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Curbside Consult with Dr. Jayne 5/15/17

May 15, 2017 Dr. Jayne No Comments

I had a rare opportunity this month to do something I haven’t done in a very long time: support a go-live. A friend who owns another consulting company reached out to me to see if I could help her out with the launch of a new EHR client when one of her consultants had to back out due to a family emergency. I had a bit of a lull in my schedule, so I was happy to oblige, especially since it happened to be one of my favorite cities. The idea of grits made by people who actually know what they are doing was enough to seal the deal.

I’ve supported the EHR in question before, but not for a couple of versions. She sent over her training documentation as well as the training records for the users at the location where I’d be covering. The end users had been through quite a bit of training along with role play and simulated patients with real-time coaching for eye contact. They also were planning a soft go-live the week prior, where end users (including providers) would be entering their visits after they left the exam room.

The plan was that by the time the actual go-live occurred on Monday, everyone would have documented at least 30 patient visits and would be ready to go. Each user had to not only attest to the fact that they did the visits, but my friend had consultants going through the charts to ensure that it was done correctly and to remediate anyone who appeared to be struggling.

I arrived Monday morning to a very calm office where everyone seemed comfortable with what was about to happen. Patient visit schedules had been adjusted, giving a 15-minute break after every three patients to allow the staff to catch up. Charts had been abstracted for upcoming visits based on a rolling schedule, and for same-day and next-day appointments, they were being loaded in real time.

Of course, the providers had spent some time cleaning up the charts for patients seen in the last six months so that abstraction could be simple data entry rather than a complex game of “hunt the data.” The practice also spent the last year adjusting their scheduling processes and panel sizes to ensure they were not trying to operate way above capacity. Some physician panels were closed and others shifted to move patient volume to where there was capacity.

The practice had been live on the practice management side of the application for a few months and also had been scanning all inbound and internally created paper (including visit notes) as well as receiving lab results via interface since the first of the year. There was very little reason to need a paper chart at the time of go live, although the practice planned to pull the chart for three patient encounters (whether in person or by phone) before archiving.

After the first couple of patient visits, I began to wonder why I was there. Although some might think the pre-live activities were grossly over-engineered, they did exactly what they were designed to do, which was to make the go-live successful.

At the end of the day, the providers were asked how they felt about their schedule and the amount of blocked time and they felt they could open some additional patient visit slots for Tuesday. Tuesday also went off without a hitch, with nearly all providers opting to continue to reduce the number of blocks on their schedule for documentation time. By Thursday afternoon, everyone was running a full schedule and seeing patients reasonably on time.

Overall, providers lost very little volume during go-live week because they were extremely well prepared. The workflow I saw in the exam rooms was good, with providers being able to interact with both the computer and the patient through reconfigured exam rooms or other adaptations. It was about as textbook of a go-live as you could ask for.

I was able to spend some time debriefing with my friend on Thursday night before heading home on Friday. My big question was how much time was spent up front to ensure the smooth go-live, especially considering the amount of training, role play, patient simulations, chart clean-up, etc. She had been tracking it pretty thoroughly and the average time commitment per provider was around 60-70 hours. That included 14 hours of system training, time needed for soft-live chart notes, time spent resolving data issues during chart clean up, additional role playing/coaching, and other activities. The only thing she didn’t have an accounting for was time spent in regular staff meetings where the EHR project was discussed.

Depending on how you think about it, 60-70 hours may or may not seem like a lot of time. When you talk about losing nearly two weeks of potential patient-facing hours, it seems like a lot. But when you hear about practices that “never got back to full productivity” despite years on an EHR, it seems like a small investment.

I think the more unquantifiable factor here was the smoothness of the go-live. There were very few chaotic times and no moments of terror at my site, and by report, none at other locations, either. Things were extremely smooth and you can’t put a price on the value of that when you’re talking about the mental health of your providers and frontline staff.

My consulting buddy, who prides herself on her “white glove” service, has follow-up assessments scheduled weekly by phone for the first month and then onsite at the 30-day, 60-day, and 90-day marks. If the practice starts to struggle, she’s going to know about it.

I look at some of the EHR vendors out there offering go-live within a week or two and I wonder how well that really goes in practice. I imagine that if the practice was fully optimized and the paper charts were all in good shape, it might be possible. But for practices that are going live on EHR this late in the game, I would think that’s less common since many net new purchases are from practices that are only being dragged into technology adoption through penalties.

I’d be interested to hear from readers in the implementation space. What do your experiences look like at this stage of the game? Can you really get practices live in a couple of weeks and have the adoption stick? What happens when you leave?

Have a good go-live story? Email me.

Email Dr. Jayne.

Morning Headlines 5/15/17

May 14, 2017 Headlines 2 Comments

Finding the kill switch to stop the spread of ransomware

The WannaCry ransomware attack that quickly spread to computers across the globe, including 48 NHS hospitals, is halted after a cybersecurity researcher, noticing that the malicious code routinely pinged an unclaimed domain, registered the domain in his own name, inadvertently halting the spread of the attack.

CareCore Admits to Improperly Authorizing Over 200,000 Procedures Paid For With Medicare and Medicaid Funds

MedSolutions CareCore agrees to a $54 million settlement with OCR, putting an end to the fraud lawsuit brought against the company after it authorized thousands Medicare and Medicaid payments for procedures without validating their medically necessary.

Use IHealth software, not paper, defiant Nanaimo doctors told

In Canada, Island Health announces that it will no longer support alternative workflows for the nine internal medicine doctors that have refused to use the recently implemented, $174 million Cerner EHR, citing patient safety concerns over its CPOE system.

Clover Health Tops $1 Billion Value With Alphabet Backing

Silicon Valley-based health insurance startup Clover Health secures a $130 million Series D investment round led by Google Ventures, bringing the three-year-old startup’s valuation to $1.2 billion.

Death By A Thousand Clicks: Leading Boston Doctors Decry Electronic Medical Records

One year after going live on Epic, three physician leaders from Massachusetts General Hospital pen an opinion piece in a local paper arguing that the administrative burden caused by poorly designed EHRs software is compromising the diagnostic abilities of providers and driving good physicians into early retirement.

Monday Morning Update 5/15/17

May 14, 2017 News 3 Comments

Top News

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An unprecedented ransomware attack affects 48 of England’s 248 trusts in waves of infections that spread globally on Friday. All but six trusts say they have returned to normal operations after they were forced to divert ambulances, cancel appointments, revert to paper, and order employees to unplug network cables from PCs and telephones.

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The WannaCry ransomware, which demands a $300 ransom per infected Windows machine, initially affected computers primarily in Russia, Ukraine, and Taiwan. It uses the EternalBlue exploit that was made publicly available by hackers in mid-April. At least one hospital in Canada said it was threatened by WannaCry, but its antivirus software blocked it. Two hospitals in Indonesia were also hit as well as one in Taiwan and another in Scotland.

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Microsoft issued a Windows patch to protect against the exploit in March, but many machines worldwide have not been updated. NHS is still  running many Windows XP PCs, for which Microsoft’s extended support and security updates ended in 2014. Microsoft has responded to the attacks by providing an unprecedented public security update for Windows XP, Windows 8, and Windows Server 2003 to address WannaCry. Both Kaspersky and Bitdefender antivirus programs already protected against it.

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The Russia-based hacker group that claims responsibility for the attack says it used cyber tools that were stolen from the US National Security Agency.

A 22-year-old security researcher apparently stopped the worldwide spread of WannaCry when his tests revealed that the malware was accessing an unregistered Internet domain, which he then registered to perform further testing. In doing so, he found that the ransomware stopped activating itself around the globe. The researcher theorizes that the hackers used the domain as a “kill switch” to prevent experts from analyzing in a sandbox environment. However, he cautions that the hackers could simply change the domain name the program checks, making it imperative that Windows PCs be brought up to date on patches.

A PC can be infected via a hyperlink spread by a phishing email, a web link or advertisement, or a document link.

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John Gomez of Sensato offers these tips for health systems:

  • Apply the SMB patch (MS17-010) to all Microsoft systems.
  • Close ports 22, 23, 3389, TCP 139 and 145/UDP 137 and 138.
  • Test backups and store them offline.
  • Warn users not to open attachments.
  • Restrict access to file-sharing sites.
  • Review ransomware response protocols.

HIStalk Announcements and Requests

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Eighty percent of poll respondents are not happy that the House passed the American Health Care Act. Frustrated says people should actually read the bill instead of parroting the opinions of others, adding that no healthcare system can survive if only sick people sign up and both the ACA and AHCA address that. Just a Nurse Analyst wonders about the backroom deals that were struck to pass it and questions the zeal to undo anything President Obama did regardless of the impact on Americans. Cosmos says every step of the process lacked moral discipline and integrity – the headlong rush and repeated attempts to repeat the ACA, the backroom negotiations, voting without CBO analysis, and a two-vote majority that suggests compromises undeserving of the resulting White House victory party. Malvern says that our healthcare cost of $10,000 per person each year can’t be solved by attacking coverage and premiums alone. Disgusted says it’s the most cynical, heartless pieces of legislation ever, especially the Medicaid cuts and the requirement of continuous coverage to have pre-existing conditions accepted. Printgeek thinks it’s a shame that the two political parties can’t even initiate a dialogue about healthcare. Bill says at least AHCA eliminates the word “affordable” as Congress finances access by increasing the federal deficit. HITgeek says healthcare requires a community health insurance risk pool to spread the cost of involuntary events, adding, “I am sick and tired of compassionless insurance, abetted by politics, being the gatekeeper for US healthcare.”

