information from previous managers, peruse previous reviews, assess completion of employee goals, etc. We had been talking about the process for a couple of weeks, and he seemed like he was with the program, so I was surprised when I met with him in person and he looked like a cornered animal. He said he had no idea what to do with some of the feedback he received from employees.

The company asks employees to write a one-page summary of their growth and accomplishments over the last year, highlighting successes and what they have learned from challenges. It’s the employee’s opportunity to offer specific details that can bolster a high-scoring review or give a new manager more flavor for what the employee has been working on and how they see themselves. However, it has the potential to be a mine field, because “one page free text” can apparently mean different things to different people. He has more than 20 people on his team, and let’s just say the variability of the personal narratives was striking. The most effective employees provided bulleted lists or well-organized statements, often with supporting quotes from other employees or customers. Those were easy to get through. The ones he wasn’t sure on handling were frankly ones that I wasn’t sure on handling either.

I’ve done a lot of performance reviews, going back to my time as Chief Resident. I can definitely say I’ve never encountered an employee or supervisee who decided to use the annual review as an opportunity to roast the company or provide openly hostile comments about management in writing. Until now, that is. The employees were clearly informed that their statements would be part of their records as part of the annual review process and would be seen by second-level approvers, yet still elected go down this path. Needless to say, after seeing their statements, their objective rankings on “insight” and “professionalism” just went down the tubes. Additionally, if there was a score for Tasseography, they’d score low on that as well. When you openly throw your manager under the bus, and fail to appreciate that your manager has a significant amount of executive support, you’re not doing yourself any favors.

These are the things that as a consultant make you say “hmmmm,” and also ensure the ability to propose ongoing engagements and assistance for your clients. We definitely need some coaching/education for these two employees, as well as creation of performance improvement plans. It’s also the opportunity to assist with the hiring process should they not be able to right themselves. In the short term, I’m going to continue supporting my new manager, and help him build the skills to get through this, manage these folks objectively, and not give in to his emotions. It’s also an opportunity to reflect on giving direction for future reviews. The idea that a review should not be a surprise goes both ways when employee comments are involved.

What’s your wildest performance review story? Email me.

Email Dr. Jayne.

Morning Headlines 4/13/17

April 12, 2017 Headlines 1 Comment

Trump Threatens to Withhold Payments to Insurers to Press Democrats on Health Bill

In an effort to draw Democrats to the healthcare policy negotiation table, President Trump threatens to withhold payments to insurers meant to cover discounts for low-income consumers, explaining “I don’t want people to get hurt. What I think should happen—and will happen—is the Democrats will start calling me and negotiating.”

The Leapfrog Group Releases Groundbreaking Tool to Estimate Lives and Dollars Lost to Medical Errors

The Leapfrog Group launches a calculator designed to illuminate the impact medical errors have on an employer’s covered population. The calculator estimates the number of avoidable deaths among covered lives, how much employers spend annually due to medical errors within general acute care hospitals, and how much of their total health care spend goes to these medical mistakes.

2017 Venrock Healthcare Prognosis

Venrock publishes results from a survey of “a few hundred of the smartest people we know across healthcare” on the future of healthcare under the new administration and the impact legislative changes will have on various healthcare IT subsectors.

ECMC officials remain mute on cause of computer shutdown

Erie County Medical Center (NY) returns to paper after a virus brings down its network. A hospital spokesman refused to comment on speculation that the virus was actually a ransomware attack, and differed questions about whether it had been contacted by hackers or asked for payments to restore access.

Morning Headlines 4/12/17

April 11, 2017 Headlines 1 Comment

How Washington’s favorite cancer fighter helps himself

A Politico investigative report on Patrick Soon-Shiong finds that the majority of funds distributed by the healthcare billionaire’s non-profit, NantHealth Foundation, ultimately flow back into his own businesses. Shares fell 14.4 percent after the report was published Monday, and dropped another 4.7 percent Tuesday. This follows a STAT investigative piece published in March that uncovered similar practices and drove shares down 35 percent following publication.

Association Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program

A longitudinal study published in JAMA finds that participation in one or more of Medicare’s value-based reimbursement programs is associated with reductions in 30-day risk-standardized readmission rates.

SA Health CIO defends EPAS following coroner’s criticism

South Australia Health CIO Bill Le Blanc defends the health system’s EPAS after the state coroner publically complained that the readability and formatting of printed reports are preventing clinicians from effectively doing their jobs.