New poll to your right or here: What’s the most important factor in reducing US healthcare costs? The presence of the word “most” means I’m not oblivious to the desirability of an easy-out “all of the above” response, although I provided an “other” box in case my mental checklist of options is incomplete.

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We funded the DonorsChoose grant request of Ms. L in Michigan, who asked for Chromebooks, headphones, and academic software subscriptions for her fourth grade class. She reports, “I am a fourth grade teacher on paper, but in reality, I teach students anywhere from a first grade to a fourth grade level. This poses a very real challenge that both my students and I deal with head-on. Technology is one way to successfully mitigate this particular hardship and thanks to you, our class was able to get the technology we need to be successful! Students have grown tremendously through these online platforms; we track and celebrate their progress weekly! It also makes students feel that they are valued. They have something BRAND NEW, that people whom they will never meet gave to them. That sense of value and feeling appreciated is HUGE and cannot be overstated. Thank you, thank you, thank you for making our class feel important!”


This Week in Health IT History

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One year ago:

  • Theranos says 2014-2015 lab test results from samples it ran using its proprietary Edison analyzer should not be trusted.
  • The VA releases a software development kit for its open source Enterprise Health Management Platform.
  • Competing Missouri HIEs argue over connectivity, member charges, and unnamed special interests.

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Five years ago:

  • Partners HealthCare announces plans to implement Epic at a cost of $600 million.
  • Greenway Medical Technologies is the largest percentage gainer on the New York Stock Exchange, with shares up 20 percent since the company’s February IPO.
  • NextGen parent Quality Systems acquires EDIS vendor The Poseidon Group.
  • 3M makes its Healthcare Data Dictionary available worldwide at no cost.
  • California’s HHS moves oversight of the Cal eConnect HIE to the Institute for Population Health Improvement.
  • Allscripts appoints Paul Black to its board.
  • A report finds that one-third of prescriptions are being sent electronically.
  • Fairview Health Services admits that it was getting extensive negative feedback from its employees about the strong-arm collection tactics of Accretive Health.

Weekly Anonymous Reader Question

I’m delighted that my anonymous reader question surveys are getting so many responses that they don’t fit nicely into the Monday Morning Update. I’ve posted the two most recent sets of results at these links:

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Quitting CHIME.

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Why I left my last job.

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This week’s survey: What is the most customer-unfriendly term or condition you’ve seen in a healthcare software contract that the customer approved? This would be a good opportunity to warn others about items they shouldn’t accept.

Meanwhile, if you have ideas for future surveys, let me know – it’s an easy way to learn what your peers are seeing or thinking.


Last Week’s Most Interesting News

  • ONC appoints Genevieve Morris, MA (Audacious Inquiry) to Principal Deputy National Coordinator for Health Information Technology.
  • Memorial Hermann Health System (TX) pays $2.4 million to settle HIPAA charges after naming an arrested patient in a press release.
  • Specialty EHR vendor Modernizing Medicine raises $231 million in funding.
  • A contractor’s error exposes patient records of Bronx-Lebanon Hospital Center (NY) to the Internet due to a misconfigured backup.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Google parent Alphabet invests $130 million in San Francisco insurance startup Clover Health, raising its total to $425 million and valuing the company at more than $1 billion. Clover manages claims for just 25,000 Medicare Advantage customers in New Jersey and competes against much larger insurers, but says its forte is mining patient data to identify potential problems that can be addressed via a Clover-managed home visit or other intervention.


Decisions

  • Memorial Hospital of Lafayette County (WI) will switch from Medhost to Epic in November 2017.
  • Kaweah Delta Health Care District (CA) will replace Cerner/Siemens Soarian with Cerner Millenium in November 2017.
  • Haxtun Hospital District (CO) switched from NextGen Healthcare to Athenahealth in April 2017.
  • Platte Valley Medical Center (CO) will go live with Infor human resources in May 2017.

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


People

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Allscripts promotes Dennis Olis to interim CFO following the resignation of Melinda Whittington, who is leaving the company for unstated reasons after just over a year on the job .


Government and Politics

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MedSolutions CareCore – now part of specialty benefits manager EviCore — will pay $54 million to settle an HHS fraud lawsuit in which the company authorized Medicare and Medicaid payments for procedures it had not validated as medically necessary. The company admits that its executives monitored a dashboard of medical review cases, and when the list got too long, ordered clinical reviewers to approve requests for prior authorization even though nothing had changed, which the Department of Justice says resulted in improper payment in up to 300,000 cases. EviCore was rumored earlier this month to be reviewing a sale of the company or an IPO, with its $300 million in 12-month EBITDA valuing it at up to $4 billion.

A former podiatrist pleads guilty to defrauding Medicare of $6 million by implementing an EHR in his 16-state long-term care practice to generate false patient documentation that would earn payments, such as falsely describing toenail conditions as “painful to such a degree as to affect ambulation and balance.”


Privacy and Security

The local paper reports that Erie County Medical Center (NY) is still trying to recover its systems more than a month after an apparent ransomware attack.


Other

The New York Times questions advertising drugs directly to consumers – legal in only two countries, the US and New Zealand — in noting TV commercials for a drug for an uncommon neurological condition for which it can stop uncontrolled crying or laughing. It notes that the commercial will likely pique the interest of overly emotional people well outside the drug’s target market who will pester their doctors to prescribe them the $700 per month drug.

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Interesting: Dexter Holland – singer/songwriter of punk rock band The Offspring for more than 30 years – earns his PhD in molecular biology from USC with his dissertation titled “Discovery of Mature MicroRNA Sequences within the Protein-Coding Regions of Global HIV-1 Genomes: Predictions of Novel Mechanisms for Viral Infection and Pathogenicity.” As a clearly Renaissance man, he also has his own brand of hot sauce, is the former owner of a record label, and is a certified flight instructor who made a solo trip around the world in 10 days. Dr. Holland isn’t the first punk rocker to earn a PhD – Bad Religion founder Greg Graffin earned a Cornell doctorate in zoology and has taught and written on academic topics.

In Canada, Island Health tells nine internists who are refusing to use its Cerner-powered EHR because of patient safety concerns that they will no longer provide other doctors to enter their paper orders electronically. The CEO of Island Health says it’s OK that ED and ICU doctors haven’t used the systems – citing similar concerns – because they never fully transitioned to the EHR, but it’s too late for the internists to go back to paper. One of the protesting doctors, who is also president of the hospital’s medical staff, says the decree puts him in a difficult position because “it has the effect of barring me from practicing … without actually suspending me.”

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Weird News Andy says that even though Sir Winston does not approve, he suggests ICD S01.22XS. In England, cocaine users are “getting Winstoned” when they use new, stiffer five-pound bank notes bearing the image of Winston Churchill to snort their drug of choice, leaving them with nose cuts.


Sponsor Updates

  • Gartner names Salesforce a leader for the ninth consecutive year in its Magic Quadrant for the CRM Customer Engagement Center.
  • The SSI Group will exhibit at the HFMA Spring Joint Conference May 17 in St. Louis.
  • TierPoint will host a grand opening for its Dallas-Allen data center on May 18 in Allen, TX.
  • The Chartis Group publishes a white paper titled “The Impact of the American Health Care Act on Children’s Hospitals: Preparing for the Road Ahead.”
  • TransUnion publishes a new white paper, “Uncompensated Care is on the Rise.”
  • Conduent reports first quarter 2017 financial results.
  • ZirMed publishes a new infographic, “ZirMed Denials by the Numbers.”

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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Reader Survey Results: Quitting CHIME

May 13, 2017 News 1 Comment

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At a CIO’s request, I asked former and current CHIME members who have either quit or thought it to explain why.


I was once a CIO member years ago. Great networking and exchange of ideas. I became vendor, and after several years, pulled out. It became a pay-to-play with diminishing value. Let me tell you, even the sponsor companies don’t like it much.


It’s become a mini-me of HIMSS.


Vendors are running the show and there is no sense of working to better the industry.


CHIMe used to be an exclusive group of of IT executives and limited number of foundation members (vendors and consultants). Now it’s a mini-HIMSS dominated by vendors, with limited value for all participants. I’m not sure what CHIME’s mission is any more.


Way more time spent with the Foundation members than with fellow CIOs.


It has become so vendor-heavy and the membership drive now allows most anyone to join.


As a CHIME Foundation member for 12 years, I am disgusted with the direction both CHIME and HIMSS are going. It has become a”Russ Branzell “let’s look as much like HIMSS as we can” show. Quantity is more important than being a true CIO venue, having invited people as far down as the director level. I talk to a lot of CIOs who are no longer attending CHIME because of their new focus on money rather than collaboration. As a vendor, I no longer get the same value and am paying a lot more money for decreased value. I still feel I have to belong, just like HIMSS, because absence in noted more than presence.