News 4/12/17

April 11, 2017 News 13 Comments

Top News

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A Kentucky-based physician with a troubled past is hospitalized after being dragged off a United Airlines flight. David Dao, MD was one of four passengers told to get off the overbooked flight to make room for United stand-by employees. Dao refused on the grounds that he needed to get back to Kentucky to see his patients, and was subsequently (and literally) dragged off the airplane by police. While United has faced extreme backlash over its handling of the situation, Dao’s criminal history hasn’t done him any favors when it comes to casting him as an innocent victim. United employees described him as disruptive and belligerent when told he needed to give up his seat. The incident brings up the issue of overbooking policies, which, as one Twitter observer noted, won’t be a problem for United if all their planes are empty.


Reader Comments

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From NantWatcher: “Re: Layoffs at NantHealth. Another round last week – spread across multiple sites, departments, and seniority from entry-level to VP. Roughly 50 impacted.” Unverified, though Politico reports that shares of the company fell 15 percent earlier this week – a circumstance it seems to directly attribute to its exposé of Soon-Shiong and his self-serving philanthropic efforts.

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From NewCrop VP Randy Barnes: “Re: NewCrop losing customers. This is nothing short of FAKE NEWS. NewCrop continues to grow at a steady pace. EHR losses to competitors are extremely rare. What have we been doing? Patient support programs, real-time benefits across a multitude of insurance companies, intelligent prior auths, pharmacogenomics, lab integrations, patient portals, secure communications, immunization registry reporting to support all 50 states, new UI and more.”


Webinars

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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


Acquisitions, Funding, Business, and Stock

Azalea Health acquires San Diego-based EHR and PM company LeonardoMD for an undisclosed sum.

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A new CB Insights report shows that, while the large majority of digital health funding has gone to US-based startups, young companies globally are also addressing the challenge of improving healthcare. On a quarterly basis, equity funding to private US-based digital health companies saw a 128-percent increase from $768 million in Q4 2016 to $1.75 billion in Q1 2017. Meanwhile, funding to digital health companies outside the US saw a 146-percent increase from $252 million in Q4 2016 to $621 million in Q1 2017. Deals to US-based companies, which picked up at the end of 2016 after taking a dive in Q3 2016, again fell in Q1 2017, down to 147. This marks the second lowest quarter of the last three years. Deals outside the US, however, have surged recently from 55 in Q3 2016 to 102 in Q4 2016 and 104 in Q1 2017.


People

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Impact Advisors promotes Rob Faix and Mike Garzone to vice president.

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Health Catalyst hires Stanley Pestotnik (Pascal Metrics) as VP of patient safety products, and Carolyn Simpkins, MD (BMJ) as CMIO.

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Teri Thomas (UNC Health Care) will join Orion Health in May as EVP for global sales, marketing, and strategy.

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Doug Abel (Encore) has joined North Kansas City Hospital (MO) as CIO.

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Recondo Technology names Dan Grote (ReadyTalk) CFO and Tom Cooke (Advisory Board) (not pictured) VP of channel sales.


Sales

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Lancashire Care NHS Foundation Trust selects UK-based Servelec’s Rio EHR.

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St. Joseph’s Healthcare System (NJ) will move from Cerner’s Soarian EHR to its Millenium EHR and HealtheIntent population health management system. It has also opted for the company’s RCM software and services.

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Arizona-based Banner Health will roll out patient access and provider management technology from Kyruus at its facilities in six states.


Announcements and Implementations

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Lake Regional Health System (MO) prepares to roll out a single patient portal for its clinic and hospital patients. The portal, presumably part of the system’s conversion to Meditech 6.1, will go live in May. CIO Scott Poest has advised patients to print out any medical records related to care provided prior to May, since data from the previous portals will apparently not carry over.

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Trinity Health (ND) implements Acute, Population, and Practice Performance software from WhiteCloud Analytics.

Mercy (LA) wraps up a six month implementation of an imaging management system from Medicalis across its 50 imaging facilities. It plans to connect the system to its virtual care center in the near future.


Research and Innovation

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A Pennsylvania Patient Safety Authority report released several weeks ago reveals that, in the first half of 2016, hospitals in the state reported 889 medication errors that were attributed in some way to EHRs and other healthcare IT. Nearly 70 percent of those errors – the majority of which involved missed or incorrect dosages – impacted patients, eight of whom were actually harmed. Co-author and pharmacist Matthew Grissinger counter intuitively stresses that while these results are the “classic tip of the iceberg” when it comes to uncovering medication errors, many of which go unreported, patients should feel no less safe.