Just like HIMSS, all about collecting vendor money and less about colleagues teaching and learning from each other. It is overwhelming being a CIO and have to deal with eight vendor staff to each one of us.


As long as CHIME works to keep the vendor contacts at the highest executive levels (Carl, Judy, etc.) it is fine. Complete openness and transparency is needed to give confidence that it exists to serve its members and not enrich its leaders though lucrative associations and spin-off ventures.


I’ve been involved in HIMSS and CHIME for many years, but have limited participation due to the vendor involvement. This has changed the focus for both organizations from members to vendors.


The move away from being a CIO-focused organization to having a variety of members, especially vendor firms.


It has taken on the same mentality as HIMSS — expand the focus to more vendors and non-CIO types. I attended HIMSS for the education sessions and the focus moved away from them. I attended CHIME for networking and CIO sessions to learn what others were doing. Sorry to say this has grown so much it does not work any more. It does not matter to me anyway because I have retired. There is a group of CIOs that formed HISEA. I could not join because a competitor CIO was already a member and that rules out many. But the concept was centered on presentations of great new ideas for other CIOs.


They are selling access to us. It felt a bit more subtle in the past, but is not that way and feels far more commercial.


I don’t like the Fall Forum. Too many vendors, the focus groups are a waste. It is clearly a business, not a professional society. Too bad.


Seeing declining value from participation year to year.


I was booted from CHIME after being a long-time member because I became employed by a healthcare vendor instead of a healthcare provider. I understand the rules, but there are plenty of old timers who are still members even after they went to work on the vendor side because their company has the massive funds to become a CHIME foundation member. So two reasons why I wouldn’t rejoin CHIME even it they would let me: 1) CHIME negates your years of healthcare provider experience once you go to work for a vendor, and 2) they purposefully exclude many vendors from the foundation by charging a huge amount of money for that privilege. I think that CHIME has done great work in the past, but I hate to see it become so commercialized and HIMSS-like.


The leadership seems more committed to growing members and expanding rather than serving the needs of the current membership.


Not providing value.


Insufficient value from membership.


I am considering it. The Fall Forum was the highlight of the year for networking with fellow CIOs and the Foundation firms. The last event I went to, the experience had dramatically changed. Now vendors have booths and instead of one or two people from a Foundation firm, there are MANY. Likewise on the CIO side. There are associate members that may number greater than the number of actual CIOs in attendance. This has moved from a very effective, intimate industry leader gathering to a mini-HIMSS. And who needs that? CHIME is clearly focused on growing revenue, just like HIMSS. I hope HIMSS selects a new leader that can actually save HIMSS from itself and that CHIME leadership watches closely and learns.

Reader Survey Results: Why I Left My Last Job

May 13, 2017 News 1 Comment

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I asked readers: what specific event crystallized your decision to leave your last job?


I was asked if I’d be willing to relocate after 3 years at one office. Said yes so my manager started the process. He never even told me what the HR package was, as it was so insulting. Knew then that it was time to leave the (slowly) sinking ship.


The PE firm that bought our company had little interest in the actual work we were doing. The CEO they put in place fell asleep in the first customer meeting I took him to and then after the meeting told me the customers in the meeting were idiots and he would rather get a needle stuck in his eye than attend another meeting like that.


Was notified by McKesson in fall 2016 my job would end March 31, 2017. Two months later was told I would need to train offshore resources how to utilize and quality test a large piece of clinical software. Given my training and years of front line experience in hospitals, my principles were on the line and no amount of severance was going to compensate me for principles. I turned in my two-week notice in early 2017 with several irons in the fire, but no offers. On my last day at McKesson, I got a call at noon offering me the job I was hoping for.


I took an early retirement package equaling a year’s pay, easing the way into lucrative consultancy for the next few years. However, the event that crystallized my decision was the concurrent layoff of valued colleagues who did not qualify for the package. It was the right choice.


To start a new company and see an idea turned into reality. Hopefully, hah.


Micromanaging leadership and leaders out for self-promotion over the company’s goals.


I was working 60-70 hours per week, seven days a week. My boss assigned me another project, and when I told him I couldn’t, he said something about digging deeper and that I could do just a little more. I already knew I was going to quit, but was trying to hold off one more month. That sealed me. They distributed my work among nine people.


I was a founding but minority partner in a consulting firm. After Having several disagreements with our managing partner about the future direction of the firm, I reached out to our board chair for advice. He made it clear that the managing partner was the majority owner and he would run the firm as he pleases. Great advice. I left and and subsequently founded a very successful and highly regarded consulting firm.


When the company that had acquired our niche software provider changed my network username from a name-based alpha to a nine-digit number.


Cruel management.


Realizing they owed me nothing, and I was simply in the way.


Missing a concert of one of my favorite performers to finish up something “critical” at work then driving home from the office so late that the sun was rising.


Promoted the worst director to be the new CIO.


Realization that in five years with an HIT consulting firm, we never once talked about “the patient.” Our mission statement was embarrassing to read.


Promoting and doctor to be the head of all IT clinical applications, over 100 people, when this doctor had NO experience being in charge of any size of team before, as he told all of us when he announced his promotion. No experience leading any organization whatsoever, no business or HR training, nothing. Talk about promoting someone to his level of incompetence. How often does leadership in healthcare think that just because someone is a doctor they can do anything?


A VP valuing contracts over business ethics and being completely detached from the realities of the marketplace, both in terms of realistic revenue targets and competitive compensation for our top talent, combined with a failing new product that was doomed from the start. The final acceptance of the fact that none of this was ever going to change was the “event.”


I left my last job because it was acquired by another company that was based in the South and I didn’t want to move from the SF Bay Area. Turns out to be the best decision.


A wholesale reduction of the middle management positions in the organization, making communication with manager more difficult (had too many direct reports to effectively manage); pushing many of our previous manager’s duties down on my team with no acknowledgement, support, or consideration of any type; and finally, removing almost any chance for future career advancement in this organization.


The CEO was corrupt (the controller quit rather than approve the yearly numbers), misused federal funds (set policy to have healthcare navigators sign up patients for ACA who were illegal using made up SSNs), racist (but because he was pro-Hispanic, it was not considered racism), did not support his leaders, required the implementation of the EHR when the environment was not stable and had not been thoroughly tested, and put blame on anyone who did not agree with him. The only reason I stayed as long as I did was due to the poor economy. It was a horrible situation to be in. The CIO was the only bright spot and he left soon after I did.


I am in sales and in a previous job sold well over $XXM and as deployment of the promised technology continued to fail, we were at a point with these clients of moving into Phase 2 of the project which would have netted the company another $XXM+ and the clients stopped everything. Lawsuits quickly began to fly. It was at this point I realized my leadership at this company was simply lying. They had done the Wolf of Wall Street. Created imaginary software that was incapable of supporting the demonstration they had put together with bubble bum and duct tape. I lost over half a million in commissions on Phase 2 because they had also conned me into believing they could make it work.

It is a train wreck in healthcare and amazingly complex. The demo experience worked flawlessly on their perfect data, but drop that bad boy vision into the reality of healthcare data and KABOOM. “Mr/s. Customer, you have to give us perfect data or this won’t work. Sorry, no refunds.” Plus, their contracts were unreal with one of the customers saying they were longer and more complex than the ones they worked through with their EMR vendor.

Unbelievable. Investors should have gone after that executive team with guns blazing in a lawsuit. They even made sales pump up pipeline numbers by telling us if anyone even picks up the phone, it is a 20 percent opportunity. Then post-acquisition, if you deleted those inflated opportunities, the same executive team (CEO) would literally email you within five minutes demanding an explanation.


When the going got tough, the C-suite exec refused to take responsibility for any of the struggles being dealt with by the staff that reported to him. In fact, he was quite adept at not listening and throwing people under the bus. Finally got to the point where I got on the bus and rode off to another job.


My company was purchased and I did not believe in the management or strategy of the acquiring company.


I found termination for cause suasive.


Toxic medical director, toxic culture , being treated like three year olds .


My director seemed to be semi-sabotaging our market install. At core team meetings, she would ask leaders whether they were on schedule, and upon hearing they weren’t, she would only say OK before moving to the next person. We were months and about a million over. She knew I thought we should ask people what the hold-up was, if they needed help, more training, etc. We had a planned core team meeting with the market CFO to give a status and tell him whether we felt on track and could make our live date. My manager came in to my office right before the meeting and told me to keep my mouth shut at the meeting. I sent my resume out the next week.


When my boss left, and HIS boss left within a day of each other. This was just after a new CEO took over.


My division was sold. The buyer offered a voluntary severance package within two weeks of the sale being final.


My company was acquired by a competitor. That’s probably the most obvious sign that’s it’s time to move on.


Our company was acquired. Marketing and accounting are the first to go.


Continually getting new “managers” who kept asking me how they should do their job.


When I realize the culture and the legacy leadership was never going to change.


My boss, the CIO of a large, multi-state IDN, falling asleep in my annual performance review.


New CEO hired through board member good-old-boy network was threatened by my skills and influence over the organization. Good thing my employment contract had a decent severance clause. CEO actually offered to extend the severance for signing a draconian non-compete agreement that went far beyond original employment contract. I turned him down. CEO was fired by the board a few months later after running the company into the ground with extravagant spending on a flawed strategy.