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A University of Michigan study finds that participation in one or more value-based care programs resulted in fewer hospital readmissions and greater cost savings. Researchers looked at patient care from 2,877 hospitals over a seven-year period and found that participation in Meaningful Use, ACOs, and/or bundled care payment programs helped the organizations save a combined $32 million.


Technology

CPSI will add TruCode’s Encoder coding software to its Evident and Healthland EHRs.

AthenaHealth adds electronic prior authorization technology from CoverMyMeds to AthenaClinicals.

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Allscripts puts its DbMotion software – part of its CareInMotion population health management platform -  on the cloud via Microsoft Azure.

Aprima Medical Software will add ActX’s genomic decision-support technology to its EHR.


Privacy and Security

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From DataBreaches.net:

  • News Corp Australia discovers that privacy settings on the nationwide My Health Record are set to “universal access,” giving the government’s 650,000 registered providers access to the information.
  • Tullamore Hospital in Ireland mistakenly sends a fax containing PHI to the office of the Data Protection Commissioner.

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Brooklyn-based artist Ace Volkov depicts computer viruses as comic book-like aliens as part of his “Brief History of Computer Viruses” series. Brain.A earns a special place in hacker history for its role as the first detected virus. Characterized by Volkov as a menacing mass of magenta-hued lines, the MS-DOS-based virus was created in 1986 to infect floppy disks.


Government and Politics

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President Trump nominates University of Minnesota healthcare economics professor Stephen Parente for assistant secretary for planning and evaluation at HHS, a role that would position him as the main advisor on policy development to HHS Secretary Tom Price, MD. Parente has had a taste of government work, having served as a health policy advisor for Sen. John McCain (R-AZ) during his 2008 presidential run.


Other

In Australia, SA Health CIO Bill Le Blanc defends the system’s beleaguered enterprise patient administration system after a coroner complains he can’t properly investigate a patient’s death because the EPAS won’t print out readable paper copies. “It was never designed to be used as a printed medical record,” Le Blanc says. “While we have already made significant improvements, the readability of printed records is an emerging issue across almost all jurisdictions using different electronic medical record systems and is not specific to the electronic medical record system used by SA Health.”


Sponsor Updates

  • Besler Consulting will present and exhibit at the 2017 HFMA Northern California Annual Spring Conference April 13 in Sacramento.
  • ECG Management Consultants ranks as a top consulting firm in the KLAS report, “Vendor Selection 2017: Crucial Factors to Consider When Choosing a Consulting Firm.”
  • AdvancedMD expands its professional services team.
  • ZeOmega releases 2017 updates to integrated patient assessments for its Jiva population health management software.
  • The local paper profiles Hartford Healthcare’s (CT) plans to build a predictive analytics “command center” powered by GE Healthcare.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Morning Headlines 4/11/17

April 10, 2017 Headlines No Comments

New Compact Helps Physicians Obtain Multiple State Licenses

The Interstate Medical Licensure Compact Commission begins accepting applications from providers seeking cross-state licensure from one of 18 participating states. The new licensing agreement is expected to ease legislative burdens on providers offering telemedicine services.

Medication errors in hospitals don’t disappear with new technology

The Pittsburg Post-Gazette reports on medication errors at Pennsylvania hospitals that were, at least in part, attributed to EHRs.

The US ACA Individual Market Showed Progress In 2016, But Still Needs Time To Mature

Standard and Poor issues a forward-looking report on insurer performance in individual markets, noting “we expect insurers, on average, to get close to break-even margins in this segment in 2017,” but cautions that 2018 and beyond are uncertain given potential legislative changes and pending legal battles.

Case giving entrepreneurs a hand, with help from MIT

Mark Chance, vice dean for research at Case Western Reserve University School of Medicine, launches a program to mentor hopeful healthcare-focused entrepreneurs through the process of starting a company. The program is based on an MIT program that has mentored more than 2,500 participants since its 2000 launch.

Curbside Consult with Dr. Jayne 4/10/17

April 10, 2017 Dr. Jayne No Comments

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Physician burnout is always a hot topic within informatics circles, especially since clinicians frequently cite the rise of EHRs as a key reason for stress and burnout. In reality, though, it’s difficult to prove causality, especially since increasing requirements for EHR use have generally been timed with governmental regulations, demanding payer programs, and the overall shift from fee-for-service to value-based care. I’m always looking for ideas to help physicians at the breaking point, and a friend recently shared this article about using military training concepts to help physicians build resiliency.