I decided to leave my job when I was told the CFO wouldn’t support me to be named the director of the business unit I was already leading. She would have to sign off on the position even though it didn’t report up through her. We had brought in $5m of unbudgeted money into the organization. It was a political mess and I am so glad that I left for a similar director position.

Morning Headlines 5/12/17

May 11, 2017 News 2 Comments

Genevieve Morris

ONC names Genevieve Morris, MA Principal Deputy National Coordinator for Health Information Technology. Morris has no clinical background, but worked on HIEs and Meaningful Use prior to taking on her new role.

NantHealth Reports 16% Increase in 2017 First Quarter Total Net Revenue; SaaS Revenue Rose 11% and GPS Adoption Continues to Climb

NantHealth reports Q1 results: revenue up 16 percent to 22.5 million, adjusted EPS –$0.24 vs. –$0.18, missing expectations for both.

Microsoft bets big on AI data with new developer, user features

Cerner is reportedly interested in working with Microsoft’s AI-powered Custom Vision Service, which allows applications to learn the names of items in images users upload. Joe Quint, an director over app development at Cerner, commented “That was very interesting. Being able to use this broadly across a hospital and being able to do image extraction of videos would be very cool."

Outbreaks, Evolution, and Rock ‘n’ Roll: Topol Talks to Pardis Sabeti

Eric Topol, MD interviews Pardis Sabeti, MD, Dphil, a professor with the Broad Institute of Harvard and MIT, where she develops algorithms investigating evolution in the genomes of deadly diseases.

News 5/12/17

May 11, 2017 News 3 Comments

Top News

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HHS appoints Genevieve Morris, MA as ONC’s principal deputy national coordinator. She was previously senior director of HIT policy with Audacious Inquiry.

Unlike her predecessor Vindell Washington, MD, Morris has no clinical education or experience (her master’s is in political science), having spent her nine-year career working on HIEs and Meaningful Use.


Reader Comments

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From Significant Other: “Re: Partners HealthCare. I worked at Partners for many years and attended a February conference  featuring CEO David Torchiana, MD (who had an insightful presentation, btw.) I asked the last question, which was ‘Can you talk a bit about Partners 2.0?’ His answer was quite candid — since its formation 23 years ago, little has been done to consolidate within the now $10+ billion organization. He expects to see a $500 million reduction over the next few years as the network reinvents itself. The Brigham and Women’s Hospital early retirement offering has nothing to do with Epic and that cost.” 

From Hospital Personality: “Re: Epic. Announced that they are developing a fetal monitoring solution so that customers don’t need to turn to a third party such as Perigen, GE, or Obix.” Unverified.

From Diego: “Re: hospital MU3 attestation for Athenahealth users. For the Athenahealth spokesperson, how many of the company’s stated 35 live hospitals are using the complete inpatient solution, including clinicals? How many have actually attested with the inpatient product? How many users have fully implemented the inpatient product, including clinicals, within a 12-month timeline with the past two years?” 


Epic’s App Orchard

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I received more reader comments about working with Epic’s App Orchard.

#1

The experience with App Orchard thus far has been very disappointing. After paying the hefty fee for the Silver tier, we expected to receive all of the perks of the tier as discussed in the App Orchard documentation. Unfortunately, upon receiving access to the App Orchard program, it became readily apparent that much of what was promised was either not available or, in some cases, not yet built. Additionally, we were informed by App Orchard personnel that our "Sandbox" access would only be for a testing Sandbox and not an environment that we could use to demonstrate our solution to clients. The original documentation was highly misleading on this point.

The documentation also suggested that any press releases were to be submitted to the App Orchard team for review. After we went through a lot of effort constructing a press release with our PR firm and submitting it to App Orchard personnel for review, we were told that Epic would be providing developers with a standard press package.

All of this inconsistency is making us very uneasy. While we appreciate that we are one of the first few companies to join the App Orchard, and that we will be helping define the process for other companies in the future, we expected the process to be far more robust and established.

On the plus side, the App Orchard personnel have been very responsive and have provided as much help as they could given the under-developed state of the Orchard at the moment.

#2

We applied to the Epic App Orchard right when it was opened to vendors. Our initial interaction with Epic required us needing some detailed information on the different levels that App Orchard offered. I was pleasantly surprised to see how quickly they replied and how helpful they were as we worked through this decision.

Our application was processed timely and we got the access that we needed to start working on the technical integration. We are currently working on the technical integration and will soon be planning the marketing efforts. So far, so good.

#3

The team has been very responsive and the APIs are robust. We wish there were a bit more clarity on the pricing model for the live application (transactions vs. revenue share structures are a bit hard to follow). We also wish we had a clear sense of the timing / duration of the approval process for an application, as well as acceptance / rejection criteria.


HIStalk Announcements and Requests

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Mrs. G’s DonorsChoose grant request was for STEM and engineering kits for her elementary school’s Robotic Rumblings program, noting that the city-wide STEM science fair includes few minorities and females. She reports, “The materials obtained through DonorsChoose are having quite an impact on my students. They are giving my students the opportunity to grow in the area of robotics. Their creative juices are definitely starting to soar. They are thinking and developing deeper thought processes on how to manipulate the materials. They are also learning how to better work together cooperatively. The students like working in small group settings. They appear to be quite focused when using the materials and do not want to leave when the session ends. We thank you from the bottom of our hearts. There are definitely some rumblings going on around here!!!!!!”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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NantHealth reports Q1 results: revenue up 16 percent, adjusted EPS –$0.24 vs. –$0.18, missing expectations for both. NH shares continued their slide on the news, now down 83 percent since last year’s IPO.

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Specialty EHR vendor Modernizing Medicine raises $231 million in a private equity investment, increasing its total to $322 million. 


People

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New York-Presbyterian promotes Peter M. Fleischut, MD to SVP/chief transformation officer. 

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Ivenix promotes Jesse Ambrosina to COO,  George Gray to CTO/VP of R&D, Janice Clements-Skelton to VP of HR, Carolyn Malleck to VP of finance, and Ben Powers to VP of infusion systems.


Announcements and Implementations

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PokitDok will build its healthcare transaction recording platform on the Linux Foundation’s open source Hyperledger Sawtooth blockchain project along with Intel Software Guard Extensions. 

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Vermont Information Technology Leaders and Medicity connect the Vermont HIE to the Veterans Health Information Exchange, allowing clinicians in the VA and the HIE members to view each other’s records for a veteran patient. 

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MModal announces enhancements to its computer-assisted physician documentation technology.

WellSpan Health brings its initial sites live on Epic.


Government and Politics

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Officers in West Virginia’s state capitol arrest a veteran journalist who was attempting to ask HHS Secretary Tom Price if domestic violence would be considered a pre-existing condition under the House’s American Health Care Act. Dan Heyman was taken away in handcuffs and charged with “willful disruption of state government processes,” with the Secret Service agents who were protecting Price and White House Special Counsel Kellyanne Conway claiming they had warned Heyman that he was interfering with their work by shouting questions that Price was ignoring.

HIMSS reports that while Congress’s spending bill still won’t allow HHS to spend money to develop a national patient identifier, it encourages HHS and ONC to provide technical assistance to non-governmental organizations trying to address the patient identification issue.

President Trump threatens to withhold $7 billion per year in ACA cost-sharing reduction payments to insurance companies, which would likely drive more insurers out of the exchange market or raise premiums. The President said in an interview, “There is no Obamacare. It’s dead. Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will, anytime I want.”


Privacy and Security

Memorial Hermann Health System (TX) pays $2.4 million to settle HIPAA charges following a 2015 incident in which it issued a press release that named an illegal immigrant who was arrested after using a phony Social Security card at one of its clinics. The hospital said it called police because of concerns about fraud, not immigration status. The woman’s husband was also in the country illegally, but had insurance through his employer.  

Hackers breach two old data servers of a Memphis, TN family medicine practice using valid login credentials and demand a $10,000 ransom after encrypting its files, which the practice declined to pay since they switched EHRs 18 months ago and only those older records were involved.


Innovation and Research

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Cerner says it’s interested in just-announced Microsoft technology that can identify, name, and index objects depicted in photos or video, saying it could be useful for alerting hospital nurses of patient actions that require their attention. 


Other

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Healthcare Growth Partners analyzes the valuation differences for enterprise vs. healthcare software as a service companies, concluding,

If the set of health IT companies were able to grow more quickly, it is likely that their valuations would become more in line with general enterprise SaaS companies. The reason for health IT’s slow growth rate is no doubt a complex combination of factors including longer sales cycles, heavy regulation, and slow adoption rates. Potentially it may be due to the relative immaturity of the healthcare software market and a different mix of publicly traded comps in health IT as compared to the larger and more mature enterprise SaaS market.

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Sonar studies at University of Mississippi Medical Center (MS) reveal that up to 7,000 human bodies are buried on the hospital’s grounds, believed to be those of patients who died in the state’s mental hospital from 1855 to 1935 when it was located on what is now hospital property. Construction work turned up 2,000 bodies three years ago. The medical center, faced with a $21 million estimate to relocate the remains, is proposing to exhume a few of them for research and then just build a memorial.