According to the American Psychological Association, resilience is “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress – such as family and relationship problems, serious health problems, or workplace and financial stressors.” As physicians, we’re assaulted by these kinds of stressors all the time, and they often cross work/home boundaries as working hours become longer or as physicians bring work home with them, now that they can access charts from anywhere. During residency training, many physicians develop the skills to adapt to the intermittent stress that being a trainee brings – long call nights, resuscitations, emergency surgeries, high-risk procedures, and more. For the most part, residency training doesn’t prepare young physicians for the daily grind of being in an office setting or dealing with the stressors of owning a practice or being an employed physician.

The article discusses statistics for physicians – that depression hits nearly a third of residents, and that physicians have higher suicide rates compared to the rest of the population. It goes on to look at how some Canadian hospitals and medical schools are using training based on US Navy SEAL programs to help build psychological skills. Both populations are under ongoing stress with overlaying episodic stress, sometimes involving life and death situations. I think the latter element is important – the life and death situations. Although many think of those as being in-hospital, emergent-type situations, I see more and more of my primary care colleagues experiencing that “life and death” level of stress even within the boundaries of office-based medicine. When patients can’t afford their medicines and physicians have to cobble together plans to try to ensure compliance, we are in effect fighting for that person’s life.

The diabetic patient who came into my urgent care last night with a blood sugar of 434 wasn’t sick enough to be admitted to the hospital, since his sugars had been high for months and his body had been trying to compensate for it. Yet, he needs intensive therapeutic interventions to get his disease under control. I can send him back to his primary care physician, but then she has to battle to get him to see the diabetic educator, get him a new blood glucose meter to replace his broken one, and try to help him figure out how to get to appointments and take care of his disease when he’s working long shifts as a municipal bus driver. Those situations, which sometimes border on hopeless depending on the patient’s insurance coverage (or lack thereof), job situation, and social supports add to the ongoing level of stress faced by physicians. This is worse now that the primary care physician is going to be penalized for this patient’s lack of blood sugar control.

This problem isn’t unique to our US system. According to the article, studies show that as many as 75 percent of Canadian resident physicians experience burnout. One can anticipate that those burned-out residents are going to carry that baggage into practice. The resiliency training created for the Canadian trainees is delivered as a four-hour course. It encourages trainees to identify how they’re faring on a mental health or stress scale. They grade themselves as green, yellow, orange, or red depending on their current level of stress and dysfunction. Similar to the kind of asthma action plan we provide patients, it also details recommended steps the trainee can take to reduce stress. Another component of the training includes skills to help the body process physical responses to stressors, such as the fight-or-flight response. It seeks to move decision making away from the emotional response and to instead harness the rational thought process.

The article also mentions that “discussions around physician mental health still remain very taboo.” Unfortunately, this is also true in the US. I know of quite a few physicians who have untreated mental health conditions who are afraid to seek help and have it on their records. Our state still asks a question during the license renewal process about treatment for mental health conditions, and people don’t want to risk whatever process might arise from checking “yes” on the affidavit. A friend of mine who is a psychologist specializes in physician care, and doesn’t bill insurance for those patients so that there isn’t a record of treatment.

Although the article doesn’t specifically mention it, we also need to work on skills for physicians to understand that doing their best really is good enough. We can’t really give it more than our best, can we? Although the quality metrics might not support this approach, the idea that we can save everyone or ensure all our patients are compliant is ludicrous. As quality increases, it’s more and more difficult to be “better” when everyone is already earning an A. I’ve lost two colleagues to suicide in my career, and both were brilliant, caring individuals who unfortunately felt their best wasn’t good enough, that they should have been doing more. No one in their lives, including spouse or fiancée, realized how bad things were or that they were at high risk for suicide.

Additionally, this discussion doesn’t just apply to physicians. It applies to all of us working in the patient care arena regardless of your title. Most of my support staff at my patient care sites are paramedics, and many have migrated to urgent care as a solution to the stressors in the field. For those readers not in the patient care space, ask your organizations what they’re doing to address caregiver burnout. Ask your friends and colleagues how they’re doing and offer support when you can. Their lives might just depend on it.

How does your organization address burnout? Email me.

Email Dr. Jayne.

Readers Write: Top Health IT Marketing Trends From #HITMC

April 10, 2017 Readers Write No Comments

Top Health IT Marketing Trends from #HITMC
By John Trader

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John Trader is VP of communications at RightPatient in Atlanta.

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I had the opportunity to attend the Health IT Marketing & PR Conference in Las Vegas last week, and thought I’d share some of my top health IT marketing takeaways.