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A scientific editor trolls one of the many predatory medical journals with lofty-sounding titles that will run articles from publication-desperate researchers in return for cash. He submits an article built entirely around “Seinfeld” episodes as researched at the prestigious Arthur Vandelay Urological Research Institute, listing himself as the primary investigator under the name Dr. Martin van Nostrand. The Urology & Nephrology Open Access Journal accepted the article about a made-up condition nearly verbatim, billing him for its $799 fee (a mistake on their part since he declined to pay).  

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Eric Topol interviews the fascinating Pardis Sabeti, MD, PhD: member of a family who emigrated from Iran just before its 1978 revolution, Rhodes scholar, physician, scientist (computational biology and medical genetics), host of an education TV series about statistics, and singer/songwriter for Thousand Days, a decent alt-rock band.


Sponsor Updates

  • Advisory Board Chief Medical Officer Dennis Weaver, MD, MBA presented “Pragmatic Approaches to Succeed at Value-Based Payment and Care” at the World Health Care Congress Hospital and Health System Summit in Washington, DC last week.
  • EClinicalWorks will exhibit at the Ohio Association of Health Plans Annual Convention May 16-17 in Columbus.
  • GE Healthcare will supply over 200 Egyptian hospitals with 700 units of its advanced healthcare technologies.
  • Healthwise will exhibit at the Cerner Collaboration Forum May 16-18 in Kansas City, MO.
  • Huntzinger Management Group’s William Reed is named a Life Fellow Member of HIMSS.
  • Consulting Magazine names Impact Advisors VP Lydon Neumann one of the Top 25 Consultants of 2017.
  • Imprivata will exhibit at VA Healthcare 2017 2017 May 15-18 in Arlington, VA.
  • Entrepreneur Magazine features LogicWorks CEO Kenneth Ziegler.
  • Healthgrades recognizes Meditech hospitals for patient safety.
  • National Decision Support Company will exhibit at WEDI 2017 May 15-18 in Los Angeles.
  • Navicure and PatientKeeper will exhibit at Centricity Live 2017 May 17-20 in Boston.
  • Shane McCarran joins Orchestrate Healthcare as senior recruiter.
  • Experian Health will exhibit at HFMA WV May 17-19 in Roanoke.
  • InterSystems will exhibit at the NEHIMSS Annual Spring Conference May 11 in Foxboro, MA.
  • The US Patent Office awards Intelligent Medical Objects a patent for its medical terminology solution.

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 5/11/17

May 11, 2017 Dr. Jayne 1 Comment

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The CMS Quality Payment Program website has been updated with an “Am I included in MIPS?” feature. Providers and organizations can search by NPI (sorry, no bulk search feature for groups yet) to determine if they are included. The site also doesn’t flag whether you’re participating in an ACO, but rather tells you to talk to the leaders managing your participation.

Forbes posts an article about the Internet making us lose trust in our doctors. I think many of us agree (at least anecdotally) that things have changed over the last decade, and exponentially so after the rise of the smart phone. The piece details a study looking at whether screenshot content can prime a pediatric patient’s parents to be biased towards a particular diagnosis. When the physician diagnosis didn’t match the Internet diagnosis, parents were less likely to trust the physician diagnosis and were more likely to say they would seek a second opinion. The researchers’ conclusions note that “conflicting online information could in some cases delay necessary medical treatment. Physicians must be aware of the influence the internet may have on parents and ensure adequate parental education to address any possible concerns.”

Physicians in the patient care trenches have known this for a while, that it can take a significant amount of counseling and discussion to counteract what “Dr. Google” or a number of other websites may have said. When it’s the occasional patient arguing with you about your clinical expertise, it can be managed, but when it feels like every patient is coming in the door with a preconceived notion about what is going on, it is a direct contributor to physician burnout. I don’t believe physicians are omniscient or that our opinions should be absolute, but sometimes you just wish your patients would trust your decades of experience and the many dollars and hours you’ve expended to arrive at your level of clinical judgment. Even a seemingly straightforward diagnosis like “contact dermatitis due to plants” can suck time out of your day when you have to engage around smart phone photos of poison oak, ivy, and sumac. Bottom line is, it doesn’t matter what plant got you, we’re going to treat you the same way regardless of botanical factors and you need to avoid coming into contact again with whatever it was.

Sometimes it’s hard for people to understand what it’s like to be a physician and the pressures we’re under outside of dealing with payers, metrics, regulations, etc. I’m talking about the actual clinical pressure to be 100 percent accurate. If you’re a good physician, it weighs on you and it’s hard to keep in balance. I recently had a situation where a patient perceived a poor outcome based on my diagnosis. She had come to the urgent care on a Saturday with back pain, which had some distinct muscular features and no acute findings on an x-ray, and was diagnosed accordingly. Our practice always has a second reader for films, and my colleague agreed with my reading. The patient was instructed to follow up with an orthopedic specialist on Monday (two days from the visit) if she was not improving. She followed up, and the orthopedist sent her for advanced imaging and diagnosed a vertebral compression fracture, then performed an expensive procedure. She came back to us demanding compensation for our missed diagnosis.

Our standard practice in this case is to convene a peer review and to also have the films re-read by a radiologist, who also failed to appreciate the compression fracture. Peer review found my treatment to be appropriate given the history and exam and the setting (urgent care). The patient was given appropriate follow-up instructions and her pain was managed adequately. Of course, we don’t have access to the advanced imaging results showing the fracture, so it’s hard to tell whether the specialist is taking advantage of a marginal finding or whether something was really there. The patient’s treatment wasn’t even delayed by my supposed misdiagnosis since she would not have been able to have advanced imaging until Monday anyway due to her insurance and its requirements. Getting a pre-certification for a non-emergent ambulatory procedure on a Saturday just doesn’t happen in our world. Assuming you agree there was a fracture, she received definitive care in a timely fashion that was more impacted by the fact that she came to care on a weekend than it was by a potential misdiagnosis.

One also has to consider the role of the urgent care, which is to rule-out any life-threatening conditions and to provide treatment for illnesses and injuries that require immediate care. Sometimes we’re also just there for convenience, for patients who don’t want to wait to see their primary care physician or whose schedules don’t mesh with their primary physician’s office hours for refills on maintenance medications. There are numerous situations in which we do not provide definitive care. Most fractures are merely stabilized and then the patient is referred for orthopedic management. For most urgent care centers, anything requiring imaging that is more than a plan film x-ray has to be referred back to a primary physician to coordinate authorization, scheduling, and follow up. We’re not in the position to order complex studies and follow up on them, and most of the time we do strive to get you back to your primary care physician for follow up.

Even when a physician feels he or she has done the right thing, and their care has been validated by a peer review and supplemental evaluation of diagnostics, it still weighs on us. There is the nagging sensation that we should have done something different, and that the patient thinks we’re bad doctors. It’s hard for people outside our world to understand what that does to a person, and culturally it’s difficult for us to find people to talk with about our experiences. It’s also legally difficult, sometimes, when you think the patient is going to sue. We end up stuck with only the risk management team to talk with and they’re not exactly caring nurturers who want to help you work through the psychological ramifications of a poor outcome and subsequent lawsuit.

Keep this in mind next time you encounter a physician who seems aggravated and preoccupied. Or any health care providers, for that matter. We’re all walking around with some baggage, and sometimes a malfunctioning EHR or one more regulatory hurdle is all it takes to break us.

Email Dr. Jayne.

Morning Headlines 5/11/17

May 10, 2017 Headlines 2 Comments

Modernizing Medicine Announces $231 Million Equity Investment from Warburg Pincus

Specialty EHR vendor Modernizing Medicine takes on a $231 million investment from PE firm Warburg Pincus.

Senate Confirms Scott Gottlieb to Head FDA

The Senate voted 57 to 42 on Tuesday to confirm Scott Gottlieb, MD as commissioner of the FDA.

Aetna fully exits Obamacare exchanges with pull-out in two states

Aetna announces that it will exit the Nebraska and Delaware public exchange markets for the 2018 open enrollment period, the two remaining states where it had still offered plans.

Kaiser raises record $4.4 billion in white-hot hospital bond market

Kaiser Permanente (CA) secures $4.4 billion in funding through three bond offerings. CFO Kathy Lancaster reports that the proceeds will be used to fund expansion.

Readers Write: The Value Proposition of Optimizing Clinical Communication

May 10, 2017 Readers Write No Comments

The Value Proposition of Optimizing Clinical Communication
By James Jones and Wayne Manuel

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James Jones, BSN, MBA, MSN, NEA-BC is VP of patient care services and nursing operations at University of Washington Medicine’s Valley Medical Center. Wayne Manuel is senior VP of strategic services at University of Washington Medicine’s Valley Medical Center.

A few years ago, Wayne was on an airplane when he came across a magazine article about how Texas Children’s Hospital switched to Apple iPhones to improve clinical communication and reduce noise. With some due diligence, he found that Cedars-Sinai Medical Center and several other hospitals had also switched from old ways of communicating to iPhones, and they experienced similar positive results. As our senior VP of strategic services, Wayne recognized the opportunity for UW Medicine’s Valley Medical Center to replace our old, noisy phones with smartphones.

Around the same time, James attended a dinner event for chief nursing officers in Seattle. Again, smartphones were a main topic of the discussion, representing a solution to some common clinical communication challenges.

With both of us having technical backgrounds, we started sharing ideas on how to transition from our disparate communication systems to a more modern solution. We approached our CNO and CMO with research on the value proposition of implementing a mobile communication strategy. It was easy to see how a new way of communicating would bring us additional value. Some of the improvements we hoped to achieve included:

  • Improving the clinician and patient experience.
  • Reducing interruptions.
  • Gaining workflow efficiencies.
  • Saving time for clinicians.
  • Improving communication between interdisciplinary teams.
  • Meeting The Joint Commission’s National Patient Safety Goals for alarm management.

At that time, we had recently deployed a new electronic health record (EHR), which gave us the opportunity to improve many other systems and workflows. Our senior leadership team felt that to get the most out of our EHR, we needed a mobile app to close the gap and provide real-time access to clinical information, allow for mobile documentation, and offer an easy way for nurses and other staff to communicate.

Our staff were already using smartphones in their personal lives and were frustrated with the multiple communication devices they were juggling (two-way radios, legacy phones, pagers, and overhead paging). We met with many of our nurses to get their input, and one said, “Anything you can do to lighten the load would be greatly appreciated.”

We started with a phased approach, rolling out iPhones to one pilot unit, then to all inpatient units and several ancillary departments for calling; secure text messaging; and notification of alarms and alerts from patient monitoring, patient elopement, and the nurse call system. This was done via Voalte and Connexall applications.

We conducted before and after analysis so we could measure the outcomes from the new clinical workflows. One area we looked at was hospital-acquired pressure ulcers and skin integrity events. Using the iPhones, our wound care nurses saw an immediate improvement in workflow by using the Epic Rover application to take a photo of the wound, which uploads the photo for documentation into the patient medical record. The physician or wound care nurses can see it immediately and even show it to the patient and their family when rounding with a physician.

With only two dedicated wound care nurses on our team, their time is extremely limited. Rather than spending time walking around looking for a physician or nurse to discuss a patient, they can now find the appropriate physician in the smartphone directory, send a photo via Rover, and ask the physician to call when he or she is available to discuss treatment. The result has been better communication among our interdisciplinary teams, more efficient use of time for our wound care team, real-time documentation to the medical record, and improved communication with patients and families.

Another area where we have made great headway with the iPhones is in reducing medication errors. Using our new workflow, a nurse changes his or her status in the directory from “available” to “busy” and types in a status message, such as “administering meds.” This lets the rest of the care team know not to interrupt that nurse until their status changes back to “available.” New workflows escalate alerts to a backup while that nurse is busy.

Today, we are using iPhones for communication on all clinical inpatient units for nurses, physicians, respiratory therapists, discharge planners, environmental services managers, and administration. We are communicating more efficiently, with about 70 percent of all communication now taking place via text message versus 30 percent via voice calls. Our very tech-savvy staff loves the new solution and has adapted well to the workflow changes. One nurse said her unit is much quieter and that the hospital “feels like a hotel, so patients can get some rest.”

In our first year using smartphones, we are still learning where we can make adjustments in our workflows to make the most of our new way of communication. Going forward, we will be analyzing workflow efficiencies, adjusting alarm settings, and managing notifications from nurse call, physiological monitors, and the EHR.

The authors presented an HIStalk webinar titled “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.”

Readers Write: An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back

May 10, 2017 Readers Write 4 Comments

An Uncomfortable Truth About Hospital Revenue and an Overlooked Way to Gain It Back
By Crystal Ewing

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Crystal Ewing is manager of data integrity at ZirMed.

In a video message from last year that he surely never intended for public and regulatory scrutiny, Mayo Clinic CEO John Noseworthy, MD appeared to advise employees to prioritize patients with commercial insurance in order for the famed hospital to remain financially strong.

Months later, Mayo is still explaining exactly what Dr. Noseworthy meant. Many healthcare leaders need no further explanation, even if they personally dislike any suggestion of favoring the commercially insured over Medicare and Medicaid patients. With government reimbursement continuing its decline, most hospitals are straining to hold on to their profitability.

Still, placing hope in commercial insurance to make up the difference is misguided, especially with the rising dominance of health plans that are not only high deductible, but also require high co-payments and high co-insurance. Touted as a means of covering more Americans, these plans often put more of the financial burden on patients than simply paying for healthcare in cash at a discount.

As such, many patients with these plans may claim they have no coverage when it comes time to pay for a procedure or service. It’s hard not to empathize with their motivation for doing so, but it’s a practice that can put the hospital in a precarious position.

With self-pay patients, things become more complicated, especially since there can be a lag of 30 or more days between the time that they are treated and the time the invoice comes due. When faced with a choice between paying for housing, utilities, food for their families, auto repairs, etc. – all of which affect the present and future – or paying a hospital bill for an event that occurred in the past, the decision is easy.

When this thinking is spread across a large patient population, bad debt accumulates quickly. Additionally, patients are unlikely to pay medical bills that are greater than 5 percent of household income, according to the Advisory Board, a consulting firm for hospitals. Median household income in the U.S. is at about $53,000, suggesting that when out-of-pocket charges exceed $2,600 hospitals can forget about collecting, according to Spencer Perlman, an analyst with Height Securities in Washington.

Given the above realities, more hospitals are using automated coverage detection technology, which also finds insurance coverage that patients legitimately aren’t aware of or are unable to communicate. When patients are brought to the hospital in the grips of a heart attack, for example, or while unconscious, they’re hardly able to convey their levels of coverage. Some fully conscious patients even may forget they have coverage, or provide information on secondary rather than primary coverage, or become confused about which carrier covers them. This isn’t uncommon with elderly patients.

No matter the reason it is problematic , it is imperative that coverage verification becomes a more streamlined process at our nation’s hospitals. It can be done in a way that respects the patient and in a timely fashion to protect the hospital’s finances. The most feasible method is to pair automated coverage detection with automated eligibility verification, the latter of which is already in place at many hospitals. However, coverage detection can also be an independent, standalone process. Either way, it makes quick work of checking with thousands of healthcare payers to determine if any are the primary or secondary insurer for a given patient.

Often, as much as 15 percent more instances of billable insurance are uncovered with superior processes and technology. Even just some quick mental calculation can see how this would recoup millions of dollars for many large hospital systems. It’s also significantly over the 1 to 5 percent rate achieved by manual and legacy coverage detection.

Much of this improvement is due to the huge data sets that now power some business intelligence engines, encompassing billions of historical health insurance transactions for millions of Americans. As these insights are tested against a pre-identified set of payers, algorithms can match the key data attributes that confirm coverage and the information needed to file the claim.

What has yet to be quantified but surely exists is the reduction in future collections activity with patients. Despite jargon that describes these patients as “empowered consumers,” the reality is they are struggling to pay their bills and rely on hospitals to help them navigate this uncertain terrain. In turn, hospitals must be fully informed about all of a patient’s sources of payment, including if commercial insurance coverage exists.

There is nothing unethical about seeking such information, only for using it to prioritize patients who it turns out are commercially covered. Clearly hospitals should be setting their sights on treating all patients, regardless of source of payment. The ability to do so is greatly enhanced when hospitals can identify all sources.

Morning Headlines 5/10/17

May 9, 2017 Headlines No Comments

Confidential medical records from Bronx-Lebanon Hospital exposed online by vendor’s error

Bronx-Lebanon Hospital exposes “tens of thousands or even millions” of patient records after a contractor misconfigures its rsync backup.

Teladoc Announces First Quarter 2017 Results

Teladoc reports Q1 results: revenue climbed 60 percent to $43 million, while net losses remained flat. EPS –$0.30 vs. –$0.40, beating analyst expectations on both. Share prices jumped 25 percent on the news.

Intelligent Medical Objects Awarded Patent for Industry-leading Medical Terminology Solution

IMO receives a patent for its “concept-based” terminology management solution.

Cambridge trust set for IT services market test decision this summer

In England, Cambridge University Hospitals NHS Trust announces that it will make a decision on its IT outsourcing contract by the end of summer.

News 5/10/17

May 9, 2017 News 6 Comments

Top News

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A DataBreaches.net investigation finds that up to several million records of Bronx-Lebanon Hospital Center (NY) were exposed after its revenue cycle contractor, iHealth Innovations, apparently misconfigured an rsync backup


Reader Comments

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From Dr. Evil: “Re: EviCore. The specialty benefits manager is considering a sale or IPO, valuing itself at $4 billion. It pays to build a business around denying care.” The company describes its services as “comprehensive care management solutions,” although the emphasis seems to be on reducing cost via evidence-based solutions. It’s a good approach, although it fails to address out-of-control provider, drug, and device costs and instead focuses on restricting what is ordered. It’s an often-missed point that all of the political wrangling over health insurance would be much less necessary if costs were made reasonable, an even more daunting and therefore unlikely legislative accomplishment since the folks making fortunes on the backs of sick people also employ lobbyists.


Epic’s App Orchard

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I received these unverified reader comments when I asked for first-person experience with Epic’s App Orchard.