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Content, Content, Content

Content was certainly king in terms of session topics. What works. What doesn’t work. How to establish a sound content-marketing strategy (even if you’re a small company with a shoestring budget). My biggest takeaway on content is that marketers need to start with the end in mind. Understand what content resonates with the demographic you target by listening first, and then developing a strategy that addresses customer needs and is strategically presented to them as they make their way down the sales funnel.

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I enjoyed Sarah Davelaar’s (from the The Signal Center for Health Innovation) session where she outlined the key elements in content strategy. I also enjoyed a panel discussion featuring four physicians who shared their content consumption habits – where they go to find information, what content resonates with them, and what they like versus what they ignore. The million-dollar question for any health IT marketer is: What influences their decision to buy? Most docs said that conferences are a great place for them to discover new products. Those docs on social platforms like Twitter do pay attention to who shares their posts and who interacts with them. Catchy headlines are important, and most of them look for unique perspectives on issues as opposed to extolling the virtues of a product.

Innovation Versus Value

Conference organizer and Netspective founder Shahid Shah’s opening presentation on day two was excellent (although the amount of information on his slides was a tad overwhelming). There was a lot of discussion at the conference about whether marketers should position themselves as innovators, since nothing we do is truthfully going to "disrupt" healthcare. The truth is, customers care a lot more about value than innovation. One of the best quotes from his presentation was, “Do customers care about what you think is innovation or will they care more about you when you care about what their innovation needs are?” 

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Social

Although I didn’t attend any sessions dedicated to social media use or strategy, there were a few that addressed how to navigate the online universe, and how to develop and execute effective social media strategies. “Go where your customers are” seemed to be the general takeaway from attendees of those sessions. Don’t chase the latest shiny social platform just for the sake of having a presence. Again, start with an end goal in mind (create leads and eventually sales), and make sure you are measuring your results (how will you be able to tell if your efforts are successful?) There was also some discussion on how to effectively measure social to gain a better understanding of what works versus what doesn’t work. There was also a lot of chatter moving beyond brand awareness and more into how social efforts are creating leads and sales.

Leveraging the Customer

A recurring theme was how to leverage existing customers to create new business. Kathy Sucich of Dimensional Insight delivered an excellent presentation, where she provided a case study on how she increased her own company’s “share of voice” (a term that was new to me), and gave sound advice on how to successfully leverage customers to create new content and increase brand visibility and messaging. The key takeaway for me here was that capturing and then bringing the customer’s voice to your messaging requires personal relationships with customers. You simply must spend the time to cultivate these relationships by establishing a set of expectations at the outset of the relationship that outlines your plan to work with your customers and get their story in front of others.

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Video

There was lot of buzz about creating more video as part of an effective marketing strategy. It continues to be a hot topic of interest because it’s clear that people want to consume more of it. The key is making it resonate. The key seems to be keeping it simple, short, and focused on addressing a problem instead of extolling the virtues of a product. Christine Slocumb’s (of Clarity Quest Marketing) session was excellent in reiterating the point that in this day and age, videos have to be personalized to be effective.

SEO Isn’t Dead

Kristine Schachinger of The Vetters Agency presented an excellent session covering modern SEO practices, soup to nuts. We talked about ways to analyze SEO performance, online SEO resources, ranking factors, inbound link tactics, do’s and don’ts for SEO, how to add Google Search Console to your site, how content affects SEO, and keyword research – just to name a few topics. There was a great deal of interaction between the presenter and the audience, and directly between audience members, which, in my opinion, is what makes this conference excellent. Questions were asked and topics brought up that were a great supplement to Kristine’s curriculum. This is perhaps what I like best about HITMC. It has a more intimate setting than most conferences I attend.

About That Other Conference

The buzz around the conference seemed to be the forthcoming HIMSS marketing conference (which, by the way, I don’t anticipate being able to offer the intimate setting I mentioned above). Many have said they heard through the rumor mill that it may be frowned upon by the marketing community to attend in lieu of supporting HITMC’s more grassroots efforts. I talked to several people who have already signed up for the HIMSS event but seem to be keeping that information to themselves. Other buzz has been the quality of HITMC – most people agree that it’s an excellent conference and gets better each year by addressing the most relevant topics to marketers.

The only drawbacks I found, aside from freezing temps in the conference rooms, was that the few tough questions I asked during Q&As weren’t answered as thoroughly as I would have liked, and there was a lack of substantial, real-world case studies to back up presenter assertions. Overall, I think the conference was a great investment. It’s always helpful for me to be around likeminded professionals eager to gain insight and tips on how we can do our jobs more effectively.

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Reader Comments

  • Paul Kennedy: Great article, Dr Butler. You have always looked differently at the challenges of what we do in implementation of EHRs....
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