  • I have worked extensively with Epic Corp over the past two years with their iterations of the App Orchard. The rules of the road require that an app developer permit Epic to take whatever IP they choose, if Epic believes it makes sense to include in future releases of Epic software. Epic will reject apps that directly compete with Epic functionality, as determined by Epic’s current and future roadmap. Further, the 30 percent fee they charge is too broad in scope for the app revenue (if there is any). Most importantly, originally, only Epic clients could submit apps to the Orchard, effectively locking out the global collective genius of non-Epic entrepreneurs (I am not sure if such a restriction remains). Based on the approach to their App Orchard, Epic seems to be trying to respond to the market demand for "open" as heavily advertised by Cerner as their competitive differentiator. However, Epic also seems to want to control the Epic app environment and has absolutely no motivation to loosen their model to the wild, as Judy mentioned several times that such a move would be the end of Epic.
  • We have started working with Epic to build out an API integration under the App Orchard. For us, the biggest concern are the revenue sharing terms. For a software vendor that is operating under tight margins in a competitive market, having to factor in up to a 25 percent gross revenue share is an impossible burden. From our perspective, the App Orchard is a blatant money grab from companies trying to innovate on the edges of the Epic ecosystem.

HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Softek Solutions. The Prairie Village, KS-based company’s OnTrack software and consulting services optimize revenue integrity and system performance for Cerner Millennium hospitals (and those preparing to move to Millennium). Its Charge Integrity Control provides visibility into revenue management by correlating patient orders and charges throughout the transaction process –one customer found a lab charge error that lost them $3 million in appropriate billing over four months before they found it instantly with Charge Integrity Control. Revenue Conversion Services allows correction of application, workflow, and configuration problems that otherwise would cause millions of dollars in lost revenue right after a Cerner go-live — a single hospital called Softek three months after go-live and avoided $20 million in annualized lost charges due to orders that weren’t charging, a location-specific workflow problem with ordering, and ED batch charges that weren’t actually charging. The company also provides Millennium system performance optimization software and services as well as conversion and purge maintenance assistance using proprietary diagnostics. Thanks to Softek Solutions for supporting HIStalk. 

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I finally pulled the trigger on replacing of my years-old, $300 laptop that I use for everything. I chose an Acer Aspire E15, which has pretty decent specs for $621: an AMD FX 9800p CPU with 2 MB L2 cache, 16 GB of DDR 4 SDRAM, a 128 GB solid state drive running Windows 10, a 1-terabyte hard drive for data, a 15.6-inch display powered by a Radeon R8 dual graphics video card with 2 GB of dedicated VRAM, and thankfully nearly zero pre-installed bloatware. I’ve had no problems so far getting it loaded up.

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HIStalk readers funded the DonorsChoose grant request of Mrs. S in California, who asked for a 3Doodler child-safe 3-D printing system (it was actually inexpensive at just $113 for everything, plus our donation was matched). She reports, “I would like to thank you from 22 very excited third grade students that have really been enjoying and benefiting from your generous donation! We have been using our 3Doodler pen each Friday afternoon during our STEAM centers time and I have truly observed some fantastic skill building. Some of the benefits that are very noticeable to me are an increased attention to detail, improved direction following within a detailed task, increased patience for a task, increased observation of the steps necessary for a positive outcome, and an increased motivation to try something new! You have made a difference!”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Video visit provider Teladoc reports Q1 results: revenue up 60 percent, EPS –$0.30 vs. –$0.40, beating analyst expectations for both.


People

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Reed Liggin (Athenahealth) joins electronic prescribing system vendor EazyScripts as CEO. He was president and CEO of the small-hospital information system vendor RazorInsights that was acquired by Athenahealth in January 2015.

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Telehealth solution provider Avizia hires Joe Quinn (ComScore) as CFO.

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Health Symmetric hires Bob Teague, MD (Quorum Health Resources) as chief medical officer. The company’s website uses a lot of vague gibberish in not saying exactly what it is they’re selling other than a “healthcare platform” that uses APIs.


Announcements and Implementations

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Intelligent Medical Objects is awarded a patent for its concept-based terminology management system that allows rapid distribution of terminology changes to the company’s EHR vendor partners. Clinician-entered terms are matched with appropriate billing and reference codes that capture clinical intent.

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Hybrid IT vendor TierPoint will expand its Hawthorne, NY data center campus for the third time, adding 38,000 square feet of raised floor to the existing facility that includes 52,000 square feet of raised floor plus a 70,000 square foot recovery and business continuity center.

PeriGen releases PeriWatch, a perinatal analytics system that integrates WatchChild fetal monitoring with PeriCALM decision support and adds a maternal dashboard.

­­­­­­­­­­­­­­­Penn Medicine Center for Health Care Innovation (PA wins ECRI Institute’s health device award for its app development platform that extracts clinical information from the EHR and other sources. 


Government and Politics

In England, the Cambridge University Hospitals trust will decide this summer whether to outsource commodity IT services that include enterprise infrastructure, service desk, and end-user computing in a tender expected to total $180 million over seven years. The trust says its increasing Epic use has created a need to expand its services. 

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The White House appoints Gopal Khanna (Illinois Department of Innovation and Technology) as director of AHRQ.


Innovation and Research

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University of Illinois at Urbana-Champaign is working on a virtual physician agent that can describe lab test results to patients via a patient portal, targeting older adults with conversational speaking, context-appropriate facial features, and other body cues that can help with retention.


Other

St. Mary’s Hospital (NJ) celebrates Nursing Week by laying off seven nurses and 13 med techs.


Sponsor Updates

  • The local paper profiles Ability Network CEO Mark Pulido.
  • Black Book identifies 10 top MACRA trends challenging providers with value-based care and quality metrics.
  • Agfa Healthcare launches a new version of its Integrated Care Suite.
  • Besler Consulting releases a new podcast, “Healthcare in the first 100 days of the Trump presidency.”
  • Washingtonian names The Advisory Board Company CEO Robert Musslewhite as one of its biennial Tech Titans.
  • Casenet announces its Connect 2017 speaker lineup, led by client executives from Cigna and Healthfirst.
  • CoverMyMeds will exhibit at the American Academy of Ambulatory Care Nursing Annual Conference May 10-13 in New Orleans.
  • Boston Software posts a white paper titled “Eliminate the Pain of EMR Upgrade Testing” that describes use of its Cognauto system to validate and set appropriate expectations for each department regarding
    the added benefits of the EMR upgrade.
  • The Hartford Business Journal interviews Diameter Health CEO Eric Rosow.
  • Health Professional Radio interviews Docent Health co-founder Paul Roscoe.

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 5/9/17

May 9, 2017 Headlines No Comments

FBI Director Invites Hospitals to Reach Out to His Agency

Addressing hospital executives at the annual AHA meeting, FBI Director James Comey calls on executives to report all instances of cyberattacks, explaining, “we have to convince you to talk to us. We will treat you as what you are — as victims. We will explain to you what will happen to any information you give us; we will be open and honest with you.”

GOP Sen. Susan Collins Says Senate Will ‘Start From Scratch’ on Health Care Bill

Senator Susan Collins (R-ME) says that the Senate will not take up a vote on the House passed AHCA, and will instead start from scratch and write its own legislation.

Mental health leader Thomas Insel is leaving Alphabet’s Verily

Former director of the National Institute of Mental Health, Thomas Insel, MD announces that he is leaving Verily, Alphabet’s life science business. Insel was developing technology that could be used to combat anxiety and depression.

The Internet Is Making Us Lose Trust In Our Doctors

A recent study links exposure to online symptom checker data with a decreased  confidence in a physician’s diagnosis, concluding that “prior exposure to information can ‘prime’ a parent to have a unique bias,” which can damage the doctor patient relationship and alter the care pathway.

Curbside Consult with Dr. Jayne 5/8/17

May 8, 2017 Dr. Jayne No Comments

 clip_image002

Readers who have followed Curbside Consult for a while might remember that I teach at an outdoor classroom program a couple of times a year. It’s a lot of fun, because you get people out of their normal environments and challenge them in different ways. It’s also great working with people from different industries and segments of the working world rather than the usual healthcare and IT people I encounter on a daily basis. One of my fellow instructors is a preschool teacher and we often commiserate around the fact that there are quite a few “everything I needed to know, I learned in kindergarten” nuggets that we inevitably have to address during the weekend.

This session, we had around 40 students organized into six teams. Each team is challenged to come up with a name and motto, then elect leadership and assign roles and responsibilities. They are then tasked to not only make it through the weekend (some of them have never been camping), but also to attend a rigorous educational program. Team-building, project planning, cooperative learning, feedback, and continuous improvement are woven into the curriculum along with camp cooking, knots and lashings, and more.

We had some extra challenges this weekend, with torrential rains in the week leading up to the course and a boil order being in effect for our facility throughout the weekend. We also had a couple of instructors unable to make it for the weekend due to flooding near their homes, which led to some scrambling to cover presentations. Fortunately, most of us have been doing this for a while and can teach the content without too much trouble. We’re lucky that we’re not teaching for mastery, but trying to give the participants an overview of various outdoorsy topics. It’s not like we’re going to drop them in uncharted lands when they’re done and expect them to survive.

This particular session, we had an exceptional group of students. Usually there is at least one team that has some level of dysfunction ranging from mild to severe. This time, however, the teams had their acts together. Any forgotten equipment was remediated by sharing with other teams, everyone had plenty of drinkable water, and the percentage of people wearing knee high rain boots was high. (Nothing spoils a weekend outdoors like wet feet, so that was a particularly good sign.) We talk about the stages of team development and it seemed like most of them went straight through forming and storming and on to norming and performing.

What we did have this weekend, however, was some breakdowns on the instructor team. I took a new role with the program this year, and in the middle of the first day, was informed by another staffer that I wasn’t fulfilling my duties despite the fact that no one had told me those duties belonged to me. The person telling me this wasn’t even in my chain of command, so that was another problem. She had done something similar during the prep work for the course, which I quickly took care of with my supervisor, but this time things were a little trickier.

I approached the colleague who previously held my position and he said he had the same issue and confusion when he held the role. Yet, nothing was resolved, and it was just handed off to the next person as a ticking time bomb. I also mentioned some frustration with the documentation for the role and how I had to redo a lot of it to align with our updated curriculum. He mentioned that he had done all the updates before handing the documentation back to leadership, so there was no reason why I should have had to do the updates again. Apparently our course director sent me the same documentation that he had sent to my predecessor without incorporating or acknowledging the updates.

Needless to say, that was pretty frustrating. When you’re used to being part of a high-performing team and it starts breaking down, one of the first things people tend to do is to doubt themselves. I went through that a bit and had to keep running my mental checklist making sure I had done everything I was asked to do to as well as I could. I also kept thinking of whether there was anything I should have done differently. Should I have asked more questions? I couldn’t come up with much I would have changed since I was essentially emulating what the previous person in the role had done to the best of my knowledge and ability.

Another thing that tends to happen when you’re being impacted by a leadership breakdown is that you want to withdraw. People don’t want to confront others. I know I didn’t want to go to the person accusing me of non-performance and have a focused conversation about why she felt I wasn’t getting it done and what we were going to do about the situation. That’s how I ended up talking to my predecessor rather than addressing the issue directly.

Although seeking expert guidance is a valid strategy, one has to be sure we’re not doing it as an avoidance mechanism. Having those difficult conversations is also hard when you’re in a high pressure situation, or when schedules don’t align. It was rare that both of us had more than two minutes of free time at the same time, and trying to slip in that kind of conversation wouldn’t have been the right thing to do.

There were some other leadership breakdowns this weekend, with the course director not following through on a couple of agreed-upon actions. It’s never fun when your boss slacks off, particularly when you’re left holding the bag. Coupled with a schedule that ran late, very little sleep, and being cold overnight (planning fail!) I wasn’t in a good place on Saturday morning. Fortunately, some attention from a camp cook staff that worked around my food allergy was enough to start boosting my mood. It’s amazing how the little things can make a difference when people are struggling, and a nice reminder that what might seem like no big deal to you might make a difference for someone else out there.

Once the program moved into full swing and we started interacting with the students, I was in a much better mood. Their enthusiasm was contagious and their willingness to tackle the challenges they were given was impressive. Several of the teams went above and beyond in ways I hadn’t seen before, with a couple writing songs or poems for the staff. Not everyone loves a kiss-up, but this weekend we certainly did. It was also good to see that regardless of what was going on behind the scenes, it didn’t trickle down to our students and they were able to get the most out of the weekend. They say you’ve never really mastered material until you can teach it, and that’s often true. It’s also true that even those of us that teach are constantly learning and there will always be something our students teach us.

By Saturday afternoon, I was back on my game with a plan to make up for my packing failure and stay warm overnight. I threw myself into cast iron cooking and slinging the best “pigs in a blanket” out of my homemade box oven the staff had seen in recent memory. I clapped when people were able to start “one-match” fires, giggled at campfire skits, and watched our students grow in their knowledge and appreciation of the outdoors as well as their readiness to be leaders back at their home organizations.

I came home Sunday exhausted but gratified, which will help get me through the difficult conversations I still have to have with some of the staff. There have already been some post-session emails that have been less than productive, so the discussions need to happen sooner than later. We’ve got another course in the fall and things need to be hashed out so we can move on. Good principles to live by regardless of whether you’re at work or in these situations elsewhere.

Have a favorite cast iron recipe? Email me.

Email Dr. Jayne.

High Hopes for HHS Cybersecurity Center

May 8, 2017 News No Comments

Stakeholders react to news that HHS will launch a healthcare cybersecurity center this summer.
By @JennHIStalk

While administrations may change and legislation come and go, the need for cybersecurity across healthcare’s many verticals seems to be a constant that will remain with the industry for the foreseeable future. News that HHS will create a Healthcare Cybersecurity Communications and Integration Center this summer highlights the federal government’s commitment to helping providers, payers, vendors, and (hopefully) patients prevent data breaches that could impact patient safety.

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Modeled after the Department of Homeland Security’s National Cybersecurity and Communications Integration Center, the new HHS center helps to fulfill the Cybersecurity Information Sharing Act of 2015, part of a broad initiative under the Obama administration to bolster the government’s offensive and defensive cybersecurity capabilities.

“HCCIC establishes the mechanism to provide proactive and anticipatory analysis of cyber threats to both HHS and the healthcare and public health sector,” says an HHS spokesperson. (The department declined a formal interview.) “The HCCIC will act as a clearinghouse to drive healthcare-relevant cyber indicators, briefings, and actionable intelligence to and from a wide variety of stakeholders – both public and private. HHS aims to begin initial operations this summer.”

The timing is apropos given the impending release of a report authored by the Health Care Industry Cybersecurity Task Force, a CISA-mandated group put together last spring tasked with:

  • Analyzing how other industries have addressed cybersecurity threats.
  • Reviewing the security challenges associated with networked medical devices and software connected to EHRs.
  • Developing and circulating cybersecurity best practices.
  • Establishing a plan the government can use to freely share real-time intel regarding healthcare cybersecurity threats.

While HHS would not confirm the HCCIC will help to implement the task force’s recommendations, one can only assume that the two resources will converge to some degree. Industry stakeholders are of course eager to collaborate and benefit from the new center’s deliverables, which are yet to be fully determined.

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“We are anxious to begin to see actionable data coming out of the HCCIC, including threat and vulnerability,” says Marc Probst, CIO of Intermountain Healthcare (UT), which formed a cybersecurity center last year with the University of Utah and several other partners. “The HHS goals around information sharing and analysis align perfectly with our organization and several that we are working with,” he adds. “We are anxious to contribute and develop automated feeds for the HCCIC.”

While emphasizing that long-overdue federal cybersecurity risk assessment and risk management efforts will provide good implementation guidance, Probst and his colleagues are reluctant to see cybersecurity become a compliance effort or a certification program. “Many of those currently participating are vendors or people with a product to sell,” Probst explains. “We hope the committees and chairs will seek more payer and provider participants.”

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While selling a product to providers in need would surely be seen as a positive outcome for any vendor involved, Divurgent CISO Stephen Watkins sees the benefit of an HHS-sponsored cybersecurity center as one of cohesive collaboration. “For advisory and consulting services organizations like ours,” he says, “these centers allow us to share and contribute our strategic, operational, and tactical insight from the field as well as act as both sounding boards and feedback loops for best-practice implementation guidance from the HCCIC, especially for small providers that may not have in-house IT security staff.”

Real-time cybersecurity guidance to the healthcare community will surely be welcome in light of today’s constant stream of data breach announcements, which have become so banal as to no longer incite the media hysteria it first engendered a year or two ago. While it may be too much to hope the center and its collaborators can help providers, payers, and vendors stay ahead of constantly evolving cyber threats, stakeholders no doubt hope HCCIC resources will become some of the strongest defenses in their cybersecurity arsenal.

Morning Headlines 5/8/17

May 7, 2017 Headlines No Comments

Warren Buffett, at Berkshire Meeting, Condemns Republican Health Care Bill

Warren Buffet comments on the recent House passage of AHCA, saying the bill amounted to “a huge tax cut for guys like me.” He also said rising health care costs, rather than high taxes, were the biggest drag on American businesses.

VA chief talks commercial Vista

Describing longstanding VA and DoD EHR interoperability issues, Rep. Thomas Rooney (R-Fla.) tells VA Secretary David Shulkin “You could be the best VA secretary of all time if you solve this one problem,” to which Shulkin agreed and affirmed that he would either replace VistA with a COTS EHR or hand development work over to a private firm, explaining "VA has to get out of the business of being a software developer. This is not our core competency, and I don’t see how it serves veterans.

Big Mega HIT Purchasing Report

A Reaction Data health IT purchasing report notes that inpatient and ambulatory EHR systems sit at the top of the shopping list for healthcare executives, followed by telemedicine solutions, patient engagement solutions, and MACRA implementation services.

Allscripts Healthcare Solutions (MDRX) Q1 2017 Results – Earnings Call Transcript

Allscripts Q1 earnings call affirms its positive Q1 results, noting a 13 percent increase in quarterly bookings, and announcing that it anticipates being accepted into the UK’s London Procurement Program, a sign of potential growth overseas.

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Reader Comments

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